Factors Affecting Virological Failure in Children Receiving First-Line Antiretroviral Therapy in Ethiopian Healthcare Facilities: A Retrospective Analysis

Figures & data

Figure 1 Proportional allocation of sample size in the study site.

Table 1 Socio-Demographic Characteristics of Children on First-Line ART and Their Caregivers

Variables	Category	Cases, N (%)	Controls, N (%)	Total, N (%)
Sex	Male	39(73.6)	78(50)	117(56.0)
	Female	14(26.4)	78(50)	92(44.0)
Age group	<5 years	4(7.5)	40(25.6)	44(21.1)
	5–10 years	18(34)	56(35.9)	74(35.4)
	≥10 years	31(58.5)	60(38.5)	91(43.5)
Residency	Urban	41(77.4)	122(78.2)	163(78.0)
	Rural	12(22.6)	34(21.8)	46(22.0)
Care giver relation	Parents(mother/father)	50(94.3)	135(86.5)	185(88.5)
	Other	3(5.7)	19(12.2)	22(10.5)
	Orphan	0(0.0)	2(1.3)	2(1.0)
Care giver HIV status	Positive	48(90.6)	137(87.8)	185(88.5)
	Negative	1(1.9)	9(5.8)	10(4.8)
	Unknown	4(7.5)	10(6.4)	14(6.7)
Vital status of the mother	Alive	45(84.9)	134(85.9)	179(85.6)
	Dead	6(11.3)	15(9.6)	21(10.0)
	Do not know	2(3.8)	7(4.5)	9(4.3)
Vital status of the father	Alive	29(54.7)	97(62.2)	126(60.3)
	Dead	7(13.2)	21(13.5)	28(13.4)
	Do not know	17(32.1)	38(24.4)	55(26.3)
Disclosure status of the child	Disclosed	32((60.4)	79(50.6)	111(53.1)
	Undisclosed	21(39.6)	77(49.4)	98(46.9)

Table 2 Laboratory and Clinical Related Information’s Among HIV-Infected Children

Variable	Category	Cases, N (%)	Controls, N (%)	Total, N (%)
Recent Hgb	Hgb<12.5g/dl	8(15.1)	48(30.8)	56(26.8)
	Hgb≥12.5g/dl	45(84.9)	108(69.2)	153(73.2)
Recent CD4	<250cells/mm3	4(7.5)	15(9.6)	19(9.1)
	250–500cells/mm3	13(24.5)	51(32.7)	64(30.6)
	≥500cells/mm3	36(67.9)	90(57.7)	126(60.3)
Baseline viral load result	≤1000 copies/mL	8(15.1)	14(9.0)	22(10.5)
	>1000 copies/mL	16(30.2)	20(12.8)	36(17.2)
	Unknown	29(54.7)	122(78.2)	151(72.3)
Functional status of the child (for age≥5yrs)	Working	13(27.1)	42(33.9)	55(32.0)
	Ambulatory	35(72.9)	82(66.1)	117(68.0)
Developmental status of the child (for age<5 yrs.)	Appropriate for the age	3(60.0)	21(63.6)	24(63.2)
	Delay	2(40%)	12(36.4)	14(36.8)
Baseline WHO Clinical Stage	Stage 1	16(30.2)	61(39.1)	77(36.8)
	Stage 2	6(11.3)	28(17.9)	34(16.3)
	Stage 3	16(30.2)	46(29.5)	62(29.7)
	Stage 4	15(28.3)	21(13.5)	36(17.2)
Opportunistic infection	Yes	8(15.1)	23(14.7)	31(14.8)
	No	45(84.9)	133(85.3)	178(85.2)
Current TB history	Positive	2(3.8)	14(9.0)	16(7.7)
	Negative	51(96.2)	142(91.0)	193(92.3)
z-score of weight for age	Wasted	25(47.2)	63(40.4)	88(42.1)
	Normal	28(52.8)	93(59.6)	121(57.9)
z-score of Height for age	Stunted	22(41.5)	57(36.5)	79(37.8)
	Normal	31(58.5)	99(63.5)	130(62.2)

Table 3 HIV Treatment and Drug-Related Characteristics Among HIV-Infected Children

Variables	Category	Cases, N (%)	Controls, N (%)	Total, N (%)
Duration on ART	≤47 month	9(17)	69(44.2)	78(37.3)
	>47 month	44(83.0)	87(55.8)	131(62.7)
Recent adherence	Good (>95%)	24(45.3)	129(82.7)	153(73.2)
	Fair (85–95%) and poor (<85%)	29(54.7)	27(17.3)	56(26.8)
Missed clinical Appointment	YES	35(66.0)	52(33.3)	87(41.6)
	NO	18(34.0)	104(66.7)	122(58.4)
Co-trimoxazole prophylaxis use	Completed	41(77.4)	112(71.8)	153(73.2)
	Not completed	12(22.6)	44(28.2)	56(26.8)
Isoniazid prophylaxis use	Completed	39(73.6)	105(67.3)	144(68.9)
	Not completed	14(26.4)	51(32.7)	65(31.1)
History of ART Drug change	Yes	23(43.4)	110(70.5)	133(63.6)
	No	30(56.6)	46(29.5)	76(36.4)
Reason for ART regimen change	Drug side effect	11(44.0)	13(11.4)	24(17.3)
	New drug availability	14(56.0)	101(88.6)	115(82.7)
Current regimen	DTG based	8(15.1)	138(88.5)	146(69.9)
	EFV based	0(0.0)	3(1.9)	3(1.4)
	LPV/R based	36(67.9)	15(9.6)	51(24.4)
	Others	9(17)	0(0.0)	9(4.3)

Table 4 Factors Associated with ART Virological Failure Among Children on First-Line ART

Variable	Category	Case, (N)	Control, (N)	COR	AOR (95%)	p
Sex	Male	39	78	2.786	4.504(1.498,13.539)	0.007*
	Female	14	78		I
RecentCD4 count	<250 cells/mm3	4	15	0.667	0.506(0.090,2.847)	0.439
	250–500cells/mm3	13	51	0.637	0.118(0.030,0.464)	0.002*
	>500 cells/mm3	36	90		I
Duration on ART	<=47 month	9	69		I
	>47 month	44	87	3.877	40.60(9.571,172.222)	0.001*
WHO Clinical Stage	Stage 1	16	61		I
	Stage 2	6	28	0.817	1.613(0.298,8.739)	0.579
	Stage 3	16	46	1.326	3.073(0.947,9.970)	0.062
	Stage 4	15	21	2.723	6.852(1.540,30.491)	0.012*
Recent Adherence	Good (>95%)	24	129		I
	Fair and poor	29	27	5.773	16.348(4.690,56.990)	0.001*
Missed Clinical appointment	Yes	35	52	3.889	3.177(1.100,9.174)	0.033*
	No	18	104		I
History of drug change	Yes	23	110	0.321	0.071(0.024,0.214)	0.001*
	No	30	46		I

Note: *Statistically significant at p-value <0.05:I, is a constant used as a comparison.

Data Sharing Statement

The data used to support the findings of the study can be obtained from the corresponding author upon reasonable request.