Magnitude and predictors of antiretroviral treatment failure in public health facilities in Addis Ababa, Ethiopia

Abstract

Background: Ethiopia has introduced the Antiretroviral Treatment (ART) program to save lives, to restore the mental and physical functions and to improve the quality of life of people living with HIV/AIDS, has got large number of patients who are initiated on first line ART regimen since HAART started , however one of the limitation of the antiretroviral treatment is the development of drug resistance but there are few evidences on magnitude and predictors of treatment failure which is crucial for timely actions. Objective: To assess the magnitude and predictors of ART failure in public health facilities in Addis Ababa, Ethiopia. Methods: The study followed a retrospective cohort design, with 1010 adult ART clients who started ART since October 2008 and have six months follow up until October 2014 Kaplan Meier survival analysis and Cox proportional hazard model were used for analysis. Results: Treatment failure using the three WHO treatment failure criteria were 16.1%.The immunologic, clinical and virologic failure were 11.8%,5.3% and 0.9% respectively. The mean survival time in months were found to be 81.6 with 95% CI(79.781,83.390).The multivariate cox hazard analysis showed time since HIV diagnosis (AHR=5.666)with 95% CI [3.675,8.737]),WHO clinical stage 3 or 4(AHR=12.519 with 95% CI [8.650,18.118]) and ART drug substitution (AHR=2.105 with 95% CI [1.384,3.202]) were independent predictors of treatment failure . Conclusion: The study showed treatment failure of 16.1%, which is comparable to that of similar settings .It should be confirmed by viral load before switching .The predictors for treatment failure were time since HIV diagnosis , WHO clinical staging and ART drug substitution. Recommendation: Facilities need to monitor ART clients to avoid disease progression and drug resistance .ART must be initiated at WHO early stages and high CD4 count according to the national ART guide line so that failure will be minimized. .................................... Thesis available at ACIPH Library