Treatment failure (TF) among patients receiving antiretroviral therapy (ART) against human immunodeficiency virus (HIV) impacts treatment outcomes is becoming a public health concern globally. However, the magnitude of TF and factors leading to it are poorly defined in the context of Ethiopia. Thus, the aim of this study was to determine the magnitude of TF and assess its determinants among HIV-infected patients on ART in Ethiopia. A prospective and retrospective study was conducted from March 2016 to 2017. Retrospective clinical and laboratory data were captured from patients’ medical records. On the other hand, socio-demographics and explanatory variables of participants were collected using pre-tested structured questionnaire and study participants were followed for additional 6 months after baseline viral load has been done to classify virologic failure (VF). Multiple logistic regression was conducted to assess risk factors associated with TF. Statistical significance was set at P-value less than 0.05.
Results of this study reveal that: 1) A total of 9,284 adults taking ART from a nationally representative 63 health facilities were included in the study. 2) Viral Load Suppression (VLS) (VL<1000 copies/ml) among the population taking HAART in Ethiopia were found to be 8,180 (88.1%). 3) Thirty-five percent of the study participants with VL>1000 copies/ml at baseline of the study.
were re-suppressed after six months of enhanced adherence and counseling, leading TF among the population on ART in Ethiopia to be 983 (11%). 4) Immunologic and clinical failure was significantly improved from 21.5% and 16.5% at ART initiation to 576 (6.2%) and 470 (5.0%) at baseline of the study, respectively. 5) Medication adherence, disclosure of HIV status, missed appointment to ART, history of ART exposure prior to initiation, residency and marital status had a significant association with TF.
In conclusion, the high level of VLS (88.1%) could explain the success of ART program in Ethiopia towards achieving the UNAIDS global target on viral suppression. TF among the population taking ART in Ethiopia is still a public health concern since 11% of the virally failed population is maintained on failed first-line regimen. However, a significant improvement in immunologic and clinical outcomes after ART initiation was maintained. Hence a close follow-up of medication adherence, ensuring disclosure of HIV status, regular appointment follow-up to ART could significantly improve the treatment outcome of the population on ART in Ethiopia.

• Antiretroviral therapy
• Treatment failure
• Viral suppression
• Adherence
• Ethiopia
• two stage cluster design
• Immunologic Failure
• Clinical failure
• UNAIDS
• human immunodeficiency virus
• prospective study
• retrospective study
• WHO

Getaneh Y, Egziabhier AG, Zealiyas K, Tilahun R, Girma M, Michael GG, et al. HIV-1 Treatment Failure among Population Taking Antiretroviral Therapy in Ethiopia. J AIDS HIV Treat. 2019; 1(2):46-57.

A retrospective and prospective follow-up study was conducted across the nationally representative Health Facilities (HFs) in Ethiopia. Baseline VL testing was done followed by second-round VL testing after three to six months of intensive adherence counseling for patients with VL>1000 copies/ml at baseline to determine Treatment Failure (TF) as defined by WHO-2013. Pre-established tools and questioner were also used to assess determinants of TF. HFs providing ART service for at least 60 patients and with at least 9 months of ART service experience was part of this study. Study participants within the HFs were those who had at least 9-month ART experience.
According to the WHO recommendation, the selection of 40 HFs is sufficient for nationally representative Virologic Failure (VF). However, due to the heterogeneity of the study participant load across the HFs and regions in Ethiopia, some regions and HFs with a small number of ART patients may not be represented with this limited number of facilities to be sampled. Provided that one health center and one hospital should be represented across all the regional administrations in the country to maintain administrative balance, the study has included an additional 23 HFs. Hence, the total number of HFs included in the study was 63.

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