Determinants of First-Line Antiretroviral Treatment Failure among HIV Patients Enrolled in ART after Post-war at Alamata General Hospital in Southern Tigray, Northern Ethiopia, 2024

Abstract

Introduction: Antiretroviral therapy (ART) has revolutionized HIV management by targeting different stages of the HIV lifecycle. However, first-line ART failure remains a significant challenge globally, affecting both patients and the healthcare system. In Sub-Saharan Africa, where the HIV epidemic is disproportionately burdened, achieving viral suppression remains a challenge. Factors contributing to ART failure include poor adherence, advanced HIV disease, co-infections, and limited access to viral load monitoring. This can lead to virus replication and resistance, compromising the effectiveness of the initial drug regimen. The recent conflict in Tigray, Ethiopia, has exacerbated the issue, putting a greater strain on the healthcare system and increasing costs. Objective: The aim of this study is to assess the determinants of first-line antiretroviral treatment failure among HIV patients after post-war enrollment in ART at Alamata General Hospital in southern Tigray, in 2024. Methods: An unmatched case control study was conducted among 689 HIV clients enrolled in ART at Alamata General Hospital from May 2024 to September 2024. The study population includes all HIV positive adult patients who were on first-line treatment and controls who met the study criteria. The study will use systematic sampling techniques and structured questionnaires to gather data from medical records and registers of patients on ART. Adherence variables will be categorized into poor, fair, and good adherence. Data quality control established through pre-testing and validation of questionnaires. Data was analyzed using Epi data version 4.2.Softwareand will be exported to SPSS for analysis and a binary logistic regression model to identify variables determining first-line antiretroviral failure. Variables will interpret as having a statistically significant association when the p-value is< 0.05. Results: A study found that a significant number of HIV patients and controls aged 25-34 years were enrolled in antiretroviral therapy (ART). Most were female, married, illiterate, self-employed, and lived below the poverty line. Most patients were on TDF-based ARV regimens at baseline, with a higher proportion in WHO clinical stage 3. A higher proportion of cases developed tuberculosis after starting ART. A significant proportion of cases exhibited poor adherence to ART, with 44.6% being regular coffee drinkers while taking ARV pills. Treatment started with partners, with 59% of cases and 67% of controls starting treatment six months apart. Support groups were involved in 67.4% of cases and 67.4% of controls. Treatment failure rates are higher in individuals aged 25-34, male patients, rural residents, WHO stage III/IV patients, patients with a baseline CD4 count <100 cells/mm³, and those with a BMI <16.5 kg/m². Poor adherence to ART is associated with a 3.6-fold increased risk of failure. Conclusion: In conclusion, this study identified several important determinants of first-line ART failure among HIV patients in post-war settings. Addressing these factors through comprehensive interventions, including early diagnosis, timely initiation of ART, adherence counseling, nutritional support, and conflict-mitigation strategies, is crucial to improve treatment outcomes and reduce the burden of HIV in affected populations.