INCIDENCE AND PREDICTORS OF INITIAL ANTIRETROVIRAL THERAPY REGIMEN CHANGE AMONG HIV INFECTED ADULTS RECIEVING ANTIRETROVIRAL THERAPY AT ARBA MINCH GENERAL HOSPITAL, SOUTHERN ETHIOPIA: RETROSPECTIVE COHORT STUDY

Abstract

ABSTRACT Introduction: The effectiveness of first antiretroviral therapy is the key for treatment success. However regimen change affects this treatment success. Study has not been conducted on incidence and predictors of initial antiretroviral therapy regimen change in this study setting. Objective: To assess the incidence and predictors of initial antiretroviral therapy regimen change among HIV infected adults receiving antiretroviral therapy at Arba Minch general hospital, Southern Ethiopia from 1st January, 2014 to December 31st, 2018. Methods: Institutional based retrospective cohort study was conducted. Data were collected from 508 patients chart selected by simple random sampling method and entered in to Epi-data version 4.43 and analyzed by STATA version 13. Life table was used to estimate the cumulative survival. Kaplan-Meir curve and log rank test were used to compare survival experience of different categories of explanatory variables. Cox proportional hazard model was used to identify predictors. Result: A total of 508 patients were followed for 871.87 person years of observation with the median follow up period of 16.12 months. A total of 99 patients changed their initial regimen during follow up period. Hence, the overall incidence rate of initial ART regimen change was 11.36 (95% CI: 9.32-13.83) per 100 person year with in the median survival time of 54 months. Not disclosing HIV status (AHR = 5.41, 95 % CI = 2.3812.27), Comedication with ART (AHR = 4.64, 95 % CI = 1.43-15.10), occurrence of side effect on initial regimen (AHR = 7.32, 95 % CI = 4.43-12.10), baseline CD4 count < 200 cells/mm3 (AHR = 2.18, 95 % CI = 1.37-3.47), ambulatory and bedridden baseline functional status (AHR = 3.55, 95 % CI = 2.30-5.48) were significant predictors of initial regimen change. Conclusion: The incidence rate of initial ART regimen change was found to be low. HIV disclosure status, Comedication with ART, occurrence of side effect on initial regimen, baseline CD4 count < 200 cells/mm3, ambulatory and bedridden baseline functional status were found to be independent predictors. Hence, early screening for side effect and close follow up is important.