HIV virological non-suppression and factors associated with non-suppression among adolescents and adults on antiretroviral therapy in northern Ethiopia: a retrospective study

Abstract

BackgroundDespite the benefits of Antiretroviral Therapy (ART), there is a growing concern of treatment failure. This study aimed to assess viral non suppression rate and factors associated with HIV viral non suppression among adolescents and adults on ART in Northern Ethiopia.MethodsA retrospective cross sectional study was done on 19,525 study subjects. All the data in the database of Tigray Health Research Institute was exported to Microsoft excel 2010 and then data verification and filtration were done before exporting to STATA 14.0 for analysis. Generalized Estimating Equation (GEE) logistic regression was used for statistical modeling of viral non suppression.ResultsA total of 5153 (26.39%; 95%CI (25.77%, 27.02)) patients had no viral suppression despite being on ART. Being male (AOR = 1.27, 95% CI: 1.18, 1.37), 15–19 years of age (AOR = 4.86, 95%CI: 3.86, 6.12), patients from primary hospital (AOR = 1.26, 95%CI: 1.05, 1.52), WHO staging II (AOR = 1.31, 95%CI: 1.10, 1.54), poor ART adherence level (AOR = 2.56, 95%CI: 1.97, 3.33), fair ART adherence level (AOR = 1.61, 95%CI: 1.36, 1.90), baseline CD-4 count of < 200 cells/micro liter (AOR = 1.33, 95%CI: 1.14, 1.54), recent CD-4 count of < 200 cells/micro liter (AOR = 3.78, 95%CI: 3.34, 4.27), regimen types: 1c (AZT-3TC-NVP) (AOR = 1.32, 95%CI: 1.22, 1.44), 2 h (TDF-3TC-ATV/R) (AOR = 1.79, 95%CI: 1.27, 2.52) and declined immunological responses after ART initiation (AOR = 1.45, 95%CI: 1.30, 1.61) were significantly associated with viral non-suppression.ConclusionsThe virological non suppression was high which makes it less likely to achieve the third 90 UNAIDS target. Being male, patients with WHO staging II and poor ART adherence level were significantly associated with viral non suppression. Therefore, intensive adherence support and counseling should be provided. It is also a high time to determine the antiretroviral drugs resistance pattern given the fact that a large number of patients had virological non suppression.

Multilevel modelling and multiple group analysis of disparities in continuity of care and viral suppression among adolescents and youths living with HIV in Nigeria

“…Also, while the odds for viral suppression reduced with lower levels of retention in older adolescents and young adults, there was no significant difference in odds for viral suppression among young adolescents retained in care and those who were not. Although these findings seem counterintuitive since better retention in care is expected to lead to higher rates of viral suppression, it corroborates findings from other studies [30][31][32][33][34][35][36] showing high rates of viral non-suppression among young adolescents despite perfect adherence, most notably among young adolescents initiated on AZT+3 TC+NVP/EFV. In our study, young adolescents were also initiated predominantly on ART regimen AZT+3 TC+NVP/EFV(63.2%), in contrast to older adolescents and young adults who were initiated predominantly on TDF/3TC/EFV or NVP (83.90% and 90.1%, respectively).…”

“…This supports previous findings from sub-Saharan Africa countries, where being young, female and less-educated increases the chances for transgenerational HIV transmission. 36 Combined with high adolescent fertility rates in Nigeria, poor retention and low viral suppression rates among older adolescents and young adults in our study might undermine ongoing efforts at eliminating HIV mother-to-child transmission. However, we also found other gender-specific disparities within our cohort in which male young adult living with HIVs had a higher likelihood of interrupting care or being LTF, and male older adolescent living with HIV being less likely to achieve viral suppression.…”

Incidence and factors associated with treatment failure among HIV infected adolescent and adult patients on second-line antiretroviral therapy in public hospitals of Northern Ethiopia: Multicenter retrospective study

“…Even though second-line ART was introduced in Ethiopia ten years prior, few studies have reported about the treatment outcome of second-line therapy. Although there were studies on treatment failure focusing on viral suppression and immunological failure on the failure of ART users [14,15], none of these studies have addressed the effect of patient adherence on second-line ART treatment. To our knowledge, the factors contributing to treatment failure of HIV infected patients on second-line ART have not been investigated in the study area.…”

<p>Level of Adherence and Associated Factors Among HIV-Infected Patients on Antiretroviral Therapy in Northern Ethiopia: Retrospective Analysis</p>

“…To come up with the sample, all records in the database were reviewed and all the data that fulfill the eligibility criteria were included in the study. [15][16][17]…”