{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T07:11:09Z","timestamp":1777965069469,"version":"3.51.4"},"reference-count":47,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Int Assoc Provid AIDS Care"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Virologic failure in children is a significant public health concern in sub-Saharan Africa. This study aims to assess the incidence rate of virologic failure and its predictors among children undergoing first-line antiretroviral therapy (ART) in Ethiopia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A multicenter retrospective follow-up study was conducted in HIV-infected children on first-line ART from January 1, 2013, to December 31, 2022, in Ethiopia. A simple random sampling method was employed to select the sample. Data entry was performed using EpiData, and analysis was conducted using STATA version 14. Kaplan\u2013Meier curves and log-rank tests were utilized for survival analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Result<\/jats:title>\n                    <jats:p>Among 537 HIV-infected children followed over the study period, 12.29% developed virologic failure, yielding an incidence rate of 17 per 10\u2005000 person-month observations (95% confidence interval [CI]: 13.4, 21.7). Factors independently associated with an increased risk of virologic failure included poor ART adherence (adjusted hazard ratio [AHR]\u2009=\u20092.63; 95% CI: 1.38, 4.97), advanced World Health Organization (WHO) Treatment (T) stages III and IV (AHR\u2009=\u20092.71; 95% CI: 1.15, 6.37), no history of regimen change (AHR\u2009=\u20095.88; 95% CI: 3.23, 10.71), and age at ART initiation above 10 years (AHR\u2009=\u20092.97; 95% CI: 1.30, 6.78). In contrast, having a caregiver younger than 40 years was associated with a significantly lower risk of virologic failure (AHR\u2009=\u20090.42; 95% CI: 0.25, 0.72). These findings emphasize the importance of monitoring adherence, providing closer follow-up for children in advanced treatment stages, and considering caregiver-related factors to reduce virologic failure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Virologic failure among HIV-infected children on first-line ART in Northwest Ethiopia was a relatively low incidence. Interventions targeting poor adherence, children with advanced WHO Treatment (T) stage, older age at ART initiation, and those with no history of regimen change are essential. Additionally, caregiver characteristics, such as age below 40 years, play a protective role and should be considered when designing adherence support and monitoring strategies to further reduce the risk of virologic failure.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/23259582261447448","type":"journal-article","created":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T12:48:01Z","timestamp":1777726081000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Incidence and Predictors of Virologic Failure Among Children on First-Line Antiretroviral Therapy in Northwest Ethiopia: A Multicenter Retrospective Follow-Up Study"],"prefix":"10.1177","volume":"25","author":[{"given":"Zemene Mesafint","family":"Kassie","sequence":"first","affiliation":[{"name":"Amhara National Regional Health Bureau"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nebiyu Mekonnen","family":"Derseh","sequence":"additional","affiliation":[{"name":"Institute of Public Health, College of Medicine and Health Sciences, University of Gondar"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tadesse Awoke","family":"Ayele","sequence":"additional","affiliation":[{"name":"Institute of Public Health, College of Medicine and Health Sciences, University of Gondar"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meron Asmamaw","family":"Alemayehu","sequence":"additional","affiliation":[{"name":"Institute of Public Health, College of Medicine and Health Sciences, University of Gondar"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9390-9189","authenticated-orcid":false,"given":"Agerie Mengistie","family":"Zeleke","sequence":"additional","affiliation":[{"name":"Debark University College of Health Sciences"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0180-5495","authenticated-orcid":false,"given":"Yeshiwas Ayale","family":"Ferede","sequence":"additional","affiliation":[{"name":"Tedda Health Science College"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7952-1738","authenticated-orcid":false,"given":"Worku Chekol","family":"Tassew","sequence":"additional","affiliation":[{"name":"School of Public Health, Tedda Health Science College"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-2735-3522","authenticated-orcid":false,"given":"Jember Ayelgne","family":"Beyene","sequence":"additional","affiliation":[{"name":"School of Public Health, Tedda Health Science College"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2026,5,2]]},"reference":[{"key":"e_1_3_4_2_2","unstructured":"WHO. HIV 2022. https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/hiv-aids."},{"key":"e_1_3_4_3_2","volume-title":"Treating all people living with HIV in sub-Saharan Africa: a new era calling for new approaches","author":"Nash D","year":"2018","unstructured":"Nash D, Yotebieng M, Sohn AH. Treating all people living with HIV in sub-Saharan Africa: a new era calling for new approaches. Elsevier; 2018: pp. 1-4."},{"key":"e_1_3_4_4_2","unstructured":"WHO. Consolidated guidelines on HIV prevention testing treatment service and monitoring. 2021."},{"key":"e_1_3_4_5_2","unstructured":"UNICEF. Paediatric care and treatment\u2014UNICEF data. 2022 . https:\/\/data.unicef.org\/topic\/hivaids\/paediatric-treatment-and-care\/."},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(11)60208-0"},{"key":"e_1_3_4_7_2","unstructured":"USAIDS. 2025 AIDS targets. 2022 . https:\/\/www.unaids.org\/sites\/default\/files\/2025-AIDS-Targets."},{"key":"e_1_3_4_8_2","unstructured":"FMOH. National guidelines for comprehensive HIV prevention care and treatment. 2022."},{"key":"e_1_3_4_9_2","unstructured":"H J. HIV A. aids JUNPo: 90-90-90: an ambitious treatment target to help end the AIDS epidemic. Geneva: UNAIDS. 2014."},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0000000000000438"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.14238\/pi62.5.2022.295-303"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofac121"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkx188"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0200242"},{"key":"e_1_3_4_15_2","doi-asserted-by":"publisher","DOI":"10.4236\/ojped.2021.114067"},{"key":"e_1_3_4_16_2","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000006282"},{"key":"e_1_3_4_17_2","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dky348"},{"issue":"1","key":"e_1_3_4_18_2","first-page":"28","article-title":"Factors associated with time to virological failure among HIV patients on first line antiretroviral at Kenyatta National Hospital Comprehensive Care Centre, Nairobi, Kenya","volume":"2","author":"Mutabari David HK","year":"2018","unstructured":"Mutabari David HK, Muiruri P, Wang'ombe A. Factors associated with time to virological failure among HIV patients on first line antiretroviral at Kenyatta National Hospital Comprehensive Care Centre, Nairobi, Kenya. Clin J HIV AIDS. 2018;2(1):28-35.","journal-title":"Clin J HIV AIDS"},{"issue":"7","key":"e_1_3_4_19_2","first-page":"487","article-title":"Risk factors of virologic failure and slow response to ART among HIV-infected children and adolescents in Nairobi","volume":"94","author":"Kabogo J","year":"2017","unstructured":"Kabogo J, Gupta S, Maina A, et al. Risk factors of virologic failure and slow response to ART among HIV-infected children and adolescents in Nairobi. East Afr Med J. 2017;94(7):487-498.","journal-title":"East Afr Med J."},{"key":"e_1_3_4_20_2","first-page":"1","article-title":"Time to first-line antiretroviral treatment failure and its predictors for seropositive children treated in public hospitals, North West Ethiopia 2021","volume":"21","author":"Kebede F","year":"2021","unstructured":"Kebede F, Kebede B, Kebede T, Giza M. Time to first-line antiretroviral treatment failure and its predictors for seropositive children treated in public hospitals, North West Ethiopia 2021. J Antivir Antiretrovir S. 2021;21:1-8.","journal-title":"J Antivir Antiretrovir S"},{"key":"e_1_3_4_21_2","unstructured":"UNICEF T. Understanding and Improving Viral Load Suppression in Children with HIV in Eastern and Southern Africa. 2021."},{"key":"e_1_3_4_22_2","doi-asserted-by":"publisher","DOI":"10.2147\/PHMT.S243656"},{"key":"e_1_3_4_23_2","doi-asserted-by":"crossref","unstructured":"Angassa D Misasew M. Incidence and predictors of antiretroviral treatment failure among children in public health facilities of Kolfe Keranyo Sub-City Addis Ababa Ethiopia: Institution-based retrospective cohort study. medRxiv. 2022.","DOI":"10.1101\/2022.03.24.22272879"},{"key":"e_1_3_4_24_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2017-019181"},{"key":"e_1_3_4_25_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-017-2487-5"},{"key":"e_1_3_4_26_2","volume-title":"Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach","author":"WHO","year":"2016","unstructured":"WHO. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach. World Health Organization; 2016."},{"key":"e_1_3_4_27_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijid.2018.10.019"},{"key":"e_1_3_4_28_2","unstructured":"UN. Transforming our world: The 2030 agenda for sustainable development. New York: United Nations Department of Economic and Social Affairs. 2015."},{"key":"e_1_3_4_29_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-022-22237-6"},{"key":"e_1_3_4_30_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13052-021-01030-7"},{"key":"e_1_3_4_31_2","doi-asserted-by":"crossref","unstructured":"Getaneh Y Yizengaw A Likie A et al. Rate and predictors of treatment failure among pediatric population taking highly active antiretroviral therapy in Ethiopia. medRxiv. 2019:19005538.","DOI":"10.1101\/19005538"},{"key":"e_1_3_4_32_2","unstructured":"Dean AGSK Soe MM. OpenEpi: open source epidemiologic statistics for public health version. www.OpenEpi.com updated 2013\/04\/06 accessed 2023\/04\/03."},{"key":"e_1_3_4_33_2","volume-title":"Nutritional anaemias: tools for effective prevention and control","author":"World Health Organization","year":"2017","unstructured":"World Health Organization. Nutritional anaemias: tools for effective prevention and control. World Health Organization; 2017."},{"key":"e_1_3_4_34_2","unstructured":"WHO. Updates on the management of severe acute malnutrition in infants and children. 2013."},{"issue":"4","key":"e_1_3_4_35_2","first-page":"981","article-title":"Comparison of cox regression and parametric models: Application for assessment of survival of pediatric cases of acute leukemia in southern Iran","volume":"18","author":"Hosseini Teshnizi S","year":"2017","unstructured":"Hosseini Teshnizi S, Taghi Ayatollahi SM. Comparison of cox regression and parametric models: Application for assessment of survival of pediatric cases of acute leukemia in southern Iran. Asian Pac J Cancer Prev APJCP. 2017;18(4):981-985.","journal-title":"Asian Pac J Cancer Prev APJCP"},{"key":"e_1_3_4_36_2","doi-asserted-by":"publisher","DOI":"10.4103\/jrms.JRMS_6_17"},{"issue":"1","key":"e_1_3_4_37_2","first-page":"8868479","article-title":"Time to first-line antiretroviral treatment failure and its predictors among HIV-positive children in Shashemene town health facilities, Oromia region, Ethiopia, 2019","volume":"2021","author":"Zenebe E","year":"2021","unstructured":"Zenebe E, Washo A, Addis Gesese A. Time to first-line antiretroviral treatment failure and its predictors among HIV-positive children in Shashemene town health facilities, Oromia region, Ethiopia, 2019. Sci World J. 2021;2021(1):8868479.","journal-title":"Sci World J"},{"key":"e_1_3_4_38_2","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.25550"},{"key":"e_1_3_4_39_2","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0000000000001921"},{"key":"e_1_3_4_40_2","doi-asserted-by":"publisher","DOI":"10.7196\/SAMJ.2021.v111i3.15221"},{"key":"e_1_3_4_41_2","unstructured":"Kibore MW. Trends and predictors of virologic failure following suppression on antiretroviral therapy among HIV Infected children in Kenya. 2016."},{"key":"e_1_3_4_42_2","doi-asserted-by":"publisher","DOI":"10.1186\/1742-6405-10-25"},{"key":"e_1_3_4_43_2","first-page":"73","article-title":"Virological and immunological antiretroviral treatment failure and predictors among HIV positive adult and adolescent clients in Southeast Ethiopia","volume":"14","author":"Mamo A","year":"2022","unstructured":"Mamo A, Assefa T, Negash W, et al. Virological and immunological antiretroviral treatment failure and predictors among HIV positive adult and adolescent clients in Southeast Ethiopia. HIV\/AIDS (Auckland, NZ). 2022;14:73-85.","journal-title":"HIV\/AIDS (Auckland, NZ)"},{"key":"e_1_3_4_44_2","unstructured":"FMOH. National guidelines for comprehensive HIV prevention care and treatment. 2017."},{"key":"e_1_3_4_45_2","doi-asserted-by":"publisher","DOI":"10.4102\/curationis.v40i1.1541"},{"key":"e_1_3_4_46_2","volume-title":"Prevalence and risk factors of virologic failure and HIV-1 drug resistance among children and adolescents in Nairobi","author":"Kabogo JM","year":"2019","unstructured":"Kabogo JM. Prevalence and risk factors of virologic failure and HIV-1 drug resistance among children and adolescents in Nairobi. JKUAT-COHES; 2019."},{"key":"e_1_3_4_47_2","doi-asserted-by":"publisher","DOI":"10.1097\/INF.0000000000000584"},{"issue":"4","key":"e_1_3_4_48_2","first-page":"594","article-title":"Time to switch to second-line antiretroviral therapy in children with human immunodeficiency virus in Europe and Thailand","volume":"66","author":"Pregnancy TE","year":"2017","unstructured":"Pregnancy TE, EuroCoord PHCCSGi. Time to switch to second-line antiretroviral therapy in children with human immunodeficiency virus in Europe and Thailand. Clin Infect Dis. 2017;66(4):594-603.","journal-title":"Clin Infect Dis."}],"container-title":["Journal of the International Association of Providers of AIDS Care (JIAPAC)"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/23259582261447448","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/23259582261447448","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/23259582261447448","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T06:16:21Z","timestamp":1777961781000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/23259582261447448"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":47,"alternative-id":["10.1177\/23259582261447448"],"URL":"https:\/\/doi.org\/10.1177\/23259582261447448","relation":{},"ISSN":["2325-9582","2325-9582"],"issn-type":[{"value":"2325-9582","type":"print"},{"value":"2325-9582","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]},"article-number":"23259582261447448"}}