Time to treatment failure and its predictors among children receiving first-line antiretroviral therapy in Tigray Region public general hospitals, North Ethiopia, 2024: Retrospective cohort study

Background Pediatric human immunodeficiency virus (HIV) remains a significant public health challenge, with an estimated 1.5 million children living with HIV globally. In addition, first-line antiretroviral therapy (ART) treatment failure has remained high, as studies and reports showed. Furthermore, time to treatment failure and its predictors on first-line ART among HIV-infected children are less researched in the study area after the test-and-treat strategy is implemented. Hence, this study was conducted to assess time to treatment failure and its predictors among children receiving first-line antiretroviral therapy in Tigray Region public general hospitals, North Ethiopia, 2024. Methods A hospital-based retrospective cohort study was conducted among children who started ART from January 2014 to March 2020 and from February 2023 to August 2023 in Tigray Region public general hospitals. Epi Data version 3.1 and Stata version 14 were used for data entry and analysis, respectively. Kaplan-Meier and log-rank tests were computed. Bivariable analysis variables with p-value < 0.2 were taken to multivariable Cox regression analysis to identify predictors. Finally, 95% CI and p-value <0.05 were considered for statistical significance. Results From 410 records of children, 55 (13.4%) (95% CI, 10.43–17.08) had treatment failure, with an incidence rate of 3.3 (95% CI, 2.6–4.3) per 1000 child-month observation. The median time to treatment failure was greater than or equal to 75 months. Poor adherence (AHR = 3.6, 95% CI: 1.7–7.5), baseline CD4 count <200 cells/mm 3 (AHR = 3.8, 95% CI: 1.8–8.4), baseline CD4 count 201–350 cells/mm 3 (AHR = 2.7, 95% CI: 1.2–6.2), and initial Nevirapine-based regimen (AHR = 4, 95% CI: 1.8–8.8) were predictors of time to treatment failure. Conclusion and recommendation The incidence of treatment failure among children receiving first-line ART was found to be high according to the UNAIDS virological suppression targets. Poor adherence, baseline CD4 count, and initial NVP-based regimen were predictors of time to treatment failure of ART. Hence, all children on ART should be closely monitored, mainly on these identified predictors.