Treatment failure and associated factors among first line patients on highly active antiretroviral therapy in Ethiopia: a systematic review and meta-analysis

Abstract

BackgroundAntiretroviral therapy (ART) restores immune function and reduces human immunodeficiency virus (HIV) related adverse outcomes. The results of previous studies in Ethiopia were replete with inconsistent findings; nonexistence of national representative figures and determinant factors are found as significant gap. The aim of this systematic review and meta-analysis was to assess the existing evidence on ART treatment failure and associated factors in Ethiopia.MethodsRelevant studies on ART treatment failure were retrieved from international databases: PubMed, Google Scholar, Scopus, and Science Direct systematically prior to March 14, 2019. All identified studies reporting the proportion of first line treatment failure among HIV patients in Ethiopia were included. Two authors independently extracted all necessary data using a standardized data extraction format. A random-effects model was used to calculate pooled estimates and associated factors in Stata/se Version-14. The Cochrane Q test statistics and I2 tests were used to assess the heterogeneity of the studies.ResultsFrom 18 articles reviewed; the pooled proportion of first line treatment failure among ART users in Ethiopia was 15.3% (95% CI: 12, 18.6) with (I2 = 97.9%, p < 0.001). The subgroup analysis by World Health Organization (WHO) treatment failure assessment criteria were carried out, accordingly the highest prevalence (11.5%) was noted on immunological and the lowest (5.8%) was observed virological treatment failure. We had found poor adherence (OR = 8.6, 95% CI: 5.6, 13.4), not disclosed (OR = 2.1, 95% CI: 1.5, 3.0), advanced WHO clinical stage III/IV (OR = 2.4, 95% CI: 1.5, 3.8), change in regimen (OR = 2.5, 95% CI: 1.6, 3.9) and being co-infected (OR = 2.56, 95% CI: 2.2, 3.0) were statistically significant factors for treatment failure.ConclusionIn this study, treatment failure among ART users in Ethiopia was significant. Adherence, co-infection, advanced WHO clinical stage, regimen change, and disclosure are determinant factors for treatment failure. Therefore, improve drug adherence, prevent co-infection, close follow up, and prevent HIV-drug resistance are required in future remedial efforts.

<p>Increased Virological Failure and Determinants Among HIV Patients on Highly Active Retroviral Therapy in Adigrat General Hospital, Northern Ethiopia, 2019: Hospital-Based Cross-Sectional Study</p>

“…A possible explanation for this might be increased viral copies which may compromise immunity and negatively affect response to treatment by contributing to the double burden side effects of tuberculosis and HIV. 76 Individuals with failure of immune reconstitution were observed to be at increased risk of experiencing immunological failure of HAART (p = 0.049). This finding was identified in previous studies from India, 77 Northwestern Ethiopia 78 and Brazil.…”

Sankofa Pediatric HIV Disclosure Intervention Did Not Worsen Depression Scores in Children Living with HIV and their Caregivers in Ghana

“…Non-disclosure of HIV status to children living with HIV is a critical barrier to optimal adherence to therapy [8]. There is a growing body of evidence to support the bene ts of disclosure, such as retention in care, avoidance of treatment failure, and improvement of HIV knowledge [9,7,10].…”

Sankofa Pediatric HIV Disclosure Intervention Did Not Worsen Depression Scores in Children Living with HIV and their Caregivers in Ghana

“…Sustained viral suppression is the goal of optimal adherence (³95%), and there are several efforts and strategies focused on ensuring this level of adherence along the HIV care continuum, particularly in children living with HIV [4,5]. Nevertheless, there are reports of poor adherence among children living with HIV leading to virologic or treatment failure [6,7]. Non-disclosure of HIV status to children living with HIV is a critical barrier to optimal adherence to therapy [8].…”