Incidence and Predictors of Virologic Failure Among Children on First-Line Antiretroviral Therapy in Northwest Ethiopia: A Multicenter Retrospective Follow-Up Study.

BackgroundVirologic failure in children is a significant public health concern in sub-Saharan Africa. This study aims to assess the incidence rate of virologic failure and its predictors among children undergoing first-line antiretroviral therapy (ART) in Ethiopia.MethodsA multicenter retrospective follow-up study was conducted in HIV-infected children on first-line ART from January 1, 2013, to December 31, 2022, in Ethiopia. A simple random sampling method was employed to select the sample. Data entry was performed using EpiData, and analysis was conducted using STATA version 14. Kaplan-Meier curves and log-rank tests were utilized for survival analysis.ResultAmong 537 HIV-infected children followed over the study period, 12.29% developed virologic failure, yielding an incidence rate of 17 per 10 000 person-month observations (95% confidence interval [CI]: 13.4, 21.7). Factors independently associated with an increased risk of virologic failure included poor ART adherence (adjusted hazard ratio [AHR] = 2.63; 95% CI: 1.38, 4.97), advanced World Health Organization (WHO) Treatment (T) stages III and IV (AHR = 2.71; 95% CI: 1.15, 6.37), no history of regimen change (AHR = 5.88; 95% CI: 3.23, 10.71), and age at ART initiation above 10 years (AHR = 2.97; 95% CI: 1.30, 6.78). In contrast, having a caregiver younger than 40 years was associated with a significantly lower risk of virologic failure (AHR = 0.42; 95% CI: 0.25, 0.72). These findings emphasize the importance of monitoring adherence, providing closer follow-up for children in advanced treatment stages, and considering caregiver-related factors to reduce virologic failure.ConclusionsVirologic failure among HIV-infected children on first-line ART in Northwest Ethiopia was a relatively low incidence. Interventions targeting poor adherence, children with advanced WHO Treatment (T) stage, older age at ART initiation, and those with no history of regimen change are essential. Additionally, caregiver characteristics, such as age below 40 years, play a protective role and should be considered when designing adherence support and monitoring strategies to further reduce the risk of virologic failure.