Rate of Viral Re-Suppression and Retention to Care Among PLHIV on Second-Line Antiretroviral Therapy at Dessie Comprehensive Specialized Hospital, Northeast Ethiopia: A Retrospective Cohort Study

Shambel Wedajo,1 Getu Degu,2 Amare Deribew,3 Fentie Ambaw2 1School of Public Health, CMHS, Wollo University, Dessie, Ethiopia; 2School of Public Health, CMHS, Bahir Dar University, Bahir Dar, Ethiopia; 3Nutrition International (NI) in Ethiopia, Addis Ababa, EthiopiaCorrespondence: Shambel Wedajo Tel...

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Autores principales:	Wedajo S, Degu G, Deribew A, Ambaw F
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2021
Materias:	second-line therapy re-suppression retention to care attrition Immunologic diseases. Allergy RC581-607
Acceso en línea:	https://doaj.org/article/21dc41b784c84630969ff8f58b991c84
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spelling	oai:doaj.org-article:21dc41b784c84630969ff8f58b991c842021-12-02T19:12:04ZRate of Viral Re-Suppression and Retention to Care Among PLHIV on Second-Line Antiretroviral Therapy at Dessie Comprehensive Specialized Hospital, Northeast Ethiopia: A Retrospective Cohort Study1179-1373https://doaj.org/article/21dc41b784c84630969ff8f58b991c842021-09-01T00:00:00Zhttps://www.dovepress.com/rate-of-viral-re-suppression-and-retention-to-care-among-plhiv-on-seco-peer-reviewed-fulltext-article-HIVhttps://doaj.org/toc/1179-1373Shambel Wedajo,1 Getu Degu,2 Amare Deribew,3 Fentie Ambaw2 1School of Public Health, CMHS, Wollo University, Dessie, Ethiopia; 2School of Public Health, CMHS, Bahir Dar University, Bahir Dar, Ethiopia; 3Nutrition International (NI) in Ethiopia, Addis Ababa, EthiopiaCorrespondence: Shambel Wedajo Tel +251 913893606Email Swedajo@gmail.comBackground: In Ethiopia, first-line antiretroviral therapy failure is growing rapidly. However, unlike first-line therapy, to date, very little is known about the outcomes of second-line therapy. Thus, this study assessed the rate of viral re-suppression and attrition to care and their predictors among people living with HIV on second-line therapy.Methods: A retrospective cohort study was conducted on 642 people living with HIV at Dessie Comprehensive Specialized Hospital from October 2016 to November 2019. A proportional Cox regression model was computed to explore predictors of viral re-suppression (viral load less than 1000 copies/mL) and attrition to care.Results: Out of 642 subjects, 19 (3%), 44 (6.9%), 70 (10.9%), and 509 (79.3%) patients were lost to follow up, died, transferred out, and alive on care, respectively. Similarly, 82.39% (95% CI: 79.24– 85.16%) of patients had achieved viral re-suppression, with 96 per 100 person-year rate of re-suppression. Patients who switched timely to second-line therapy were at a higher rate of viral re-suppression than delayed patients [adjusted hazard rate, AHR = 1.43 (95% CI: 1.17– 1.74)]. Not having drug substitution history [AHR = 1.25 (95% CI: 1.02– 1.52)] was positively associated with viral re-suppression. In contrast, being on anti-TB treatment [AHR = 0.67 (95% CI: 0.49– 0.91)] had lower likelihood with viral re-suppression. In the current study, attrition to care was 11% (95% CI: 8.7– 13.9%). Ambulatory or bedridden patients were more at risk of attrition to care as compared with workable patients [AHR = 2.61 (95% CI: 1.40– 4.87)]. Similarly, being not virally re-suppressed [AHR = 6.87 (95% CI: 3.86– 12.23)] and CD4 count ≤ 450 cells/mm3 [AHR = 2.61 (95% CI: 1.40– 4.87)] were also positively associated with attrition to care.Conclusion: A significant number of patients failed to achieve viral re-suppression and attrition from care. Most identified factors related to patient monitoring. Hence, patient-centered intervention should be strengthened, besides treatment switch.Keywords: second-line therapy, re-suppression, retention to care, attritionWedajo SDegu GDeribew AAmbaw FDove Medical Pressarticlesecond-line therapyre-suppressionretention to careattritionImmunologic diseases. AllergyRC581-607ENHIV/AIDS: Research and Palliative Care, Vol Volume 13, Pp 877-887 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	second-line therapy re-suppression retention to care attrition Immunologic diseases. Allergy RC581-607
spellingShingle	second-line therapy re-suppression retention to care attrition Immunologic diseases. Allergy RC581-607 Wedajo S Degu G Deribew A Ambaw F Rate of Viral Re-Suppression and Retention to Care Among PLHIV on Second-Line Antiretroviral Therapy at Dessie Comprehensive Specialized Hospital, Northeast Ethiopia: A Retrospective Cohort Study
description	Shambel Wedajo,1 Getu Degu,2 Amare Deribew,3 Fentie Ambaw2 1School of Public Health, CMHS, Wollo University, Dessie, Ethiopia; 2School of Public Health, CMHS, Bahir Dar University, Bahir Dar, Ethiopia; 3Nutrition International (NI) in Ethiopia, Addis Ababa, EthiopiaCorrespondence: Shambel Wedajo Tel +251 913893606Email Swedajo@gmail.comBackground: In Ethiopia, first-line antiretroviral therapy failure is growing rapidly. However, unlike first-line therapy, to date, very little is known about the outcomes of second-line therapy. Thus, this study assessed the rate of viral re-suppression and attrition to care and their predictors among people living with HIV on second-line therapy.Methods: A retrospective cohort study was conducted on 642 people living with HIV at Dessie Comprehensive Specialized Hospital from October 2016 to November 2019. A proportional Cox regression model was computed to explore predictors of viral re-suppression (viral load less than 1000 copies/mL) and attrition to care.Results: Out of 642 subjects, 19 (3%), 44 (6.9%), 70 (10.9%), and 509 (79.3%) patients were lost to follow up, died, transferred out, and alive on care, respectively. Similarly, 82.39% (95% CI: 79.24– 85.16%) of patients had achieved viral re-suppression, with 96 per 100 person-year rate of re-suppression. Patients who switched timely to second-line therapy were at a higher rate of viral re-suppression than delayed patients [adjusted hazard rate, AHR = 1.43 (95% CI: 1.17– 1.74)]. Not having drug substitution history [AHR = 1.25 (95% CI: 1.02– 1.52)] was positively associated with viral re-suppression. In contrast, being on anti-TB treatment [AHR = 0.67 (95% CI: 0.49– 0.91)] had lower likelihood with viral re-suppression. In the current study, attrition to care was 11% (95% CI: 8.7– 13.9%). Ambulatory or bedridden patients were more at risk of attrition to care as compared with workable patients [AHR = 2.61 (95% CI: 1.40– 4.87)]. Similarly, being not virally re-suppressed [AHR = 6.87 (95% CI: 3.86– 12.23)] and CD4 count ≤ 450 cells/mm3 [AHR = 2.61 (95% CI: 1.40– 4.87)] were also positively associated with attrition to care.Conclusion: A significant number of patients failed to achieve viral re-suppression and attrition from care. Most identified factors related to patient monitoring. Hence, patient-centered intervention should be strengthened, besides treatment switch.Keywords: second-line therapy, re-suppression, retention to care, attrition
format	article
author	Wedajo S Degu G Deribew A Ambaw F
author_facet	Wedajo S Degu G Deribew A Ambaw F
author_sort	Wedajo S
title	Rate of Viral Re-Suppression and Retention to Care Among PLHIV on Second-Line Antiretroviral Therapy at Dessie Comprehensive Specialized Hospital, Northeast Ethiopia: A Retrospective Cohort Study
title_short	Rate of Viral Re-Suppression and Retention to Care Among PLHIV on Second-Line Antiretroviral Therapy at Dessie Comprehensive Specialized Hospital, Northeast Ethiopia: A Retrospective Cohort Study
title_full	Rate of Viral Re-Suppression and Retention to Care Among PLHIV on Second-Line Antiretroviral Therapy at Dessie Comprehensive Specialized Hospital, Northeast Ethiopia: A Retrospective Cohort Study
title_fullStr	Rate of Viral Re-Suppression and Retention to Care Among PLHIV on Second-Line Antiretroviral Therapy at Dessie Comprehensive Specialized Hospital, Northeast Ethiopia: A Retrospective Cohort Study
title_full_unstemmed	Rate of Viral Re-Suppression and Retention to Care Among PLHIV on Second-Line Antiretroviral Therapy at Dessie Comprehensive Specialized Hospital, Northeast Ethiopia: A Retrospective Cohort Study
title_sort	rate of viral re-suppression and retention to care among plhiv on second-line antiretroviral therapy at dessie comprehensive specialized hospital, northeast ethiopia: a retrospective cohort study
publisher	Dove Medical Press
publishDate	2021
url	https://doaj.org/article/21dc41b784c84630969ff8f58b991c84
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Rate of Viral Re-Suppression and Retention to Care Among PLHIV on Second-Line Antiretroviral Therapy at Dessie Comprehensive Specialized Hospital, Northeast Ethiopia: A Retrospective Cohort Study

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