Determinants of Virological Treatment Failure among Adults on First Line Highly Active Antiretroviral Therapy in Arada Sub City Public Health Facilities, Addis Ababa, Ethiopia

Abstract

Background: At this time viral load monitoring has become the standard of care to monitoring the success and diagnosing of virological treatment failure. In Ethiopia, prevalence of virological treatment failure is high (20.85%). However, little is known about the determinants of virological treatment failure in the study area. Objective: To identify determinants of virological treatment failure among adults on first line highly active antiretroviral therapy in Arada sub city public health facility, Addis Ababa, Ethiopia, 2023. Methods: Facility-based unmatched Case-control study was conducted from April to June 2023 among 316 participants (106 cases and 210 controls). Simple Random Sampling technique was used by computer generated random numbers based on medical registration number of patients. Data were collected from patients and medical records using structured interviewer administered questionnaire and structured checklists respectively. The association of virological treatment failure and each covariate was assessed by bivariate analysis to identify candidate variables at p value < 0.25. All candidate variables were entered into multivariate analysis to declare statistical significance association at p value < 0.05, 95% confidence interval. Results: Not disclosing HIV status (AOR = 2.732; 95% CI: 1.059, 7.049), waiting longer at clinic (AOR = 2.956; 95% CI: 1.361, 6.418), ART initiation after seven days of HIV diagnosis (AOR = 3.067; 95% CI: 1.117, 8.420), history of TB co-infection (AOR = 3.323; 95% CI: 1.272, 8.680), baseline WHO stage III/IV (AOR = 5.377; 95% CI: 2.225, 12.992), unemployment (AOR = 3.835; 95% CI: 1.069, 13.761), and poor adherence (AOR = 6.135; 95% CI: 2.649, 14.205) were determinants of virological failure. Conclusion: this study show that unemployment, nondisclosure, longer waiting time, advance in baseline WHO stage, history of TB co-infection, time-lag to initiate ART, and poor adherence were determinants of virological treatment failure. Therefore, health care providers and program developers should give special attention to; testing and rapid ART initiation, strengthening adherence support for clients who had poor adherence, improving waiting time, creating network of work for unemployed, disclosure and intensifying TB prevention and control.