Predicting HIV Drug Resistance among Persons Living with HIV/AIDS in Sub-Saharan Africa using Population-based HIV Impact Assessment Surveys: 2015-2019

Introduction HIV drug resistance (HIVDR) remains a significant challenge in sub-Saharan Africa (SSA), where access to effective treatment and healthcare resources varies widely. Socioeconomic status, demographic factors, clinical parameters, and regional disparities have been associated with patterns of HIVDR across SSA. Understanding the interplay of these factors is crucial for designing effective interventions to mitigate the impact of HIVDR and improve treatment outcomes in the region. Methods We conducted a secondary analysis of the Population-based HIV Impact Assessment (PHIA) HIV drug resistance datasets from Cameroon, Malawi, Eswatini, Ethiopia, Namibia, Rwanda, Tanzania, Zambia and Zimbabwe. All recipients of care aged between 15+ years were included in this analysis. The outcome of interest was whether a person had HIVDR resistant strains or no HIVDR resistant strains. Predictive analysis, chi-square test, univariable and multivariable logistic regression analyses were conducted in R. Statistical significance was set at P<0.05. Results The total sample size across the nine countries was 1008. Tanzania had the highest representation (16.8%), followed by Zambia (16.3%) and Zimbabwe (14.2% while Rwanda had the lowest representation (5.1%). Significant associations were observed between ARV status, viral suppression, country of residence and HIVDR in SSA. Individuals residing in Rwanda had significantly higher odds of HIVDR (adjusted OR = 3.63, 95% CI: 1.22-11.0, p = 0.021) compared to other countries. Additionally, individuals with suppressed viral loads had significantly lower odds of HIVDR (adjusted OR = 0.31, 95% CI: 0.21-0.45, p < 0.001), while those on ART exhibited higher odds of HIVDR (adjusted OR = 2.6, 95% CI: 1.75-3.91, p <   0.001). Conclusion This study focused on how clinical and sociodemographic factors influence HIVDR patterns in SSA. To mitigate the effects of HIVDR and improve treatment outcomes in the region, it is critical to address barriers to treatment access and adherence and upgrade the healthcare system. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The author(s) received no specific funding for this work. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Not Applicable The details of the IRB/oversight body that provided approval or exemption for the research described are given below: University of Zambia Biomedical Research Ethics Committe (UNZABREC) I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Not Applicable I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Not Applicable I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Not Applicable The data used in this manuscript was derived from the Population-based HIV Impact Assessment Survey (PHIA). Please refer to the data access policies of PHIA for more information