Rate and predictors of first line antiretroviral treatment failure among adults living with HIV/aids in Dar es salaam, Tanzania

Abstract

Background: HIV/AIDS is a major public health problem in Tanzania, where 1.4 million people are living with HIV in 2017. Of these 66%, are on ART and 48% are virally suppressed. In order to respond to the HIV epidemic, UNAIDS set a 90 90 90 global target. In Tanzania, several studies have been done prior availability and implementation of routine viral load testing. Therefore, this study shall be the first to assess the treatment failure since the initiation of the routine viral testing and implementation of the test and treat policy. Objectives: To determine the rate and predictors of first line antiretroviral treatment failure among adults living with HIV/AIDS in Dar es salaam, Tanzania. Methods: A retrospective cohort study including all clients on first line antiretroviral therapy for at least six months aged 18 years and above was conducted in all five municipals in Dar as Salaam in 2019. Using probability proportional to size (PPS) sampling methods, eligible clients from high volume CTC clinics were recruited. Kaplan-Meier curve and Log -Rank test was used to assess the median time to failure. Bivariate and multivariate Cox-regression modelling were used to determine predictors of treatment failure. Results: A total of 340 participants with a median age was 37years were recruited and two third of them (67.9%) were female. The overall treatment failure rate was 5.24 (95% CI =3.72-7.27) per 100 person years at risk with a median time to failure of 18 months. Independent predictors of treatment failure were being on treatment for less than two years (Adjusted Hazard Ratio=12.48, 95%CI 3.64-42.71), being male (AHR=2.78,95%CI 1.16-6.63) and self-employed (AHR=5.58, 95%CI 1.43-21.82). Conclusion and Recommendation: The rate of treatment failure was unacceptably high in this population and occurs early during the treatment. Self-employed male clients who have been on treatment for less than 2 years were at higher risk of failure to continue with fist line treatment.CTC should provide special counseling and follow up mechanism for self-employed male including reinforced routine viral load monitoring and this should be intensified very early on during treatment initiation.