Factors Influencing Antiretroviral Treatment Failure Among Adult HIV Patients at Bomu Hospital Mombasa County

Abstract

Bomu Hospital is one of the sites in Mombasa which started providing antiretroviral therapy (ART) to HIV-infected patients since 2004. At this hospital, as in other sites, there are an increasing number of patients requiring a switch from first line to second line ART drug regimens due to treatment failure. The objective of this study was to determine the factors that influence ARV treatment failure among adult patients under treatment at Bomu Hospital. The study was cross sectional at initial patient recruitment and retrospective for patient level data. Two hundred and ninety nine study participants were selected from a total of 18 425 active on ART. Convenient sampling technique was used to select the adult population for study and thereafter it was categorized into two groups. Those with one - off plasma viral load of ≥ 1000 copies per ml were termed as failing treatment while those with less than 1000 copies per ml were termed as responding well to treatment. Semi-structured interview schedules were used to obtain demographic information and patients’ views on various dimensions of ART services at the hospital. The study discussed several broad areas related to antiretroviral treatment failure, including finding out the socioeconomic and sociodemographic patterns of adult patients under ARV treatment at Bomu Hospital. This study also determined the duration at which the patient has been on ART and the development of treatment failure. The study compared the failure rate of ARV to Co infections and the relationship of viral load and CD4 counts on patients on ART. Fisher’s exact tests and unpaired t-tests were performed to compare clinical and laboratory characteristics according to viral load screening status. Multiple logistic regression attempts was used to determine the factors which can predict treatment failure and hence useful models for prediction of treatment failure can be used for decision making. Using Chi square test of independence (Fisher exact test) it was found that there was significant association at 5% level of significance between viral suppression and some of the social demographic factors namely marital status and age groups. Using multiple logistic regression model to determine which social demographic and social economic factors affect viral suppression, it was found that age groups and marital status are statistically significant at 10% and 5% respectively. The elderly had a complete viral suppression (88.2%) compared to the young while the married people had a complete viral suppression (p value 0.003) compared to other segment of marital status. The results showed that there was no significant relationship between period of treatment, co infections and viral suppression. There was significant relationship between the viral suppression and current CD4 count (p value 0.000). The viral suppression was higher among those with high CD4 count. Bomu Hospital had an overall viral suppression of 76.9% compared to the national target of 90% hence concerted efforts required to identify patients, the youth and young adults with high viral load at higher risk of treatment failure.