Incidence, survival, and risk factors for first-line antiretroviral therapy failure among adults on ART follow-up in health facilities in Southwest Shoa, Oromia, Ethiopia, 2023: a retrospective cohort study

Abstract Background The inability of antiretroviral medications to inhibit HIV is known as antiretroviral treatment failure. One of the greatest problems facing HIV patients receiving antiretroviral therapy is treatment failure. Updated data is crucial to assess program realities and effectiveness on ART. In this study, we aimed to determine incidence, survival, and risk factors for first-line ART failure by incorporating clinical, immunological, and virologic criteria, including primary health care. Methods A retrospective cohort study was conducted among 579 adult patients. These patients were followed between January 1, 2016, and October 2023. Double-stage cluster sampling was used. The data were entered into Epi-Data version 3.1, then cleaned and analyzed via SPSS v.25. The Kaplan–Meier curve was used to estimate the probability of first-line ART failure. The log-rank test was used to compare the time to treatment failure. The Cox proportional hazard model was used to determine predictors of first-line ART failure. Results The overall incidence rate of first-line ART failure was 2.57/1000 person-months over 24,925.7 person-months of follow-up. The patients’ cumulative survival probabilities at 12 and 84 months were 100% and 76.73%, respectively. Predictor variables of first-line ART failure were male sex (AHR = 1.953; 95% CI: 1.11–3.43), disclosure of HIV infection (AHR = 0.53; 95% CI: 0.29–0.95), tuberculosis and HIV coinfections (AHR = 2.79; 95%CI: 1.33–5.87), opportunistic infections (AHR = 2.34; 95% CI: 1.23–4.28), poor/fair adherence (AHR = 3.87; 95% CI: 2.13–7.03), WHO clinical stage III/IV (AHR = 2.54; 95% CI: 1.04–6.20), and provision of CPT (AHR = 0.20; 95% CI: 0.08–0.51). Conclusions and recommendations The low incidence of first-line ART failure suggests effective ART implementation in the region. However, first-line ART failure was significantly linked to advanced WHO stage, poor adherence, TB/HIV coinfection, male sex, lack of cotrimoxazole prophylaxis, non-disclosure of HIV status, and opportunistic infections. These findings showed the need for early monitoring, adherence support, and comprehensive care. Clinical trial number Not applicable.