Rate of Viral Re-Suppression and Retention to Care Among PLHIV on Second-Line Antiretroviral Therapy at Dessie Comprehensive Specialized Hospital, Northeast Ethiopia: A Retrospective Cohort Study

Abstract

Shambel Wedajo,1 Getu Degu,2 Amare Deribew,3 Fentie Ambaw2 1School of Public Health, CMHS, Wollo University, Dessie, Ethiopia; 2School of Public Health, CMHS, Bahir Dar University, Bahir Dar, Ethiopia; 3Nutrition International (NI) in Ethiopia, Addis Ababa, EthiopiaCorrespondence: Shambel Wedajo Tel [phone]Email [email protected]: In Ethiopia, first-line antiretroviral therapy failure is growing rapidly. However, unlike first-line therapy, to date, very little is known about the outcomes of second-line therapy. Thus, this study assessed the rate of viral re-suppression and attrition to care and their predictors among people living with HIV on second-line therapy.Methods: A retrospective cohort study was conducted on 642 people living with HIV at Dessie Comprehensive Specialized Hospital from October 2016 to November 2019. A proportional Cox regression model was computed to explore predictors of viral re-suppression (viral load less than 1000 copies/mL) and attrition to care.Results: Out of 642 subjects, 19 (3%), 44 (6.9%), 70 (10.9%), and 509 (79.3%) patients were lost to follow up, died, transferred out, and alive on care, respectively. Similarly, 82.39% (95% CI: 79.24– 85.16%) of patients had achieved viral re-suppression, with 96 per 100 person-year rate of re-suppression. Patients who switched timely to second-line therapy were at a higher rate of viral re-suppression than delayed patients [adjusted hazard rate, AHR = 1.43 (95% CI: 1.17– 1.74)]. Not having drug substitution history [AHR = 1.25 (95% CI: 1.02– 1.52)] was positively associated with viral re-suppression. In contrast, being on anti-TB treatment [AHR = 0.67 (95% CI: 0.49– 0.91)] had lower likelihood with viral re-suppression. In the current study, attrition to care was 11% (95% CI: 8.7– 13.9%). Ambulatory or bedridden patients were more at risk of attrition to care as compared with workable patients [AHR = 2.61 (95% CI: 1.40– 4.87)]. Similarly, being not virally re-suppressed [AHR = 6.87 (95% CI: 3.86– 12.23)] and CD4 count ≤ 450 cells/mm3 [AHR = 2.61 (95% CI: 1.40– 4.87)] were also positively associated with attrition to care.Conclusion: A significant number of patients failed to achieve viral re-suppression and attrition from care. Most identified factors related to patient monitoring. Hence, patient-centered intervention should be strengthened, besides treatment switch.Keywords: second-line therapy, re-suppression, retention to care, attrition

Keywords

• second-line therapy
• re-suppression
• retention to care
• attrition