Background
Materials and method
Study area, design, period and population
Operational definition of terms
Base line data
Immunological failure
Virological failure
Responders
Adherence
Sample size determination and sampling technique
Data collection
Socio-demographic data
Sample collection and transport
Laboratory testing methods
Data processing and analysis
Ethical consideration
Results
Socio-demographic characteristics of patients
Variables | Frequency | Percent | |
---|---|---|---|
Age | 18–29 | 54 | 12.8 |
30–39 | 169 | 40.0 | |
40–49 | 136 | 32.2 | |
> = 50 | 64 | 15.1 | |
Marital status | Single | 97 | 22.9 |
Married | 209 | 49.4 | |
Divorced | 81 | 19.1 | |
Widowed | 36 | 8.5 | |
Gender | Female | 272 | 64.3 |
Male | 151 | 35.7 | |
Resident | Urban | 343 | 81.1 |
Rural | 80 | 18.9 | |
Occupation | Farmer | 51 | 12.1 |
Merchant | 58 | 13.7 | |
Student | 17 | 4 | |
government employ | 43 | 10.2 | |
daily laborer | 62 | 14.7 | |
house life | 101 | 23.9 | |
Private employ | 66 | 15.6 | |
Other | 25 | 5.9 | |
Educational status | Illiterate | 121 | 28.6 |
primary school | 117 | 27.7 | |
secondary school | 142 | 33.6 | |
Tertiary | 43 | 10.2 | |
Religion | Orthodox | 386 | 91.3 |
Muslim | 30 | 7.1 | |
Protestant | 7 | 1.7 | |
Total | 423 | 100.0 | |
Duration of ART in year | <=6 | 162 | 38.3 |
> 6 | 261 | 61.7 | |
Mean ART duration in year | 7 year (+ 3) | 423 | 100% |
Base line WHO stage | WHO stage I | 57 | (13.5) |
WHO stage II | 97 | (22.9) | |
WHO stage III | 214 | (50.6) | |
WHO stage IV | 55 | (13.0) | |
WHO stage during data collection | WHO stage I | 11 | (2.6) |
WHO stage II | 408 | (96.5) | |
WHO stage III | 4 | (.9) | |
Type of Opportunistic infection | No | 308 | (72.8) |
Protozoa | 4 | (.9) | |
Helminths | 12 | (2.8) | |
Hepatitis viruses | 3 | (.7) | |
fungal infections | 1 | (.2) | |
TB | 89 | (21.0) | |
Mixed | 6 | (1.4) | |
Initial regimen | D4T + 3TC + NVP | 78 | (18.4) |
D4T + 3TC+ EFV | 29 | (6.9) | |
AZT +3TC + NVP | 156 | (36.9) | |
AZT + 3TC + EFV | 30 | (7.1) | |
TDF + 3TC + EFV | 87 | (20.6) | |
TDF + 3TC + NVP | 31 | (7.3) | |
D4T + 3TC + NVP | 6 | (1.4) | |
Pediatric 4C (AZT + 3TC + NVP) | 6 | (1.4) | |
Switching | No | 261 | (61.7) |
Yes | 162 | (38.3) | |
Total | 423 | (100.0) | |
Switching | To 1st line drug | 150 | (35.5) |
To 2nd line drug | 12 | (2.8) | |
Second regimen | AZT +3TC + NVP | 61 | 37.7 |
AZT + 3TC + EFV | 25 | 15.4 | |
TDF + 3TC + NVP | 25 | 15.4 | |
TDF + 3TC + EFV | 39 | 24.1 | |
ABC + ddl + LPV/R | 11 | 6.8 | |
TDF + ddl + IPV/R | 1 | .6 | |
Reason of switching drug | Toxicity | 109 | (67.3) |
Pregnancy | 7 | (4.3) | |
TB | 18 | (11.1) | |
Clinical failure | 1 | (.6) | |
Age | 9 | (5.6) | |
ARV drug ADH at base line | Good | 408 | (96.5) |
Fair | 2 | (.5) | |
Poor | 13 | (3.1) | |
ARV drug ADH During data collection | Good | 420 | (99.3) |
Poor | 3 | (.7) | |
Base line CD4 count | <=199 | 267 | (63.1) |
200–349 | 120 | (28.4) | |
350–499 | 27 | (6.4) | |
> = 500 | 9 | (2.1) | |
CD4 count during data collection | <=199 | 44 | (10.4) |
200–349 | 110 | (26.0) | |
350–499 | 114 | (27.0) | |
> = 500 | 155 | 36.6 | |
Viral load count | Undetected | 224 | 53.0 |
0–19 | 84 | 19.9 | |
20–999 | 53 | 12.5 | |
> = 1000 | 62 | 14.7 | |
Total | 423 | 100 | |
Component of immunological failure | CD4 Falling More Than 50% | 30 | 53.6 |
CD4 Falling Below Baseline | 21 | 37.5 | |
CD4 Persistently Below 100 | 5 | 8.9 | |
Total | 56 | 100 |
Clinical characteristics of HIV/AIDS patients
Treatment failure and associated factors
Overall failure
Immunological failure and associated factors
Variables | Immunological failure | COR(95%CI) | AOR(95%CI) | P value | ||
---|---|---|---|---|---|---|
Yes | No | |||||
Age | 18–29 | 13 (24.1%) | 41 (75.9%) | 2.58 (0.95–7.04) | 0.96 (0.25–3.66) | 0.955 |
30–39 | 18 (10.7%) | 151 (89.3%) | 0.97 (0.39–2.45) | 0.74 (.26–2.09) | 0.570 | |
40–49 | 18 (13.2%) | 118 (89.3%) | 1.23 (0.49–3.14) | 1.19 (0.43–3.34) | 0.731 | |
> = 50 | 7 (10.9%) | 57 (89.1%) | Ref | |||
Educational status | Illiterate | 18 (14.9%) | 103 (85.1%) | 2.33 (0.65–8.34) | 2.05 (0.53–7.92) | 0.297 |
primary school | 17 (14.5%) | 100 (85.5%) | 2.27 (0.63–8.16) | 2.14 (0.57–0.14) | 0.265 | |
secondary school | 18 (12.7%) | 124 (87.3%) | 1.94 (0.54–6.91) | 1.55 (0.41–5.94) | 0.522 | |
Tertiary | 3 (7.0%) | 40 (93.0%) | Ref | |||
Duration on ART in year | <=6 | 30 (18.5%) | 132 (81.5%) | 2.05 (1.16–3.62) | 2.07 (1.11–3.87) | 0.023* |
> 6 | 26(10%) | 235 (90)% | Ref | |||
Initial regimen | D4T + 3TC+ EFV | 1 (3.4%) | 28 (96.6%) | 0.22 (0.03–1.77) | 0.29 (0.04–2.49) | 0.262 |
AZT +3TC + NVP | 20 (12.8%) | 136 (87.2%) | 0.89 (0.41–1.98) | 0.73 (0.28–1.92) | 0.529 | |
AZT + 3TC + EFV | 2 (6.7%) | 28 (93.3%) | 0.44 (0.09–2.09) | 0.46 (0.09–2.49) | 0.370 | |
TDF + 3TC + EFV | 10 (11.5%) | 77 (88.5%) | 0.79 (0.32–1.98) | 0.50 (0.16–1.59) | 0.239 | |
TDF + 3TC + NVP | 6(19.4%) | 25 (80.6%) | 1.46(0.49–4.37) | 0.99 (0.29–3.45) | 0.996 | |
D4T + 3TC + NVP | 2 (33.3%) | 4 (66.7%) | 3.04 (0.49–18.67) | 1.173 (0.18–7.49) | 0.866 | |
AZT+ 3TC + NVP(4c) | 4 (66.7%) | 2 (33.3%) | 12.18 (1.99–74.67) | 12.90 (1.17–142.67) | 0.051 | |
D4T + 3TC + NVP(4a) | 11 (14.1%) | 67 (85.9%) | Ref | |||
Viral load | > = 20 | 33(28%) | 82(72%) | 4.987(2.775–8.963) | 5.19 (2.81–9.62) | 0.0001* |
< 20 | 23(7%) | 285(93%) | Ref |
Virological failure and associated factors
Variables | Virological failure | COR(95%CI) | AOR(95%CI) | P value | ||
---|---|---|---|---|---|---|
Yes | No | |||||
Age | 18–29 | 15 (27.8%) | 39 (72.2%) | 4.53 (1.52–13.49) | 2.18 (0.28–16.98) | 0.456 |
30–39 | 22 (13.0%) | 147 (87.0%) | 1.76 (.63–4.88) | 1.15 (0.25–0.45) | 0.858 | |
40–49 | 20 (14.7%) | 116 (85.3%) | 2.03(0.72–5.69) | 0.91 (0.19–4.44) | 0.907 | |
> = 50 | 5 (7.8%) | 59 (92.2%) | Ref | |||
Marital status | Married | 19 (9.1%) | 190 (90.9%) | 0.32 (.16–.62) | 0.61 (0.15-2.44) | 0.347 |
Divorced | 14 (17.3%) | 67 (82.7%) | 0.67(.32–1.41) | 2.52 (0.61-10.45) | 0.243 | |
Widowed | 6 (16.7%) | 30 (83.3%) | 0.64 (.23–1.73) | 1.59 (0.27-9.55) | 0.665 | |
Single | 23 (23.7%) | 74 (76.3%) | Ref | |||
Reason of switching | Tb + pregnant | 6 (15.4%) | 33 (84.6%) | 1.45 (.50–4.18) | 1.15 (0.37–3.57) | 0.811 |
Default + age | 8 (53.3%) | 7 (46.7%) | 9.14 (2.81–29.71) | 7.20 (1.99-25.94) | 0.003* | |
Toxicity | 12 (11.1%) | 96 (88.9%) | Ref | |||
Current CD4 count | <=199 | 2659.1% | 18 (40.9%) | 23.43 (9.50–57.77) | 10.09 (2.47–41.29) | 0.001* |
200-349 | 19 (17.3%) | 91 (82.7%) | 3.38 (1.46–7.80) | 2.94 (0.86–10.07) | 0.085 | |
350–499 | 8 (7.0%) | 106 (93.0%) | 1.22 (.45–3.27) | 0.83 (0.18-3.80) | 0.807 | |
> = 500 | 9 (5.8%) | 146 (85.3%) | Ref |
Discordance
Variables | Immune-virological failure discordant | COR(95%CI) | AOR(95%CI) | P value | ||
---|---|---|---|---|---|---|
Yes | No | |||||
Age | 18–29 | 10 (52.6%) | 9 (47.4%) | 0.27(0.04–1.66) | 2.46 (0.104–0.04) | 0.577 |
30–39 | 22 (71.0%) | 9 (29.0%) | 0.61(0.10–3.45) | 8.29 (0.38–179.94) | 0.178 | |
40–49 | 14 (53.8%) | 12 (46.2%) | 0.29(0.05–1.64) | 6.51 (0.27–154.25) | 0.246 | |
> = 50 | 8(80.0%) | 2 (20.0%) | Ref | |||
Duration of ART in yrs. | <=6 | 20 (51.3%) | 19 (48.7%) | 2.48(1.01–6.09) | 5.68 (0.569–56.71) | 0.139 |
> 6 | 34 (72.3%) | 13(27.7%) | Ref | |||
Reason of switching drug | Toxicity | 15 (83.3%) | 3 (16.7%) | 11(2.15–56.09) | 11(2.15–56.09) | 0.004* |
Others | 5 (31.2%) | 11 (68.8%) | Ref |
Associated factors for treatment failure
Variables | Treatment failure | COR (95%CI) | AOR(95%CI) | P value | ||
---|---|---|---|---|---|---|
Yes | No | |||||
Age | 18–29 | 19(35%) | 35(65%) | 2.93 (1.22–7.04) | 1.59 (0.54–4.72) | 0.398 |
30–39 | 31(18%) | 138(82%) | 1.21(0.56–2.64) | 1.13 (0.49–2.61) | 0.772 | |
40–49 | 26(19%) | 110(81%) | 1.28(0.57–2.84) | 1.31 (0.56–3.04) | 0.530 | |
> = 50 | 10(16%) | 54(84%) | Ref | Ref | ||
Educational status | No formal education | 26(22%) | 95(79%) | 3.65 (1.05–12.75) | 3.89(1.10–13.77) | .035* |
primary school | 26 (22%) | 91(78%) | 3.81 (1.09–13.32) | 3.730(1.06–13.18) | .041* | |
secondary school | 31 (22%) | 111(78%) | 3.72 (1.08–12.86) | 2.93(0.83–10.38) | .096 | |
Tertiary | 3 (7%) | 40(93%) | Ref | |||
Duration of ART in yrs. | < 6 | 39(24%) | 123(76%) | 1.44 (0.89–2.33) | 2.1 (1.12–3.81) | 0.021* |
6 | 47(18%) | 214(82%) | Ref | |||
Initial regimen | D4T + 3TC + NVP | 18 (23%) | 60(77%) | 0.08 (0.01–0.71) | 0.10 (0.01–1.06) | 0.056 |
D4T + 3TC+ EFV | 2 (7%) | 27(93%) | 0.02 (0.001–0.25) | 0.03 (0.002–0.37) | 0.007* | |
AZT +3TC + NVP | 31 (20%) | 125(80%) | 0.06 (0.01–0.57) | 0.07 (0.01–0.72) | 0.025* | |
AZT + 3TC + EFV | 4(13%) | 26(87%) | 0.04 (0.003–0.44) | 0.05 (0.004–0.57) | 0.016* | |
TDF + 3TC + EFV | 14(16%) | 73(84%) | 0.05 (0.01–0.46) | 0.04 (0.004–0.46) | 0.009* | |
TDF + 3TC + NVP | 9 (29%) | 22(71%) | 0.102 (0.01–1.045) | 0.11 (0.01–1.25) | 0.075 | |
D4T + 3TC + NVP(4a) child regimen | 4 (57%) | 3(43%) | 0.33 (0.02–4.736) | 0.32 (0.02–4.76) | 0.408 | |
AZT + 3TC + NVP(4c) child regimen | 4 (80%) | 1(20%) | Ref | |||
AZT +3TC + NVP | 18(30%) | 43(71%) | Ref |