Incidence and Predictors of Treatment Failure Among Children Receiving First-Line Antiretroviral Therapy in East Gojjam, Ethiopia: A Fifteen-year Retrospective Cohort Study

Abstract

Abstract Background Human immunodeficiency virus (HIV) infection is still a major health problem in children in Ethiopia. Even though there is a rapid scale-up of antiretroviral therapy (ART), information on pediatric treatment failure is limited in the country. Hence, this study was designed to assess the incidence and predictors of ART treatment failure among children who were receiving first-line ART in East Gojjam, Ethiopia. Methods A fifteen-year retrospective follow-up study was conducted among 538 randomly selected under-15-year-old children who started antiretroviral medication between September 11, 2006, and September 10, 2021, in multicentre health facilities in East Gojjam. The medical records of the study participants were reviewed, and the required data were extracted using pretested structured checklists. The data were entered and cleaned using SPSS version 25 and exported to STATA version 14 for further statistical analysis. The Kaplan‒Meier survival curve, the log-rank test, and the scaled Schoenfeld residual test were applied for analysis. Results From a total of 538 medical records of children receiving antiretroviral treatment reviewed, 114 (21.2%) (95% CI: 17.8–24.9) developed treatment failure, 85 (74.6%) were virological, 19 (16.7%) were immunological (CD4), and 10 (8.8%) were clinical failures. The overall incidence density of treatment failure was 4.53 per 1000 person-months, with a mean survival time of 43.8 months (95% CI = 37.65–50.89) at treatment failure. WHO clinical stage III/IV (AHR = 3.0, CI = 1.3, 7.1), regimen not changed (AHR = 4.4, CI = 1.7, 11.7), poor ART adherence (AHR = 6.6, CI = 4.11, 10.66), stunting (AHR = 2.2, CI = 1.43, 3.44), and nevirapine containing regimen (AHR = 2.72, CI = 1.13–6.54) were significant predictors of treatment failure. Conclusion The incidence of ART treatment failure among the study participants was significantly high. WHO clinical stage III/IV, poor adherence to ART, regimen not changed, and nevirapine-containing regimen were all significant predictors of ART failure. Hence, by providing intensive care and close monitoring to higher-risk patients, a timely change in regimen was recommended.