Viral load suppression and associated factors among patients receiving ART in Mekelle, Ethiopia: a cross-sectional study.

backgroundA significant number of individuals living with HIV are currently receiving combined antiretroviral therapy (cART), which is a combination of three or more antiretroviral medications used to treat HIV, with the goal of achieving viral suppression. However, little is known about the virological status of patients in Ethiopia, particularly in Mekelle, and the factors influencing viral load in this region have not been well studied. Therefore, this study aimed to assess the magnitude of viral load suppression and identify factors influencing it among patients attending ART care.

methodsA facility-based cross-sectional study was conducted in Mekelle City in March 2018. The study population included adult patients receiving cART, at public health facilities in Mekelle. A sample size of 456 was calculated using the double population proportion formula. A stratified systematic random sampling technique was used to select participants, and both primary and secondary data were collected. In the first step, the total number of patients on cART from October 1995 to March 1, 2017, was determined for each selected health facility. Patients who had been on cART for more than one year and met the inclusion criteria were identified. Proportional-to- population -size (PPS) sampling was then used to allocate the sample size across the health facilities. The first participant was selected randomly based on appointment numbers in the logbook, and the remaining participants were chosen at regular intervals (K = 4) from each facility. Variables with a p-value ≤ 0.20 in the bivariate analysis were included in the multivariable logistic regression model. Statistical significance in the multivariable analysis was set at p < 0.05. Results are presented as odds ratios (ORs) with 95% confidence intervals (CIs).

resultsA total of 456 eligible HIV-infected patients on cART were identified from medical records. Of these, 452 consented to participate in the interview, yielding a response rate of 99.1%. The viral load suppression rate was 86.7%. Factors significantly associated with lower odds of viral load suppression included being younger than 40 years (AOR = 0.30; 95% CI: 0.14–0.62), having an adherence rate below 95% (AOR = 0.21; 95% CI: 0.08–0.52), daily alcohol use (AOR = 0.12; 95% CI: 0.04–0.33), and a CD4 count of 0-199 cells/mm³ (AOR = 0.12; 95% CI: 0.04–0.39). Conversely, factors that increased the likelihood of viral load suppression included having at least a secondary education (AOR = 6.65; 95% CI: 2.26–19.58) and being on a single-tablet regimen (AOR = 4.87; 95% CI: 1.43–16.59).

conclusionThis study demonstrated a high viral load suppression rate (86.7%) among HIV-infected patients receiving cART, indicating generally effective treatment outcomes within the study population. However, viral suppression was significantly lower among patients younger than 40 years, those with suboptimal adherence (< 95%), daily alcohol users, and individuals with advanced immunosuppression (CD4 count 0–199 cells/mm³). Conversely, patients with at least secondary education and those receiving a single-tablet regimen were significantly more likely to achieve viral load suppression, underscoring the importance of educational empowerment and simplified treatment regimens in improving treatment success. CLINICAL TRIAL NUMBER: Not applicable.