Journal Article

Retention in care and virological failure among adult HIV+ patients on second-line ART in Rwanda: a national representative study

Kanters, Steve, Ndahindwa, Vedaste, Bucher, Heiner C., Remera, Eric, Semakula, Muhammed, Sebuhoro, Dieudonne, Mills, Edward J., Uwizihiwe, Jean Paul, Nsanzimana, Sabin, Ford, Nathan, Tanner, Marcel

2019

Overview

Background Currently, there is limited evidence on the effectiveness of second-line antiretroviral therapy (ART) in sub-Saharan Africa. To address this challenge, outcomes of second-line protease inhibitor (PI) based ART in Rwanda were assessed. Methods A two-stage cluster sampling design was undertaken. 49 of 340 health facilities linked to the open-source electronic medical record (EMR) system of Rwanda were randomly sampled. Data sampling criteria included adult HIV positive patients with documented change from first to second-line ART regimen. Retention in care and treatment failure (viral load above 1000 copies/mL) were evaluated using multivariable Cox proportional hazards and logistic regression models. Results A total of 1688 patients (60% females) initiated second-line ART PI-based regimen by 31st December 2016 with a median follow-up time of 26 months (IQR 24–36). Overall, 92.5% of patients were retained in care; 83% achieved VL ≤ 1000 copies/ml, 2.8% were lost to care and 2.2% died. Defaulting from care was associated with more recent initiation of ART- PI based regimen, CD4 cell count ≤500 cells/mm 3 at initiation of second line ART and viral load > 1000 copies/ml at last measurement. Viral failure was associated with younger age, WHO stage III&IV at ART initiation, CD4 cell count ≤500 cells/mm 3 at switch, atazanavir based second-line ART and receiving care at a health center compared to hospital settings. Conclusions A high proportion of patients on second-line ART are doing relatively well in Rwanda and retained in care with low viral failure rates. However, enhanced understandings of adherence and adherence interventions for less healthy individuals are required. Routine viral load measurement and tracing of loss to follow-up is fundamental in resource limited settings, especially among less healthy patients.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Acquired immune deficiency syndrome / AIDS / Anti-HIV agents / Antiretroviral agents / Antiretroviral drugs / Antiretroviral therapy / Atazanavir / Care and treatment / CD4 antigen / Data sampling / Electronic health records / Electronic medical records / Electronic records / Evaluation / Failure rates / Hazards / Health / Health care facilities / Highly active antiretroviral therapy / HIV / HIV and co-infections / HIV patients / Hospital facilities / Human immunodeficiency virus / Infectious Diseases / Internal Medicine / Medical Microbiology / Medical records / Medicine / Medicine & Public Health / Parasitology / Patient outcomes / Patients / Protease inhibitors / Proteases / Proteinase inhibitors / Regression analysis / Regression models / Research Article / Retention / Sampling / Sampling designs / Second-line antiretroviral therapy / Systematic review / Treatment failure / Tropical Medicine / Viral load