Prevalence, trend and risk factors for antiretroviral therapy discontinuation among HIV-infected adults in Ethiopia in 2003-2015

Abstract

BackgroundIt is well acknowledged that antiretroviral therapy (ART) discontinuation hampers the progress towards achieving the UNAIDS treatment targets that aim to treat 90% of HIV diagnosed patients and achieve viral suppression for 90% of those on treatment. Nevertheless, the magnitude, trend and risk factors for ART discontinuation have not been explored extensively. We carried out a retrospective data analysis to assess prevalence, trend and risk factors for ART discontinuation among adults in Southwest Ethiopia.Methods12 years retrospective cohort analysis was performed with 4900 HIV-infected adult patients between 21 June 2003 and 15 March 2015 registered at the ART clinic at Jimma University Teaching Hospital. ART discontinuation could be loss to follow-up, defaulting and/or stopping medication while remaining in care. Because data for 2003 and 2015 were incomplete, the 10 years data were used to describe trends for ART discontinuation using a line graph. We used binary logistic regression to identify factors that were correlated with ART discontinuation. To handle missing data, we applied multiple imputations assuming missing at random pattern.ResultsIn total, 4900 adult patients enrolled on ART, of whom 1090 (22.3%) had discontinued, 954 (19.5%) had transferred out, 300 (6.1%) had died, 2517 (51.4%) were alive and on ART, and the remaining 39 (0.8%) had unknown outcome status. The trend of ART discontinuation showed an upward direction in the recent times and reached a peak, accounting for a magnitude of 10%, in 2004 and 2005. Being a female (AOR = 2.1, 95%CI: 1.7–2.8), having an immunological failure (AOR = 2.3, 1.9–8.2), having tuberculosis/HIV co-infection (AOR = 1.5, 1.1–2.1) and no previous history of HIV testing (AOR = 1.8, 1.4–2.9) were the risk factors for ART discontinuation.ConclusionsOne out of five adults had discontinued from ART, and the trend of ART discontinuation increased recently. Discontinued adults were more likely to be females, tuberculosis/HIV co-infected, with immunological failure and no history of HIV testing. Therefore, it is vital to implement effective programs such as community ART distribution and linkage-case-management to enhance ART linkage and retention.

Treatment Failure among People living with HIV taking Antiretroviral Therapy in Ethiopia

“…Most of the variables which found to have association with TF in this study were established facts to predict TF and are among the global recommendations to improve TF (8,(32)(33)(34). Among these, medication adherence, disclosure of HIV status, missed appointment to ART, history of ART exposure prior to initiation, residency and marital had significant association with VLS which is in line with most of the studies conducted in low and middle income countries (32)(33)(34)(35)(36).…”

Predictors of Health Insurance Enrollment among HIV Positive Pregnant Women in Kenya: Potential for Adverse Selection and Implications for HIV Treatment and Prevention

“…Additionally, from a health systems perspective, increasing risk tolerance among high-risk populations would not be optimal, especially if the patients are dependent on regular uninterrupted care (ART) to maintain good health. Various studies continue to show that adherence to ART is an ongoing challenge across the world [79][80][81]. As such, continued engagement with the healthcare system-which is facilitated by health insurance-is going to be critical for HIV care, as well as achieving the global HIV targets of 90-90-90 [7].…”

Antiretroviral Therapy Adherence Level and Associated Factors Among HIV/AIDS Patients in Jimma Zone Government Health Facilities, ART Clinics, South-west Ethiopia

“…However, many people find it very difficult to take ARVs drug as precisely as they should for a number of reasons. Some of the reasons for common and consistent barriers for ART adherence include: stigma, perceptions of side effects, lack of food, inadequate knowledge of ART, patient reported symptoms, stress, lack of social support, substance use, regimen complexity, self-efficacy for medication taking, depression (Edward., Machtinger & Bangsber., 2006;Tassie., 2010); gender, having immunological failure, having tuberculosis/HIV co-infection (Gesesew., Ward., Woldemichael., & Mwanri., 2017;Alagaw et al, 2014).…”

“…Even though level of adherence; associated factors and implications have become more and more recognized, studies about this issue still need further investigations particularly in Jimma zone government ART facilities-tremendously scale up to reach people with HIV particularly in rural and semi urban settings. Furthermore, though very few studies attempted to assess antiretroviral therapy discontinuations and identified some possible associated factors (Gesesew et al, 2017;Assefa., Taha., Dejene & Dube., 2013;Amberbir., Deribe., Hailekiros., Biadglign & Kebede., 2008;Tiyou et al, 2010). These studies were all of them based on sole, well organized study setting such as Jimma University Specialized Hospital ART clinic or Nekemte Hospital.…”