Determinants of First-line Antiretroviral Treatment Failure Among Patients on Antiretroviral Therapy in Public Hospitals Jimma, Southwest Ethiopia a Case-Control Study
Volume 4, Issue 2, June 2019, Pages: 13-24
Received: Mar. 16, 2019;
Accepted: Oct. 14, 2019;
Published: Oct. 23, 2019
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Amrachu Bekele Asfaw, Public Health Department, Disease Prevention and Control Unit Mizan Teferi, Southwest, Ethiopia
Aderajew Nigusie, Department of Population and Family Health, Jimma University, Jimma, Ethiopia
Tamirat Shewanow, Department of Epidemiology, Jimma University, Jimma, Ethiopia
Esayas Kebede Gudina, Departments of Internal Medicine, Jimma University, Jimma, Ethiopia
Masrie Getnet, Department of Epidemiology, Jimma University, Jimma, Ethiopia
Demuma Amdisa, Department of Health Behaviour and Society, Jimma University, Jimma, Ethiopia
Tefera Belachew Lemma, Department of Population and Family Health, Jimma University, Jimma, Ethiopia
Lelisa Sena Dadi, Department of Epidemiology, Jimma University, Jimma, Ethiopia
Highly Active Antiretroviral Therapy (HAART) has substantially declined morbidity and mortality related to Human immunodeficiency virus/Acquired immunodeficiency syndrome (HIV/AIDS). Despite this fact, first-line ART failure has emerged as a growing concern. However, factors associated with first-line ART failure are not well empathized and studied. Hence, we aimed to identify the determinants of first-line ART failure among patients attending ART in Public Hospitals Jimma, Southwest Ethiopia. A case-control study was conducted in March 2018 on a sample of 384 (288 controls and 96 cases) adult people living with HIV/AIDS (PLWHA). Cases were HIV patients aged 15 years or older who were on first-line ART regimens with documented therapeutic failure. Controls were HIV patients aged 15 years or older who were on first-line ART regimen but without evidence of therapeutic failure. Data were extracted from electronic databases and supplemented by data collected through interviewer-administered questionnaires. Bivariate and multivariate logistic regression analyses were used. Adjusted odds ratios and 95% confidence intervals were used to report independently associated factors at P-value<0.05. In this study, higher odds of first-line ART failure was experienced among urban residents (AOR:2.2; 95%CI: 1.1, 3.6), smokers (AOR:5.9; 95%CI:3.2, 10.8), Khat users (AOR:2.2; 95%CI:1.3,3.7), poor treatment adherents (AOR:2.2; 95%CI: 1.1,4.5), tuberculosis coinfection (AOR:3.9; 95%CI:2.2, 6.8), prior exposure to ART (AOR:3.8; 95%CI:1.7, 8.1), zidovudine based regimen (AOR:4.8; 95%CI: 2.5,9.0) and longer duration on ART more than 73 months (AOR:1.9; 95%CI:1.2, 3.3). This study evidenced that being an urban resident, TB co-infection, poor medication adherence, and zidovudine-based regiment were positively and independently associated with first-line ART failure. Thus, the focus should be given assessment and management of medication compliance for urban residents and longer duration ART users. Assessment and management of substance use disorders are highly recommended besides ARV medication refills. Attention should be given enhanced adherence counseling and peer support to improve adherence. Early screening and management of tuberculosis infection should be strengthened. It is advisable to initiate ART with the recommended TDF-based first-line ART regimens instead of AZT-based.
Amrachu Bekele Asfaw,
Esayas Kebede Gudina,
Tefera Belachew Lemma,
Lelisa Sena Dadi,
Determinants of First-line Antiretroviral Treatment Failure Among Patients on Antiretroviral Therapy in Public Hospitals Jimma, Southwest Ethiopia a Case-Control Study, Rehabilitation Science.
Vol. 4, No. 2,
2019, pp. 13-24.
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