Furthermore, the previous studies were done at the referral hospitals with diverse health workers to manage cases. However, some critical factors such as HIV status disclosure, level of Hgb, history of ART interruption, CD4 cell counts, and caregiverвЂ™s HIV status, which contribute to VF occurrence, were not included. In Ethiopia, few studies have been conducted on TF by considering previous guidelines. Ending the AIDS epidemic by 2030 is the aim of this strategic plan in line with the three 90вЂ™s targets. Ethiopia has adopted the UNAIDS 90вЂ“90-90 HIV treatment target and has developed HIV/AIDS prevention and strategic treatment plan, which has been implemented since 2015. Likewise, the Ethiopian government launched different strategies, programs, and policies that provide aspiring and far-reaching goals on prevention, treatment, health coverage, and access to affordable medicine for HIV/AIDS patients like Sustainable Development Goals (SDGs). Adherence counseling, early detection of TF, and appropriate switching to second-line therapy are key strengths of a viral load monitoring. In 2014, the Joint United Nations Program on HIV/AIDS (UNAIDS) and partners launched the three 90вЂ“90вЂ“90 targets, having 90% of patients on ART with VLS is the third вЂњ90вЂќ targets. The World Health Organization (WHO) recommends routine annual viral load monitoring for all patients on ART, as the most accurate and preferred method to measure treatment response. Treatment failure can be assessed in three ways: clinically, immunologically, and virologically, which offers early and accurate indication of treatment failure. Thus, monitoring people on ART is important to ensure treatment success, identify adherence problems, and determine whether ART regimens should be switched in case of treatment failure (TF). The goal of antiretroviral therapy (ART) is to suppress viral replication and reduce HIV associated mortality among infected children. Beside that 20,130 were newly infected and 7684 were died with HIV related illness. Based on Ethiopian public health institution HIV related estimates and projections about 704,454 populations were living with HIV in 2020. Sub-Saharan Africa (SSA) suffers from the global burden of HIV- infection, with nearly 70% of the worldвЂ™s HIV/AIDS-infections and deaths occurs in this region. Approximately 1.8 million children (ageвЂ‰<вЂ‰15вЂ‰years) were living with HIV globally in 2018. Globally, human immunodeficiency virus (HIV) is a major public health problem and associated with a range of short-and long-term consequences. Thus, special attention should be given to children who had poor/fair ART adherence and presenting with opportunistic infections. Children with poor/fair ART adherence, history of treatment interruption, advanced baseline WHO clinical staging, younger age, and opportunistic infections were significantly associated with virologic failure. The magnitude of virological failure among HIV-infected children remained high.

Opportunistic infections (AORвЂ‰=вЂ‰2.19, CI: 1.13вЂ“4.25), history of treatment interruption and restart (AORвЂ‰=вЂ‰2.21, CI: 1.09вЂ“4.54), younger age (AORвЂ‰=вЂ‰2.42, CI: 1.02вЂ“5.74), poor/fair ART adherence (AORвЂ‰=вЂ‰2.19, CI: 1.05вЂ“4.57), and advanced baseline WHO clinical staging (AORвЂ‰=вЂ‰2.32, CI: 1.14вЂ“4.74) were found to be factors significantly associated with virological failure. The period prevalence of virological failure was found to be 14.8% (95% CI: 11.5вЂ“19.3%). Finally, variables with p-values <0.05 were considered as statistically significant factors.

Variables with p-values <вЂ‰0.25 were fitted into the multivariable analysis. Bivariable and multivariable binary logistic regression models were done to identify factors associated with virological failure.

Data were entered using Epi-Data Version 3.1, and analyzed using SPSS Version 25. Data were extracted from childrenвЂ™s charts using a standardized data extraction tool, adapted from ART intake and follow-up forms. MethodsДЄ facility-based cross-sectional study was conducted among 399 HIV-positive children on antiretroviral therapy from 2016 to 2019 in Bahir Dar Town public health facilities.

Thus, this study aims to assess the magnitude and associated factors of virological failure among children on antiretroviral therapy. Viral load monitoring is an important approach to identify treatment failure and develop public health interventions in children receiving antiretroviral therapy. Despite the rapid scale-up of antiretroviral therapy, virologic failure has become global public health concern and challenge, especially in developing countries.

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