Factors associated with Human Immunodeficiency Virus first line treatment failure in Zvishavane District, Midlands Province, 2014

Globally, first line HIV treatment failure remains a challenge particularly in resource constrained settings. Midlands Province 2013 data showed that Zvishavane district had the highest prevalence of first line treatment failure at 16% against a national average of 1%. First line ART failure comes with poor treatment outcomes. We conducted a study to determine factors associated with first line HIV treatment failure in Zvishavane district. Methods: A 1:1 unmatched case control study was conducted. A case was an HIV positive patient who was on first line ART for >6 months in Zvishavane district and was switched to second line ART regimen because of treatment failure in 2013/2014. A control was an HIV patient in Zvishavane district who had been on first line ART for >6 months and had not failed first line ART. Pretested interviewer administered questionnaires were used to collect data from randomly selected participants from health facilities registers. Logistic regression analysis was conducted. Results: A total of 246 participants, 123 cases and 123 controls, were recruited. Independent risk factors were poor adherence (<80% adherence) to ART [AOR=5.14, 95%CI (2.75-9.62)], drug stock outs [AOR=3.02, 95%CI (1.20-6.98)], baseline CD4 count of <50 cells/mm3 [AOR=3.25, 95%CI (1.47-7.16)] and baseline WHO Stage 3 or 4 [AOR=1.95, 95%CI (1.05-3.61)]. Drug stock outs were a significant determinant of poor ART adherence [OR=3.09, 95%CI (1.83-5.21)]. Conclusion: Low baseline CD4 count and WHO stage 3 or 4 at ART initiation is associated with treatment failure. Improving adherence and avoiding ART drug stock outs may reduce treatment failure

Factors associated with Human Immunodeficiency Virus first line treatment failure in Zvishavane District, Midlands Province, 2014

Globally, first line HIV treatment failure remains a challenge particularly in resource constrained settings. Midlands Province 2013 data showed that Zvishavane district had the highest prevalence of first line treatment failure at 16% against a national average of 1%. First line ART failure comes with poor treatment outcomes. We conducted a study to determine factors associated with first line HIV treatment failure in Zvishavane district. Methods: A 1:1 unmatched case control study was conducted. A case was an HIV positive patient who was on first line ART for >6 months in Zvishavane district and was switched to second line ART regimen because of treatment failure in 2013/2014. A control was an HIV patient in Zvishavane district who had been on first line ART for >6 months and had not failed first line ART. Pretested interviewer administered questionnaires were used to collect data from randomly selected participants from health facilities registers. Logistic regression analysis was conducted. Results: A total of 246 participants, 123 cases and 123 controls, were recruited. Independent risk factors were poor adherence (<80% adherence) to ART [AOR=5.14, 95%CI (2.75-9.62)], drug stock outs [AOR=3.02, 95%CI (1.20-6.98)], baseline CD4 count of <50 cells/mm3 [AOR=3.25, 95%CI (1.47-7.16)] and baseline WHO Stage 3 or 4 [AOR=1.95, 95%CI (1.05-3.61)]. Drug stock outs were a significant determinant of poor ART adherence [OR=3.09, 95%CI (1.83-5.21)]. Conclusion: Low baseline CD4 count and WHO stage 3 or 4 at ART initiation is associated with treatment failure. Improving adherence and avoiding ART drug stock outs may reduce treatment failure

Factors associated with Human Immunodeficiency Virus first line treatment failure in Zvishavane District, Midlands Province, 2014

Globally, first line HIV treatment failure remains a challenge particularly in resource constrained settings. Midlands Province 2013 data showed that Zvishavane district had the highest prevalence of first line treatment failure at 16% against a national average of 1%. First line ART failure comes with poor treatment outcomes. We conducted a study to determine factors associated with first line HIV treatment failure in Zvishavane district. Methods: A 1:1 unmatched case control study was conducted. A case was an HIV positive patient who was on first line ART for >6 months in Zvishavane district and was switched to second line ART regimen because of treatment failure in 2013/2014. A control was an HIV patient in Zvishavane district who had been on first line ART for >6 months and had not failed first line ART. Pretested interviewer administered questionnaires were used to collect data from randomly selected participants from health facilities registers. Logistic regression analysis was conducted. Results: A total of 246 participants, 123 cases and 123 controls, were recruited. Independent risk factors were poor adherence (<80% adherence) to ART [AOR=5.14, 95%CI (2.75-9.62)], drug stock outs [AOR=3.02, 95%CI (1.20-6.98)], baseline CD4 count of <50 cells/mm3 [AOR=3.25, 95%CI (1.47-7.16)] and baseline WHO Stage 3 or 4 [AOR=1.95, 95%CI (1.05-3.61)]. Drug stock outs were a significant determinant of poor ART adherence [OR=3.09, 95%CI (1.83-5.21)]. Conclusion: Low baseline CD4 count and WHO stage 3 or 4 at ART initiation is associated with treatment failure. Improving adherence and avoiding ART drug stock outs may reduce treatment failure

Anti-retroviral therapy after “Treat All” in Harare, Zimbabwe: What are the changes in uptake, time to initiation and retention?

Background: In Zimbabwe, Harare was the first province to implement “Treat All” for people living with human immunodeficiency virus (PLHIV). Since its roll out in July 2016, no study has been conducted to assess the changes in key programme indicators. We compared antiretroviral therapy (ART) uptake, time to ART initiation from diagnosis, and retention before and during “Treat All”. Methods: We conducted an ecological study to assess ART uptake among all PLHIV newly diagnosed before and during “Treat All”. We conducted a cohort study to assess time to ART initiation and retention in care among all PLHIV newly initiated on ART from all electronic patient management system-supported sites (n=50) before and during “Treat All”. Results: ART uptake increased from 65% (n=4619) by the end of quarter one, 2014 to 85% (n=5152) by the end of quarter four, 2018.  A cohort of 2289 PLHIV was newly initiated on ART before (April-June 2015) and 1682 during “Treat all” (April-June 2017). Their age and gender distribution was similar. The proportion of PLHIV in early stages of disease was significantly higher during “Treat all” (73.2% vs. 55.6%, p&lt;0.001). The median time to ART initiation was significantly lower during “Treat All” (31 vs. 88 days, p&lt;0.001). Cumulative retention at three, six and 12 months was consistently lower during “Treat all” and was significant at six months (74.9% vs.78.1% p=0.022). Conclusion: Although there were benefits of early ART initiation during “Treat All”, the programme should consider strategies to improve retention.</ns4:p

Anti-retroviral therapy after “Treat All” in Harare, Zimbabwe: What are the changes in uptake, time to initiation and retention?

Background: In Zimbabwe, Harare was the first province to implement “Treat All” for people living with human immunodeficiency virus (PLHIV). Since its roll out in July 2016, no study has been conducted to assess the changes in key programme indicators. We compared antiretroviral therapy (ART) uptake, time to ART initiation from diagnosis, and retention before and during “Treat All”. Methods: We conducted an ecological study to assess ART uptake among all PLHIV newly diagnosed before and during “Treat All”. We conducted a cohort study to assess time to ART initiation and retention in care among all PLHIV newly initiated on ART from all electronic patient management system-supported sites (n=50) before and during “Treat All”. Results: ART uptake increased from 65% (n=4619) by the end of quarter one, 2014 to 85% (n=5152) by the end of quarter four, 2018.  A cohort of 2289 PLHIV were newly initiated on ART before (April-June 2015) and 1682 during “Treat all” (April-June 2017). Their age and gender distribution was similar. The proportion of PLHIV in early stages of disease was significantly higher during “Treat all” (73.2% vs. 55.6%, p&lt;0.001). The median time to ART initiation was significantly lower during “Treat All” (31 vs. 88 days, p&lt;0.001). Cummulative retention at three, six and 12 months was consistently lower during “Treat all” and was significant at six months (74.9% vs.78.1% p=0.022). Conclusion: Although there were benefits of early ART initiation during “Treat All”, the programme should consider strategies to improve retention.</ns4:p

Evaluation of the Zimbabwe HIV Case Surveillance Pilot Program, 2019 (Preprint)

BACKGROUND Zimbabwe has a high burden of HIV, with an estimated 1.3 million people living with the virus and an HIV prevalence and incidence of 13.8% and 0.48%, respectively (2017 Spectrum estimates). In 2017, the Zimbabwe Ministry of Health and Child Care (MOHCC) developed and implemented a pilot of HIV case surveillance (CS) based on the 2017 World Health Organisation (WHO) Person-centred HIV patient monitoring (PM) and case surveillance guidelines. As the case surveillance guidelines were new, lessons learned from field implementation experiences were intended to inform the development of HIV case surveillance implementation guidance and tools. OBJECTIVE At the end of the pilot phase, the Ministry of Health and Child Care (MOHCC) commissioned an evaluation to inform further steps. METHODS Two districts, Umzingwane in Matabeleland South Province and Mutare in Manicaland Province were commissioned to run the CS pilot from August 2017 to December 2018. During this period, 1602 people living with HIV (PLHIV) newly diagnosed with HIV were reported in the CS system, while other HIV sentinel events, including ART initiation and first viral load test, were routinely reported. A mixed-methods cross-sectional study of stakeholders and health facility staff was used to assess the following CS system features: design and operations, performance, usefulness, sustainability and scalability. A total of 13 stakeholders responded to an online questionnaire, while 33 health facility respondents were interviewed in 11 health facilities in the two pilot districts. RESULTS The HIV CS system was adequately designed for Zimbabwe’s context, integrated within existing health information systems at the facility level. However, the training was minimal, and an opportunity to train the data entry clerks in data analysis was missed. The system performed well in terms of surveillance and informatics attributes. However, viral load test results return was a significant problem. The system was used at the health facility level to track the HIV positive clients in their catchment area; all facilities that were visited were aware of what is happening to their clients. Almost all respondents believed that the country can roll out the HIV CS system to all facilities with partner support. CONCLUSIONS The HIV CS system was found useful at the health facility level and should be rolled out in a phased manner, beginning with all facilities in Manicaland and Matabeleland South provinces. An electronic link needs to be made between the health facilities and the laboratory to reduce viral load test results delays. Lessons learned from the provincial roll out can be used for a nationwide scale-up. </sec