Prevalence and factors associated with HIV drug resistance among adult persons living with HIV/AIDS in nine countries of Sub-Saharan Africa using Population-based HIV Impact Assessments: 2015-2019.

Introduction HIV drug resistance (HIVDR) remains a significant challenge in sub-Saharan Africa (SSA) due to limited effective treatment and healthcare resources varies. Using the first widely available HIVDR surveillance data in SSA, we calculated the prevalence and associated factors of HIVDR amongst the persons that were on ART between 2015 and 2019 using the Population-based HIV Impact Assessment (PHIA). Methods A secondary analysis of the combined PHIA HIVDR data from Cameroon, Malawi, Eswatini, Ethiopia, Namibia, Rwanda, Tanzania, Zambia and Zimbabwe over the 2015–2019 period. We calculated frequencies, proportions, 95% confidence intervals (95%CI), odds ratios (OR), chi-Square statistics using in R. The outcome of interest was whether a person had HIVDR resistant strains or no HIVDR resistant strains. We examined the prevalence and associated factors of HIVDR in SSA. Statistical significance was set at P < 0.05. Results An overall prevalence of HIVDR was 35%. Not reaching HIV viral load suppression, being on antiretroviral medication (ART), and certain sociodemographic characteristics including age (35 + years), living in a rural area, and particular national contexts (e.g., higher resistance in Rwanda and Zimbabwe) were important factors linked to higher HIVDR likelihood. Additionally, the study revealed that having viral load suppression was associated with lower HIVDR likelihood (aOR: 0.31, 95% CI: 0.21–0.45, P < 0.001), whereas being on ART was associated with higher HIVDR likelihood (aOR: 2.6, 95% CI: 1.75–3.91, P < 0.001). Predictive models showed that HIVDR is strongly predicted by HIV viral suppression and ART status. In order to effectively manage HIVDR and enhance patient outcomes, these data highlight the significance of focused interventions, particularly in rural and high-resistance settings. Conclusion This study concludes by highlighting the substantial prevalence of HIVDR in SSA, which varies significantly among nations and sociodemographic characteristics. The results highlight the importance of ART use and viral load suppression in determining HIVDR prevalence, underscoring the necessity of focused interventions to enhance viral load monitoring and ART adherence. To combat the growing threat of HIVDR and guarantee the long-term efficacy of HIV treatment programs in the area, ongoing surveillance and context-specific approaches are crucial.