Predictors of Poor Adherence to CART and Treatment Failure at Second-Line Regimens Among Adults in Public Hospitals of Amhara Region, North-Western Ethiopia: A Retrospective Cohort Study

Background: Globally, HIV/AIDS has challenged the lives of 36.3 million people and resulted in 17 million orphans. The disease has neither a vaccine nor a cure and the only option currently is highly active antiretroviral therapy. This research was conducted to identify the predictors of poor adherence to CART and treatment failure at second-line regimen among adults living with HIV/AIDS in public hospitals of Amhara region, north-western Ethiopia. Methods: A retrospective cohort study design was conducted on 700 HIV-positive people who were receiving a second-line CART regimen. Participants on second-line regimens who followed their treatment between 2016 and 2019 were considered. Data were extracted from participants' clinical charts from June 18-July 7, 2020. Results: A multivariate regression analysis indicates that age of patients (OR = 1.025, 95% CI: 1.001-1.321; p = 0.005), follow-up visits (OR = 0.979, 95% CI: 0.873-0.998; p < 0.001), CD4 cell count change (OR = 0.9860; 95% CI: 0.835-0.998; p < 0.01), marital status (OR = 0.973, 95% CI: 0.789- 0.997; p = 0.006), female HIV-infected patients (OR = 0.990; 95% CI: 0.789-0.999; p <0.001), rural patients (OR = 1.151; 95% CI 1.065-1.398; p = 0.004), non-educated adult patients (OR = 1.026, 95% CI: 1.002-1.198; p = 0.003), existence of social violence (OR = 0.012, 95% CI: 0.008-0.134; p< 0.01), patients with opportunistic diseases (OR = 1.0345, 95% CI 1.002-1.142; p = 0.001), CD4 cell count (OR = 0.901, 95% CI: 0.843-0.995; p = 0.025) and malnutrition (OR = 0.883, 95% CI; 0.762-0.954; p = 0.001) significantly affected the two response variables. Conclusion: Several variables affected both poor adherence to HAART and treatment failure at second-line regimens in the current investigation. Due attention should be given to aged patients, rural residents, non-educated patients, and patients with other morbidities to be successful with second-line treatment regimens.