Antiretroviral Therapy Discontinuation among Adults Receiving HIV Care in Kadoma City in 2015-2019

Abstract

Background: Discontinuation remains a legitimate threat to the long-term success of antiretroviral therapy (ART) scale-up in Zimbabwe. Furthermore, the characteristics associated with ART discontinuation and trends are poorly understood in developing countries like Zimbabwe. We analysed the HIV/AIDS data to describe the characteristics associated with ART discontinuation and the trends from 2015 to 2019. Methods: We conducted an analytical cross-sectional study using secondary data from Electronic Patient Management System (ePMS) in Kadoma City. We interviewed eighteen health care workers to find the reasons for ART discontinuation. Data were analysed using Microsoft Office Excel 2016 and Epi info 7 version 7.2.2.6. Microsoft office excel was used to generate linear graphs to demonstrate the trends in ART discontinuation in Kadoma City in 2015-2019. Epi info 7 was used to generate fre-quencies, means, prevalence odds ratios p-values, and 95% confidence intervals (CI) and significance testing. Backward stepwise logistic regression analysis was done to determine the independent factors associated with discontinuation. Results: A total number of 2833 patients were enrolled on ART from 2015 to 2019. One hundred and seventy-three 173/2833 attended school (adjusted pOR = 3.9, [95% CI: 2.5 - 6.0], p = 0.003) and having immunological failure (adjusted pOR = 6.2, [95% CI: 4.5 - 8.6], p = 0.0001). The reasons mentioned by the health care workers which cause people living with HIV (PLHIV) to discontinue ART were health state not improving 13/18 (72.2%), participating in artisanal mining activities 11/18 (61.1%), change in marital status 9/18 (50.0%), medical side effects of ART 8/18 (44.4%), living far from health facilities 5/18 (27.8%) and relocating to neighbouring countries 3/18 (16.7%). Conclusion: We concluded that the characteristics associated with ART discontinuation were having never attended school, being less than forty years of age and having immunological failure. The reasons why patients discontinue ART were health state not improving, participating in artisanal mining activities, change in marital status, medical side effects of ART, living far from health facilities, and relocating to neighbouring countries. We recommended continuous provision of health education, enhanced adherence counselling sessions to those with unsup-pressed viral loads and investigating the cause of virologic failure.