PREVALENCE OF ANTIRETROVIRAL TREATMENT FAILURE AND ASSOCIATED FACTORS AMONG ADULT HIV POSITIVE PATIENTS IN HARAR PUBLIC HOSPITALS, EASTERN ETHIOPIA

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 xi 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.