Antiretroviral Therapy Discontinuation among Adults Receiving HIV Care in Kadoma City in 2015-2019

Background: Discontinuation remains a legitimate threat to the long-term success of antiretroviral therapy (ART) scale-up in Zimbabwe. Furthermore, the characteristics associated with ART discontinuation and trends are poorly understood in developing countries like Zimbabwe. We analysed the HIV/AIDS data to describe the characteristics associated with ART discontinuation and the trends from 2015 to 2019. Methods: We conducted an analytical cross- sectional study using secondary data from Electronic Patient Management System (ePMS) in Kadoma City. We interviewed eighteen health care workers to find the reasons for ART discontinuation. Data were analysed using Microsoft Office Excel 2016 and Epi info 7 version 7.2.2.6. Microsoft office excel was used to generate linear graphs to demonstrate the trends in ART discontinuation in Kadoma City in 2015-2019. Epi info 7 was used to generate frequencies, means, prevalence odds ratios p-values, and 95% confidence intervals (CI) and significance testing. Backward stepwise logistic regression analysis was done to determine the independent factors associated with discontinuation. Results: A total number of 2833 patients were enrolled on ART from 2015 to 2019. One hundred and seventy-three 173/2833 (6.1%) discontinued ART, 415/2833 (14.7%) transferred out, 69/2833 (2.4%) died and 2176/2833 (76.8%) were retained on ART. Out of those who discontinued ART, sixty-five percent (112/173) were females. Approximately two-thirds had immunological failure 110/173 (64%). The trend in ART discontinuation decreased over the years but was not statistically significant (R2 = 0.57, p > 0.05). ART discontinuation was independently associated with being <40 years of age (adjusted pOR = 2.3, [95% CI: 1.6 - 3.2], p = 0.001), having never attended school (adjusted pOR = 3.9, [95% CI: 2.5 - 6.0], p = 0.003) and having immunological failure (adjusted pOR = 6.2, [95% CI: 4.5 - 8.6], p = 0.0001). The reasons mentioned by the health care workers which cause people living with HIV (PLHIV) to discontinue ART were health state not improving 13/18 (72.2%), participating in artisanal mining activities 11/18 (61.1%), change in marital status 9/18 (50.0%), medical side effects of ART 8/18 (44.4%), living far from health facilities 5/18 (27.8%) and relocating to neighbouring countries 3/18 (16.7%). Conclusion: We concluded that the characteristics associated with ART discontinuation were having never attended school, being less than forty years of age and having immunological failure. The reasons why patients discontinue ART were health state not improving, participating in artisanal mining activities, change in marital status, medical side effects of ART, living far from health facilities, and relocating to neighbouring countries. We recommended continuous provision of health education, enhanced adherence counselling sessions to those with unsuppressed viral loads and investigating the cause of virologic failure.