Abstract:
Background: First-line antiretroviral therapy (ART) failure reduces the benefits of the ART
program and leads to switching to more expensive and the challenging implementation of
second-line ART. Routine viral load monitoring is recommended as the gold standard for
identifying ART failure and has been fully implemented in Ethiopia since 2017. However, there
is limited information available regarding the virological failure of first-line ART in Ethiopia,
notably in Dire Dawa.
Objective: The aim of this study was to determine the magnitude and assess factors affecting
virological treatment failure among adults initiated on first-line ART between January 2017
and December 2019 in Dire Dawa.
Methods: A facility-based cross-sectional study was conducted utilizing routine ART data from
all health facilities providing the service in the Dire Dawa. Stratification by the year of ART
initiation with proportional allocation to the patient load was used to randomly draw 272
records. The data were collected using a record review checklist prepared in the English
language. EpiData version 3.02 was used for data entry while analysis was conducted using
Stata version 15 software. To identify factors associated with virological ART failure, both
bivariable binary logistic regression (with a p-value ≤ 0.25), and then multivariable binary
logistic regression (with 0.05 significance level) that computed adjusted odds ratio (AOR) and
95% confidence intervals (CI) was used.
Results: A total of 257 ART patients’ records were reviewed. The magnitude of first-line ART
virological failure was 11.28% (95% CI: 7.69, 15.80). Baseline under-nutritional status (AOR
= 3.717: 1.051, 13.139), serostatus nondisclosure (AOR = 4.453: 1.340, 14.793), early (≤ 30
days) ART initiation (AOR = 0.235: 0.064, 0.859), history of missed daily ART dose (AOR =
3.156: 1.007, 9.891) and dolutegravir (DTG) based regimen (AOR = 0.275: 0. 085, 0.895) were
statistically associated with virological failure of first-line ART.
Conclusion: The healthcare providers should focus on an accelerated ART (preferably DTG
based regimen) initiation, and supplemental nutritional therapy for under-nutrition. To enhance
the virological outcome, Dire Dawa Administration Health Bureau and pertinent partners
should work to promote the initiation or substitution of DTG and facilitate access to facilities
for viral load testing.
