School of Public Health, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan-Aman, Ethiopia.
Department of Statistics, College of Natural Sciences, Mizan-Tepi University, Tepi, Ethiopia.
Front Public Health. 2022 Oct 25;10:916454. doi: 10.3389/fpubh.2022.916454. eCollection 2022.
BACKGROUND: Virological failure remains a public health concern among patients with human immunodeficiency virus (HIV) after treatment initiation. Ethiopia is one of the countries that aims to achieve the global target of 90-90-90 that aims to achieve 90% virological suppression, but there is a paucity of evidence on the determinants of virological failure. Therefore, the study is intended to assess determinants of virological treatment failure among patients on first-line highly active antiretroviral therapy (HAART) at Mizan Tepi University Teaching Hospital (MTUTH), Southwest Ethiopia. METHOD: A hospital-based unmatched case-control study was conducted from 11 November to 23 December 2020, among 146 cases and 146 controls. All cases and controls were selected randomly using computer-generated random numbers based on their medical record numbers. During the document review, data were collected using checklists, entered into Epi-data version 4.0.2, and analyzed by SPSS version 25. A multivariable logistic regression analysis was done to identify the independent determinants of virological treatment failure. RESULTS: In this study, being male (adjusted odds ratio (AOR) = 1.89, 95% CI: 1.04, 3.47), substance use (AOR = 2.67, 95% CI: 1.40, 4.95), baseline hemoglobin (Hgb) < 12 mg/dl (AOR = 3.22, 95% CI: 1.82, 5.99), poor drug adherence (AOR = 3.84, 95% CI: 1.77, 5.95), restart ART medication (AOR = 2.45, 95% CI: 1.69, 7.35), and opportunistic infection (OI) while on HAART (AOR = 4.73, 95% CI: 1.76, 12.11) were determinants of virological treatment failure. CONCLUSION: The study revealed that the sex of the patient, history of substance use, baseline Hgb < 12 mg/dl, poor drug adherence, restart after an interruption, and having OI through the follow-up period were determinants of virological failure. Therefore, program implementation should consider gender disparity while men are more prone to virological failure. It is also imperative to implement targeted interventions to improve drug adherence and interruption problems in follow-up care. Moreover, patients with opportunistic infections and restart HAART need special care and attention.
背景：在开始治疗后，艾滋病毒（HIV）患者的病毒学失败仍然是一个公共卫生问题。埃塞俄比亚是旨在实现全球 90-90-90 目标的国家之一，该目标旨在实现 90%的病毒学抑制，但关于病毒学失败的决定因素的证据很少。因此，本研究旨在评估米赞提皮大学教学医院（MTUTH），埃塞俄比亚西南部，接受一线高效抗逆转录病毒治疗（HAART）的患者发生病毒学治疗失败的决定因素。
方法：这是一项 2020 年 11 月 11 日至 12 月 23 日在埃塞俄比亚西南部米赞提皮大学教学医院进行的医院病例对照研究，共有 146 例病例和 146 例对照。所有病例和对照均使用基于病历号的计算机生成随机数随机选择。在文件审查期间，使用检查表收集数据，将数据输入 Epi-data 版本 4.0.2，并使用 SPSS 版本 25 进行分析。采用多变量逻辑回归分析确定病毒学治疗失败的独立决定因素。
结果：在这项研究中，男性（调整后的优势比（AOR）= 1.89，95%置信区间：1.04，3.47）、物质使用（AOR = 2.67，95%置信区间：1.40，4.95）、基线血红蛋白（Hgb）<12mg/dl（AOR = 3.22，95%置信区间：1.82，5.99）、药物依从性差（AOR = 3.84，95%置信区间：1.77，5.95）、重新开始 ART 药物治疗（AOR = 2.45，95%置信区间：1.69，7.35）和在接受 HAART 期间发生机会性感染（OI）（AOR = 4.73，95%置信区间：1.76，12.11）是病毒学治疗失败的决定因素。
结论：该研究表明，患者的性别、物质使用史、基线 Hgb<12mg/dl、药物依从性差、中断后重新开始、随访期间发生 OI 是病毒学失败的决定因素。因此，在实施项目时应考虑性别差异，因为男性更容易发生病毒学失败。还必须实施有针对性的干预措施，以改善药物依从性和中断后续护理中的问题。此外，患有机会性感染和重新开始 HAART 的患者需要特别护理和关注。
BMC Public Health. 2020-1-20
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