The Effect of the Same Day Initiation of Antiretroviral Treatment (ART) on Viral Load Suppression among Adults >15yrs. People Living with HIV in public health facilities in Addis Ababa

Background: The same day initiation of antiretroviral treatment among PLHIV with age greater or equal to 15, regardless of their CD4 count can reduce morbidity, mortality, HIV transmission and eventually the incidence of new HIV infection. However, the effect of the same day ART initiation on viral suppression remains contradicting. Objective: The aim of this study was to determine the effects of the same day ART initiation on viral suppression; and identify predicators of viral suppression in the era of test and treat strategy. Methods: A quantitative multicenter retrospective cohort study was conducted using routinely collected data in ART clinics during the initial and follow-up visits of clients in 18 public health facilities in Addis Ababa, Ethiopia. Results: The viral suppression rates at 12 ^th month among those who started ART on the same day and after seven days diagnosed with HIV were 94.3% with 95% CI: 92.3-96.4 and 90.3 % with 95% CI: 87.1-93.3 respectively. The difference between the two groups was statistically significant (P-value: 0.033) with RR of 1.044 (95% CI: RR: 1.001-1.090). The TDF-based regimen, working functional status, and alive and on ART follow-up status were found to be predicators of viral suppression. Conclusion & recommendation : The viral load suppression rate among the same day ART started was higher compared to those started ART after seven days, and is consistent with previous studies in other countries. TDF- based regimen, alive and on ART follow-up status, and working functional status were predicators of viral suppression in this study. Strengthening the same day ART initiation with TDF based regimen is critical for prevention of HIV through viral suppression. Improving the quality of ART data is also essential to generate evidence and inform the practice.