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Girma D, Abita Z, Guteta M, Abebe A, Adugna A, Alie MS, Abebe GF. Incidence density mortality rate among HIV-positive children on antiretroviral therapy in Ethiopia: a systematic review and meta-analysis. BMC Public Health 2024; 24:2061. [PMID: 39085806 PMCID: PMC11290179 DOI: 10.1186/s12889-024-19579-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 07/24/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Human Immunodeficiency Virus (HIV) continues to be the major cause of childhood deaths, particularly in the sub-Saharan African region. In Ethiopia, though several primary studies have been conducted on the incidence of HIV-related child mortality, the pooled incidence density mortality rate among HIV-positive children is unknown. Therefore, this systematic review and meta-analysis aimed to estimate the pooled incidence density mortality rate among HIV-positive children and identify its associated factors in Ethiopia. METHODS We browsed PubMed, HINARI, Science Direct, Google Scholar, African Journals Online, and cross-references using different search terms to identify articles. Quality appraisal was done using the Joanna Briggs Institute checklist. Meta-package was used to estimate the pooled incidence of mortality and hazard ratio (HR) of predictors. Heterogeneity was tested using the I-square statistics. Publication bias was tested using a funnel plot visual inspection and Egger's test. Data was presented using forest plots and tables. The random effect model was used to compute the pooled estimate. RESULTS The overall pooled incidence density mortality rate among HIV-positive children was 2.52 (95% CI: 1.82, 3.47) per 100 child years. Advanced HIV disease (hazard ratio (HR): 3.45, 95% CI (Confidence Interval): 2.64, 4.51), tuberculosis co-infection (HR: 3.19, 95% CI: 2.08, 4.88), stunting (3.22, 95% CI: 2.46, 4.22), underweight (HR: 2.71, 95% CI: 1.72, 4.26), wasting (HR: 4.14, 95% CI: 2.27, 7.58), didn't receive Isoniazid preventive therapy (HR: 3.33, 95% CI: 2.22, 4.99), anemia (HR: 3.03, 95% CI: 2.52, 3.64), fair or poor antiretroviral therapy adherence (HR: 4.14, 95% CI: 3.28, 5.28) and didn't receive cotrimoxazole preventive therapy (HR: 3.82, 95% CI: 2.49, 5.86) were factors associated with a higher hazard of HIV related child mortality. CONCLUSIONS The overall pooled incidence density mortality rate among HIV-positive children was high in Ethiopia as compared to the national strategy target. Therefore, counseling on antiretroviral therapy adherence should be strengthened. Regular monitoring of hemoglobin levels and assessment of nutritional status should be done for all children living with HIV. Moreover, healthcare professionals should follow the national HIV treatment guidelines and provide cotrimoxazole preventive therapy and Isoniazid preventive therapy up on the guidelines for children living with HIV. REGISTRATION Registered in PROSPERO with ID: CRD42023486902.
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Affiliation(s)
- Desalegn Girma
- College of Health Science, Department of Midwifery, Mizan-Tepi University, Mizan-Teferi, Ethiopia.
| | - Zinie Abita
- College of Health Science, department of public health, Mizan-Tepi University, Mizan-Teferi, Ethiopia
| | - Mirresa Guteta
- College of Health Science, Department of Nursing, Mizan Tepi University, Mizan-Teferi, Ethiopia
| | - Abinet Abebe
- College of Health Science, school of pharmacy, department of clinical pharmacy, Mizan Tepi University, Mizan-Teferi, Ethiopia
| | - Amanuel Adugna
- College of Health Science, Department of Midwifery, Mizan-Tepi University, Mizan-Teferi, Ethiopia
| | - Melsew Setegn Alie
- College of Health Science, department of public health, Mizan-Tepi University, Mizan-Teferi, Ethiopia
| | - Gossa Fetene Abebe
- College of Health Science, Department of Midwifery, Mizan-Tepi University, Mizan-Teferi, Ethiopia
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Bizuneh FK, Bizuneh TK, Masresha SA, Kidie AA, Arage MW, Sirage N, Abate BB. Tuberculosis-associated mortality and risk factors for HIV-infected population in Ethiopia: a systematic review and meta-analysis. Front Public Health 2024; 12:1386113. [PMID: 39104893 PMCID: PMC11298472 DOI: 10.3389/fpubh.2024.1386113] [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: 02/14/2024] [Accepted: 06/24/2024] [Indexed: 08/07/2024] Open
Abstract
Background Despite the effectiveness of antiretroviral therapy in reducing mortality from opportunistic infections among people living with HIV (PLHIV), tuberculosis (TB) continues to be a significant cause of death, accounting for over one-third of all deaths in this population. In Ethiopia, there is a lack of comprehensive and aggregated data on the national level for TB-associated mortality during co-infection with HIV. Therefore, this systematic review and meta-analysis aimed to estimate TB-associated mortality and identify risk factors for PLHIV in Ethiopia. Methods We conducted an extensive systematic review of the literature using the Preferred Reporting of Systematic Review and Meta-Analysis (PRISMA) guidelines. More than seven international electronic databases were used to extract 1,196 published articles from Scopus, PubMed, MEDLINE, Web of Science, HINARY, Google Scholar, African Journal Online, and manual searching. The pooled mortality proportion of active TB was estimated using a weighted inverse variance random-effects meta-regression using STATA version-17. The heterogeneity of the articles was evaluated using Cochran's Q test and I 2 statistic test. Subgroup analysis, sensitivity analysis, and Egger's regression were conducted to investigate publication bias. This systematic review is registered in Prospero with specific No. CRD42024509131. Results Overall, 22 individual studies were included in the final meta-analysis reports. During the review, a total of 9,856 cases of TB and HIV co-infection were screened and 1,296 deaths were reported. In the final meta-analysis, the pooled TB-associated mortality for PLHIV in Ethiopia was found to be 16.2% (95% CI: 13.0-19.2, I 2 = 92.9%, p = 0.001). The subgroup analysis revealed that the Amhara region had a higher proportion of TB-associated mortality, which was reported to be 21.1% (95% CI: 18.1-28.0, I 2 = 84.4%, p = 0.001), compared to studies conducted in Harari and Addis Ababa regions, which had the proportions of 10% (95% CI: 6-13.1%, I 2 = 83.38%, p = 0.001) and 8% (95% CI: 1.1-15, I 2 = 87.6%, p = 0.001), respectively. During the random-effects meta-regression, factors associated with co-infection of mortality in TB and HIV were identified, including WHO clinical stages III & IV (OR = 3.01, 95% CI: 1.9-4.7), missed co-trimoxazole preventive therapy (CPT) (OR = 1.89, 95% CI: 1.05-3.4), and missed isoniazid preventive therapy (IPT) (OR = 1.8, 95% CI: 1.46-2.3). Conclusion In Ethiopia, the mortality rate among individuals co-infected with TB/HIV is notably high, with nearly one-fifth (16%) of individuals succumbing during co-infection; this rate is considered to be higher compared to other African countries. Risk factors for death during co-infection were identified; the included studies examined advanced WHO clinical stages IV and III, hemoglobin levels (≤10 mg/dL), missed isoniazid preventive therapy (IPT), and missed cotrimoxazole preventive therapy (CPT) as predictors. To reduce premature deaths, healthcare providers must prioritize active TB screening, ensure timely diagnosis, and provide nutritional counseling in each consecutive visit. Systematic review registration Trial registration number in Prospero =CRD42024509131 https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=509131.
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Affiliation(s)
| | - Tsehay Kebede Bizuneh
- Faculties of Social Science, Geography department, Bahir Dare University, Bahir Dare, Ethiopia
| | | | | | | | - Nurye Sirage
- College of Health Sciences, Woldia University, Woldia, Ethiopia
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Nura GJ, Guyo AB, Erango MA. Determinants of longitudinal changes of CD4 cell count and survival time to death of HIV/AIDS patients treated at Yabelo General Hospital, the case of pastoralist area: Using joint modelling approach. PLoS One 2024; 19:e0305519. [PMID: 38913649 PMCID: PMC11195975 DOI: 10.1371/journal.pone.0305519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 06/01/2024] [Indexed: 06/26/2024] Open
Abstract
INTRODUCTION HIV/AIDS is a chronic disease that challenges public health worldwide and causes morbidity and mortality in humans. The main purpose of this study was to investigate the determinants of longitudinal changes in CD4 cell count and survival time to death among HIV/AIDS patients as adults from January 2016 to December 2019 at Yabelo General Hospital. The intellectual gap in this study was focused on the study area, which means that the study related to joint modeling doesn't exist in the pastoralist community of Borena. METHODS This study involved 293 adult HIV-infected adults that could be collected from the recorded patient chart data, and the study design is a retrospective cohort design. The study used a Cox proportional hazard model, a linear mixed effect model, and a joint model, which is the combination of both model processes. RESULTS The joint model showed that longitudinal CD4 cell count is significantly associated with survival time (p-value = 0.0253). Covariates such as visiting time, age, weight, educational status, ART adherence, and functional status were statistically significant factors associated with mean changes in the CD4 cell count of HIV patients. WHO stage, educational status, place of residence, TB, family history, and opportunistic infection disease had a significant effect on the survival time of HIV patients. CONCLUSIONS The estimated association parameter is a negative value, which indicates both outcomes are negatively associated, and higher values of the CD4 cell count are associated with better survival.
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Affiliation(s)
- Galgalo Jaba Nura
- Department of Statistics, Arba Minch University, Arba Minch, Ethiopia
| | - Arero Biqicha Guyo
- Yabello General Hospital Coordinator, Borena Zone, Oromia Region, Ethiopia
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Girma D, Abita Z, Lemu LG, Asmelash D, Bambo GM, Alie MS, Abebe GF. Incidence of lost to follow up among HIV-positive children on antiretroviral therapy in Ethiopia: Systematic review and meta-analysis. PLoS One 2024; 19:e0304239. [PMID: 38776343 PMCID: PMC11111029 DOI: 10.1371/journal.pone.0304239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 05/08/2024] [Indexed: 05/24/2024] Open
Abstract
BACKGROUND At the end of 2022, globally, only 46% of children (aged 0-14 years) on ART had suppressed viral loads. Viral load suppression is crucial to reduce HIV-related deaths. To suppress the viral load at the expected level, children must be retained in ART treatment. Nevertheless, lost to follow-up from ART treatment continues to be a global challenge, particularly, in developing countries. Previously, primary studies were conducted in Ethiopia to assess the incidence of lost to follow-up among HIV-positive children on ART treatment. However, variations have been seen among the studies. Therefore, this systematic review and meta-analysis aimed to estimate the pooled incidence of lost to follow-up among HIV-positive children on ART and identify its associated factors in Ethiopia. METHODS We searched PubMed, HINARI, Science Direct, Google Scholar, and African Journals Online to obtain articles published up to November 20, 2023. Critical appraisal was done using the Joanna Briggs Institute checklist. Heterogeneity was identified using I-square statistics. Funnel plot and Egger's tests were used to identify publication bias. Data was presented using forest plots and tables. Random and fixed-effect models were used to compute the pooled estimate. RESULTS Twenty-four studies were included in the final analysis. The pooled incidence of lost to follow-up among HIV-positive children on ART was 2.79 (95% CI: 1.99, 3.91) per 100-child-year observations. Advanced HIV disease (HR: 2.20, 95% CI: 1.71, 2.73), having opportunistic infection (HR: 2.59, 95% CI: 1.39; 4.78), fair or poor ART treatment adherence (HR: 2.92, 95% CI: 1.31; 6.54) and children aged between 1-5 years (HR: 2.1,95% CI: 1.44; 2.95) were factors associated with lost to follow up among HIV positive children on ART. CONCLUSIONS The overall pooled incidence of lost to follow-up among HIV-positive children on ART is low in Ethiopia. Therefore, counseling on ART drug adherence should be strengthened. Moreover, emphasis has to be given to children with advanced HIV stage and opportunistic infection to reduce the rate of lost to follow up among HIV-positive children on ART. TRIAL REGISTRATION Registered in PROSPERO with ID: CRD42024501071.
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Affiliation(s)
- Desalegn Girma
- Department of Midwifery, College of Health Science, Mizan-Tepi University, Mizan-Teferi, Ethiopia
| | - Zinie Abita
- Department of Public Health, College of Health Science, Mizan-Tepi University, Mizan-Teferi, Ethiopia
| | - Lidya Gutema Lemu
- Department of Midwifery, College of Health Science, Mizan-Tepi University, Mizan-Teferi, Ethiopia
| | - Daniel Asmelash
- Department of Medical Laboratory, College of Health Science, Mizan Tepi University, Mizan-Teferi, Ethiopia
| | - Getachew Mesfin Bambo
- Department of Medical Laboratory, College of Health Science, Mizan Tepi University, Mizan-Teferi, Ethiopia
| | - Melesew Setegn Alie
- Department of Public Health, College of Health Science, Mizan-Tepi University, Mizan-Teferi, Ethiopia
| | - Gossa Fetene Abebe
- Department of Midwifery, College of Health Science, Mizan-Tepi University, Mizan-Teferi, Ethiopia
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Woldegeorgis BZ, Asgedom YS, Gebrekidan AY, Kassie GA, Borko UD, Obsa MS. Mortality and its predictors among human immunodeficiency virus-infected children younger than 15 years receiving antiretroviral therapy in Ethiopia: a systematic review and meta-analysis. BMC Infect Dis 2024; 24:471. [PMID: 38702591 PMCID: PMC11069260 DOI: 10.1186/s12879-024-09366-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 04/29/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Despite antiretroviral treatment (ART), the human immunodeficiency virus (HIV) continues to pose a considerable health burden in resource-poor countries. This systematic review and meta-analysis aimed to determine the pooled incidence density of mortality and identify potential predictors among HIV-infected children receiving ART, from studies conducted in various parts of Ethiopia. METHODS A comprehensive database search was made in Excerpta Medica, PubMed, Web of Science, African Journals Online, Google Scholar, and Scopus. We reported results following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020. Excel Spreadsheet and STATA Version 14 software were used for data abstraction and meta-analysis, respectively. Statistical heterogeneity among studies was assessed using I2 statistics. Meta-regression and subgroup analysis were performed to further explore the sources of statistical heterogeneity. Moreover, publication bias and a leave-out-one sensitivity analysis were performed. RESULTS Twenty-two articles involving 8,731 participants met inclusion criteria and were included. The pooled incidence density of mortality was 3.08 (95% confidence interval (CI), 2.52 to 3.64) per 100 child years. Predictors of mortality were living in rural areas (hazard ratio (HR), 2.18 [95% CI, 1.20 to 3.98]), poor adherence to ART (HR, 2.85 [ 95% CI, 1.39 to 5.88]), failure to initiate co-trimoxazole preventive therapy (HR, 2.16 [95% CI, 1.52 to 3.07]), anemia (HR, 2.28 [95% CI, 1.51 to 3.45]), opportunistic infections (HR, 1.52 [ 95% CI, 1.15 to 2.00]), underweight (HR, 1.74 [95% CI, 1.26 to 2.41]), wasting (HR, 2.54 [95% CI, 1.56 to 4.16]), stunting (HR, 2.02 [95% CI, 1.63 to 2.51]), World Health Organization classified HIV clinical stages III and IV (HR, 1.71 [95% CI, 1.42 to 2.05]), and Nevirapine-based regimens (HR, 3.91 [95% CI, 3.09 to 4.95]). CONCLUSIONS This study found that the overall mortality rate among HIV-infected children after ART initiation was high. Therefore, high-level commitment and involvement of responsible caregivers, healthcare providers, social workers, and program managers are of paramount importance to identify these risk factors and thus enhance the survival of HIV-infected children receiving ART.
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Affiliation(s)
- Beshada Zerfu Woldegeorgis
- Department of Internal Medicine, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia.
| | - Yordanos Sisay Asgedom
- Department of Epidemiology, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Amanuel Yosef Gebrekidan
- School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Gizachew Ambaw Kassie
- School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Ushula Deboch Borko
- Department of Internal Medicine, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
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Kassaw A, Chekole B, Agimas MC, Azmeraw M, Beletew B, Zeleke S, Asferi WN, Demis S, Hailemeskel HS, Bayih WA, Chane ES, Kefale D, Aytenew TM. Effects of undernutrition on mortality of HIV-infected children after initiation of antiretroviral therapy in Ethiopia: A systematic review and meta-analysis. Heliyon 2024; 10:e29308. [PMID: 38601598 PMCID: PMC11004412 DOI: 10.1016/j.heliyon.2024.e29308] [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: 01/06/2024] [Revised: 04/01/2024] [Accepted: 04/04/2024] [Indexed: 04/12/2024] Open
Abstract
Background Undernutrition is the leading cause of mortality among children infected with HIV particularly in resource-deprived settings. Despite several studies were disclosed the effect of undernutrition on mortality of children living with HIV in Ethiopia, the findings were fragmented and inconclusive. Therefore, this review aimed to determine the pooled effects of undernutrition on mortality of children infected with HIV in Ethiopia. Methods The search were performed using international online electronic data bases (MEDLINE/though PubMed, Google scholar, Hinari, Scopus and open Google). The review included only retrospective/prospective cohort studies reporting the effects of undernutrition on mortality of children infected with HIV. Heterogeneity between included studies was assessed using Cochrane Q-test and the I2 statistics. Sub-group analysis was done by study regions, sample size and publication year. Results A total of 1345 articles were identified from databases. Among these, 14 studies met the inclusion criteria and included in the study. Meta-analysis of 4 studies revealed that stunting has a significant effect on mortality of children infected with HIV (AHR: 3.36; 95 % CI: 2.95-3.77). Of 14 included studies, 6 articles indicated that wasting has a significant effect on mortality in children infected with HIV (AHR: 3.93; 95 % CI: 2.56-5.30) as compared to their counterparts. Furthermore, the pooled effect of 8 studies showed that underweight has 3.4 times hazard of death among children who lived with HIV as compared to well-nourished children. Conclusion This review revealed that undernutrition has deleterious effect on mortality of children infected with HIV/AIDS by disease progression and prone the children to serious opportunistic infections. From the study, the authors recommended that nutritional status of children on antiretroviral therapy need to be evaluated regularly.
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Affiliation(s)
- Amare Kassaw
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Bogale Chekole
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Wolkite University, Wolkite, Ethiopia
| | - Muluken Chanie Agimas
- Department of Epidemiology and Biostatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Molla Azmeraw
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Biruk Beletew
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Shegaw Zeleke
- Department of Adult Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Worku Necho Asferi
- Department of Maternal and Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Solomon Demis
- Department of Maternal and Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Habtamu Shimeles Hailemeskel
- Department of Maternal and Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Wubet Alebachew Bayih
- Department of Maternal and Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Ermias Sisay Chane
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Demewoz Kefale
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Tigabu Munye Aytenew
- Department of Adult Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Tsegaye D, Wude S, Kebede T, Adane S, Shumet T, Kebede F. Epidemiological survival pattern, risk factors, and estimated time to develop tuberculosis after test and treat strategies declared for children living with human immune deficiency virus. Indian J Tuberc 2023; 70 Suppl 1:S89-S99. [PMID: 38110268 DOI: 10.1016/j.ijtb.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 04/26/2023] [Accepted: 05/10/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND Due to their age category and the immune-suppressing effects of HIV, children were more vulnerable to experience endogenous reactivation of latent bacilli in the lung and increased risk of active tuberculosis incidence. The aim of this study is to assess the survival pattern, risk factors, and estimated time to develop TB after children started ART at selected health facilities of North Wollo, Ethiopia, from November 1, to September 30, 2021. METHODS Facility-based retrospective cohort study was employed from November 1 to September 30, 2021. Cox proportional hazard regression model was used to assess factors associated with incidence of tuberculosis. AHR with 95% CI was used to declare statistical significance for tuberculosis incidence. RESULTS During follow-up, 54 (10.9%) new cases of tuberculosis was reported. At the end of follow-up period, overall cumulative survival probability was determined as 43.8% (95%CI: 28.2-54.3). WHO clinical stage III&IV (AHR: 2.4 (95% CI: 1.4, 4.7), Hgb≤10 gm/dl (AHR = 2.2: (95%CI: 1.12-5.8), missed isoniazid preventive therapy (AHR = 2.5 (95%CI: 1.56-10.3) and Viral Load (≥400 cell/ml) (AHR = 2.02 (95%CI: 2.03-6.8) were significant risk factors for tuberculosis incidence. CONCLUSION Nearly ten % of HIV-positive children experienced new cases of tuberculosis with median time of 25(IQR = ±12) months. It would be better to give special attention to children who missed isoniazid preventive therapy with WHO stages III&IV Viral load (≥400 cells/ml), and Hgb≤10 gm/dl to prevent tuberculosis incidence and prolonged quality of life.
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Affiliation(s)
- Dejen Tsegaye
- Debre Markos University, College of Health Sciences, Department of Nursing, Ethiopia.
| | - Sintayehu Wude
- Pawi general hospital, Department of Psychiatry, Metekel zone, Ethiopia
| | - Tsehay Kebede
- Bahir Dare University, Faculty of Social Science, Department of Geography, Ethiopia
| | - Setamlak Adane
- Woldia University, College of Health Science, Department of Epidemiology, Ethiopia
| | - Tesfaye Shumet
- Woldia University, College of Health Science, Department of Epidemiology, Ethiopia
| | - Fassikaw Kebede
- Woldia University, College of Health Science, Department of Epidemiology, Ethiopia
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Mekonnen GB, Birhane BM, Engdaw MT, Kindie W, Ayele AD, Wondim A. Predictors of a high incidence of opportunistic infections among HIV-infected children receiving antiretroviral therapy at Amhara regional state comprehensive specialized hospitals, Ethiopia: A multicenter institution-based retrospective follow-up study. Front Pediatr 2023; 11:1107321. [PMID: 37205221 PMCID: PMC10185808 DOI: 10.3389/fped.2023.1107321] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 03/30/2023] [Indexed: 05/21/2023] Open
Abstract
Introduction Globally, opportunistic infections are the leading causes of morbidity and mortality among HIV-infected children, contributing to more than 90% of HIV-related deaths. In 2014, Ethiopia launched and began to implement a "test and treat" strategy aiming to reduce the burden of opportunistic infections. Despite this intervention, opportunistic infections continue to be a serious public health issue, with limited evidence available on their overall incidence among HIV-infected children in the study area. Objective The study aimed to assess the incidence of opportunistic infections and to identify predictors of their occurrence among HIV-infected children receiving antiretroviral therapy at Amhara Regional State Comprehensive Specialized Hospitals in 2022. Methods A multicenter, institution-based retrospective follow-up study was conducted among 472 HIV-infected children receiving antiretroviral therapy at Amhara Regional State Comprehensive Specialized Hospitals from May 17 to June 15, 2022. Children receiving antiretroviral therapy were selected using a simple random sampling technique. Data were collected using national antiretroviral intake and follow-up forms via the KoBo Toolbox. STATA 16 was used for data analyses, and the Kaplan-Meier method was used to estimate probabilities of opportunistic infection-free survival. Both bi-variable and multivariable Cox proportional hazard models were employed to identify significant predictors. A P-value <0.05 was taken to indicate statistical significance. Results Medical records from a total of 452 children (representing a completeness rate of 95.8%) were included and analyzed in the study. The overall incidence of opportunistic infections among children receiving ART was 8.64 per 100 person-years of observation. The predictors of elevated incidence of opportunistic infections were: a CD4 cell count below a specified threshold [AHR: 2.34 (95% CI: 1.45, 3.76)]; co-morbidity of anemia [AHR: 1.68 (95% CI: 1.06, 2.67)]; ever having exhibited only fair or poor adherence to ART drugs [AHR: 2.31 (95% CI: 1.47, 3.63)]; never having taken tuberculosis-preventive therapy [AHR: 1.95 (95% CI: 1.27, 2.99)]; and not having initiated antiretroviral therapy within 7 days of HIV diagnosis [AHR: 1.82 (95% CI: 1.12, 2.96)]. Conclusion In this study, the incidence of opportunistic infections was high. Early initiation antiretroviral therapy has direct effect on boosting the immunity, suppressing viral replications and increases the CD4 count, so that the occurrence of opportunistic infection will reduce the incidence of OIs.
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Affiliation(s)
- Gebrehiwot Berie Mekonnen
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
- Correspondence: Gebrehiwot Berie Mekonnen
| | - Binyam Minuye Birhane
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
- School of Public Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Melaku Tadege Engdaw
- Social and Population Health Unit, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Wotetenesh Kindie
- Department of Surgical Nursing, School of Nursing, College of Medicine and Health Sciences, and Specialized Hospital, University of Gondar, Gondar, Ethiopia
| | - Amare Demsie Ayele
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, Specialized Hospital, University of Gondar, Gondar, Ethiopia
| | - Amare Wondim
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, Specialized Hospital, University of Gondar, Gondar, Ethiopia
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Effects of Undernutrition and Predictors on the Survival Status of HIV-Positive Children after Started Antiretroviral Therapy (ART) in Northwest Ethiopia. Int J Pediatr 2022; 2022:1046220. [PMID: 35222650 PMCID: PMC8872677 DOI: 10.1155/2022/1046220] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 01/14/2022] [Accepted: 02/04/2022] [Indexed: 11/17/2022] Open
Abstract
Malnutrition and human immunodeficiency virus/acquired immunodeficiency syndrome have complex and multidirectional relationships. Ethiopia is one of the countries hardest hit by the HIV epidemic as well as malnutrition. This study was aimed at assessing the effects of undernutrition on the survival status of HIV-positive children who received HIV/AIDS care in Northwest Ethiopia. Materials and Methods. A facility-based retrospective follow-up was conducted from January 1, 2009, to December 31, 2020. The data was entered into EpiData version 4.2.0. Then, the entered data was exported to STATA 14 software for further analysis, and the Kaplan-Meier survival curve was used to estimate survival time after the initiation of ART. The Bivariable and multivariable Cox regression analyses were conducted to identify predictors of mortality associated with undernutrition. Results. The mean (±SD) age of participant children was found 118.4 (±38.24) months. The overall mortality rate in this study was determined as 5.4 per 100 child-years (95% CI: 3.6, 5.8). Children with CD4 cell counts below the threshold [AHR = 1.6; 95% CI (1.19, 7.85)], advanced WHO clinical stages (III and IV) HIV [AHR = 4.5; 95% CI (2.80, 8.40)], and being severe stunting at the beginning [AHR = 2.9; 95% CI (1.80, 6.40)] were significantly associated with mortality of HIV-positive children. Conclusion. The findings of the current study indicated that HIV-positive children on ART had a high rate of mortality. Baseline undernutrition has the mortality of children who had CD4 counts below a threshold, advanced WHO HIV clinical staging (III and IV), and being severe stunting (HAZ ≤ −3 Z score) which were found to be independent predictors for mortality of undernourished HIV.
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Lee CY, Wu PH, Lu PL, Liang FW. Different Trends of Distinct Time Points of AIDS Events Following HIV Diagnosis in Various At-risk Populations: A Retrospective Nationwide Cohort Study in Taiwan. Infect Dis Ther 2021; 10:1715-1732. [PMID: 34245451 PMCID: PMC8322356 DOI: 10.1007/s40121-021-00494-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 06/28/2021] [Indexed: 12/04/2022] Open
Abstract
Introduction Acquired immune deficiency syndrome (AIDS) events at distinct time points after human immunodeficiency virus (HIV) diagnosis require various AIDS prevention strategies. However, no nationwide epidemiological surveillance studies have been conducted to explore the trends of distinct AIDS event time points in various at-risk populations. The aim of this study was to explore the issues and characterize the determinants of AIDS status after HIV diagnosis. Methods This nationwide cohort study enrolled HIV-positive Taiwanese during 1984–2016. AIDS events were classified into three time points (≤ 3, 4–12, > 12 months) by their occurrence time after HIV diagnosis. The periods of HIV/AIDS diagnosis were divided into six categories according to the calendar year of HIV/AIDS diagnosis: 1984–1991, 1992–1996, 1997–2001, 2002–2006, 2007–2011, and 2012–2016. HIV-positive Taiwanese during 1984–2011 were then selected to determine the factors associated with four AIDS statuses within 5 years after HIV diagnosis (no AIDS, AIDS ≤ 3 months, within 4–12 months, > 12 months) using multinomial logistic regression. Results Of 33,142 cases, we identified 15,254 (46%) AIDS events. The overall AIDS incidence (events/100 person-years) peaked during 1992–1996 (20.61), then declined, and finally stabilized from 2002 (8.96–9.82). The evolution of the proportion of distinct time points of AIDS events following HIV diagnosis changed significantly in heterosexuals and intravenous drug users (IDUs) during 1984–2016 (decline at ≤ 3 months in IDUs, decline at 4–12 months in IDUs, and increase at > 12 months in heterosexuals and IDUs) but not among men who have sex with men (MSM). Time points at ≤ 3 months remained at > 50% among MSM and at > 55% among heterosexuals. In multinomial logistic regression, IDUs (vs. men who have sex with men; MSM) had a lower risk of all AIDS statuses; heterosexuals (vs. MSM) had a higher risk of AIDS events ≤ 3 months after HIV diagnosis. Conclusion The magnitude of AIDS in Taiwan has been stable since 2002. Enhancing early diagnosis among people with sexual contact and optimizing the HIV care continuum among heterosexuals and IDUs should be priorities for further AIDS prevention strategies.
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Affiliation(s)
- Chun-Yuan Lee
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, No. 482, Shanming Rd., Xiaogang Dist., Kaohsiung City, Taiwan
- Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Pei-Hua Wu
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, No. 100, Ziyou 1st Rd., Sanmin Dist., Kaohsiung City, Taiwan
- Department of Public Health, College of Health Science, Kaohsiung Medical University, No. 100, Tzyou 1st Road, Kaohsiung City, 807 Taiwan
| | - Po-Liang Lu
- Department of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, No. 100, Ziyou 1st Rd., Sanmin Dist., Kaohsiung City, Taiwan
- Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan
- College of Medicine, Kaohsiung Medical University Hospital, No. 100, Ziyou 1st Rd., Sanmin Dist., Kaohsiung City, Taiwan
| | - Fu-Wen Liang
- Department of Public Health, College of Health Science, Kaohsiung Medical University, No. 100, Tzyou 1st Road, Kaohsiung City, 807 Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, No. 100, Tzyou 1st Road, Kaohsiung City, 807 Taiwan
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