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

Abstract

Background: Although treatment failure (TF) among population on antiretroviral therapy (ART) become a major public health threat, its magnitude of and factors leading to it are poorly defined. Hence, we aimed to estimate the magnitude of TF and its determinants in Ethiopia. Methods:A follow-up study was conducted from March 2016 to 2017. Clinical and laboratory data were captured from paticipants' medical record. Socio-demographics and explanatory variables were collected using structured questionnaire. Participants with baseline viral load (VL) >1000 copies/ml were followed for three to six month to clasify virologic failure (VF).Logistic regression was conducted to assess associated risk factors and statistical significance was set at P-value < 0.05.Results: A total of 9,284 adults from 63 health facilities were included in the study.Viral load suppression (VLS) were found to be 8,180 (88.1%). Thirty-five percent of the study participants with VL>1000 copies/ml at baseline of the study were re-suppressed after three to six month of adherence counseling and hence VF was found to be 983 (11%). Immunologic and clinical failure was significantly improved from 21.5% and 16.5% at ART initiation to 576 (6.2%) and 470 (5.0%) at baseline of the study, respectively. Adherence, disclosure of HIV status, missed appointment to ART, history of ART exposure prior to initiation, residency and marital status had significant association with VLS.Conclusions: VLS (88.1%) could explain the success of ART program in Ethiopia towards the UNAIDS global target. Eleven percent of the population is maintained on a failed first-line Page 2 of 14 regimen. Improving adherence, ensuring disclosure of HIV status and appointment follow-up could improve treatment outcome.

Rate and predictors of Treatment Failure among pediatric population taking Highly Active Antiretroviral Therapy in Ethiopia

“…However, this contradicts with other study conducted at Rohde Island which showed 43% viral suppression among pediatric population [14]. This study revealed that pediatric TF is a programmatic concern since there is significant difference with VLS among pediatric versus adult in Ethiopia which was reported as 88.1% [23]. Immunologic failure at base line of this study was 185 (33.3%) at ART initiation and improved to 39 (7%) after 80 month of ART experience.…”

Detection of Antiretroviral treatment failure among adult HIV-1 patients on anti-retroviral therapy for 12 +/- 3 months attending different Voluntary Counseling Testing and treatment centers in Khartoum state, Sudan

“…The most higher WHO clinical stage of HIV was stage 3 in this study, which is dissimilar to study done in India in 2019 in which the most common unsuppressed patients were in stage 1 (23) The virological failure was observed in the age group 39-48 years, which is similar to the nding of the study done in Ethiopia in which virological failure was observed among patients aged < 35 years (20) Most of patients 82.1% had suppressed viral load (non detectable copies/ ml and less than 40 copies/ ml) because viral load usually become not detected after 12 3 month successful treatment, while patients with unsuppressed viral load may need a good adherence, they may have metabolic problems or they may have drug resistance mutations. This nding put Sudan closer to the UNAIDS treatment target 2020 in which 90% of patients under treatment must have suppressed viral load.…”

“…Regarding sex status, the number of males were higher than females (58% versus 42%) in this study, which is similar to study done in Sudan in 2015 in which males were higher (22) , however it was dissimilar to the study done in Ethiopia in 2019 in which the females were higher in number (20) .…”

“…As in study conducted in South Africa in 2018, the percentage of patients in the rst line of treatment with virological failure was 22% (19) . Also studies done in Ethiopia in 2019 (20) and Uganda in 2015 (21) the percentage was 11% although their HIV frequency is higher than Sudan.…”

Incidence and predictors of virological failure among adult HIV patients on first-line antiretroviral therapy in Amhara regional referral hospitals; Ethiopia: a retrospective follow-up study

“…In sub-Saharan African countries, viral load suppression rate was 40.2-77.4% [10], and 24% of the adult patients on first-line ART experienced virological failure within 12 months of ART initiation [11]. In the Ethiopian public health facilities, virological failure was estimated to be 11.9% [12]. Ethiopia has adopted the UNAIDS 90-90-90 treatment target by 2020 [13], and other countries have planned to reach 90% viral suppression among all people receiving ART [5].…”