HIV/AIDS: Research and Palliative Care (Mar 2022)

Time to Switch to Second-Line Anti-Retroviral Treatment and Its Predictors Among HIV Infected Adults with Virological Failure in Northwest Ethiopia: A Retrospective Follow-Up Study

  • Demeke Alemu K,
  • Abebe Moges N,
  • Jara Boneya D,
  • Assemu Asrade A,
  • Degu Tsega T,
  • Shitaw Tewachew A

Journal volume & issue
Vol. Volume 14
pp. 87 – 100

Abstract

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Kasaye Demeke Alemu,1 Nurilign Abebe Moges,2 Dube Jara Boneya,2 Abaynew Assemu Asrade,1 Tilahun Degu Tsega,2 Abrham Shitaw Tewachew1,3 1Department of HIV/AIDS Prevention Care and Treatment, International Center for AIDS Care Program/ICAP, Bahir Dar, Ethiopia; 2Departments of Public Health College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia; 3College of Medicine, Debre Berhan University, Debre Berhan, EthiopiaCorrespondence: Kasaye Demeke Alemu, Tel +251921668185, Email [email protected]: HIV treatment failure is a devastating public health challenge worldwide. Low rates and delays in switching are associated with increased death and second-line failure. But the time to switch and predictors are not well studied in Ethiopia. Therefore, this study assessed the time to switch to second-line ART and its predictors among HIV-infected adults with virological failure in Northwest Ethiopia.Methods: An institution-based retrospective follow-up study was conducted from Oct 1/2016 to Feb 28/2020 in Northwest Ethiopia. Secondary data were extracted through a predefined extraction tool from 427 HIV-infected adults, which were selected by systematic random sampling. Kaplan–Meier with log rank test was done to identify the survival time and compare survival time among different categorical independent variables. The Cox proportional hazard model was fitted and variables having a p-value of less than 0.05 with a 95% confidence level were identified as a predictor of time to switch to second-line ART and interpreted accordingly.Results: A total of 288 (67.45%) HIV-infected adults were switched to second-line ART with a median time of 162 days (IQR: 35,682). The risk of switching is higher among HIV infected adults with viral RNA of 60,000 copies/mL or more at failure (AHR=1.80, 95% CI: 1.31– 2.48), ≥ 8 years duration on first-line ART (AHR: 2.31, 95% CI: 1.62, 3.29) and enhanced adherence counseling of 4 to 6 sessions (AHR: 1.28, 95% CI: 1.01, 1.63), and lower with 4 or more missed appointments (AHR: 0.49, 95% CI; 0.28, 0.84) and no history of 1st line regimen change (AHR: 0.53: 95% CI: 0.41,0.69).Conclusion: The median time to switch to second-line ART following 1st line virological failure is about 162 days, higher than other related studies. But switching was higher in patients with high viral RNA copies, missed appointments, longer duration on first-line ART, and the number of enhanced adherence counseling. So, intervention strategies that aid patients to have timely switch without due delays as soon as virologic failure should be prioritized.Keywords: virological failure, switch, second-line ART, Northwest Ethiopia, Ethiopia

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