Virologic outcomes and associated factors among people living with HIV on antiretroviral therapy in the Upper East Region of Ghana: a facility-based cross-sectional study

Background Achieving sustained virologic suppression is critical for the effective management of HIV infection. This study assessed the prevalence and factors associated with virologic outcomes among people living with HIV (PLHIV) on antiretroviral therapy (ART) in the Upper East Region of Ghana. Methods A cross-sectional study was conducted between June and August 2024 among 336 PLHIV on ART from three sites: Bongo, Navrongo, and Paga in the Upper East Region of Ghana. Sociodemographic, clinical, and comorbidity data were collected. Viral load was measured using a quantitative GeneXpert HIV-1 viral load nucleic acid amplification assay. Virologic suppression was defined as viral load < 1,000 copies/mL. Associations between participant characteristics and virologic outcomes were evaluated using logistic regression analyses. Results The mean age of participants was 44.36 ± 12.09 years, with a predominance of females (81.6%) and rural residents (73.2%). Most participants were on first-line ART regimens (98.8%), with over half receiving treatment for more than five years. The mean viral load was 2.28 ± 1.05 log copies/mL. Virologic suppression was achieved in 89.5% of participants, with significant variation across study sites (Navrongo: 96.5%; Bongo: 80.0%; and Paga 78.8%; p < 0.001) and WHO clinical stages (Stage 3: 95.9%; Stage 1: 81.4%; p < 0.001). The prevalence of virologic failure was 10.5%, and educational attainment was protective against virologic failure, with individuals having basic education showing lower odds compared to those without formal education (aOR = 0.33, 95% CI: 0.12–0.93, p = 0.037). Comorbid conditions, such as a history of opportunistic infections (aOR = 4.71, 95% CI: 1.24–17.88, p = 0.023) and osteoporosis (aOR = 14.05, 95% CI: 1.27-155.69, p = 0.031), were associated with increased odds of virologic failure. Conclusion Virologic suppression among people living with HIV on antiretroviral therapy in the Upper East Region of Ghana was high and virologic failure in the cohort was influenced by site of care, education level, WHO clinical stage and some comorbidities. Interventions targeting patients with comorbid conditions, strengthening patient education and addressing facility-level disparities could further improve virologic outcomes in this population.