Predictors of Time to First Line Antiretroviral Treatment Failure among Adult Patients Living with HIV in Public Health Facilities of Arba Minch Town, Southern Ethiopia

Abstract

BACKGROUND: Antiretroviral therapy is a proven medication given for Human Immunodeficiency Virus positive individuals. However, first-line antiretroviral treatment failure becomes a public health issue and early detection of treatment failure is crucial for timely actions. Therefore, this study aimed to identify the predictors of time to first-line antiretroviral treatment failure among adult patients living with HIV in public health facilities of Arba Minch Town.METHODS: Institution-based retrospective cohort study was employed among 396 adult patients that were selected using simple random sampling. The data on relevant variables were extracted from patient medical cards. Bi-variable and multi-variable Cox proportional hazard regression analyses were used to identify predictors.RESULTS: The median survival time was 21 months. Substance use (AHR=2.94, 95% CI=1.62 to 5.32), disclosure status (AHR=1.98, 95% CI=1.03 to 3.79), time since HIV diagnosis (AHR=2.19 95% CI=1.01 to 4.79), WHO clinical stage (AHR=2.02, 95% CI=1.02 to 4.00), opportunistic infection (AHR=2.27, 95% CI=1.23 to 4.19), nutritional status (AHR=3.78, 95% CI=1.99 to 7.17), functional status (AHR=2.71 95% CI=1.33 to 5.51), CD4 count (AHR=1.99, 95% CI=1.05 to 3.75), and adherence level (AHR=1.99, 95% CI=1.05 to 3.76) were independent predictors of time to first line ART treatment failure.CONCLUSION: History of substance use, lack of disclosure status, time since HIV diagnosis, advanced WHO clinical staging, low CD4 counts, opportunistic infection, functional status, poor adherence to ART and under-nutrition affect the time to first-line treatment failure among adult patients living with HIV. Therefore, preventive interventions, and information and counseling focusing on high risk groups of HIV infected adult are very important.

Predictors of Mortality Among Adult HIV-Infected Patients Taking Antiretroviral Therapy (ART) in Harari Hospitals, Ethiopia

“…HIV-infected patients with poor ART adherence had a higher risk of death compared to those who had good ART adherence scores. This finding is agreed with the study findings from Northern Ethiopia, 26 India, 27 Arba Minch, 42 Southwestern Ethiopia, 43 and Jharkhand, India. 44 This can be due to forgetting about taking ARV drugs, late initiation of the follow-up care, lack of close supervision and counsel from adherence supporters, and follow-up interruptions due to the patients and health facility/health care worker’s factors.…”

Determinants of virological failure among patients on first line highly active antiretroviral therapy (HAART) in Southwest Ethiopia: A case-control study

“…In addition, the odds of virological failure were higher among those who had a history of OI throughout the follow-up period compared with those who had no history of OI throughout the follow-up period. This finding is in line with the studies conducted in Jimma ( 17 ) and Arba Minch towns of Ethiopia ( 35 ) which showed patients with opportunistic infections, such as TB, appear to be at a higher risk of virological failure. This finding also consisted of a study conducted in Nigeria ( 36 ).…”

Antiretroviral treatment failure and associated factors among people living with HIV on therapy in Homa Bay, Kenya: A retrospective study

“…Although the rate of VTF was higher among PLHIV who stated ART with CD4 <200 cells/mL (11.6% (95% CI: 8.1%, 15.1%)) compared to those who started ART with CD4 > = 200 cells/ mL (8.1% (95% CI:6.4%, 9.9%)), this difference was not statistically significant, p = 0.062. The failure rate of 3.7% among adults in this study was inconsistent with previous findings from studies conducted among adults in Ethiopia, Uganda, India, and Kenya [13,14,[22][23][24][25][26][27], where rates of VTF among adults ranged from about 10% to as high as 34%. Many of these studies however, used the definition of two consecutive VL >1000 copies/ml 3 3 months apart, without the condition of adherence counseling, somewhat different to the definition used in our study.…”