Virological failure among HIV-infected adult patients taking second line antiretroviral treatment in Addis Ababa, Ethiopia

Abstract

HIV virological failure presents significant challenges, including drug resistance, increased transmission of HIV, morbidity, and mortality. The study aimed to assess the magnitude and risk factors of virological failure among HIV-infected adult patients taking second line Anti-Retroviral Therapy (ART) in selected hospitals in Addis Ababa, Ethiopia. A concurrent mixed-methods study was conducted among adults living with HIV on second-line ART in Addis Ababa, Ethiopia, enrolled between 2018 and 2022. The study underwent rigorous ethical review and received approval. The research period spanned from August 20 to November 25, 2024, and involved retrospective and prospective data, including records, FGDs, and KIIs. Quantitative analysis was conducted using SPSS 28, STATA 18, and R; qualitative data were thematically analyzed with Atlas.ti 24. A total of 369 study participants were enrolled in this study. Of these, 191 (52%) were male, with a median age of 44. The study found a magnitude of 14.9% virological failure (VF). Risk factors influencing VF included clients transferred from other facilities [AOR 2.726 (95% CI: 1.235, 6.016, P-value: 0.013)] and a greater risk of VF among those lost to follow-up (LTFU), with an AOR of 6.007 (95% CI: 2.778, 12.990, P-value < 0.001), as well as those with poor adherence, with an AOR of 6.641 (95% CI: 1.077, 40.95, P-value: 0.041). Patients not changing their regimen were less likely to experience VF, with an AOR 0.475 (95% CI: 0.250, 0.902), P-value: 0.023. The study revealed an incidence density of 27.2 per 10,000 person-months. Cumulative probabilities of failure were 4.5% at 24 months, 80.7% at 60 months, and 92% at 72 months. The qualitative result identified effective strategies for enhancing ART adherence, including Enhanced Adherence Counseling (EAC). Guidelines for managing virological failure were developed, along with policy recommendations for improving the quality of life. v The findings provided valuable insights for HIV program managers and policymakers to strengthen the monitoring and management of second line ART programs and highly recommend the implementation of DSD modalities, strengthening EAC, and active follow-up using technology to capture LTFU clients, drug resistance testing, and timely switching to the next level appropriate regimen.