Incidence and predictors of treatment failure among children on first-line antiretroviral therapy in Amhara Region Referral Hospitals, northwest Ethiopia 2018: A retrospective study

RESEARCH ARTICLE Incidence and predictors of treatment failure among children on first-line antiretroviral therapy in Amhara Region Referral Hospitals, northwest Ethiopia 2018: A retrospective study Birtukan Aklog Yihun1, Getiye Dejenu Kibret2, Cheru Tesema Leshargie ID2* a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 1 College of Health Science, Debre Markos University, Debre Marko, Ethiopia, 2 Debre Markos Referral Hospital, Debre Marko, Ethiopia * Abstract OPEN ACCESS Citation: Yihun BA, Kibret GD, Leshargie CT (2019) Incidence and predictors of treatment failure among children on first-line antiretroviral therapy in Amhara Region Referral Hospitals, northwest Ethiopia 2018: A retrospective study. PLoS ONE 14 (5): e0215300. https://doi.org/10.1371/journal. pone.0215300 Editor: Sphiwe Madiba, Sefako Makgatho Health Sciences University, SOUTH AFRICA Background Human immunodeficiency virus (HIV) infection is a major public health concern globally, especially in sub-Saharan African countries. Even though determining the incidence of treatment failure and its predictor is a crucial step to reduce the problem, there is limited information indicating the incidence and predictors of treatment failure among children in Ethiopia. Therefore, this study was conducted to assess the incidence and predictors of treatment failure among children on first-line antiretroviral therapy (ART) in Amhara Region referral hospitals, Northwest Ethiopia. Received: October 20, 2018 Accepted: March 30, 2019 Published: May 1, 2019 Copyright: © 2019 Yihun et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the manuscript and its Supporting Information files. Funding: The authors received no specific funding for this work. Competing interests: The authors have declared that no competing interests exist. Abbreviations: AIDS, Acquired Immune Deficiency Syndrome; ART, Antiretroviral Therapy; HAART, Methods An institution-based retrospective follow-up study was conducted from January 30, 2011, to January 30, 2018. A total of 402 children on first-line antiretroviral therapy were selected with a simple random sampling method in Amhara Region Referral Hospitals, Northwest Ethiopia. Data were extracted by reviewing patients’ ART intake and follow-up forms using pretested and structured checklists. The collected data were entered into Epidata Version 4.2 and analysis was done using STATA Version 13. Bivariable and multivariable Cox proportional hazards regression models were fitted to identify predictors of treatment failure. Results A total of 402 records of children on antiretroviral therapy (ART) were reviewed and treatment failures rate within the follow-up period were 12.19% (95% CI: 8.5, 15.88). This study also found that the overall incidence density rate was 3.77% per 100 person-years observation. Virologic failure accounts 48.98% followed by immunologic (28.57%) and mixed failures (22.44%). Poor ART adherence (AHR: 4.6, 95%CI: 1.61, 13.20), drug regimens, AZT3TC-NVP (AHR: 5.2, 95%CI: 1.9, 14.26), and AZT-3TC-EFV (AHR: 6.26, 95% CI: 1.88, PLOS ONE | https://doi.org/10.1371/journal.pone.0215300 May 1, 2019 1 / 15 Incidence and predictors of treatment failure among children on first line antiretroviral therapy Highly Active Antiretroviral Therapy; HIV, Human Immunodeficiency Virus; PMTCT, Prevention of Mother to Child Transmission; WHO, World Health Organization. 20.87), Children whose both parent were died (AHR: 2.8, 95%CI: 1.07, 7.37) and world health organization (WHO) clinical stage-4 (AHR: 2.95, 95%CI: 1.04, 8.366) were found to be predictors for treatment failure among children. Conclusion The proportion of treatment failure among children on first-line ART in Amhara Region referral hospitals, Northwest Ethiopia was found to be high. Nearly half of the children experienced Virologic failure. Poor ART adherence, children whose parents‘died without parents, WHO clinical stage-4 at baseline and type of regimen patients took were found to be predictors of first-line ART treatment failure. Therefore, expanding access to routine viral load, CD4 and clinical monitoring is mandatory to detect and early intervene of treatment failures’ to improve outcomes for children on ART. Patient caregivers or parents should strictly support children on medication adherence. Training to health professionals should be given time-based on revised guidelines, and follow up of treatment outcome should be monitored nationally to take the appropriate intervention. Introduction Acquired immune deficiency syndrome (AIDS) is a viral infection caused by the human immunodeficiency virus (HIV) that weakens the immune system and makes the body susceptible to secondary and opportunistic infections [1]. The disease continues to be a major global health priority, where more than 2 million children worldwide are infected with HIV, approximately 90% of whom live in sub-Saharan Africa. Sub-Saharan Africa has the highest burden of HIV/ AIDS worldwide [2–4]. It remains the most heavily affected region, accounting for 71% of all new HIV infections and an estimated 430,000 new HIV infections occurred among children under the age of 15 [4]. Antiretroviral therapy (ART) coverage rose from 7% in 2003 to 42% in 2008, with especially high coverage achieved in eastern and southern Africa (48%) [2, 3, 5]. AIDS develops very rapidly among Infants and young children living with HIV, have a high risk of poor outcomes, with up to 52% of children born with HIV dying before the age of 2 years and one third before year one in the absence of any intervention [6]. There were 120,000 children who died of AIDS-related causes in 2016[4]. A serious challenge for children with HIV is maintaining long-term adherence to treatment regimens, and thus virological suppression and prevention of treatment failure [7]. The long duration of therapy needed for HIVinfected children requires maximal efficacy, minimal toxicity, and prevention of development of drug resistance which requires consideration of ways to minimize the occurrence of resistance and treatment failure [8]. There is a growing problem of treatment failure Even if many HIV-positive clients accessed ART and not a common diagnosis in most centers especially in low-middle income countries including Ethiopia in which there is a delay in detecting it and switching to second-line treatment, which results in an increased rate of mortality [6, 9]. Evidences showed that different predictors affect treatment failure. The most common predictors are age [7, 10–14], gender [10–12], being orphan [15], time from ART initiation [15], poor adherence to ART failure [10, 11, 16–18] [19], nevirapine (NVP)-based regimen [13, 20], drug side-effects, (...truncated)