Unsuppressed Viral Load and Associated Factors among Adult ART Users at Public Health Facilities of Jimma Town, Ethiopia

Abstract

Background: Unsuppressed viral load in patients on antiretroviral therapy (ART) occurs when treatment fails to suppress a person’s viral load and is associated with decreased survival and increased human immunodeficiency virus transmission. To our knowledge, studies on the incidence and risk factors of virologic failure in Ethiopia are scant. Objective: To assess unsuppressed viral load (Viral Load >1000 copies/ml) and associated factors among patients taking first line anti-retroviral treatment at public health facilities found in Jimma town 2019. Methods: A retrospective review of data was performed for 669 patients on first-line ART (at least for six months) in public health facilities in Jimma Town. Socio-demographic, treatment, clinical, immunological and viral load data were extracted from medical records, entered into Epidata version 3.1 and analyzed by SPSS version 20. Multivariate logistic regression analysis was performed to identify factors independently associated with viral non-suppression, considering a 95%CI with p-value <0.05 statistical significance level. Result: In this study, prevalence of unsuppressed viral load was 20.3%. The risk of unsuppressed viral loads was 91% lower among ART patients who had been taking ART for <2 years (AOR=0.09, 95% CI: (0.01, 0.83) compared to those taking for >2 years. Having a baseline BMI between 16 and 18.5 kg/m2 (AOR=2.89, 95% CI: (1.76, 4.79) versus BMI > 18.5 kg/m2 , baseline BMI <16 kg/m2 (AOR=4.44, 95% CI: (1.56, 12.64) compared with those BMI >18.5 kg/m2 , baseline CD4 >100-250 cells/mm3 (AOR=2.07, 95% CI: (1.28, 3.34) versus CD4>250 cells/mm3 , baseline CD4 <100 cells/mm3 (AOR=2.76, 95% CI: (1.45, 5.29) compared to those with CD4>250 cells/mm3 , poor Adherence to ART medication (AOR=3.19, 95% CI: 1.29, 7.89) versus good adherence and immunologic failure (AOR=4.26, 95% CI: 2.56, 7.09) compared to those with no immunological failure significantly increased the risk of virological failure. Conclusion: This study revealed that high level of viroligic failure among adult HIV-patients. Patients initiated on ART for less than two years, lower baseline BMI, low baseline CD4, poor adherence and immunologic failure were independent predictors of unsuppressed viral load. These results indicated the need to develop and close follow up strategies of targeted interventions for patients in care who are at high risk of unsuppressed viral load.