Human Immuno deficiency Virus Infection is the commonest public wellness problems in the glob in general and in sub Saharan countries in particular^[1]. Multispectral based global Access to HIV control, Care was adopted and implemented in Ethiopia^[2].Lack of sufficient manpower, fragile supply of management and distribution, and incompetent administrative power at all levels are the main barrier in the country’s tackling for the diseases^[3].

One of the obstacles in care and treatment of patients is discontinuation of drugs due to lose to attend and defaulter. Death of Human Immuno Virus infection in turn increases as the consequent of development of drug resistance and incapability of immune system as withdrawal of drugs decreases effectiveness and because of this white blood cell count decreases there by viral load duplicates. Strong retention is one of the mechanisms by which viral load decrement in Uganda effectively implemented as 84%^[4].

A number of factors associating with ART discontinuation are sociodemographic characteristics, psychosocial issues, patient perception and knowledge, pattern of drugs and side effect of treatments^[5]. One study showed that 51% of drug interruption was because of delay of physician’s advice^[6]. Another predictor for drug discontinuation was patient’s problem and medication related problems^[7]. It is mandatory to maximize level of compliance and sustain ability of drugs in third world nations^[7]. Close follow up and consistent advice to improve adherence should be emphasized to lower ART failure^[8]. So that, knowing the magnitude and reasons for the problem and appropriate intervention studies can improve the overall performance of ART in the health center and hence this research targeted to explore drug discontinuation prevalence and its related factors^[9].

Aim

The main aim of the current study was to assess magnitude of ART discontinuation and its determinants among adult HIV-AIDS patients.

Ethical Approval

Once ethical approval letter was received from Universal Medical College Research and Publication office, approbation letter was got from Kirkos medical Center prior to data gathering process was begun. Oral agreement was accepted from each research subjects. solitude of patient was verified and secrecy of the patients were authorized by excluding patient’s identity and adopting tabulates to differentiate documents on interpretation plus all participants were kindly requested to participate voluntarily.

Method and study participants

Setting and Period

The research was carried out at Kirkos Sub City Kirkos Health Center Addis Ababa; Ethiopia from June 2019 up to August 2019.

Design of the Study

Single health institution targeted cross sectional study layout was applied to explore occurrence of Antiretroviral treatment interruption and its related predictors among adult AIDS patients who were following their clinical care in Kirkos Health Center, Addis Ababa, Ethiopia.

Population

Target population

Adult HIV-AIDS patients who started ART and who were on follow up at Kirkos Health Center.

Sample population

All Adult Patients living with HIV/AIDS using ARV drugs at Kirkos Sub-city Kirkos Health Center at the time of data collection.

Criteria

Inclusion criteria

Patients who were on ART follow up at Kirkos Health Center for at least 3 months and whose Ages were 18 years and above.

Exclusion criteria

Critical patients who are not able to cooperate for in-depth interview .Participants with hearing and speech impairment

Determination of number of Participants

Size of research participants sample size was calculated by applying level of drug interruption rate to 12.3% ^[20] and 5% degree of precision with 95% certainty gap. Depending on all these criteria and using simple population proportion formula, the exact study subjects’ sample size was found to be as follows.

Thus, n = number of studyparticipants

Z ∝/2 = interpretive value 1.96

P = drug Interruptionlevel 12.3 % ^[20]

d = degree of freedom = 0.05

Hence, the number of research participants were again calculated using

n = (1.96)² x 0.123 (1-0.123)/ 0.05²

= 165.75 ≈166

Since the total of the source patient is less than 10,000 which were 1200, the number of research participants was estimated by applying corrected medical calculation as

NF =____n_____

         1 + n/N

Namely: NF = Total participants, n = size of source patient, N = study population

NF = _____166_______ = 145.8

          1 + 166/1200

Total = 146

Therefore, 146 total HIV-AIDS adult patients were the final sample size on whom, the researcher planned to collect data.

Sampling technique/sampling procedures

According to participant selection criteria, total adult RVI Population with a follow up at Kirkos Health Center, during data collection time that fulfilled the involvement criteria. Study subjects selected from the rest of RVI patients by using basic systematic selection technique.

Information gathering procedures

Information gathered from participants using validated and organized information investigator administered data gathering tool and formally designed patient profile check list which was adopted from different literatures. Both the questionnaire and checklist were developed in English and then the tool was verified, checked for its clarity and understand ability with completeness, in case some unclear questions that need revision was corrected before the beginning of data collection by data collectors (See supplementary materials).

Research variables

Outcome variable: ART discontinuation

Independent variable

a Age of patient

a Sex

a Ethnicity

a Substance Abuse

a Patient and physician Relation ship

a Access to medical care

a Medication adverse effect

a Emotional and practical support

Data interpretation and analysis procedures

Information was inserted, cleaned and interpreted using Statistical Package for Social Science version twenty and significant relation between drug discontinuation level and each independent variable was considered as factor when p is less than 0.05 with 95% Confidence Interval, AOR was greater than one. The finding was presented by using tables, figures and graphs when necessarily. Bivariate logistic regression applied to see the relationship between each independent variable with discontinuation prevalence then, factor having p less than 0.2 was reentered at multivariate logistic regression to show related factors for occurrence of ART discontinuation. Factors with p value of <0.05, CI not containing 1 in between at 95% and AOR of > 1 were considered as statistically significant factors for ART discontinuation.

Data quality management

The prepared self-administered questionnaire and checklist was checked by researchers. The questionnaire was translated to Amharic before conducting the study, pre-test of the questionnaire was performed. The investigator cheeked the collected data for completeness, accuracy clarity procedures also carefully considered to maintain the quality of the study Repeated visits were conducted where first visit have been a failure in the data collection process.

Operational definitions

Adherence: The extent to which patients taking drugs in accordance with standard of science and agreed recommendations by a health care provider.

Noncompliance: Lack of capacity, motivation to take medication.

Discontinuation: Therapy stopping all antiretroviral drugs for at least one month

Lost to Follow Up: Patients who do not take medication for > 3 month start from the final attendance.

Results

Socio-demographic characteristics of research participants

From the whole of 146 persons who took part in the research, 103 (70.5) females and 43 (29.5) males. Of the respondents, majority were the age range of 26-35 years, 56 (38.4) followed by age range of 36-45, 53 (36). The majority of the participants had primary school complete 29.5% followed by secondary school completed were 23.3% and the rest participants were diploma and degree holders respectively. As to the religion of respondents, 118[80.8%], 18[12.3%] and 7[4.8%], were Orthodox Christian, Muslim and Protestants respectively. From the respondents, 61[41.8%] were married and 59[40.4] were single. Majority monthly income of respondents 85[58.2%] were earn less than 1500 ETB and 56[38.4%] earned between 1500 and 5000 ETB (See table 1 below for demographic background of study participants).

Table 1: Demographic background of study subjects of ART Discontinuation in Kirkos Health Center, Addis Ababa, Ethiopia, 2019(n=146).

Prevalence of ART medication Discontinuation

Around 146 patients considered in the exploration of drug interruption, only 22 (15.1%) of them discontinued their ART medications while 84.9% were taking their ART without discontinuation (see figure 1 below, for prevalence of discontinuation in Retroviral viral infection patients).

Figure 1: Factors associated with Antiretroviral Treatment Interruption

Findings from the logistic regression analysis clearly indicated that fear of medication adverse effect (AOR = 0.062(0.001-3.461), lack of social support (AOR = 4.164(0.419-41.427)) having substance abuse (AOR = 2.244(0.365-13.803) and relationship with clinician (AOR =0.084(0.013-0.530) were the major associated factors for discontinuation (See Table 2 below for factors related to ART discontinuation done using regression).

Discussion

This study showed that 22(15.1%) of them had withdrawn their treatment. Women were more discontinued their antiretroviral therapy due to toxicity symptoms such as headache, anemia, gastrointestinal irritations and depressions^[23]. ART drug interruption levelfrom this research was higher than studies from USA (6%)^[5], Uganda (13.7 %)^[16], Addis Ababa University (12.3%)^[20], Tigray (11 %)^[21], and Jimma (13.6 %)^[26]. But it was lower than results from research’s doneat Argentina (30.8%)^[13], Boston (17%)^[14], South Africa (35.4%)^[15], Nigeria (28%)^[25].

This result was in similar with a trend research conducted at Kenya Nairobi from where ART withdrawal had been increased from 17% to 18% in one-year difference. With respect to Sex, this result was similar with the research carried out at certain place at Ethiopia^[24]. According to this finding the proportion of females who discontinue their ART drugs were 48% vs 52% and this result was comparable with the study carried out at South Africa^[27]. The level of ART interruption in the current study indicated thatmore RVI patients were wind rowing their medication and it was below the allowed interruption. As the consequent of this, health care professionals including pharmacist while they are dispensing, physicians when they prescribe and nurses when they administer drugs, should increase the compliance of RVI patients for their medication to 98%^[4].

According to this study, RVI patients with the age group of 18-45 years, were shown to have lower Antiretroviral treatment discontinuation rate as compared with >45 years old RVI patients due toprobably, more frequent social drug abuse and carelessness^[5]. However, there were no significance difference in discontinuation of ART drugs between male and female as per result of this research^[12]. Despite no difference in proportion of ART interruption with respect to sex, there were different studies which showed that males were more interrupting their ART medication than females^[13,21,27]. This was probably due to study subject selection bias in terms of gender^[22].

This research indicated that RVI patients who ignored professional’s advice and counseling were windrowing their ART 4.084 times more than HIV AIDS patients who had good contact with health professionals at the time of their follow up in the study center (AOR=4.084; CI 95%=0.013-0.530; P=0.023) (see table 2).This finding was similar with the study conducted at South wollo, Ethiopia (AOR = 2.31(95% CI: 1.94- 4.63)^[17]. This was because, ignorant of health care professionals counseling can reduce adherence of medications^[10].

The risk of ART interruption was significantly associated with history of social drug abuse of RVI patients and it was judged that patients with chat and alcohol social drug abuse with were probably discontinuing their medication 2.244 times more than AIDS patients who did not have social drug abuse history (AOR= 2.244 , CI 95%= 0.365-0.803, P=0.01 ) (see table 2). This significant association was similarly shown from the study conducted at Nepal (AOR = 12.89, p =,0.00)^[28]. The significant association was due to alcohol addiction minimizes compliance of medication in RVI patients. Different studies had recommended that advancement of knowledge of RVI patients on social drug abuse can reduce drug discontinuation^[10,11].

Another related factor found with interruption of Antiretroviral treatment from this research was absence of social support (AOR=4.164, CI 95%=9.419-41.427, P= 0.03) (see table 2). As per this study, RVI patients who had not social support from the community and family were interrupting their ART Medication 4.164 times more than patients who were supported by family and socially. The interrelation of discountitution of ART medication and lack family and social support has been implied by different studies carried out at different hospitals (AOR = 2.387, CI.95% = 1.155-4.93, p=0.019)^[18], (AOR = 2.61; 95 % CI = 1.45–4.72)^[29]. This might be lack of reminding of time at which drug could be taken is entirely assured by families and care givers when needed. But in the case of this study, lack of reminder and supporter of patient was significantly associated with drug discontinuation.

Conclusion and Recommendation

The magnitude of ART discontinuation in Kirkos Health Center was 15.1% among 146 participants. The trend of ART discontinuation was increased recently from 12.3% to 15.1% in Addis Ababa City. Factors associated with discontinuation were more likely to be females (sex), medication adverse effect, and lack of social and psychological support, substance abuse and poor relationship with clinician. Federal Ministry of health should afford safe and effective ART medications to minimize ART discontinuation due to side effect/adverse effect and improve the relationships between clinicians and patients to alleviate poor adherence.

Acknowledgements

We authors are very much excited and gland to our supporters for their unwavering guidance and constructive recommendations and comments from the initial phase of proposal drafting to paper final submission at this Journal. We want to thank Universal Medical College for sponsoring of the research completionto this final. Finally, our deepest gratitude and thanks goes to Yekatit 12, Hospital Medical College health care professionals who assisted and permitted us in gathering and finalizing data collection from the stated hospital.

Authors Contribution: GA; did the research Conceptualization; Data curation; Formal analysis; Funding acquisition; Investigation; Methodology; Project administration; Resources; Software; Supervision; Validation; Visualization; and had Roles of Writing – original draft; Writing – review & editing.

Funding: This work was supported by Universal Medical and Business College but the funding agent had no decision of submitting the manuscript.

Data Sharing Statement

The data sets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Consent for Publication

Not applicable. No individual personal details, images or videos were being used in this study.

Conflict of interest/ Disclosure

“I confirm and declare that there is no conflict of interest regarding the publication of this paper at this Journal.”

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