Unsuppressed Viral Load Level in Public Health Facilities: Nonvirological Predictors among Adult Antiretroviral Therapy Users in Southwestern Ethiopia

Abstract

Birhanu Waju,1 Lamessa Dube,2 Muktar Ahmed,2,3 Semira Shimeles Assefa4 1ICAP Ethiopia HIV Prevention, Care and Treatment Program, Addis Ababa, Ethiopia; 2Jimma University, Department of Epidemiology, Jimma, Ethiopia; 3Australian Centre for Precision Health, Adelaide, SA, Australia; 4Department of Biomedical Sciences, Jimma University, Jimma, EthiopiaCorrespondence: Semira Shimeles Assefa Tel [phone]Email [email protected]: Unsuppressed viral load in patients on antiretroviral (ARV) therapy occurs when treatment fails to suppress a patient’s viral load, and is associated with decreased survival and increased HIV transmission. Identifying the level of unsuppressed viral load with its associated factors has benefits in controlling transmission and reducing burden. Therefore, this study aimed to assess unsuppressed viral load (> 1,000 copies/mL) and associated factors among HIV patients taking first-line antiretroviral treatment at public health facilities in Jimma, Ethiopia.Methods: A facility-based cross-sectional study was conducted on 669 patients on first-line ARV therapy (at least 6 months) in public health facilities in Jimma. Sociodemographic, treatment, clinical, immunological, and viral load data were extracted from medical records, entered into EpiData 3.1, and analyzed with SPSS 20. Multivariate logistic regression analysis was performed to identify factors independently associated with viral nonsuppression, considering a 95% CI with P< 0.05 statistically significant.Results: Among the participants, 258 (38.6%) were aged 25– 34 years. Median age was 35 years. Prevalence of unsuppressed viral load was 20.3%. Risk of unsuppressed viral loads was 91% lower among ARV therapy patients who had been taking ARV therapy < 2 years (AOR 0.09, 95% CI 0.01– 0.83), lower baseline BMI (AOR 4.44, 95% CI 1.56– 12.64), lower baseline CD4 (AOR 2.76, 95% CI 1.45– 5.29), poor adherence to ARV therapy medication (AOR 3.19, 95% CI 1.29– 7.89), and immunological failure (AOR 4.26, 95% CI 2.56– 7.09) were the independent predictors of unsuppressed viral load.Conclusion: This study revealed that there is a high level of virological failure among adult HIV patients, and confirms the need to develop close follow-up strategies of targeted interventions for patients in care who are at high risk of unsuppressed viral load.Keywords: human immunodeficiency virus, HIV, antiretroviral therapy, viral load suppression

Keywords

• human immune deficiency virus
• hiv
• antiretroviral therapy
• viral load suppression