Predictors of HIV Antiretroviral Treatment Failure among Patients Attending a Semi - Urban HIV Clinic– Kenya, 2012: Can Social Support Help?

Abstract

Background: HIV antiretroviral treatment [ART] failure increases morbidity and mortality. In Kenya, use of treatment supporter, HIV serostatus disclosure, and support groups are believed to reduce the risk of treatment failure by improving adherence.

Methods: We conducted a case-control study to identify factors associated with clinical or immunologic indicators of treatment failures. Cases and controls were adult patients attending a semi-urban HIV clinic who initiated ART at least six months prior to the study. Cases were patients who had a] a decline in CD4 count [below baseline or 30% from highest value since ART initiation] or b] unimproved CD4 counts or c] a World Health Organization [WHO] stage III or IV opportunistic infection. Controls did not meet either immunologic or clinical criteria for treatment failure. Information was obtained through face-to-face interviews medical chart reviews.

Results: We enrolled 52 cases and 104 controls. Twenty-eight [53%] cases and 71 [70%] controls were women, and median age was 44 years [range: 38-50 years] among cases and 43 years [range: 38-49 years] among controls. Discontinued ART for 2 weeks or more [adjusted odds ratio [AOR] 8.9, 95% confidence interval [CI] 1.4-57.4] and alcohol use [AOR 7.2, 95% CI 1.1-45.5] were found to significantly increase the risk of ART failure. Compared to men who discontinued ART for less than 2 weeks, women who discontinued ART for less than 2 weeks had reduced risk [AOR 0.4, 95% CI 0.2-0.9] while those who discontinued for two weeks or more had a greater risk [AOR 12.97, 95% CI 1.5-111.8] of developing ART failure. Social support factors were not associated with treatment failure.

Conclusions: Discontinuing ART and alcohol use were identified to be modifiable factors associated with clinical or immunologic criteria of ART failure. Interventions with proven efficacy at reducing alcohol use and increasing continuous ART should be implemented.

Key words: Antiretroviral treatment failure, HIV, AIDS, adherence, alcohol, Kenya