Abstract
BackgroundAchieving optimal adherence to highly active antiretroviral therapy (HAART) is necessary to attain viral suppression and hence optimal clinical outcome. Interruptions in antiretroviral therapy medication often occur, but a substantial proportion restart treatment. Long-term care engagement practices and clinical outcomes have not been described among cohorts of individuals on HAART in Ethiopia.MethodsIn this study we describe treatment interruption patterns over time among clients who interrupt and subsequently resume HAART, and those who are continuously engaged in treatment, and determine clinical factors associated with loss to engagement.An observational, longitudinal, retrospective cohort design was engaged, using secondary treatment program data. We analyzed differences in treatment interruption among clients who were continuously active and those that interrupted and restarted treatment at months 6, 12, 18, and 24. Cox proportional hazards regression analysis was used to identify predictors of loss from treatment. We estimated time to first treatment interruption, time to restarting after interruption, and time to second interruption. Data from all clients registered to receive HAART in ten study health facilities, from 2005 to 2014, were used to study clinical and treatment outcomes up to 60 months or study end.ResultsIn this study, 39% (8,759/22,647) of clients interrupted treatment for more than 1 month at least at one point during follow-up. Of these, only 35% ever restarted treatment. At the end of follow-up, the hazard of unfavorable treatment outcome (dead, lost, stopped HAART) for clients who restarted treatment at months 6, 12, 18 and 24 was higher by a factor of 1.9, 2.4, 2.6 and 2.4, as compared to those who never discontinued treatment at those times.ConclusionHAART treatment interruption was common in the study population. In those with a history of treatment interruption, long term clinical outcomes were found to be suboptimal. Targeted interventions are required to address follow-up challenges and prevent treatment interruption.
Highlights
Achieving optimal adherence to highly active antiretroviral therapy (HAART) is necessary to attain viral suppression and optimal clinical outcome
Since the initiation of programs to provide free Highly Active Antiretroviral Therapy (HAART) in many lowand middle-income countries worldwide, the number of people living with Human-immune deficiency (HIV)/AIDS who are receiving treatment has been increasing; reaching 17 million in 2015 [1]
The UNAIDS reports a decline in HIV/AIDS-associated mortality and in the rate of new HIV infection globally; an indication of both the success of HAART treatment programs and other methods to prevent disease transmission
Summary
Achieving optimal adherence to highly active antiretroviral therapy (HAART) is necessary to attain viral suppression and optimal clinical outcome. Since the initiation of programs to provide free Highly Active Antiretroviral Therapy (HAART) in many lowand middle-income countries worldwide, the number of people living with HIV/AIDS who are receiving treatment has been increasing; reaching 17 million in 2015 [1]. Such programs have helped prevent mortality and new HIV infection among people irrespective of gender, age, race or economic status. A multi-site assessment conducted in low- and middle- income countries estimated average retention at 12, 24, and 60 months post-initiation was 81%, 75%, and 67%, respectively [4]. Variation was present between facilities; in the sites evaluated, 12month retention ranged from 78 to 92% [5]
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