Predictors of Poor Adherence to CART and Treatment Failure at Second-Line Regimens Among Adults in Public Hospitals of Amhara Region, North-Western Ethiopia: A Retrospective Cohort Study

Abstract

Background

Globally, HIV/AIDS has challenged the lives of 36.3 million people and resulted in 17 million orphans. The disease has neither a vaccine nor a cure and the only option currently is highly active antiretroviral therapy. This research was conducted to identify the predictors of poor adherence to CART and treatment failure at second-line regimen among adults living with HIV/AIDS in public hospitals of Amhara region, north-western Ethiopia.

Methods

A retrospective cohort study design was conducted on 700 HIV-positive people who were receiving a second-line CART regimen. Participants on second-line regimens who followed their treatment between 2016 and 2019 were considered. Data were extracted from participants’ clinical charts from June 18–July 7, 2020.

Results

A multivariate regression analysis indicates that age of patients (OR = 1.025, 95% CI: 1.001–1.321; p = 0.005), follow-up visits (OR = 0.979, 95% CI: 0.873–0.998; p < 0.001), CD4 cell count change (OR = 0.9860; 95% CI: 0.835–0.998; p < 0.01), marital status (OR = 0.973, 95% CI: 0.789– 0.997; p = 0.006), female HIV-infected patients (OR = 0.990; 95% CI: 0.789–0.999; p <0.001), rural patients (OR = 1.151; 95% CI 1.065–1.398; p = 0.004), non-educated adult patients (OR = 1.026, 95% CI: 1.002–1.198; p = 0.003), existence of social violence (OR = 0.012, 95% CI: 0.008–0.134; p< 0.01), patients with opportunistic diseases (OR = 1.0345, 95% CI 1.002–1.142; p = 0.001), CD4 cell count (OR = 0.901, 95% CI: 0.843–0.995; p = 0.025) and malnutrition (OR = 0.883, 95% CI; 0.762–0.954; p = 0.001) significantly affected the two response variables.

Conclusion

Several variables affected both poor adherence to HAART and treatment failure at second-line regimens in the current investigation. Due attention should be given to aged patients, rural residents, non-educated patients, and patients with other morbidities to be successful with second-line treatment regimens.

Keywords:

• adherence
• second-line regimens
• bivariate data analysis
• treatment failure
• HIV/AIDS

Data Sharing Statement

The data used for the current investigation is within the hands of the corresponding author.

Ethical Approval and Consent for Participate

Informed consent has been waived, because the data were secondary and there was no chance of communication between investigators and respondents. To secure the confidentiality and compliance with the Declaration of Helsinki within the manuscript of patient related data, the name of patients was not given to investigators, rather id number and important variables related to current investigation were given to researchers. The waiver was done by Bahir Dar University Ethical approval committee, Ethiopia with reference number: RCS/1412/2021. Hence, the Bahir Dar University Ethical Committee approved this study.

Consent for Publication

This manuscript is not published in any journal or not under consideration by any other journals.

Author Contributions

All authors made a significant contribution in the conception, study design, execution and acquisition of data, analysis and interpretation. The authors also participated equally in drafting, revising or critically reviewing the article; gave final approval of the version to be published and have agreed on the journal to which the article has been submitted. Authors agreed to be accountable for all aspects of the work.

Disclosure

Authors declared that there are no conflicts of interest in this work.