Factors Associated with Virologic Failure Amongst Adults on Antiretroviral Therapy in Nyanza Region, Kenya.

Abstract

Background: Access to Antiretroviral Therapy (ART) to patients living with HIV (PLHIV) has markedly improved especially in Sub-Saharan Africa. The goal of ART is to ensure viral suppression and prevention of treatment failure which may be clinical, immunological or virologic. Viral suppression is important to better outcomes of treatment. This study aimed at determining the factors associated with virologic failure amongst patients with clinical and/or immunologic failure. Methodology: This was a cross sectional study based on a retrospective review of viral load test electronic data of patients with immunologic and/or clinical treatment failure. A total of 320 randomly selected records of patients tested for viral load were included in the analysis. Statistical Package for Social Sciences (SPSS) was used to analyze the data. Descriptive statistics such as frequency and median was used to describe demographic and clinical characteristics of patients. Univariate, bivariate and multivariate analysis was done to determine the factors associated with virologic failure. Odd ratio was calculated. Results: Among patients with suspected ART treatment failure and viral load test requested to confirm failure, the median age was 39 years; 186 (58.1%) were female; 173 (54.1%) were aged ≤ 40; only 6 (1.9%) had missed ARVs for a period of more than 2 weeks; 31 (9.7%) had missed ARVs due to missing clinic visits; majority (30.6%) of the patients had been on ARVs for more than 4 years; (96.9%) of the patients were on first line ART regimen; 208 (65.2%) had baseline CD4 less than 100 cells/mm 3 ; baseline median CD4 of 152 cells/mm 3 , peak median was 336 cells/mm 3 and median CD4 at the time of viral load request was 170 cells/mm 3 . Age younger than 40 years was associated with virologic failure (AOR 2.33, p value 0.0011). Other patient characteristics were not associated with virologic failure. Conclusion: Key factor associated with virologic failure amongst patients with suspected treatment failure is age lower than 40 years. Recommendation:Focus on patients younger than 40 years should be prioritized and comprehensive and focused services friendly to the young need to be strengthened at the health facility level.