Timeliness of switching to second-line antiretroviral therapy following virologic failure in Dar es Salaam, Tanzania

Abstract

OBJECTIVE: Timely transition from first-line to second-line antiretroviral therapy (ART) is critical to prevent treatment failure and minimize resistance. The World Health Organization (WHO) recommends switching within 90 days of confirmed virologic failure (VF). This study assessed the timeliness of switching to second-line ART in three HIV care and treatment clinics in Ilala District, Dar es Salaam. RESULTS: A retrospective cross-sectional study reviewed patient records from 2019 onward. Data were collected using a structured questionnaire in Kobo Toolbox, verified against patient files, and analyzed in SPSS version 29. Of 5456 patients on ART, 213 were on second-line therapy; 121 patients with complete records were included in the analysis. Most participants were female (69.4%), aged 25-34 years (31.4%), married (49.6%), self-employed (38.8%), and living with family (90.9%). Before switching, most patients had at least two viral load tests (94.3%). The most common second-line regimen was Tenofovir + Emtricitabine + Atazanavir/ritonavir (38.8%). Overall, 72.7% of patients were switched within 90 days of confirmed VF, while 27.3% experienced delays. No statistically significant associations were found between timely switching and sociodemographic or clinical factors. Conclusively, more than 25% of patients experienced delayed switching, indicating suboptimal adherence to WHO-recommended timelines in the studied clinics.