Viral load suppression (VLS) is a critical marker of treatment success among people living with HIV (PLWH), yet prolonged conflict and health-system disruptions can undermine ART continuity and monitoring. The Tigray region of Ethiopia experienced severe service interruptions between 2020 and 2022, making an assessment of suppression patterns essential. To examine the magnitude, temporal trends, and determinants of viral load suppression among people living with HIV receiving antiretroviral therapy (ART) in the Tigray region. from 2016 to 2024. We analyzed routinely collected viral load data from ART sites across Tigray. Annual aggregated viral load results were used to describe temporal trends before, during, and after the regional conflict. For the analytic component, a cross-sectional dataset was constructed by retaining each client’s most recent viral load result. Included participants were HIV-positive individuals on ART with documented viral load, demographic, and clinical information. Trend patterns were summarized descriptively, and determinants of viral suppression were assessed using multivariable logistic regression. Model diagnostics, including assessment of multicollinearity and overall model fit, were conducted. Statistical significance was set at p < 0.05. Between 2016 and 2024, 145,769 people living with HIV underwent viral load testing, of whom 127,644 (87.6%) achieved viral suppression. Among 23,222 children living with HIV, 18,797 (80.9%) were suppressed. Suppression increased steadily from 2016 to 2018, declined sharply during the conflict years (2021–2022), and showed partial recovery thereafter, though not to pre-conflict levels. Multivariable analysis identified advanced WHO stage, poor adherence, low baseline CD4 + count, and certain ART regimens as significant predictors of non-suppression. Viral suppression in Tigray remains below the Joint United Nations Programme on HIV and AIDS 95% target and below pre-conflict levels, reflecting the substantial impact of the 2020–2022 conflict on ART service continuity, monitoring, and adherence. Geographic disparities and conflict-related disruptions highlight the need for targeted recovery strategies, strengthened supply chains, and differentiated care models to restore and sustain optimal treatment outcomes.
Kidane et al. (Tue,) studied this question.