Abstract:
ABSTRACT
Background:
Global efforts towards achieving child HIV control include high level adherence to ART. However despite that, reports in Tanzania have reported that ART treatment failure in children ranged from 25.4% to 40%.Treatment failure and delay in switching to the second-line regimen are of significant concerns in the treatment of Human Immunodeficiency Virus (HIV) infected children in a resource-limited setting such as Tanzania. Tanzania HIV treatment and care electronic register at National AIDS Control Program had enrolled 43337 HIV positive children on treatment and care among whom 3669 had experienced first line ART treatment failure thus had been switched to second ART treatment line during the period 2016 to 2018.
Objective: to determine the predictors of the first-line treatment failure in HIV infected children receiving the Second-Line Antiretroviral Therapy (ART) in Tanzania.
Methods: this study was un-matched case-control which extracted data from the Care and Treatment Centers (CTC3) macro database, an electronic database at Tanzania National AIDS Control Program (NACP). The study used 3669 cases and 3669 controls. Cases were 0-15 years old children with HIV who had been switched from the first-line ART to currently the second-line ART in CTC3 in Tanzania between2016 and 2018. The control group composed0-15 years HIV infected children who had remained on the first-line ART during the study period, and who were in the CTC3 register during the same period. A prepared format was used to extract social demographic and disease profiles of the cases and controls. Unconditional logistic regression for unpaired data was used to assess the first-line ART treatment failure predictors at p-value ≤ 0.05 significant level.
Results: the study established that cases had a lower proportion of males (46.4%) than controls (50.4), which was significant difference at (p<0.01). Age groups, ART adherence, and WHO staging were also significant variables different between cases and controls. Furthermore, health facility ownership and health facility type distribution were also found to be significantly different between cases and controls. In the multivariate analysis, being 0-4 years showed a higher likelihood of treatment failure by 60 % compared to being older(AOR:1.59;95%CI:1.42,1.78). Similarly, treatment failure in female children was lesser than in male children(AOR:0.88;95%CI:0.81,0.96).Other significant predictor were poor ART adherence(AOR:2.15;95%CI:1.79,2.57), private health facilities (AOR:1.52;95CI:1.08,2.15), dispensaries and health centers (AOR:0.44;95%CI:0.39,0.50) and AOR:0.60;95%CI:0.54,0.66) respectively.
Conclusion: predictors of the first line ART treatment failure and consequent switch to the second line ART included patients' sex, age group, and ART adherence. Health system predictors included health facility type and health facility ownership. Consequently, health managers and providers need to adopt policies and actions that mitigate against the identified significant predictors. Moreover, more research on how predictors mediate the effects is recommended to inform an effective method to institute real time-based interventions.
