Abstract
BackgroundThe public health approach to antiretroviral treatment management encourages the public private partnership in resource limited countries like Ethiopia. As a result, some private health facilities are accredited to provide antiretroviral treatment free services. Evidence on magnitude and predictors of treatment failure are crucial for timely actions. However, there are few studies in this regard.ObjectiveTo assess the magnitude and predictors of ART failure in private health facilities in Addis Ababa, Ethiopia.MethodsThe study followed retrospective cohort design, with 525 adult antiretroviral treatment clients who started the treatment since October 2009 and have at least six months follow up until December 31, 2013. Kaplan Meier survival analysis and Cox proportional hazard model were used for analysis.ResultsTreatment failure, using the three WHO antiretroviral treatment failure criteria, was 19.8%. The immunologic, clinical, and virologic failures were 15%, 6.3% and 1.3% respectively. The mean and median survival times in months were 41.17 with 95% Confidence Interval (CI) [39.69, 42.64] and 49.00, 95% CI [47.71, 50.29] respectively. The multivariate cox regression analysis showed years since HIV diagnosis (Adjusted Hazard Ratio (AHR)=13.87 with 95% CI [6.65, 28.92]), disclosure (AHR=0.59, 95% CI [0.36, 0.96]), WHO stage at start (AHR=1.84, 95% CI [1.16, 2.93]), weight at baseline (AHR=0.58, 95% CI [0.38, 0.89]), and functionality status at last visit (AHR=2.57, 95% CI [1.59, 4.15]) were independent predictors of treatment failure.ConclusionThe study showed that the treatment failure is high among the study subjects. The predictors for antiretroviral treatment failure were years since HIV diagnosis, weight at start, WHO stage at start, status at last visit and disclosure.RecommendationsFacilities need to monitor antiretroviral treatment clients to avoid disease progression and drug resistance.
Highlights
Ethiopia is one of the low income countries experiencing high communicable, non-communicable disease burdens and injuries [1], including HIV/AIDS
The multivariate cox regression analysis showed years since HIV diagnosis (Adjusted Hazard Ratio (AHR)=13.87 with 95% Confidence Interval (CI) [6.65, 28.92]), disclosure (AHR=0.59, 95% CI [0.36, 0.96]), WHO stage at start (AHR=1.84, 95% CI [1.16, 2.93]), weight at baseline (AHR=0.58, 95% CI [0.38, 0.89]), and functionality status at last visit (AHR=2.57, 95% CI [1.59, 4.15]) were independent predictors of treatment failure
The predictors for antiretroviral treatment failure were years since HIV diagnosis, weight at start, WHO stage at start, status at last visit and disclosure
Summary
Ethiopia is one of the low income countries experiencing high communicable, non-communicable disease burdens and injuries [1], including HIV/AIDS. As a result of public private partnership the country established, some private health facilities (Non-Government Organization (NGO) clinics and private hospitals) have started providing ART services since 2005 though the ART treatment outcomes in the private health facilities have not been well documented. Treatment failure in resource poor countries is determined by clinical, immunological and/or virological failures [3]. In such countries, patient monitoring system is dependent on clinic-immunological methods, though they lack sensitivity/specificity to detect virological failures of ART [4], which is the gold standard for ART treatment failure. The public health approach to antiretroviral treatment management encourages the public private partnership in resource limited countries like Ethiopia. Some private health facilities are accredited to provide antiretroviral treatment free services.
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