Magnitude and Factors Affecting Virological Treatment Failure among HIV Reactive Adults from Selected Hospitals of North Shoa Zone, Amhara Region, Ethiopia

Background Nowadays Human Immuno-deficiency Virus (HIV) is one of the devastating and prevalent viruses affecting the globe without a cure. Highly Active Antiretroviral Therapy (HAART) significantly reduced the morbidity and mortality of patients with HIV infection. Although there is increasing global use of antiretroviral therapy (ART) for the treatment of HIV/AIDs, the global trends in ART failure are growing. In developing countries including Ethiopia, particularly in our study settings, information related to the magnitude and correlates of virological treatment failure is scarce. Thus, this study aimed at assessing the magnitude of virological treatment failure and associated factors among HIV reactive adults at selected hospitals of North Shoa, Amhara Region, Ethiopia. Methods a facility-based cross-sectional study was conducted among 498 study participants who started their first-line HAART from August 2005 to December 2018. Data were collected from patients’ charts and face-to-face interviews using a structured questionnaire. The bivariable analysis was executed to select candidate predictor variables at a p-value of less than 0.2. Multivariable logistic regression (forward stepwise, conditional) analysis was used to identify factors associated with virologic failure at a significant level of 5%. Model adequacy check was done by Hosmer and Lemeshow (p = 0.57) and Naglkerke R Square (0.46) was calculated to express the variability of virological failure by predictors. Result More than half 290 (58.2%) of the study participants were females. The median age at ART initiation was 40 years with an interquartile range (IQR) of 15 years. The median duration of virologic failure since initiation of treatment was 96 months (IQR) of 72. The magnitude of virological treatment failure was 10.24% (95% CI: 7.57% − 12.91%). Poor ART drug adherence (AOR = 4.54; 95% CI: 2.09, 9.87), CD4 count less than 250 cell/µl (AOR = 24.88; 95% CI: 11.73, 52.81) and Poor Quality of Life (QoL) (AOR = 2.65; 95% CI: 1.12, 6.25) were independent predictors of virologic failure. Conclusion The magnitude of Virologic ART treatment failure in this study was relatively high. Poor ART drug adherence, patients’ having lower CD4 count and poorer quality of life were predictors of treatment failure. Thus, an intervention programs that enriches patients’ health-related quality of life should be implemented. Moreover, counseling that supplements the importance of drug adherence and reduction of risks that lower CD4 counts should be given emphasis which in turn helps to prevent first-line ART treatment failure.

Magnitude and Factors Affecting Virological Treatment Failure among HIV Reactive Adults from Selected Hospitals of North Shoa Zone, Amhara Region, Ethiopia.

Background: Nowadays Human Immuno-deficiency Virus (HIV) is one of the devastating and prevalent virus affecting the globe without a cure. Highly Active Antiretroviral Therapy (HAART) significantly reduced the morbidity and mortality of patients with HIV infection. Although there is increasing global use of antiretroviral therapy (ART) for the treatment of HIV/AIDs, the global trends in ART failure is growing. In developing countries including Ethiopia, particularly in our study settings, information related to magnitude and correlates of virological treatment failure is scarce. Thus, this study aimed at assessing the magnitude of virological treatment failure and associated factors among HIV reactive adults at selected hospitals of north Shoa, Amhara Region, Ethiopia.Methods: a facility based cross-sectional study was conducted among 498 study participants who started their first-line HAART from August 2005 to December 2018. Data were collected from patients’ charts and face-to-face interviews using a structured questionnaire. Bivariable analysis was executed to select candidate predictor variables at a p-value less than 0.2. Multivariable logistic regression (forward stepwise, conditional) analysis was used to identify factors associated with virologic failure at significant level of 5%. Model adequacy check was done by Hosmer and Lemshow (p = 0.57) and Naglkerke R Square (0.46) was calculated to express the variability of virological failure by predictors.Result: More than half 290 (58.2%) of study participants were females. The median age at ART initiation was 40 years with an interquartile range (IQR) of 15 years. The median duration of virologic failure since initiation of treatment was 96 months (IQR) of 72. The magnitude of virological treatment failure was 10.24% (95% CI: 7.57% - 12.91%). Poor ART drug adherence (AOR = 4.54; 95% CI: 2.09, 9.87), CD4 count less than 250 cell/μl (AOR = 24.88; 95% CI: 11.73, 52.81) and Poor Quality of Life (QoL) (AOR = 2.65; 95% CI: 1.12, 6.25) were independent predictors of virologic failure. Conclusion: The magnitude of Virologic ART treatment failure in this study was relatively high. Poor ART drug adherence, patients’ having lower CD4 count and poorer quality of life were predictors of treatment failure. Thus, intervention program that enrich patients’ health related quality of life should be implemented. Moreover, counselling that supplement the importance of drug adherence and reduction of risks that lowers CD4 counts should be given emphasis which in turn helps to prevent first-line ART treatment failure.

Prevalence and Factors Associated With Virological Treatment Failure Among Children and Adolescents on Antiretroviral Therapy Attending HIV/AIDS Care and Treatment Clinics in Dodoma Municipality, Central Tanzania

Background As the World Health Organization (WHO) and its joint partners such as USAIDS target achieving 90% sustained virological suppression among children and adolescents living with Human Immunodeficience Virus (HIV)/AIDS, it is imperative to elucidate the current prevalence and factors associated with virological treatment failure for formulation of appropriate strategies. This study was conducted determine the prevalence and factors associated with virological treatment failure among children and adolescents with HIV/AIDS on antiretroviral therapy (ART) attending HIV/AIDS care clinics in Dodoma, Central Tanzania. Methods This was a cross-sectional study of children aged 1–19 years attending 3 HIV/AIDS care clinics in Dodoma (central Tanzania) from November 2018 to February 2019. Sociodemographic and clinical factors were documented, HIV viral load and CD4+ T lymphocytes were evaluated for children on ART for ≥6 months. The primary outcomes were the prevalence and factors associated with viralogic treatment failure. Results Of 300 children enrolled, 102 (34%) had virological treatment failure. Poor adherence to ART (adjusted odds ratio [AOR] = 3.221; 95% confidence interval [CI], 1.867–5.558; P = .032), nevirapine regimen (AOR = 3.185; 95% CI, 1.473–6.886; P ≤ .001), not using cotrimoxazole prophylaxis (AOR = 25.56; 95% CI, 3.15–27.55; P = .002) and nondisclosure of HIV status to others (AOR = 7.741; 95% CI, 2.351–25.489; P = .001) were independently associated with virological treatment failure. Conclusions Current prevalence of virological treatment failure among children and adolescents living with HIV on ART remain high. Factors such as ART adherence, nevirapine based regimen, HIV status disclosure to those caring for the child need to be addressed to achieve sustained virological suppression.

Magnitude of Virological Treatment Failure and Its Determinate Factors Among Adults on First Line Antiretroviral Treatment at Defence Main Health Department - Level II & Level III Hospitals In Ethiopia

Introduction: Highly active antiretroviral therapy (HAART) played a critical role in the medical management of HIV infected individuals by restoring the immune function and minimizes HIV related outcomes. But treatment failure minimized these advantages and leads to an increment of morbidity and mortality with poor quality of life in all HIV patients. Objective: The aim of this study was to assess the virological treatment failure and its determinant factors of patients on first line HAART at five commandant Hospitals, Ethiopia. Methods: A Retrospective hospital based study design was used to determine magnitude of treatment/virology failure and its determinant factors, among HIV positive adults enrolled to HAART program at five commandant Hospitals from February 1 to May 30, 2018. Data abstracted from patient charts or electronic data base was cleaned, coded, entered and analyzed using EPI data version 3.1 and SPSS version 23 statistical software package. Descriptive statistics, proportion of treatment failure cases among those diagnosed to have treatment failure was calculated. Bi-variate and multiple logistic regressions were used to analysis association between the outcome and the independent variables were taken as significant at P<0.05 (2 tail test) and 95% confidence intervals (CIs). Result: Among the 326 participants enrolled, 229(70.2%) were males. The mean ages were 36.84 years (SD+7.716) years and the median months on HAART from initiation were 81.50 months. A total of 75(23%) participants were found to have treatment failure among those 50(15.3%) immunological failure, 7(2.1%) virological failure and 16(4.9%) all Treatment failure (VF, IF&CF in one). The mean CD4 T-cells at base line and at study time were 213.3 cells/ µl. Long duration on treatment (AOR= 4.231, 95% CI: 1.453-12.320) , IPT cycle (AOR = 3.060, 95% CI: 1.388-6.746), Type of drug AZT based therapy (AOR= 2.572, 95% CI: 1.357-4.875), experience of PEP (AOR=7.950, 95% CI: 1.945-66.915) and lost to follow up (AOR= 9.104, 95% CI: 2.973-27.873) were found to be significant predictors of treatment/virologic failure and showed positive odds ratio. Conclusion: This study demonstrates high treatment /virologic failure and the determinant factors of treatment/virologic failures among HAART first line adult are still changing. Therefore, evidence-based intervention and early detection of treatment failure must be made to further identify the potential causes and set standardized protective mechanisms of treatment/virologic failures.