As HAART continues to be scaled up in Ethiopia, with more PrimaryHealth Care (PHC) facilities providing ART services, increasingly more effortsand resources need to be directed at ensuring that patients who continue toenroll at these facilities receive quality care to optimize their health.
Thisparticular study was designed to identify treatment outcomes, mainly virologicfailure, as a way to assess programme performance at ART facility. Virologic failure is a golden standard for detecting treatment failurein HAART. Prevalence of treatment failure was 10.7% (45/421) among the studyparticipants.
The mean and median time on treatment was 75.7 and 81 monthswhich signifies high suppression rate 84.8% (viral load below detection limit).There is a possibility of improving the suppression rate near to 100% byproviding an efficient early HAART service such as letting patients to commenceARV early and ensuring adherence of patients to treatment. Similar study conducted in Uganda reported prevalence oftreatment failure 9.9% (Reynolds et al.
, 2009) which is comparable to the result of the present study. Compared toother studies, this study revealed a lower prevalence of treatment failure thanthe one reported (23.2%) from Cameron (Meriki et al., 2014) and also from costal Kenya (24%) (Hassan et al.
, 2014). The probable reason for lower failure in the present study mightbe that the great majority 391(92.9%) of participants being urban dwellerswhich gives them an advantage over the rural dwellers in getting informationfrom a number of media and easily accessible to health facilities. It is alsopossible that the existence of nearby ART clinic which is at a distance of 10km, on average, might give the chance the urban dwellers to frequently visitthe clinic for further information. The present study, however, showed highertreatment failure rate compared with 4.1% which was reported from Gondar (Ayalew et al., 2016).
The higher prevalence in the present study might be because ofpoor adherence and high duration on treatment that could possibly increasetreatment failure. In treatment failure, viral load criteria identified failuresignificantly earlier (median, 47.0 months; p<0.001) than did CD4 countcriteria (median, 63.0 months). In this survival analysis, time to failure iscompared between immunologic and virologic monitoring methods among the entire421 participants.
The present study indicated a higher time to failure (47months) compared to a median time of 15 months which was reported from SouthAfrica (El-Khatib et al., 2011), 24 months from Cameron (Meriki et al., 2014), 24 months from Gondar, Ethiopia (Zeleke, 2016), 19.7 months from Addis Ababa, Ethiopia (Bacha et al., 2012). Interestingly, as duration on HAART increased, drug failureincreased especially in long duration of 73-158 months treatment. This is,however, independently associated with virologic failure.
A similar studyconducted in Cameron showed long time duration of treatment to be one ofdeterminant factors for treatment failure (Zoufaly et al., 2013) and this particular factor,long duration on treatment, for example, for above 60 months among patients inGondar, Ethiopia, was found to be an independent predictor for an increasedrisk of HIV treatment failure (Zeleke, 2016). By ROC curve analysis, performance ofimmunologic failure was evaluated against good predictive capacity of virologicfailure. Accordingly sensitivity of 62.2%, specificity of 89.
6%, positivepredictive value of 41.8%, and negative predictive value of 95.2% were found.These values are higher than those values 23% (sensitivity), 90% (specificity),21% (positive predictive value), and 91% (negative predictive value) reportedfrom Uganda (Reynolds et al.
, 2010). Similarly, the values of the present study are higher than thevalues (sensitivity of 34%; specificity of 94%; positive predictive value of75%; and negative predictive value of71%) reported in another study conducted in Tanzania (Mgelea et al., 2014). Reason for fair predicting value ROCanalysis and its higher values other studies is probably due to longer mediantime to failure of HAART with good adherence of patients.Using multivariate logisticregression, there was anassociation between treatment failureand the following factors: long duration of treatment (73-158 months, p< 0.
05), immunologic failure, baselinefunctional status, high medication dosage, not feeling privacy duringconsultation, faith heal and sub-optimal adherence to ART during study period.However, there was no statistical significant association (p> 0.05) betweentreatment failure and the following factors: educational status, distance to clinic,TB history, CD4 baseline, base line regimen, and regimen substitutes. Before patients commence HAART, it is essential that they should beadequately prepared for this life-long drug therapy.
ART treatment necessitatesa change in life style and social habits. Poor patient treatment follow up maylead to poor drug adherence by patients, increasing the likelihood of treatmentfailure. A similar study in South Africa has shown that incomplete adherence asone of the risk factors for virologic failure (El-Khatib et al., 2011). Similarly, a study in Kenya has shown that unsatisfactoryadherence to have strong correlation with virologic failure (Hassan et al., 2014). In Gondar, Ethiopia, poor adherence during follow up has beenshown to be associated with treatmentfailure (Zeleke, 2016).
This studyindicated that faith heal, mostly known by community as “Holy Water” was found to be associated factor with treatmentfailure. Some people go to the place where this holy water is available andthey greatly believe in its healing power. Alternative medicine or faith healis one of the major factors that makes patients to less adhere to HAART.Although, there is no study that depicted the statistical association of treatment failure with holy water, some studies, however, haveindicated an evidence of positive outcomes of faith healing involving holywater and spiritual aspects that mentally benefit the chronicpatients (Kloos et al., 2013).
On the contrary, the very existence ofhigh prevalence of holy water in Debrebirhan, Ethiopia, has been implicated ashindrance (not taking medicines as a spiritual fear to holy water) to HAART, (Kebede and Shewangizaw, 2015).Functional status (ambulatory/bedridden)at baseline is associated factor to treatment failure and in line with studydone in Addis Ababa, Ethiopia (Yimer andYalew, 2015; Haile et al., 2016).In the present study, high medication dosage currently taken bypatients (Jean-Jacques et al., 2004), consultation privacy and immunologicfailures were the factors that wereassociated with treatment failure/virologic failure.