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

Abstract

Background Despite the scale up of antiretroviral therapy (ART), unsuppressed viral load among population taking ART in private and public health facilities is still a public health concern increasing the risk of treatment failure. Studies comprehensively assessing significant predictors of non-suppressed viral load among patients on follow up of AR in public and private health facilities are limited. The objective of the study was to identify predictors of unsuppressed viral load among adult patients taking antiretroviral therapy at selected public and private health facilities of Adama town, East shewa zone, Ethiopia. Methods An unmatched case-control study was conducted from April 15 /2021 to May 20/2021. A total sample size of 347 patients consisting 116 cases and 231 controls was selected from electronic database among patients who started ART from September 2015 to August 2020. Data were collected using checklist from patient medical records and analyzed by SPSS. The association of dependent and independent variables was determined using multivariate analysis with 95% confidence interval and P - value in logistic regression model to identify independent predictors. Result From the total 347 participants, 140 (40.3%) of them were males and 207 (59.7%) were females. In multivariate logistic regression, CD4 count < 100 [(AOR:1.22, 95% CI: 1.4-7.3)], CD4 100-200[(AOR: 2.58 95% CI: 1.06-8.28)], Fair Adherence [(AOR: 2.44, 95% CI: 1.67-4.82)], poor adherence [(AOR: 1.11, 95% CI: 1.7-6.73)], History of Cotrimoxazole Therapy (CPT) use and not used [(AOR: 2.60, 95% CI: 1.23-5.48)] and History of drug substitution [(AOR:. 361, 95% CI: .145-.897)] were independent predictors of unsuppressed viral load with the p-value less than 0.05. Conclusion and commendation In this study, Baseline CD4, adherence, History of CPT used and history of drug substitution was predictors of unsuppressed viral load. Monitoring immunological response through scheduled CD4 tests is essential to maintain immunity of the patients preventing diseases progression. Intensive adherence support and counseling should conclusively be provided through effective implementation of ART programs by providers would enhance viral suppression ensuring the quality of care and treatment.

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

“…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 ].…”

“…Another study showed that patients on second-line regimens were more likely to have virological suppression than those on first-line regimens (AOR, 8.98; 95% CI, 2.64–30.58) [ 35 ]. Patients who used cotrimexazole preventive therapy (CPT; AHR, 1.997; 95% CI, 1.108–3.600 [ 38 ]; AOR, 2.6; 95% CI, 1.23–5.48 [ 31 ]) and isoniazid preventive therapy (IPT; AHR, 3.09; 95% CI, 1.72–5.53 [ 38 ]) were more likely to achieve virological suppression compared with nonusers.…”

Virological suppression rate and its predictors among HIV/AIDS patients on antiretroviral therapy before and during the COVID-19 pandemic in Ethiopia: Systematic review and meta-analysis

“…The study found through database searching was performed between 2011 and 2022. Regarding the study area/region, seven studies were conducted in the Amhara region (19,24,25,26,27,28,29), six studies in the Oromia region (20,30,31,32,33,34), ve studies in the South Nation and Nationalities and Peoples of Ethiopia (SNNPE) region (18,35,36,37,38), one study in the Tigray region (39) and two studies in the Addis Abeba city administration (40,41).…”

“…By study design, ten studies were conducted using a cross-sectional study design (18,24,27,31,32,33,34,36,38,39), two studies were conducted using a case control study design (30,40), eight studies were conducted using a retrospective cohort stud (19,20,25,26,28,29,35,41) and one study was conducted using a prospective cohort study (37). Nine studies were conducted on rst-line ART patients (20,25,30,32,33,35,36,37,41), nine studies were conducted on both rst-and second-line ART patients (18, 19,24,27,28,31,34,38,39,40), and two were conducted on second-line ART patients (26, 29). The minimum sample size was 152 taken in the study in Arba Minch (37), and the maximum sample size was 19,525 used in the study in the Tigray region (39) for detail (Table 1).…”