Factors Affecting Virological Failure in Children Receiving First-Line Antiretroviral Therapy in Ethiopian Healthcare Facilities: A Retrospective Analysis

Abstract

Background

The causes of virological failure are poorly recognized and investigated. This study aimed to identify determinant factors of viral failure in children taking first-line ART at a randomly selected federal hospital in Addis Ababa, Ethiopia.

Methods

A facility-based unmatched case–control study was carried out from May 10, 2022, to July 20, 2022, G.C. among HIV-infected children on first-line antiretroviral therapy. There were 209 HIV-positive youngsters in the study’s overall sample size, comprising 53 cases and 156 controls. Data was gathered by chart review using an organized checklist in English. The data were entered using Epi-data 4.2 and exported into SPSS version 24 for analysis. The relationship between each explanatory variable and the result variable was described using both bivariate and multivariate analysis. An adjusted odds ratio with 95% confidence intervals was conducted, and a p-value <0.05 was considered statistically significant.

Results

Being male (AOR= 4.504; 95% CI: 1.498, 13.539), duration on ART exceeding 47 months (AOR=40.6; 95% CI:9.571,172.222), fair and poor drug adherence (AOR=16.348; 95% CI:4.690,56.990), missed clinical appointments (AOR = 3.177; 95% CI: 1.100–9.174), and baseline WHO clinical stage 4 disease (AOR = 6.852; 95% CI: 1.540–30.49) were associated with an increased risk of virological failure. Conversely, a history of drug change and a CD4 count ranging from 250 to 500 cells/mm3 were significantly protective factors (AOR = 0.071; 95% CI: 0.024–0.214 and AOR=0.118; 95% CI: 0.030, 0.464, respectively).

Conclusion

Being male, duration on ART >47 months, fair and poor adherence, missed clinical appointments, and baseline WHO Stage 4 are factors that increase the odds of virological failure. History of ART Drug change and a CD4 count between 250 and 500 cells/mm3 are factors that decrease the odds of virological failure.

Keywords:

• retrospective
• virological failure
• antiretroviral therapy
• children
• Ethiopia

Data Sharing Statement

The data used to support the findings of the study can be obtained from the corresponding author upon reasonable request.

Ethics Statement

Ethical clearance was obtained from the ethical review committee of Yanet Health science College with the approval reference No: Y/C/6010/14 and a support letter no: Y/C/7002/11/2014 dated on May 19, 2022. All methods were performed in accordance with the relevant regulations and according to the criteria set by Declaration of Helsinki. Informed consent was waived by the review committee as all the data source of patients’ medical record numbers were anonymously registered using codes without personal identifiers such as names of patients. Permission letters for the selected facilities were obtained from institutional review board of ethical clearance of each facility. The data were collected by maintaining confidentiality while reviewing the card of the patient.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare that they have no conflicts of interest.