Incidence of Virological Failure and Associated Factors among Adult HIV-Positive Patients on First Line Antiretroviral Therapy Regimen, Central Ethiopia

Abstract

Introduction: Viral replication continued to be a major challenge among patients living with HIV and on antiretroviral treatment. In Adama hospital medical college virological failure incidence and factors associated were not well investigated. The aim of this study is to assess Incidence of virological failure and associated factor among adult HIV-patients on first line antiretroviral therapy regimen in Adama Hospital Medical College, Adama town, East Shoa Zone, Oromia Regional State, Ethiopia. Methods: A retrospective cohort study design, 5 years of follow up, was conducted through reviewed and analyzed data of 445 adult patients who had started ART between January 01, 2013 and April 30, 2018. The Kaplan–Meier method was used to estimate the probability of virological failure at different time points. Incidence of virological failure was calculated per 100 Person-years. The Cox proportional hazards model was used to identify factors associated with virological failure. Results: Out of the total 445 cohort patients who were assessed for viral load, there were 40 (9.0%) virological failures in 1,594 person years of retrospective follow-up. This makes the incidence rate of virological failure 2.5 per 100 person-years of follow-up. The cumulative hazard of virological failure at 1 year, 2 years, 3 years, 4 years and 5 years after starting ART amongst those tested was 1.1%, 4.3%, 6.6%, 9.9% and 12.3% respectively. Age 15-24 years [AHR = 4.13, 95%CI (1.29-13.22)], poor adherence [AHR = 2.62, 95%CI (1.21-5.68)], Short duration on ART taking [AHR = 6.93, 95%CI (2.62-18.33)], and changing ART regimen [AHR = 2.82, 95%CI (1.18-6.75)] were risk factors significantly associated with virological failure. Conclusion and recommendations: Overall there was substantial incidence rate of virological failure. Age 15-24 years, poor adherence, and Short duration on ART taking, and changing ART regimen were risk factors significantly associated with virological failure. Therefore, stakeholders should develop strategies and interventions that may help to minimize virological failure by giving more attention to young (15-24 years) age as well as efforts should be strengthened to improve adherence to antiretroviral therapy.