Magnitude and causes of first-line antiretroviral therapy regimen changes among HIV patients in Ethiopia: a systematic review and meta-analysis

Abstract Background Antiretroviral therapy (ART) has markedly decreased the morbidity and mortality due to HIV/AIDS. ART regimen change is a major challenge for the sustainability of human immunodeficiency virus (HIV) treatment program. This is found to be a major concern among HIV/AIDS patients in a resource-limited setting, where treatment options are limited. Objectives The aim of this review is to generate the best available evidence regarding the magnitude of first-line antiretroviral therapy regimen change and the causes for regimen change among HIV patients on ART in Ethiopia. Methods The reviewed studies were accessed through electronic web-based search strategy from PubMed Medline, EMBASE, Hinari, Springer link and Google Scholar. Data were extracted using Microsoft Excel and exported to Stata software version 13 for analyses. The overall pooled estimation of outcomes was calculated using a random-effect model of DerSimonian–Laird method at 95% confidence level. Heterogeneity of studies was determined using I2 statistics. For the magnitude of regimen change, the presence of publication bias was evaluated using the Begg’s and Egger’s tests. The protocol of this systematic review and meta-analysis was registered in the Prospero database with reference number ID: CRD42018099742. The published methodology is available from: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=99742. Results A total of 22 studies published between the years 2012 and 2018 were included. Out of 22 articles, 14 articles reported the magnitude of regimen change and consisted of 13,668 HIV patients. The estimated national pooled magnitude of regimen change was 37% (95% CI: 34, 44%; Range: 15.1–63.8%) with degree of heterogeneity (I2), 98.7%; p-value < 0.001. Seventeen articles were used to identify the causes for first-line antiretroviral therapy regimen change. The major causes identified were toxicity, 58% (95% CI: 46, 69%; Range: 14.4–88.5%); TB co-morbidity, 12% (95% CI: 8, 16%; Range: 0.8–31.7%); treatment failure, 7% (95% CI: 5, 9%; Range: 0.4–24.4%); and pregnancy, 5% (95% CI: 4, 7%; Range: 0.6–11.9%). Conclusions The original first-line regimen was changed in one-third of HIV patients on ART in Ethiopia. Toxicity of the drugs, TB co-morbidity, treatment failure, and pregnancy were the main causes for the change of the first-line regimen among HIV patients on antiretroviral therapy.

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Treatment failure and associated factors among first line patients on highly active antiretroviral therapy in Ethiopia: a systematic review and meta-analysis

Global Health Research and Policy ◽

10.1186/s41256-019-0120-4 ◽

2019 ◽

Vol 4 (1) ◽

Cited By ~ 4

Author(s):

Moges Agazhe Assemie ◽

Muluneh Alene ◽

Daniel Bekele Ketema ◽

Selishi Mulatu

Keyword(s):

Systematic Review ◽

Antiretroviral Therapy ◽

Treatment Failure ◽

Associated Factors ◽

Meta Analysis ◽

Clinical Stage ◽

Line Treatment ◽

First Line ◽

Determinant Factors ◽

First Line Treatment

Abstract Background Antiretroviral therapy (ART) restores immune function and reduces human immunodeficiency virus (HIV) related adverse outcomes. The results of previous studies in Ethiopia were replete with inconsistent findings; nonexistence of national representative figures and determinant factors are found as significant gap. The aim of this systematic review and meta-analysis was to assess the existing evidence on ART treatment failure and associated factors in Ethiopia. Methods Relevant studies on ART treatment failure were retrieved from international databases: PubMed, Google Scholar, Scopus, and Science Direct systematically prior to March 14, 2019. All identified studies reporting the proportion of first line treatment failure among HIV patients in Ethiopia were included. Two authors independently extracted all necessary data using a standardized data extraction format. A random-effects model was used to calculate pooled estimates and associated factors in Stata/se Version-14. The Cochrane Q test statistics and I2 tests were used to assess the heterogeneity of the studies. Results From 18 articles reviewed; the pooled proportion of first line treatment failure among ART users in Ethiopia was 15.3% (95% CI: 12, 18.6) with (I2 = 97.9%, p < 0.001). The subgroup analysis by World Health Organization (WHO) treatment failure assessment criteria were carried out, accordingly the highest prevalence (11.5%) was noted on immunological and the lowest (5.8%) was observed virological treatment failure. We had found poor adherence (OR = 8.6, 95% CI: 5.6, 13.4), not disclosed (OR = 2.1, 95% CI: 1.5, 3.0), advanced WHO clinical stage III/IV (OR = 2.4, 95% CI: 1.5, 3.8), change in regimen (OR = 2.5, 95% CI: 1.6, 3.9) and being co-infected (OR = 2.56, 95% CI: 2.2, 3.0) were statistically significant factors for treatment failure. Conclusion In this study, treatment failure among ART users in Ethiopia was significant. Adherence, co-infection, advanced WHO clinical stage, regimen change, and disclosure are determinant factors for treatment failure. Therefore, improve drug adherence, prevent co-infection, close follow up, and prevent HIV-drug resistance are required in future remedial efforts.

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Predictors of virological treatment failure among adult HIV patients on first-line antiretroviral therapy in Woldia and Dessie hospitals, Northeast Ethiopia: a case-control study

BMC Infectious Diseases ◽

10.1186/s12879-019-3924-4 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 9

Author(s):

Mohammed Ahmed ◽

Hailu Merga ◽

Habtemu Jarso

Keyword(s):

Antiretroviral Therapy ◽

Treatment Failure ◽

Case Control Study ◽

Case Control ◽

First Line ◽

Hiv Patients ◽

Northeast Ethiopia ◽

Control Study ◽

Virological Treatment Failure

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Comparative efficacy and safety of first-line antiretroviral therapy for the treatment of HIV infection: a systematic review and network meta-analysis

The Lancet HIV ◽

10.1016/s2352-3018(16)30091-1 ◽

2016 ◽

Vol 3 (11) ◽

pp. e510-e520 ◽

Cited By ~ 71

Author(s):

Steve Kanters ◽

Marco Vitoria ◽

Meg Doherty ◽

Maria Eugenia Socias ◽

Nathan Ford ◽

...

Keyword(s):

Systematic Review ◽

Antiretroviral Therapy ◽

Hiv Infection ◽

Meta Analysis ◽

Efficacy And Safety ◽

Comparative Efficacy ◽

First Line

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Comparative efficacy and safety of second-line antiretroviral therapy for treatment of HIV/AIDS: a systematic review and network meta-analysis

The Lancet HIV ◽

10.1016/s2352-3018(17)30109-1 ◽

2017 ◽

Vol 4 (10) ◽

pp. e433-e441 ◽

Cited By ~ 30

Author(s):

Steve Kanters ◽

Maria Eugenia Socias ◽

Nicholas I Paton ◽

Marco Vitoria ◽

Meg Doherty ◽

...

Keyword(s):

Systematic Review ◽

Antiretroviral Therapy ◽

Meta Analysis ◽

Second Line ◽

Efficacy And Safety ◽

Comparative Efficacy ◽

Second Line Antiretroviral Therapy ◽

Hiv Aids

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Antiretroviral treatment failure and associated factors among HIV patients on the first-line antiretroviral therapy at Mizan-Tepi University teaching hospital, Southwest Ethiopia

Medicine ◽

10.1097/md.0000000000028357 ◽

2021 ◽

Vol 100 (51) ◽

pp. e28357

Author(s):

Jafer Siraj ◽

Desalegn Feyissa ◽

Yitagesu Mamo ◽

Ameha Zewudie ◽

Tolcha Regesa ◽

...

Keyword(s):

Antiretroviral Therapy ◽

Treatment Failure ◽

Teaching Hospital ◽

Associated Factors ◽

Antiretroviral Treatment ◽

University Teaching ◽

First Line ◽

Hiv Patients ◽

Southwest Ethiopia ◽

Antiretroviral Treatment Failure

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Study protocol: Strengthening understanding of effective adherence strategies for first-line and second-line antiretroviral therapy (ART) in selected rural and urban communities in South Africa

PLoS ONE ◽

10.1371/journal.pone.0261107 ◽

2021 ◽

Vol 16 (12) ◽

pp. e0261107

Author(s):

Siphamandla Bonga Gumede ◽

John Benjamin Frank de Wit ◽

Willem Daniel Francois Venter ◽

Samanta Tresha Lalla-Edward

Keyword(s):

Public Health ◽

South Africa ◽

Systematic Review ◽

Data Analysis ◽

Antiretroviral Therapy ◽

Meta Analysis ◽

Secondary Data ◽

Limpopo Province ◽

Second Line ◽

First Line

Multiple factors make adherence to antiretroviral therapy (ART) a complex process. This study aims to describe the barriers and facilitators to adherence for patients receiving first-line and second-line ART, identify different adherence strategies utilized and make recommendations for an improved adherence strategy. This mixed method parallel convergent study will be conducted in seven high volume public health facilities in Gauteng and one in Limpopo province in South Africa. The study consists of four phases; a retrospective secondary data analysis of a large cohort of patients on ART (using TIER.Net, an ART patient and data management system for recording and monitoring patients on ART and tuberculosis (TB)) from seven Johannesburg inner-city public health facilities (Gauteng province); a secondary data analysis of the Intensified Treatment Monitoring Accumulation (ITREMA) trial (a randomized control trial which ran from June 2015 to January 2019) conducted at the Ndlovu Medical Center (Limpopo province); in-depth interviews with people living with Human Immunodeficiency Virus (PLHIV) who are taking ART (in both urban and rural settings); and a systematic review of the impact of treatment adherence interventions for chronic conditions in sub-Saharan Africa. Data will be collected on demographics, socio-economic status, treatment support, retention in care status, disclosure, stigma, clinical markers (CD4 count and viral load (VL)), self-reported adherence information, intrapersonal, and interpersonal factors, community networks, and policy level factors. The systematic review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) reporting and Population, Interventions, Comparisons and Outcomes (PICO) criteria. Analyses will involve tests of association (Chi-square and t-test), thematic analysis (deductive and inductive approaches) and network meta-analysis. Using an integrated multilevel socio-ecological framework this study will describe the factors associated with adherence for PLHIV who are taking first-line or second-line ART. Implementing evidence-based adherence approaches, when taken up, will improve patient’s overall health outcomes. Our study results will provide guidance regarding context-specific intervention strategies to improve ART adherence.

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