Antiretroviral treatment failure and associated factors among people living with HIV on therapy in Homa Bay, Kenya: A retrospective study

Rose Masaba; Godfrey Woelk; Stephen Siamba; James Ndimbii; Millicent Ouma; Jacob Khaoya; Abraham Kipchirchir; Boniface Ochanda; Gordon Okomo

doi:10.1371/journal.pgph.0001007

Antiretroviral treatment failure and associated factors among people living with HIV on therapy in Homa Bay, Kenya: A retrospective study

PLOS Glob Public Health. 2023 Mar 2;3(3):e0001007. doi: 10.1371/journal.pgph.0001007. eCollection 2023.

Authors

Rose Masaba¹, Godfrey Woelk², Stephen Siamba¹, James Ndimbii¹, Millicent Ouma¹, Jacob Khaoya¹, Abraham Kipchirchir¹, Boniface Ochanda³, Gordon Okomo⁴

Affiliations

¹ Elizabeth Glaser Pediatric AIDS Foundation, Nairobi, Kenya.
² Elizabeth Glaser Pediatric AIDS Foundation, Washington, D.C., United States of America.
³ Division of Global HIV & TB, Center for Global Health, US Centers for Disease Control and Prevention Kenya, Kisumu, Kenya.
⁴ Ministry of Health, Homa Bay County, Kenya.

Abstract

Despite large numbers of patients accessing antiretroviral treatment (ART) in Kenya, few studies have explored factors associated with virologic failure in Western Kenya, specifically. We undertook a study in Homa Bay County, Kenya to assess the extent of virologic treatment failure and factors associated with it. This was an observational retrospective study conducted from September 2020 to January 2021. Data were abstracted from the records of patients who had been on ART for at least six months at the time of data collection after systematic sampling stratified by age group at ART initiation (0-14 and 15+ years), using probability proportion to the numbers of patients attending the facility. Confirmed viral treatment failure was defined as viral load ≥1000 copies/ml based on two consecutive viral load measurements after at least three months of enhanced adherence counseling. Data were analyzed using descriptive statistics and Cox regression modeling. Of the 2,007 patients sampled, 160 (8.0%) had confirmed virologic treatment failure. Significantly higher virologic treatment failure rates were identified among male patients 78/830 (9.4%) and children 115/782 (14.7%). Factors associated with virologic treatment failure (VTF), were age 0-14 years, adjusted hazard ratio (AHR) 4.42, (95% Confidence Interval [CI], 3.12, 6.32), experience of treatment side effects AHD: 2.43, (95% CI, 1.76, 3.37), attending level 2/3 health facility, AHR: 1.87, (95% CI: 1.29, 2,72), and history of opportunistic infections (OIs), AHR: 1.81, (95% CI, 1.76, 3.37). Children, attendees of level 2/3 health facilities, patients with a history of OIs, and those experiencing treatment side-effects are at risk of VTF. Increased focus on children and adolescents on screening for drug resistance, administration of and adherence to medication, and on effective information and education on side-effects is critical. Additionally, there is need for increased training and support for health care workers at primary level care facilities.

Copyright: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.

Grants and funding

This study was supported by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Centers for Disease Control and Prevention (CDC) under the terms of Cooperative Agreement No. NU2GGH001948-01-00. The funder contributed to study design and reviewed the manuscript and did not interact with human subjects or have access to identifiable data or specimens for research purposes. The funder cleared the manuscript for publication. The findings and conclusions in this manuscript are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention and other funding agencies.