Determinants of First Line Antiretroviral Treatment Failure among Patients on Highly Active Antiretroviral Therapy in Selected Public Hospitals - Jimma, Southwest Ethiopia a Case Control Study

  • Viral hepatitis and HIV
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Highly Active Antiretroviral Therapy (HAART) has substantially declined morbidity and mortality related to Hu- man immunodeficiency virus/Acquired immunodeficiency syndrome (HIV/AIDS). Nevertheless, the failure of first- line ART regimens has emerged as a growing concern. Identifying and managing determinants of first-line ART failure is of utmost importance to attain viral load suppression and is crucial to achieving the 90-90-90 treatment target. However, there is limited evidence on these determinants in Ethiopia and the study area. Accordingly, We assessed the determinants of first-line ART failure among patients attending ART in Public Hospitals Jimma, South- west Ethiopia.
A case-control study was conducted in selected public hospitals Jimma, from March 1-26, 2018. A sample of 384 (288 controls and 96 cases) were recruited. All cases were enrolled in the study, but controls were selected using simple random sampling. A case was an HIV patient aged ≥15 years on a first-line ART regimen with a documented treatment failure (virologic, immunologic or clinical). Controls were HIV patients ≥15 years on a first-line ART reg- imen with no evidence of therapeutic failure. Data was collected by interviewer-administrated questionnaires and extracted from an electronic database. Bivariate and multivariate logistic regression analysis was used. Adjusted odds ratios and 95%confidence intervals were used to report independent variables associated with first-line ART failure at P-value<0.05.
In this study, higher odds of first-line ART failure was detected 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), zidovu- dine 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).
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.

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