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Transitioning to Second-line Antiretroviral Therapy Among Adolescents in Copperbelt Province, Zambia: Predictors of Treatment Switching and Adherence to Second-line Regimens

Stalter, Randy M. MPH*; Katayamoyo, Patrick MBChB; Packer, Catherine MSPH*; Banda, Harry; Chen, Pai-Lien PhD*; Mwansa, Jonathan K. MBChB§; McCarraher, Donna R. PhD*; Denison, Julie A. PhD

Pediatric Infectious Disease Journal: August 2017 - Volume 36 - Issue 8 - p 768–773
doi: 10.1097/INF.0000000000001547
HIV Reports

Background: Adolescents living with HIV (ALHIV) experience less favorable antiretroviral therapy (ART) outcomes than other age groups. First-line treatment failure complicates ART management as second-line regimens can be costlier and have greater pill burdens. Understanding predictors of switching ART regimens and adherence among adolescents on second-line ART may help to prevent poor treatment outcomes.

Methods: A quantitative survey was administered to 309 ALHIV attending 3 ART clinics in the Copperbelt Province, Zambia. Medical chart data, including pharmacy refill data, were abstracted. Associations between being on second-line ART and sociodemographic, psychosocial and ART adherence characteristics were tested. Cox proportional hazards models were used to estimate the effect of baseline ART variables on time to switching.

Results: Ten percent of participants were on second-line regimens. Compared with ALHIV on first-line ART, adolescents on second-line regimens were older (P = 0.02), out of school due to completion of secondary studies (P = 0.04) and on ART longer (P = 0.03). Adolescents on second-line regimens were more likely to report missing ≥48 consecutive hours of drugs in the last 3 months (P = 0.01). Multivariable analysis showed that adolescents who initiated ART with efavirenz-based regimens were more likely to switch to second-line than those put on nevirapine-based regimens (hazard ratio = 2.6; 95% confidence interval: 1.1–6.4).

Conclusions: Greater support is needed for ALHIV who are on second-line regimens. Interventions for older adolescents that bridge the gap between school years and young adulthood would be helpful. More research is needed on why ALHIV who start on efavirenz-based regimens are more likely to switch within this population.

From the *Global Health, Population and Nutrition Group, FHI 360, Durham, North Carolina; Clinical Care Unit, FHI 360, Lusaka, Zambia; FHI 360, Ndola, Zambia; §Arthur Davison Children’s Hospital, Ndola, Zambia; and Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.

Accepted for publication October 6, 2016.

This study was made possible by the generous support of the American people through the US Agency for International Development (USAID). Financial assistance was provided by USAID to FHI 360 under the terms of the Preventive Technologies Agreement No. GHO-A-00-09-00016-00. The contents of this article do not necessarily reflect the views of USAID or FHI 360.

The authors have no conflicts of interest to disclose.

Address for correspondence: Randy M. Stalter, MPH, FHI 360, 359 Blackwell Street, Suite 200, Durham, NC 27701. E-mail:

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.