Factors Associated with Human Immunodeficiency Virus First Line Treatment Failure in Zvishavane District, Zimbabwe, 2014

Introduction: Globally, first line HIV treatment failure remains a challenge, particularly in resource constrained settings. Midlands Province 2013 data showed that Zvishavane district had the highest prevalence of first line treatment failure at 16% against a national average of 1%. First line ART failure comes with poor treatment outcomes. We conducted a study to determine factors associated with first line HIV treatment failure in Zvishavane district. Methods: A 1:1 unmatched case control study was conducted. A case was an HIV positive patient who was on first line ART for >6 months in Zvishavane district and was switched to second line ART regimen because of treatment failure in 2013/2014. A control was an HIV patient in Zvishavane district who had been on first line ART for >6 months and had not failed first line ART. Pretested interviewer administered questionnaires were used to collect data from randomly selected participants. Logistic regression analysis was conducted. Results: A total of 246 participants, 123 cases and 123 controls, were recruited. Independent risk factors were poor adherence (<80% adherence) to ART [AOR=5.14, 95%CI (2.75-9.62)], drug stock outs [AOR=3.02, 95%CI (1.20- 6.98)], baseline CD4 count of <50 cells/mm3 [AOR=3.25, 95%CI (1.47-7.16)] and baseline WHO Stage 3 or 4 [AOR=1.95, 95%CI (1.05-3.61)]. Drug stock outs were a significant determinant of poor ART adherence [OR=3.09, 95%CI (1.83-5.21)]. Conclusion: Low baseline CD4 count and WHO stage 3 or 4 at ART initiation is associated with treatment failure. Improving adherence and avoiding ART drug stock outs may reduce treatment failure.