Abstract:
Background: Treatment failure occurred when the antiretroviral regimen is unable to control HIV
infection and it can be clinical, immunological, virological or any combination of the three. The patients
who had failed for first line drug are 46% more likely to fail for second line drugs and have greater
likelihood of experiencing drug resistance. However, there is no study conducted to determine rate of
failure in eastern Ethiopia.
Objective: The objective is to assess the prevalence and associated factors of antiretroviral treatment
failure among HIV positive adult patients on antiretroviral treatment in Harar public hospitals from January
15 to February15, 2018.
Method: Institutional based cross sectional study was conducted using chart review data from February
2005 – July 2017 in Harar public hospitals. Systematic sampling technique was used to include a sample of
1094 patient charts. Data were collected by pre-tested structured checklist. The collected data were
entered using Epidata version 3.1softwar while cleaning and analysis were performed using SPSS version
20.0. Descriptive data were presented using tables and graphs. Bivariate analysis was used to see the
association between dependent and each independent variable. Adjusted odds ratio along with 95%
confidence interval was used to identify factors associated with the outcome variable and to control all
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possible confounders using multi variable logistic regression analysis and level of statistical significance was
declared at p-value less than 0.05.
Results: The prevalence of first line ART failure was 21% (95% CI 18.3, 23.5) mean duration of failure is
71 months. Of those 87% (201) of them were switched to second line and the remaining 13% (30) were on
the failing regimen at the time of this study. Sex being male (AOR: 1.6, 95%CI=1.09, 2.3), age 45-54
(AOR: 2.4, 95% CI=1, 5.4), WHO clinical stage on ART initiation stage 3& 4(AOR=2.04, 95% CI=1.36,
3.07), a baseline CD4 count <100 cells/mm3 (AOR=2.7, 95% CI=1.77, 3.98), drug interruption
(AOR=9.9, 95% CI=6.6, 14.8). Length of follow up on ART >25months were independent predictors
association with treatment failure.
Conclusion: In this study, the rate of treatment failure is relatively high that require intervention. Very low
base line CD4 count, interrupting and restarting, age of the patient 45-54 years old, male patients and
presence of WHO stage 3 & 4 conditions at the initiation of ART showed that there was a significant level
of treatment failure. Therefore the concerned body should pay attention to this group to reduce the risk of
treatment failure among this study groups.
