Determinants of First Line Antiretroviral Treatment Failure in Public Hospitals of Addis Ababa, Ethiopia: Unmatched Case Control Study

Abstract

Background: The identification and management of first-line antiretroviral therapy failure is a key challenge for human immune deficiency virus programs in resource-limited settings. Ethiopia being one of the resource-limited countries has limited resources available for diagnosing treatment failure and monitoring patient response with viral load, which is the gold standard, is not feasible in this limited setting. Patients initiate treatment with very advanced disease. However, factors lead to treatment failure is not well understood and well-studied. Objective: To identify determinants of first line antiretroviral treatment failure in public hospitals of Addis Ababa Methods: An unmatched case control study was conducted at Addis Ababa public hospitals using record review. Total sample size was 309 (103 cases and 206 controls). Bivariate analysis was done and all explanatory variables associated with first line treatment failure with P<.05 were entered in to multivariable logistic regression analysis using back ward stepwise likely hood ratio method to identify independent predictors. Result: One hundred three cases and two hundred six controls were included in the study. Treatment interruption (Adjusted odds ratio 5.4, 95% confidence interval 2.33 to 12.13), base line clusters of differentiation cell count <50 cells/?l (Adjusted odds ratio 2.7, 95% confidence interval 1.24 to 5.64), pulmonary Tuberculosis treatment (Adjusted odds ratio 2.9, 95% confidence interval 1.55 to 5.34) and history of gastric problem (Adjusted odds ratio 6.6, 95% confidence interval 2.33 to 18.87) were all independently associated with first line antiretroviral treatment failure. Conclusion and Recommendation: Base line lower clusters of differentiation cell count <50 cell/?l, treatment interruption, history of pulmonary Tuberculosis treatment during follow up time and chronic gastric problem were the independent predictors of first line antiretroviral treatment failure. There for Health professionals should pay special attention for the risk group identified.

Keywords: antiretroviral therapy, case control study, treatment failure, highly active