Abstract:
Background: In 2010, the world Health organization (WHO) published prevention of mother
to child transmission (PMTCT) guideline, to initiate ART to all HIV +ve pregnant/
breastfeeding women regardless of their CD 4 or WHO clinical Stages. Tanzania adopted this
new guideline in September 2013 called PMTCT option B plus (PMTCT Option B+). The
implementation of PMTCT B+ option has already begun to show impressive results and many
pregnant and breastfeeding women have been put on ART. However the challenges of,
adherence to ART, retention and ART treatment failure are yet to be clearly understood.
Objective: To assess the magnitude and predictors of ART treatment failure among women
on option B+ attending PMTC clinics in Dar es Salaam region.
Material and Methods: A cross sectional study conducted among 410 HIV +ve women who
access PMTCT option B + services in Dar es Salaam. A two stage cluster random sampling
method was used to select 410 participants of this study and 15 health facilities; First stage
was to select Health facilities for study and second study for selection of participants of study.
Ethical approval pursued from MUHAS ethical committee and informed consent from study
participants. Structured questionnaire were used for data collection. And summarization of
data was done through descriptive statistics; Chi square was used to test association between
independent and dependent factors and multiple logistic regression were used to determine
independent predictor of ART treatment failure after controlling for potential confounding
variables. The study was conducted between April and May 2017. ART treatment failure were
considered in this study when women on ART for more 6monthsand have viral load of more
than 1000copies after repeat viral test and CD4 cells drop of more than 50% from high peak
value or baseline.
Results: The overall ART treatment failure for women on PMTCT option B+ was at 26.6%;
Those who had immunological failure were about at 8%, virological failure was at 11.5% and
those with both immunological and virological failures were at 6.8%. Findings showed that
women who had not disclosed their HIV status to partner or relatives had higher odds of developed treatment failure compared to those disclosed their HIV status, women with poor
adherence to ART medication has higher odds of develop failure compared to those with good
adherence to ART medication and women who experienced ART related side effects had
higher odds of developing treatment failure compared to those with no history of ART related
side effects.
Conclusion: This study findings show that overall ART treatment failure was 26.6% and were
strongly associated with poor adherence, Lack of disclosure HIV status and ART related side
effects. It is recommended that health workers be trained .on identifying patients with ART
failure for timely intervention which may include both targeted adherence interventions and
better preservation of efficacy of second-line regimens.
