Evaluation of Namibia's antiretroviral therapy guidelines' recommendations for switching from first-line to second-line, using predictors of first-line treatment failure: an exploratory study

F Kalemeera, ST Ndevahoma, M Mubita, Brian Godman

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: The objective of this study was to find out the extent to which the antiretroviral therapy (ART) switching guidelines were complied with and to assess whether immediate switching from first- to second-line ART would have been appropriate than attempting to comply with the guidelines. Methods: A case–control study. Cases and controls were patients on second- and first-line ART, respectively. Regression analysis was used to identify factors that were associated with switching to second-line ART. Confidence level was 95% and significance at a p-value <0.05. Results: 81 cases and 102 controls were included. VLs at six and 9 months were implemented for 8.2% and 2.7%, respectively. Switching predictors were poor adherence (adjusted Hazard Ratio [aHR] = 20.3 (p = 0.013); a first VL >1000 copies/ml (aHR = 20.2), <0.001); opportunistic infections (aHR = 12.9, p = 0.006); male gender (aHR = 5.2, p = 0.003); and lack of adherence counseling (aHR = 3.8 p = 0.024). Conclusion: AVL >1000 copies/ml was a predictor of switching. New local research is underway, with a large number of patients, to assess whether this finding applies to the dolutegravir-based regimens.

Original languageEnglish
Number of pages14
JournalExpert Review of Anti-infective Therapy
Early online date4 Jan 2022
DOIs
Publication statusE-pub ahead of print - 4 Jan 2022

Keywords

  • Namibia
  • antiretroviral therapy
  • guidelines
  • evaluation
  • viral load
  • switching
  • predictor
  • case-control study

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