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

Figures & data

Table 1 Socio-Demographic Characteristics of HIV Infected Adults with 1st Line Virological Failure at High Load Public Health Facilities in Northwest Ethiopia, from 2016 to 2020 (n=427)

Variable	Category	Frequency (%)
Sex	Male	184(43.1)
	Female	243(56.9)
Age	18–34 years	164(38.4)
	≥35 years	263(61.6)
Religion	Orthodox	412(96.5)
	Muslim	11(2.6)
	Protestant	4(1)
Residence	Urban	278(65.1)
	Rural	149(34. 9)
Marital status	Never married	102(23.9)
	Married	183(42.9)
	Divorced	103(24.2)
	Widowed/er	39(9.1)
Does the patient have a cell phone?	Yes	347(81.2)
	No	80(18.7)
Education level	No Education	192(45.0)
	Primary	155(36.3)
	Secondary	63(14.7)
	Above Secondary	17(4.0)
Is the patient in the catchment area?	Yes	337(78.9)
	No	90(21.1)
Occupation	Government work	56(13.1)
	Private work	169(39.6)
	Student	92(21.5)
	Missed	110(25.8)

Table 2 Baseline Clinical, Laboratory, and ART Information of HIV Infected Adults with Virological Failure at High Load Public Health Facilities in Northwest Ethiopia, from 2016 to 2020 (n=427)

Variable	Category	Frequency (%)
Baseline WHO clinical stage	Stage I	97(22.7)
	Stage II	134(31.4)
	Stage III	173(40.5)
	Stage IV	23(5.4)
Baseline BMI	≤18.4 kg/m^2	132(31.2)
	18.5–24.9 kg/m^2	277(65.5)
	≥25 kg/m^2	14(3.3)
Baseline Regimen	1e (TDF+3TC+EFV)	158(37)
	1c(AZT+3TC+NVP)	159(37)
	1d (AZT+3TC+EFV)	23(5.4)
	1f (TDF+3TC+NVP)	17(4.0)
	1a (d4t+3TC+NVP)	60(14.1)
	1b (d4t+3TC+EFV)	10(2.3)
Baseline regimen by category	NVP based	236(55.3)
	EFV based	191(44.7)
Baseline functional status	Working	358(83.8)
	Ambulatory	65(15.2)
	Bedridden	4(1)

Abbreviations: WHO, World Health Organization; NVP, nevirapine; EFV, efavirenz; BMI, body mass index.

Table 3 ART Adherence Barriers of HIV Infected Adults with the First-Line Virological Failure at High Load Public Health Facilities in Northwest Ethiopia from 2016 to 2020 (n=427)

Variable	Category	Frequency (%)
Consistent condom use	Yes	101(23.7)
	No	200(46.8)
	NA	70(16.4)
	Missed	56(13.1)
Take alcohol/khat	Yes	105(24.6)
	No	264(61.8)
	Missed	58(13.6)
Disclosed status to a family member	Yes	193(45.1)
	No	177(41.5)
	Missed	57(13.4)
Has caregiver	Yes	368(86.4)
	No	58(13.4)
	Missed	1(0.2)

Abbreviation: NA, not applicable, respond as “no any sexual activity” while the patient is on an enhanced adherence counseling session.

Table 4 ART Follow-Up, Laboratory and Clinical Information of Adult HIV Infected Patients with Virological Failure at High Load Public Health Facilities in Northwest Ethiopia, from 2016 to 2020 (n=427)

Variables	Category	Frequency (%)
Experience of opportunistic infection	Yes	285(66.0)
	No	145(34.0)
Recent adherence level	Good	390(91.3)
	Fair	12(2.8)
	Poor	25(5.9)
Missed appointment	No missed appointment	286(67.0)
	1 to 4 appointments	98(23.0)
	≥ 4 appointments	43(10.0)
First line regimen change	Yes	162(37.9)
	No	265(62.3)
Latest BMI before failure	≤18.4 kg/m^2	75(17.6)
	18.5–24.9 kg/m^2	329(77.0)
	≥25 kg/m^2	23(5.4)
Number of EAC session	3 sessions	239(55.7)
	4–6 sessions	188(44.3)
History of CPT provision stats	Provided	164(39.0)
	On-going	184(43.7)
	Not Provided	73(17.3)
History of TPT provision status	Completed	310(72.6)
	Discontinued	19(4.5)
	On-going	11(2.6)
	Not Provided	87(20.4)
Ever enrolled to ASM	Yes	31(7.3)
	No	393(92.7)
Duration between 1st and 2nd HVL	Less than 6 months	145(34.0)
	6–12 months	152(35.6)
	≥12 months	130(30.4)
Duration on first line ART before failure	<4 years	87(20.4)
	5–8 years	182(42.6)
	≥8 years	158(37)
Viral load count at failure	1001–10,000 copy/mL	138(32.3)
	10,001–60,000 copy/mL	183(42.9)
	≥60,000 copy/mL	106(24.8)

Abbreviations: ASM, appointment spacing model; HVL, high viral load; EAC, enhanced adherence counseling; TPT, TB preventive therapy; BMI, body mass index; CPT, cotrimoxazole preventive therapy; ART, anti-retroviral therapy.

Figure 1 The Kaplan–Meier survival curve of time to switch to 2nd line anti-retroviral therapy (ART) and its predictors among HIV-infected adults at high load public health facilities in Northwest Ethiopia, from 2016 to 2020 (n=427).

Figure 2 The Kaplan–Meier survival curve by regimen change for time to switch to 2nd line Anti-Retroviral Therapy (ART) and its predictors among HIV-infected adults at high load public health facilities Northwest Ethiopia, from 2016 to 2020 (n=427). (Blue line=survival curve of patients with 1st line regimen change, Black line = survival curve of patients with 1st line regimen change).

Figure 3 The bar graph of the proportion of switching by time to switch to the 2nd line Anti-Retroviral Therapy (ART) among HIV-infected adults at high load public health facilities in Northwest Ethiopia, from 2016 to 2020 (n=427).

Figure 4 The pie chart of the proportion of patients by final status among HIV-infected adults at high load public health facilities in Northwest Ethiopia, from 2016 to 2020 (n=427), (Blue=active, Orange=transferred out to other facility, Red=Lost to follow up, Green=dead).

Table 5 Bi-Variable and Multivariable Analysis of Predictors of Time to Switch to 2nd Line ART Among HIV-Infected Adults at High Load Public Health Facilities in Northwest Ethiopia, from 2016 to 2020 (n=427)

Variable	Category	Switching Status		CHR with (95% CI)	AHR with (95% CI)	P-value
		Event	Censored
Change in first-line ART Regimen	No	192	73	1	1
	Yes	96	66	0.62(0.48, 0.79)	0.53(0.41, 0.69)	<0.01*
Viral RNA at failure	1001–10,000 c/mL	86	52	1	1
	10,001–60,000 c/mL	125	58	1.22(0.93, 1.60)	1.37(1.03, 1.81)	0.027
	≥60,000 c/mL	77	29	1.70(1.25, 2.32)	1.80(1.31, 2.48)	<0.01*
Duration on first line ART	≤ 4 years	86	52	1	1
	4−8 years	125	58	1.19(0.86, 166)	1.47(1.05, 2.06)	0.023
	≥8 years	77	29	1.62(1.17, 2.27)	2.31(1.62, 3.29)	<0.01*
Number of Missed appointments	No	67	185	1	1
	1–4 appointments	58	88	0.80(0.62, 1.04)	0.85(0.65, 1.10)	0.231
	≥4 appointments	14	15	0.54(0.32, 0.92)	0.49(0.28, 0.84)	0.01*
Months between date of 1st & 2nd HVL	< 6 months	105	35	1	1
	6–12 months	109	46	1.05(0.80, 1.37)	1.08(0.82, 1.42)	0.545
	≥12 months	74	68	0.75(0.55, 1.01)	0.76(0.56, 0.96)	0.094
EAC sessions	3 sessions	152	95	1	1
	4–6 sessions	136	44	1.33(1.06, 1.68)	1.28(1.01, 1.63)	0.040*

Abbreviations: *, significant by multi-variable analysis; c/mL, copy per milliliter; AHR, adjusted hazard ratio; CHR, crude hazard ratio; CI, confidence interval; ART, anti retro viral therapy; HVL, high viral load; EAC, enhanced adherence session.