VIROLOGICAL TREATMENT FAILURE AND ASSOCIATED FACTORS AMONG ADULTS ON FIRST-LINE ANTIRETROVIRAL THERAPY IN DIRE DAWA, EASTERN ETHIOPIA: A HEALTH-FACILITY BASED CROSS-SECTIONAL STUDY

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.