Magnitude and Predictors of Antiretroviral (ART) Treatment Failure among Women on Option B Plus Attending PMTCT Clinics in Dar Es Salaam, Tanzania

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.