A Retrospective Cross-Sectional Study on the Prevalence and Factors Associated with Virological Non-Suppression among HIV-Positive Adult Patients on Antiretroviral Therapy in Woliso Town, Oromia, Ethiopia

Background: HIV virological failure still remains a problem in HV/AIDS treatment and care. This study aimed to describe the prevalence and identify the factors associated with viral non-suppression among HIV-positive adult patients on antiretroviral therapy in Woliso Town, Oromia, Ethiopia. Methods: A retrospective cross-sectional study was conducted among 424 HIV-positive patient’s attending antiretroviral therapy (ART) in Woliso Town during the period from August 25, 2020 to August 30, 2020. Data collected from patient medical records were entered into Epi Info version 2.3.2.1 and exported to SPSS version 21.0 for analysis. Logistic regression analysis was done to identify factors associated with viral load non-suppression, and statistical significance of odds ratios were declared using 95% confidence interval and p-value < 0.05. Results: A total of 424 patients were included in this study. The mean age (± SD) of the study participants was 39.88 (± 9.995) years. The prevalence of HIV viral load non-suppression was 55 (13.0%) with 95% CI (9.9-16.5). Second-line ART treatment regimen (Adjusted Odds Ratio (AOR) = 8.98, 95% Confidence Interval (CI): 2.64, 30.58) and routine viral load testing (AOR = 0.01, 95% CI: 0.001, 0.02) were significantly associated with virological non-suppression. Conclusion: Virological non-suppression was high, which hinders the achievement of the third global 95 target. The second-line regimen and routine viral load testing were significantly associated with virological non-suppression. It suggests the need to assess the effectiveness of antiretroviral drugs for epidemic control. It also clearly shows the need to decentralize third-line ART treatment for those patients in need.




References:
[1] Federal HIV/AIDS Prevention and Control Office, “HIV Prevention in Ethiopia National Road Map 2018 - 2020.” Nov. 2018.
[2] Federal Ministry of Health Ethiopia (FMOH), “National Comprehensive Care and Treatment guideline for Implementation 2018.” Aug. 2018.
[3] PEPFAR, “PEPFAR 2020 Country Operational Plan Guidance for all PEPFAR Countries” US Government, Nov. 25, 2019, (Online). Available: https://www.pepfar.net.
[4] P. K. Drain et al., “Point-of-Care HIV Viral Load Testing: an Essential Tool for a Sustainable Global HIV/AIDS Response,” Clin. Microbiol. Rev., vol. 32, no. 3, 19 2019, doi: 10.1128/CMR.00097-18.
[5] J. E. Haberer et al., “ART adherence and viral suppression are high among most non-pregnant individuals with early-stage, asymptomatic HIV infection: an observational study from Uganda and South Africa,” J Int AIDS Soc, vol. 22, no. 2, p. e25232, 2019, doi: 10.1002/jia2.25232.
[6] L. S. Park et al., “Association of Viral Suppression with Lower AIDS-Defining and Non-AIDS-Defining Cancer Incidence in HIV-Infected Veterans: A Prospective Cohort Study,” Ann. Intern. Med., vol. 169, no. 2, pp. 87–96, 17 2018, doi: 10.7326/M16-2094.
[7] P. Cherutich et al., “Detectable HIV Viral Load in Kenya: Data from a Population-Based Survey,” PLoS ONE, vol. 11, no. 5, p. e0154318, 2016, doi: 10.1371/journal.pone.0154318.
[8] C. Shoko and D. Chikobvu, “Determinants of viral load rebound on HIV/AIDS patients receiving antiretroviral therapy: results from South Africa,” Theor Biol Med Model, vol. 15, no. 1, p. 10, 16 2018, doi: 10.1186/s12976-018-0082-0.
[9] A. F. Schoffelen, A. M. J. Wensing, H. A. Tempelman, S. P. M. Geelen, A. I. M. Hoepelman, and R. E. Barth, “Sustained Virological Response on Second-Line Antiretroviral Therapy following Virological Failure in HIV-Infected Patients in Rural South Africa,” PLoS One, vol. 8, no. 3, Mar. 2013, doi: 10.1371/journal.pone.0058526.
[10] D. Edessa, M. Sisay, and F. Asefa, “Second-line HIV treatment failure in sub-Saharan Africa: A systematic review and meta-analysis,” PLoS ONE, vol. 14, no. 7, p. e0220159, 2019, doi: 10.1371/journal.pone.0220159.
[11] V. Q. Dat et al., “Viral load suppression and acquired HIV drug resistance in adults receiving antiretroviral therapy in Viet Nam: results from a nationally representative survey,” Western Pac Surveill Response J, vol. 9, no. 3, pp. 16–24, Sep. 2018, doi: 10.5365/wpsar.2018.9.1.008.
[12] E. Umar, J. A. Levy, R. C. Bailey, G. Donenberg, R. C. Hershow, and M. E. Mackesy-Amiti, “Virological Non-suppression and Its Correlates Among Adolescents and Young People Living with HIV in Southern Malawi,” AIDS Behav, vol. 23, no. 2, pp. 513–522, Feb. 2019, doi: 10.1007/s10461-018-2255-6.
[13] L. Bulage et al., “Factors Associated with Virological Non-suppression among HIV-Positive Patients on Antiretroviral Therapy in Uganda, August 2014-July 2015,” BMC Infect. Dis., vol. 17, no. 1, p. 326, 03 2017, doi: 10.1186/s12879-017-2428-3.
[14] G. Namale et al., “Sustained virological response and drug resistance among female sex workers living with HIV on antiretroviral therapy in Kampala, Uganda: a cross-sectional study,” Sex Transm Infect, vol. 95, no. 6, pp. 405–411, Sep. 2019, doi: 10.1136/sextrans-2018-053854.
[15] E. Kuhn et al., “Viral load strategy: impact on risk behaviour and serocommunication of men who have sex with men in specialized care,” J Eur Acad Dermatol Venereol, vol. 30, no. 9, pp. 1561–1566, Sep. 2016, doi: 10.1111/jdv.13672.
[16] N. Aziz et al., “Time to viral load suppression in antiretroviral-naive and -experienced HIV-infected pregnant women on highly active antiretroviral therapy: implications for pregnant women presenting late in gestation,” BJOG, vol. 120, no. 12, pp. 1534–1547, Nov. 2013, doi: 10.1111/1471-0528.12226.
[17] D. M. Coviello et al., “Prevalence of HIV Viral Load Suppression Among Psychiatric Inpatients with Comorbid Substance Use Disorders,” Community Ment Health J, vol. 54, no. 8, pp. 1146–1153, 2018, doi: 10.1007/s10597-018-0284-2.
[18] M. Daskalopoulou et al., “Non-Disclosure of HIV Status and Associations with Psychological Factors, ART Non-Adherence, and Viral Load Non-Suppression Among People Living with HIV in the UK,” AIDS Behav, vol. 21, no. 1, pp. 184–195, Jan. 2017, doi: 10.1007/s10461-016-1541-4.
[19] T. Nsubuga-Nyombi et al., “Multivariate analysis of covariates of adherence among HIV-positive mothers with low viral suppression,” AIDS Res Ther, vol. 15, no. 1, p. 9, 31 2018, doi: 10.1186/s12981-018-0197-8.
[20] A. A. Desta et al., “HIV virological non-suppression and factors associated with non-suppression among adolescents and adults on antiretroviral therapy in northern Ethiopia: a retrospective study,” BMC Infectious Diseases, vol. 20, no. 1, p. 4, Jan. 2020, doi: 10.1186/s12879-019-4732-6.
[21] A. Mulu, U. G. Liebert, and M. Maier, “Virological efficacy and immunological recovery among Ethiopian HIV-1 infected adults and children,” BMC Infect. Dis., vol. 14, p. 28, Jan. 2014, doi: 10.1186/1471-2334-14-28.
[22] C. D. Agegnehu, M. W. Merid, and M. K. Yenit, “Incidence and predictors of virological failure among adult HIV patients on first-line antiretroviral therapy in Amhara regional referral hospitals; Ethiopia: a retrospective follow-up study,” BMC Infect Dis, vol. 20, Jul. 2020, doi: 10.1186/s12879-020-05177-2.
[23] H. Negash et al., “The effect of tuberculosis on immune reconstitution among HIV patients on highly active antiretroviral therapy in Adigrat general hospital, eastern Tigrai, Ethiopia; 2019: a retrospective follow up study,” BMC Immunol., vol. 20, no. 1, p. 45, 05 2019, doi: 10.1186/s12865-019-0327-7.
[24] J. H. Ali and T. G. Yirtaw, “Time to viral load suppression and its associated factors in cohort of patients taking antiretroviral treatment in East Shewa zone, Oromiya, Ethiopia, 2018,” BMC Infect. Dis., vol. 19, no. 1, p. 1084, Dec. 2019, doi: 10.1186/s12879-019-4702-z.
[25] A. T. Tsegaye, M. Wubshet, T. Awoke, and K. Addis Alene, “Predictors of treatment failure on second-line antiretroviral therapy among adults in northwest Ethiopia: a multicentre retrospective follow-up study,” BMJ Open, vol. 6, no. 12, p. e012537, 08 2016, doi: 10.1136/bmjopen-2016-012537.
[26] K. Chhim et al., “Factors associated with viral non-suppression among adolescents living with HIV in Cambodia: a cross-sectional study,” AIDS Res Ther, vol. 15, no. 1, p. 20, 17 2018, doi: 10.1186/s12981-018-0205-z.
[27] H. Negash et al., “Increased Virological Failure and Determinants Among HIV Patients on Highly Active Retroviral Therapy in Adigrat General Hospital, Northern Ethiopia, 2019: Hospital-Based Cross-Sectional Study,” Infect Drug Resist, vol. 13, pp. 1863–1872, Jun. 2020, doi: 10.2147/IDR.S251619.
[28] G. Ayele, B. Tessema, A. Amsalu, G. Ferede, and G. Yismaw, “Prevalence and associated factors of treatment failure among HIV/AIDS patients on HAART attending University of Gondar Referral Hospital Northwest Ethiopia,” BMC Immunol, vol. 19, no. 1, p. 37, Dec. 2018, doi: 10.1186/s12865-018-0278-4.
[29] J. Ross et al., “High levels of viral load monitoring and viral suppression under Treat All in Rwanda - a cross-sectional study,” J Int AIDS Soc, vol. 23, no. 6, p. e25543, Jun. 2020, doi: 10.1002/jia2.25543.
[30] “Failure of second-line ART is common in resource-limited countries, but modern third-line regimens work well,” aidsmap.com. https://www.aidsmap.com/news/mar-2018/failure-second-line-art-common-resource-limited-countries-modern-third-line-regimens (accessed Aug. 25, 2020).
[31] Z. El-Khatib et al., “Viremia and drug resistance among HIV-1 patients on antiretroviral treatment: a cross-sectional study in Soweto, South Africa,” AIDS, vol. 24, no. 11, pp. 1679–1687, Jul. 2010, doi: 10.1097/QAD.0b013e32833a097b.
[32] G. U. van Zyl et al., “Low lopinavir plasma or hair concentrations explain second-line protease inhibitor failures in a resource-limited setting,” Apr. 2011, doi: 10.1097/QAI.0b013e31820dc0cc.
[33] R. K. A. Sang and F. O. Miruka, “Factors Associated with Virologic Failure Amongst Adults on Antiretroviral Therapy in Nyanza Region, Kenya.,” IOSR, vol. 15, no. 07, pp. 108–121, Jul. 2016, doi: 10.9790/0853-15076108121.
[34] M. Sylla et al., “Second-line antiretroviral therapy failure and characterization of HIV-1 drug resistance patterns in children in Mali,” Arch Pediatr, vol. 26, no. 5, pp. 254–258, Jul. 2019, doi: 10.1016/j.arcped.2019.06.002.
[35] S. Miti et al., “Prevalence and characteristics of HIV drug resistance among antiretroviral treatment (ART) experienced adolescents and young adults living with HIV in Ndola, Zambia,” PLOS ONE, vol. 15, no. 8, p. e0236156, Aug. 2020, doi: 10.1371/journal.pone.0236156.
[36] R. G. Mungwira et al., “A targeted approach for routine viral load monitoring in Malawian adults on antiretroviral therapy,” Trop. Med. Int. Health, vol. 23, no. 5, pp. 526–532, 2018, doi: 10.1111/tmi.13047.
[37] S. Rangarajan et al., “Factors associated with HIV viral load suppression on antiretroviral therapy in Vietnam,” J Virus Erad, vol. 2, no. 2, pp. 94–101, Apr. 2016.
[38] T. M. Pollack et al., “Routine versus Targeted Viral Load Strategy among Patients Starting Antiretroviral in Hanoi, Vietnam,” J Int AIDS Soc, vol. 22, no. 3, p. e25258, 2019, doi: 10.1002/jia2.25258.
[39] C. Laxmeshwar et al., “Routine viral load monitoring and enhanced adherence counselling at a public ART centre in Mumbai, India,” PLoS ONE, vol. 15, no. 5, p. e0232576, 2020, doi: 10.1371/journal.pone.0232576.