Viral load change and time to death among adult HIV/AIDS patients on ART after initiation of test and treat program, multi-center retrospective follow up study, North West Ethiopia

Eyob Tilahun Abeje ^1* Eskezyiaw Agedew ² Bekalu Endalew ² Gedefaw Diress ²

• ¹ Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
• ² Department of Public Health, College of Health Science, Debre Markos University, Debre Markos, Amhara, Ethiopia

Introduction: Among Human Immunodeficiency Virus infected patients on antiretroviral therapy, nearly one-fifth develop viral load rebound within two years of initiation of therapy. There are few studies conducted in Ethiopia on viral load change, and these studies had limitations on unable to include undetectable viral load in the analysis and there is no study on the association of viral load change overtime and time to death.Institution-based retrospective follow-up study was conducted. The data was extracted from April 24/2022 to May 30/2022 from charts of 489 study participants, selected using simple random sampling. OpenBUGS software from R2OpenBUGS R package was used for model building. A joint Tobit skewed normal mixed effects model and survival analysis using a Bayesian approach was employed.The data was extracted from total 489 participants. The viral load is decreased by 0.027 log viral load up to 10.82 months and increased by 0.034 log viral load after 20.9 months for every increase in time by one month. Outside the catchment area increase the log viral load by 0.29 times than within the catchment area. The hazard of death is increased by 3.5 when the individual log viral load slope increased by one standard deviation from the slope of the population up to followup time of 10.82 months.The change in viral load increment is high at the latter follow up period compared to the decrement in viral load at the beginning of follow up period. Outside the catchment area, stage three and four WHO clinical stage, poor adherence. Emphasis on mitigation of stigmatism and discrimination is needed, which influence patients to take medication outside the catchment area, leading to high viral load count.