Abstract
Background: Treatment failure (TF) among patients receiving antiretroviral therapy (ART) against human immunodeficiency virus (HIV) impacts on treatment outcome and is becoming a public health concern globally. However, magnitude of TF and factors leading to it are poorly defined in the context of Ethiopia. Thus, the aim of this study was to determine the magnitude of TF and assess its determinants among HIV-infected patients on ART in Ethiopia. Methods: A prospective and retrospective study was conducted from March 2016 to 2017. Retrospective clinical and laboratory data were captured from patients’ medical record. Socio-demographics and explanatory variables of participants were collected using pre-tested structured questionnaire and study participants were followed for additional 6 month after baseline viral load has been done to classify virologic failure (VF). Multiple logistic regression was conducted to assess risk factors associated with TF. Statistical significance was set at P-value less than 0.05. Results: A total of 9,284 adults taking ART from a nationally representative 63 health facilities were included in the study. Viral Load Suppression (VLS) (VL1000 copies/ml at baseline of the study were re-suppressed after six months of enhanced adherence and counseling, leading TF among population on ART in Ethiopia 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. Medication adherence, disclosure of HIV status, missed appointment to ART, history of ART exposure prior to initiation, residency and marital status had significant association with TF. Conclusions: The high level of VLS (88.1%) could explain the success of ART program in Ethiopia towards achieving the UNAIDS global target on viral suppression. TF among population taking ART in Ethiopia is still a public health concern, since 11% of virally failed population is maintained on failed first-line regimen. However, a significant improvement on immunologic and clinical outcome after ART initiation was maintained. Close follow-up of medication adherence, ensuring disclosure of HIV status, regular appointment follow-up to ART could significantly improve the treatment outcome of population on ART in Ethiopia.
Highlights
For more than 35 years, the world has grappled with an AIDS epidemic that has claimed an estimated 35.0 million [28.9 million-41.5 million] lives and at its peak threatened global stability and security [1]
Sub-Saharan Africa suffers from the undue burden of human immunodeficiency virus (HIV), with an estimated 70% of the world HIV/AIDS infections and deaths occur in this region [2,3]
Our data showed considerable lost-to-follow up for the second round Viral Load (VL) testing and missing data which might introduce some errors in our estimation. In this nation-wide study, we evaluated the level of virological failure amongst HIV infected adults receiving antiretroviral therapy (ART) in Ethiopia and the determinants of virologic failure (VF)
Summary
For more than 35 years, the world has grappled with an AIDS epidemic that has claimed an estimated 35.0 million [28.9 million-41.5 million] lives and at its peak threatened global stability and security [1]. Active Antiretroviral therapy (HAART) is the lifesaving treatment for patients with HIV/AIDS, as it significantly reduces HIV-related mortality and morbidity [5]. The aim of the treatment is to suppress virus replication for as long as possible, restore and/or preserve immune function, improve quality of life, and reduce HIV-related morbidity and mortality [6]. This has not always been true due to Treatment Failure (TF), which can be explained by virological, clinical, or immunological causes. Treatment failure (TF) among patients receiving antiretroviral therapy (ART) against human immunodeficiency virus (HIV) impacts on treatment outcome and is becoming a public health concern globally.
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