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, Abbas Lugemwa, Nicholas Musinguzi, Winnie Muyindike, Ann Nakirijja, Cissy Kityo, Peter Mugyenyi

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 400c/ml OR a VL > 5000c/ml (>12 mos on HAART) OR already switched to 2nd line Results o4719 evaluable patients o60% Female, and 53% married o46% initiated ART at WHO stage 3/4 o2.1% (100/4,719) met definition of treatment failure o51% of failing patients were still using the same failing regimen

Distribution and determinants of treatment Failure Variable of interest Adjusted OR 95% CI Age (years) Treatment duration Baseline CD4 Count Baseline Weight Baseline Hemoglobin Gender (M/F) Marital Status WHO stage 4 v Table 1: Predictors of HIV treatment Failure Figure 2: Definition and distribution of Treatment failure

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

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