Effectiveness of structured Behavior Change Communication methods in control of mosquito-borne diseases: A quasi-experimental study.

Background: Behavior Change Communication (BCC) is evidence-based, theoretically supported and utilizes all opportunities for communication. Evidence reports BCC as a relevant tool for averting and controlling many forms of public health challenges. Through schools, many countries have shown health improvements via students and the community's exposure to behavior change messages. The study was planned with an aim of evaluating the effectiveness of mosquito-borne disease control measures implementation through BCC to adolescent school students in a Cantonment area, in North India. Methods: The present study was undertaken as a quasi-experimental study from April 2019 to March 2020. Of the 334 students enrolled in the school as per eligibility criteria, 315 were available during the initial assessment, and 288 were available throughout the study. For the evaluation of effectiveness of the BCC at household level, 200 households (100 intervention and 100 control) were selected. Students' knowledge about mosquito-borne diseases was the primary outcome measure. The difference in proportions was tested using the chi-square test. The difference in proportions for paired samples was tested using Mc Nemar's test. Results: Proportion of students who gave correct responses significantly increased after intervention in post-test as compared to pre-test for most of the knowledge-related questions. The proportion of households with the availability of mosquito nets and self-reported use of mosquito nets was significantly high in intervention group as compared to control group post-intervention. Conclusion: BCC in the form of different intervention programs to adolescent school children was effective in improving the knowledge and attitude toward mosquito-borne diseases and also ensured less mosquito-genic environment in households.

Strengthening Comprehensive Primary Health Care through Ayushman Bharat: Role of Demand and Supply-side Interventions.

BACKGROUND: Comprehensive primary health care (CPHC) is an effective way to respond to the challenges of changing epidemiology, growing population expectations, and universal health coverage. A set of demand and supply improvement strategies was developed to support primary health center provision and pilot tested in three model health and wellness centers (HWCs) in Punjab. OBJECTIVE: The study aimed to assess the early effects of interventions on the inputs, processes, and outputs for optimal implementation of the AyushmanBharat-HWC (AB-HWC) program. MATERIALS AND METHODS: Cross-sectional facility assessments were conducted using a standardized methodology at three time points to identify the changes in inputs and processes at subcenter-HWCs from 2019 to 2021. In addition, daily and month-wise service utilization data of model HWCs and nonmodel HWCs in the intervention block and control block in a district of Punjab from the AB-HWC portal were analyzed from May 2020 to April 2021. RESULTS: The difference-in-difference analysis indicated that the CPHC strengthening interventions in the model HWCs improved the mean number of people screened for noncommunicable diseases, mean newly diagnosed patients with hypertension and diabetes, mean hypertensive and diabetic patients on treatment, mean outpatient attendance, and mean number of wellness sessions by 265.71, 21.31, 29.48, 102.17, and 4.88 units per month, compared to control HWCs. CONCLUSION: The success of the initiatives can be attributed to an integrated approach encompassing multistakeholder planning of interventions, community involvement, empowerment of service providers, and consistent supportive supervision. The long-term success will be contingent on the quality of training, team dynamics, community participation, social accountability, and supervision support.

A systematic review of excess all-cause mortality estimation studies in India during COVID-19 pandemic.

Background: Mortality statistics are fundamental to understand the magnitude of the COVID-19 pandemic. Due to limitation of real-time data availability, researchers had used mathematical models to estimate excess mortality globally during COVID-19 pandemic. As they demonstrated variations in scope, assumptions, estimations, and magnitude of the pandemic, and hence raised a controversy all over the world. This paper aims to review the mathematical models and their estimates of mortality due to COVID-19 in the Indian context. Methods: The PRISMA and SWiM guidelines were followed to the best possible extent. A two-step search strategy was used to identify studies that estimated excess deaths from January 2020 to December 2021 on Medline, Google Scholar, MedRxiv and BioRxiv available until 0100 h, 16 May 2022 (IST). We selected 13 studies based on a predefined criteria and extracted data on a standardised, pre-piloted form by two investigators, independently. Any discordance was resolved through consensus with a senior investigator. Estimated excess mortality was analysed using statistical software and depicted using appropriate graphs. Results: Significant variations in scope, population, data sources, time period, and modelling strategies existed across studies along with a high risk of bias. Most of the models were based on Poisson regression. Predicted excess mortality by various models ranged from 1.1 to 9.5 million. Conclusion: The review presents a summary of all the estimates of excess deaths and is important to understand the different strategies used for estimation, and it highlights the importance of data availability, assumptions, and estimates.

Factors influencing life satisfaction and discrimination among the elderly in India.

India is moving toward a demographic transition which leads to more elderly population than younger. Maximum life satisfaction (LS) and minimum discrimination are necessary to have healthy aging. The secondary data analysis was conducted to assess the perceived LS and discrimination among the elderly based on Longitudinal Aging Study in India (LASI). Data from the LASI-Wave I were used to analyzing to assess the LS and discrimination and factors associated with them. This study reported that the majority of the elderly were satisfied with their life and does not face any kind of discrimination; however, various factors affect them. LS was positively associated with the level of Monthly per capita consumption expenditure quintile, and education, self-rated good health. Furthermore, refraining from alcohol and tobacco positively influence the LS among the elderly. The factors responsible for more LS among the elderly were education, money, social support, and a healthy lifestyle.

Findings of second multicentric follow-up serosurvey among Health Care Workers in government hospitals.

Background: The change in serological status of community may be used as input for guiding the public health policy. Hence, the present study was conducted to determine change in seroprevalence of COVID-19 among healthcare workers (HCWs). Methods: From the baseline multicentric study sample, a subsample was followed up, and a seroepidemiological study was conducted among them between 6 and 22 weeks after the second dose of the vaccination. Multistage population proportion to size sampling was performed for the selection of subsample of HCWs. The serosurvey was conducted using the enzyme-linked immunosorbent assay-based IgG antibody test (COVID KAVACH). Results: Follow-up serological testing was done in subsample of 1122 participants of original 3253 participants. The mean age of the participants was 34.6 (8.13) years. A total of 300 (26.7%) participants were females. The seroprevalence was 78.52, (95%CI:76-80.1). Among those who were seronegative at initial test, 708 (77.04%) were seroconverted. Those who were not seroconverted (241 (21.5%)) have longer duration from the second dose of the vaccination (93 (31.4) vs. 56 (38.4); p value < 0.001). The COVID-19 infection was significantly associated with seropositive status and being a medical staff was associated with remaining seronegative on follow-up. The higher age (≥50 years) was found to be significantly associated with seroreversion. Conclusion: Four in five HCWs had detectable antibodies. Seroepidemiological studies carry vital information to control the public health response in the course of the pandemic. The study can also further help as a platform to study the seroconversion and effect of vaccination among HCWs for newer variants of SARS-CoV-2.

Biothreat & One Health: Current scenario & way forward.

There is an increased connectedness among humans, animals, and the environment and the current pandemic has taught the interlinking of the health of humans, animals and the planet. This inter-connectedness and factors like population growth, migration, urbanization, and climate change contribute significantly to the enhanced probability of emergence of previously unknown wildlife source pathogens at any place, any time, and without warning. Lurking in the background is the massive potential for the deliberate use of biological agents as weapons by State or non-State entities. Biological weapons have been used in wars since antiquity, however, newer research and techniques have led to these being real threats with a vast potential of harm to humans, animals, and crops. Over a period, it has become increasingly difficult to differentiate between deliberate and natural biothreat incidents. The response to both types is alike to safeguard lives, livestock, crops and the environment and reduce the consequent socio-economic ramifications. Biothreat may be targeted towards humans, animals, or crops, or all these concurrently. Every country including India is at risk of biothreat. The concept of one health is thus essential for responding to emerging infectious diseases or biothreats. Comprehensive surveillance for early detection, reporting and early concerted action is needed for prevention and blunting the effect of biothreats, which require close coordination and collaboration among various stakeholders within each country as well as globally.

A pilot study comparing hearing thresholds of soldiers at induction and after completion of one year in high altitude area.

BACKGROUND: Despite so much research in high altitude area, our existing knowledge is still lacking on otological effects of long-term stay in high altitude. This pilot study was conducted to compare the hearing thresholds of army soldiers at induction and after completion of one year in high altitude area (HAA). METHODS: Hearing thresholds of 433 soldiers posted in HAA were recorded using pure tone audiometry at the time of induction and second thresholds after one year of stay in high altitude for frequencies of 500Hz, 1KHzs, 2 KHzs and 4 KHzs. The two sets of hearing thresholds for air conduction were compared using paired "t" test for any statistical significance. RESULTS: The mean Pure Tone Audiometry (PTA) thresholds for 433 left ears worsened from 9.43dB to 9.65dB at 500 HZs ; 14.02dB to 14.32dB at 1 KHZs ; 15.04dB to 16.09dB at 2KHzs and 18.63dB to 22.59dB at 4 KHZs. Similarly for right ear, PTA thresholds worsened from 9.43dB to 9.69dB at 500HZs; 13.95dB to 14.34dB at 1 KHZs; 15.38dB to 17.26dB at 2 KHZs and from 18.59dB to 23.06dB at 4KHZs. These results are found to be statistically significant (p<0.05) for all frequencies. CONCLUSION: This pilot study shows deterioration of hearing thresholds in tested frequencies in both ears after a long stay (one year) in high altitude area. We recommend further structured research on otologic effect of long term stay in high altitude.

Seroconversion among COVID-19 patients admitted in a dedicated COVID hospital: A longitudinal prospective study of 1000 patients.

BACKGROUND: The immune response after SARS-CoV-2 is complex and may be affected by severity of the disease, race, etc. The present study was conducted to assess the serial antibody response among the COVID-19 patients admitted in the hospital. METHODS: The study was conducted between July and October 2020 in a dedicated COVID-19 hospital. All consented patients underwent serial testing of antibodies using a rapid chromatographic immunoassay-based qualitative IgG/IgM kit every third day until their discharge or death. The data about age, sex, severity of disease, length of stay, onset of symptoms, date of molecular testing were also collected. Appropriate statistical tests were used. RESULTS: The mean age of 1000 COVID-19 patients was 47.5 ± 17.9 years. Out of the total, 687 (68.7%) were males. With respect to severity, 682 (68.2%) were asymptomatic/mild, 200 (20%) were moderate and 118 (11.8%) were severe cases. The seroconversion percentage increased from 12.8% to 97.9% and 16.3% to 80.9% for IgG and IgM respectively in 21 days. The median time for seroconversion was 10 days (IQR:6-12 days) for IgG and eight days (IQR: 6-11 days) for IgM. At the time of discharge (median nine days), detectable IgG and IgM antibodies were present in 502 (52.46%) and 414 (43.26%) participants respectively. Seroconversion was associated with days after the symptoms, increasing severity of the disease and the presence of co-morbidity. CONCLUSION: Seroconversion increased during the period of observation. The severe/moderate cases of COVID-19 tend to have an early seroconversion as compared to the asymptomatic/mild cases. Only half of the patients were seroconverted at discharge.

Seropositivity of severe acute respiratory syndrome coronavirus 2 infection among healthcare workers of the Armed Forces medical services, India: A multicentric study.

BACKGROUND: Serosurveys provide the prevalence of infection and over time will reveal the trends. The present study was conducted to estimate the seroprevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among healthcare workers (HCWs) and to analyse various characteristics (risk factors) associated with SARS CoV-2 infection. METHODS: Eight government designated Corona virus disease -19 (COVID-19) hospitals were selected based on the hospital admission of patients with COVID-19 and the local epidemiological situation in the region. Multistage population proportion to size sampling was performed for the selection of HCWs. Serosurvey was conducted using the enzyme-linked immunosorbent assay-based IgG antibody test (COVID KAVACH). Bivariate and multiple logistic regression was performed to find out the factor/factors associated with the positive antibody test. RESULTS: Out of 3255 HCWs that participated in the study, data of 3253 were analysed. The seroprevalence was 19.7% (95% confidence interval: 18.5-21.3%). Factors associated were location, category of HCWs, male sex, previously tested positive by the molecular test, training on infection prevention and control, personal protective measures, handwashing technique, close contact with a patient confirmed with COVID-19, use of personal protective equipment and symptoms in the last 30 days. However, in multiple logistic regression, only location, category, previously tested positive by the molecular test and symptoms in the last 30 days were statistically significant. CONCLUSION: HCWs are vulnerable to SARS-CoV-2 infection. One in five HCWs had detectable antibodies. The presence of antibodies among HCWs may help in their placement and triage. HCWs may be advised to report early in case of any symptoms of COVID-19. Preventive measures may be targeted based on the location, with particular emphasis on ancillary workers and nurses.

Predictive models of COVID-19 in India: A rapid review.

BACKGROUND: The mathematical modelling of coronavirus disease-19 (COVID-19) pandemic has been attempted by a wide range of researchers from the very beginning of cases in India. Initial analysis of available models revealed large variations in scope, assumptions, predictions, course, effect of interventions, effect on health-care services, and so on. Thus, a rapid review was conducted for narrative synthesis and to assess correlation between predicted and actual values of cases in India. METHODS: A comprehensive, two-step search strategy was adopted, wherein the databases such as Medline, google scholar, MedRxiv, and BioRxiv were searched. Later, hand searching for the articles and contacting known modelers for unpublished models was resorted. The data from the included studies were extracted by the two investigators independently and checked by third researcher. RESULTS: Based on the literature search, 30 articles were included in this review. As narrative synthesis, data from the studies were summarized in terms of assumptions, model used, predictions, main recommendations, and findings. The Pearson's correlation coefficient (r) between predicted and actual values (n = 20) was 0.7 (p = 0.002) with R2 = 0.49. For Susceptible, Infected, Recovered (SIR) and its variant models (n = 16) 'r' was 0.65 (p = 0.02). The correlation for long-term predictions could not be assessed due to paucity of information. CONCLUSION: Review has shown the importance of assumptions and strong correlation between short-term projections but uncertainties for long-term predictions. Thus, short-term predictions may be revised as more and more data become available. The assumptions too need to expand and firm up as the pandemic evolves.

Knowledge, attitude, practices, and behavior regarding COVID-19 among serving personnel of a large military garrison: a quick online cross-sectional survey.

BACKGROUND: There is a deluge of information available and circulated about COVID-19, during the ongoing course of the pandemic. This study was conducted to assess knowledge, attitudes, practices, and behavior regarding COVID-19 among serving soldiers. METHODS: A quick cross-sectional online survey was conducted using a web portal and social media platform, wherein a pretested questionnaire was uploaded. Responses were collected for 3 days. Data were analyzed using Epi Info software. RESULTS: A total of 1231 serving personnel participated in the survey, 133 (10.80%) officers, 144 (11.69%) Junior Commissioned Officers, and 954 (77.49%) Other Ranks. The prevalence of correct knowledge was more than 80% (range 81.47-88.13) except 29.97% regarding transmission by food and water. A statistically significant association (all P values < 0.05) was found with increasing age and education. Social distancing was an effective method as per 93.54%, and 81.38% thought that the response measures were adequate. Handwashing was the only practice which demonstrated a statistically significant association across change in all 3, i.e. age (P = 0.001), education (P = 0.005) and rank (P = 0.022). In the affective domain, increased perception of anxiousness, worriedness, and not feeling relaxed was found in the responses. CONCLUSION: Levels of knowledge, positive attitude, and practice are high among serving soldiers, however feeling of anxiousness and worry prevail. Aggressive, continuous, relevant target population-oriented Information Education and Communication is the need of the hour, with structured and programmed interventions for positive mental health during course of the pandemic and this has been implemented in our area.

Clinical evaluation of "componeers" and direct composite veneers using minimally invasive enamel preparation technique: In vivo study.

AIM: The aim of this study was to evaluate the clinical behavior of prefabricated componeers and direct composite veneering. The objective of the study was to compare the changes in color, surface texture, marginal integrity, and gingival response for componeers and direct composite veneers. SETTINGS AND STUDY DESIGN: This was an in vivo, comparative study. MATERIALS AND METHODS: Ten patients indicated for anterior veneers were selected and divided into Groups A and B of five patients each. Group A was restored with componeers and Group B with direct composite veneers. Both the groups were compared for color changes, surface textural changes, marginal integrity, and gingival response, starting immediately post veneering and at 3, 6, 9, and 12 months subsequently. STATISTICAL ANALYSIS USED: Friedman's two-way analysis of variance and Mann-Whitney test were used for statistical analysis. RESULTS: Results for color ranged from excellent to good with minimal color changes post veneering. Overall, "gingival response," in both the groups, showed statistically significant differences in mean rank scores (P ≤ 0.05). The data depicted an improvement in gingival response for all patients during the period of the study. Surface textural changes were significant only for maxillary right canine and maxillary left lateral incisor (P = 0.024 and 0.039, respectively) in both the groups. Maxillary right canine in both the groups showed significant changes in marginal integrity. Intergroup comparison of gingival response, surface texture, and marginal integrity depicted no significant difference between the groups (P > 0.05). CONCLUSIONS: This study concluded that the intergroup comparison of componeers and direct composite veneers for the parameters, gingival response, surface texture, and marginal integrity did not depict any significant differences. Both the groups displayed minimal changes in color, surface texture, and marginal integrity and improved gingival response.

A systematic review and cost-effectiveness analyses of the new World Health Organization guidelines for the treatment of HIV-positive adults in India.

BACKGROUND: The World Health Organization (WHO) in 2013 has revised its guidelines on antiretroviral therapy (ART) treatment for human immunodeficiency virus (HIV)-positive adults and further updated it in 2016. Based on the WHO recommendations, in May 2017, National AIDS Control Organisation, India recommended initiation of ART treatment for all people living with HIV, regardless of CD4 count, clinical stage, age, or population. This systematic review aims to assess the clinical effectiveness and cost implication of the new guidelines for India. METHODS: A systematic and comprehensive literature search on PubMed, OvidSP, Cochrane Library, and Google Scholar was carried out. Studies reporting either acquired immunodeficiency syndrome (AIDS) or mortality or both as outcome variables were selected. A meta-analysis of the available studies was carried out. The risk ratio was calculated to assess the reduction in AIDS or mortality or both. Cost-effectiveness analysis using health technology principles evaluating the lives saved in terms of incremental cost-effectiveness ratio and cost per quality-adjusted life years gained was carried out. RESULTS: Nine eligible studies were included for the meta-analysis. For India, the pooled relative risk of AIDS or mortality or both being 0.84 (95% confidence interval [CI], 0.76-0.92) and 0.78 (95% CI, 0.68-0.89) for ART initiation at CD4 count of ≤350 vs CD4 count of ≤500 and at CD4 count of ≤500 vs CD4 count > 500 cells/mm3, respectively. The incremental cost for per additional life saved is US$ 2592 and US$ 2357 for ART initiation at ≤500 and > 500 CD4 count, respectively. CONCLUSION: The adoption of the new WHO guidelines is beneficial with substantial reduction in AIDS or mortality or both. This study suggests that adopting new WHO guidelines is cost-effective for India.

Is it time to revise the acclimatization schedule at high altitude? Evidence from a field trial in Western Himalayas.

BACKGROUND: In Western Himalayas, Indian Army soldiers take 11 days (6 days of acclimatization and 5 days of travel) on a sea-level to high altitude road (SH road) to reach a high altitude location (HAL) situated at an altitude of 11,500 feet from sea-level location (SLL) at an altitude of 1150 feet while following acclimatization schedule (AS). AS has an extra safety margin over the conventional 'mountaineering thumb rule' of not exceeding 500 m sleeping altitude above 3000 m altitude. We carried out this randomised field trial to study the feasibility of moving large number of troops rapidly from SLL to HAL on SH road in western Himalayas in 4 days under pharmaco-prophylaxis. METHODS: Based on the pharmaco-prophylaxis, at SLL 508 healthy lowland soldiers were divided into two groups: 'A' (n = 256) with Acetazolamide + Dexamethasone and 'B' (n = 252) with Acetazolamide + Placebo. They travelled rapidly by road to HAL in 4 days and prevalence of acute mountain sickness (AMS), high altitude pulmonary edema (HAPE) and high altitude cerebral edema (HACE) during the ascent was measured. RESULTS: Prevalence of AMS was found to be 1.56% and 1.59% in group 'A' and group 'B' respectively during the ascent with no cases of HAPE and HACE. CONCLUSION: At least on SH road, troops can be inducted rapidly to HAL from SLL in 4 days under pharmaco-prophylaxis with Acetazolamide with minimal occurrence of acute high altitude illnesses.

Seroprevalence of influenza A H1N1 (swine) infection in the human population in a cantonment.

BACKGROUND: Various serosurveys and studies were conducted globally on pandemic influenza. H1N1 virus reported so far provides ample evidence of differing perspectives, regarding its epidemiology especially with regard to prevalence, populations groups, and behaviour related to vaccine acceptance. A multigroup, cross-sectional survey among 658 healthy subjects was carried out, in Pune among students, health-care workers (HCWs), and soldiers to assess the seroprevalence of pandemic influenza H1N1 virus and its associated factors. METHODS: The total sample size, based on forecasted prevalence of 33%, worked out to be 640. We studied 658 subjects including 103 students, 201 HCWs, and 354 serving soldiers. The sample for each group was selected from the respective study population by simple random sampling using a random number table. Haemagglutination inhibition test was carried out at the National Institute of Virology. RESULTS: The overall seroprevalence of pandemic influenza H1N1 (2009) virus was found to be 46.5% (95% confidence interval 42.6-50.4) which was adjusted to 39.4% after excluding those vaccinated. The availability of vaccine for high-risk group such as HCWs did not find much favour with the HCWs who did not accept vaccine for various reasons. Whereas only one student was vaccinated, 21.4% of HCWs and 32.5% of soldiers were vaccinated. CONCLUSION: Based on high seroprevalence of antibodies against H1N1 virus during pandemic, vaccination of general population is not recommended. However, high-risk groups and HCWs need to be protected with flu vaccine. There is a need to encourage HCWs for accepting vaccination.

Osteoporosis among household women: A growing but neglected phenomenon.

BACKGROUND: Osteoporosis is associated with variable morbidity and socio-economic burden and referred as a "silent epidemic" with increasing risk among Indian women. The present study was conducted to find prevalence of osteoporosis. METHODS: A descriptive cross-sectional study was conducted in Ranchi city with household women as participants. Data was collected by means of pre-tested structured questionnaire in Hindi language and bone status was screened utilizing calcaneal quantitative ultrasound as a diagnostic tool to estimate bone mineral density from 223 participants and statistical analysis was performed with SPSS software. RESULTS: The mean age of the participants was 37.9 (5.63) and majority (52.5%) of them were vegetarian. The prevalence of osteoporosis was 8.5% (5.2-13%) while 45.7% (39-52.5%) had osteopenia. We found no significant association of osteoporosis and osteopenia with income, physical activity, and dietary patterns on univariate analysis. There was no statistical significant difference between mean age and BMI of participant among normal, osteoporosis, and osteopenia participant (p value >0.5). Multivariate logistic regression analysis shows that 20% increase chances of risk with five years increase in age, the protective effect of physical activity (22%) and non-vegetarian diet (18%) though not statistically significant. CONCLUSION: This study shows that significant number of women had osteopenia/osteoporosis within 35-40 years age group. Intensive information, education, and communication activities with regard to osteoporosis causative factors and preventive measures targeted to household women may play an important role, if started at young age.

Tobacco use among serving army personnel: An epidemiological study.

BACKGROUND: India has consequential burden of tobacco related disease and death. Though there are surveys conducted at national and regional level yet the information about tobacco consumption among army personnel is scarce. Thus an epidemiological study was conducted to estimate the prevalence and assess determinants of tobacco consumption amongst army personnel. METHODS: A community based cross sectional study was conducted using simple random sampling to enroll 380 personnel. Data was collected using a pretested and validated questionnaire with relevant domains. RESULTS: The age of participants was 33 + 7 years. The prevalence of ever tobacco users was 47.90% (95% CI: 42.78-53.05) and of current tobacco users was 35.00% (95% CI: 30.21-40.03). No association was found between ever users and age group, monthly income, occupation, length of service, family member usage (p > 0.05). Among smokeless tobacco forms, Khaini was most preferred (49.45%) followed by Gutkha. Majority of them (41.21%) were moderate tobacco chewers. Tobacco user friends (53.85%) were the main stimulants, which induced respondents to start tobacco. The important source of tobacco procurement was local vendor. 91.76% ever user were aware of the ill-effects of the tobacco use. There was statistically significant association for knowledge regarding tobacco use being harmful to family members between current users and ever users (p = 0.036). CONCLUSION: The study highlights a high prevalence of tobacco user amongst army personnel. Reduction of easy accessibility, Behaviour Change Communication activities and stricter implementation of regulations are urgently required.

Predictors of first line antiretroviral therapy failure and burden of second line antiretroviral therapy.

BACKGROUND: As HIV steps into the third decade, there are more number of patients living on lifelong (antiretroviral therapy) ART and facing the threat of drug resistance with subsequent treatment failure. The aim of this study was to determine predictors of first-line ART failure with the objectives to estimate the burden of 2nd line ART. METHODS: A retrospective 5-year cohort of HIV patients who were initiated on first line ART in 2008-09 was studied. Patients were followed from the time of ART initiation. Kaplan-Meier methods and Cox proportional hazards regression models were used to estimate probabilities and predictors of first line ART failure. RESULTS: Of the total of 195 patients initiated on first line ART, 15 patients were switched to second line ART yielding 7.69% failure rate. During the 7178 person-years of follow-up, the incidence of first line ART failure was 2.09 per 1000 person-years. The Kaplan-Meier survival analysis gave a mean survival time of 55.6 months. BMI, CD4 count at ART initiation and presence of opportunistic infections were significant predictors of first line ART failure. The burden of second line ART patients by the end of 5 years of first line ART is expected to be 151 patients. CONCLUSION: Though the first line ART failure is quite low in this study, we still need to be vigilant for lower BMI, low baseline CD4 count and occurrence of opportunistic infections to efficiently manage failures on first line ART.