Background: Limited data are available on factors associated with treatment interruption among people living with HIV (PLHIV) initiated on antiretroviral therapy (ART) in Kazakhstan. Although, approximately 60% of all PLHIV have a history of injection drug use, access to opioid maintenance therapy remains limited.
Methods: We conducted a retrospective cross-sectional analysis of routinely collected data on 6339 ART-naive patients (≥15 years old) that initiated ART from 2014-2016. Bivariate and multivariate logistic regression analyses were conducted to assess factors associated with treatment interruption within 12 months of ART initiation.
Results: 3693 men and 2646 women initiated ART during the study period, including 2724 (43%) that ever injected drugs. The median age at ART initiation was 36 years (IQR=31-42 years). The median time between HIV diagnosis and ART initiation was 791 days (IQR=77-2129 days). Median baseline CD4 cell count at ART initiation was 257 cells/µl (IQR=144-361 cells/µl). 620 (9.8%) patients died and another 1106 (17.4%) stopped ART within the first 12 months after ART initiation. Median number of days between ART initiation and the first ART interruption was 170 (IQR=95-254 days).
On multivariate analysis, discontinuation of ART within the first 12 months of initiation was independently associated with reported ART toxicities (OR=2.87, 95% CI=1.94-4.26, p< 0.0005), injection drug use (OR=2.03, 95% CI=1.31-3.16, p=0.002) and reported alcohol abuse (OR=2.16, 95% CI=1.48-3.15, p< 0.0005).
Conclusions: Substance abuse including injecting drugs and harmful use of alcohol were associated with treatment discontinuation among patients initiated on ART in Kazakhstan. Implementation of effective alcohol abuse treatment and scale-up of opioid dependence treatment are needed to improve ART retention and adherence among PLHIV in Kazakhstan.