Viral suppression among adolescents and adults living with human immunodeficiency virus in Ethiopia during the test-and-treat era

Background Despite progress in reducing the time from HIV diagnosis to treatment initiation, achieving sustained viral suppression remains a major public health challenge among people living with HIV in Ethiopia. However, evidence on viral suppression and its predictors during the test-and-treat era remains limited. Objective This study aimed to assess the rate and predictors of viral suppression among adolescents and adults living with HIV during the test-and-treat era, January 2018 to December 2022, Shashemene City, Ethiopia. Methods A retrospective cohort study was conducted among 414 patients aged 15 years and older who initiated ART between January 2018 and December 2021. Patients were selected using a proportional stratified random sampling technique and followed for a maximum of two years in public health facilities in Shashemene City. Kaplan-Meier was used to estimate the median time to viral suppression, and Cox proportional hazards regression identified predictors of suppression. Results Of the 414 patients, 290 (70.05%; 95% CI: 65.64–74.46) achieved viral suppression by the end of the follow-up period (December 2022). The rate of viral suppression was 6.68 per 100 person-months (95%CI: 5.95–7.49), and the median time to suppression was 9.33 months (95%CI: 8.55–10.11). Rapid ART initiation was associated with twofold higher likelihood of early suppression (aHR = 2.05, 95%CI: 1.58–2.67) compared to delayed initiation. Undernourished patients had 46% lower chance of early suppression (aHR = 0.54, 95%CI: 0.36–0.81), and those who were ambulatory/bedridden at baseline had an 87% lower chance (aHR = 0.13; 95%CI: 0.07–0.27) than working patients. Not good adherence lowered suppression by 36% (aHR = 0.64; 95%CI: 0.41–0.99). Conclusion and recommendation The viral suppression rate was well below the UNAIDS target of 95%. Strengthening rapid ART initiation, adherence and providing nutritional support are essential to improve outcomes. Lower suppression rates among ambulatory/bedridden patients could partly reflect additional health challenges influencing treatment response.