Determinants of HIV viral load suppression rates in Amhara region, Ethiopia with a large number of internally displaced people.

Background: The Amhara region in Ethiopia has been affected by a war that led to displacement of millions of people. This study was conducted with the objectives of evaluating HIV viral suppression rates, assessing viral load (VL) testing turnaround time (TAT) and pilot testing of a new webapp to make VL results available in real time while the health system is affected by large numbers of internally displaced people (IDP). Methods: Data was obtained from 7 HIV VL testing centers that serve 378 anti-retroviral treatment centers. Viral load (VL) suppression rates and VL result turnaround time (TAT) were used as markers of effectiveness of HIV control. Findings: A total of 98,957 records were analyzed. Patients at three of the seven VL testing sites including Debre-Birehan Referral Hospital (aOR 1.87, 95 CI [1.63-2.14]), Debre-Markos Referral Hospital (aOR 1.76, 95 CI [1.61-1.93]) and University of Gonder (aOR 2.28, 95 CI [2.07-2.51]) had increased risk of virologic failure. TAT between the time VL results were available to the time results were mailed to treatment centers was ≤ 1 week for 61,148 (63.4%) and 2 weeks for 25,172 (26.1%) tests. TAT vary among the 7 VL testing centers. Interpretation: In a region with large numbers of IDP, virologic failure is more common in older age groups. VL and TAT vary by testing centers which could be reflective of ART default and delay in courier mail driven by internal displacement.