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HIV Treatment Failure in Uganda: A Case Study at Mbarara JCRC HAART Clinic

This case study examines HIV treatment failure among patients on HAART at Mbarara JCRC Clinic in Uganda. Findings suggest delayed identification and management of failure despite low prevalence of HIVDR mutations. The study highlights the importance of therapy duration on treatment outcomes in experienced patients.

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HIV Treatment Failure in Uganda: A Case Study at Mbarara JCRC HAART Clinic

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  1. Are Patients on HAART in Uganda experiencing less treatment failure than earlier anticipated? A case study of Mbarara JCRC HAART Clinic Francis Kiweewa, Harriet Namata, AbbasLugemwa, Nicholas Musinguzi, Winnie Muyindike, Ann Nakirijja, CissyKityo, Peter Mugyenyi

  2. Background and Results • Data from observational studies and programs indicate excellent response to ART in Africa • Prolonged treatment associated 20-30% failure rate • Prevalence of HIVDR mutations in the range 0f 5-10% • Infrequent laboratory monitoring and screening for treatment failure Goal: To determine the prevalence and determinants of HIV treatment failure Outcome: CD4 < 200cell/ul & VL > 400c/ml OR a VL > 5000c/ml (>12 mos on HAART) OR already switched to 2nd line Results • 4719 evaluable patients • 60% Female, and 53% married • 46% initiated ART at WHO stage 3/4 • 2.1% (100/4,719) met definition of treatment failure • 51% of failing patients were still using the same failing regimen

  3. Distribution and determinants of treatment Failure Figure 2: Definition and distribution of Treatment failure Table 1: Predictors of HIV treatment Failure

  4. Conclusions • Treatment failure may not be as common as would be expected from the high prevalence of HIVDR mutations • However identification and management of treatment failure is delayed compromising the quality of care for experienced patients • Given good adherence, duration on therapy seems to be the most important determinant of treatment failure

  5. Acknoledgement • Mbarara RCE HAART clinic staff • JCRC management • Mr. Joshua Kayiwa- biostatistician JCRC • The TREAT program and USAID Kampala

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