Table 1.
Associations of variables with viral non-suppression among HIV infected adolescents and adult patients on ART in Northern Ethiopia. (n = 19,525)
| Variable | Category | Viral suppression status | Total n (%) | COR(95% CI) | AOR (95% CI) | |
|---|---|---|---|---|---|---|
| Suppressed, n (%) | Non suppressed, n (%) | |||||
| Gender | Female | 9738 (67.76) | 3128 (60.70) | 12,866 (65.90) | 1 (Ref.) | |
| Male | 4634 (32.24) | 2025 (39.30) | 6659 (34.10) | 1.36 (1.27, 1.45)*** | 1.27 (1.18, 1.37) *** | |
| Pregnant mother | No | 9659 (99.19) | 3112 (99.49) | 12,771 (99.26) | 1 (Ref.) | 1 (Ref.) |
| Yes | 79 (0.81) | 16 (0.51) | 95 (0.74) | 0.63 (0.37, 1.08) | ||
| Lactating mother | No | 9577 (98.35) | 3087 (98.69) | 12,664 (98.43) | 1 (Ref.) | |
| Yes | 161 (1.65) | 41 (1.31) | 202 (1.57) | 0.79 (0.56, 1.12) | ||
| Age category | 15–19 | 204 (1.42) | 216 (4.19) | 420 (2.15) | 3.67 (2.97, 4.53) *** | 4.86 (3.86, 6.12) *** |
| 20–24 | 391 (2.72) | 164 (3.18) | 555 (2.84) | 1.45 (1.19, 1.78) *** | 1.96 (1.57, 2.45) *** | |
| 25–29 | 1312 (9.13) | 520 (10.09) | 1832 (9.38) | 1.37 (1.20, 1.57) *** | 1.79 (1.55, 2.08) *** | |
| 30–34 | 2757 (19.18) | 959 (18.61) | 3716 (19.03) | 1.21 (1.08, 1.35) *** | 1.46 (1.29, 1.65) *** | |
| 35–39 | 3113 (21.6) | 1117 (21.68) | 4230 (21.66) | 1.24 (1.11, 1.39) *** | 1.43 (1.27, 1.61) *** | |
| 40–44 | 2749 (19.13) | 964 (18.71) | 3713 (19.02) | 1.21 (1.08, 1.36) *** | 1.22 (1.08, 1.39) *** | |
| 45–49 | 1587 (11.04) | 561 (10.89) | 2148 (11.00) | 1.22 (1.08, 1.39) ** | 1.22 (1.06, 1.40) ** | |
| 50+ | 2259 (15.72) | 652 (12.6) | 2911 (14.91) | 1 (Ref.) | 1 (Ref.) | |
| Age | Median (IQR) | 38 (32–45) | 37 (30–44) | 38 (31–45) | ||
| Facility ownership | Government | 13,713 (95.41) | 4958 (96.22) | 18,671 (95.63) | 1.20 (1.02, 1.41) * | 1.09 (0.89, 1.33) |
| Non-governmental organization | 645 (4.49) | 195 (3.78) | 840 (4.30) | 1 (Ref.) | ||
| Private | 14 (0.10) | 0 | 14 (0.07) | ___ | ||
| Facility type | Clinic | 30 (0.21) | 13 (0.25) | 43 (0.22) | 1.35 (0.69, 2.61) | |
| Health center | 4191 (29.16) | 1491 (28.93) | 5682 (29.10) | 1.11 (0.97,1.26) | ||
| Primary Hospital | 1428 (9.94) | 703 (13.64) | 2131 (10.91) | 1.53 (1.32, 1.77) *** | 1.26 (1.05, 1.52) * | |
| General Hospital | 7315 (50.90) | 2514 (48.79) | 9829 (50.34) | 1.07 (0.94, 1.21) | ||
| Referral Hospital | 1134 (7.89) | 365 (7.08) | 1499 (7.68) | 1 (Ref.) | ||
| Other | 274 (1.91) | 67 (1.30) | 341 (1.75) | 0.76 (0.57, 1.02) | ||
| Service provided at military health care facility | No | 13,837 (96.28) | 5013 (97.28) | 18,850 (96.54) | 1.38 (1.15, 1.67) *** | 1.47 (1.15, 1.89) ** |
| Yes | 535 (3.72) | 140 (2.72) | 675 (3.46) | 1 (Ref.) | 1 (Ref.) | |
| WHO Staging | I | 13,255 (92.23) | 4574 (88.76) | 17,829 (91.31) | 1 (Ref.) | 1 (Ref.) |
| II | 481 (3.35) | 294 (5.71) | 775 (3.97) | 1.77 (1.53, 2.06) *** | 1.31 (1.10, 1.54) ** | |
| III | 248 (1.73) | 160 (3.10) | 408 (2.09) | 1.87 (1.53, 2.29) *** | 1.12 (0.89, 1.40) | |
| IV | 388 (2.70) | 125 (2.43) | 513 (2.63) | 0.93 (0.76, 1.15) | ||
| Adherence | Poor | 123 (0.86) | 163 (3.16) | 286 (1.46) | 3.92 (3.09, 4.96) *** | 2.56 (1.97, 3.33) *** |
| Fair | 413 (2.87) | 309 (6.00) | 722 (3.70) | 2.21 (1.90, 2.57) *** | 1.61 (1.36, 1.90) ** | |
| Good | 13,836 (96.27) | 4681 (90.84) | 18,517 (94.84) | 1 (Ref.) | 1 (Ref.) | |
| Virological test reason | Routine First VL | 8910 (62) | 3049 (51.17) | 11,959 (61.25) | 1.41 (1.31, 1.52) *** | 1.35 (1.25, 1.46) *** |
| Routine annual VL Test | 4856 (33.79) | 1176 (22.82) | 6032 (30.89) | 1 (Ref.) | 1 (Ref.) | |
| Suspected ART failure-Clinical | 22 (0.15) | 28 (0.54) | 50 (0.26) | 5.26 (3.00, 9.22) *** | 3.37 (1.86, 6.12) ** | |
| Suspected ART failure-immunological | 38 (0.26) | 43 (0.83) | 81 (0.41) | 4.67 (3.01, 7.26) *** | 2.19 (1.36, 3.51) *** | |
| Suspected ART Failure initial VL | 301 (2.09) | 790 (15.33) | 1091 (5.59) | 10.84 (9.35, 12.56) *** | 7.62 (6.53, 8.90) *** | |
| Not indicated in the form | 245 (1.70) | 67 (1.30) | 312 (1.60) | 1.13 (0.86, 1.49) | ||
| CD4 baseline | < 200 cells/micro liter | 6950 (48.36) | 2737 (53.11) | 9687 (49.61) | 1.50 (1.34, 1.68) *** | 1.33 (1.14, 1.54) *** |
| 200–499 cell/ micro liter | 5653 (39.33) | 1952 (37.88) | 7605 (38.95) | 1.32 (1.17, 1.48) *** | 1.32 (1.15, 1.50) *** | |
| + 500 cells/ micro liter | 1769 (12.31) | 464 (9.01) | 2233 (11.44) | 1 (Ref.) | 1 (Ref.) | |
| CD4 baseline | Median (IQR) | 206 (116–348) | 188 (103–320) | 201 (112–341) | ||
| CD4 Recent | < 200 cells/micro liter | 1542 (10.73) | 1501 (29.13) | 3043 (15.59) | 5.25 (4.78, 5.77) *** | 3.78 (3.34, 4.27) *** |
| 200–499 cell/ micro liter | 6441 (44.82) | 2468 (47.89) | 8909 (45.63) | 2.07 (1.91, 2.23) *** | 1.89 (1.73, 2.06) *** | |
| + 500 cells/ micro liter | 6389 (44.45) | 1184 (22.98) | 7573 (38.79) | 1 (Ref.) | 1 (Ref.) | |
| CD4 Recent | Median (IQR) | 463 (307–648) | 309 (180–480) | 423 (264–611) | ||
| Regimen | 1c (AZT-3TC-NVP) | 4147 (28.85) | 1685 (32.70) | 5832 (29.87) | 1.30 (1.21, 1.40) *** | 1.32 (1.22, 1.44) *** |
| 1d (AZT-3TC-EFV) | 1362 (9.48) | 545 (10.58) | 1907 (9.77) | 1.28 (1.15, 1.43) *** | 1.31 (1.16, 1.48) *** | |
| 1e (TDF-3TC-EFV) | 7155 (49.78) | 2235 (43.37) | 9390 (48.09) | 1 (Ref.) | 1 (Ref.) | |
| 1f(TDF-3TC-NVP) | 1559 (10.85) | 583 (11.31) | 2142 (10.97) | 1.20 (1.08, 1.33) *** | 1.30 (1.16, 1.46) *** | |
| 1 g (ABC-3TC-EFV) | 5 (0.035) | 1 (0.019) | 6 (0.03) | 0.64 (0.07, 5.48) | ||
| 1 h(ABC-3TC-NVP) | 4 (0.028) | 3 (0.058) | 7 (0.04) | 2.40 (0.54, 10.74) | ||
| 2a (ABC-ddl-LPV/R), 2c (TDF-ddl-LPV/R), 2d(TDF-ddl-NFV)& 2 g (TDF-3TC-LPV/r) | 8 (0.056) | 4 (0.078) | 12 (0.06) | 1.60 (0.48, 5.32) | ||
| 2f (AZT-3TC-ATV/r) | 39 (0.27) | 23 (0.446) | 62 (0.32) | 1.89 (1.13, 3.17) * | 1.65 (0.95, 2.86) | |
| 2 h (TDF-3TC-ATV/R) | 93 (0.65) | 74 (1.436) | 167 (0.86) | 2.55 (1.87, 3.47) *** | 1.79 (1.27, 2.52) *** | |
| Treatment | First line | 14,232 (99.03) | 5052 (98.04) | 19,284 (98.77) | 1 (Ref.) | 1 (Ref.) |
| Second line | 140 (0.97) | 101 (1.96) | 241 (1.23) | 2.03 (1.57, 2.63) *** | Omitted | |
| Immunological response after ART initiation | Declined | 2133 (14.84) | 1406 (27.29) | 3539 (18.13) | 2.16 (2.00, 2.33) *** | 1.45 (1.30, 1.61) *** |
| No change | 183 (1.27) | 67 (1.30) | 250 (1.28) | 1.20 (0.90, 1.59) | 0.86 (0.64, 1.17) | |
| Enhanced | 12,056 (83.89) | 3680 (71.41) | 15,736 (80.59) | 1 (Ref.) | 1 (Ref.) | |
Notes: *significant at P-value of ≤0.05; ** significant at P-value of ≤0.01; significant at P-value of ≤0.001; Omitted, Collinearity effect was allowed to be omitted in the multivariable analysis
Abbreviations: 3TC lamivudine; ABC abacavir; AOR Adjusted Odds Ratio; ATV/r atazanavir/ Ritonavir; AZT azidothymidine; CD-4 Cluster of Differentiation 4; COR Crude Odds Ratio; ddl didanosine; EFV efavirenz; LPV/R Lopinavir/Ritonavir; n number; NFV nelfinavir; NVP nevirapine; P-value, Precession value; Ref Referrence; TDF tenofovirdisoproxilfumarate