Level of Adherence and Associated Factors Among HIV-Infected Patients on Antiretroviral Therapy in Northern Ethiopia: Retrospective Analysis

Figures & data

Figure 1 Map of the study area.

Figure 2 Levels of adherences of ART medication among HIV-positive adolescents and adults in Tigray region, North Ethiopia, 2015–2019 (n = 19,525).

Table 1 Bivariable and Multivariable Ordinal Logistic Regression Analysis of Adherence to Antiretroviral Therapy Among HIV-Positive Adolescents and Adults in Tigray Region, North Ethiopia, 2015–2019 (N = 19,525)

Variables	Category	ART Adherence			Total	COR (95% CI)	AOR (95% CI)
		Poor, n (%)	Fair, n (%)	Good, n (%)
Age	15–19	13 (4.55)	23 (3.19)	384 (2.07)	420 (2.15)	1 (Ref.)	1 (Ref.)
	20–24	11 (3.85)	15 (2.08)	529 (2.86)	555 (2.84)	1.91 (1.13, 3.22)*	1.55 (0.91, 2.62)
	25–29	31 (10.84)	65 (9.00)	1736 (9.38)	1832 (9.38)	1.70 (1.14, 2.54)**	1.33 (0.88, 2.01)
	30–34	58 (20.28)	119 (16.48)	3539 (19.11)	3716 (19.03)	1.88 (1.29, 2.74)***	1.54 (1.04, 2.26)*
	35–39	53 (18.53)	163 (22.58)	4014 (21.68)	4230 (21.66)	1.75 (1.21, 2.54)**	1.47 (1.01, 2.15)*
	40–44	56 (19.58)	167 (23.13)	3490 (18.85)	3713 (19.02)	1.48 (1.02, 2.14)*	1.32 (0.90, 1.93)
	45–49	28 (9.79)	69 (9.56)	2051 (11.08)	2148 (11.00)	1.99 (1.34, 2.97)***	1.87 (1.24, 2.83)**
	50+	36(12.59)	101 (13.99)	2774 (14.98)	2911 (14.91)	1.91 (1.30, 2.81)***	1.68 (1.13, 2.50)*
Gender	Female	158 (55.24)	412 (57.06)	12,296 (66.40)	12,866 (65.90)	1 (Ref.)	1 (Ref.)
	Male	128 (44.76)	310 (42.94)	6221 (33.60)	6659 (34.10)	0.66 (0.58, 0.75)***	0.75 (0.65, 0.87)***
Pregnant mother	No	157 (99.37)	410 (99.51)	12,204 (99.25)	12,771 (99.26)	1 (Ref.)
	Yes	1 (0.63)	2 (0.49)	92 (0.75)	95 (0.74)	1.42 (0.45, 4.51)
Lactating mother	No	155 (98.10)	402 (97.57)	12,107 (98.46)	12,664 (98.43)	1 (Ref.)
	Yes	3 (1.90)	10 (2.43)	189 (1.54)	202 (1.57)	0.67 (0.38, 1.18)
Facility ownership	Government	277 (96.85)	661 (91.55)	17,733 (95.77)	18,671 (95.63)	1 (Ref.)
	NGO	9 (3.15)	61 (8.45)	770 (4.16)	840 (4.30)	0.59 (0.46, 0.76)
	Private	0	0	14 (0.08)	14 (0.07)	–
Facility type	Clinic	0	0	43 (0.23)	43 (0.22)
	Health center	69 (24.13)	134 (18.56)	5479 (29.59)	5682 (29.10)	1.05 (0.77, 1.41)
	Primary hospital	28 (9.79)	81 (11.22)	2022 (10.92)	2131 (10.91)	0.72 (0.52, 1.002)
	General hospital	163 (56.99)	461 (63.85)	9205 (49.71)	9829 (50.34)	0.57 (0.43, 0.76)***	0.52 (0.39, 0.69)***
	Referral hospital	16 (5.59)	40 (5.54)	1443 (7.79)	1499 (7.68)	1 (Ref.)
	Other	10 (3.50)	6 (0.83)	325 (1.76)	341 (1.75)	0.77 (0.44, 1.38)
Service provided at defense facility	No	276 (96.50)	692 (95.84)	17,882 (96.57)	18,850 (96.54)	1 (Ref.)
	Yes	10 (3.50)	30 (4.16)	635 (3.43)	675 (3.46)	0.86 (0.62, 1.19)
WHO staging	I	220 (76.92)	582 (80.61)	17,027 (91.95)	17,829 (91.31)	1 (Ref.)	1 (Ref.)
	II	23 (8.04)	64 (8.86)	688 (3.72)	775 (3.97)	0.37 (0.30, 0.47)***	0.47 (0.36, 0.60)***
	III	28 (9.79)	50 (6.93)	330 (1.78)	408 (2.09)	0.20 (0.15, 0.25)***	0.25 (0.19, 0.34)***
	IV	15 (5.24)	26 (3.60)	472 (2.55)	513 (2.63)	0.54 (0.39, 0.75)***	0.57 (0.41, 0.81)**
Viral load test reason	First at 6 months	177 (61.89)	427 (59.14)	11,355 (61.32)	11,959 (61.25)	1 (Ref.)	1 (Ref.)
	Routine annual VL test	37 (12.94)	175 (24.24)	5820 (31.43)	6032 (30.89)	1.47 (1.25, 1.72)***	1.40 (1.19, 1.65)***
	Suspected ART failure clinical	0	4 (0.55)	46 (0.25)	50 (0.26)	0.63 (0.23, 1.75)
	Suspected ART failure– immunological	8 (2.8)	8 (1.11)	65 (0.35)	81 (0.41)	0.21 (0.12, 0.36)***	0.45 (0.24, 0.82)**
	Suspected ART failure – initial viral load	56 (19.58)	92 (12.74)	943 (5.09)	1091 (5.59)	0.33 (0.28, 0.41)***	0.55 (0.44, 0.69)***
	Not indicated in the form	8 (2.8)	16 (2.22)	288 (1.56)	312 (1.60)	0.64 (0.42, 0.97)*	0.62 (0.41, 0.94)
Viral load status	Suppressed	123 (43.01)	413 (57.20)	13,836 (74.72)	14,372 (73.61)	1 (Ref.)	1 (Ref.)
	Non-suppressed	163 (56.99)	309 (42.80)	4681 (25.28)	5153 (26.39)	0.38 (0.34, 0.43)***	0.54 (0.47, 0.63)***
Regimen	1c (AZT–3TC–NVP)	85 (29.72)	222 (30.75)	5525 (29.84)	5832 (29.87)	1 (Ref.)	1 (Ref.)
	1d (AZT–3TC–EFV)	28 (9.79)	85 (11.77)	1794 (9.69)	1907 (9.77)	0.88 (0.71, 1.10)
	1e (TDF–3TC–EFV)	141 (49.30)	309 (42.80)	8940 (48.28)	9390 (48.09)	1.10 (0.95, 1.28)
	1f (TDF–3TC–NVP)	29 (10.14)	90 (12.47)	2023 (10.93)	2142 (10.97)	0.95 (0.76, 1.18)
	1g (ABC–3TC–EFV)	0	0	6 (0.03)	6 (0.03)	–
	1h (ABC–3TC–NVP)	0	1 (0.14)	6 (0.03)	7 (0.04)	0.35 (0.04, 2.88)
	2a (ABC–ddl–LPV/R), 2c (TDF–ddl–LPV/R), 2d (TDF–ddl–NFV) and 2g (TDF–3TC–LPV/r)	0	0	12 (0.06)	12 (0.06)	–
	2f (AZT–3TC–ATV/r)	0	3 (0.42)	59 (0.32)	62 (0.32)	1.11 (0.35, 3.55)
	2h (TDF–3TC–ATV/R)	3 (1.05)	12 (1.66)	152 (0.82)	167 (0.86)	0.57 (0.33, 0.98)*	1.04 (0.59, 1.83)
Baseline CD4 count	<200	164 (57.34)	392 (54.29)	9131 (49.31)	9687 (49.61)	1 (Ref.)	1 (Ref.)
	200–499	103 (36.01)	250 (34.63)	7252 (39.16)	7605 (38.95)	1.25 (1.09, 1.43)**	1.03 (0.88, 1.21)
	500 and above	19 (6.64)	80 (11.08)	2134 (11.52)	2233 (11.44)	1.32 (1.06, 1.64)*	0.95 (0.71, 1.27)
Recent CD4 count	<200	88 (30.77)	206 (28.53)	2749 (14.85)	3043 (15.59)	1 (Ref.)	1 (Ref.)
	200–499	125 (43.71)	325 (45.01)	8459 (45.68)	8909 (45.63)	2.01 (1.73, 2.35)***	1.45 (1.21, 1.74)***
	500 and above	73 (25.52)	191 (26.45)	7309 (39.47)	7573 (38.79)	2.96 (2.50, 3.52)***	1.84 (1.47, 2.32)***
Immunological response compared to baseline	Negative	80 (27.97)	180 (24.93)	3279 (17.71)	3539 (18.13)	1 (Ref.)	1 (Ref.)
	No change	6 (2.10)	12 (1.66)	232 (1.25)	250 (1.28)	0.72 (0.43, 1.21)
	Positive response	200 (69.93)	530 (73.41)	15,006 (81.04)	15,736 (80.59)	1.63 (1.41, 1.89)***	1.14 (0.93, 1.40)

Notes: *P-value ≤ 0.05; **P-value ≤ 0.01; ***P-value ≤ 0.001.

Abbreviations: 3TC, lamivudine; ABC, abacavir; AOR, adjusted odds ratio; ART, antiretroviral therapy; ATV/r, atazanavir/ritonavir; AZT, azidothymidine; CD4, cluster of differentiation 4; COR, crude odds ratio; ddl, didanosine; EFV, efavirenz; LPV/R, lopinavir/ritonavir; n, number; NFV, nelfinavir; NGO, non-governmental organization; NVP, nevirapine; P-value, precession value; Ref., reference; TDF, tenofovir disoproxil fumarate; WHO, World Health Organization; VL, viral load.