ANTI-RETROVIRAL REGIMEN CHANGE AND ITS PREDICTORS AMONG PEOPLE LIVING WITH HIV AT HAWASSA UNIVERSITY COMPREHENSIVE SPECIALIZED HOSPITAL, SOUTHERN ETHIOPIA

Abstract

Background: Anti-retroviral regimen change is among the major challenges for the success of treatment among people living with human immunodeficiency virus (PLHIV), affecting its sustainability and outcome among ART patients. Yet, the evidence on the incidence and predictors of regimen change is unknown in this setting and the region. Objective: The aim of this study was to determine the incidence of antiretroviral regimen change and its predictors among PLHIV at Hawassa University Comprehensive Specialized Hospital in 2024 Methods: An institutional-based retrospective cohort study was conducted among PLHIV who started ART from January 1, 2006, to December 31, 2023. Regimen change was defined as changing the ART regimen due to adverse events. Records were reviewed and standard data extraction form was used to collect data on a kobo tool kit. A Kaplan-Meier plot with a log-rank test at p<0.05 was used to estimate the median follow-up time and compare survival between the covariates. Bi-variable cox-regression analysis was done and variables with p≤0.25 were entered into the multivariable cox-regression model. Predictors with p values<0.05 reported with their adjusted hazard ratios and the 95% confidence intervals. Results: A total of 3856 patients were followed for 39,350 person-years of observation with the median follow-up period of 11.2 years. The incidence rate of anti-retroviral regimen change was 12.1 (95% confidence interval (CI): 11.5–12.7) per 100 person-years. Female gender (Adjusted hazard ratio (AHR) = 2.9, 95%CI = 2.6–3.4), occurrence of TB (AHR = 4.6, 95%CI = 2.9–7.4), occurrence of side effects (AHR = 3.4, 95%CI = 2.9–3.8), baseline CD4 count below 100 cells/mm3 (AHR = 1.3, 95%CI = 1.1–1.6) and availability of social support (AHR = 0.47, 95%CI = 0.38–0.58) were the predictors of regimen change among PLHIV receiving anti-retroviral therapy. Conclusion and recommendation: The incidence of regimen change in this study was comparable to other findings. A number of variables predicted regimen change and female gender, occurrence of drug side effects, occurrence of TB, CD4 below 100cells/mm3 and availability of social support were predictors of incidence of regimen change. Clinicians are recommended to early assess the adverse effects, TB, immunologic failure and strengthen social support to reduce the risk of regimen change among PLIHV.