Time to first line antiretroviral treatment failure and time to switching to second line regimen among art clients at St. Francis Hospital Nsambya, Uganda

Abstract

Background: WHO recommends that all HIV+ clients on ART with 2 consecutive high viral load i.e.> 1000 copies/mL be switched to second-line regimen. Delay to detecting virological failure results in clients remaining on already failing regimens which is likely to lead to accumulation of drug resistance, increased morbidity and mortality, thereby affecting timely switching ofclients to the much needed second-line regimens. Weassessedtime to first-line ART failure and time to switching to Second-lineamong HIV+ clients at St Francis Hospital Nsambya. Methods:Secondary data analysis of 484HIV+ clients with two consecutive viral loads (VLs) >1000 copies/ml after 6 monthsinitiated on first-line ART ARTbetween 2014 and 2016at St Francis Hospital Nsambya. Kaplan Meier estimator was used to determine Time to failure and to switching to second-line whileCox proportional hazards was used to identify predictors of time to switching to second-line with covariates selected using a backward step-wise selection method. 95% CI crude and adjusted hazard ratios at p< 0.05 were computed using STATA 12. Results:Of the 484 clients, 11.26%(n=54) experienced virological failure and only 27.8% (n=15) switched to second line regime. The median time from date of ART initiation to documented second high viral load was25.58 (IQR: 20.33, 38.8) months and from second high viral load to switching to second-line was5.90 (IQR: 2.77-12.17) months. Entry in care through Outpatient (p=0.012) and having a baseline viral load of between 1,000 and 9,999 copies/mL (p=0.045) werepredictors of time to switching to second-line regimen Conclusion:Clients on first-line regimen failed after a very short time period compared to a previous study in Uganda. There was a substantially longperiod of delay before switching clients to second-line regimen. Further research to understand reasons for failing after a short time on ART and not switching clients promptly to second-line should be carried out.