Background: Antiretroviral treatment (ART) is aimed for complete suppression of viral replication but fails for various reasons. This study aimed to determine the prevalence and associated factors of treatment failure among people on first line ART in Amhara region, Northeast Ethiopia.
Methods: A cross sectional study was conducted from March to October, 2018 among people of all age who came for HIV viral monitoring laboratory test in 16 randomly selected antiretroviral treatment sites. Sample size was calculated by using single population proportion formula proportionated to facilities and clients were recruited consecutively when they come to their viral load test. Questionnaire survey was taken focusing on demographic data and possible risk factors of antiretroviral treatment failure. Clinical history including baseline characteristics was extracted by reviewing medical records. Viral load test was done using real time HIV-1 viral load assay (Abbott Laboratories, USA) and data was analyzed using STATA version 14.
Results: A total of 640 clients (median age of 38 years ± SD=11.3 years) on first line antiretroviral treatment were enrolled. The overall treatment failure was 19.04% with clinical, immunologic and viral failures of 0.31%, 12.66% and 6.09% respectively. The viral suppression was 91.09% and re-suppression was 27.58%. Multivariable logistic regression analysis showed significance association of treatment failure with low baseline CD4 count ≤250 (AOR=2.16) and fair/poor adherence (AOR=3.41).
Conclusion: In conclusion the overall antiretroviral treatment failure in Amhara region, Ethiopia was 19.04%. Fair/poor adherence and low base line CD4 count are significantly independent predictors of treatment failure. Therefore proving client follow up to adherence and early testing and initiation of ART before decline of CD4 count should be strengthened. Higher proportion of viral failure in male study participants indicates the need for drug resistance survey in the study area as they are highly mobile.