<p>Determinants of Virological Failure Among Patients on First-line Antiretroviral Therapy in Central Oromia, Ethiopia: A Case–Control Study</p>

Abstract

Background Viral suppression among people living with HIV is the main goal of antiretroviral therapy (ART). Despite the treatment, more than four million people and over 55 thousand patients globally and in Ethiopia had virological failure respectively in 2017. The purpose of this study was to identify determinants of virological failure among patients on ART in central Oromia, Ethiopia. Methods A facility-based unmatched case–control study was conducted. Sample size was calculated using EpiInfo software, and 504 randomly selected patient’s records were analyzed. Case to control ratio was one to one. Separate sampling frames were prepared for cases and controls using medical registration numbers (MRN) from patients’ registrations data. Cases and controls were selected from respective sampling frames. Respective patient charts were traced using the MRN, and data were extracted from patient charts using data abstraction format. The data were entered using EpiInfo version seven and analyzed using SPSS version 20.0. Descriptive statistics and binary logistic regression were used for the analysis. Adjusted odds ratio with its 95%CI was used to present strength association. A P -value of <0.05 was used to determine statistical significance of the association. Results Age <15 years (AOR=3.72, 95%CI: 1.70–8.12), baseline CD4 count <100/mm 3 (AOR=2.31, 95%CI: 1.05–5.08), TDF-3TC-NVP regimen (AOR=2.81, 95%CI: 1.28–6.18), nondisclosure of HIV status (AOR=6.78, 95%CI: 3.24–14.15) and history of poor adherence (AOR=11.19, 95%CI: 5.65–22.15) were factors independently associated with virological failure among the study participants. Conclusion Younger age, low baseline CD4 count, TDF/NVP containing regimen, poor adherence, and nondisclosure of HIV status were significant determinants of virological failure. Therefore, adherence counseling and paying due attention to patients having these determinants are required to achieve adequate viral load suppression.

Predictors of unsuppressed viral load among adults on follow up of antiretroviral therapy at selected public and private health facilities of Adama town: unmached case-control study

“…This study is consistent with the study conducted in South Wollo zone of Ethiopia and Northern Ethiopia, Southwestern Ethiopia and Central part of Oromia in which lower CD4 count was significantly associated with viral suppression status [ 15 , 20 – 22 ]. This implies that when CD4-count is very low, the immune system no longer strong enough to fight back infections and the viral load continuous to rise.…”

“…This is consistent with the studies conducted in Northern Ethiopian, South west Ethiopia, Oromia and Rwanda in which fair and poor adherence level were significantly associated with non-suppressed viral load compared to patients with good adherence [ 15 , 21 , 22 , 26 , 27 ].…”

“…Patients with fairly and poorly adhered to their medications were 2.44 and 1.11 times more likely to have unsuppressed viral load in their blood than those patient who well adhered to their medications. This is consistent with the studies conducted in Northern Ethiopian, South west Ethiopia, Oromia and Rwanda in which fair and poor adherence level were significantly associated with non-suppressed viral load compared to patients with good adherence [15,21,22,26,27].…”

“…Data were collected using checklist developed from ART guidelines of Federal ministry of health of Ethiopia [1,8] and literatures [20][21][22][23] to obtain the necessary data from patients' records. The checklist containing sociodemographic, medication and clinical related characteristics were designed to review records in to identify the predictors of unsuppressed viral load.…”

Attrition and Its Predictors Among Adults Receiving First-Line Antiretroviral Therapy in Woldia Town Public Health Facilities, Northeast Ethiopia: A Retrospective Cohort Study

“…Viral load measurement is an indicator of successful medication adherence to clients and a suppressed viral load result is less risk of attrition. 49 This finding implies the need for expansion to viral load testing sites to attain universal access to timely viral load monitoring to avoid premature switching of clients to either second-or third-line ART regimen, which is more toxic and not as effective as the first-line regimen.…”