Incidence and predictors of virological failure among HIV infected children and adolescents on first-line antiretroviral therapy in East Shewa hospitals, Oromia Region, Ethiopia: A retrospective follow up study

Abstract

Introduction: Despite gains made from improved antiretroviral therapy coverage in resource limited countries, the occurrence of first line drug resistance remains a priority agenda. To reduce the emergence of resistant viruses, HIV viral load monitoring plays a critical role. However, many resource limited countries have difficulty of monitoring viral load due to economic constraints.There is also limited study regarding viral failure in developing countries. Therefore, this study aimed to assess the incidence and predictors of virological failure among HIV-infected children and adolescents on first-line ART Ethiopia, 2021.

Methods: Institution based retrospective follow-up study was employed on 492 children and adolescents. Data were collected by trained nurses who have experience working in ART clinics. Data were entered using Epi-data version 4.6 and exported to Stata version 14 for analysis. The proportional hazard assumption was checked, and the Weibull regression was fitted. Cox-Snell residual was used to test the goodness of fit, and the appropriate model was selected by AIC. Finally, an AHR with a 95% CI was computed, and variables with a P-value < 0.05 in the multivariable analysis were taken as significant predictors of virological failure.

Results: The overall incidence rate of virological failure was 4.2, (95% CI: 3.41, 5.22) per 1000 person-months of observation with 20,169 person-months follow-up time. In multivariable analysis living in rural area (AHR = 1.97, 95% CI: 1.15-3.36), poor adherence (AHR = 2.20, 95% CI: 1.24-3.91), lower CD4 Count <200 cells/mm3 (AHR = 2.57, 95% CI: 1.27-5.18) and 201-350 cells/mm3 (AHR = 2.44, 95% CI: 1.28-4.67) respectively, and recent OI (AHR = 4.60, 95% CI: 2.38-8.90) are significantly associated with virological failure.

Conclusion: The incidence rate of virological failure was high. Living in a rural, poor adherence, lower CD4 count, and recent opportunistic infection were independent risk factors associated with virological failure. Hence, it is better to give priority to strengthening the focused evaluation of important variables and managing accordingly.

Fig 1. Plot of Nelsen-Aalen cumulative hazard function against Cox-Snell residual obtained by fitting Cox, exponential, Gompertz, and Weibull models for the virological failure of HIV/AIDS patients on first-line ART in public hospitals in East Shewa, Oromia region, Ethiopia, January 2015—December 2019.

Fig 2. Kaplan failure hazard curve by (A) recent opportunistic infection (B) Adherence status of virological failure among HIV infected children and adolescents on first-line anti-retroviral therapy regimen at public hospitals in East Shewa, Oromia region, Ethiopia, January 2015 to December 2019 (N = 492).

Fig 3. Kaplan Meier failure curve by hospitals among HIV infected children’s and adolescents on first-line antiretroviral therapy regimen at public hospitals in East Shewa, Oromia region, Ethiopia, January 2015 to December 2019 (N = 492).

Fig 4. Kaplan Meier survival estimate of virological failure among HIV infected children and adolescents on first line ART in East Shewa Oromia region, Ethiopia from January 2015 to December 2019 (N = 492).

Fig 5. Reasons of ART regimens change among HIV infected children and adolescents on first-line ART in Oromia regions East Shewa hospitals, Ethiopia from September 2015 to December 2019 (N = 492).

Fig 6. Flow chart showing a selection of HIV infected children and adolescents on first-line ART in public hospitals in East Shewa, Oromia region Ethiopia, January 2015—December 2019.