Socio-economic condition and lack of virological suppression among adults and adolescents receiving antiretroviral therapy in Ethiopia

Abstract

Introduction The potential impact of socio-economic condition on virological suppression during antiretroviral treatment (ART) in sub-Saharan Africa is largely unknown. In this case-control study, we compared socio-economic factors among Ethiopian ART recipients with lack of virological suppression to those with undetectable viral load (VL). Methods Cases (VL>1000 copies/ml) and controls (VL<150 copies/ml) aged ≥15years, with ART for >6 months and with available VL results within the last 3 months, were identified from registries at public ART clinics in Central Ethiopia. Questionnaire-based interviews on socio-economic characteristics, health condition and transmission risk behavior were conducted. Univariate variables associated with VL>1000 copies/ml (p<0.25) were added to a multivariable logistic regression model. Results Among 307 participants (155 cases, 152 controls), 61.2% were female, and the median age was 38 years (IQR 32–46). Median HIV-RNA load among cases was 6,904 copies/ml (IQR 2,843–26,789). Compared to controls, cases were younger (median 36 vs. 39 years; p = 0.004), more likely to be male (46.5% vs. 30.9%; p = 0.005) and had lower pre-ART CD4 cell counts (170 vs. 220 cells/μl; p = 0.009). In multivariable analysis of urban residents (94.8%), VL>1000 copies/ml was associated with lower relative wealth (adjusted odds ratio [aOR] 2.98; 95% CI 1.49–5.94; p = 0.016), geographic work mobility (aOR 6.27, 95% CI 1.82–21.6; p = 0.016), younger age (aOR 0.94 [year], 95% CI 0.91–0.98; p = 0.011), longer duration of ART (aOR 1.19 [year], 95% CI 1.07–1.33; p = 0.020), and suboptimal (aOR 3.83, 95% CI 1.33–10.2; p = 0.048) or poor self-perceived wellbeing (aOR 9.75, 95% CI 2.85–33.4; p = 0.012), after correction for multiple comparisons. High-risk sexual behavior and substance use was not associated with lack of virological suppression. Conclusion Geographic work mobility and lower relative wealth were associated with lack of virological suppression among Ethiopian ART recipients in this predominantly urban population. These characteristics indicate increased risk of treatment failure and the need for targeted interventions for persons with these risk factors.

HIV virological non-suppression is highly prevalent among 18- to 24-year-old youths on antiretroviral therapy at the Kenyan coast

“…In contrast, other studies have found significant association between VNS and youth age [ 22 – 24 ] or sex [ 24 , 59 ]. In support of our finding, an Ethiopian study [ 23 ] found a null association between VNS and participant sex. We think that the lack of association in our study may be because these young people aged 18 to 24 years are at a developmental age where they are equally exposed to the challenges of transitioning into adulthood while living with HIV, regardless of gender.…”

“…In the present analysis, the sample of 384 eligible participants is > 95% powered (at 5% level of significance) to detect a proportion of at least 0.20 given a null proportion of 0.11 [ 31 ]. The same sample is > 85% powered (at 5% level of significance) to carry out a logistic regression analysis of correlates of VNS based on previously reported effect sizes [ 23 ].…”

“…Most of the existing studies are limited in terms of consensus and some studies present contradictory findings, albeit because of contextual differences. For instance, long duration on ART was found to be significantly associated with lower odds of VNS among Cambodian youths [ 22 ], while among Ethiopian youths [ 23 ] this was associated with significantly higher odds of VNS. In SSA, male sex [ 24 , 25 ] and poor ART adherence [ 24 , 26 ] appear important risk indicators for VNS in YLWH; there is some consensus between studies but more research is warranted for a clear insight.…”

“…In SSA, male sex [ 24 , 25 ] and poor ART adherence [ 24 , 26 ] appear important risk indicators for VNS in YLWH; there is some consensus between studies but more research is warranted for a clear insight. Other risk indicators for VNS reported by studies conducted in Ethiopia and Malawi include WHO HIV clinical stage 2 [ 24 ], HIV-related stigma [ 25 ], lower socioeconomic status and poor self-reported wellbeing [ 23 ]. Whether these are also important correlates of VNS among YLWH across SSA is inconclusive; further research evidence is needed from other SSA countries.…”

Using a Syndemics Framework to Understand How Substance Use Contributes to Morbidity and Mortality among People Living with HIV in Africa: A Call to Action

“…While some societal forces that produce stigma and social exclusion are unique to each geographic, social, cultural, political, economic context in Nigeria, South Africa, and Uganda, the underlying disease pathways [73,74] (e.g., inflammatory mechanism) and non-disease pathways [75] (e.g., intersectional [76,77] and psychosocial [78][79][80]) that promote syndemic clustering of noncommunicable and communicable diseases for PWH are likely similar, based on context. The factors that drive syndemic emergence of disease for PWH in an LMIC are unique and different from the factors that drive emergence of disease in high income countries (HICs).…”