Background: Highly Active Antiretroviral Therapy (HAART) has substantially declined morbidity and mortality related to Human immunodeficiency virus/Acquired immunodeficiency syndrome (HIV/AIDS). Despite this fact, first-line ART failure has emerged as a growing concern. However, factors associated with first-line ART failure are not well empathized and studied. Hence, we aimed to identify the determinants of first-line ART failure among patients attending ART in Public Hospitals Jimma, Southwest Ethiopia. Methods: A case-control study was conducted in March 2018 on a sample of 384(288 controls and 96 cases) adult people living with HIV/AIDS (PLWHA). Cases were HIV patients aged 15 years or older who were on first-line ART regimens with documented therapeutic failure. Controls were HIV patients aged 15 years or older who were on first-line ART regimen but without evidence of therapeutic failure. Data were extracted from electronic databases and supplemented by data collected through interviewer-administered questionnaires. Bivariate and multivariate logistic regression analyses were used. Adjusted odds ratios and 95% confidence intervals were used to report independently associated factors at P-value<0.05. Results: In this study, higher odds of first-line ART failure was experinced among urban residents (AOR:2.2;95%CI: 1.1, 3.6), smokers (AOR:5.9; 95%CI:3.2, 10.8), Khat users (AOR:2.2; 95%CI:1.3,3.7), poor treatment adherents (AOR:2.2; 95%CI: 1.1,4.5), tuberculosis coinfection (AOR:3.9; 95%CI:2.2, 6.8), prior exposure to ART (AOR:3.8; 95%CI:1.7, 8.1), zidovudine based regimen (AOR:4.8; 95%CI: 2.5,9.0) and longer duration on ART more than 73 months (AOR:1.9; 95%CI:1.2, 3.3). Conclusions: This study evidenced that being an urban resident, TB co-infection, poor treatment adherence, and zidovudine-based regiment were positively and independently associated with first-line ART failure. Thus, enhanced adherence counseling should be provided for those urban residents as well as substance users to improve adherence to ART; early screening and management of tuberculosis is highly recommended. Moreover, close follow up of adverse effects of ARVs must be strengthened. Keywords : determinants, first-line ART failure, HIV/AIDS, Jimma Zone, Public hospitals

Background: Identifying determinant factors of antiretroviral therapy (ART) treatment failure are crucial to achieving 90-90-90 treatment target to help end AIDS epidemic by 2020. However, evidences on determinants of first line ART failure in Ethiopia are limited. Hence, the aim of this study was to assess determinants of first line ART failure among patients attending ART care in selected Public Hospitals Jimma, Southwest Ethiopia. Methods: A case control study was conducted in March 2018 on sample of 384(288 controls and 96 cases) adult people living with HIV/AIDS (PLWHA). All available cases were enrolled in the study whereas controls were selected using simple random sampling. Cases were HIV patients aged 15 years or older who were on first line ART regimen with documented treatment failure (virologic, immunologic or clinical). Controls were HIV patients aged 15 years or older who were on first line ART regimen but without evidence of therapeutic failure. Data was extracted from electronic database and supplemented by data collected through interviewer administered questionnaire. Bivariate and Multivariate logistic regression analyses were used. Adjusted odds ratios and 95% confidence interval were used to report independently associated factors with the first line ART failure at P-value<0.05. Results: Median ages of cases and controls were 28 (IQR 25-32) and 27 (IQR23-33), respectively. Being urban resident (AOR:2.2; 95%CI: 1.1, 3.6), smoking (AOR:5.9; 95%CI:3.2, 10.8), Khat use (AOR:2.2; 95%CI:1.3,3.7), poor treatment adherence (AOR: 2.2; 95% CI: 1.1,4.5), tuberculosis coinfection (AOR: 3.9; 95% CI:2.2, 6.8), prior exposure to ART (AOR: 3.8; 95% CI:1.7, 8.1), zidovudine based regimen (AOR: 4.8; 95% CI: 2.5,9.0) and median duration on treatment of more than 73 months (AOR:1.9; 95% CI:1.2, 3.3) were independently associated with first line treatment failure. Conclusions: Multiple factors such as being urban resident, TB co-infection, poor treatment adherence, and zidovudine based regiment were independently associated with first line ART failure. Thus, strategies designed to curb the HIV pandemic should focus on these factors, among others, to achieve the ambitious target of ending AIDS pandemic by 2020 set by UNAIDS. Key words: determinants, first line ART failure, HIV/AIDS, Jimma Zone, Public hospitals