Factors associated with antiretroviral treatment failure among people living with HIV on antiretroviral therapy in resource-poor settings: a systematic review and metaanalysis

Lailulo, Yishak Abraham; Kitenge, Marcel; Jaffer, Shahista; Aluko, Omololu; Nyasulu, Peter

doi:10.1186/s13643-020-01524-1

Cited by 35 publications

(33 citation statements)

References 45 publications

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“…Adherence to ART also reduces rates of mother-to-child transmission (MTCT) of HIV (8)(9)(10)(11). Suboptimal adherence to ART is detrimental: it is associated with virologic failure (12)(13)(14)(15)(16)(17)(18)(19), drug resistance (12,(20)(21)(22)(23), and ultimately death (24)(25)(26)(27)(28)(29)(30). In 2014, the United Nations Program on HIV/AIDS (UNAIDS) launched the 90-90-90 global targets for HIV and AIDS programming.…”

Section: Introductionmentioning

confidence: 99%

Hunger and Adherence to Antiretroviral Therapy: Learning From HIV Positive Caregivers of Orphans and Vulnerable Children in Tanzania

Exavery¹,

Charles²,

Kuhlik

et al. 2022

Front. Public Health

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The association between hunger and adherence to antiretroviral therapy (ART) is less known especially in vulnerable populations receiving HIV care and treatment services. Caregivers of orphans and vulnerable children (OVC) are vulnerable and likely to experience hunger due to additional economic pressure in caring for OVC. Using data from the community–based, USAID–funded Kizazi Kipya project, this study assesses the association between hunger and ART adherence among caregivers of OVC in Tanzania. HIV positive caregivers enrolled in the project from January to July 2017 were analyzed. The outcome variable was adherence to ART, defined as “not having missed any ART dose in the last 30 days,” and household hunger, measured using the Household Hunger Scale (HHS), was the main independent variable. Data analysis included multivariable logistic regression. The study analyzed 11,713 HIV positive caregivers who were on ART at the time of enrollment in the USAID Kizazi Kipya project in 2017. Aged 48.2 years on average, 72.9% of the caregivers were female. While 34.6% were in households with little to no hunger, 59.4 and 6.0% were in moderate hunger and severe hunger households, respectively. Overall, 90.0% of the caregivers did not miss any ART dose in the last 30 days. ART adherence rates declined as household hunger increased (p < 0.001). Multivariable analysis showed that the odds of adhering to ART was significantly lower by 42% among caregivers in moderate hunger households than those in little to no hunger households (OR = 0.58, 95% CI 0.50–0.68). The decline increased to 47% among those in severe hunger households (OR = 0.53, 95% CI 0.41–0.69). Hunger is an independent and a significant barrier to ART adherence among caregivers LHIV in Tanzania. Improving access to adequate food as part of HIV care and treatment services is likely to improve ART adherence in this population.

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Section: Introductionmentioning

confidence: 99%

Hunger and Adherence to Antiretroviral Therapy: Learning From HIV Positive Caregivers of Orphans and Vulnerable Children in Tanzania

Exavery¹,

Charles²,

Kuhlik

et al. 2022

Front. Public Health

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“… 30 A study conducted in a developing nation found that patients with CD4 counts below 200 cells/mm 3 had nearly five times higher chance of treatment failure than those with CD4 counts above 200 cells/mm 3 . 31 Viral replication reduces when CD4 cell count rises, implying that viral burden is inversely proportional to CD4 cell count. When compared with immune-competent patients with HIV infection, patients with deteriorated immune status had raised viral load.…”

Section: Discussionmentioning

confidence: 99%

Magnitude of optimal adherence and predictors for a low level of adherence among HIV/AIDS-infected adults in South Gondar zone, Northwest Ethiopia: a multifacility cross-sectional study

Zewude

Ajebe

2022

BMJ Open

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ObjectivesThis study aims to identify levels of adherence to antiretroviral therapy (ART) drugs and factors associated with them in Northwest Ethiopia. We hypothesise that in the era of COVID-19, there would be suboptimal adherence to ART drugs.DesignAn observational cross-sectional study was conducted. Factors associated with the level of adherence were selected for multiple logistic regressions at a p value of less than 0.2 in the analysis. Statistically significant associated factors were identified at a p value less than 0.05 and adjusted OR with a 95% CI.SettingThe study was conducted in one specialised hospital and three district hospitals found in the South Gondar zone, Northwest Ethiopia.ParticipantsAbout 432 people living with HIV/AIDS receiving highly active ART in South Gondar zone public hospitals and who have been on treatment for more than a 3-month period participated in the study.Primary and secondary outcome measuresLevels of adherence to ART drugs and their associated factors.ResultsAmong 432 study participants, 81.5% (95% CI: 78% to 85.2%) of participants were optimally adherent to ART drugs. Determinants of a low level of adherence: stigma or discrimination (OR=0.4, p=0.016), missed scheduled clinical visit (OR=0.45, p=0.034), being on tuberculosis treatment (OR=0.45, p=0.01), recent CD4 cell count less than 500 cells/mm3 (OR=0.3, p=0.023) and patients who had been on WHO clinical stage III at the time of ART initiation (OR=0.24, p=0.027) were factors significantly associated with adherence to ART drugs.ConclusionsLevel of adherence was relatively low compared with some local studies. The intervention targeted to reduce discrimination, counselling before initiation of treatment and awareness regarding compliance is advised to improve adherence to antiretroviral regimens.

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“…In our study, it was found that persons were more likely to be virally suppressed at 12 months if they had baseline CD4 counts ≤ 200 cells/mm 3 (OR, 1.71; 95% CI 1.26–2.32) however the results were not statistically significant for retention in care at 12 months. There are mixed results in patients with CD4 < 200 cells/mm 3 and subsequent viral suppression as a systematic review by Lailulo et al [ 29 ] done to identify factors associated with ART treatment failure showed that the likelihood of treatment failure was significantly higher in patients with CD4 < 200 cells/mm 3 (OR, 4.82; 95% CI 2.44–9.52) in resource limited areas perhaps due to HIV related opportunistic infections, increased pill burdens and the potential to develop increased drug toxicity in patients with advanced disease on multiple medications [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

The expansion of a patient tracer programme to identify and return patients loss to follow up at a large HIV clinic in Trinidad

et al. 2021

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Background Patients who default from HIV care are usually poorly adherent to antiretroviral treatment which results in suboptimal viral suppression. The study assessed the outcomes of retention in care and viral suppression by expansion of an intervention using two patient tracers to track patients lost to follow up at a large HIV clinic in Trinidad. Methods Two Social Workers were trained as patient tracers and hired for 15 months (April 2017–June 2018) to call patients who were lost to follow up for 30 days or more during the period July 2016–May 2018 at the HIV clinic Medical Research Foundation of Trinidad and Tobago. Results Over the 15-month period, of the of 2473 patients who missed their scheduled visits for 1 month or more, 261 (10.6%) patients were no longer in active care—89 patients dead, 65 migrated, 55 hospitalized, 33 transferred to another treatment clinic and 19 incarcerated. Of the remaining 2212 patients eligible for tracing, 1869 (84.5%) patients were returned to care, 1278 (68.6%) were virally unsuppressed (viral load > 200 copies/ml) and 1727 (92.4%) were re-initiated on ART. Twelve months after their return, 1341 (71.7%) of 1869 patients were retained in care and 1154 (86.1%) of these were virally suppressed. Multivariate analysis using logistic regression showed that persons were more likely to be virally suppressed if they were employed (OR, 1.39; 95% CI 1.07–1.80), if they had baseline CD4 counts < 200 cells/mm3 (OR, 1.71; 95% CI 1.26–2.32) and if they were retained in care at 12 months (OR, 2.48; 95% CI 1.90–3.24). Persons initiated on ART for 4–6 years (OR, 3.09; 95% CI 1.13–8.48,), 7–9 years (OR, 3.97; 95% CI 1.39–11.31), > 10 years (OR, 5.99; 95% CI 1.74–20.64 were more likely to be retained in care. Conclusions Patient Tracing is a feasible intervention to identify and resolve the status of patients who are loss to follow up and targeted interventions such as differentiated care models may be important to improve retention in care.

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Factors associated with antiretroviral treatment failure among people living with HIV on antiretroviral therapy in resource-poor settings: a systematic review and metaanalysis

Cited by 35 publications

References 45 publications

Hunger and Adherence to Antiretroviral Therapy: Learning From HIV Positive Caregivers of Orphans and Vulnerable Children in Tanzania

Hunger and Adherence to Antiretroviral Therapy: Learning From HIV Positive Caregivers of Orphans and Vulnerable Children in Tanzania

Magnitude of optimal adherence and predictors for a low level of adherence among HIV/AIDS-infected adults in South Gondar zone, Northwest Ethiopia: a multifacility cross-sectional study

The expansion of a patient tracer programme to identify and return patients loss to follow up at a large HIV clinic in Trinidad

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