Abstract

HIV/AIDS continues to be a major global public health issue and a significant cause of death. While the WHO advocates for viral load testing as the primary approach to monitor treatment and detect antiretroviral therapy (ART) failure, the factors affecting viral load trends are frequently neglected. This study exclusively analyzes viral load trajectories, identifying predictors of virological suppression independent of adverse outcomes. This study aimed to assess predictors of longitudinal viral load suppression HIV patients on first-line ART in Central Ethiopia: a mixed-effects analysis. A retrospective follow-up study was conducted in public hospital in Central Ethiopia. A total of 376 adult patients who started first-line ART and had at least two viral load measurements between March 1, 2017, and November 30, 2021, were selected using simple random sampling. Follow-up continued until November 30, 2022.Variables with a univariable association (p < 0.20) with viral load changes were included in the multivariable analysis. A linear mixed-effects model was applied, with statistical significance set at 5%, using adjusted coefficients and 95% confidence intervals. To maintain focus on viral load trends, we excluded time-to-event endpoints and adverse reaction analyses. A total of 376 adult patients on anti-retroviral therapy were assessed. WHO clinical stage (stage II) (B = 0.199: p < 0.0001), (stage III) (B = 0.2: p = 0.0318), (stage IV) (B 0.37: p = 0.0011), CD4 count (> = 200) (B = − 0.2: p = 0.0070) and poor adherence increased log VL by 0.36, p < 0.001 were found to have a significant effect on the log of viral load. In this study, we have found an overtime decrement in the log of the Viral Load of patients with HIV on ART. Factors such as baseline CD4 count, WHO clinical stage, and adherence were found to be significant predictors of log Viral Load evolution. In order to maximize the results of the policy of test and treat, we suggest that health professionals focus on the interventions that will result in the initiation of ART and long-term viral suppression.