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Shimbre MS, Tunja A, Bodicha BB, Belete AG, Hailgebereal S, Fornah L, Ma W. Spatial mapping and predictors of ever-tested for HIV in adolescent girls and young women in Ethiopia. Front Public Health 2024; 12:1337354. [PMID: 38633231 PMCID: PMC11021716 DOI: 10.3389/fpubh.2024.1337354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 02/29/2024] [Indexed: 04/19/2024] Open
Abstract
Background Adolescent girls and young women (AGYW) are expected to be healthy in life. However, the unique health challenges faced by AGYW include unsafe sex practices and substance abuse. Only 46.3% of AGYW in Africa are aware of their HIV status, and difficulties are underlined in HIV testing among adolescents and young people. To demarcate the areas with low and high HIV testing, this study aimed to map predictors of ever-tested for HIV among adolescent girls and young women in Ethiopia. Methods Secondary data analysis was conducted using the dataset from the 2016 Ethiopia Demographic and Health Survey (EHDS). We conducted spatial autocorrelation and Moran's I statistics to investigate the regional variance of HIV being ever-tested in AGYW. In addition, spatial regression analyses such as ordinary least squares (OLS) regression and geographically weighted regression (GWR) were carried out to determine the predictors of being ever-tested for HIV among AGYW. Results Addis Ababa, some parts of Amhara, Dire Dawa, Gambela, and Tigray were the primary regions and city administrations for being ever-tested for HIV among AGYW. A lesser proportion of AGYW being ever-tested for HIV was found in Somalia, Afar, Benshangul Gumuz, and southern nations. Spatial regression analyses identified an age range of 15-19 years, being Muslim, having no formal education, having no knowledge about HIV, and experiencing severe stigma as predictors of being ever-tested for HIV among AGYW. Conclusion The proportion of AGYW being ever-tested for HIV was high in Addis Ababa, some parts of Amhara, Dire Dawa, Gambela, and Tigray. Spatial regression analyses identified that AGYW aged 15-19 years, having no formal education, having no knowledge about HIV, and experiencing severe community stigma as predictors negatively affecting the proportion of being ever-tested for HIV, while being Muslim was a predictor that positively affected the proportion of being ever-tested for HIV. The governments and other stakeholders should focus on increasing HIV testing among these special groups of the population.
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Affiliation(s)
- Mulugeta Shegaze Shimbre
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Schools of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Abayneh Tunja
- Schools of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Belay Boda Bodicha
- Department of Biomedical Sciences, School of Medicine, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Abebe Gedefaw Belete
- Schools of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Samuel Hailgebereal
- School of Public Health, College of Medicine and Health Sciences, Wachamo University, Hosaena, Ethiopia
| | - Lovel Fornah
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Wei Ma
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
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Kgotlaetsile K, Bogart LM, Phaladze N, Klein DJ, Mosepele M. Feasibility and Acceptability of Human Immunodeficiency Virus Self-Testing for Men of Middle-to-Upper Socioeconomic Status in Botswana: A Pilot Study at 4 Worksites in the Financial Sector. Open Forum Infect Dis 2024; 11:ofad661. [PMID: 38264095 PMCID: PMC10805380 DOI: 10.1093/ofid/ofad661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 12/18/2023] [Indexed: 01/25/2024] Open
Abstract
Background Although Botswana has made great progress in expanding human immunodeficiency virus (HIV) testing, men are less likely to be tested for HIV and test at a later stage compared with women. For Botswana to increase HIV testing coverage among men, HIV self-testing (HIVST) may be a promising supplement to standard, healthcare facility-based HIV testing. We conducted a pilot test of the feasibility and acceptability of HIVST for men of middle-to-upper socioeconomic status in Botswana. Methods Thirty-five men were recruited through 4 workplaces (banking sector). Wellness officers emailed all potentially eligible male employees about the opportunity to participate. Men were surveyed at baseline and follow-up on basic sociodemographic characteristics, HIV testing history, HIV stigma, use of the HIVST kit (at follow-up), and confirmatory testing and linkage to care if a preliminary positive result is obtained (at follow-up). Results All 35 men used the kit. The proportion who agreed with the statement that getting tested for HIV helps people feel better increased significantly from 80.7% at baseline to 100% at follow-up. In open-ended questions, men described the advantages of HIVST, including improved privacy and convenience, lowered HIV stigma, and enhanced control over testing. Concerns about HIVST included potential negative mental health consequences owing to not receiving pretest and posttest counseling, and not linking to care after a reactive result. Conclusions Results suggest that an intervention in which HIVST is discrete, private, and under men's control can help overcome stigma around HIV testing, resulting in a greater number of men tested.
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Affiliation(s)
- Keonayang Kgotlaetsile
- University of Botswana, Faculty of Medicine, & Boitekanelo College, Counselling Department, Gaborone, Botswana
| | - Laura M Bogart
- RAND Corporation, Santa Monica, California, USA
- Department of Psychiatry, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
| | | | - David J Klein
- Faculty of Medicine, University of Botswana and Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Mosepele Mosepele
- Faculty of Medicine, University of Botswana and Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
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Debusho LK, Bedaso NG. Bayesian Spatial Modelling of HIV Prevalence in Jimma Zone, Ethiopia. Diseases 2023; 11:diseases11010046. [PMID: 36975595 PMCID: PMC10047877 DOI: 10.3390/diseases11010046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 02/28/2023] [Accepted: 03/05/2023] [Indexed: 03/11/2023] Open
Abstract
Background: Although the human immunodeficiency virus (HIV) is spatially heterogeneous in Ethiopia, current regional estimates of HIV prevalence hide the epidemic’s heterogeneity. A thorough examination of the prevalence of HIV infection using district-level data could assist to develop HIV prevention strategies. The aims of this study were to examine the spatial clustering of HIV prevalence in Jimma Zone at district level and assess the effects of patient characteristics on the prevalence of HIV infection. Methods: The 8440 files of patients who underwent HIV testing in the 22 Districts of Jimma Zone between September 2018 and August 2019 were the source of data for this study. The global Moran’s index, Getis–Ord Gi* local statistic, and Bayesian hierarchical spatial modelling approach were applied to address the research objectives. Results: Positive spatial autocorrelation was observed in the districts and the local indicators of spatial analysis using the Getis–Ord statistic also identified three districts, namely Agaro, Gomma and Nono Benja, as hotspots, and two districts, namely Mancho and Omo Beyam, as coldspots with 95% and 90% confidence levels, respectively, for HIV prevalence. The results also showed eight patient-related characteristics that were considered in the study were associated with HIV prevalence in the study area. Furthermore, after accounting for these characteristics in the fitted model, there was no spatial clustering of HIV prevalence suggesting the patient characteristics had explained most of the heterogeneity in HIV prevalence in Jimma Zone for the study data. Conclusions: The identification of hotspot districts and the spatial dynamic of HIV infection in Jimma Zone at district level may allow health policymakers in the zone or Oromiya region or at national level to develop geographically specific strategies to prevent HIV transmission. Because clinic register data were used in the study, it is important to use caution when interpreting the results. The results are restricted to Jimma Zone districts and may not be generalizable to Ethiopia or the Oromiya region.
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Affiliation(s)
- Legesse Kassa Debusho
- Department of Statistics, College of Science, Engineering and Technology, University of South Africa, Private Bag X6, Florida 1710, South Africa
- Correspondence:
| | - Nemso Geda Bedaso
- Department of Statistics, College of Natural and Computational Science, Madda Walabu University, Bale Robe P.O. Box 247, Ethiopia
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Bossonario PA, Ferreira MRL, Andrade RLDP, de Sousa KDL, Bonfim RO, Saita NM, Monroe AA. Risk factors for HIV infection among adolescents and the youth: a systematic review. Rev Lat Am Enfermagem 2022; 30:e3697. [PMID: 36197391 PMCID: PMC9647917 DOI: 10.1590/1518-8345.6264.3696] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE to identify and analyze HIV infection risk factors among adolescents and the youth. METHOD this is a systematic review whose guide question is: what are the risk factors for HIV infection among adolescents and the youth?" In total, five databases and Google Scholar were searched in December 2021 and the found publications between 2012-2022 were filtered without language restriction. Studies were selected by two independent reviewers. The included materials were subjected to methodological quality evaluation and narrative synthesis. RESULTS overall, we included seven studies out of the 26,191 retrieved. All studies were conducted in Africa. We found that the female gender, older age, low schooling, Black ethnicity, multiple sexual partners, inconsistent use of condoms, alcohol consumption, and early sexual onset constituted risk factors for HIV infection in adolescents and the youth. CONCLUSION understanding risk factors underscores the provision of health policies and intervention strategies to strengthen the responsiveness of health services and nursing teams' care to reduce HIV transmission among adolescents and the youth. UNLABELLED (1) Our knowledge synthesis contributes to the care provided in health services. (2) The main factors for HIV are related to risk behaviors. (3) Our results point to the purpose of health policies to prevent HIV. (4) IWe assessed the importance of different social actors and management bodies to cope with HIV. (5) This study strengthens the role of nursing in preventing HIV transmission.
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Affiliation(s)
- Pedro Augusto Bossonario
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Centro Colaborador da OPAS/OMS para o Desenvolvimento da Pesquisa em Enfermagem, Ribeirão Preto, SP, Brasil
| | - Melisane Regina Lima Ferreira
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Centro Colaborador da OPAS/OMS para o Desenvolvimento da Pesquisa em Enfermagem, Ribeirão Preto, SP, Brasil
| | - Rubia Laine de Paula Andrade
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Centro Colaborador da OPAS/OMS para o Desenvolvimento da Pesquisa em Enfermagem, Ribeirão Preto, SP, Brasil
| | - Keila Diane Lima de Sousa
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Centro Colaborador da OPAS/OMS para o Desenvolvimento da Pesquisa em Enfermagem, Ribeirão Preto, SP, Brasil
| | - Rafaele Oliveira Bonfim
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Centro Colaborador da OPAS/OMS para o Desenvolvimento da Pesquisa em Enfermagem, Ribeirão Preto, SP, Brasil
| | - Nanci Michele Saita
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Centro Colaborador da OPAS/OMS para o Desenvolvimento da Pesquisa em Enfermagem, Ribeirão Preto, SP, Brasil
| | - Aline Aparecida Monroe
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Centro Colaborador da OPAS/OMS para o Desenvolvimento da Pesquisa em Enfermagem, Ribeirão Preto, SP, Brasil
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Gelibo T, Lulseged S, Eshetu F, Abdella S, Melaku Z, Ajiboye S, Demissie M, Solmo C, Ahmed J, Getaneh Y, Kaydos-Daniels SC, Abate E. Spatial distribution and determinants of HIV prevalence among adults in urban Ethiopia: Findings from the Ethiopia Population-based HIV Impact Assessment Survey (2017–2018). PLoS One 2022; 17:e0271221. [PMID: 35819961 PMCID: PMC9491827 DOI: 10.1371/journal.pone.0271221] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 06/24/2022] [Indexed: 11/19/2022] Open
Abstract
The design and evaluation of national HIV programs often rely on aggregated
national data, which may obscure localized HIV epidemics. In Ethiopia, even
though the national adult HIV prevalence has decreased, little information is
available about local areas and subpopulations. To inform HIV prevention efforts
for specific populations, we identified geographic locations and drivers of HIV
transmission. We used data from adults aged 15–64 years who participated in the
Ethiopian Population-based HIV Impact Assessment survey (October 2017–April
2018). Location-related information for the survey clusters was obtained from
the 2007 Ethiopia population census. Spatial autocorrelation of HIV prevalence
data were analyzed via a Global Moran’s I test. Geographically weighted
regression analysis was used to show the relationship of covariates. The finding
indicated that uncircumcised men in certain hotspot towns and divorced or
widowed individuals in hotspot woredas/towns might have contributed to the
average increase in HIV prevalence in the hotspot areas. Hotspot analysis
findings indicated that, localized, context-specific intervention efforts
tailored to at-risk populations, such as divorced or widowed women or
uncircumcised men, could decrease HIV transmission and prevalence in urban
Ethiopia.
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Affiliation(s)
- Terefe Gelibo
- ICAP in Ethiopia, Mailman School of Public Health, Columbia University,
Addis Ababa, Ethiopia
- * E-mail:
| | - Sileshi Lulseged
- ICAP in Ethiopia, Mailman School of Public Health, Columbia University,
Addis Ababa, Ethiopia
| | - Frehywot Eshetu
- Division of Global HIV & TB (DGHT), United States Centers for Disease
Control and Prevention (CDC), Addis Ababa, Ethiopia
| | - Saro Abdella
- TB/HIV Directorate, Ethiopia Public Health Institute (EPHI), Addis Ababa,
Ethiopia
| | - Zenebe Melaku
- ICAP in Ethiopia, Mailman School of Public Health, Columbia University,
Addis Ababa, Ethiopia
| | - Solape Ajiboye
- Division of Global HIV & TB (DGHT), United States Centers for Disease
Control and Prevention (CDC), Atlanta, GA, United States of
America
| | - Minilik Demissie
- TB/HIV Directorate, Ethiopia Public Health Institute (EPHI), Addis Ababa,
Ethiopia
| | - Chelsea Solmo
- ICAP at Columbia University, New York, New York, United States of
America
| | - Jelaludin Ahmed
- Division of Global HIV & TB (DGHT), United States Centers for Disease
Control and Prevention (CDC), Addis Ababa, Ethiopia
| | - Yimam Getaneh
- TB/HIV Directorate, Ethiopia Public Health Institute (EPHI), Addis Ababa,
Ethiopia
| | - Susan C. Kaydos-Daniels
- Division of Global HIV & TB (DGHT), United States Centers for Disease
Control and Prevention (CDC), Addis Ababa, Ethiopia
| | - Ebba Abate
- TB/HIV Directorate, Ethiopia Public Health Institute (EPHI), Addis Ababa,
Ethiopia
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Pérez-Butragueño M, Ramos-Rincón JM, Tesfamariam A, Comeche B, Mohammed N, Tiziano G, Endirays J, Biru D, Elala T, Edri A, Prieto L, Górgolas M. Impact of Xpert MTB/RIF in the Diagnosis of Childhood Tuberculosis in Rural Ethiopia. J Trop Pediatr 2022; 68:6644981. [PMID: 35848941 DOI: 10.1093/tropej/fmac055] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND This study assesses the impact of the Xpert MTB/RIF in the diagnosis of childhood tuberculosis (TB) in a rural hospital in a resource-constrained setting. METHODS Retrospective cross-sectional study in children evaluated for presumptive TB from 1 June 2016 to 31 May 2017 at the Gambo General Hospital in rural Southern Ethiopia. Children were evaluated according to a defined protocol based on national guidelines. Samples were submitted for Xpert MTB/RIF assay to the nearest reference laboratory. RESULTS Of the 201 children assessed for presumptive TB, 46.3% (93/201) were diagnosed with TB. Of these, 49.5% (46/93) were microbiologically confirmed, mostly by Xpert MTB/RIF (only one patient was diagnosed by smear alone). The rest were clinically diagnosed. Microbiologically confirmed patients had a higher mean age, longer duration of fever and cough and lymphadenopathy more frequently than those clinically diagnosed. Gastric aspirates were Xpert MTB/RIF-positive in 18.2% of the samples (26/143); none were smear-positive (0/140). Sputum samples were Xpert MTB/RIF-positive in 27.1% (13/35) of the samples and smear-positive in 8.6% (3/35). There were no HIV-positive patients and just one case of rifampicin-resistant TB. A long delay (median 15 days) was detected in returning the results. CONCLUSION Xpert MTB/RIF serves as an important adjunctive test for diagnosing childhood TB in rural settings, with microbiological confirmation in up to half the TB cases. Processes need to be optimized to achieve an early diagnosis. The diagnosis of childhood TB in high-burden countries such as Ethiopia still relies largely upon diagnostic algorithms and the clinician's skills.Lay summaryWorld Health Organization recommends the use of Xpert MTB/RIF to improve the microbiological diagnosis of childhood tuberculosis (TB) since 2014, but the impact of this test under real conditions in rural areas of low-income countries is not clear. We conducted a cross-sectional study in children evaluated for presumptive TB from 1 June 2016 to 31 May 2017 at the Gambo General Hospital in rural Southern Ethiopia. Children were evaluated according to a clinical protocol based on national guidelines and samples were submitted for Xpert MTB/RIF assay to the nearest reference laboratory.Of the 201 children assessed, 46.3% (93/201) were diagnosed with tuberculosis. Of these, 48.4% (45/93) were microbiologically confirmed by Xpert MTB/RIF [smear microscopy only diagnosed the 5.4% (5/93)]. Patients with microbiologically confirmed tuberculosis had a higher mean age, longer duration of fever and cough and had lymphadenopathy more frequently than those clinically diagnosed. A long delay in returning the results (median 15 days) was detected. Xpert MTB/RIF serves as an important test for diagnosing childhood TB in rural settings, with microbiological confirmation in up to half the cases. Processes need to be optimized to achieve an early diagnosis. The diagnosis of childhood TB in high-burden countries still relies largely upon diagnostic algorithms and the clinician's skills.
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Affiliation(s)
- Mario Pérez-Butragueño
- Department of Medicine and Pediatrics, Gambo General Rural Hospital, Gambo, Ethiopia.,Department of Pediatrics, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - José-Manuel Ramos-Rincón
- Department of Medicine and Pediatrics, Gambo General Rural Hospital, Gambo, Ethiopia.,Department of Internal Medicine, Hospital Universitario General de Alicante-ISABIAL and Miguel Hernández University of Elche, Alicante, Spain
| | - Abraham Tesfamariam
- Department of Medicine and Pediatrics, Gambo General Rural Hospital, Gambo, Ethiopia
| | - Belén Comeche
- Department of Medicine and Pediatrics, Gambo General Rural Hospital, Gambo, Ethiopia.,National Referral Unit for Tropical Diseases, Infectious Diseases Department, Hospital Universitario Ramón y Cajal, IRICYS, Madrid, Spain
| | - Nurih Mohammed
- Department of Medicine and Pediatrics, Gambo General Rural Hospital, Gambo, Ethiopia
| | - Gebre Tiziano
- Department of Medicine and Pediatrics, Gambo General Rural Hospital, Gambo, Ethiopia
| | - Jacob Endirays
- Department of Medicine and Pediatrics, Gambo General Rural Hospital, Gambo, Ethiopia
| | - Dejene Biru
- Department of Medicine and Pediatrics, Gambo General Rural Hospital, Gambo, Ethiopia
| | - Tamasghen Elala
- Department of Medicine and Pediatrics, Gambo General Rural Hospital, Gambo, Ethiopia
| | - Abu Edri
- Department of Medicine and Pediatrics, Gambo General Rural Hospital, Gambo, Ethiopia
| | - Laura Prieto
- Department of Medicine and Pediatrics, Gambo General Rural Hospital, Gambo, Ethiopia.,Department of Internal Medicine, Division of Infectious Diseases, Hospital Universitario Fundación Jimenez Díaz, Autonomous University Madrid, Madrid, Spain
| | - Miguel Górgolas
- Department of Medicine and Pediatrics, Gambo General Rural Hospital, Gambo, Ethiopia.,Department of Internal Medicine, Division of Infectious Diseases, Hospital Universitario Fundación Jimenez Díaz, Autonomous University Madrid, Madrid, Spain
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Bedaso NG, Debusho LK. Clinics register based HIV prevalence in Jimma zone, Ethiopia: applications of likelihood and Bayesian approaches. BMC Infect Dis 2022; 22:281. [PMID: 35331136 PMCID: PMC8944036 DOI: 10.1186/s12879-021-06965-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 12/01/2021] [Indexed: 11/19/2022] Open
Abstract
Background The distribution of HIV is not uniform in Ethiopia with some regions recording higher prevalence than others. However, reported regional HIV prevalence estimates mask the heterogeneity of the epidemic within regions. The main purpose of this study was to assess the district differences in HIV prevalence and other factors that affect the prevalence of HIV infection in Jimma zone, Oromia region of Ethiopia. We aimed to identify districts which had higher or lower than zone average HIV prevalence. Such in-depth analysis of HIV data at district level may help to develop effective strategies to reduce the HIV transmission rate. Methods Data collected from 8440 patients who were tested for HIV status in government clinics at the 22 Districts between September 2018 to August 2019 in Jimma zone were used for the analyses. A generalized linear mixed effects model with district random effects was applied to assess the factors associated with HIV infection and the best linear unbiased prediction was used to identify districts that had higher or lower HIV infection. Both likelihood and Bayesian methods were considered. Results The statistical test on district random effects variance suggested the need for district random effects in all the models. The results from applying both methods on full data show that the odds of HIV infection are significantly associated with covariates considered in this study. Disaggregation of prevalence by gender also highlighted the persistent features of the HIV epidemic in Jimma zone. After controlling for covariates effects, the results from both techniques revealed that there was heterogeneity in HIV infection prevalence among districts within Jimma zone, where some of them had higher and some had lower HIV infection prevalence compared to the zone average HIV infection prevalence. Conclusions The study recommends government to give attention to those districts which had higher HIV infection and to conduct further research to improve their intervention strategies. Further, related to those districts which had lower infection, it would be advantageous to identify reasons for their performance and may apply them to overcome HIV infection among residents in those districts which had higher HIV infection. The approach used in this study can also help to assess the effect of interventions introduced by the authorities to control the epidemic and it can easily be extended to assess the regions HIV infection rate relative to the rate at the national level, or zones HIV infection rate relative to the rate at a region level. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06965-0.
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Affiliation(s)
- Nemso Geda Bedaso
- Department of Statistics, College of Natural and Computational Science, Madda Walabu University, Bale Robe, Ethiopia
| | - Legesse Kassa Debusho
- Department of Statistics, College of Science, Engineering and Technology, University of South Africa, Johannesburg, South Africa.
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Worke MD, Koricha ZB, Debelew GT. Development and validation of contextual measures of sexual harassment perceptions, experiences, and coping for women employees in Ethiopian hospitality workplaces. Arch Public Health 2022; 80:59. [PMID: 35180896 PMCID: PMC8857844 DOI: 10.1186/s13690-022-00828-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 02/10/2022] [Indexed: 02/03/2023] Open
Abstract
Background Sexual harassment among female employees in the hospitality industry is a complex phenomenon, and it has ramifications for employment, psychological, physical, and reproductive health. Nevertheless, our interpretation is constrained by a lack of agreement on its definition and measurement. As a result, hospitality workplaces require accurate tools that provide a detailed understanding of sexual harassment and inputs for action to limit adverse outcomes. Thus, this study aimed to develop a reliable and valid measure of female hospitality employees’ perceptions, experiences, and coping features concerning sexual harassment. Methods Item development, scale development, and scale evaluation were all parts of the design process. Following a round of feedback from the expert group, qualitative results, and a comprehensive literature review on related themes, item pools were created for the first version of the questionnaire. Pre-testing, survey administration, item reduction, and transformation of extracted latent factors of individual items into a unified and measurable construct were also performed. Field testing included five cognitive interviews with women who had experienced sexual harassment, a pre-test study of 30 women, and a survey of 345 women who worked in hospitality workplaces. Finally, tests for dimensionality, reliability, and validity were conducted. Results In Bahir Dar, Ethiopia, 345 women working in the hospitality workplaces, with a mean age of 24.31 ± 4.30 years, took part in this study. The robust maximum likelihood estimation approach was used to do confirmatory factor analysis. The model’s stability was determined by calculating the goodness of fit and the factorial invariance. Subsequently, the validity was confirmed. The findings supported the validity and reliability of the questionnaires designed for the target group. Therefore, the questionnaires can be used as research instruments. Conclusions The sexual harassment perceptions, experiences and coping scales provide a locally verified method for assessing sexual harassment in Ethiopia by government authorities and local and international non-governmental organisations, which aid in providing necessary services and the evaluation of efforts aimed at improving workplace safety, workplace health, and psychosocial well-being. Supplementary Information The online version contains supplementary material available at 10.1186/s13690-022-00828-z.
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Affiliation(s)
- Mulugeta Dile Worke
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia. .,Department of Population and Family Health, Faculty of Public Health, Jimma University, Jimma, Ethiopia.
| | - Zewdie Birhanu Koricha
- Department of Health, Behavior, and Society, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Gurmesa Tura Debelew
- Department of Population and Family Health, Faculty of Public Health, Jimma University, Jimma, Ethiopia
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Bossonario PA, Ferreira MRL, Andrade RLDP, Sousa KDLD, Bonfim RO, Saita NM, Monroe AA. Factores de riesgo de infección por VIH entre adolescentes y jóvenes: revisión sistemática. Rev Lat Am Enfermagem 2022. [DOI: 10.1590/1518-8345.6264.3695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Resumen Objetivo: identificar y analizar los factores de riesgo de infección por VIH entre adolescentes y jóvenes. Método: se trata de una revisión sistemática que tuvo como pregunta orientadora: “¿Cuáles son los factores de riesgo a la infección por el VIH entre adolescentes y jóvenes?”. Las búsquedas en cinco bases de datos y en Google Scholar ocurrieron en diciembre de 2021, teniendo como filtro de publicaciones entre 2012-2022 sin limitación de idiomas. Las publicaciones fueron seleccionadas por dos revisores independientes. Los materiales incluidos fueron sometidos a la evaluación de la calidad metodológica y a una síntesis narrativa. Resultados: se recuperaron 26.191 materiales, siendo siete artículos incluidos. Todos los estudios se realizaron en África. Se identificó que el sexo femenino, la mayor edad de los jóvenes, baja escolaridad, personas negras, múltiples parejas sexuales, el uso inconsistente de preservativos, consumo de alcohol y el inicio temprano de las relaciones sexuales eran factores de riesgo de infección por el VIH en adolescentes y jóvenes. Conclusión: la comprensión de los factores de riesgo fundamenta la proposición de políticas de salud y estrategias de intervención con la finalidad de fortalecer la capacidad de respuesta de los servicios de salud y el cuidado del equipo de enfermería para la disminución de la transmisión del VIH entre adolescentes y jóvenes.
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10
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Bossonario PA, Ferreira MRL, Andrade RLDP, Sousa KDLD, Bonfim RO, Saita NM, Monroe AA. Fatores de risco à infecção pelo HIV entre adolescentes e jovens: revisão sistemática. Rev Lat Am Enfermagem 2022; 30:e3697. [DOI: 10.1590/1518-8345.6264.3697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 06/20/2022] [Indexed: 12/23/2022] Open
Abstract
Resumo Objetivo: identificar e analisar os fatores de risco à infecção pelo HIV entre adolescentes e jovens. Método: trata-se de uma revisão sistemática que teve como questão norteadora: quais são os fatores de risco à infecção pelo HIV entre adolescentes e jovens?”. As buscas em cinco bases de dados e no Google Scholar ocorreram em dezembro de 2021, tendo como filtro publicações entre 2012-2022 sem limitação de idiomas. As publicações foram selecionadas por dois revisores independentes. Os materiais incluídos foram submetidos à avaliação da qualidade metodológica e a uma síntese narrativa. Resultados: recuperou-se 26.191 materiais, sendo sete artigos incluídos. Todos os estudos foram conduzidos na África. Identificou-se que o sexo feminino, a maior idade dos jovens, baixa escolaridade, pessoas negras, múltiplas parcerias sexuais, uso inconsistente de preservativos, consumo de álcool e início sexual precoce constituíram fatores de risco para a infecção pelo HIV em adolescentes e jovens. Conclusão: a compreensão dos fatores de risco alicerça a propositura de políticas de saúde e estratégias de intervenção com a finalidade de fortalecer a capacidade de resposta dos serviços de saúde e o cuidado da equipe de enfermagem para a diminuição da transmissão do HIV entre adolescentes e jovens.
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Bogart LM, Kgotlaetsile K, Phaladze N, Mosepele M. HIV self-testing may overcome stigma and other barriers to HIV testing among higher-socioeconomic status men in Botswana: A qualitative study. AFRICAN JOURNAL OF AIDS RESEARCH : AJAR 2021; 20:297-306. [PMID: 34905451 PMCID: PMC8717737 DOI: 10.2989/16085906.2021.2000450] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
In Botswana, HIV prevalence is 20.3% among those between 15 and 49 years old, and in sub-Saharan Africa, higher income has been associated with increased HIV risk. We qualitatively explored barriers to HIV testing and acceptability of HIV self-testing (HIVST) among higher socio-economic status (SES) men in Botswana. Twenty higher SES men (10 tested, 10 not tested recently) participated in semi-structured interviews and 10 men participated in asynchronous online focus groups (FGs) about HIV testing barriers and HIVST acceptability. Results indicated that stigma, inconvenience and perceived lack of confidentiality were barriers to HIV testing, as were masculinity-related concerns (e.g. fear of losing status if they accessed testing or were found to be HIV positive). Men said that HIVST reduced barriers to testing and that test kits could be placed in public spaces for pick-up and used in private. Overall, HIVST was seen as acceptable and feasible among higher SES men in Botswana.
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Affiliation(s)
| | | | | | - Mosepele Mosepele
- Faculty of Health Sciences, University of Botswana, Gaborone, Botswana
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
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Andrus E, Mojola SA, Moran E, Eisenberg M, Zelner J. Has the relationship between wealth and HIV risk in Sub-Saharan Africa changed over time? A temporal, gendered and hierarchical analysis. SSM Popul Health 2021; 15:100833. [PMID: 34141854 PMCID: PMC8184650 DOI: 10.1016/j.ssmph.2021.100833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 11/29/2022] Open
Abstract
This study examines the relationship between wealth and HIV infection in Sub-Saharan Africa to determine whether and how this relationship has varied over time, within and across countries, by gender, and urban environment. The analysis draws on DHS and AIS data from 27 Sub-Saharan African countries, which spanned the 14 years between 2003 and 2016. We first use logistic regression analyses to assess the relationship between individual wealth, HIV infection and gender by country and year stratified on urban environment. We then use meta-regression analyses to assess the relationship between country level measures of wealth and the odds of HIV infection by gender and individual level wealth, stratified on urban environment. We find that there is a persistent and positive relationship between wealth and the odds of HIV infection across countries, but that the strength of this association has weakened over time. The rate of attenuation does not appear to differ between urban/rural strata. Likewise, we also find that these associations were most pronounced for women and that this relationship was persistent over the study period and across urban and rural strata. Overall, our findings suggest that the relationship between wealth and HIV infection is beginning to reverse and that in the coming years, the relationship between wealth and HIV infection in Sub-Saharan Africa may more clearly mirror the predominant global picture.
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Affiliation(s)
- Emily Andrus
- University of Michigan, Department of Epidemiology, School of Public Health, Ann Arbor, MI, USA
| | - Sanyu A. Mojola
- Department of Sociology, School of Public and International Affairs, Office of Population Research, Princeton University, Princeton, NJ, USA
| | - Elizabeth Moran
- University of Michigan, Department of Epidemiology, School of Public Health, Ann Arbor, MI, USA
| | - Marisa Eisenberg
- University of Michigan, Department of Epidemiology, School of Public Health, Ann Arbor, MI, USA
| | - Jon Zelner
- University of Michigan, Department of Epidemiology, School of Public Health, Ann Arbor, MI, USA
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Lulseged S, Belete W, Ahmed J, Gelibo T, Teklie H, West CW, Melaku Z, Demissie M, Farhani M, Eshetu F, Birhanu S, Getaneh Y, Patel H, Voetsch AC. Factors associated with unawareness of HIV-positive status in urban Ethiopia: Evidence from the Ethiopia population-based HIV impact assessment 2017-2018. PLoS One 2021; 16:e0255163. [PMID: 34380145 PMCID: PMC8357455 DOI: 10.1371/journal.pone.0255163] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 07/09/2021] [Indexed: 01/07/2023] Open
Abstract
Background The HIV epidemic in Ethiopia is concentrated in urban areas. Ethiopia conducted a Population-based HIV Impact Assessment (EPHIA) in urban areas between October 2017 and April 2018 to measure the status of the country’s response to the epidemic. Methods We conducted field data collection and HIV testing in randomly selected households using the national, rapid testing algorithm with laboratory confirmation of seropositive samples using a supplemental assay. In addition to self-report on HIV diagnosis and treatment, all HIV-positive participants were screened for a set of HIV antiretroviral (ARV) drugs indicative of the first- and second-line regimens. We calculated weighted frequencies and 95% confidence intervals to assess regional variation in participants’ level of unawareness of their HIV-positive status (adjusted for ARV status). Results We interviewed 20,170 survey participants 15–64 years of age, of which 19,136 (95%) were tested for HIV, 614 (3.2%) tested positive, and 119 (21%) of HIV-positive persons were unaware of their HIV status. Progress towards the UNAIDS first 90 target (90% of people living with HIV would be aware of their HIV status by 2020) substantially differed by administrative region of the country. In the bivariate analysis using log binomial regression, three regions (Oromia, Addis Ababa, and Harari), male gender, and young age (15–24 years) were significantly associated with awareness of HIV positive status. In multivariate analysis, the same variables were associated with awareness of HIV-positive status. Conclusion One-fifth of the HIV-positive urban population were unaware of their HIV-positive status. The number of unaware HIV-positive individuals has a different distribution than the HIV prevalence. National and regional planning and monitoring activities could address this potentially substantial source of undetected HIV infection by increasing HIV testing among young people, men and individuals who do not use condoms.
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Affiliation(s)
- Sileshi Lulseged
- ICAP in Ethiopia, Mailman School of Public Health, Columbia University, Addis Ababa, Ethiopia
- * E-mail:
| | - Wudinesh Belete
- Department of HIV and Tuberculosis Research, Ethiopia Public Health Institute, Addis Ababa, Ethiopia
| | - Jelaludin Ahmed
- United States Centers for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Terefe Gelibo
- ICAP in Ethiopia, Mailman School of Public Health, Columbia University, Addis Ababa, Ethiopia
| | - Habtamu Teklie
- Department of HIV and Tuberculosis Research, Ethiopia Public Health Institute, Addis Ababa, Ethiopia
| | - Christine W. West
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Zenebe Melaku
- ICAP in Ethiopia, Mailman School of Public Health, Columbia University, Addis Ababa, Ethiopia
| | - Minilik Demissie
- Department of HIV and Tuberculosis Research, Ethiopia Public Health Institute, Addis Ababa, Ethiopia
| | - Mansoor Farhani
- ICAP. Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Frehywot Eshetu
- United States Centers for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Sehin Birhanu
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Yimam Getaneh
- Department of HIV and Tuberculosis Research, Ethiopia Public Health Institute, Addis Ababa, Ethiopia
| | - Hetal Patel
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Andrew C. Voetsch
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Model-based small area estimation methods and precise district-level HIV prevalence estimates in Uganda. PLoS One 2021; 16:e0253375. [PMID: 34358233 PMCID: PMC8345831 DOI: 10.1371/journal.pone.0253375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 06/03/2021] [Indexed: 11/19/2022] Open
Abstract
Background Model-based small area estimation methods can help generate parameter estimates at the district level, where planned population survey sample sizes are not large enough to support direct estimates of HIV prevalence with adequate precision. We computed district-level HIV prevalence estimates and their 95% confidence intervals for districts in Uganda. Methods Our analysis used direct survey and model-based estimation methods, including Fay-Herriot (area-level) and Battese-Harter-Fuller (unit-level) small area models. We used regression analysis to assess for consistency in estimating HIV prevalence. We use a ratio analysis of the mean square error and the coefficient of variation of the estimates to evaluate precision. The models were applied to Uganda Population-Based HIV Impact Assessment 2016/2017 data with auxiliary information from the 2016 Lot Quality Assurance Sampling survey and antenatal care data from district health information system datasets for unit-level and area-level models, respectively. Results Estimates from the model-based and the direct survey methods were similar. However, direct survey estimates were unstable compared with the model-based estimates. Area-level model estimates were more stable than unit-level model estimates. The correlation between unit-level and direct survey estimates was (β1 = 0.66, r2 = 0.862), and correlation between area-level model and direct survey estimates was (β1 = 0.44, r2 = 0.698). The error associated with the estimates decreased by 37.5% and 33.1% for the unit-level and area-level models, respectively, compared to the direct survey estimates. Conclusions Although the unit-level model estimates were less precise than the area-level model estimates, they were highly correlated with the direct survey estimates and had less standard error associated with estimates than the area-level model. Unit-level models provide more accurate and reliable data to support local decision-making when unit-level auxiliary information is available.
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Patel HK, Duong YT, Birhanu S, Dobbs T, Lupoli K, Moore C, Detorio M, Sleeman K, Manjengwa J, Wray-Gordon F, Yavo D, Jackson K, Domaoal RA, Yufenyuy EL, Vedapuri S, Ndongmo CB, Ogollah FM, Dzinamarira T, Rubinstein P, Sachathep KK, Metz M, Longwe H, Saito S, Brown K, Voetsch AC, Parekh BS. A Comprehensive Approach to Assuring Quality of Laboratory Testing in HIV Surveys: Lessons Learned From the Population-Based HIV Impact Assessment Project. J Acquir Immune Defic Syndr 2021; 87:S17-S27. [PMID: 34166309 DOI: 10.1097/qai.0000000000002702] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Conducting HIV surveys in resource-limited settings is challenging because of logistics, limited availability of trained personnel, and complexity of testing. We described the procedures and systems deemed critical to ensure high-quality laboratory data in the population-based HIV impact assessments and large-scale household surveys. METHODS Laboratory professionals were engaged in every stage of the surveys, including protocol development, site assessments, procurement, training, quality assurance, monitoring, analysis, and reporting writing. A tiered network of household, satellite laboratories, and central laboratories, accompanied with trainings, optimized process for blood specimen collection, storage, transport, and real-time monitoring of specimen quality, and test results at each level proved critical in maintaining specimen integrity and high-quality testing. A plausibility review of aggregate merged data was conducted to confirm associations between key variables as a final quality check for quality of laboratory results. RESULTS Overall, we conducted a hands-on training for 3355 survey staff across 13 surveys, with 160-387 personnel trained per survey on biomarker processes. Extensive training and monitoring demonstrated that overall, 99% of specimens had adequate volume and 99.8% had no hemolysis, indicating high quality. We implemented quality control and proficiency testing for testing, resolved discrepancies, verified >300 Pima CD4 instruments, and monitored user errors. Aggregate data review for plausibility further confirmed the high quality of testing. CONCLUSIONS Ongoing engagement of laboratory personnel to oversee processes at all levels of the surveys is critical for successful national surveys. High-quality population-based HIV impact assessments laboratory data ensured reliable results and demonstrated the impact of HIV programs in 13 countries.
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Affiliation(s)
- Hetal K Patel
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | | | - Sehin Birhanu
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | - Trudy Dobbs
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | - Kathryn Lupoli
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | - Carole Moore
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | - Mervi Detorio
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | - Katrina Sleeman
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | | | - Floris Wray-Gordon
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | - Daniel Yavo
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | - Keisha Jackson
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | - Robert A Domaoal
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | - Ernest L Yufenyuy
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | - Shanmugam Vedapuri
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | - Clement B Ndongmo
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | | | | | | | | | | | | | | | - Kristin Brown
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | - Andrew C Voetsch
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
| | - Bharat S Parekh
- Division of Global HIV/TB, Centers for Disease Control and Prevention, Atlanta, GA; and
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Biressaw W, Tilaye H, Melese D. Clustering of HIV Patients in Ethiopia. HIV AIDS (Auckl) 2021; 13:581-592. [PMID: 34079385 PMCID: PMC8164663 DOI: 10.2147/hiv.s301510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 04/28/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Among the many worldwide health problems, HIV/AIDS has caused severe health problems in several countries. The problem is also widely seen in Ethiopia. The general objective of the study is to cluster HIV patients and to find out the factors that mostly affect the prevalence of HIV within a group (cluster) and between groups (clusters) of HIV patients. METHODS The study is made based on the 2016 Ethiopian Demographic Health Survey (EDHS) which was collected by the Central Statistical Agency (CSA) of Ethiopia, and the survey collected a total of 26,753 samples, of which 14,785 were women and 11,968 were men and the age group was between 15 and 49 years for both. Binary logistic regression, principal component analysis, cluster analysis, and ANOVA were applied to analyze the data. RESULTS The result from binary logistic regression reveals that 15 factors such as ever heard of AIDS, region, water not available for at least a day in the last 2 weeks, has a radio, family members wash their hands, location of the source of water, everything completed to water to make it harmless to drink, food cooked in the house/separate house/outside, has a mobile telephone, has a table, type of place of residence, highest education level attained, current marital status, sex of household members, and age of household members are all significant factors that affect HIV status. CONCLUSION Using these significant variables, 12 principal components are identified which describe 78% of the variation in the data. The result of HIV patients are clustered into 3 clusters and determine the status of HIV levels. Mainly, cluster 2 accounts for 50% of HIV patients whereas cluster 3 and 1 accounts for 40% and 10%, respectively.
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Affiliation(s)
- Wondimu Biressaw
- Benishangul-Gumuz, Wombera Sineor Secondary and Preparatory School, Benishangul, Ethiopia
| | - Habtamu Tilaye
- University of Gondar, College of Natural and Computational Science, Departmentof Statistics, Gondar, Ethiopia
| | - Dessie Melese
- University of Gondar, College of Natural and Computational Science, Departmentof Statistics, Gondar, Ethiopia
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Alem AZ, Liyew AM, Guadie HA. Spatial pattern and associated factors of HIV testing and counselling among youths (15-24 years) in Ethiopia. BMC Public Health 2021; 21:644. [PMID: 33794831 PMCID: PMC8017837 DOI: 10.1186/s12889-021-10677-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 03/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND HIV testing and counseling (HTC) services are key for HIV prevention, treatment, care, and support. Although the prevalence of HIV infection is high among adolescents and young adults, evidence suggests the utilization of HTC service among youth is very low in Ethiopia. Identifying factors and the geographic variation of HTC uptake is important to prioritize and design targeted prevention programs to increase its utilization and reduce HIV infection in hot spot areas. METHODS Data from the 2016 Ethiopian Demographic and Health Survey were used to analyze 10,781 youth aged 15-24 years. The spatial analysis was performed in ArcGIS 10.1. The Bernoulli model was used by applying Kulldorff methods using the SaTScan software to analyze the purely spatial clusters of HTC uptake. A multilevel logistic regression analysis was used to identify the associated individual and community-level factors of HTC uptake and estimate between community variance. All models were fitted in Stata version 14.0 and finally, the adjusted odds ratio (AOR) with a corresponding 95% confidence interval (CI) were reported. RESULTS In this study, the spatial patterns of HTC uptake were found to be non-random (Global Moran's I = 0.074, p value< 0.001). Forty-seven primary clusters were identified that were located in the entire Somali region with a relative likelihood of 1.50 and the Log-Likelihood Ratio of 135.57. Youth who were ever married (AOR = 4.65; 95% CI; 4.05, 5.34), those attended higher education (AOR = 3.97; 95% CI; 3.10,5.08), those from richest household (AOR = 1.86; 95% CI; 1.44, 2.39), aged 20-24 years (AOR = 2.25; 95% CI; 2.02,2.51), having compressive HIV related knowledge (AOR = 2.05; 95% CI; 1.75,2.41), and exposed to media (AOR = 1.38; 95% CI; 1.22,1.57) were positive association with HTC uptake. However, being male (AOR = 0.81; 95% CI; 0.73,0.91) and having high HIV related stigma (AOR = 0.53; 95% CI; 0.42,0.67) were negatively associated with HTC uptake. At the community-level, youth from communities with a high percentage of educated (AOR = 1.45; 95% CI; 1.17,1.80) were more likely to utilize HTC compared with those from communities with low percentages of educated. CONCLUSION The current study indicated differences in HTC uptake in the country. Both individual and community-level factors affected HTC uptake in Ethiopia. Multifaceted intervention approaches that consider individual and community factors are required to improve HTC uptake.
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Affiliation(s)
- Adugnaw Zeleke Alem
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Alemneh Mekuriaw Liyew
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Habtamu Alganeh Guadie
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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Merzouki A, Estill J, Orel E, Tal K, Keiser O. Clusters of sub-Saharan African countries based on sociobehavioural characteristics and associated HIV incidence. PeerJ 2021; 9:e10660. [PMID: 33520455 PMCID: PMC7812934 DOI: 10.7717/peerj.10660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 12/07/2020] [Indexed: 11/20/2022] Open
Abstract
Introduction HIV incidence varies widely between sub-Saharan African (SSA) countries. This variation coincides with a substantial sociobehavioural heterogeneity, which complicates the design of effective interventions. In this study, we investigated how sociobehavioural heterogeneity in sub-Saharan Africa could account for the variance of HIV incidence between countries. Methods We analysed aggregated data, at the national-level, from the most recent Demographic and Health Surveys of 29 SSA countries (2010–2017), which included 594,644 persons (183,310 men and 411,334 women). We preselected 48 demographic, socio-economic, behavioural and HIV-related attributes to describe each country. We used Principal Component Analysis to visualize sociobehavioural similarity between countries, and to identify the variables that accounted for most sociobehavioural variance in SSA. We used hierarchical clustering to identify groups of countries with similar sociobehavioural profiles, and we compared the distribution of HIV incidence (estimates from UNAIDS) and sociobehavioural variables within each cluster. Results The most important characteristics, which explained 69% of sociobehavioural variance across SSA among the variables we assessed were: religion; male circumcision; number of sexual partners; literacy; uptake of HIV testing; women’s empowerment; accepting attitude toward people living with HIV/AIDS; rurality; ART coverage; and, knowledge about AIDS. Our model revealed three groups of countries, each with characteristic sociobehavioural profiles. HIV incidence was mostly similar within each cluster and different between clusters (median (IQR); 0.5/1000 (0.6/1000), 1.8/1000 (1.3/1000) and 5.0/1000 (4.2/1000)). Conclusions Our findings suggest that the combination of sociobehavioural factors play a key role in determining the course of the HIV epidemic, and that similar techniques can help to predict the effects of behavioural change on the HIV epidemic and to design targeted interventions to impede HIV transmission in SSA.
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Affiliation(s)
- Aziza Merzouki
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Janne Estill
- Institute of Global Health, University of Geneva, Geneva, Switzerland.,Institute of Mathematical Statistics and Actuarial Science, University of Bern, Bern, Switzerland
| | - Erol Orel
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Kali Tal
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Olivia Keiser
- Institute of Global Health, University of Geneva, Geneva, Switzerland
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Maranhão TA, Alencar CH, Magalhães MDAFM, Sousa GJB, Ribeiro LM, Abreu WCD, Pereira MLD. Mortality due to acquired immunodeficiency syndrome and associated social factors: a spatial analysis. Rev Bras Enferm 2020; 73:e20200002. [PMID: 33027500 DOI: 10.1590/0034-7167-2020-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 06/23/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze the spatial pattern of AIDS mortality and social factors associated with its occurrence. METHODS An ecological study that considered 955 AIDS deaths of residents in Piauí, reported in the Mortality Information System (MIS) from 2007 to 2015. Non-spatial and spatial regression models were used to identify social determinants of AIDS mortality, with a significance of 5%. RESULTS The predictors of AIDS mortality were illiteracy rate in males (p = 0.020), proportion of households with water supply (p = 0.015), percentage of people in households with inadequate walls (p = 0.022), percentage of people in households vulnerable to poverty and in whom no one has completed primary education (p = 0.000) and percentage of people in households vulnerable to poverty and dependent on the elderly (p = 0.009). CONCLUSION Social indicators related to education, job and income generation and housing were associated with AIDS mortality.
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Manda S, Haushona N, Bergquist R. A Scoping Review of Spatial Analysis Approaches Using Health Survey Data in Sub-Saharan Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3070. [PMID: 32354095 PMCID: PMC7246597 DOI: 10.3390/ijerph17093070] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/01/2020] [Accepted: 04/03/2020] [Indexed: 01/03/2023]
Abstract
Spatial analysis has become an increasingly used analytic approach to describe and analyze spatial characteristics of disease burden, but the depth and coverage of its usage for health surveys data in Sub-Saharan Africa are not well known. The objective of this scoping review was to conduct an evaluation of studies using spatial statistics approaches for national health survey data in the SSA region. An organized literature search for studies related to spatial statistics and national health surveys was conducted through PMC, PubMed/Medline, Scopus, NLM Catalog, and Science Direct electronic databases. Of the 4,193 unique articles identified, 153 were included in the final review. Spatial smoothing and prediction methods were predominant (n = 108), followed by spatial description aggregation (n = 25), and spatial autocorrelation and clustering (n = 19). Bayesian statistics methods and lattice data modelling were predominant (n = 108). Most studies focused on malaria and fever (n = 47) followed by health services coverage (n = 38). Only fifteen studies employed nonstandard spatial analyses (e.g., spatial model assessment, joint spatial modelling, accounting for survey design). We recommend that for future spatial analysis using health survey data in the SSA region, there must be an improve recognition and awareness of the potential dangers of a naïve application of spatial statistical methods. We also recommend a wide range of applications using big health data and the future of data science for health systems to monitor and evaluate impacts that are not well understood at local levels.
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Affiliation(s)
- Samuel Manda
- Biostatistics Research Unit, South African Medical Research Council, Pretoria 0001, South Africa
- Department of Statistics, University of Pretoria, Pretoria 0002, South Africa
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Pietermaritzburg 3209, South Africa
| | - Ndamonaonghenda Haushona
- Biostatistics Research Unit, South African Medical Research Council, Pretoria 0001, South Africa
- Division of Epidemiology and Biostatistics, University of Stellenbosch, Cape Town 8000, South Africa
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Gebreyesus T, Belay A, Berhe G, Haile G. Burden of fatigue among adults living with HIV/AIDS attending antiretroviral therapy in Ethiopia. BMC Infect Dis 2020; 20:280. [PMID: 32295546 PMCID: PMC7161178 DOI: 10.1186/s12879-020-05008-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 04/01/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Fatigue is one of the most common and devastating Human Immuno-deficiency Virus (HIV) - related symptoms, with a varying prevalence in different study areas. In Ethiopia, there is a paucity of information on the magnitude and factors associated with fatigue among HIV/Acquired Immune Deficiency Syndrome (AIDS) patients. This may lead to under-diagnosis and eventually under-management of the symptom. METHODS Institution based cross-sectional study design was conducted among 609 HIV/AIDS patients who were selected by using a systematic random sampling method. Data were collected by using interviewer administered structured questionnaire. Level of fatigue was measured by Fatigue Severity Scale. RESULTS The prevalence of fatigue was found to be 51.7%. The factors associated with fatigue were: Parity [AOR = 2.01; 95% CI: 1.09-3.71], CD4 count 200-499 cells/mm3 [AOR = 2.81; 95% CI: 1.58-4.99], anemia [AOR = 4.90 95% CI: 2.40-9.97], co-morbidities [AOR = 3.65; 95% CI: 1.71-7.78], depression [AOR = 3.68 95% CI: 1.99-6.79], not being physically active [AOR = 3.20 95% CI: 1.50-6.81], clinical stage II or IV HIV [AOR = 3.11; 95% CI: 1.51-6.40] and [AOR = 4.08; 95% CI: 1.37-12.14], respectively. CONCLUSION The finding of this study revealed that fatigue is a common health problem among adult People Living with HIV (PLHIV). Factors associated with fatigue included: Parity, CD4 count 200-499 cells/mm3, Clinical Stage II or IV HIV, anemia, co-morbidities, depression, and not being physically active. The health care service needs to address the predisposing factors by provision integrated care including timely detection and treatment of comorbidities, mental health problems, and promote physical activity to slow down disease progression and then reduce exposure to fatigue.
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Affiliation(s)
- Tsiwaye Gebreyesus
- Department of Physiotherapy, School of Medicine, College of Health Sciences and Ayder Comprehensive Specialized Hospital, Mekelle University, P.O.Box: 1871, Mekelle, Ethiopia
| | - Addisalem Belay
- Department of Physiotherapy, School of Medicine, College of Health Sciences and Ayder Comprehensive Specialized Hospital, Mekelle University, P.O.Box: 1871, Mekelle, Ethiopia
| | - Gebretsadik Berhe
- Department of Epidemiology, School of Public Health, College of Health Sciences and Ayder Comprehensive Specialized Hospital, Mekelle University, Mekelle, Ethiopia
| | - Gebremedhin Haile
- Department of Physiotherapy, School of Medicine, College of Health Sciences and Ayder Comprehensive Specialized Hospital, Mekelle University, P.O.Box: 1871, Mekelle, Ethiopia
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Ying R, Fekadu L, Schackman BR, Verguet S. Spatial distribution and characteristics of HIV clusters in Ethiopia. Trop Med Int Health 2020; 25:301-307. [PMID: 31808592 PMCID: PMC7079229 DOI: 10.1111/tmi.13356] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Ethiopia's HIV prevalence has decreased by 75% in the past 20 years with the implementation of antiretroviral therapy, but HIV transmission continues in high-risk clusters. Identifying the spatial and temporal trends, and epidemiologic correlates, of these clusters can lead to targeted interventions. METHODS We used biomarker and survey data from the 2005, 2011 and 2016 Ethiopia Demographic and Health Surveys (DHS). The spatial-temporal distribution of HIV was estimated using the Kulldorff spatial scan statistic, a likelihood-based method for determining clustering. Significant clusters (P < 0.05) were identified and compared based on HIV risk factors to non-cluster areas. RESULTS In 2005, 2011 and 2016, respectively, 219, 568 and 408 individuals tested positive for HIV. Four HIV clusters were identified, representing 17% of the total population and 43% of all HIV cases. The clusters were centred around Addis Ababa (1), Afar (2), Dire Dawa (3) and Gambella (4). Cluster 1 had higher rates of unsafe injections (4.9% vs. 2.2%, P < 0.001) and transactional sex (6.0% vs. 1.6%, P < 0.001) than non-cluster regions, but more male circumcision (98.5% vs. 91.3%, P < 0.001). Cluster 2 had higher levels of transactional sex (4.9% vs. 1.6%, P < 0.01), but lower levels of unsafe injections (0.8% vs. 2.2%, P < 0.01). Cluster 3 had fewer individuals with> 1 sexual partner (0% vs. 1.7%, P < 0.001) and more male circumcision (100% vs. 91.3%, P < 0.001). Cluster 4 had less male circumcision (59.1% vs. 91.3%, P < 0.01). CONCLUSIONS In Ethiopia, geographic HIV clusters are driven by different risk factors. Decreasing the HIV burden requires targeted interventions.
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Affiliation(s)
- Roger Ying
- Yale School of MedicineYale UniversityNew HavenCTUSA
| | - Lelisa Fekadu
- Department of Global Health and Primary CareUniversity of BergenBergenNorway
- Federal Ministry of HealthAddis AbabaEthiopia
| | - Bruce R. Schackman
- Department of Healthcare Policy and ResearchWeill Cornell Medical CollegeCornell UniversityNew YorkNYUSA
| | - Stéphane Verguet
- Department of Global Health and PopulationHarvard T.H. Chan School of Public HealthBostonMAUSA
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Maranhão TA, Sousa GJB, Alencar CH, Magalhães MDAFM, Abreu WCD, Pereira MLD. INFLUENCE OF THE SOCIAL DETERMINANTS ON THE INCIDENCE OF AIDS IN PIAUÍ: AN ECOLOGICAL STUDY. TEXTO & CONTEXTO ENFERMAGEM 2020. [DOI: 10.1590/1980-265x-tce-2019-0235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objective: to identify the social factors that determine the incidence of aids in the Piauí territory. Method: an ecological study that uses geoprocessing techniques in which 2,908 aids cases of individuals residing in Piauí were considered, notified to the Notifiable Disease Information System (Sistema de Informações de Agravos de Notificação, SINAN), from 2007 to 2015. Gross and Bayesian incidence rates were calculated using the population of the central year (2011), multiplied by 100,000 inhabitants, with Bayesian statistics used to identify spatial clusters. The non-spatial Ordinary Least Squares Estimation (OLS) and spatial Geographically Weighted Regression (GWR) regression models were used to identify the social determinants of the incidence of aids in the state, with 5% of significance. Results: the highest rates of the disease are concentrated in cities near the capital Teresina, with a Bayesian incidence of over 11.27 cases/100,000 inhabitants. The predictor variables of the incidence of ADIS in Piauí cities were the following: the percentage of individuals in houses with inadequate walls (p=0.0139), the mean number of residents per household (p=0.0309), and the percentage of individuals in households vulnerable to poverty and in which no one has completed elementary school (p=0.0051). Conclusion: according to GWR, the social factors that influence the incidence of aids in the cities of Piauí are the percentage of individuals in houses with inadequate walls, the mean number of residents per household, and the percentage of individuals in houses vulnerable to poverty and in which no one has completed elementary school. Given the above, interventions on the health social determinants of a structural nature should be established as effective methods for the prevention of HIV/ aids.
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Adal M. Systematic review on HIV situation in Addis Ababa, Ethiopia. BMC Public Health 2019; 19:1544. [PMID: 31752778 PMCID: PMC6873765 DOI: 10.1186/s12889-019-7885-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 11/01/2019] [Indexed: 11/13/2022] Open
Abstract
Background HIV prevalence in the Addis Ababa is still higher in key and priority populations. Therefore, this systematic review was carried out aiming in determining the prevalence of HIV and predisposing risk factors, identification of hotspot areas, key and priority populations, availability and utilization of services, and challenges and gaps to be addressed for prevention and control of HIV epidemic in Addis Ababa. Methods The documents relevant to address the objectives were collected from online databases Google scholar and PubMed for published works. In addition, unpublished survey and surveillance reports, performance reports and project assessment findings, and mapping results were collected from partner organizations working on HIV/AIDS prevention and control. Results It appears that the HIV prevalence stabilizes, but varies along areas and socio-demographic groups. The most common hot spots in Addis Ababa are areas where bars, groceries, pensions, guest houses, hotels, brothels, massage houses, khat houses, shisha houses, night clubs, drinking establishments and tourist frequented settings are concentrated. The recognized key population (KP) is the female sex workers (FSWs). There is sexual mixing of key and priority populations (KPPs) with the general population. There are various behavioural, biological and socio-economic predisposing risk factors that drive HIV epidemic, and respective behavioural, biomedical and structural intervention measures are identified in the presence of gaps and challenges to address the problem. Conclusions HIV prevalence in Addis Ababa seems stabilized. However, it varies along different groups of the population. There are many behavioural, biological and socio-economic factors that predisposed to HIV/AIDS. Weak monitoring of the quality of interventions, limited linkage of positive clients, lost to follow up, financial shortage, limited man-power and coordination, data quality and gaps in use of program data or research findings are some of the gaps and challenges. Therefore, prevention and control measures using behavioural, structural and biomedical interventions through filling of gaps and tackle challenges should be strengthened in order to prevent and control HIV transmission.
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Affiliation(s)
- Melaku Adal
- Microbial, Cellular and Molecular Biology Department, Addis Ababa University, Addis Ababa, Ethiopia.
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Kibret GD, Ferede A, Leshargie CT, Wagnew F, Ketema DB, Alebel A. Trends and spatial distributions of HIV prevalence in Ethiopia. Infect Dis Poverty 2019; 8:90. [PMID: 31623689 PMCID: PMC6796490 DOI: 10.1186/s40249-019-0594-9] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 09/05/2019] [Indexed: 11/29/2022] Open
Abstract
Background Globally, by the end of 2018, 37.9 million people were living with human immunodeficiency virus (HIV). Sub-Saharan Africa carries the highest burden with an estimated 71% of the global total. In Ethiopia, an estimated 715 404 people were living with HIV in 2015 and this increased to 722 248 in 2017. This study was to explore the trends and spatial distributions of HIV cases in Ethiopia. Methods In this study, we explored the spatial and temporal distribution of persons living with HIV in Ethiopia using data from 2005, 2011, and 2016 Ethiopian Demographic and Health Surveys (EDHS). Geographic information system (Getis-Ord Gi* statistics) and spatial scan statistics (SaTScan) were used for exploratory and confirmatory spatial analyses respectively. Results The overall prevalence of HIV in Ethiopia unveiled inconsistent trends, with the majority of areas showing decreasing trends. Hot spot clusters exhibited in all the three surveys, which include areas where Amhara, Afar and Tigray regions share neighbourhoods. In 2005 regionally, Gambella, Addis Ababa, and Harari had the highest prevalence at 6.0, 4.7 and 3.5%, respectively. While in the 2016 survey the highest prevalence (4.8%) was observed in Gambella regional state followed by Addis Ababa (3.4%). Conclusions The distribution of HIV infection in Ethiopia is not random in all the three EDHS surveys. High clusters of HIV cases were consistently observed in Addis Ababa and neighbouring areas of the Afar Tigray and Amhara regional states and central Oromia. This analysis revealed that there are still areas which need studying with respect to the epidemic of HIV. In this regard Addis Ababa, certain areas of Amhara regional state, large areas of Afar region and central Oromia require special attention.
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Affiliation(s)
| | - Aster Ferede
- College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | | | - Fasil Wagnew
- College of Health Sciences Department of Nursing, Debre Markos University, Debre Markos, Ethiopia
| | | | - Animut Alebel
- College of Health Sciences Department of Nursing, Debre Markos University, Debre Markos, Ethiopia
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Leveraging Geospatial Approaches to Characterize the HIV Prevention and Treatment Needs of Out-of-School Adolescent Girls and Young Women in Ethiopia. AIDS Behav 2019; 23:183-193. [PMID: 31134462 PMCID: PMC6773675 DOI: 10.1007/s10461-019-02537-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Adolescent girls and young women (AGYW) remain underserved and at risk for HIV acquisition in Ethiopia. However, there is significant risk heterogeneity among AGYW with limited consensus on optimal strategies of identifying vulnerable AGYW. This study assessed the utility of venue-based sampling approaches to identify AGYW at increased risk for HIV infection. Venue mapping and time-location-sampling (TLS) methods were used to recruit AGYW from three sub-cities of Addis Ababa, February–June 2018. Interviewer-administered surveys captured socio-demographic and behavioral characteristics. Measures of AGYW vulnerability were assessed geographically and described by venue type. A total of 2468 unique venues were identified, of which 802 (32%) were systematically selected for validation and 371 (46%) were eligible including many sites that would traditionally not be included as venues in need of HIV prevention services. Overall, 800 AGYW were enrolled across 81 sampled venues. AGYW reached were largely out-of-school (n = 599, 75%) with high proportions of AGYW reporting transactional sex (n = 101, 12.6%), food insecurity (n = 165, 20.7%) and migration (n = 565, 70.6%). Taken together, these data suggest the utility of TLS methods in reaching vulnerable, out-of-school AGYW in Addis Ababa, Ethiopia.
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Alene KA, Clements ACA. Spatial clustering of notified tuberculosis in Ethiopia: A nationwide study. PLoS One 2019; 14:e0221027. [PMID: 31398220 PMCID: PMC6688824 DOI: 10.1371/journal.pone.0221027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 07/30/2019] [Indexed: 12/20/2022] Open
Abstract
Background Tuberculosis (TB) remains a major health problem worldwide and in Ethiopia. This study aimed to investigate the spatial distributions of notified TB over the whole territory of Ethiopia and to quantify the role of health care access, environmental, socio-demographic, and behavioural factors associated with the clustering of TB. Methods A spatial analysis was conducted using national TB data reported between June 2016 and June 2017 in Ethiopia. Spatial clustering of TB was explored using Moran’s I statistic and the local indicator of spatial autocorrelation (LISA). A multivariate Poisson regression model was developed with a conditional autoregressive (CAR) prior structure and with posterior parameters estimated using Bayesian Markov chain Monte Carlo (MCMC) simulation with Gibbs sampling to investigate the drivers of the clustering. Result A total of 120,149 TB cases were reported from 745 districts in Ethiopia during the study period; 41,343 (34%) were bacteriologically confirmed new pulmonary TB and 33,997 (28%) were clinically diagnosed, new, smear-negative pulmonary TB patients. The nationwide annual incidence rate of notified TB was 112 per 100,000 population. The highest incidence was observed in three city administrative regions, namely Dire Dewa (348 cases per 100,000 population), Addis Ababa (262 per 100,000 population) and Harari (206 per 100,000 population), and the lowest incidence was observed in Somali region (51 per 100,000 population). High-high spatial clustering of notified TB was detected at Humera, Gog, and Surima district, and low-low clustering was detected in some districts located in the Somali region. Poor health care access (IRR = 0.78; 95%CI: 0.66, 0.90) and good knowledge about TB (IRR = 0.84; 95%CI: 0.73, 0.96) were negatively associated with the incidence of notified TB. Conclusion Substantial spatial clustering of notified TB was detected at region, zone and district level in Ethiopia. Health care access and knowledge about TB was associated with incidence of TB. This study may provide policy makers target hotspot areas, where national control programs could be implemented more efficiently for the prevention and control of TB, and to address potential under-reporting in poor access areas.
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Affiliation(s)
- Kefyalew Addis Alene
- Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Archie C A Clements
- Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
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Dessie G, Wagnew F, Mulugeta H, Amare D, Jara D, Leshargie CT, Negesse A, Rayasam S, Burrowes S. The effect of disclosure on adherence to antiretroviral therapy among adults living with HIV in Ethiopia: a systematic review and meta-analysis. BMC Infect Dis 2019; 19:528. [PMID: 31208346 PMCID: PMC6580562 DOI: 10.1186/s12879-019-4148-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 05/31/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Several factors have been identified as being associated with increased adherence to antiretroviral therapy, including sero-status disclosure; however, studies examining the effect of disclosure on ART adherence in Ethiopia have had inconsistent findings. This systematic review and meta-analysis therefore aims to estimate the pooled effect of disclosure on adherence to ART among adults living with HIV in Ethiopia. METHODS We performed a systematic search for articles reporting on peer-reviewed, quantitative, English-language observational studies of reporting the association between self sero-status disclosure and good ART adherence in adults living with HIV/AIDS in Ethiopia during published from 2010 to 2015. We searched four electronic databases: PubMed/Medline, the World Health Organization's Hinari portal (which includes the SCOPUS, African Index Medicus, and African Journals Online databases) for studies from December 1, 2017 to January 30, 2018. We also searched university repositories and conference abstracts for unpublished studies. We conducted a meta-analysis for the pooled effect of adherence using a random effects model in Stata version 14 and assessed publication bias using the Egger's test for funnel plot asymmetry. RESULTS Our search returned in 179 studies, of which seven (3.9%), were eligible and included in the final meta-analysis. The seven included studies were conducted from 2010 to 2015. Our analysis found that disclosure had a significant effect on the adherence to ART in adult patients living with HIV. Patients who disclosed were 1.64 times more likely to have good adherence to ART compared with those who did not (OR: 1.64, 95% CI: 1.11, 2.42). The small number of studies eligible for review and differences in study definitions of adherence and disclosure were the main limitations of this study. CONCLUSION This review found a statistically significant positive effect of disclosure status on the adherence to ART in adult patients living with HIV in Ethiopia. This suggests that Ethiopia's national treatment and prevention programs should redouble efforts to encourage self-disclosure among people living with HIV/AIDS. Encouraging supportive social environments for disclosure, and promoting partner notification and partner disclosure support initiatives might be particularly helpful in this regard.
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Affiliation(s)
- Getenet Dessie
- Department of Nursing, school of health science, College of medicine and Health Science Bahr Dar University, P.O. Box 79, Bahir Dar, Ethiopia
| | - Fasil Wagnew
- Department of Nursing, College of Health Science Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
| | - Henok Mulugeta
- Department of Nursing, College of Health Science Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
| | - Dessalegn Amare
- Department of Nursing, school of health science, College of medicine and Health Science Bahr Dar University, P.O. Box 79, Bahir Dar, Ethiopia
| | - Dube Jara
- Department of Public Health, College of Health Science Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
| | - Cheru Tesema Leshargie
- Department of Environmental Health, College of Health Science Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
| | - Ayenew Negesse
- Department of Human Nutrition and Food Sciences, College of Health Science Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
| | | | - Sahai Burrowes
- Public Health Program, College of Education and Health Sciences, Touro University California, Vallejo, USA
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Boyda DC, Holzman SB, Berman A, Grabowski MK, Chang LW. Geographic Information Systems, spatial analysis, and HIV in Africa: A scoping review. PLoS One 2019; 14:e0216388. [PMID: 31050678 PMCID: PMC6499437 DOI: 10.1371/journal.pone.0216388] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 04/20/2019] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Geographic Information Systems (GIS) and spatial analysis are emerging tools for global health, but it is unclear to what extent they have been applied to HIV research in Africa. To help inform researchers and program implementers, this scoping review documents the range and depth of published HIV-related GIS and spatial analysis research studies conducted in Africa. METHODS A systematic literature search for articles related to GIS and spatial analysis was conducted through PubMed, EMBASE, and Web of Science databases. Using pre-specified inclusion criteria, articles were screened and key data were abstracted. Grounded, inductive analysis was conducted to organize studies into meaningful thematic areas. RESULTS AND DISCUSSION The search returned 773 unique articles, of which 65 were included in the final review. 15 different countries were represented. Over half of the included studies were published after 2014. Articles were categorized into the following non-mutually exclusive themes: (a) HIV geography, (b) HIV risk factors, and (c) HIV service implementation. Studies demonstrated a broad range of GIS and spatial analysis applications including characterizing geographic distribution of HIV, evaluating risk factors for HIV, and assessing and improving access to HIV care services. CONCLUSIONS GIS and spatial analysis have been widely applied to HIV-related research in Africa. The current literature reveals a diversity of themes and methodologies and a relatively young, but rapidly growing, evidence base.
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Affiliation(s)
- Danielle C. Boyda
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
| | - Samuel B. Holzman
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Amanda Berman
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
- Johns Hopkins Bloomberg School of Public Health Center for Communication Programs, Baltimore, MD, United States of America
| | - M. Kathyrn Grabowski
- Department of Pathology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Larry W. Chang
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
- * E-mail:
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Kwena ZA, Njuguna SW, Ssetala A, Seeley J, Nielsen L, De Bont J, Bukusi EA. HIV prevalence, spatial distribution and risk factors for HIV infection in the Kenyan fishing communities of Lake Victoria. PLoS One 2019; 14:e0214360. [PMID: 30908555 PMCID: PMC6433243 DOI: 10.1371/journal.pone.0214360] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 03/12/2019] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Global efforts to end HIV by 2030 focus on reducing and eventually eliminating new infections in priority populations. Identifying these populations and characterizing their vulnerability factors helps in guiding investment of scarce HIV prevention resources to achieve maximum impact. We sought to establish HIV prevalence, spatial distribution and risk factors for HIV infection in the Kenyan fishing communities of Lake Victoria. METHODS We conducted a cross-sectional survey of 2637 people from all the 308 fish-landing beaches on the Kenyan shore of Lake Victoria. The number of participants enrolled at each beach were weighted based on the size of the beach, determined by the number of functional registered boats. We used simple random sampling to select those to be approached for study participation. Consenting participants were privately interviewed about their socio-economic and demographic characteristics and sexual behavior, and were invited for HIV test using the Kenya rapid HIV testing protocol. We used descriptive statistics and multivariate logistic and linear regression for analysis. RESULTS We found high HIV prevalence of 32% with significant differences between men (29%) and women (38%). Among men, having an HIV negative sexual partner, being circumcised, increasing number of condom protected sex acts in the preceding month, being younger and being a resident of Homa Bay, Kisumu, Siaya and Busia counties compared to Migori County reduced the risk of HIV infection. For women, being married, having more children with the current spouse, having an HIV negative sexual partner and being a resident of Busia compared to Migori County reduced the risk of HIV infection. We also found that longer distance from the beaches to the nearest public health facilities was associated with increasing cumulative HIV prevalence at the beaches. CONCLUSION Fishing communities have high HIV prevalence and may greatly benefit from interventions such as wider ART coverage, couple HIV risk reduction counseling, PrEP use for HIV negative partner at substantial continuous risk, alongside other HIV prevention services that the Kenyan government is currently rolling out. This will additionally require adequate plans to synchronize the provision of these services with the population's routine schedules for all these options to be reasonably accessible to them.
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Affiliation(s)
| | | | - Ali Ssetala
- UVRI-IAVI HIV Vaccine Program, Entebbe, Uganda
| | | | - Leslie Nielsen
- International AIDS Vaccine Initiative, New York, United States of America
| | - Jan De Bont
- International AIDS Vaccine Initiative, New York, United States of America
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Gelaw YA, Magalhães RJS, Assefa Y, Williams G. Spatial clustering and socio-demographic determinants of HIV infection in Ethiopia, 2015-2017. Int J Infect Dis 2019; 82:33-39. [PMID: 30844516 DOI: 10.1016/j.ijid.2019.02.046] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 02/24/2019] [Accepted: 02/26/2019] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Amhara Region has the largest at-risk population in Ethiopia, with widespread traditional practices that are likely to increase transmission of HIV. However, the identification and characterization of HIV hotspots within this region have not been undertaken. This study aimed to explore and describe the geographical pattern of HIV infection using notification data in Amhara Region, Ethiopia. METHODS Data on HIV infection at the district level were obtained from the Amhara Regional Health Bureau. A Bayesian conditional autoregressive (CAR) model was used to explore the association between HIV infection and socio-demographic variables in OpenBUGS. RESULTS A total of 35 210 new HIV cases were reported during 2015-2017 in Amhara Region, Ethiopia. Metema and Mirab Armacho districts were found to be hotspots throughout the study period. There was a decrease in HIV infection in 2016 (odds ratio 0.77, 95% credible interval (CrI) 0.72-0.82) and 2017 (odds ratio 0.71, 95% CrI 0.60-0.76) as compared with HIV infection in 2015. HIV infection increased by 1.004 (95% CrI 1.001-1.008) and 1.47 (95% CrI 1.11-3.59) for a one-unit increase in the proportion of the population who had never attended school and migrants, respectively. CONCLUSIONS This study identified spatial clustering of HIV infection in Amhara Region, with a slight reduction in the annual infection rates from 2015 to 2017. The proportion of the population who were migrants or who had a low educational status was associated with a high risk of infection. Access to HIV counselling and the promotion of condom utilization, integrated with other health care services, targeting those with a lower level of education and seasonal migrants, are important strategies for the prevention of new HIV infections.
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Affiliation(s)
- Yalemzewod Assefa Gelaw
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston 4006, Brisbane, Queensland, Australia; Institute of Public Health, College of Medicine and Health Science, University of Gondar, 196, Gondar, Ethiopia.
| | - Ricardo J Soares Magalhães
- UQ Spatial Epidemiology Laboratory, School of Veterinary Science, Faculty of Science, The University of Queensland, Gatton 4343, Queensland, Australia; Children's Health and Environment Program, Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane 4101, Queensland, Australia
| | - Yibeltal Assefa
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston 4006, Brisbane, Queensland, Australia
| | - Gail Williams
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston 4006, Brisbane, Queensland, Australia
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TOMITA A, VANDORMAEL A, BÄRNIGHAUSEN T, PHILLIPS A, PILLAY D, DE OLIVEIRA T, TANSER F. Sociobehavioral and community predictors of unsuppressed HIV viral load: multilevel results from a hyperendemic rural South African population. AIDS 2019; 33:559-569. [PMID: 30702520 PMCID: PMC6547375 DOI: 10.1097/qad.0000000000002100] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Extensive antiretroviral therapy scale-up is expected to prevent onward transmission of HIV by reducing the overall community viral load. Despite multiple studies about predictors of detectable viral load derived from clinical setting, to date, no study has established such predictors using a population-based viral load survey in a sub-Saharan African hyperendemic setting to inform interventions designed to halt HIV transmission. We used one of Africa's largest prospective cohorts in rural KwaZulu-Natal Province, South Africa, to establish the key sociodemographic, behavioral and community predictors of unsuppressed viral load at the population level. METHODS We collected 5454 viral load measurements from a population-based viral load survey of 3892 women living with HIV from a rural population during 2011, 2013 and 2014. Multilevel logistic regression models were fitted to examine the risk predictors of unsuppressed viral load. RESULTS Among women living with HIV in this population, the prevalence of unsuppressed viral load was 69% in 2011, 58% in 2013 and 53% in 2014. Although time since HIV infection was associated with lower risk for virologic detection [adjusted odds ratio (aOR) = 0.91,0.87-0.94], young women (aOR = 2.59,1.47-4.55) with extensive external migration history (aOR = 1.25,1.02-1.54), greater number of sexual partners (aOR = 1.30,1.02-1.67), and longer history of residing in an HIV incidence hotspot community were more likely to experience unsuppressed viral load (aOR = 1.12,1.06-1.19). CONCLUSION Young women, number of sexual partners, transiency and longer residence in an HIV hotspot community are important determinants of unsuppressed viral load in a hyperendemic rural African setting. To substantially reduce the persistently high transmission potential in these settings, targeted interventions to address these risk factors will be essential for both individual and population health gains.
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Affiliation(s)
- Andrew TOMITA
- Africa Health Research Institute, Durban, South Africa
- KwaZulu-Natal Research Innovation and Sequencing (KRISP), Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, South Africa
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Alain VANDORMAEL
- Africa Health Research Institute, Durban, South Africa
- KwaZulu-Natal Research Innovation and Sequencing (KRISP), Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, South Africa
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Till BÄRNIGHAUSEN
- Africa Health Research Institute, Durban, South Africa
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA
- Heidelberg Institute for Public Health, University of Heidelberg, Heidelberg, Germany
| | - Andrew PHILLIPS
- Institute for Global Health, University College London, London, UK
| | - Deenan PILLAY
- Africa Health Research Institute, Durban, South Africa
- Division of Infection and Immunity, University College London, London, UK
| | - Tulio DE OLIVEIRA
- KwaZulu-Natal Research Innovation and Sequencing (KRISP), Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, South Africa
- School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Frank TANSER
- Africa Health Research Institute, Durban, South Africa
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Research Department of Infection & Population Health, University College London, London, UK
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
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Teweldemedhin M, Asres N, Gebreyesus H, Asgedom SW. Tuberculosis-Human Immunodeficiency Virus (HIV) co-infection in Ethiopia: a systematic review and meta-analysis. BMC Infect Dis 2018; 18:676. [PMID: 30563476 PMCID: PMC6299573 DOI: 10.1186/s12879-018-3604-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 12/10/2018] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Human Immunodeficiency Virus (HIV) and Tuberculosis (TB) are the double burden diseases of the world. The African continent takes a great share of TB-HIV cases worldwide. This study was aimed to determine the prevalence of TB-HIV co-infection in Ethiopia, using a meta-analysis based on a systematic review of published articles. METHODS An electronic search was conducted in databases including PubMed, HINARI, EMBASE, Cochrane library and Google Scholar to extract the articles. Articles published between 1995 and November 2017 had been searched for using different keywords. The analysis was performed using MetaXL software and R statistical software (version 3.2.3). RESULT Our searches returned a total of (n = 26,746) records from 30 articles of which 21 were cross-sectional, 7 were retrospectives and 2 were prospective studies. The range of prevalence of TB-HIV co-infection was found to be from 6 to 52.1% with random effects pooled prevalence of 22% (95% CI 19-24%) and with substantial heterogeneity chi-square (X2) = 746.0, p < 0.001, (I2 = 95.84%). CONCLUSION Our analysis indicated that the prevalence of TB-HIV co-infection is high in Ethiopia with substantial regional variation. An integrated, facility-based and community-based effort towards the prevention, early detection and management of cases should be further strengthened throughout the country to mitigate the double burden disease.
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Affiliation(s)
- Mebrahtu Teweldemedhin
- Department of Medical Laboratory Sciences, College of Health Sciences, Aksum University, PO.BOX 298, Aksum, Tigray Ethiopia
| | - Negasi Asres
- Department of Public Health, College of Health Sciences, Aksum University, Aksum, Tigray Ethiopia
| | - Hailay Gebreyesus
- Department of Public Health, College of Health Sciences, Aksum University, Aksum, Tigray Ethiopia
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Abera B, Adem Y, Yimer M, Mulu W, Zenebe Y, Mekonnen Z. Community seroprevalence of hepatitis B, C and human immunodeficiency virus in adult population in gojjam zones, northwest Ethiopia. Virol J 2017; 14:21. [PMID: 28166829 PMCID: PMC5294870 DOI: 10.1186/s12985-017-0696-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 01/30/2017] [Indexed: 12/11/2022] Open
Abstract
Background In Ethiopia, there is lack of data on the prevalence of hepatitis B virus (HBV), hepatitis C virus (HCV) and human immune deficiency virus (HIV) infections in adult population at community level. This study aimed at determining the HBV, HCV and HIV seroprevalence in adult population at community level in East and West Gojjam zones in Amhara region, Ethiopia. Methods A cross-sectional study was conducted between October 01 and November 30, 2015. The Hepatitis B surface antigen (HBsAg) and anti-HCV were detected using the standard serological tests. The antibody to HIV infection was tested using the national HIV rapid tests algorithms. Results A total of 481 adults comprised of 51% females with median age of 25 years took part in the study. Overall, 7.5% (95% CI: 5.5–10.2%) of adult population were infected either with HBV, HCV and HIV. The prevalence of HBV was 15 (3.1%) and for HIV was 16 (3.3%). The seroprevalence of HCV was five (1.0%). HIV-HCV co-infection was found to be two (0.4%). HIV prevalence was higher in non-educated population than their counter parts (P = 0.001). HIV prevalence was high in housewives (6.0%) and merchants (4.7%). Conclusions This study revealed an intermediate HBV prevalence and low prevalence of HCV in adult population at community level. HIV prevalence is still a major public health problem in the area. To have the national data, we recommend further study on genotypes of HBV and HCV including local risk factors for transmissions. Moreover, health education on HBV, HCV and HIV transmission should be an intervention measure in the community.
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Affiliation(s)
- Bayeh Abera
- Department of Microbiology, Immunology & Parasitology, College of Medicine & Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
| | - Yesuf Adem
- Department of Microbiology, Immunology & Parasitology, College of Medicine & Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Mulat Yimer
- Department of Microbiology, Immunology & Parasitology, College of Medicine & Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Wondemagegn Mulu
- Department of Microbiology, Immunology & Parasitology, College of Medicine & Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Yohannes Zenebe
- Department of Microbiology, Immunology & Parasitology, College of Medicine & Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Zewdie Mekonnen
- Department of Biochemistry, College of Medicine & Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.,Department of Biomedical research, Biotechnology Research Institute, Bahir Dar University, Bahir Dar, Ethiopia
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