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. 2025 Jun 2:13:1440504.
doi: 10.3389/fpubh.2025.1440504. eCollection 2025.

Virological treatment failure and associated factors among adults on first-line antiretroviral therapy in West Hararghe, Ethiopia

Ebisa Zerihun  1 , Kenesa Tesema  2 , Fekadu Abera  1
Affiliations

Virological treatment failure and associated factors among adults on first-line antiretroviral therapy in West Hararghe, Ethiopia

Ebisa Zerihun et al. Front Public Health. .

Abstract

Background: Virological failure on first-line antiretroviral therapy (ART) remains a major challenge in the management of HIV/AIDS in resource-limited settings, including Ethiopia. However, the prevalence of virological failure and its associated factors among adult patients on first-line ART in West Hararghe, Ethiopia, are not well documented. Therefore, this study aimed to assess virological treatment failure and its determinants among people living with HIV (PWH) in West Hararghe, Eastern Ethiopia.

Methods: A retrospective cohort study was conducted using routine HIV-related data from a health facility providing services in West Hararghe between 01 January 2017 and 31 December 2020. Sociodemographic, behavioral, clinical, and HIV-related data were collected through medical chart reviews. Virological treatment failure was defined as a plasma viral load above 1,000 copies/mL based on two consecutive viral load measurements. A logistic regression model was used to identify factors associated with virological treatment failure.

Results: A total of 257 records of PWH were reviewed and included in this analysis. Of these, 11.67% experienced virological failure while on first-line ART. Baseline undernutrition (AOR = 3.717: 1.051, 13.139), non-disclosure of serostatus (AOR = 4.453: 1.340, 14.793), early (≤ 30 days) ART initiation (AOR = 0.235: 0.064, 0.859), a history of missed daily ART doses (AOR = 3.156: 1.007, 9.891), and the use of a dolutegravir (DTG)-based regimen (AOR = 0.275: 0. 085, 0.895) were statistically associated with virological failure on first-line ART.

Conclusion: Virological failure on first-line ART was found to be significantly high in West Hararghe. Factors such as undernutrition, non-disclosure of serostatus, interruption of ART doses, and the use of DTG-based regimens were identified as significant predictors of virological treatment failure. Healthcare providers should focus on the accelerated initiation of ART (preferably with a DTG-based regimen) and supplemental nutritional therapy for patients with undernutrition.

Keywords: HIV/AIDS; West Hararghe; early ART initiation; first-line ART; virological failure.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Conceptual framework describing predictors of ART virological treatment failure [Source: developed by the investigators, combining variables from the literature review (–13, 19)].
Figure 2
Figure 2
ROC showing the good predictive ability of the final model.
See this image and copyright information in PMC

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