Predictors of HIV Antiretroviral Treatment Failure among Patients Attending the Comprehensive Care Clinic at Rift Valley Provincial General Hospital – Kenya, 2012
Background: HIV antiretroviral treatment (ART) failure is known to increase morbidity and mortality. Early identification of HIV patients who are failing treatment offers the opportunity to implement timely interventions. We conducted a study to determine predictors of ART failure among patients attending a HIV clinic in Kenya.
Methods: We conducted a case-control study; participants recruited were clinic enrolled HIV infected adults on ART for 6 months or more. A case-patient was recruited if they had a decline in CD4 count (below baseline or 30% from highest value since ART initiation) or unimproved CD4 counts or a World Health Organization (WHO) stage III or IV opportunistic infection. A control-patient was recruited if all aforementioned signs were absent. Data were obtained through patient interviews, medical chart reviews and included information on CD4 count at ART initiation, episodes of not taking ART and concurrent medications.
Results: We enrolled 52 cases and 104 controls. Twenty-eight (53%) case-patients and 71 (70%) control-patients were women, and median age was 44 years (range: 38-50 years) among case-patients and 43 years (range: 38-49 years) among control-patients. Discontinued ART for 2 weeks or more was found to significantly increase the risk of ART failure [Adjusted Odds Ratio (AOR) 8.9, 95% Confidence Interval (CI) 1.4-57.4]. Compared to men who discontinued ART for less than 2 weeks, women who discontinued ART for less than 2 weeks had reduced risk (AOR 0.4, 95% CI 0.2-0.9) while those who discontinued for more than 2 weeks had a greater risk (AOR 12.97, 95% CI 1.5-111.8) of developing ART failure.
Conclusions: Discontinuing ART was identified to be a modifiable behaviour associated with ART failure. Positive periodic adherence counselling remains crucial in psychosocial support for HIV patients.