Incidence and predictors of virologic failure among children taking first -line antiretroviral treatment in public comprehensive specialized hospitals of west Amhara region,northwest, Ethiopia,2023:a Multicenter retrospective follow up study

Abstract

Background: In sub-Saharan Africa, virologic failure is still a public health problem, even if different strategies have been tried to decrease virologic failure in children. Viral load is a preferable tool for HIV-infected patients monitoring and early detection of treatment failure. Objective: The aim of this study was to assess the incidence rate of virologic failure and predictors among children taking first-line ART in public comprehensive and special ized hospitals in the west Amhara region, northwest, Ethiopia. Methods:A Multicenter retrospective follow-up study was conducted among a total of 5 42 charts of HIV-infected children on first- line ART were extracted from January 1, 201 3 to December 31, 2022 in three selected public comprehensive specialized hospitals. A simple random sampling method was used to select sample.Epidata was used to ente r data and analyzed using STATA veirsion14.Kaplan Meier curve and log rank tests wer e done. The assumption of Cox proportional hazard model was checked.The best fitting model was selected using AIC, and the Weibull regression model was selected,Cox-Sn ell residual was used to test the goodness of fit.Both bi-variable,and multivariable Weib ull regression analysis were fitted.Finally,significant predictors were selected at P-value <0.05. Result: A total of 537 children medical records were included in the final analysis and the overall incident rate was 17 (95% CI:13.4,21.7)per 10000 person-months with a total of 38679 person-month observation. From these 66(12.29%)developed virologic failure, children with poor ART adherence (AHR=2.63;1.38,4.97),recent WHO T stage(III&IV) ( AHR=2.71;1.15,6.37),had no history of regimen change (AHR=5.88;3.23,10.71), age at start of ART above 10 years old (AHR=2.97;1.30,6.78)and caregivers age below 40 yea rs old (AHR=0.42;0.25,0.72)were statistically significant predictors of virologic failure. Conclusion and recommendation:The incidence rate of VF among HIV-infected childr en was 17per10000 PM observation.Poor adherence, advanced WHO T stage (III&IV), children age above 10 years old at ART initiation,had no regimen changed and caregive r age below 40 years were significant predictors.Therefore,strengthening HIV care servi ces and addressing these predictors recommended in this study area.