Predictors of Poor Adherence to CART and Treatment Failure at Second-Line Regimens Among Adults in Public Hospitals of Amhara Region, North-Western Ethiopia: A Retrospective Cohort Study.

Abstract

BackgroundGlobally, HIV/AIDS has challenged the lives of 36.3 million people and resulted in 17 million orphans. The disease has neither a vaccine nor a cure and the only option currently is highly active antiretroviral therapy. This research was conducted to identify the predictors of poor adherence to CART and treatment failure at second-line regimen among adults living with HIV/AIDS in public hospitals of Amhara region, north-western Ethiopia.MethodsA retrospective cohort study design was conducted on 700 HIV-positive people who were receiving a second-line CART regimen. Participants on second-line regimens who followed their treatment between 2016 and 2019 were considered. Data were extracted from participants’ clinical charts from June 18–July 7, 2020.ResultsA multivariate regression analysis indicates that age of patients (OR = 1.025, 95% CI: 1.001–1.321; p = 0.005), follow-up visits (OR = 0.979, 95% CI: 0.873–0.998; p < 0.001), CD4 cell count change (OR = 0.9860; 95% CI: 0.835–0.998; p < 0.01), marital status (OR = 0.973, 95% CI: 0.789– 0.997; p = 0.006), female HIV-infected patients (OR = 0.990; 95% CI: 0.789–0.999; p <0.001), rural patients (OR = 1.151; 95% CI 1.065–1.398; p = 0.004), non-educated adult patients (OR = 1.026, 95% CI: 1.002–1.198; p = 0.003), existence of social violence (OR = 0.012, 95% CI: 0.008–0.134; p< 0.01), patients with opportunistic diseases (OR = 1.0345, 95% CI 1.002–1.142; p = 0.001), CD4 cell count (OR = 0.901, 95% CI: 0.843–0.995; p = 0.025) and malnutrition (OR = 0.883, 95% CI; 0.762–0.954; p = 0.001) significantly affected the two response variables.ConclusionSeveral variables affected both poor adherence to HAART and treatment failure at second-line regimens in the current investigation. Due attention should be given to aged patients, rural residents, non-educated patients, and patients with other morbidities to be successful with second-line treatment regimens.