Determinants of Virological Failure Among Adult Clients on First-Line Antiretroviral Therapy in Amhara Regional State, Northeast Ethiopia. A Case –Control Study

BACKGROUND: Virological failure is defined as having viral load measurement greater or equal to 1000 copies/mm(3) after at least six-month exposure to antiretroviral therapy. According to the Joint United Nations Programme on HIV/AIDS (UNAIDS-2018) report, globally nearly one in five patients on first-line antiretroviral therapy had experienced virological failure. In line with this, Ethiopia federal ministry of health also reported that one in four patients had experienced virological failure in the year 2016. To date, very little is known about the predictors of virological failure in the local context. Therefore, this study intended to address the determinants of virological failure among patients on a first-line antiretroviral regimen. METHODS: A case–control study was conducted among clients on first-line antiretroviral therapy in Amhara regional state, January 2019 with a sample of 257 clients; of these, 86 clients were cases. Data were collected via patient interview and chart extraction for clinical profiles using standardized tools. Binary logistic regression was computed to identify the determinants of virological failure using Stata version 14 and the result was displayed using adjusted odds ratio with a 95% confidence interval. RESULTS: Out of the proposed samples, 255 clients were considered for final analysis. The odds of virological failure are higher among poor medication adherence (AOR: 10.2:95% CI [4.1–25.8]), age<35 years (AOR: 3.07 95% CI 1.4–6.8), low baseline CD4 (AOR 3.9: 95% CI 1.6–9.6), and Khat chewers (AOR: 9.5:95% CI 2.8–32.4) as compared with their counterparts. CONCLUSION: Being a young age, poor immunity at the initiation of antiretroviral, Khat chewer, and poor medication adherence significantly associated with virological failure.