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???metadata.dc.contributor.*???: Dr. Alemayehu Worku
Selamawit Ejigu
Keywords: Through the advent of Highly Active Antiretroviral Therapy (HAART) in 1996
Issue Date: Jun-2009
Publisher: AAU
Abstract: Abstract Background Monitoring patient response with viral load, which is the gold standard, is not feasible in resource limited settings. Therefore it’s essential to look for factors that can be used to identify those patients at higher risk of treatment failure in these settings. Objective To explore factors that can be used to identify those at a higher risk of treatment failure. Method A Nested case-control study from a cohort of HIV patients on ART at government hospitals in Addis Ababa was conducted through review of medical records. A total sample size of 423 with 141 patients with failure of their first line regimen (cases) and 282 patients without failure (controls) is used. Base line socio-demographic and clinical information were collected. Comparison of survival times were made through Kaplan Meier and Log-rank tests. Independent predictors of treatment failure were identifies using multivariate COX regression analysis. Results The mean survival time (without treatment failure) was 53 months (95% CI, 50 – 57). Females were found to have a higher survival time of 57months (95%CI, 52-62, P= 0.01) and males have a significantly higher risk of developing treatment failure with an adjusted HR of 1.518 (95%CI, 1.084-2.125, P=0.01). Those with two or more episodes of poor adherence during their follow-up have a significantly higher adjusted hazard ratio of 4.02 (95% CI, 2.71, 5.96, P=<0.001) compared to those with no episode of poor adherence. Missed appointment is another independent predictor of treatment failure with adjusted HR of 1.77 (1.11, 2.96, P= 0.03). Conclusion This study has shown that non- adherence to medication and clinic visits are independently associated with treatment failure. Following patients closely for their level of adherence and their trend of missing clinic visits can be used to help identify those at higher risk of treatment failure. Providing intense adherence counseling for these patients may prevent occurrence of failure.
Description: A Thesis Submitted to School of Public Health, Addis Ababa University, as partial fulfillment of the requirements for the degree of Masters of Public Health
Appears in Collections:Thesis - Public Health

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