Abstract:
Background: HIV remains a significant global health issue affecting millions of individuals worldwide. Antiretroviral therapy (ART) has transformed HIV from a life-threatening condition into a manageable chronic illness, and the WHO recommends same-day ART initiation to promote early viral suppression and improve overall health. While studies conducted in general hospital settings have demonstrated varying outcomes of same-day ART initiation, there is a need to examine these effects in distinct population groups, such as the police personnel, aiming to inform tailored interventions for this population.
Objective: This study aims to determine the association of same-day antiretroviral treatment initiation with viral load suppression and identify factors associated with viral load suppression among adults over 15 years living with HIV at the Federal Police Referral Hospital, Addis Ababa.
Methods: A retrospective cohort study was conducted in the Federal Police Referral Hospital. A simple random sampling method was used to obtain a total sample size of 596 for exposed and unexposed groups. Data collection involved a review of patients' charts with information extracted by three trained data clerks. Data was cleaned and analyzed using Stata version 17. Descriptive statistics were used to characterize the dependent and independent variables of the two groups. Comparisons were made using the chi-square test and the Wilcoxon signed-rank test. Subsequently, a modified Poisson regression model with robust error variance was employed.
Results: the viral load suppression at 12 months among those who started ART on the same day of HIV diagnosis was 95.6 % compared to 92.1% among those who started ART >7 days of HIV diagnosis. The difference between the groups was not statistically significant (p value: 0.136) with a relative risk (RR) of 1.02 (95% CI: 0.99, 1.06). Baseline CD4 count of less than 200 cells/mm³ and fair/poor adherence were predictors of lower viral suppression.
Conclusion and Recommendation: There wasn’t a statistically significant difference in viral load suppression at 12 months between individuals who initiated ART on the same day as their HIV diagnosis and those who initiated 7 days later. Fair or poor adherence and a baseline CD4 count below 200 cells/mm3 were associated with lower viral suppression. Enhanced adherence support and comprehensive care for immunocompromised patients are essential. Moreover, conducting multicenter studies that address individual-level factors such as social, behavioral, psychological, and mental health issues is recommended.