Predictors of virologic failure among adults receiving first-line antiretroviral therapy in the Sunyani Municipality, Ghana

Abstract

Introduction: Antiretroviral therapy (ART) is designed to lower viral loads in people living with HIV (PLWHIV), improving their quality of life and reducing HIV-related illnesses and mortality. However, in 2022, the Sunyani Municipal Health Directorate (SMHD) reported low rates of viral suppression. Supporting this, a study by Abban et al. (2021) also revealed that PLWHIV on ART often failed to reach the expected viral suppression levels in the area. This study identified predictors of virologic failure among adults receiving ART in the Sunyani Municipality to inform targeted interventions. Methods: A 1:2 unmatched case-control study was conducted from October to November 2022, involving 585 adults (195 cases with viral loads ≥1000 copies/mL and 390 controls with <1000 copies/mL) who had been on ART for at least six months. Data on socio-demographic, clinical, ART-related, and health facility-related factors were extracted from medical records using Kobo Collect and analyzed with STATA 16.1. Adherence to ART was measured using the pill count method, and multivariate logistic regression was used to identify predictors of virologic failure, with statistical significance set at p-value ≤ 0.05. Results: The mean age of participants was 42 years (SD: ±11 years), with cases averaging 41 years (SD: ±11) and controls 43 years (SD: ±11). Females contributed 80.00% (156/195) of cases and 74.87% (292/390) of controls. Predictors of virologic failure included rural residence (aOR=2.86, 95% CI: 1.70-4.81), non-disclosure of HIV status (aOR=2.32, 95%CI: 1.45-3.70), poor adherence to ART (aOR=3.68, 95% CI: 2.05-6.59), opportunistic infections (aOR=7.19, 95%CI: 3.94-13.09), and alcohol consumption (aOR=4.22, 95% CI: 1.93-9.26). Having at least Sec/Tech/Voc education (aOR =0.58, 95% CI: 2.30, 48.75) and being self-employed (aOR= 0.52, 95% CI: 0.32-0.85) were protective. Conclusion: Key predictors of virologic failure in Sunyani Municipality include rural residence, non-disclosure, poor adherence, opportunistic infections, and alcohol consumption. Health authorities should enhance social support and implement targeted education to improve adherence among PLWHIV.