Determinants of First- Line Treatment Failure among HIV Infected Adults at Public Hospitals, Harar Town, Eastern Ethiopia

Abstract

Background:-Treatment failure is the inability of antiretroviral therapy to control human immune deficiency virus infection and further mortality risk. The identification and management of first-line treatment failure is a key challenge for human immune deficiency virus programs. Identifying and managing determinants of first-line treatment failures are the main important to improve a high treatment success rate and develop the quality of life. However, there is limited evidence on the determinants of treatment failure among Human Immunodeficiency Virus-infected people on highly active antiretroviral treatment in Harar, eastern Ethiopia. Objective: To identify determinants of first- line antiretroviral treatment failure at Hiwot Fana Specialized University Hospital & Jugula General Hospital from 12 March to 12 May 2019. Methodology: Case- control study was conducted in selected public hospitals among adults on first-line antiretroviral therapy. In this study, 171 cases and 342 controls were collected from medical records of positive adults. Data were entering in to Epi data version 3.1 and has been exported to STATA version 14.2for analysis. The multivariate logistic regression model was used to identify determinants on first-line treatment failure. In bivariate analysis, were all variables of p-value <0.25 entered in to multivariate analysis. Adjusted odds Ratio with 95% confidence intervals were computed and statistical significance was declared with P-value <0.05. Results: In this study, higher odds of first line antiretroviral treatment failure were observed on the patients with age ranges 15 to 30 years (Adjusted odd ratio (AOR) =2.95, 95% CI: 1.72-4.99), low CD4 count <200 cell/mm3 at current (AOR=2.22, 95% CI: 1.30-4.17), WHO stage III or IV (AOR=3.21, 95% CI: 1.98-5.23), poor adherence to treatment (AOR= 2.98, 95% CI: 1.60-5.56) had had gastric problem (AOR=5.02, 95% CI: 2.73-9.23) and recent body mass index <= 16.5 kg/m2 (AOR=3.11, 95% CI: 1.69-5.71). Conclusion: From this study, age 15 to 30 years, low cluster differentiation cell count at recent, treatment stage III and IV at baseline, low current body mass index at recent, poor adherence to treatment, and history of gastro intestinal problem were associated with first-line antiviral therapy failure. Health professionals should pay special attention to the risk group identified. Keywords: antiretroviral therapy, case-control study, treatment, Immunological, virology