Treatment outcomes of second line antiretroviral therapy in Mbagathi District Hospital Comprehensive Care Clinic

Abstract

Background Human Immunodeficiency Virus (HIV) is one of the leading causes of morbidity and mortality in sub-Saharan Africa. In Kenya, an estimated 1.5 million people are living with HIV. Antiretroviral Therapy (ART) has been in use in public health facilities since 20031. ART scale up has significantly reduced morbidity and mortality. As at December 2012, there were 606,793 patients on ART in 1405 sites country wide. It is estimated that 3.2% of these are on second line ART corresponding to a total of 19,4172. As more patients are put on ART, the number requiring second line therapy has continued to increase. The aim of this study was to determine treatment outcomes of patients on second line ART at Mbagathi District Hospital, Compressive Care Clinic (MDH-CCC) Objectives The primary objectives of this study were: to determine the clinical, immunologic and virologic outcomes of patients on second line ART and to determine their adherence using pharmacy refill records. A subset of the population was used to determine retention in care after switch to second line ART. Methodology This was a retrospective observational cohort study. Patients who had been switched to second line ART between January 2005 and March 2012 were studied to determine clinical, immunologic and virologic outcomes; and to determine levels of adherence. A subset of this population who had been switched to second line ART between January 2008 and March 2012 were studied to determine retention in care. Results We found 93% of patients had successful clinical treatment outcomes while those with successful immunologic outcomes were 90%. We found 87% of patients had adequate viral suppression. The proportion of patients with satisfactory adherence was 98%. Out of the patients with virologic failure, only 4 (11.8%) had both virologic and immunologic failure. Another 4 (11.8%) had both clinical and virologic failure while only 1 had clinical, immunologic and virologic failure. Unsatisfactory adherence (<95%) was noted in 2 patients (5.9%) with virologic failure. We found that immunologic criteria would fail to identify 88% of patients with virologic failure. There were 161 (82%) patients retained in care after a mean duration of follow up of 35 months. Conclusion We showed that second line ART is associated with good clinical, immunologic and virologic outcomes in MDH-CCC as expected. We found that most patients had satisfactory adherence to their therapies. Retention in care after switch to second line ART was high.