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Demeke Dejen,1 Dube Jara,2 Fanos Yeshanew,3 Zinabu Fentaw,4 Tesfa Mengie Feleke,5 Fentaw Girmaw,6 Birhanu Wagaye3 1Care and Treatment, Amhara Regional Health Bureau CDC Project Cluster Health Facilities HIV Case Detection Linkage, Woldia, Ethiopia; 2Department of Epidemiology and Biostatics, School of Public Health, College of Medicine and Health Science, Addis Ababa University, Addis Ababa, Ethiopia; 3Department of Public Health Nutrition, School of Public Health, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia; 4Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia; 5Amhara Regional Health Bureau CDC Project Zonal Monitoring and Evaluation, Dessie, Ethiopia; 6Department of Pharmacy, College of Health Science, Woldia University, Woldia, EthiopiaCorrespondence: Zinabu FentawDepartment of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Science, Wollo University, Dessie, EthiopiaTel +251912757286Email zfentaw5@gmail.comIntroduction: There is an expansion and advancement of antiretroviral therapy. However, attrition of patients from HIV care is one of the major drivers of poor performance of HIV/AIDS programs, which leads to drug resistance, morbidity and mortality. The study aimed to assess the incidence of attrition and its predictors among adults receiving first-line antiretroviral therapy.Methods: An institution-based retrospective cohort study was conducted among 634 adults receiving antiretroviral therapy, and study participants were selected using a simple random sampling technique. Data were cleaned and entered into Epi Data version 3.1 and exported to STATA 14.1 for further analysis. The predictors of attrition were identified using bivariable and multivariable Cox Proportional hazard models; then, variables at a p-value of less than 0.25 and 0.05 were included in the multivariable analysis and statistically significant, respectively.Results: The total time observed was found to be 1807.08 person-years of observation with a median follow-up time of 2.67 years (IQR 1.25− 4.67). The incidence rate of attrition was 8.36 (95% CI: 7.12− 9.80) per 100 person-years. Significant predictors of attrition were being young age [adjusted hazard ratio (AHR) =2.0, 95% CI, (1.11− 3.58)], nearest calendar year of ART initiation [AHR =2.32, 95% CI, (1.08– 5.01)], bedridden functional status [AHR=3.25, 95% CI, (1.33− 7.96)], WHO stage III [AHR=3.57, 95% CI, (1.58− 8.06)] and stage IV [AHR=5.46, 95% CI, (1.97− 15.13)], viral load result of ≤ 1000 [AHR=0.11, 95% CI, (0.06− 0.23)], disclosure status [AHR=2.03, 95% CI, (1.22− 3.37)] and adherence level of poor [AHR=3.19, 95 CI, (1.67− 6.09)].Conclusion: The result of this study showed that the incidence of attrition among adults receiving antiretroviral therapy was high. However, as a standard, every client who started antiretroviral therapy should be retained. Positive predictors of attrition were young age (15– 24), recent year of ART initiation, baseline functional status, advanced WHO stage III and IV, no disclosure status, fair/poor adherence whereas, viral load result of ≤ 1000 copies/mL had a preventive effect on attrition.Keywords: attrition, HIV/AIDS, antiretroviral therapy, retrospective cohort, Ethiopia

Getachew Bisetegn,1 Mastewal Arefaynie,2 Anissa Mohammed,3 Zinabu Fentaw,3 Amare Muche,3 Reta Dewau,3 Yimer Seid1 1Dessie City Zonal Health Department, CDC-Ethiopia, Dessie, Ethiopia; 2Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia; 3Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Science, Wollo University, Dessie, EthiopiaCorrespondence: Zinabu FentawDepartment of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Science, Wollo University, Dessie, EthiopiaTel +251-91-275-7286Email zfentaw5@gmail.comBackground: HIV virological failure is a common challenging problem, even after adherence-enhancement counseling. However, there have been few studies on the determinants of virological failure after adherence-enhancement counseling among adult patients on antiretroviral therapy in Ethiopia in general, and there is variation across clients and settings for unknown reasons. Therefore, this study aimed to identify predictors of virological failure after adherence-enhancement counseling among adults living with HIV/AIDS.Methods: A case–control study was conducted in the town of Kombolcha from January 1, 2019 to March 30, 2019 using simple random sampling for 338 participants. Data were collected through face-to-face interviews for social and personal characteristics and document review for clinical profiles. Descriptive statistics were used for frequency, proportions, and summary measures. Binary logistic regression analysis was carried out to identify the predictors of virological failure after adherence-enhancement counseling among adults. For multivariate logistic regression,P< 0.05 was considered statistically significant. AORs are presented with 95% CIs.Results: The odds of virological failure after adherence-enhancement counseling were higher following poor antiretroviral medication adherence (AOR 7.3, 95% CI 2.57– 20.79) and for patients who had had a first high viral load (≥ 10,000 copies/mL, (AOR 5, 95% CI 1.86– 13.56) and a history of opportunistic infection (AOR 3.7, 95% CI 1.11– 8.44) compared with their counterparts.Conclusion: Poor antiretroviral medication adherence during adherence-enhancement counseling session, first viral load ≥ 10,000 copies/mL, and recent history of opportunistic infection were predictors of virological failure. Therefore, efforts should be strengthened to improve adherence to antiretroviral medication, which helps to boost immunity and suppress viral replication.Keywords: HIV/AIDS, adherence-enhancement counseling, virological failure, case–control, Ethiopia

Zinabu Fentaw, Assresie Molla, Shambel Wedajo, Wondwosen Mebratu School of Public Health, Wollo University College of Medicine and Health Science, Dessie, Amhara Region, EthiopiaCorrespondence: Zinabu FentawSchool of Public Health, Wollo University College of Medicine and Health Science, Dessie, EthiopiaTel +251 912757286Email zfentaw5@gmail.comBackground: Virological failure is defined as having viral load measurement greater or equal to 1000 copies/mm3 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.Keywords: HIV/AIDS, virological failure, highly active antiretroviral therapy, case–control study