Time to Viral Load Suppression and Its Predictors Among Adult Patients on Antiretro Viral Therapy in Nigist Eleni Mohammed Memorial Comprehensive Specialized Hospital, Hossana, Southern Ethiopia

Abstract

Background Unsuppressed viral load count in patients on anti-retroviral therapy is linked to poorer survival and increased transmission of the virus. Despite efforts made in Ethiopia, the viral load suppression rate is still low. Objective To estimate time to viral load suppression and predictors of viral load suppression among adults on anti-retroviral therapy in Nigist Elen Mohamed Memorial Comprehensive Specialized Hospital, 2022. Materials and Methods A retrospective follow-up study was conducted among 297 adults on anti-retroviral therapy from January 1, 2016, to December 31, 2021. A simple random sampling technique was used to select study participants. The data were analyzed using STATA 14. Cox regression model was used. The adjusted hazard ratio with 95% CI was estimated. Results A total of 296 records of patients on anti-retroviral therapy were included in this study. The incidence of viral load suppression was 9.68 per 100-person months. The median time for viral load suppression was 9 months. Patients with baseline CD4 ≥200 cell/mm 3 (AHR: 1.87; 95% CI = 1.34, 2.63), who had no opportunistic infections (AHR = 1.84; 95% CI = 1.34, 2.52), who were on WHO clinical stage-I or II (AHR = 2.12; 95% CI = 1.18, 3.79) and who have taken tuberculosis preventive therapy (AHR = 2.24; 95% CI = 1.66, 3.02) had higher hazards of viral load suppression. Conclusion The median time for viral load suppression was 9 months. Patients who had no opportunistic infection, with higher CD4 count, on WHO clinical stage-I or II, who have taken tuberculosis preventive therapy had higher hazards of viral load suppression. Careful monitoring and counseling of patients with CD4 levels lower than 200 cells/mm3 are necessary. Careful monitoring and counseling of patients in advanced WHO clinical stages, with lower CD4 count levels and with opportunistic infections is crucial. Strengthening the provision of tuberculosis preventive therapy is warranted.

Virological Suppression and its Predictors Among HIV/AIDS Patients on Antiretroviral Therapy in Ethiopia: Systematic Review and Meta-analysis

“…This finding suggests that preventing and managing common opportunistic infections can improve viral suppression in Ethiopia. Additionally, a high baseline viral load copy reduces the rate of viral suppression in Ethiopia, which is consistent with the literature [ 26 , 27 , 36 ] because a high viral load indicates disease progression and adherence issues, resulting in lower viral suppression. Furthermore, limited appropriate action is taken based on viral load results in various resource-poor settings [ 52 ].…”

“…The presence of opportunistic infections plays a significant role in determining the virological suppression of patients receiving ART. Patients without any opportunistic infections are more likely to achieve virological suppression, which is supported in the literature [ 20 , 36 ]. Initiating ART can help prevent many opportunistic infections, but in Ethiopia, the late presentation of patients to care and treatment leads to a high incidence of opportunistic infections and nonsuppression of the virus.…”

“…The studies found through database searching and included for the current review were performed between 2016 and 2022 and published between 2018 and 2023. Regarding the study area/region, 7 articles were conducted in the Amhara region [ 20 , 25–30 ], 6 studies in the Oromia region [ 21 , 31–35 ], 5 articles in the South Nation and Nationalities and Peoples of Ethiopia (SNNPE) region [ 19 , 36–39 ], 1 study in the Tigray region [ 40 ], and 2 studies in the Addis Abeba city administration [ 41 , 42 ].…”

“…Ten articles were conducted using a cross-sectional study design [ 19 , 25 , 28 , 32–35 , 37 , 39 , 40 ], 2 studies were conducted using a case–control study design [ 31 , 41 ], 8 studies were conducted using a retrospective cohort study [ 20 , 21 , 26 , 27 , 29 , 30 , 36 , 42 ], and 1 study was conducted using a prospective cohort study [ 38 ]. Nine studies were conducted on first-line ART patients [ 21 , 26 , 31 , 33 , 34 , 36 , 37 , 38 , 42 ], 9 studies were conducted on both first- and second-line ART patients [ 19 , 20 , 25 , 28 , 29 , 32 , 35 , 39 , 40 , 41 ], and 2 were conducted on second-line ART patients [ 27 , 30 ]. The minimum sample size was 152 in the study in Arba Minch [ 38 ], and the maximum sample size was 19 525 in the study in the Tigray region ( Table 1 ) [ 40 ].…”

Relationship Between Tenofovir Diphosphate Concentrations in Dried Blood Spots and Virological Outcomes After Initiating Tenofovir–Lamivudine–Dolutegravir as First-Line or Second-Line Antiretroviral Therapy

“…This may indicate that multiple factors contributed to viremia at early time points (such as the control of concurrent opportunistic infections and baseline viral loads), whereas virological suppression at later time points was more independently related to ART exposure. 26 …”