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All relevant data are within the paper and its Supporting Information files. A total of 84 study participants with a median age of 22 years were enrolled. HIV-1 genotyping was performed and investigated for drug resistance in 67 individuals. Four of 67 individuals 6. Strains of the C-EA clade were most prevalent as we found no evidence of temporal changes during this time period.

However, strains of the C-SA clade, prevalent in Southern Africa, have been introduced in Ethiopia, and became more abundant during the study period. Moreover, some of the larger clusters dated back to the s but transmissions within clusters have been ongoing up till end of the study period. One cluster was associated with the GA mutation and showed onward transmissions at high rate. TDR was detected in 6. Moreover, the findings indicated an increased diversity in the epidemic as well as differences in transmission clusters sizes of the different clades and association with resistance mutations.

These findings provide epidemiological insights not directly available using standard surveillance and may inform the adjustment of public health strategies in HIV prevention in Ethiopia. In most low and middle income countries LMIC standardized first line antiretroviral regimens are used, consisting of two nucleoside reverse transcriptase inhibitor NRTI and one non-nucleoside reverse transcriptase inhibitor NNRTI ] [ 1 — 3 ]. One explanation for this is likely to be the lack of routine monitoring of plasma viral load, which has not been scaled up at the same rate as ART service expansion ART roll-out [ 2 — 9 ].

This leads to delayed identification of patients with treatment failure, with risk of accumulation of drug resistance mutations DRM in such individuals.

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