Viral load undetectable state and predictors among children and adolescents living with HIV in South Gondar, Ethiopia, 2023: an 8-year retrospective cohort study

Objectives: The objective of this study is to examine the zonal-wide load undetectable state and predictors among children and adolescents living with HIV at South Gondar health institutions, 2023.

Design: A retrospective cohort study.

Setting: South Gondar Health Institutions, Northwest, Ethiopia.

Participants: We recruited 430 children and adolescents living with HIV who had a follow-up at the antiretroviral therapy (ART) clinic at health institutions from 1 June 2016 to 30 April 2023.

Outcome measures: The primary outcome measure of this study was the viral load undetectable state estimation. Moreover, the study assessed the median time viral load undetectable state and its predictors by the Cox-proportional hazard model. Data were entered into Epi-data V.4.2 and exported to STATA V.17 statistical software for analysis.

Results: The mean follow-up period was 8.5 (95% CI 8.1 to 8.9)±4.4 SD months, overall yielding 9151 person-month observations. At the end of the follow-up, 369 (85.8%, 95% CI 82.6% to 88.8%) of the children and adolescents achieved the viral load undetected state. Moreover, the overall median survival time to develop viral load undetectable state was found to be 6 months.The viral load undetected state in children and adolescents who have a cluster of differentiation 4 (CD4) count above the threshold level was 2.8 times higher than those in children and adolescents with a CD4 count lower than the threshold level (adjusted HR (AHR) 2.8 (95% CI 1.5, 5.3)). Likewise, the viral load undetected state in children and adolescents who have a good level of ART adherence was 2.0 times higher than those children and adolescents with a fair/poor level of ART adherence (AHR 2.0 (95% CI 1.1, 3.9)). Moreover, children and adolescents who had nutritional status ≥-2 Z score increased a viral load undetected state by 2.3 times as compared with children and adolescents with nutritional status <-2 Z score (AHR 2.3 (95% CI 1.3, 4.0)). Furthermore, children and adolescents who had no treatment failure increased a viral load undetected state by 2.1 times as compared with children and adolescents who had treatment failure (AHR 3.0 (95% CI 1.1, 4.0).

Conclusion: The lower proportion of individuals achieving an undetectable viral load compared with the target set by the WHO strategic plan (95-95-95 target by 2025), highlights the need for targeted interventions and improved HIV management strategies. Factors such as CD4 count, ART adherence, nutritional status and treatment failure play a significant role in achieving viral load undetectable state. Healthcare providers better prioritise these factors through comprehensive care and support. The study emphasises the importance of aligning efforts with the WHO strategic plan to meet targets and improve treatment outcomes. Therefore, stakeholders better address the identified predictors to enhance care and support for this vulnerable population.