Time to viral load re-suppression and its predictors among adult patients on Second-line Anti-Retro Viral Therapy in Northeastern Ethiopia: Multi-center prospective follow-up study

Muluken Amare Wudu ^1* Abebe Yehualaw Melaku ² Niguss Cherie ¹ Tarikua Afework Birhanu ¹

• ¹ Wollo University, Dessie, Ethiopia
• ² Dessie Hospital, Dessie, Ethiopia

Background: Despite the increasing number of patients on second-line antiretroviral therapy in low-income countries like Ethiopia, there is limited evidence regarding the time to viral resuppression. Consequently, this study aimed to assess the time to viral load re-suppression and its predictors among adult patients on second-line antiretroviral therapy in Northeastern Ethiopia. Method: A multi-center, institution-based prospective follow-up study was conducted over 48 months, from February 2022 to February 2024, involving 526 adults living with Human Immunodeficiency Virus (HIV) who were receiving second-line Antiretroviral Therapy in northeast Ethiopia. Data were collected through face-to-face interviews and chart reviews. A Weibull proportional hazards model was fitted to identify the predictors of viral re-suppression. Result: The median time to viral re-suppression was 9 months (IQR = 3-15 months). Moreover, the rate of viral re-suppression was 44.3 per 1,000 person-months (95% CI: 40.4-49). Predictors of viral re-suppression included disclosure of Human Immunodeficiency Virus status [AHR 2.24 (95% CI: 1.4-3.7)], classification in World Health Organization clinical stages I and II [AHR 6.9 (95% CI: 4.4-9.6)], receipt of Tuberculosis preventive treatment [AHR 3.7 (95% CI: 2.3-5.93)], absence of first-line drug substitution history [AHR 1.44 (95% CI: 1.2-1.8)], and good adherence to treatment [AHR 1.9 (95% CI: 1.4-2.54)]. Conclusion and Recommendations: In this study, the time to viral load re-suppression was longer than expected. Disclosure status, WHO clinical stage I or II, receiving tuberculosis preventive treatment, and the absence of first-line drug substitution history were predictors of viral load resuppression. Health managers and Antiretroviral Therapy care providers must improve the timing and effectiveness of early disclosure, encourage the early use of Tuberculosis prophylaxis, and maintain good adherence through various strategies.