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Evaluation of Second Line Antiretroviral Treatment Outcomes and Determinants in Epworth, MSF-OCA HIV Cohort, ZimbabweSummary Epworth poly-clinic is found in Epworth district, Harare. It is a clinic jointly run by Epworth local board (on behalf of the Ministry of Health and Child Care) and Médecins sans Frontiers (MSF). One of the major MSF activities in the clinic is early detection and management of patients who fail first line ART. Patients with elevated viral load (VL), HIV RNA greater than 1000 copies/ml, undergo five to six sessions of two weekly enhanced adherence counseling (EAC) support. After enhanced adherence counseling sessions, those with elevated repeat VL test result are then switched to second line ART. Since the number of patients on second line ART is growing, there is an increased need to know the outcomes of second line ART and predictors of treatment failure. The main objective of this study is to evaluate the prognosis and determinants of second line ART regimen for cohort of HIV patients in Epworth MoH/MSF poly-clinic, Zimbabwe. The study will also identify cumulative incidence of SL ART treatment failure through clinical, immunological or virological criteria at 6, 12, 24 and 36 months of second line ART initiation for a cohort of patients enrolled from March 2009 to January 2016 in Epworth poly-clinic. This is a retrospective cohort study of patients on second line ART in Epworth poly-clinic enrolled since 2009. We describe baseline characteristics and outcomes of treatment using descriptive analysis. Multivariate cox proportional hazard modeling is used to model predictors of time to treatment failure. Kaplan–Meier curve is used to calculate cumulative incidence of treatment failure at 6, 12, 24 and 36 months of second line ART initiation. The study is expected to be finished and communicated to relevant stakeholders in December 2016. The report will be published on peer reviewed journals in January 2017. All the costs needed for this study will be covered by MSF OCA.