Increased Viral Suppression Among People on First-Line Antiretroviral Treatment in Ethiopia: Meeting the Third 90s
Abstract
Minwuyelet Maru Temesgen, Daniel Dagne, Addisu Tesfie, Asefa Missaye, Gizachew Yismaw, Andargachew Mulu
Background: Antiretroviral therapy (ART), which aims to completely suppress viral replication, fails for a variety of reasons. The aim of this study was to identify factors associated with prevalence and treatment failure in ART patients who received first-line treatment in the Amhara region of northeastern Ethiopia.
Methods: A cross-sectional study was conducted from March 2018 to July 2018. Survey using a pre-structured questionnaire focused on demographics and potential risk factors for antiretroviral treatment failure was used. Medical history, including baseline features, was extracted by reviewing medical records and data was analyzed using STATA version 14.
Results: A total of 640 clients of all age from 16 health facilities were enrolled in the study. The overall treatment failure of first line antiretroviral drugs was 19.04% with clinical, immunologic and viral failure of 0.31%, 12.66% and 6.09% respectively. More than half of the 57 participants with an unsuppressed viral load (>1000 copies/ml at 6 months), 29 (50.88%) were dropped out from follow up. Females had a higher proportion of immunologic failure (13.09%), but males had a higher proportion of viral failure (8.09%). A high proportion of overall treatment failure (33.33%), immunologic failure (18.75%), as well as viral failure (14.58%), was observed in age groups under the age of 18 years. Multivariate logistic regression revealed clients with a CD4 baseline count of less than 250 and fair/poor adherence had higher odds of treatment failure.
Conclusions: In this study we conclude that antiretroviral treatment failure indicated by viral failure in Amhara region, Ethiopia is 6.09% which indicated increased viral suppression as compared to Ethiopia’s national viral failure rate of 11%. Low CD4 baseline count and fair/poor adherence are significantly associated independent predictors of treatment failure. Therefore improving client follow up to adherence to treatment should be strengthened and ART program should focus on strengthening test and start strategy to enroll clients early before CD4 count declines. A higher proportion of viral failure in male and younger age suggests acquisition of resistant viral strain and indicate the need for a drug resistance survey