Efforts to reduce AIDS-related mortality have been instrumental in providing antiretroviralrntherapy ART services. However people are still dying while on treatment due to severalrnfactors. Recent studies have reported several treatment failures.
The main focus ofrnthe study was to determine predictors of treatment failure among HIV-positive clients throughrna case study of patients in Webuye sub-county Bungoma County Kenya.
The study was carriedrnout in the Webuye sub-county hospital and employed a cross-sectional study approach. Thernstudy included 3975 adults who had been on ART for more than twelve months. The Mugendarnand Mugenda 2003 formula was used to calculate the desired sample size capturing a totalrnof 361 respondents. A structured questionnaire and a face-to-face interview were used torncollect data. Data entry was done on SPSS and analysed using version 23. Demographicrncharacteristics such as age and sex were summarised into means and percentages. The oddsrnratio and chi-square test were conducted to investigate the correlation between prognosticrnfactors and adherence to therapy.
In this study 361 participants were enrolled with 133 males and 228 females. Most of the clients under care and treatment were more than 45 years old: 43.8rn158/361 35-44 yrs 102 25-34 yrs 80 15-24 yrs 21. A higher proportion of clients who smoke 71.9 23/32 and use alcohol 67.6 46/68rnexperienced treatment failure. Patients with poor ARV adherence had the highest treatmentrnfailure rate of 63.0 29/46. Clients who were enrolled in WHO stage 3 had higher failurernrates at 32.9 46/140. On univariable analysis although not significantrnclients aged 1524 and those aged more than 45 years had higher odds of treatment failurernOR 2.00 95 CI 0.675.69 and OR 1.59 95 CI 0.593.53 respectively. Although notrnsignificant male clients had higher odds of treatment failure than female clients OR 1.12rn95 CI 0.671.84. Clients with a history of marriage divorced separated and widowed andrnthose in polygamous relationships had higher odds of treatment failure OR 1.41 95 CIrn0.60-3.55 and OR 1.84 95 CI 0.71-4.99 respectively. The odds of treatment failurernwere significantly higher for clients who smoked and drank. OR 11.0 95 CI 5.01-26.2 andrnOR 13.6 95 CI 7.50-25.5 respectively. Clients with a poor history of ARV adherence wererneight times more likely to have treatment failure OR 7.89 95 CI 4.1015.6. Clients withrna history of T.B. were almost three times more likely to have treatment failure OR 2.93 95rnCI 1.33-6.38.rnOn multivariable analysis clients aged more than 45 years had significantly higher odds ofrntreatment failure OR 2.59 95 CI 1.076.75. Clients with a history of T.B. were two timesrnmore likely to have treatment failure OR 2.30 95 CI 1.247.23 compared to those thatrndidnt have a history of T.B. Clients taking alcohol had significantly higher odds of treatmentrnfailure OR 21.1 95 CI 9.08-52.7. Clients with a CD4 count of less than 200 and 201-300rnhad nearly three times the odds of failing treatment OR 2.91 95 CI 1.33-6.72 and OR rn2.72 95 CI 1.05-7.20 respectively. Clients with a poor history of ARV adherence hadrnsignificantly higher odds of treatment failure OR 15.2 95 CI 6.3239.6
Comorbidities associated with HIV infection such as TB are common among HIV-positivernclients exposing them to treatment failure. Drug-related factors such as adherence tornmedication determine the risk of treatment failure among patients. Missed clinical visitsrnaffected medication adherence.