HIV-1 prevalence, drug resistance, and associated factors in the urban Ethiopian population.

Despite progress in HIV control, gaps persist in understanding the prevalence, drug resistance, and associated factors in urban Ethiopia. This cross-sectional study analyzed data from 19,136 consenting participants (aged 15-64 years) for interview and blood testing in the 2017-2018 Population-based HIV Impact Assessment (PHIA) survey to assess HIV-1 prevalence, drug resistance mutations, and associated factors. Participants confirmed to be living with HIV (PLHIV) provided additional samples for CD4 + T-cell counts, viral load testing, and drug resistance analysis. Forty-three samples were analyzed for viral subtyping and drug resistance profiling, of which 42 samples successfully amplified. Data were analyzed using descriptive statistics and logistic regression. The overall HIV-1 prevalence was 3%. Among genotyped samples, 79.1% harbored drug resistance mutations, with high rates of resistance to Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs) (78.8%) and Nucleoside Reverse Transcriptase Inhibitors (NRTIs) (66.7%). Regarding associated factors, females had 1.7 times higher odds of HIV infection than males (AOR = 1.7). Participants aged 35-44 and 45-54 had significantly higher odds of infection (AOR = 6.7 for both) compared to those aged 15-24. Lower educational attainment (primary school: AOR = 2.5; secondary school: AOR = 2.2) was associated with increased HIV prevalence compared to post-secondary education. Previously married individuals had higher infection odds than never-married participants (AOR = 2.7). Geographically, residents of Gambella showed significantly higher odds (AOR = 2.8) compared to those in Tigray. This study identified a high HIV-1 prevalence in Ethiopia, along with elevated virological failure rates, a significant proportion of PLHIV unaware of their status, and widespread drug resistance. Sex, age, education level, marital status, and region were the identified factors associated with HIV-1 prevalence. To improve treatment outcomes and curb transmission, Ethiopia should strengthen HIV prevention strategies focused on vulnerable populations, enhance testing and linkage to care, and implement routine drug resistance monitoring.