Incidence and Predictors of Treatment Failure Among Children Receiving First-Line Antiretroviral Treatment in General Hospitals of Two Zones, Tigray, Ethiopia, 2019

Figures & data

Table 1 Distribution of Socio-Demographic Characteristics Among HIV/AIDS Infected Children in Public General Hospitals of Mekelle and Southern Zones of Tigray Region, Northern Ethiopia, 2019 (n=404)

Independent Variables	Categories	Outcome Variable
		Failed		Censored		Total
		Frequency	Percent	Frequency	Percent
Age at ART initiation	<5 yrs	24	5.94%	82	20.3%	106 (26.24)
	5–10	40	9.9%	98	24.26%	138 (34.16)
	>10	32	7.92%	128	31.68%	160 (39.6)
Sex	Female	46	11.39%	157	38.86%	203 (50.25)
	Male	50	12.38%	151	37.37%	201 (49.75)
Parent Status	Both alive	55	13.6%	200	49.5%	255 (63.12)
	Either Died	21	5.2%	74	18.32%	95 (23.51)
	Both Died	20	4.95%	34	8.41%	54 (13.36)

Table 2 Clinical Characteristics of HIV/AIDS Infected Children in Public General Hospitals of Mekelle and Southern Zones of Tigray Region, Northern Ethiopia, 2019 (N=404)

Independent Variables	Category	Outcome Variable
		Failed		Censored		Total (%)
		Frequency	Percent	Frequency	Percent
WFA	< 3rd	67	16.58%	175	43.32%	242 (59.90)
	3^rd–97th	29	7.18%	128	31.68%	157 (38.86)
	> 97th	0	0%	5	1.23%	5 (1.23)
HFA at baseline	< 3rd percentile	82	20.3%	256	63.36%	338 (83.66)
	3rd–97th percentiles	9	2.23%	32	7.92%	41(10.15)
	> 97th percentile	5	1.23%	20	4.95%	25 (6.19)
WHO stage at ART start	Early-stage	49	12.13%	249	61.63%	298 (73.76)
	Advanced stage	47	11.63%	59	14.6%	106 (26.24)
WHO stage at last visit	Early-stage	66	16.33%	308	76.24%	374 (92.57)
	Advanced stage	30	7.42%	0	0%	30 (7.42)
CD4 count at baseline	<50	10	2.47%	4	0.99%	14 (3.46)
	50–200	10	2.47%	29	7.18%	39 (9.5)
	201–499	27	6.68%	83	20.54%	110 (27.23)
	≥500	34	8.42%	110	27.23%	144 (35.64)
	Unknown	15	3.71%	82	20.3%	97 (24.0)
The most recent CD4 count	<50	7	1.73%	0	0%	7 (1.73)
	50–200	20	4.95%	0	0%	20 (4.95)
	201–499	15	3.71%	35	8.66%	50 (12.38)
	≥500	23	5.69%	119	29.45%	142 (35.15)
	Unknown	31	7.67%	154	38.12%	185 (45.79)
Access to viral load	No	24	5.94%	157	38.86%	181 (44.8)
	Yes	72	17.82%	151	37.37%	223 (55.2)
VL at initiation	<1000	2	0.49%	31	7.67%	33 (8.17)
	1000–50,000	16	3.96%	11	2.72%	27 (6.68)
	≥50,000	4	0.99%	0	0%	4 (0.99)
	Unknown	74	18.32%	266	65.84%	340 (84.16)
Recent VL	<1000	13	3.22%	149	36.88%	162 (40.1)
	1000–50,000	23	5.69%	0	0%	23 (5.69)
	≥50,000	36	8.91%	0	0%	36 (8.91)
	Unknown	24	5.94%	159	39.35%	183 (45.3)

Abbreviation: WFA, weight for age; HFA, height for age; WHO, world health organization; VL, viral load.

Table 3 Distribution of Opportunistic Infections Among HIV/AIDS Infected Children in Public General Hospitals of Mekelle and Southern Zones of Tigray Region, Northern Ethiopia, 2019 (n=404)

Independent Variables	Category		Outcome Variable				Total (%)
			Failed		Censored
Opportunistic infections at baseline	No		46	11.39%	201	49.75%	247 (61.14)
	Yes	Anemia	4	0.99%	11	2.72%	15 (3.71)
		Diarrhea	26	6.44%	34	8.42%	60 (14.85)
		SAM	11	2.72%	20	4.95%	31 (7.67)
		TB	19	4.7%	31	7.67%	50 (12.38)
		Pneumonia	25	6.19%	45	11.14%	70 (17.33)
		URTI	8	1.98%	17	4.21%	25 (6.19)
		UTI	2	0.49%	2	0.49%	4 (0.99)
		Candidiasis	2	0.49%	1	0.25%	3 (0.74)
		Oral thrush	2	0.49%	4	0.99%	6 (1.48)
		Meningitis	1	0.25%	4	0.99%	5 (1.23)
		Total	50	12.38%	107	26.48%	157 (38.86)
Opportunistic infections after ART initiation	No		51	12.62%	255	63.12%	306 (75.74)
	Yes	Anemia	15	3.71%	8	1.98%	23 (5.69)
		Diarrhea	13	3.22%	13	3.22%	26 (6.43)
		SAM	15	3.71%	7	1.73%	22 (5.44)
		TB	20	4.95%	10	2.47%	30 (7.42)
		Pneumonia	23	5.69%	15	3.71%	38 (9.41)
		URTI	5	1.23%	14	3.46%	19 (4.7)
		UTI	0	0%	4	0.99%	4 (0.99)
		Candidiasis	8	1.98%	1	0.25%	9 (2.23)
		Oral thrush	2	0.49%	4	0.99%	6 (1.48)
		Meningitis	3	0.74%	3	0.74%	6 (1.48)
		Total	45	11.14%	53	13.12%	98 (24.23)

Abbreviation: TB, tuberculosis; SAM, severe acute malnutrition; URTI, upper respiratory tract infection; UTI, urinary tract infection.

Figure 1 Overall Kaplan Meier failure estimate of HIV/AIDS infected children in public general hospitals of Mekelle and Southern zones of Tigray Region, Northern Ethiopia, 2019 (n=404). The Y-axis represents the probability of failure whereas the X-axis indicates the analysis time in months.

Table 4 Bi–Variable and Multi–Variable Analysis Output for HIV/AIDS Infected Children in Public General Hospitals of Mekelle and Southern Zones of Tigray Region, Northern Ethiopia, 2019 (n=404)

Independent Variables	Category	Last Outcome		P>|z|	Crude HR (95% CI)	P>|z|	Adjusted HR (95% CI)
		Failed	Censored
Parent status	Both alive	55	200	–	–	-	-
	Either died	21	74	0.773	1.08 (0.65–1.78)	0.384	0.75 (0.39–1.43)
	Both died	20	34	0.008	1.99 (1.19–3.33)	0.239	1.48 (0.77–2.86)
OI after initiation	Yes	51	255	<0.001	2.63 (1.76–3.95)	0.672	1.17 (0.56–2.45)
	No	45	53	-	-	-	-
Adherence to ART	Optimal	47	247	-	-	-	-
	Sub-optimal	49	61	<0.001	3.3 (2.20–4.94)	0.000*	2.84 (1.71–4.72)*
Disclosure status	No	32	82	0.026	-	-	-
	Yes	64	226	-	0.61 (0.40–0.94)	0.400	0.78 (0.43–1.40)
Follow up duration		96	308	<0.001	0.88 (0.87–0.9)	0.000*	0.85 (0.82–0.87)*
Baseline ART regimen	NVP-based	48	143	0.017	0.43 (0.21–0.86)	0.076	0.46 (0.19–1.09)
	ABC-based	12	30	0.471	0.73 (0.32–1.70)	0.926	0.95 (0.35–2.58)
	EFV-based	26	112	0.026	0.44 (0.21–0.91)	0.228	0.57 (0.22–1.43)
	LPV/r-based	10	23	-	-	-	-
Baseline WHO stage	Early-stage	49	249	-	-	-	-
	Advanced stage	47	59	<0.001	2.76 (1.85–4.14)	0.417	1.27 (0.71–2.27)
Recent WHO stage	Early-stage	66	303	-	-	-	-
	Advanced stage	30	5	<0.001	10.1 (6.48–15.73)	0.000*	5.21 (2.75–9.88)*
Anemia after start	No	81	300	-	-	-	-
	Yes	15	8	<0.001	4.68 (2.67–8.22)	0.592	0.81 (0.37–1.77)
Drug substitution	No	70	274	-	-	-	-
	Yes	26	34	0.05	1.34 (0.88–2.04)	0.860	1.04 (0.61–1.79)
Diarrhea after start	No	83	295	-	-	-	-
	Yes	13	13	0.003	2.83 (1.56–5.11)	0.312	1.56 (0.66–3.68)
Pneumonia at baseline	No	85	288	-	-	-	-
	Yes	11	20	0.005	1.93 (1.22–3.05)	0.077	0.54 (0.27–1.07)
Malnutrition after start	No	81	301	-	-	-	-
	Yes	15	7	0.001	4.90 (2.80–8.59)	0.586	0.77 (0.31–1.95)
TB at baseline	No	77	277	-	-	-	-
	Yes	19	31	<0.001	3.32 (1.99–5.55)	0.022*	2.27 (1.12–4.56)*
TB after initiation	No	76	298	-	-	-	-
	Yes	20	10	0.001	2.55 (1.55–4.20)	0.522	1.32 (0.56–3.13)
Pneumonia after start	No	73	293	-	-	-	-
	Yes	23	15	<0.001	2.83 (1.77–4.54)	0.256	1.5 (0.75–3.01)

Note: *significant at 5% level of significance.

Abbreviations: NVP, nevirapine; ABC, abacavir; EFZ, Efavirenz; LPV/r, lopinavir/ritonavir; VL, viral load; OI, opportunistic infection; ART, anti retroviral therapy; WHO, world health organization; TB, tuberculosis.