Incidence and predictors of antiretroviral treatment failure among children in public health facilities of Kolfe Keranyo Sub-City, Addis Ababa, Ethiopia: Institution-based retrospective cohort study.

Background: Human immunodeficiency virus (HIV) infection is a public health concern globally. The number of people living with HIV worldwide in 2018 was estimated at 37.9 million; of those, 1.7 million are children. Globally, 62% of the 37.9 million people were receiving Antiretroviral treatment (ART); and among those who were on ART, 53% had achieved viral suppression. This study aimed to assess the incidence and predictors of Antiretroviral treatment failure among children in Kolfe Keranyo sub-city, Addis Ababa, Ethiopia.

Methods: An institution-based retrospective cohort study was conducted among 250 children who were enrolled in first-line Antiretroviral treatment from January 2013 to May 2020 in Kolfe Keranyo sub-city. Data was collected by using a data extraction checklist and data were extracted by reviewing children's medical charts and electronic database. Kaplan-Meier method was used to estimate the probability of treatment failure. During bivariable analysis variables with p-value < 0.25 were taken for multivariable Cox regression analysis to assess predictors of treatment failure. Statistically significant association was declared at p-value < 0.05 with a 95% confidence interval.

Result: The overall proportion of treatment failure within the follow-up period was 17.2%. This study also found that the overall incidence rate was 3.45 (95% CI: 2.57-4.67) per 1000 person-month observation. Infant prophylaxis for PMTCT (AHR: 3.59, 95% CI: 1.65-7,82), drug substitution (AHR: 0.18, 95% CI: 0.09-0.37), AZT/3TC/NVP based regimen (AHR: 2.27, 95% CI: 1.14-4.25), and more than 3 episodes of poor ART adherence (AHR: 2.27, 95% CI: 1.17-4.38) were found to be predictors of treatment failure among children.

Conclusion: High proportion of treatment failure was found among children on first-line ART in Kolfe Keranyo sub-city, Addis Ababa according to the UNAIDs virological suppression targets. Infant prophylaxis for PMTCT, drug substitution, AZT/3TC/NVP based initial regimen, and poor ART adherence were found to be predictors of first-line ART treatment failure. Close follow-up of children on medication adherence and revising the AZT/3TC/NVP based regimen need to be considered.