Magnitude and factors associated with virological failure among adults on first-line antiretroviral therapy in Dire Dawa, eastern Ethiopia: a retrospective chart review.

BACKGROUND

First-line antiretroviral therapy failure reduces the benefits of the antiretroviral therapy (ART) program and could lead to regimen change to a more expensive second-line ART. To identify ART failure, routine viral load monitoring is recommended as the gold standard and has been implemented in Ethiopia since 2017. However, evidence regarding the virological failure of the first-line ART is limited in the study setting, Dire Dawa Ethiopia.

OBJECTIVE

This study aimed to determine the magnitude and factors associated with virological treatment failure among adults on first-line ART follow-up in Dire Dawa between January 2017 and December 2019.

METHODS

A retrospective chart review was conducted among 272 randomly selected adults on first-line ART follow-up, between January 2017 to December 2019. Data were collected from patients’ medical records, entered into epi data version 3.02 and exported to Stata version 15 software for analysis. A bivariable and multivariable binary logistic regression model was used to identify factors associated with virological first-line ART failure. The goodness of fit of the model was assessed using the Hosmer–Lemeshow test. All statistical tests are declared significant at a P-value of < 0.05.

RESULTS

A total of 257 ART patients’ records were included for final analysis. The magnitude of first-line ART virological failure was 11.28% (95% CI 7.69, 15.80). Baseline undernutritional status (AOR = 3.72: 1.05, 13.14), serostatus nondisclosure (AOR = 4.45: 1.34, 14.79), early (≤ 30 days) ART initiation (AOR = 0.235: 0.064, 0.859), history of missed any daily ART dose (AOR = 3.16: 1.01, 9.89) and dolutegravir-based regimen (AOR = 0.28: 0. 09, 0.90) were significantly associated with virological failure of first-line ART.

CONCLUSION

The magnitude of virological first-line ART failure in this study was relatively high. Virological first-line ART failure was significantly associated with baseline BMI, HIV serostatus disclosure, duration of ART initiation after HIV diagnosis, history of missed ART doses, and substitution of DTG-based ART first-line regimens. To avoid treatment failure, it is crucial to disclose one's serostatus, encourage adherence initiatives, and early initiation of ART preferably a dolutegravir-based regimen.