Determinants Of Human Immunodeficiency Virus Viral Non-Suppression Among Children On Antiretroviral Treatment At Public Health Facilities In Oromia, Ethiopia, 2024

Abstract

Background: Despite the availability of antiretroviral therapy, many Human Immunodeficiency virus-positive children struggle to achieve viral suppression. There were limited studies of determinants of viral non-suppression in children in resource-limited countries like Ethiopia. This study identified determinants of viral non-suppression which is crucial for improving the health outcomes of these children. Objective: This study aims to identify the determinants of Human Immunodeficiency virus viral non-suppression among children on antiretroviral therapy in Oromia, Ethiopia, 2024. Methods: An institution-based case-control study was conducted among 475 (95 cases and 380 controls) children receiving antiretroviral therapy in Oromia from January 22/2024 to March 31/2024. Primary and secondary data were collected using a structured and face-to-face interviewer-administered checklist with a consecutive sampling method. A binary logistic regression analysis was conducted to identify determinants of viral non-suppression. Bivariable logistic regression having a P-value less than 0.25 was used for multivariable analysis after checking the assumptions. Lastly, a 95% confidence interval and P-value <0.05 were considered as a statistically significant association. Tabular, textual and graphical data presentation was used. Result: The response rate of the study was 100%. The independent determinant of viral non-suppression were recent malnutrition (AOR: 3.65, 95% CI: 1.08- 12.33), inappropriate baseline developmental status (AOR: 2.93, 95% CI: 1.14 – 7.55), the first viral load >1000 copies/ml (AOR: 3.92, 95% CI: 1.55 - 9.95), antiretroviral treatment interruption (AOR: 6.66, 95% CI: 2.24 – 19.85), recent protease Inhibitor or Non-Nucleoside Reverse Transcriptase Inhibitor-based regimen (AOR: 4.12, 95% CI: 1.10, 15.40) and children on the 2nd line regimen (AOR: 12.45, 95% CI: 3.09- 50.08). On the contrary, recent CD4 count >450 cells/mm3 (AOR: 0.15, 95% CI: 0.04 – 0.57), children on antiretroviral treatment for 36-84 months (AOR: 0.22, 95% CI: