Sociodemographic characteristics of respondents
The overall response rate was 100%. The median age of respondents was 39 years. Two hundred fifteen (54.6%) respondents were females. Most of the respondents (362, 91.9%) were from the Amhara ethnic group. Nearly half of the respondents (48.7%) were married. Forty percent of the respondents completed secondary education. Regarding the occupation of respondents, 114 (28.9%) were civil servants, and 52 (13.2%) were housewives. Two hundred thirty-three (59.1%) of the respondents were living with their families. Three hundred thirty-three (84.5%) of the respondents were urban residents (Table 1).
Table 1: Sociodemographic characteristics of patients on second-line antiretroviral therapy at Dessie City administration public hospitals, Northeast Ethiopia, 2021
Item
|
Variable
|
Frequency
|
Percent
|
Sex
|
Male
|
179
|
45.4
|
Female
|
215
|
54.6
|
Ethnicity
|
Amhara
|
362
|
91.9
|
Oromo
|
21
|
5.3
|
Others*
|
11
|
2.8
|
Marital status
|
Single
|
70
|
17.8
|
Married
|
192
|
48.7
|
Divorce
|
86
|
21.8
|
Windowed
|
46
|
11.7
|
Religion
|
Orthodox
|
198
|
50.3
|
Muslim
|
183
|
46.4
|
Protestant
|
10
|
2.5
|
Others**
|
3
|
.8
|
Educational status
|
.Illiterate
|
43
|
10.9
|
Read and write
|
53
|
13.5
|
Primary
|
64
|
16.2
|
Secondary
|
158
|
40.1
|
College and above
|
76
|
19.3
|
Occupation
|
Merchant
|
51
|
12.9
|
Housewife
|
52
|
13.2
|
Student
|
10
|
2.5
|
Private
|
85
|
21.6
|
Civil servant
|
114
|
28.9
|
Farmer
|
31
|
7.9
|
Daily laborer
|
36
|
9.2
|
Other***
|
15
|
3.8
|
Whom do you live with
|
Live alone
|
125
|
31.7
|
My family
|
233
|
59.1
|
My parents
|
34
|
8.6
|
Other ****
|
2
|
.5
|
Residence
|
Urban
|
333
|
84.5
|
Rural
|
61
|
15.5
|
*Tigre, Gurage, ** Catholic, Waqifeta, *** No occupation, bar lady, **** partner
Behavioral characteristics of people on second-line ART
Of the total respondents, 246 (62.4%) had ever used substances in the last three months. Among respondents who had a history of substance use in the last three months, twenty-two (5.6%) used alcohol, 27 (6.9%) used cigarate/tobacco, 35 (8.9%) used chats and 8 (2%) used shisha on a daily basis (Table 2).
Table 2: Behavioral characteristics of patients on second-line antiretroviral therapy at Dessie City administration public hospitals, Northeast Ethiopia, 2021
Items
|
Variables
|
frequency
|
percent
|
Substance use(alcohol) in the last three months
|
Never use
|
261
|
66.2
|
Once or two times
|
21
|
5.3
|
Once every month
|
7
|
1.8
|
Once every week
|
83
|
21.1
|
Daily
|
22
|
5.6
|
Substance use (cigarate/tobaco) in the last three months?
|
Never use
|
360
|
91.4
|
Once or two times
|
2
|
.5
|
Once every week
|
5
|
1.3
|
Daily
|
27
|
6.9
|
Substance use (chat) in the last three months?
|
Never use
|
224
|
56.9
|
Once or two times
|
8
|
2.0
|
Once every month
|
7
|
1.8
|
Once every week
|
120
|
30.5
|
Daily
|
35
|
8.9
|
Substance use(shisha/canabis)in the last three months
|
Never use
|
362
|
91.9
|
Once or two times
|
2
|
0.5
|
Once every week
|
22
|
5.6
|
Daily
|
8
|
2.0
|
Psychosocial factors
Three-fourths of the respondents (296, 75.1%) had adherence supporters. Among those who had adherence support, 234 (79.1%) had support from family. Psychological/advice support was the main kind of support. More than one-third (34%) of respondents were members of HIV-related social organizations. Seventy-eight percent of respondents disclosed their HIV status to their families. One hundred forty-eight (37.6%) respondents were experiencing stigma from others. Three hundred twelve (79.2%) of respondents were uncomfortable taking ART in the presence of others (Table 3).
Table 3: Psychosocial characteristics of patients on second-line antiretroviral therapy at Dessie city administration public hospitals, Northeast Ethiopia, 2021.
Items
|
Variable
|
frequency
|
Percent
|
Have adherence supporter
|
Yes
|
296
|
75.1
|
No
|
98
|
24.9
|
From whom do you have support
|
Family
|
234
|
79.1
|
Friends
|
28
|
10.1
|
Relatives
|
23
|
7.8
|
Others
|
9
|
3
|
Kind of support
|
Material/money
|
43
|
14.5
|
Psychological/advice
|
215
|
72.6
|
Nutritional support
|
8
|
3.4
|
Drug adherence
|
28
|
9.5
|
How many people gives you adherence support
|
No one
|
75
|
19.0
|
One or two
|
86
|
21.8
|
3-5 people
|
190
|
48.2
|
6 and above
|
43
|
10.9
|
How do you rate the possibility of getting help
|
Very difficult
|
8
|
2.0
|
Difficult
|
43
|
10.9
|
May get help
|
229
|
58.1
|
Simply I get help
|
103
|
26.1
|
Very simple to get help
|
11
|
2.8
|
Member in HIV related social organization
|
Yes
|
134
|
34.0
|
No
|
260
|
66.0
|
Disclosed your HIV status to your families
|
Yes
|
309
|
78.4
|
No
|
85
|
21.6
|
Have you experiencing stigma
|
From others
|
148
|
37.6
|
Self-stigma
|
68
|
17.3
|
No stigma
|
178
|
45.2
|
Comfortable to take ART in presence of others
|
Comfortable
|
62
|
15.7
|
Uncomfortable
|
312
|
79.2
|
Neither confortable nor uncomfortable
|
20
|
5.1
|
Drug-related characteristics of patients on second-line ART
Of the participants, 128 (32.5%) were on the 2H (TDF+3TC+ATVr) regimen of second-line ART drugs. Two hundred sixty-eight (68.0%) respondents took their medication twice daily. Nearly seventy percent of the respondents (272, 69.0%) took a total of three or more pills every day. The majority of the respondents (259, 65.7%) reported that there is a clinical benefit of 2nd-line ART to improve their quality of life. Among those reported clinical benefits, weight gain was the common clinical benefit reported by respondents, followed by minimizing hospital admission. One hundred forty-seven (37.3%) experienced adverse effects of drugs. Gastrointestinal discomfort (85, 55.6) was the most common side effect, followed by headache (41, 26.8%). The majority of the respondents (328, 83.2%) had a history of poor first-line adherence before switching to second-line ART. One hundred sixty-six (42.1%) respondents took other medications with antiretroviral therapy (ARV). Among those who took other medications with ARV, cotrimoxazole prophylaxis (CPT) was the most common (79, 47.3%). Thirty respondents had a drug substitution history while on the 2nd line (Table 4).
Table 4: Drugs used by people on second-line antiretroviral therapy in Dessie City administration public hospitals, Northeast Ethiopia 2021
Variable
|
variables
|
frequency
|
Percent
|
Name of the drugs
|
2E
|
7
|
1.8
|
2F
|
121
|
30.7
|
2G
|
1
|
0.3
|
2H
|
128
|
32.5
|
2I
|
3
|
0.8
|
Other 2nd line
|
134
|
34.0
|
Frequency of drugs
|
once per day
|
126
|
32.0
|
Twice
|
268
|
68.0
|
Total pills daily
|
Two
|
122
|
31.0
|
Three
|
135
|
34.3
|
Five
|
128
|
32.5
|
Six and above
|
9
|
2.3
|
2nd line improve quality of life
|
Yes
|
259
|
65.7
|
No
|
135
|
34.3
|
Clinical benefit
|
Weight gain
|
119
|
30.2
|
Reduced fever
|
44
|
11.2
|
Minimize hospital admission
|
46
|
11.7
|
minimize diarrhea
|
35
|
8.9
|
other benfit
|
2
|
0.5
|
Never
|
12
|
3.0
|
No benefit
|
90
|
22.8
|
Adverse effect
|
Yes
|
158
|
40.1
|
No
|
236
|
59.9
|
Type of adverse side
effects (multiple repose)
|
Nausea did you feel
|
29
|
7.4
|
Vomiting
|
30
|
19.6
|
Headache
|
41
|
26.8
|
Anemia
|
8
|
5.2
|
GI discomfort
|
85
|
55.6
|
Depression
|
24
|
15.7
|
Rash
|
8
|
5.2
|
Diarrhea
|
14
|
9.2
|
Last visit first line adherence
|
Good
|
56
|
14.2
|
Poor
|
338
|
85.8
|
Any other medication with your ARV
|
Yes
|
166
|
42.1
|
No
|
228
|
57.9
|
Drugs other than ARV
|
CPT
|
79
|
47.3
|
TPT
|
48
|
28.7
|
HTN Drug
|
21
|
12.6
|
DM drug
|
11
|
6.6
|
anti TB
|
4
|
2.4
|
Others *
|
3
|
2.4
|
Drug substitution history while on 2nd line
|
Yes
|
30
|
7.6
|
No
|
364
|
92.4
|
*Anti TB drug, anti-epilepsy drug
Attitudes and knowledge about ART
Most of the respondents 381 (96.7%) know that taking ART can delay the development of the disease into the AIDS stage. Three hundred seventy-three respondents (94.7%) knew that HIV could not be cured by ART. The majority of respondents understood that ART drugs should be taken at a specific time (382, 97.0%) and that ART drug daily doses should not be escaped (391, 99.2%). All patients agreed that drug resistance will develop if there are missing doses and ART is essential for HIV patients.
Clinical characteristics of people on second-line ART
Sixty-five (16.5%) of the respondents had a history of admission after switching to second-line ART. Forty-six (11.7%) of the respondents had chronic disease. Among those who had chronic illness, more than half had hypertensive disorder. Seventy-one percent of respondents had ever encountered opportunistic infections. Among those who had opportunistic infection, nearly one-fourth of respondents (24.1%) encountered greater than 10% body weight loss (Table 5).
Table 5: Clinical-related characteristics of patients on second-line antiretroviral therapy in Dessie City administration public hospitals, Northeast Ethiopia 2021
Item
|
Variable
|
frequency
|
percent
|
History of admission after ART start
|
Yes
|
65
|
16.5
|
No
|
329
|
83.5
|
Any chronic illness
|
Yes
|
46
|
11.7
|
No
|
348
|
88.3
|
Types of chronic illness if yes
|
HTN
|
26
|
55.3
|
DM
|
12
|
27.7
|
psychiatric disorders
|
3
|
6.4
|
Others*
|
5
|
10.6
|
OI encountered
|
oral trash/candidiasis
|
41
|
10.4
|
Herpes simplex
|
66
|
16.8
|
HIV is associated dementia
|
22
|
5.6
|
Wasting-loss of > 10% body weight
|
95
|
24.1
|
Chronic diarrhea > 30
|
67
|
17.0
|
Fever and fatigue
|
26
|
6.6
|
Cough, chest pain
|
59
|
15.0
|
Others
|
14
|
3.6
|
T- stage
|
T1
|
307
|
77.9
|
T2
|
70
|
17.8
|
T3
|
17
|
4.3
|
Have you screen for TB
|
Yes
|
392
|
99.5
|
No
|
2
|
.5
|
Last Viral load measurement
|
<1000
|
299
|
75.9
|
>1000
|
95
|
24.1
|
Functional status
|
Working
|
350
|
88.8
|
Ambulatory
|
44
|
11.2
|
Depression
|
Depressed
|
64
|
16.2
|
Not depressed
|
330
|
83.8
|
CD4 cells
|
< 350
|
98
|
24.9
|
>= 350
|
296
|
75.1
|
*TB, epilepsy
Service-related characteristics
More than half of the respondents (221, 56.1%) visited their healthcare provider every three months. Eighty-seven (22.1%) respondents had a history of missing their appointment for different reasons. Most respondents (382, 97.0%) received counseling from health care workers about treatment adherence. Fifteen percent of respondents were not satisfied with the service given in the ART clinic. More than half 206 (52.3%) of the respondents perceived that they had a medium relationship with their health care provider (Table 6).
Table 6: Service-related characteristics of patients on second-line antiretroviral therapy in Dessie City administration public hospitals, Northeast Ethiopia 2021
Item
|
Variable
|
Frequency
|
Percent
|
How frequent do you visit your health care provider
|
every month
|
165
|
41.9
|
every 2 months
|
8
|
2.0
|
every 3 months
|
221
|
56.1
|
Have you ever miss your visit because of different reason
|
Yes
|
87
|
22.1
|
No
|
307
|
77.9
|
Counseling from health care workers about treatment adherence
|
Yes
|
382
|
97.0
|
No
|
12
|
3.0
|
Were you satisfied with the service?
|
very good
|
168
|
42.6
|
Medium
|
166
|
42.1
|
not satisfied
|
60
|
15.2
|
Your satisfaction with one to one health care provider
|
very good
|
166
|
42.1
|
Medium
|
176
|
44.7
|
not satisfied
|
52
|
13.2
|
Were you satisfied with one to one supporter groups?
|
very good
|
192
|
48.7
|
Medium
|
151
|
38.3
|
not satisfied
|
51
|
12.9
|
Your relationship with your health care provider
|
very good
|
180
|
45.7
|
Medium
|
206
|
52.3
|
not satisfied
|
8
|
2.0
|
Reason for skipping ART medication
Respondents listed some of the reasons for skipping their medication. The most commonly listed reason was being too busy with other things 91 (44.6%). Other reasons were being away from home 30 (14.7%), feeling sick or ill at that time 16 (7.8%), due to fasting 23 (11.7%) and fear of disclosure 16 (7.8%).
Adherence to second-line ART therapy
In this study, self-reported adherence was assessed among patients on 2nd-line ART, and the results revealed a good adherence level of 66.8% (95% CI: 61.9%, 71.3%).
Factors associated with second-line ART adherence
The results of multivariable logistic regression analysis revealed that being male, having support adherence support, good first-line adherence history, substance use and ever missed visits had statistically significant associations with second-line ART adherence.
Male respondents were 1.7 times more likely to have good second-line ART adherence than female participants (AOR=1.71; 95% CI: 1.05, 2.78). Participants who had a good first-line ART adherence history were three times more likely to have good second-line adherence than those who had a poor first-line adherence history (AOR= 3.32; 95% CI: 1.43, 7.69). Participants with adherence support were three times more likely to have good adherence than those who had no adherence support (AOR= 2.8; 95% CI: (1.65, 4.75)). Those respondents who had ever missed their visit were 51% less likely to have good second-line adherence than those who did not miss their visit (AOR= 0.49; 95% CI: 0.28, 0.86). Respondents who had ever used substances in the last three months were 67% less likely to have good second-line adherence (AOR= 0.33; 95% CI: 0.19, 0.55) than those who did not use substances (Table 7).
Table 7: Bivariable and multivariate logistic regression of patients on second-line antiretroviral therapy in Dessie City administration public hospitals, Northeast Ethiopia, 2021
Characteristics
|
|
Adherence
|
Total
|
COR(95%CI)
|
AOR(95%CI)
|
Good
|
Poor
|
Sex
|
Male
|
131
|
48
|
179
|
2.71(1.12-3.63)
|
1.71(1.05-2.78) *
|
Female
|
132
|
83
|
215
|
1
|
1
|
Having support from someone
|
Yes
|
218
|
78
|
296
|
3.29(2.049-5.28)
|
2.80(1.65-4.75)*
|
No
|
45
|
53
|
98
|
1
|
1
|
Member in HIV related social organization
|
Yes
|
104
|
30
|
134
|
2.20(1.37-3.55)
|
0.59(0.34-1.01)
|
No
|
159
|
101
|
260
|
|
|
Disclosed you HIV status your families
|
Yes
|
221
|
88
|
309
|
2.57(1.57-4.20)
|
0.929(0.39-2.18
|
No
|
42
|
43
|
85
|
1
|
1
|
Stigma
|
From others
|
91
|
57
|
148
|
1.56(0.981-2.48)
|
1.15(0.65-2.03)
|
Self-stigma
|
45
|
23
|
68
|
1.27(0.70-2.32)
|
0.53(0.24-1.18)
|
No stigma
|
127
|
51
|
178
|
1
|
1
|
Perceived clinical benefits of 2nd line for improve quality of life
|
Yes
|
186
|
73
|
259
|
1.92(1.24-2.97)
|
0.71(0.42-1.22)
|
No
|
77
|
58
|
135
|
1
|
1
|
First line adherence before switch to 2 nd line.
|
Good
|
48
|
8
|
56
|
3.43(1.57-7.49)
|
3.32(1.4 3, 7.69) *
|
Poor
|
215
|
123
|
|
1
|
1
|
Ever used substance
|
Yes
|
173
|
109
|
282
|
0.55(0.36-0.84)
|
0.33(0.19- 0.55) *
|
No
|
165
|
63
|
228
|
1
|
1
|
Comfortable to take ART in presence of others
|
comfortable
|
48
|
14
|
62
|
1.17(0.34-4.0)
|
1.0(0.23-4.81)
|
uncomfortable
|
199
|
113
|
312
|
2.27(0.74-6.96)
|
1.7(0.41-7.20)
|
neither comfortable nor uncomfortable
|
16
|
4
|
20
|
1
|
1
|
T- staging
|
T1
|
218
|
89
|
307
|
0.29 (0.11-0.77)
|
0.59(0.16-2.11)
|
T2
|
38
|
32
|
70
|
0. 59(0.20-1.73)
|
0.64(0.17-2.50)
|
T3
|
7
|
10
|
17
|
1
|
1
|
Last Viral load measurement
|
Less than 1000
|
206
|
93
|
299
|
1.48(0.92-2.38)
|
1.2(0.64-2.40)
|
Greater than 1000
|
57
|
38
|
95
|
1
|
1
|
Functional status
|
Working
|
241
|
109
|
350
|
2.21(1.17-4.16)
|
0.63(0.27-1.50)
|
Ambulatory
|
22
|
22
|
44
|
1
|
1
|
Frequency of visit
|
Every month
|
113
|
52
|
165
|
0.86(0.56-1.32)
|
0.62(0.36-1.0)
.
|
Every two months
|
6
|
2
|
8
|
0.62(0.12-3.16)
|
0.81(0.11-5.90)
|
Every 3 months
|
144
|
77
|
221
|
1
|
1
|
Ever miss your visit because of different reason
|
Yes
|
46
|
41
|
87
|
0.47(0.29-0.76)
|
0.49(0.28-0.86) *
|
No
|
217
|
90
|
307
|
1
|
1
|
History of admission
|
Yes
|
38
|
27
|
65
|
0.65(0.38-1.12)
|
0.86(0.43-1.71)
|
No
|
225
|
104
|
329
|
1
|
1
|
Ever experienced adverse effect
|
Yes
|
91
|
67
|
158
|
0.51(0.33-0.77)
|
0.50(0.31-0.81).
|
No
|
172
|
64
|
236
|
1
|
1
|
* Significant association