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

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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. HIV/AIDS virologic suppression virologic failure Antiretroviral therapy comorbidities Figures Figure 1 Introduction Despite major advances in antiretroviral therapy, achieving and maintaining virologic suppression remains the cornerstone of HIV care. Virologic suppression prevents disease progression, reduces transmission, and is essential to meeting global targets to end the AIDS pandemic 1 – 4 . The Joint United Nations Programme on HIV/AIDS (UNAIDS) has set the 95-95-95 targets to ensure that 95% of people living with HIV (PLHIV) know their status, 95% of those diagnosed receive sustained antiretroviral therapy (ART), and 95% of those on treatment achieve durable viral suppression 5 . Progress towards these targets depends critically on localized gains in diagnosis, treatment access and retention, and on addressing the clinical and social drivers of virologic failure. Ghana has made policy and programmatic commitments aligned with these global goals. The Ghana National HIV and AIDS Strategic Plan 2021–2025 emphasize expanded testing, differentiated service delivery, and improved viral load monitoring as key strategies to increase suppression rates and reduce new infections 6 . ART coverage remains suboptimal (47–63%), whereas the viral suppression rate among people on ART ranges from 64% to 89% 7–9 . The national HIV estimates indicate a concentrated epidemic with an adult (15–59 years) prevalence around 1.5–1.7% and a national population living with HIV of 330,000 (290,000-400,000), underscoring the need for efficient targeted interventions 10 . At the individual and programme level, several determinants have been repeatedly associated with virologic failure. Poor adherence to ART remains one of the strongest and most consistent predictors of detectable viral load 11 , 12 . Other frequently reported factors include; shorter duration on ART, suboptimal or interrupted drug supply, lower economic status, limited education, and comorbid illnesses 13 – 15 . Studies in Ghana and other sub-Saharan African settings report substantial variations in suppression rates and identify both clinical and structural barriers, such as stigma, poverty, and rural service constraints that undermine durable suppression 16 – 18 . Regional-level evidence is especially important because Ghana’s epidemic is heterogeneous: patterns of HIV testing, stigma, health service access, and social determinants differ by region and between rural and urban communities. The Upper East Region, a predominantly rural area in the northern part of Ghana, faces peculiar challenges, including higher reported levels of discriminatory attitudes towards PLHIV and limited health system resources relative to urban centres 19 – 22 . These contextual factors may influence both retention in care and virologic outcomes, yet region-specific, up-to-date data on virologic suppression and its drivers remain limited. A recent retrospective study in the Upper East Region reported an estimated virologic failure in nearly one out of every two (47%) PLHIV on ART 23 . This study sought to estimate the prevalence of virologic suppression and virologic failure among PLHIV on ART in the Upper East Region of Ghana and to identify determinants associated with virologic failure. The findings of this study provide locally relevant evidence needed to inform targeted interventions to accelerate progress towards national and global viral suppression targets. Materials and Methods Study design and setting A health facility-based, cross-sectional study was conducted among PLHIV receiving ART in the Upper East Region (UER) of Ghana. The UER is a predominantly rural region where HIV care is offered at district and regional hospitals, coordinated by the Regional Health Directorate. Routine viral load monitoring and ART services at these facilities follow national and WHO HIV treatment guidelines 1,6 . Three district HIV care and treatment centres, including the Bongo District Hospital (Bongo), Paga District Hospital (Paga) in the Kassena-Nankana West District, and War Memorial Hospital in the Kassena-Nankana Municipality, all in the Upper East Region of Ghana were purposively selected for this study. These facilities are major ART service delivery points, serving a large and diverse catchment population. The Bongo District Hospital provides services to about 200 PLHIV, the Kassena-Nankana West District Hospital serves about 100 PLHIV and the War Memorial Hospital serves over 1,000 PLHIV receiving ART. Study population, recruitment strategy and eligibility criteria The study population comprised PLHIV receiving ART at Bongo District Hospital, Paga District Hospital, and War Memorial Hospital between June 2024 and August 2024. PLHIV who came to the clinic for services were approached by the ART nurse and had the study introduced to them. Individuals who were willing to participate in the study were referred to the study team for further engagement, eligibility screening and informed consent. Qualified participants were systematically enrolled. Individuals were eligible for inclusion if they provided informed consent for voluntary participation, including blood draw, and had been on ART treatment for at least one year. PLHIV were excluded due to non-provision of informed consent, not being on ART for a duration ≥ 1 year, being severely ill and unable to complete questionnaire administration, or having mental conditions that impaired their ability to provide informed consent or participate in the interview. Pregnant women were also excluded from this study. Sociodemographic information and HIV risk-related behavioural factors were obtained using a structured questionnaire. Additionally, clinical information such as duration on ART, ART regimen, WHO clinical staging, HIV type data, and comorbid information was abstracted from participants’ records. Three (3) mL of venous blood were collected into an EDTA tube and sent to the laboratory for HIV viral load estimation. Sample size and sampling procedure The minimum sample size required to estimate the prevalence of virologic failure was estimated using the Cochran formula for a single proportion at a 95% confidence interval and a precision of 0.05 24 . A previous survey in Kumasi reported the prevalence of virologic failure as 23.6% 13 . Therefore, an estimated sample size of 278 was obtained. To account for the possibility of non-response or incomplete data during recruitment, the sample was adjusted by 5%, yielding a target sample size of 292 participants. A multi-stage sampling approach was used. First, three district hospitals were purposively selected, as they were major ART service delivery points in the Upper East Region, serving large and diverse catchment populations. They also had established ART clinics with reliable records to support participant recruitment and data quality. Secondly, at each facility, participants were consecutively approached and enrolled upon informed consent. Data collection procedures Socio-demographic data (i.e., age, sex, marital status, residence (urban/rural), employment status, and educational status) and behavioural-related risk factors (such as alcohol intake, use of herbal medications, smoking, and hard drug usage) 25,26 were obtained with a structured questionnaire (Supplementary file 1) by a trained research assistant in a face-to-face interview with participants. The questionnaires for young participants (i.e., 12–17 years old) were administered in the same format as for adults, but interviewers were trained to explain items in simple, clear terms when needed. Clinical-related data, such as duration on ART, ART treatment regimen, baseline WHO clinical staging 27 , HIV type diagnosed (HIV-1 or HIV-2), and comorbidities (such as opportunistic infection, hypertension, diabetes, mental health history, kidney disease, cancer, etc.), were abstracted from participants’ folders. To comply with ethical protocols, no personal identifiers were included during the data abstraction. Laboratory procedures and definitions Viral load testing was performed using a cartridge-based real-time PCR platform: a quantitative GeneXpert HIV-1 viral load nucleic acid amplification assay (Cepheid, USA). This assay platform is validated for routine decentralised use in Ghana. In brief, the whole blood collected into the EDTA tube was centrifuged to obtain plasma. Approximately 1 mL of the plasma was transferred into the test cartridge according to the manufacturer’s instructions. The loaded cartridge was then placed into the GeneXpert instrument, which automatically performed nucleic acid extraction, reverse transcription, amplification, and quantification using real-time PCR. The results were generated and displayed by the system software in about 90 minutes with no additional hands-on processing. Each batch of tests performed included internal controls. These operational definitions guided outcome classification and the identification determinants of virologic failure. The primary outcome was defined according to WHO guidelines 28 : 1. Virologic suppression was defined as plasma HIV-1 RNA < 1,000 copies/mL and 2. Virologic failure as plasma HIV-1 RNA ≥ 1,000 copies/mL. ART regimens: 1. First-line therapy – consisted of dolutegravir-based combination (tenofovir + lamivudine +dolutegravir) 2. Second-line regimens – were based on a protease inhibitor backbone, most commonly atazanavir/ritonavir or lopinavir/ritonavir, combined with lamivudine. Based on the presence of specific clinical conditions, WHO clinical staging system classifies HIV cases into four progressive clinical stages, from stage 1 (asymptomatic) through to stage 4 (severe symptoms or AIDS) 27 . Data handling and analysis The data collected in this study were entered in Microsoft Excel and checked for completeness and consistency. Stata version 15 (STATA Corporation, Texas, USA) and GraphPad Prism version 9.0 (San Diego, CA, USA) were used for data analysis. Descriptive statistics were used to describe the prevalence of virologic suppression and virologic non-suppression among the various sociodemographic groups and clinical characteristics. The Pearson chi-square and Wilcoxon rank-sum tests were used to compare the differences between categorical and continuous variables, respectively. Logistic regression analysis, with both unadjusted and adjusted models, was used to assess the association between virologic failure and various sociodemographic, clinical, and behaviour-related characteristics and comorbidities. Regardless of statistical significance in unadjusted analysis, the multivariate logistic regression model included all the variables. This was to ensure that any potential confounding effect of each variable was accounted for as well as all theoretical factors. Multicollinearity was assessed during model development by variance inflation factors (VIFs) for all predictors. VIFs < 5 were acceptable. An alpha value less than 0.05 was considered to be statistically significant. Although 336 participants were enrolled and included in the sociodemographic and clinical description, virologic outcome analysis were restricted to 294 participants who had viral load measurement. Forty-two participants were excluded from virologic analysis because viral load results were unavailable, primarily due to inconclusive results. Ethical Consideration Ethical approval for the conduct of this study was obtained from the Navrongo Health Research Centre institutional review board (NHRCIRB) (ID: NHRCIRB596). Permission to get access to the facility records was obtained from the Upper East Regional Health Directorate and participating facility management. Informed consent was obtained from participants prior to their enrolment into the study. In addition to parental informed consent, assent was obtained from participants aged 12 to 17 years old. Upon enrolment, data collected from study participants were labelled with unique identification numbers to ensure anonymity throughout the study process. Individuals who were classified under virologic failure were referred to the HIV care and treatment unit within the facility where the study was conducted for counselling, further evaluation and management, in line with routine care procedures. All the study procedures were conducted in conformity with the Declaration of Helsinki. Results Sociodemographic, clinical, and comorbidity profile of the study population A total of 336 participants were enrolled, with most recruited from Navrongo (57.4%), followed by Bongo (27.4%) and Paga (15.2%) ( Table 1 ). The mean age was 44.36 (±12.09) years (range: 12-100 years), with 48.2% of participants in this category and 32.4% aged 35.44 years. Females predominated (81.6%), and over half of the participants were married (51.2%). Most participants were Christians (80.1%), and participants from rural areas were 73.2%. Over half of the participants had basic education (52.7%), 41.4% had no formal education, and 6.0% had tertiary education. Self-employment was the most common occupation (79.2%). Lifestyle risk factors were low, with 1.5% smoking tobacco, 30.7% consuming alcohol, 9.8% using herbal medications, and 0.6% reporting use of hard drugs. Most participants had been on ART for more than five years (53.6%) and were on first-line regimens (98.8%). Participants classified as WHO clinical stage 3 were the majority (58.6%), and HIV-1 infection predominated (97.9%). Opportunistic infections were reported in 8.0% of participants. Co-infections included hepatitis B (9.8%) and C (4.2%) positivity. Common comorbidities were hypertension (19.4%), cardiovascular disease (9.5%), diabetes (7.4%), and mental health conditions (11.0%), while other conditions such as kidney disease, osteoporosis and cancer were rare (< 2%). Table 1: Sociodemographic, clinical, and comorbidity characteristics of the study population Variable: Sociodemographic/Clinical/Comorbidity Frequency Percent Mean age ± SD (years) 44.36 ± 12.09 Site Navrongo 193 57.4 Bongo 92 27.4 Paga 51 15.2 Age category (years) 44 162 48.2 Sex Male 62 18.5 Female 274 81.6 Marital status Single 63 18.8 Married 172 51.2 Others 101 30.1 Religion Christians 269 80.1 Islam 36 10.7 Tradition 31 9.2 Place of residence Rural 246 73.2 Urban 90 26.8 Educational Status None 139 41.4 Basic 177 52.7 Tertiary 20 6.0 Employment status Unemployed 48 14.3 Self-employed 266 79.2 Public servant 22 6.6 Smoke tobacco Yes 5 1.5 No 331 98.5 Drink alcohol Yes 103 30.7 No 233 69.4 Herbal medication Yes 33 9.8 No 303 90.2 Hard drugs Yes 2 0.6 No 334 99.4 Duration on ART (years) 1-2 64 19.1 3-5 92 27.4 >5 180 53.6 ART regimen 1st line 332 98.8 2nd line 4 1.2 WHO clinical stage Stage 1 133 39.6 Stage 2 6 1.8 Stage 3 197 58.6 HIV type HIV-1 329 97.9 HIV-2 7 2.1 Opportunistic infection Yes 27 8.0 No 309 92.0 HBsAg Reactive 33 9.8 Non-reactive 303 90.2 HCV antibody Reactive 14 4.2 Non-reactive 322 95.8 Hypertension Yes 65 19.4 No 271 80.7 Diabetes Yes 25 7.4 No 311 92.6 Mental health history Yes 37 11.0 No 299 89.0 Kidney diseases Yes 5 1.5 No 331 98.5 Cardiovascular disease Yes 32 9.5 No 304 90.5 Cancer Yes 2 0.6 No 334 99.4 Osteoporosis Yes 6 1.8 No 330 98.2 Total 336 100.0 ART: Antiretroviral therapy; HBsAg: Hepatitis B surface antigen; HCV: Hepatitis C virus. Distribution of mean viral load across participants’ characteristics A total of 294 participants with available viral load data were included in this analysis. The mean viral load was 2.28 ± 1.05 standard deviation, range: 1.18–6.58 log copies/mL. Males had a mean viral load of 2.27 ± 0.94, while females had 2.28 ± 1.08, and the difference was not significant (p = 0.939) ( Figure 1A ). Viral load differed by study site (p < 0.001). Participants from Navrongo had the lowest mean viral load at 1.94 ± 0.72, compared to 2.62 ± 1.26 in Bongo and 2.73 ± 1.07 in Paga. Post-hoc testing showed significant differences between Navrongo and Bongo (p < 0.001) and between Navrongo and Paga (p = 0.002), while Bongo and Paga did not differ (p = 1.000) ( Figure 1B ). HIV type showed no significant relationship with mean viral load. Individuals with HIV-1 recorded a mean of 2.28 ± 1.05 compared to 2.01 ± 0.69 among those with HIV-2 (p = 0.562) ( Figure 1C ). Mean viral load varied by duration on ART, although this did not reach statistical significance (p = 0.072). Participants on treatment for three to five years had a higher mean viral load of 2.55 ± 1.30 compared with those on therapy for one to two years (2.24 ± 0.86) or more than five years (2.15 ± 0.93). Post-hoc comparisons showed no significant differences among the groups ( Figure 1D ). There was a significant association between WHO clinical infection stage and viral load (p < 0.001). Mean viral load was highest in individuals at Stage 1 (2.26 ± 1.22) and Stage 2 (2.58 ± 0.96) and lowest in Stage 3 (1.93 ± 0.72). Post-hoc analysis showed a significant difference between Stage 1 and Stage 3 (p < 0.001), while the comparison between Stage 2 and Stage 3 was not significant ( Figure 1E ). Virologic suppression and failure across sociodemographic, clinical, and comorbidity characteristics Out of a total of 294 participants with available viral load data included in this analysis, 263 participants (89.5%) achieved virologic suppression, while 31 (10.5%) had virologic failure ( Table 2 ). Navrongo recorded the highest rate of virologic suppression at 96.5%, followed by Bongo (80.0%) and Paga (78.8%), with a significant difference across sites (p < 0.001). Age showed a non-significant trend, with virologic suppression ranging from 84.6% to 93.8% across age categories (p = 0.105). A greater proportion of females (90.5%) than males had virologic suppression, though the difference was not statistically significant (p = 0.210). Marital status, religion, place of residence, educational level, and employment status also showed no significant difference with virologic outcomes. Similarly, lifestyle factors such as tobacco use, alcohol consumption, and use of herbal or hard drugs were not significantly different with virologic failure. Clinical characteristics showed notable variation. Duration on ART did not show a statistically significant difference, although individuals on therapy for more than five years had the highest virologic suppression rate (91.9%). WHO clinical stage was statistically different with virologic outcomes (p < 0.001). Participants in Stage 3 had the highest viral suppression rate (95.9%), while those in Stage 2 had the lowest (60.0%). Virologic outcomes did not differ significantly by ART regimen, HIV type, co-infection with hepatitis B or C, hypertension, diabetes, mental health history, kidney disease, cardiovascular disease, and cancer. Although not statistically significant, participants with opportunistic infections had the highest proportion of virologic failure (21.7%) compared to those without such infections (9.6%, p = 0.069). Osteoporosis was the only comorbidity that showed a significant difference with virologic outcome, with a higher proportion of virologic failures among affected individuals (40.0%, p = 0.031). Table 2: Prevalence of virologic suppression and failure among sociodemographic, clinical, and comorbidity groups Variables: Sociodemographic/Clinical/Comorbidity Virologic suppression n (%) Virologic failure n (%) p-value Site Navrongo 165 (96.5) 6 (3.5) <0.001 Bongo 72 (80.0) 18 (20.0) Paga 26 (78.8) 7 (21.2) Age category (years) <25 13 (86.7) 2 (13.3) 0.105 25-34 33 (84.6) 6 (15.4) 35-44 79 (85.0) 14 (15.1) ≥45 138 (93.8) 9 (6.1) Sex Male 44 (84.6) 8 (15.4) 0.210 Female 219 (90.5) 23 (9.5) Marital status Single 53 (91.4) 5 (8.6) 0.251 Married 129 (86.6) 20 (13.4) Others 81 (93.1) 6 (6.9) Religion Christians 216 (90.4) 23 (9.6) 0.134 Islam 25 (92.6) 2 (7.4) Tradition 22 (78.6) 6 (21.4) Place of residence Rural 193 (87.7) 27 (12.3) 0.096 Urban 70 (94.6) 4 (5.4) Educational Status None 115 (86.5) 18 (13.5) 0.314 Basic 135 (91.8) 12 (8.2) Tertiary 13 (92.9) 1 (7.1) Employment status Unemployed 34 (82.9) 7 (17.1) 0.281 Self-employed 211 (90.2) 23 (9.8) Public servant 18 (94.7) 1 (5.3) Smoke tobacco Yes 5 (100.0) 0 (0.00) No 258 (89.3) 31 (10.7) 0.439 Drink alcohol Yes 82 (89.1) 10 (10.9) No 181 (89.6) 21 (10.4) 0.902 Herbal medication Yes 27 (96.4) 1 (3.6) No 236 (88.7) 30 (11.3) 0.207 Hard drugs Yes 2 (100.0) 0 (0.00) 0.626 No 261 (89.4) 31 (10.6) Duration on ART (years) 1-2 33 (86.8) 5 (13.2) 0.237 3-5 70 (85.4) 12 (14.6) >5 160 (91.9) 14 (8.1) ART regimen 1st line 261 (89.4) 31 (10.6) 0.626 2nd line 2 (100.0) 0 (0.0) WHO clinical stage Stage 1 96 (81.4) 22 (18.6) <0.001 Stage 2 3 (60.0) 2 (40.0) Stage 3 164 (95.9) 7 (4.1) HIV type HIV-1 258 (89.6) 30 (10.4) 0.622 HIV-2 5 (83.3) 1 (16.7) Opportunistic infection Yes 18 (78.3) 5 (21.7) 0.069 No 245 (90.4) 26 (9.6) HBsAg Reactive 24 (88.9) 3 (11.1) 0.920 Non-reactive 239 (89.5) 28 (10.5) HCV antibody Reactive 11 (91.7) 1 (8.3) 0.799 Non-reactive 252 (89.4) 30 (10.6) Hypertension Yes 52 (91.2) 5 (8.8) 0.628 No 211 (89.0) 26 (11.0) Diabetes Yes 21 (95.5) 1 (4.6) 0.341 No 242 (89.0) 30 (11.0) Mental health history Yes 30 (83.3) 6 (16.7) 0.202 No 233 (90.3) 25 (9.7) Kidney diseases Yes 5 (100.0) 0 (0.00) 0.439 No 258 (89.3) 31 (10.7) Cardiovascular disease Yes 25 (96.2) 1 (3.9) 0.244 No 238 (88.8) 30 (11.2) Cancer Yes 2 (100.0) 0 (0.0) 0.626 No 261 (89.4) 31 (10.6) Osteoporosis Yes 3 (60.0) 2 (40.0) No 260 (90.0) 29 (10.0) 0.031 Total 263 (89.5) 31 (10.5) ART: Antiretroviral therapy; HBsAg: Hepatitis B surface antigen; HCV: Hepatitis C virus. Association between participant characteristics and virologic failure Table 3 presents the association between sociodemographic and clinical characteristics and virologic failure. In the unadjusted analysis, participants receiving care at Bongo and Paga had significantly higher odds of virologic failure compared with Navrongo. After adjustment, these associations were no longer statistically significant. Educational status showed a significant association with virologic outcome. Individuals with basic education had lower odds of virologic failure compared to those with no education (aOR = 0.33, 95% CI: 0.12-0.93, p = 0.037), and this was the only factor that remained statistically significant in the adjusted model. Employment status, alcohol use, use of herbal medication, HIV type, and duration on ART did not show significant associations with virologic failure. Participants classified as WHO clinical Stage 2 had significantly higher odds of virologic failure in the crude analysis (aOR = 12.09, 95% CI: 1.09-133.94, p = 0.042), but the association was not significant in the adjusted model. Table 3: Sociodemographic and clinical factors associated with virologic failure Variables cOR (95% CI) p-value aOR (95% CI) p-value Site Navrongo 1 1 Bongo 6.87 (2.62-18.04) <0.001 5.25 (0.31-90.25) 0.253 Paga 7.40 (2.31-23.76) 0.001 6.28 (0.32-123.12) 0.227 Age category (years) <25 1 1 25-34 1.91 (0.33-11.14) 0.471 1.63 (0.19-14.35) 0.657 35-44 2.01 (0.39-10.39) 0.404 1.31 (0.14-12.23) 0.812 ≥45 0.91 (0.17-4.91) 0.911 0.33 (0.03-3.39) 0.352 Sex Female 1 1 Male 1.45 (0.59-3.58) 0.422 1.78 (0.59-5.37) 0.304 Marital status Single 1 1 Married 1.82 (0.63-5.32) 0.270 2.99 (0.73-12.16) 0.126 Others 2.25 (0.56-9.13) 0.256 4.20 (0.77-23.08) 0.098 Religion Christians 1 1 Islam 0.85 (0.17-4.20) 0.842 0.64 (0.11-3.61) 0.625 Tradition 1.98 (0.67-5.82) 0.216 1.93 (0.54-6.90) 0.314 Place of residence Rural 1 1 Urban 0.90 (0.27-2.95) 0.861 1.34 (0.34-5.34) 0.673 Educational Status None 1 1 Basic 0.62 (0.27-1.39) 0.241 0.33 (0.12-0.93) 0.037 Tertiary 0.62 (0.07-5.69) 0.675 0.48 (0.02-13.48) 0.666 Employment status Unemployed 1 1 Self-employed 0.64 (0.24-1.69) 0.370 0.50 (0.15-1.66) 0.260 Public servant 0.47 (0.05-4.62) 0.515 0.30 (0.01-9.86) 0.496 Drink alcohol No 1 1 Yes 1.68 (0.70-4.03) 0.250 2.34 (0.85-6.43) 0.098 Herbal medication No 1 1 Yes 0.54 (0.07-4.43) 0.568 0.33 (0.03-3.60) 0.363 Duration on ART (years) 1-2 1 1 3-5 1.26 (0.39-4.07) 0.695 1.44 (0.37-5.57) 0.599 >5 0.80 (0.26-2.49) 0.703 0.90 (0.24-3.34) 0.871 WHO clinical stage Stage 1 1 1 Stage 2 12.09 (1.09-133.94) 0.042 16.08 (0.61-424.60) 0.096 Stage 3 1. 89 (0.32-11.31) 0.485 3.01 (0.32-28.25) 0.334 HIV type HIV-1 1 1 HIV-2 2.18 (0.21-22.70) 0.515 3.92 (0.27-56.41) 0.315 ART: Antiretroviral therapy; aOR: adjusted odds ratio; cOR: Crude odds ratio; 95% CI: 95% confidence interval Comorbidities associated with virologic failure Table 4 shows the relationship between selected comorbidities and virologic failure among participants. After adjusting for confounders, only opportunistic infections and osteoporosis showed significant associations with virologic failure. Participants with a history of opportunistic infections had higher odds of virologic failure compared with those without such infections (aOR = 4.71, 95% CI: 1.24-17.88, p = 0.023). Osteoporosis was also strongly associated with virologic failure, with affected individuals showing higher adjusted odds compared with those without the conditions (aOR = 14.05, 95% CI: 1.27-155.69, p = 0.031). Other comorbidities, including hepatitis B and C exposure, hypertension, diabetes, mental health history, and cardiovascular disease, did not show significant associations with virologic failure in either crude or adjusted models. Table 4: Association between comorbidities and virologic failure Variables cOR (95% CI) p-value aOR (95% CI) p-value Opportunistic infection No 1 1 Yes 3. 99 (1.21-13.19) 0.023 4.71 (1.24-17.88) 0.023 HBsAg Non-reactive 1 1 Reactive 1.43 (0.37-5.42) 0.603 1.46 (0.35-6.02) 0.601 HCV antibody Non-reactive Reactive 0.90 (0.10-7.77) 0.921 1.23 (0.14-11.03) 0.855 Hypertension No 0.95 (0.33-2.72) 0.928 0.78 (0.25-2.46) 0.962 Yes 1 Diabetes No 0.50 (0.06-4.06) 0.517 0.41 (0.05-3.57) 0.417 Yes 1 Mental health history No 1.69 (0.61-4.72) 0.315 2.07 (0.69-6.20) 0.194 Yes 1 Cardiovascular disease No 1 1 Yes 0.77 (0.09-6.47) 0.81 0.77 (0.08-6.95) 0.814 Osteoporosis No 1 1 Yes 14.86 (1.84-119.82) 0.011 14.05 (1.27-155.96) 0.031 HBsAg: Hepatitis B surface antigen; HCV: Hepatitis C virus; aOR: adjusted odds ratio; cOR: Crude odds ratio; 95% CI: 95% confidence interval Discussion The study assessed virologic outcomes and their associated factors among people living with HIV receiving ART in three sites in the Upper East Region of Ghana. Overall, virologic suppression was high, with nearly nine out of ten participants achieving a viral load below 1,000 copies/mL. This finding aligns with reports from similar ART programmes in sub-Saharan Africa, where expanded access to treatment and improved, programmatic monitoring have led to substantial gains in viral suppression rate 29 , 30 . However, the virologic outcomes observed in this study in comparison with other Ghanaian settings appear relatively high but still fall short of the national and the UNAIDS 95-95-95 targets. In a study conducted in the Kumasi metropolis, 76.4% of adults on ART achieved viral suppression, with a 23.6% virologic failure rate, which is lower suppression and higher failure rates than in this cohort 13 . Similarly, research from the Asante Mampong Municipal Hospital in the Ashanti Region reported viral suppression rates under 80%, again below the UNAIDS targets 8 . From the Upper East Region itself, a previous retrospective study reported 53% and 47% viral suppression and virologic failure, respectively, among PLHIV on ART 23 . National estimates also suggest that viral suppression across Ghana has been below optimal, with reports indicating suppression in only about 64% to 89% of patients on ART. These findings show that although the suppression rate in the present study exceeds some regional estimates, virologic failure remains an important challenge and highlights the need for continued efforts to improve adherence and treatment outcomes within the national HIV programme. The relatively high virologic suppression observed in this study could be explained by several programmatic and patient-level factors. Access to ART, including the widespread use of potent first-line regimens, likely contributed to effective control. Also, routine viral load monitoring and timely clinical follow-up may have enabled early identification and management of adherence challenges, thereby preventing prolonged viraemia. In addition, a relatively stable cohort of patients engaged in care, with fewer treatment interruptions, could favour better outcomes. Sociodemographic determinants, such as educational status, were drivers of virologic outcomes. Participants with basic education had significantly lower odds of virologic failure compared with those with no formal education. Education may enhance health literacy, understanding of ART regimens, and adherence to long-term treatment, all of which are critical for viral suppression. This finding is consistent with evidence linking higher educational attainment to improved ART adherence and treatment outcomes across diverse settings 23 , 31 , 32 . Interestingly, tertiary education did not show a similar protective effect, likely due to the small number of participants in this category. Some studies have also reported a non-linear relationship between education and adherence, suggesting that basic literacy may be sufficient to support treatment success in resource-limited settings 26 , 33 , 34 . It underscores the need for tailored adherence counselling and simplified messaging for individuals with limited formal education. Although females were predominant in the study population and demonstrated a higher proportion of viral suppression than males (90.5% vs. 84.6%), the difference was not statistically significant. This contrasts with previous studies where male sex had been associated with poorer virologic outcomes, often linked to delayed care seeking and poorer adherence 35 . Nonetheless, sex differences in virologic response are often inconsistent, with some reporting no significant difference in viral suppression between men and women 36 – 38 , consistent with our findings. The absence of a sex difference in this study may partly reflect the predominance of women in this cohort, improved engagement in care within these facilities or effective adherence counselling that minimises sex disparities. Age was also not associated with virologic outcomes, consistent with findings from other ART programme evaluations. This suggests that clinical and structural factors, such as adherence support and service delivery quality, may have greater influence on suppression than demographic characteristics alone (e.g., age) in similar treatment settings 39 , 40 . Other sociodemographic factors, including marital status, religion, residence and employment, were not significantly associated with virologic outcomes. This contrasts with findings elsewhere, where rural residence and unemployment have been linked to poorer outcomes due to barriers in access and continuity of care 41 – 43 . The lack of association may indicate relatively equitable service across rural and urban settings within the area. On the contrary, site-level differences were observed. Participants receiving care in Navrongo consistently showed lower mean viral loads and higher suppression rates compared to those in Bongo and Paga. Although these differences were attenuated, they suggest potential variability in service delivery, patient follow-up, adherence support, or laboratory turnaround times across facilities. Similar inter-facility differences have been reported in other Ghanaian and regional studies and highlight the importance of health system factors in achieving optimal virologic outcomes 44 – 47 . Clinical characteristics, such as the WHO clinical infection stage, showed a complex relationship with viral load and suppression. Paradoxically, participants classified as Stage 3 had lower mean viral loads and higher suppression rates compared with those in their early stages. This finding contrasts with earlier pre-ART era studies where advanced clinical stage predicted poorer outcomes. While counterintuitive, in the ART era, this pattern has been observed elsewhere and may reflect closer clinical monitoring, intensified adherence support, and heightened patient motivation following more advanced disease or prior illness 48 – 51 . In contrast, the high odds of virologic failure observed among Stage 2 participants in crude analysis, although it was not sustained, may reflect small numbers and unstable estimates. There is also the possibility of reverse causality, whereby individuals who achieve viral suppression may have been clinically stable at the time of assessment despite prior history of advanced disease. In addition, the potential of misclassification of WHO clinical stage is acknowledged, which may occur in routine programmatic settings where staging relies on historical records rather than contemporaneous clinical assessment. Opportunistic infections were independently associated with virologic failure. Participants with such infections had nearly fivefold higher adjusted odds of failure, consistent with previous studies showing that active or recurrent infections can impair immune recovery, complicate adherence, and signal underlying treatment failure 52 – 55 . This finding reinforces the importance of early detection and prompt management of opportunistic infections as part of comprehensive HIV care 56 , 57 . Comorbid condition osteoporosis was associated with virologic failure, although the number of affected participants was small. Bone disease in people living with HIV has been linked to chronic inflammation, long-term ART exposure, and advanced disease 58 – 60 . The observed association may therefore reflect cumulative disease burden or prolonged systemic inflammation rather than a direct causal relationship 61 , 62 . Given the wide confidence intervals, this finding should be interpreted cautiously but warrants further investigation in larger cohorts. Other comorbidities, including hepatitis B and C exposure, hypertension, diabetes, cardiovascular disease, and mental health history, were not significantly associated with virologic failure. This contrasts with studies from high-income settings where multimorbidity and mental health disorders often predict poorer adherence and viral suppression 63 . This suggests that the difference within this cohort may reflect underdiagnosis of these conditions, effective integration of HIV care with chronic disease management, or limited statistical power due to the small subgroup sizes. Similar findings have been reported in settings where integrated HIV and chronic disease care models are in place 64 – 67 . Implications In the Ghanaian context, the high level of virologic suppression observed in this study suggests that the national ART program is performing well in achieving viral control among PLHIV, particularly among those retained in care and receiving first-line therapy 68 . However, the observed differences across sites indicate that gains in viral suppression are not evenly distributed, emphasizing the need for district- and facility-level performance reviews, strengthened supervision, and more consistent implementation of national treatment guidelines to ensure uniform quality of care across the country 46 , 69 . The protective effect of basic education highlights the importance of health literacy within Ghana’s HIV response. Tailored counselling approaches that account for low formal education, including the use of local languages, visual tools, and community-based peer support, may be critical for improving adherence and reducing virologic failure, especially in predominantly rural settings 26 , 34 , 70 . The association between opportunistic infection and virologic failure underscores the continued relevance of early diagnosis and integrated management of HIV-related infection within Ghana’s health system. Strengthening routine screening, prophylaxis, and timely treatment of opportunistic infections could improve both clinical outcomes and viral suppression, supporting national efforts towards sustained epidemic control 71 – 73 . Beyond Ghana, these findings are relevant to other low- and middle-income countries with decentralised ART programs and similar demographic profiles. They reinforce the idea that achieving and sustaining a high level of viral suppression depends not only on ART availability but also on health system performance, patient education, and effective management of comorbidities. Addressing facility-level disparities and integrating comprehensive care into HIV services may therefore be key strategies for advancing progress towards global HIV targets in comparable settings. Limitations of the study The study has some limitations that should be considered when interpreting the findings. First, the cross-sectional design limits the ability to infer causal relationships between participant characteristics and virologic outcomes. Temporal relationships between exposures such as opportunistic infections or comorbidities and virologic failure cannot be firmly established. Second, the analysis relied on routinely collected clinical and self-reported data. Variables such as alcohol used, herbal medication use, and mental health history, which were self-reported, may be subject to recall and desirability bias, potentially leading to underreporting. In addition, important factors such as ART adherence, drug stock-outs, and missed clinic appointments were not directly measured, yet these factors are known to influence virologic suppression. Third, viral load data were not available for all enrolled participants, which reduced the sample size for some analyses and may have introduced selection bias if those without viral load differed systematically from those included. Similarly, some subgroups, such as participants with HIV-2 infections, Osteoporosis, cancer, or kidney disease, were small, resulting in wide confidence intervals and reduced statistical power to detect meaningful associations. Fourth, comorbidities were identified based on clinical records and participant history rather than standardised diagnostic assessments in all cases. This may have led to misclassification, particularly for conditions such as mental health disorders and osteoporosis. Finally, the study was conducted in three ART clinics in the Upper East Region of Ghana, which may limit the generalizability of the findings to other regions or settings with different health system structures, patient populations, or levels of resource availability. Despite these limitations, the study provides valuable insights into virologic outcomes and their determinants in a real-world ART program setting. To better understand the pathways to virologic failure and to inform targeted interventions that can sustain long-term viral suppression in similar ART program settings, future longitudinal and multi-site studies that integrate robust adherence measures, detailed health system assessments, and standardised evaluation of comorbidities are recommended. Conclusion Overall, these findings highlight that while virologic suppression rates are encouraging, gaps remain, particularly related to education, opportunistic infections, and site-level differences in care. Strengthening patient education, improving early detection and management of opportunistic infections, and addressing facility-level disparities could further improve virologic outcomes in this setting. Future studies using longitudinal designs and incorporating direct measures of adherence and health system performance would help clarify causal pathways and inform targeted interventions. Abbreviations ART Antiretroviral Therapy CI Confidence interval EDTA Ethylenediaminetetraacetic acid HBV Hepatitis B Virus HCV Hepatitis C virus HIV Human Immunodeficiency Virus NHRC Navrongo Health Research Centre PCR Polymerase chain reaction PLHIV People living with HIV RNA Ribonucleic Acid USA United State of America USAID United Nations program on HIV/AIDS UER Upper East Region VIFs Variance inflation factors WHO World Health Organization Declarations Acknowledgement The authors are grateful to the participants of the study. We are also grateful to the staff of War Memorial Hospital, Bongo District Hospital, and Paga District Hospital ART clinics for their immense support during the participants’ recruitment and sample collection processes. A special gratitude goes to Ms. Ramatu Abdulai, Ms. Linda Dabou, and Ms. Mabel Mallam for assisting in participant recruitment and Mr. Courage Honorfe, Mr. Kingsley Duodu, Ms. Rosemary Ankudze, Mr. Prince Antwi-Boasiako, and Mr. Albert Mensah for assisting in sample collection and laboratory analysis. Author’s Contribution Conceptualized and designed study: SDD, FYD, and JA. Data collection: FYD, SPN, NK, and EA. Performed experiment: FYD, SPN, EA, and DKS. Data analysis: FYD and SDD. Writing draft manuscript: FYD, RSS, and SDD. Review, editing, and approval of final version of manuscript: FYD, SPN, EA, NK, DKS, RSS, TA, GA, JA, and SDD. Competing interests The authors declare that they have no competing interests to report. Funding The study received no funding support from any agency. Availability of data and materials The dataset used and/or analysed in the study is available from corresponding authors upon reasonable request. 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Clinical Infectious Diseases 62, 1595–1603 (2016). Puplampu, P., Asafu-Adjaye, O., Harrison, M., Tetteh, J. & Ganu, V. J. Opportunistic Infections among newly diagnosed HIV patients in the largest tertiary facility in Ghana. Ann Glob Health 90, (2024). Additional Declarations No competing interests reported. Supplementary Files Supplementaryfile1Questionaire.pdf Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Sciences","correspondingAuthor":false,"prefix":"","firstName":"Godfred","middleName":"","lastName":"Agongo","suffix":""},{"id":586746613,"identity":"4451d3db-cca3-4af2-ba61-2d1a785e5479","order_by":8,"name":"James Abugri","email":"","orcid":"","institution":"University of Technology and Applied Sciences","correspondingAuthor":false,"prefix":"","firstName":"James","middleName":"","lastName":"Abugri","suffix":""},{"id":586746614,"identity":"07bf879b-543e-48c8-983f-d900b66ff024","order_by":9,"name":"Sylvester Donne Dassah","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+0lEQVRIiWNgGAWjYFCCBAMwyc/ABhcCiRwgrEWygY2xgSGBFC0GB4jVIt+evPHjjz92ecbHj6U/5v1hZ8/A3rxNguHXHZxaDM48K5bmbUsuNjuTdrCZJyE5sYHnWJkEY98z3FokcgykGRuYE7fdYG8EamFOYJDIMZNg7DmM22Ezcox//vhTn7h5BlhLvT2D/Bv8WhhuAM3kYTucuEGCDeSww4wNEjxmEgw/cGsB+qXMmrfteOKMM2mJM+ekHU9s40krtkhswOOw9uTNN3/8qU7sbz9m8OGNTbU9P/vhjTc+/MHjMAwATgSJbSTogII/pGsZBaNgFIyCYQsAW+JaTVNJs9oAAAAASUVORK5CYII=","orcid":"","institution":"University of Technology and Applied Sciences","correspondingAuthor":true,"prefix":"","firstName":"Sylvester","middleName":"Donne","lastName":"Dassah","suffix":""}],"badges":[],"createdAt":"2026-01-14 15:38:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8603324/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8603324/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102326354,"identity":"1aa587c0-f72c-4d9a-85be-e75629ebebc3","added_by":"auto","created_at":"2026-02-10 14:35:19","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":115931,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eComparison of mean viral load across participant groups\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe figure shows the mean viral load (log10) of PLHIV stratified by sex (\u003cstrong\u003eA\u003c/strong\u003e), study site (\u003cstrong\u003eB\u003c/strong\u003e), HIV type (\u003cstrong\u003eC\u003c/strong\u003e), duration on ART (D) and WHO clinical stage (\u003cstrong\u003eE\u003c/strong\u003e). ART: Antiretroviral therapy; VL: Viral load; SD: Standard deviation. Mean viral loads are presented with standard deviations.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8603324/v1/d29f23c917afa029e43d2b24.png"},{"id":104306522,"identity":"3df109fe-5505-4cec-81c3-9ba401eb415d","added_by":"auto","created_at":"2026-03-10 09:57:14","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2225561,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8603324/v1/f36843c9-6abe-4881-9d77-81004edcdc4d.pdf"},{"id":102398007,"identity":"40de3eda-9999-4ae7-b20a-afc0c4a6a80c","added_by":"auto","created_at":"2026-02-11 10:20:28","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":1591721,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementaryfile1Questionaire.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8603324/v1/820dce52ed7eddd775f8f9f9.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"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","fulltext":[{"header":"Introduction","content":"\u003cp\u003eDespite major advances in antiretroviral therapy, achieving and maintaining virologic suppression remains the cornerstone of HIV care. Virologic suppression prevents disease progression, reduces transmission, and is essential to meeting global targets to end the AIDS pandemic \u003csup\u003e\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. The Joint United Nations Programme on HIV/AIDS (UNAIDS) has set the 95-95-95 targets to ensure that 95% of people living with HIV (PLHIV) know their status, 95% of those diagnosed receive sustained antiretroviral therapy (ART), and 95% of those on treatment achieve durable viral suppression \u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. Progress towards these targets depends critically on localized gains in diagnosis, treatment access and retention, and on addressing the clinical and social drivers of virologic failure.\u003c/p\u003e \u003cp\u003eGhana has made policy and programmatic commitments aligned with these global goals. The Ghana National HIV and AIDS Strategic Plan 2021\u0026ndash;2025 emphasize expanded testing, differentiated service delivery, and improved viral load monitoring as key strategies to increase suppression rates and reduce new infections \u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. ART coverage remains suboptimal (47\u0026ndash;63%), whereas the viral suppression rate among people on ART ranges from 64% to 89% \u003csup\u003e7\u0026ndash;9\u003c/sup\u003e. The national HIV estimates indicate a concentrated epidemic with an adult (15\u0026ndash;59 years) prevalence around 1.5\u0026ndash;1.7% and a national population living with HIV of 330,000 (290,000-400,000), underscoring the need for efficient targeted interventions \u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eAt the individual and programme level, several determinants have been repeatedly associated with virologic failure. Poor adherence to ART remains one of the strongest and most consistent predictors of detectable viral load \u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. Other frequently reported factors include; shorter duration on ART, suboptimal or interrupted drug supply, lower economic status, limited education, and comorbid illnesses \u003csup\u003e\u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e. Studies in Ghana and other sub-Saharan African settings report substantial variations in suppression rates and identify both clinical and structural barriers, such as stigma, poverty, and rural service constraints that undermine durable suppression \u003csup\u003e\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eRegional-level evidence is especially important because Ghana\u0026rsquo;s epidemic is heterogeneous: patterns of HIV testing, stigma, health service access, and social determinants differ by region and between rural and urban communities. The Upper East Region, a predominantly rural area in the northern part of Ghana, faces peculiar challenges, including higher reported levels of discriminatory attitudes towards PLHIV and limited health system resources relative to urban centres \u003csup\u003e\u003cspan additionalcitationids=\"CR20 CR21\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e. These contextual factors may influence both retention in care and virologic outcomes, yet region-specific, up-to-date data on virologic suppression and its drivers remain limited. A recent retrospective study in the Upper East Region reported an estimated virologic failure in nearly one out of every two (47%) PLHIV on ART \u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThis study sought to estimate the prevalence of virologic suppression and virologic failure among PLHIV on ART in the Upper East Region of Ghana and to identify determinants associated with virologic failure. The findings of this study provide locally relevant evidence needed to inform targeted interventions to accelerate progress towards national and global viral suppression targets.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy design and setting\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA health facility-based, cross-sectional study was conducted among PLHIV receiving ART in the Upper East Region (UER) of Ghana. The UER is a predominantly rural region where HIV care is offered at district and regional hospitals, coordinated by the Regional Health Directorate. Routine viral load monitoring and ART services at these facilities follow national and WHO HIV treatment guidelines\u0026nbsp;\u003csup\u003e1,6\u003c/sup\u003e. Three district HIV care and treatment centres, including the Bongo District Hospital (Bongo), Paga District Hospital (Paga) in the Kassena-Nankana West District, and War Memorial Hospital in the Kassena-Nankana Municipality, all in the Upper East Region of Ghana were purposively selected for this study. These facilities are major ART service delivery points, serving a large and diverse catchment population. The Bongo District Hospital provides services to about 200 PLHIV, the Kassena-Nankana West District Hospital serves about 100 PLHIV and the War Memorial Hospital serves over 1,000 PLHIV receiving ART.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy population, recruitment strategy and eligibility criteria\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study population comprised PLHIV receiving ART at Bongo District Hospital, Paga District Hospital, and War Memorial Hospital between June 2024 and August 2024.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePLHIV who came to the clinic for services were approached by the ART nurse and had the study introduced to them. Individuals who were willing to participate in the study were referred to the study team for further engagement, eligibility screening and informed consent. Qualified participants were systematically enrolled. Individuals were eligible for inclusion if they provided informed consent for voluntary participation, including blood draw, and had been on ART treatment for at least one year. PLHIV were excluded due to non-provision of informed consent, not being on ART for a duration\u0026nbsp;\u0026ge;\u0026nbsp;1 year, being severely ill and unable to complete questionnaire administration, or having mental conditions that impaired their ability to provide informed consent or participate in the interview. Pregnant women were also excluded from this study. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSociodemographic information and HIV risk-related behavioural factors were obtained using a structured questionnaire. Additionally, clinical information such as duration on ART, ART regimen, WHO clinical staging, HIV type data, and comorbid information was abstracted from participants\u0026rsquo; records. Three (3) mL of venous blood were collected into an EDTA tube and sent to the laboratory for HIV viral load estimation.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample size and sampling procedure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe minimum sample size required to estimate the prevalence of virologic failure was estimated using the Cochran formula for a single proportion at a 95% confidence interval and a precision of 0.05\u0026nbsp;\u003csup\u003e24\u003c/sup\u003e. A previous survey in Kumasi reported the prevalence of virologic failure as 23.6%\u0026nbsp;\u003csup\u003e13\u003c/sup\u003e. Therefore, an estimated sample size of 278 was obtained. To account for the possibility of non-response or incomplete data during recruitment, the sample was adjusted by 5%, yielding a target sample size of 292 participants.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA multi-stage sampling approach was used. First, three district hospitals were purposively selected, as they were major ART service delivery points in the Upper East Region, serving large and diverse catchment populations. They also had established ART clinics with reliable records to support participant recruitment and data quality. Secondly, at each facility, participants were consecutively approached and enrolled upon informed consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection procedures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSocio-demographic data (i.e., age, sex, marital status, residence (urban/rural), employment status, and educational status) and behavioural-related risk factors (such as alcohol intake, use of herbal medications, smoking, and hard drug usage)\u0026nbsp;\u003csup\u003e25,26\u003c/sup\u003e were obtained with a structured questionnaire (Supplementary file 1) by a trained research assistant in a face-to-face interview with participants. The questionnaires for young participants (i.e., 12\u0026ndash;17 years old) were administered in the same format as for adults, but interviewers were trained to explain items in simple, clear terms when needed. Clinical-related data, such as duration on ART, ART treatment regimen, baseline WHO clinical staging\u0026nbsp;\u003csup\u003e27\u003c/sup\u003e, HIV type diagnosed (HIV-1 or HIV-2), and comorbidities (such as opportunistic infection, hypertension, diabetes, mental health history, kidney disease, cancer, etc.), were abstracted from participants\u0026rsquo; folders. To comply with ethical protocols, no personal identifiers were included during the data abstraction.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLaboratory procedures and definitions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eViral load testing was performed using a cartridge-based real-time PCR platform: a quantitative GeneXpert HIV-1 viral load nucleic acid amplification assay (Cepheid, USA). This assay platform is validated for routine decentralised use in Ghana. In brief, the whole blood collected into the EDTA tube was centrifuged to obtain plasma. Approximately 1 mL of the plasma was transferred into the test cartridge according to the manufacturer\u0026rsquo;s instructions. The loaded cartridge was then placed into the GeneXpert instrument, which automatically performed nucleic acid extraction, reverse transcription, amplification, and quantification using real-time PCR. The results were generated and displayed by the system software in about 90 minutes with no additional hands-on processing. Each batch of tests performed included internal controls.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThese operational definitions guided outcome classification and the identification determinants of virologic failure.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe primary outcome was defined according to WHO guidelines\u0026nbsp;\u003csup\u003e28\u003c/sup\u003e:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e1. Virologic suppression was defined as plasma HIV-1 RNA \u0026lt; 1,000 copies/mL and\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e2. Virologic failure as plasma HIV-1 RNA\u0026nbsp;\u0026ge; 1,000 copies/mL.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eART regimens: 1. First-line therapy \u0026ndash; consisted of dolutegravir-based combination (tenofovir + lamivudine +dolutegravir) 2. Second-line regimens \u0026ndash; were based on a protease inhibitor backbone, most commonly atazanavir/ritonavir or lopinavir/ritonavir, combined with lamivudine.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBased on the presence of specific clinical conditions, WHO clinical staging system classifies HIV cases into four progressive clinical stages, from stage 1 (asymptomatic) through to stage 4 (severe symptoms or AIDS)\u0026nbsp;\u003csup\u003e27\u003c/sup\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData handling and analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data collected in this study were entered in Microsoft Excel and checked for completeness and consistency. Stata version 15 (STATA Corporation, Texas, USA) and GraphPad Prism version 9.0 (San Diego, CA, USA) were used for data analysis. Descriptive statistics were used to describe the prevalence of virologic suppression and virologic non-suppression among the various sociodemographic groups and clinical characteristics. The Pearson chi-square and Wilcoxon rank-sum tests were used to compare the differences between categorical and continuous variables, respectively. Logistic regression analysis, with both unadjusted and adjusted models, was used to assess the association between virologic failure and various sociodemographic, clinical, and behaviour-related characteristics and comorbidities. Regardless of statistical significance in unadjusted analysis, the multivariate logistic regression model included all the variables. This was to ensure that any potential confounding effect of each variable was accounted for as well as all theoretical factors. Multicollinearity was assessed during model development by variance inflation factors (VIFs) for all predictors. VIFs \u0026lt; 5 were acceptable. An alpha value less than 0.05 was considered to be statistically significant.\u003c/p\u003e\n\u003cp\u003eAlthough 336 participants were enrolled and included in the sociodemographic and clinical description, virologic outcome analysis were restricted to 294 participants who had viral load measurement. Forty-two participants were excluded from virologic analysis because viral load results were unavailable, primarily due to inconclusive results.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Consideration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval for the conduct of this study was obtained from the Navrongo Health Research Centre institutional review board (NHRCIRB) (ID: NHRCIRB596). Permission to get access to the facility records was obtained from the Upper East Regional Health Directorate and participating facility management. Informed consent was obtained from participants prior to their enrolment into the study. In addition to parental informed consent, assent was obtained from participants aged 12 to 17 years old. Upon enrolment, data collected from study participants were labelled with unique identification numbers to ensure anonymity throughout the study process. Individuals who were classified under virologic failure were referred to the HIV care and treatment unit within the facility where the study was conducted for counselling, further evaluation and management, in line with routine care procedures. All the study procedures were conducted in conformity with the Declaration of Helsinki.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eSociodemographic, clinical, and comorbidity profile of the study population\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 336 participants were enrolled, with most recruited from Navrongo (57.4%), followed by Bongo (27.4%) and Paga (15.2%) (\u003cstrong\u003eTable 1\u003c/strong\u003e). The mean age was 44.36 (\u0026plusmn;12.09) years (range: 12-100 years), with 48.2% of participants in this category and 32.4% aged 35.44 years. Females predominated (81.6%), and over half of the participants were married (51.2%). Most participants were Christians (80.1%), and participants from rural areas were 73.2%. Over half of the participants had basic education (52.7%), 41.4% had no formal education, and 6.0% had tertiary education. Self-employment was the most common occupation (79.2%).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eLifestyle risk factors were low, with 1.5% smoking tobacco, 30.7% consuming alcohol, 9.8% using herbal medications, and 0.6% reporting use of hard drugs. Most participants had been on ART for more than five years (53.6%) and were on first-line regimens (98.8%). Participants classified as WHO clinical stage 3 were the majority (58.6%), and HIV-1 infection predominated (97.9%). Opportunistic infections were reported in 8.0% of participants. Co-infections included hepatitis B (9.8%) and C (4.2%) positivity. Common comorbidities were hypertension (19.4%), cardiovascular disease (9.5%), diabetes (7.4%), and mental health conditions (11.0%), while other conditions such as kidney disease, osteoporosis and cancer were rare (\u0026lt; 2%).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1: Sociodemographic, clinical, and comorbidity characteristics of the study population\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"464\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable: Sociodemographic/Clinical/Comorbidity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercent\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean age \u0026plusmn; SD (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 179px;\"\u003e\n \u003cp\u003e44.36\u0026nbsp;\u0026plusmn;\u0026nbsp;12.09\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSite\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003eNavrongo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e193\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003e57.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003eBongo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003e27.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003ePaga\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003e15.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge category (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003e\u0026lt;25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003e6.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003e25-34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003e12.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003e35-44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e109\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003e32.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003e\u0026gt;44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e162\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003e48.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003e18.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e274\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003e81.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003eSingle\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003e18.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e172\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003e51.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e101\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003e30.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReligion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003eChristians\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e269\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003e80.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003eIslam\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003e10.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003eTradition\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003e9.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePlace of residence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e246\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003e73.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003e26.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducational Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e139\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003e41.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003eBasic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e177\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003e52.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003eTertiary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003e6.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmployment status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003eUnemployed\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003e14.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003eSelf-employed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e266\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003e79.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003ePublic servant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003e6.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;Smoke tobacco\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003e1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e331\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003e98.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDrink alcohol\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e103\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003e30.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e233\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003e69.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHerbal medication\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003e9.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e303\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003e90.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHard drugs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e334\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003e99.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDuration on ART (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003e1-2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003e19.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003e3-5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003e27.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003e\u0026gt;5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e180\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003e53.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eART regimen\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003e1st line\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e332\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003e98.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003e2nd line\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003e1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWHO clinical stage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003eStage 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e133\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003e39.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003eStage 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003e1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003eStage 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e197\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003e58.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHIV type\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003eHIV-1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e329\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003e97.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003eHIV-2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003e2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOpportunistic infection\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003e8.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e309\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003e92.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHBsAg\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003eReactive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003e9.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003eNon-reactive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e303\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003e90.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHCV antibody\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003eReactive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003e4.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003eNon-reactive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e322\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003e95.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHypertension\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003e19.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e271\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003e80.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiabetes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003e7.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e311\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003e92.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMental health history\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003e11.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e299\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003e89.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eKidney diseases\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003e1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e331\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003e98.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCardiovascular disease\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003e9.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e304\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003e90.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCancer\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e334\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003e99.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOsteoporosis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003e1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e330\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003e98.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 285px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e336\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e100.0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eART: Antiretroviral therapy; HBsAg: Hepatitis B surface antigen; HCV: Hepatitis C virus.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDistribution of mean viral load across participants\u0026rsquo; characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 294 participants with available viral load data were included in this analysis. The mean viral load was 2.28\u0026nbsp;\u0026plusmn; 1.05 standard deviation, range: 1.18\u0026ndash;6.58\u0026nbsp;log copies/mL.\u0026nbsp;Males had a mean viral load of 2.27\u0026nbsp;\u0026plusmn;\u0026nbsp;0.94, while females had 2.28\u0026nbsp;\u0026plusmn; 1.08, and the difference was not significant (p = 0.939) (\u003cstrong\u003eFigure 1A\u003c/strong\u003e). Viral load differed by study site (p \u0026lt; 0.001). Participants from Navrongo had the lowest mean viral load at 1.94 \u0026plusmn; 0.72, compared to 2.62 \u0026plusmn; 1.26 in Bongo and 2.73 \u0026plusmn; 1.07 in Paga. Post-hoc testing showed significant differences between Navrongo and Bongo (p \u0026lt; 0.001) and between Navrongo and Paga (p = 0.002), while Bongo and Paga did not differ (p = 1.000) (\u003cstrong\u003eFigure 1B\u003c/strong\u003e).\u003c/p\u003e\n\u003cp\u003eHIV type showed no significant relationship with mean viral load. Individuals with HIV-1 recorded a mean of 2.28 \u0026plusmn; 1.05 compared to 2.01 \u0026plusmn; 0.69 among those with HIV-2 (p = 0.562) (\u003cstrong\u003eFigure 1C\u003c/strong\u003e). Mean viral load varied by duration on ART, although this did not reach statistical significance (p = 0.072). Participants on treatment for three to five years had a higher mean viral load of 2.55 \u0026plusmn; 1.30 compared with those on therapy for one to two years (2.24 \u0026plusmn; 0.86) or more than five years (2.15 \u0026plusmn; 0.93). Post-hoc comparisons showed no significant differences among the groups (\u003cstrong\u003eFigure 1D\u003c/strong\u003e). There was a significant association between WHO clinical infection stage and viral load (p \u0026lt; 0.001). Mean viral load was highest in individuals at Stage 1 (2.26 \u0026plusmn; 1.22) and Stage 2 (2.58 \u0026plusmn; 0.96) and lowest in Stage 3 (1.93 \u0026plusmn; 0.72). Post-hoc analysis showed a significant difference between Stage 1 and Stage 3 (p \u0026lt; 0.001), while the comparison between Stage 2 and Stage 3 was not significant (\u003cstrong\u003eFigure 1E\u003c/strong\u003e).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eVirologic suppression and failure across sociodemographic, clinical, and comorbidity characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOut of a total of 294 participants with available viral load data included in this analysis, 263 participants (89.5%) achieved virologic suppression, while 31 (10.5%) had virologic failure (\u003cstrong\u003eTable 2\u003c/strong\u003e). Navrongo recorded the highest rate of virologic suppression at 96.5%, followed by Bongo (80.0%) and Paga (78.8%), with a significant difference across sites (p \u0026lt; 0.001).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAge showed a non-significant trend, with virologic suppression ranging from 84.6% to 93.8% across age categories (p = 0.105). A greater proportion of females (90.5%) than males had virologic suppression, though the difference was not statistically significant (p = 0.210). Marital status, religion, place of residence, educational level, and employment status also showed no significant difference with virologic outcomes. Similarly, lifestyle factors such as tobacco use, alcohol consumption, and use of herbal or hard drugs were not significantly different with virologic failure.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eClinical characteristics showed notable variation. Duration on ART did not show a statistically significant difference, although individuals on therapy for more than five years had the highest virologic suppression rate (91.9%). WHO clinical stage was statistically different with virologic outcomes (p \u0026lt; 0.001). Participants in Stage 3 had the highest viral suppression rate (95.9%), while those in Stage 2 had the lowest (60.0%). Virologic outcomes did not differ significantly by ART regimen, HIV type, co-infection with hepatitis B or C, hypertension, diabetes, mental health history, kidney disease, cardiovascular disease, and cancer. Although not statistically significant, participants with opportunistic infections had the highest proportion of virologic failure (21.7%) compared to those without such infections (9.6%, p = 0.069). Osteoporosis was the only comorbidity that showed a significant difference with virologic outcome, with a higher proportion of virologic failures among affected individuals (40.0%, p = 0.031).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2: Prevalence of virologic suppression and failure among sociodemographic, clinical, and comorbidity groups\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"609\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables: Sociodemographic/Clinical/Comorbidity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVirologic suppression \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVirologic failure \u0026nbsp; n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSite\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003eNavrongo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e165 (96.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e6 (3.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003eBongo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e72 (80.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e18 (20.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003ePaga\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e26 (78.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e7 (21.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge category (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003e\u0026lt;25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e13 (86.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e2 (13.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\n \u003cp\u003e0.105\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003e25-34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e33 (84.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e6 (15.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003e35-44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e79 (85.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e14 (15.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003e\u0026ge;45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e138 (93.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e9 (6.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e44 (84.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e8 (15.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\n \u003cp\u003e0.210\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e219 (90.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e23 (9.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003eSingle\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e53 (91.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e5 (8.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\n \u003cp\u003e0.251\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e129 (86.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e20 (13.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e81 (93.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e6 (6.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReligion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003eChristians\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e216 (90.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e23 (9.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\n \u003cp\u003e0.134\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003eIslam\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e25 (92.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e2 (7.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003eTradition\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e22 (78.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e6 (21.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePlace of residence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e193 (87.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e27 (12.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\n \u003cp\u003e0.096\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e70 (94.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e4 (5.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducational Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e115 (86.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e18 (13.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\n \u003cp\u003e0.314\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003eBasic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e135 (91.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e12 (8.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003eTertiary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e13 (92.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e1 (7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmployment status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003eUnemployed\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e34 (82.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e7 (17.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\n \u003cp\u003e0.281\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003eSelf-employed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e211 (90.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e23 (9.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003ePublic servant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e18 (94.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e1 (5.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSmoke tobacco\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e5 (100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e0 (0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e258 (89.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e31 (10.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\n \u003cp\u003e0.439\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDrink alcohol\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e82 (89.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e10 (10.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e181 (89.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e21 (10.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\n \u003cp\u003e0.902\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHerbal medication\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e27 (96.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e1 (3.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e236 (88.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e30 (11.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\n \u003cp\u003e0.207\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHard drugs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e2 (100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e0 (0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\n \u003cp\u003e0.626\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e261 (89.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e31 (10.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDuration on ART (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003e1-2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e33 (86.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e5 (13.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\n \u003cp\u003e0.237\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003e3-5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e70 (85.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e12 (14.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003e\u0026gt;5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e160 (91.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e14 (8.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eART regimen\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003e1st line\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e261 (89.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e31 (10.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\n \u003cp\u003e0.626\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003e2nd line\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e2 (100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWHO clinical stage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003eStage 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e96 (81.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e22 (18.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003eStage 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e3 (60.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e2 (40.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003eStage 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e164 (95.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e7 (4.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHIV type\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003eHIV-1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e258 (89.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e30 (10.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\n \u003cp\u003e0.622\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003eHIV-2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e5 (83.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e1 (16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOpportunistic infection\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e18 (78.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e5 (21.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\n \u003cp\u003e0.069\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e245 (90.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e26 (9.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHBsAg\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003eReactive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e24 (88.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e3 (11.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\n \u003cp\u003e0.920\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003eNon-reactive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e239 (89.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e28 (10.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHCV antibody\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003eReactive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e11 (91.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e1 (8.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\n \u003cp\u003e0.799\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003eNon-reactive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e252 (89.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e30 (10.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHypertension\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e52 (91.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e5 (8.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\n \u003cp\u003e0.628\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e211 (89.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e26 (11.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiabetes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e21 (95.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e1 (4.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\n \u003cp\u003e0.341\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e242 (89.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e30 (11.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMental health history\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e30 (83.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e6 (16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\n \u003cp\u003e0.202\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e233 (90.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e25 (9.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eKidney diseases\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e5 (100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e0 (0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\n \u003cp\u003e0.439\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e258 (89.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e31 (10.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCardiovascular disease\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e25 (96.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e1 (3.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\n \u003cp\u003e0.244\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e238 (88.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e30 (11.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCancer\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e2 (100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\n \u003cp\u003e0.626\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e261 (89.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e31 (10.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOsteoporosis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e3 (60.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e2 (40.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e260 (90.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e29 (10.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\n \u003cp\u003e0.031\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e263 (89.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e31 (10.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 59px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eART: Antiretroviral therapy; HBsAg: Hepatitis B surface antigen; HCV: Hepatitis C virus.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAssociation between participant characteristics and virologic failure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3\u003c/strong\u003e presents the association between sociodemographic and clinical characteristics and virologic failure. In the unadjusted analysis, participants receiving care at Bongo and Paga had significantly higher odds of virologic failure compared with Navrongo. After adjustment, these associations were no longer statistically significant.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEducational status showed a significant association with virologic outcome. Individuals with basic education had lower odds of virologic failure compared to those with no education (aOR = 0.33, 95% CI: 0.12-0.93, p = 0.037), and this was the only factor that remained statistically significant in the adjusted model.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEmployment status, alcohol use, use of herbal medication, HIV type, and duration on ART did not show significant associations with virologic failure. Participants classified as WHO clinical Stage 2 had significantly higher odds of virologic failure in the crude analysis (aOR = 12.09, 95% CI: 1.09-133.94, p = 0.042), but the association was not significant in the adjusted model.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3: Sociodemographic and clinical factors associated with virologic failure\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"653\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 184px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ecOR (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eaOR (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 184px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSite\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 184px;\"\u003e\n \u003cp\u003eNavrongo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 184px;\"\u003e\n \u003cp\u003eBongo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\n \u003cp\u003e6.87 (2.62-18.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\n \u003cp\u003e5.25 (0.31-90.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.253\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 184px;\"\u003e\n \u003cp\u003ePaga\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\n \u003cp\u003e7.40 (2.31-23.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\n \u003cp\u003e6.28 (0.32-123.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.227\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 184px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge category (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 184px;\"\u003e\n \u003cp\u003e\u0026lt;25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 184px;\"\u003e\n \u003cp\u003e25-34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\n \u003cp\u003e1.91 (0.33-11.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\n \u003cp\u003e0.471\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\n \u003cp\u003e1.63 (0.19-14.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.657\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 184px;\"\u003e\n \u003cp\u003e35-44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\n \u003cp\u003e2.01 (0.39-10.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\n \u003cp\u003e0.404\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\n \u003cp\u003e1.31 (0.14-12.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.812\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 184px;\"\u003e\n \u003cp\u003e\u0026ge;45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\n \u003cp\u003e0.91 (0.17-4.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\n \u003cp\u003e0.911\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\n \u003cp\u003e0.33 (0.03-3.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.352\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 184px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 184px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 184px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\n \u003cp\u003e1.45 (0.59-3.58)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\n \u003cp\u003e0.422\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\n \u003cp\u003e1.78 (0.59-5.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.304\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 184px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 184px;\"\u003e\n \u003cp\u003eSingle\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 184px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\n \u003cp\u003e1.82 (0.63-5.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\n \u003cp\u003e0.270\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\n \u003cp\u003e2.99 (0.73-12.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.126\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 184px;\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\n \u003cp\u003e2.25 (0.56-9.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\n \u003cp\u003e0.256\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\n \u003cp\u003e4.20 (0.77-23.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.098\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 184px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReligion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 184px;\"\u003e\n \u003cp\u003eChristians\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 184px;\"\u003e\n \u003cp\u003eIslam\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\n \u003cp\u003e0.85 (0.17-4.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\n \u003cp\u003e0.842\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\n \u003cp\u003e0.64 (0.11-3.61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.625\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 184px;\"\u003e\n \u003cp\u003eTradition\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\n \u003cp\u003e1.98 (0.67-5.82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\n \u003cp\u003e0.216\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\n \u003cp\u003e1.93 (0.54-6.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.314\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 184px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePlace of residence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 184px;\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 184px;\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\n \u003cp\u003e0.90 (0.27-2.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\n \u003cp\u003e0.861\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\n \u003cp\u003e1.34 (0.34-5.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.673\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 184px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducational Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 184px;\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 184px;\"\u003e\n \u003cp\u003eBasic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\n \u003cp\u003e0.62 (0.27-1.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\n \u003cp\u003e0.241\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\n \u003cp\u003e0.33 (0.12-0.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.037\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 184px;\"\u003e\n \u003cp\u003eTertiary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\n \u003cp\u003e0.62 (0.07-5.69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\n \u003cp\u003e0.675\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\n \u003cp\u003e0.48 (0.02-13.48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.666\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 184px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmployment status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 184px;\"\u003e\n \u003cp\u003eUnemployed\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 184px;\"\u003e\n \u003cp\u003eSelf-employed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\n \u003cp\u003e0.64 (0.24-1.69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\n \u003cp\u003e0.370\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\n \u003cp\u003e0.50 (0.15-1.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.260\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 184px;\"\u003e\n \u003cp\u003ePublic servant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\n \u003cp\u003e0.47 (0.05-4.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\n \u003cp\u003e0.515\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\n \u003cp\u003e0.30 (0.01-9.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.496\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 184px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDrink alcohol\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 184px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 184px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\n \u003cp\u003e1.68 (0.70-4.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\n \u003cp\u003e0.250\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\n \u003cp\u003e2.34 (0.85-6.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.098\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 184px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHerbal medication\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 184px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 184px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\n \u003cp\u003e0.54 (0.07-4.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\n \u003cp\u003e0.568\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\n \u003cp\u003e0.33 (0.03-3.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.363\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 340px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDuration on ART (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 184px;\"\u003e\n \u003cp\u003e1-2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 184px;\"\u003e\n \u003cp\u003e3-5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\n \u003cp\u003e1.26 (0.39-4.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\n \u003cp\u003e0.695\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\n \u003cp\u003e1.44 (0.37-5.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.599\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 184px;\"\u003e\n \u003cp\u003e\u0026gt;5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\n \u003cp\u003e0.80 (0.26-2.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\n \u003cp\u003e0.703\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\n \u003cp\u003e0.90 (0.24-3.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.871\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 184px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWHO clinical stage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 184px;\"\u003e\n \u003cp\u003eStage 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 184px;\"\u003e\n \u003cp\u003eStage 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\n \u003cp\u003e12.09 (1.09-133.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\n \u003cp\u003e0.042\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\n \u003cp\u003e16.08 (0.61-424.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.096\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 184px;\"\u003e\n \u003cp\u003eStage 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\n \u003cp\u003e1. 89 (0.32-11.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\n \u003cp\u003e0.485\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\n \u003cp\u003e3.01 (0.32-28.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.334\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 184px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHIV type\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 184px;\"\u003e\n \u003cp\u003eHIV-1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 184px;\"\u003e\n \u003cp\u003eHIV-2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\n \u003cp\u003e2.18 (0.21-22.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 71px;\"\u003e\n \u003cp\u003e0.515\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 155px;\"\u003e\n \u003cp\u003e3.92 (0.27-56.41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.315\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eART: Antiretroviral therapy; aOR: adjusted odds ratio; cOR: Crude odds ratio; 95% CI: 95% confidence interval\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eComorbidities associated with virologic failure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4\u003c/strong\u003e shows the relationship between selected comorbidities and virologic failure among participants. After adjusting for confounders, only opportunistic infections and osteoporosis showed significant associations with virologic failure.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eParticipants with a history of opportunistic infections had higher odds of virologic failure compared with those without such infections (aOR = 4.71, 95% CI: 1.24-17.88, p = 0.023). Osteoporosis was also strongly associated with virologic failure, with affected individuals showing higher adjusted odds compared with those without the conditions (aOR = 14.05, 95% CI: 1.27-155.69, p = 0.031).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOther comorbidities, including hepatitis B and C exposure, hypertension, diabetes, mental health history, and cardiovascular disease, did not show significant associations with virologic failure in either crude or adjusted models.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4: Association between comorbidities and virologic failure\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"742\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 243px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ecOR (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eaOR (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 127px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 243px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOpportunistic infection\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 127px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 243px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 127px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 243px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\n \u003cp\u003e3. 99 (1.21-13.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\n \u003cp\u003e4.71 (1.24-17.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 127px;\"\u003e\n \u003cp\u003e0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 243px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHBsAg\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 127px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 243px;\"\u003e\n \u003cp\u003eNon-reactive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 127px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 243px;\"\u003e\n \u003cp\u003eReactive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\n \u003cp\u003e1.43 (0.37-5.42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.603\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\n \u003cp\u003e1.46 (0.35-6.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 127px;\"\u003e\n \u003cp\u003e0.601\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 243px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHCV antibody\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 127px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 243px;\"\u003e\n \u003cp\u003eNon-reactive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 127px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 243px;\"\u003e\n \u003cp\u003eReactive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\n \u003cp\u003e0.90 (0.10-7.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.921\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\n \u003cp\u003e1.23 (0.14-11.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 127px;\"\u003e\n \u003cp\u003e0.855\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 243px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHypertension\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 127px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 243px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\n \u003cp\u003e0.95 (0.33-2.72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.928\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\n \u003cp\u003e0.78 (0.25-2.46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 127px;\"\u003e\n \u003cp\u003e0.962\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 243px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 127px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 243px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiabetes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 127px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 243px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\n \u003cp\u003e0.50 (0.06-4.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.517\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\n \u003cp\u003e0.41 (0.05-3.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 127px;\"\u003e\n \u003cp\u003e0.417\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 243px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 127px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 243px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMental health history\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 127px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 243px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\n \u003cp\u003e1.69 (0.61-4.72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.315\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\n \u003cp\u003e2.07 (0.69-6.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 127px;\"\u003e\n \u003cp\u003e0.194\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 243px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 127px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 243px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCardiovascular disease\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 127px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 243px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 127px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 243px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\n \u003cp\u003e0.77 (0.09-6.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\n \u003cp\u003e0.77 (0.08-6.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 127px;\"\u003e\n \u003cp\u003e0.814\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 243px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOsteoporosis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 127px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 243px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 127px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 243px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\n \u003cp\u003e14.86 (1.84-119.82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\n \u003cp\u003e14.05 (1.27-155.96)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 127px;\"\u003e\n \u003cp\u003e0.031\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eHBsAg: Hepatitis B surface antigen; HCV: Hepatitis C virus; aOR: adjusted odds ratio; cOR: Crude odds ratio; 95% CI: 95% confidence interval\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe study assessed virologic outcomes and their associated factors among people living with HIV receiving ART in three sites in the Upper East Region of Ghana. Overall, virologic suppression was high, with nearly nine out of ten participants achieving a viral load below 1,000 copies/mL. This finding aligns with reports from similar ART programmes in sub-Saharan Africa, where expanded access to treatment and improved, programmatic monitoring have led to substantial gains in viral suppression rate \u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e,\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e. However, the virologic outcomes observed in this study in comparison with other Ghanaian settings appear relatively high but still fall short of the national and the UNAIDS 95-95-95 targets. In a study conducted in the Kumasi metropolis, 76.4% of adults on ART achieved viral suppression, with a 23.6% virologic failure rate, which is lower suppression and higher failure rates than in this cohort \u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. Similarly, research from the Asante Mampong Municipal Hospital in the Ashanti Region reported viral suppression rates under 80%, again below the UNAIDS targets \u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. From the Upper East Region itself, a previous retrospective study reported 53% and 47% viral suppression and virologic failure, respectively, among PLHIV on ART \u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e. National estimates also suggest that viral suppression across Ghana has been below optimal, with reports indicating suppression in only about 64% to 89% of patients on ART. These findings show that although the suppression rate in the present study exceeds some regional estimates, virologic failure remains an important challenge and highlights the need for continued efforts to improve adherence and treatment outcomes within the national HIV programme. The relatively high virologic suppression observed in this study could be explained by several programmatic and patient-level factors. Access to ART, including the widespread use of potent first-line regimens, likely contributed to effective control. Also, routine viral load monitoring and timely clinical follow-up may have enabled early identification and management of adherence challenges, thereby preventing prolonged viraemia. In addition, a relatively stable cohort of patients engaged in care, with fewer treatment interruptions, could favour better outcomes.\u003c/p\u003e \u003cp\u003eSociodemographic determinants, such as educational status, were drivers of virologic outcomes. Participants with basic education had significantly lower odds of virologic failure compared with those with no formal education. Education may enhance health literacy, understanding of ART regimens, and adherence to long-term treatment, all of which are critical for viral suppression. This finding is consistent with evidence linking higher educational attainment to improved ART adherence and treatment outcomes across diverse settings \u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e,\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e,\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e. Interestingly, tertiary education did not show a similar protective effect, likely due to the small number of participants in this category. Some studies have also reported a non-linear relationship between education and adherence, suggesting that basic literacy may be sufficient to support treatment success in resource-limited settings \u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e,\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e,\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e. It underscores the need for tailored adherence counselling and simplified messaging for individuals with limited formal education.\u003c/p\u003e \u003cp\u003eAlthough females were predominant in the study population and demonstrated a higher proportion of viral suppression than males (90.5% vs. 84.6%), the difference was not statistically significant. This contrasts with previous studies where male sex had been associated with poorer virologic outcomes, often linked to delayed care seeking and poorer adherence \u003csup\u003e\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e. Nonetheless, sex differences in virologic response are often inconsistent, with some reporting no significant difference in viral suppression between men and women \u003csup\u003e\u003cspan additionalcitationids=\"CR37\" citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e–\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u003c/sup\u003e, consistent with our findings. The absence of a sex difference in this study may partly reflect the predominance of women in this cohort, improved engagement in care within these facilities or effective adherence counselling that minimises sex disparities.\u003c/p\u003e \u003cp\u003eAge was also not associated with virologic outcomes, consistent with findings from other ART programme evaluations. This suggests that clinical and structural factors, such as adherence support and service delivery quality, may have greater influence on suppression than demographic characteristics alone (e.g., age) in similar treatment settings \u003csup\u003e\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e,\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u003c/sup\u003e. Other sociodemographic factors, including marital status, religion, residence and employment, were not significantly associated with virologic outcomes. This contrasts with findings elsewhere, where rural residence and unemployment have been linked to poorer outcomes due to barriers in access and continuity of care \u003csup\u003e\u003cspan additionalcitationids=\"CR42\" citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e–\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u003c/sup\u003e. The lack of association may indicate relatively equitable service across rural and urban settings within the area. On the contrary, site-level differences were observed. Participants receiving care in Navrongo consistently showed lower mean viral loads and higher suppression rates compared to those in Bongo and Paga. Although these differences were attenuated, they suggest potential variability in service delivery, patient follow-up, adherence support, or laboratory turnaround times across facilities. Similar inter-facility differences have been reported in other Ghanaian and regional studies and highlight the importance of health system factors in achieving optimal virologic outcomes \u003csup\u003e\u003cspan additionalcitationids=\"CR45 CR46\" citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e–\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eClinical characteristics, such as the WHO clinical infection stage, showed a complex relationship with viral load and suppression. Paradoxically, participants classified as Stage 3 had lower mean viral loads and higher suppression rates compared with those in their early stages. This finding contrasts with earlier pre-ART era studies where advanced clinical stage predicted poorer outcomes. While counterintuitive, in the ART era, this pattern has been observed elsewhere and may reflect closer clinical monitoring, intensified adherence support, and heightened patient motivation following more advanced disease or prior illness \u003csup\u003e\u003cspan additionalcitationids=\"CR49 CR50\" citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e–\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e\u003c/sup\u003e. In contrast, the high odds of virologic failure observed among Stage 2 participants in crude analysis, although it was not sustained, may reflect small numbers and unstable estimates. There is also the possibility of reverse causality, whereby individuals who achieve viral suppression may have been clinically stable at the time of assessment despite prior history of advanced disease. In addition, the potential of misclassification of WHO clinical stage is acknowledged, which may occur in routine programmatic settings where staging relies on historical records rather than contemporaneous clinical assessment.\u003c/p\u003e \u003cp\u003eOpportunistic infections were independently associated with virologic failure. Participants with such infections had nearly fivefold higher adjusted odds of failure, consistent with previous studies showing that active or recurrent infections can impair immune recovery, complicate adherence, and signal underlying treatment failure \u003csup\u003e\u003cspan additionalcitationids=\"CR53 CR54\" citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e–\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e\u003c/sup\u003e. This finding reinforces the importance of early detection and prompt management of opportunistic infections as part of comprehensive HIV care \u003csup\u003e\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e,\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eComorbid condition osteoporosis was associated with virologic failure, although the number of affected participants was small. Bone disease in people living with HIV has been linked to chronic inflammation, long-term ART exposure, and advanced disease \u003csup\u003e\u003cspan additionalcitationids=\"CR59\" citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e–\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e\u003c/sup\u003e. The observed association may therefore reflect cumulative disease burden or prolonged systemic inflammation rather than a direct causal relationship \u003csup\u003e\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e,\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e\u003c/sup\u003e. Given the wide confidence intervals, this finding should be interpreted cautiously but warrants further investigation in larger cohorts. Other comorbidities, including hepatitis B and C exposure, hypertension, diabetes, cardiovascular disease, and mental health history, were not significantly associated with virologic failure. This contrasts with studies from high-income settings where multimorbidity and mental health disorders often predict poorer adherence and viral suppression \u003csup\u003e\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e\u003c/sup\u003e. This suggests that the difference within this cohort may reflect underdiagnosis of these conditions, effective integration of HIV care with chronic disease management, or limited statistical power due to the small subgroup sizes. Similar findings have been reported in settings where integrated HIV and chronic disease care models are in place \u003csup\u003e\u003cspan additionalcitationids=\"CR65 CR66\" citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e–\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eImplications\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eIn the Ghanaian context, the high level of virologic suppression observed in this study suggests that the national ART program is performing well in achieving viral control among PLHIV, particularly among those retained in care and receiving first-line therapy \u003csup\u003e\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e\u003c/sup\u003e. However, the observed differences across sites indicate that gains in viral suppression are not evenly distributed, emphasizing the need for district- and facility-level performance reviews, strengthened supervision, and more consistent implementation of national treatment guidelines to ensure uniform quality of care across the country \u003csup\u003e\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e,\u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e\u003c/sup\u003e. The protective effect of basic education highlights the importance of health literacy within Ghana’s HIV response. Tailored counselling approaches that account for low formal education, including the use of local languages, visual tools, and community-based peer support, may be critical for improving adherence and reducing virologic failure, especially in predominantly rural settings \u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e,\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e,\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e\u003c/sup\u003e. The association between opportunistic infection and virologic failure underscores the continued relevance of early diagnosis and integrated management of HIV-related infection within Ghana’s health system. Strengthening routine screening, prophylaxis, and timely treatment of opportunistic infections could improve both clinical outcomes and viral suppression, supporting national efforts towards sustained epidemic control \u003csup\u003e\u003cspan additionalcitationids=\"CR72\" citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e–\u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003e\u003c/p\u003e \u003cp\u003eBeyond Ghana, these findings are relevant to other low- and middle-income countries with decentralised ART programs and similar demographic profiles. They reinforce the idea that achieving and sustaining a high level of viral suppression depends not only on ART availability but also on health system performance, patient education, and effective management of comorbidities. Addressing facility-level disparities and integrating comprehensive care into HIV services may therefore be key strategies for advancing progress towards global HIV targets in comparable settings.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eLimitations of the study\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eThe study has some limitations that should be considered when interpreting the findings. First, the cross-sectional design limits the ability to infer causal relationships between participant characteristics and virologic outcomes. Temporal relationships between exposures such as opportunistic infections or comorbidities and virologic failure cannot be firmly established. Second, the analysis relied on routinely collected clinical and self-reported data. Variables such as alcohol used, herbal medication use, and mental health history, which were self-reported, may be subject to recall and desirability bias, potentially leading to underreporting. In addition, important factors such as ART adherence, drug stock-outs, and missed clinic appointments were not directly measured, yet these factors are known to influence virologic suppression. Third, viral load data were not available for all enrolled participants, which reduced the sample size for some analyses and may have introduced selection bias if those without viral load differed systematically from those included. Similarly, some subgroups, such as participants with HIV-2 infections, Osteoporosis, cancer, or kidney disease, were small, resulting in wide confidence intervals and reduced statistical power to detect meaningful associations. Fourth, comorbidities were identified based on clinical records and participant history rather than standardised diagnostic assessments in all cases. This may have led to misclassification, particularly for conditions such as mental health disorders and osteoporosis. Finally, the study was conducted in three ART clinics in the Upper East Region of Ghana, which may limit the generalizability of the findings to other regions or settings with different health system structures, patient populations, or levels of resource availability. Despite these limitations, the study provides valuable insights into virologic outcomes and their determinants in a real-world ART program setting.\u003c/p\u003e \u003cp\u003e\u003c/p\u003e \u003cp\u003eTo better understand the pathways to virologic failure and to inform targeted interventions that can sustain long-term viral suppression in similar ART program settings, future longitudinal and multi-site studies that integrate robust adherence measures, detailed health system assessments, and standardised evaluation of comorbidities are recommended.\u003c/p\u003e \u003cp\u003e\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eOverall, these findings highlight that while virologic suppression rates are encouraging, gaps remain, particularly related to education, opportunistic infections, and site-level differences in care. Strengthening patient education, improving early detection and management of opportunistic infections, and addressing facility-level disparities could further improve virologic outcomes in this setting. Future studies using longitudinal designs and incorporating direct measures of adherence and health system performance would help clarify causal pathways and inform targeted interventions.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eART Antiretroviral Therapy\u003c/p\u003e\n\u003cp\u003eCI Confidence interval \u003c/p\u003e\n\u003cp\u003eEDTA Ethylenediaminetetraacetic acid\u003c/p\u003e\n\u003cp\u003eHBV Hepatitis B Virus\u003c/p\u003e\n\u003cp\u003eHCV Hepatitis C virus\u003c/p\u003e\n\u003cp\u003eHIV Human Immunodeficiency Virus\u003c/p\u003e\n\u003cp\u003eNHRC Navrongo Health Research Centre \u003c/p\u003e\n\u003cp\u003ePCR Polymerase chain reaction\u003c/p\u003e\n\u003cp\u003ePLHIV People living with HIV\u003c/p\u003e\n\u003cp\u003eRNA Ribonucleic Acid\u003c/p\u003e\n\u003cp\u003eUSA United State of America \u003c/p\u003e\n\u003cp\u003eUSAID United Nations program on HIV/AIDS\u003c/p\u003e\n\u003cp\u003eUER Upper East Region \u003c/p\u003e\n\u003cp\u003eVIFs Variance inflation factors\u003c/p\u003e\n\u003cp\u003eWHO World Health Organization\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors are grateful to the participants of the study. We are also grateful to the staff of War Memorial Hospital, Bongo District Hospital, and Paga District Hospital ART clinics for their immense support during the participants\u0026rsquo; recruitment and sample collection processes. A special gratitude goes to Ms. Ramatu Abdulai, Ms. Linda Dabou, and Ms. Mabel Mallam for assisting in participant recruitment and Mr. Courage Honorfe, Mr. Kingsley Duodu, Ms. Rosemary Ankudze, Mr. Prince Antwi-Boasiako, and Mr. Albert Mensah for assisting in sample collection and laboratory analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u0026rsquo;s Contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualized and designed study: SDD, FYD, and JA. Data collection: FYD, SPN, NK, and EA. Performed experiment: FYD, SPN, EA, and DKS. Data analysis: FYD and SDD. Writing draft manuscript: FYD, RSS, and SDD. Review, editing, and approval of final version of manuscript: FYD, SPN, EA, NK, DKS, RSS, TA, GA, JA, and SDD.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests to report.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study received no funding support from any agency.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe dataset used and/or analysed in the study is available from corresponding authors upon reasonable request.\u0026nbsp;\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWorld Health Organization (WHO). 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Opportunistic Infections among newly diagnosed HIV patients in the largest tertiary facility in Ghana. \u003cem\u003eAnn Glob Health\u003c/em\u003e 90, (2024).\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"HIV/AIDS, virologic suppression, virologic failure, Antiretroviral therapy, comorbidities","lastPublishedDoi":"10.21203/rs.3.rs-8603324/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8603324/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eAchieving 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.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA 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\u0026thinsp;\u0026lt;\u0026thinsp;1,000 copies/mL. Associations between participant characteristics and virologic outcomes were evaluated using logistic regression analyses.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe mean age of participants was 44.36\u0026thinsp;\u0026plusmn;\u0026thinsp;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\u0026thinsp;\u0026plusmn;\u0026thinsp;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\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and WHO clinical stages (Stage 3: 95.9%; Stage 1: 81.4%; p\u0026thinsp;\u0026lt;\u0026thinsp;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\u0026thinsp;=\u0026thinsp;0.33, 95% CI: 0.12\u0026ndash;0.93, p\u0026thinsp;=\u0026thinsp;0.037). Comorbid conditions, such as a history of opportunistic infections (aOR\u0026thinsp;=\u0026thinsp;4.71, 95% CI: 1.24\u0026ndash;17.88, p\u0026thinsp;=\u0026thinsp;0.023) and osteoporosis (aOR\u0026thinsp;=\u0026thinsp;14.05, 95% CI: 1.27-155.69, p\u0026thinsp;=\u0026thinsp;0.031), were associated with increased odds of virologic failure.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eVirologic 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.\u003c/p\u003e","manuscriptTitle":"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","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-10 14:35:14","doi":"10.21203/rs.3.rs-8603324/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e405668e-dc99-4c1f-9c06-0b134af37721","owner":[],"postedDate":"February 10th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-10T09:56:01+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-10 14:35:14","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8603324","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8603324","identity":"rs-8603324","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}