Viral Suppression And Associated Factors Among Adult HIV Patients on Third Line Antiretroviral Therapy at 24 weeks in Referral Hospitals of Amhara Regional State, Ethiopia: A Cross-sectional Multicenter Study

Abstract

Background: Antiretroviral therapy has brought a significant impact in reduction of HIV related morbidity & mortality and transformed the infection into almost manageable disease. However, the long duration of treatment decreases the therapeutic and preventive effects of ART drugs resulted in treatment failure which require a switch to third-line antiretroviral regimen. Global data on virological and clinical outcomes of people living with HIV receiving third-line antiretroviral therapy through public health programs are severely limited. There is no published data in Ethiopia including the study areas. Objective: To assess the magnitude of Viral Suppression and associated factors among PLHIV on Third-Line ART in seven referral hospitals of Amhara Regional state, Ethiopia, 2023 Methods: Institution-based retrospective cross-sectional multicenter study was conducted among 160 adult PLHIV who are on third-line antiretroviral therapy enrolled in ART follow-up clinic from January 1, 2018 – August 01, 2023. Study subjects were recruited by purposive consecutive non-random sampling in the study. A validated data extraction checklist was adopted from a study conducted in South Africa. After the data was checked for its completeness, it was entered into Epi data version 4.6 and was exported to SPSS version 25 for analysis. A bivariate logistic regression model was used to select predictors. In multivariate logistic regression variables having p value of less than 0.05 were considered to be independent predictors. Result: Among the participants 135 (84.34%, 95%CI: 77.81-89.26) had viral suppression. More than half were males, three quarters had more than 10 years of ART exposure, a baseline median was VL of 13,532cp/ml and more than half took DRV/r-DTG-AZT/3TC regimen. Active TB at switch (AOR=12.975 95% CI: 2.033-82.802), medication adherence (AOR=0.125 95% CI 0.041-0.382), viral load (AOR= 0.219 95% CI: 0.054-0.886) and residence (AOR= 0.26 95% CI: 0.084-1.038) were found to be predictors of viral suppression for PLHIV on TLART. Conclusion and Recommendations: Remarkably, the viral suppression of third line ART was optimally good in the study areas. Concerned stakeholders and health care facilities should work on intervention programs such as TB preventive therapy, adherence and VL monitoring