Rate and predictors of Treatment Failure among pediatric population taking Highly Active Antiretroviral Therapy in Ethiopia

Abstract

AbstractBackgroundThough the unprecedented global effort at scaling up universal access to antiretroviral therapy (ART) has decreased the progression of HIV, treatment failure (TF) among pediatric patients receiving ART against human immunodeficiency virus (HIV) is becoming a global public health concern which may impact on treatment outcome. Thus, the aim of this study was to determine the rate and predictors of treatment failure (TF) among HIV-infected pediatric patients taking ART in Ethiopia.MethodsA prospective and retrospective follow-up study was conducted from March 2016 to 2017. Retrospective clinical and laboratory data were captured from patients’ medical record. Socio-demographics and explanatory variables of participants were collected using pre-tested structured questionnaire and study participants were followed for three to six month after baseline viral load has been done to classify virologic failure (VF). TF was ascertained from population who virally failed with the denominator of population taking ART. Chi-square test and multiple logistic regressions were conducted to assess predictors TF. Statistical significance was set at P-value less than 0.05.ResultsA total of 554 pediatrics patients taking ART from 40 selected health facilities were included in the study. Viral load suppression (VLS) (VL<1000 copies/ml) among pediatric population taking ART in Ethiopia were found to be 344 (62.1%). From those who was not virally suppressed at baseline of the study 210 (37.9%), 99 (51.6%) were re-suppressed after three to six month of enhanced adherence and counseling, leading the overall virologic failure (VF) among pediatric population taking ART in Ethiopia to be 93 (17.3%). The mean CD4 count was improved from 490 cells/ml at ART initiation to 921 cells/ml after 80 months of ART exposure. Moreover, the clinical outcome was improved from 42% to 89% at ART initiation and after 80 month of ART experience. CD4 count, clinical stage, Hemoglobin and weight were found to be predictors of VF. Moreover; family HIV and disclosure status, duration on ART, age, being orphan, stigma and medication adherence have significant association with VF.ConclusionsThe low level of VLS (62.1%) and the high level of VF (18.3%) could explain the challenge on the national ART program among pediatric population. The significant improvement on immunologic and clinical outcome could indicate the success of ART on treatment outcome among pediatric population. CD4 count, clinical stage, Hemoglobin and weight could be good predictors of TF among pediatric population. Improving disclosure status, stigma and medication adherence could improve the treatment outcome of pediatric population taking ART in Ethiopia.