Time to viral load re-suppression and its predictors among adult patients on second-line anti-retro viral therapy in northeastern Ethiopia: multi-center prospective follow-up study

Background: Despite the increasing number of patients on second-line antiretroviral therapy in low-income countries such as Ethiopia, there is limited evidence regarding the time to viral re-suppression. Therefore, this study aimed to assess the time to viral load re-suppression and its predictors among adult patients on second-line antiretroviral therapy in northeastern Ethiopia. Method: A multi-center, institution-based prospective follow-up study was conducted over 48 months, from February 2022 to February 2024, involving 526 adults living with human immunodeficiency virus (HIV) who were receiving second-line antiretroviral therapy in northeastern Ethiopia. Data were collected through face-to-face interviews and chart reviews. A Weibull proportional hazards model was fitted to identify the predictors of viral re-suppression. Results: The median time to viral re-suppression was 9 months (IQR = 3-15 months). The rate of viral re-suppression was 44.3 per 1,000 person-months (95% CI: 40.4-49). Predictors of viral re-suppression included disclosure of Human Immunodeficiency Virus (HIV) status [AHR 2.24 (95% CI: 1.4-3.7)], classification in World Health Organization (WHO) clinical stages I and II [AHR 6.9 (95% CI: 4.4-9.6)], receipt of tuberculosis (TB) preventive treatment [AHR 3.7 (95% CI: 2.3-5.93)], absence of first-line drug substitution history [AHR 1.44 (95% CI: 1.2-1.8)], and good adherence to treatment [AHR 1.9 (95% CI: 1.4-2.54)]. Conclusion and recommendations: In this study, the time to viral load re-suppression was longer than expected. Disclosure status, WHO clinical stage I or II, receiving tuberculosis preventive treatment, and the absence of first-line drug substitution history were predictors of viral load re-suppression. Health managers and antiretroviral therapy care providers must improve the timing and effectiveness of early disclosure, encourage the early use of tuberculosis prophylaxis, and maintain good adherence through various strategies.