Prevalence and predictors of immunologic failure among HIV patients on HAART in southern Ethiopia

Immunologic monitoring is part of the standard care for patients on antiretroviral treatment. Yet, little is known about the routine implementation of immunologic monitoring in Ethiopia. This study assessed the pattern of immunologic monitoring, immunologic response, level of immunologic treatment failure and factors related to it among patients on antiretroviral therapy in selected hospitals in southern Ethiopia. A retrospective longitudinal analytic study was conducted using documents of patients started on antiretroviral therapy. A total of 1,321 documents of patients reviewed revealed timely immunologic monitoring were inadequate. Despite overall adequate immunologic response, the prevalence of immunologic failure was 11.5% (n=147). Having WHO Stage III/IV of the disease and a higher CD4 (cluster differentiation 4) cell count at baseline were identified as risks for immunologic failure. These findings highlight the magnitude of the problem of immunologic failure. Prioritizing monitoring for high risk patients may help in effective utilisation of meager resourcesHealth StudiesM. A. (Public Health

Exploratory analysis of time from HIV diagnosis to ART start, factors and effect on survival: A longitudinal follow up study at seven teaching hospitals in Ethiopia

Background: the HIV care in Ethiopia has reached 79% coverage. The timeliness of the care provided at the different levels in the course of the disease starting from knowing HIV positive status to ART initiation is not well known. This study intends to explore the timing of the care seeking, the care provision and associated factors.Methods: This is a longitudinal follow-up study at seven university hospitals. Patients enrolled in HIV care from September 2005 to December 2013 and aged ≥14 years were studied. Different times in the cascade of HIV care were examined including the duration from date HIV diagnosed to enrollment in HIV care, duration from enrollment to eligibility for ART and time from eligibility to initiation of ART. Ordinal logistic regression was used to investigate their determinants while the effect of these periods on survival of patients was determined using cox-proportional hazards regression.Results: 4159 clients were studied. Time to enrollment after HIV test decreased from 39 days in 2005 to 1 day after 2008. It took longer if baseline CD4 was higher, and eligibility for ART was assessed late. Young adults, lower baseline CD4, HIV diagnosis<2008, late enrollment, and early eligibility assessment were associated with early ART initiation. Male gender, advanced disease stage and lower baseline CD4 were consistent risk factors for mortality.Conclusion and recommendation: Time to enrollment and duration of ART eligibility assessment as well as ART initiation time after eligibility is improving. Further study is required to identify why mortality is slightly increasing after 2010.Key words: HIV, HIV testing, enrollment, eligibility, antiretroviral therapy, mortality, Ethiopia

Kaplan-Meier survival functions by baseline CD4 cell count group (n = 1,282).

<p>Event free survival, the even being free of immunological treatment failure, was lower for patients with baseline CD4 cell count more than 349 as compared to those with other CD4 cell count categories.</p

Magnitude of follow-up CD4 cell count by demographic and baseline treatment variables among patients on anti-retroviral therapy (N = 1,321).

<p>Magnitude of follow-up CD4 cell count by demographic and baseline treatment variables among patients on anti-retroviral therapy (N = 1,321).</p

Kaplan-Meier survival functions by WHO Stage (n = 1,282).

<p>Event free survival, the even being free of immunological treatment failure, was higher for patients with WHO stages I or II as compared to those with WHO stage III or IV.</p

Life table for immunological failure among patients on anti-retroviral therapy (n = 1,282).

<p>Life table for immunological failure among patients on anti-retroviral therapy (n = 1,282).</p

Cox proportional hazards regression analysis for predictors of immunological failure among patients on anti-retroviral therapy (n = 1,282).

<p>Cox proportional hazards regression analysis for predictors of immunological failure among patients on anti-retroviral therapy (n = 1,282).</p

Immunologic failure risk assessment and management tool.

<p>Immunologic failure risk assessment and management tool.</p

Follow-up immunological evaluation and final immunological status of patients with immunological failure (n = 226).

<p>Follow-up immunological evaluation and final immunological status of patients with immunological failure (n = 226).</p

Description of follow-up time in years for study patients on anti-retroviral therapy (n = 1,282).

<p>Description of follow-up time in years for study patients on anti-retroviral therapy (n = 1,282).</p