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Woldegeorgis BZ, Asgedom YS, Habte A, Kassie GA, Badacho AS. Highly active antiretroviral therapy is necessary but not sufficient. A systematic review and meta-analysis of mortality incidence rates and predictors among HIV-infected adults receiving treatment in Ethiopia, a surrogate study for resource-poor settings. BMC Public Health 2024; 24:1735. [PMID: 38943123 PMCID: PMC11214252 DOI: 10.1186/s12889-024-19268-1] [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: 01/18/2024] [Accepted: 06/25/2024] [Indexed: 07/01/2024] Open
Abstract
BACKGROUND Owing to the introduction of highly active antiretroviral therapy (HAART), the trajectory of mortality and morbidity associated with human immunodeficiency virus (HIV) infection has significantly decreased in developed countries. However, this remains a formidable public health challenge for people living with HIV in resource-poor settings. This study was undertaken to determine the pooled person-time incidence rate of mortality, analyze the trend, and identify predictors of survival among HIV-infected adults receiving HAART. METHODS Quantitative studies were searched in PubMed, Embase, Scopus, Google Scholar, African Journals Online, and Web of Science. The Joana Briggs Institute critical appraisal tool was used to assess the quality of the included articles. The data were analyzed using the random-effects Dersimonian-Laird model. RESULTS Data abstracted from 35 articles involving 39,988 subjects were analyzed. The pooled person-time incidence rate of mortality (all-cause) was 4.25 ([95% uncertainty interval (UI), 3.65 to 4.85]) per 100 person-years of observations. Predictors of mortality were patients aged ≥ 45 years (hazard ratio (HR), 1.70 [95% UI,1.10 to 2.63]), being female (HR, 0.82 [95% UI, 0.70 to 0.96]), history of substance use (HR, 3.10 [95% UI, 1.31 to 7.32]), HIV positive status non disclosure (HR, 3.10 [95% UI,1.31 to 7.32]), cluster of differentiation 4 + T cell - count < 200 cells/mm3 (HR, 3.23 [95% UI, [2.29 to 4.75]), anemia (HR, 2.63 [95% UI, 1.32 to 5.22]), World Health Organisation classified HIV clinical stages III and IV (HR, 3.02 [95% UI, 2.29 to 3.99]), undernutrition (HR, 2.24 [95% UI, 1.61 to 3.12]), opportunistic infections (HR, 1.89 [95% UI, 1.23 to 2.91]), tuberculosis coinfection (HR, 3.34 [95% UI, 2.33 to 4.81]),bedridden or ambulatory (HR,3.30 [95% UI, 2.29 to 4.75]), poor treatment adherence (HR, 3.37 [95% UI,1.83 to 6.22]), and antiretroviral drug toxicity (HR, 2.60 [95% UI, 1.82 to 3.71]). CONCLUSION Despite the early introduction of HAART in Ethiopia, since 2003, the mortality rate has remained high. Therefore, guideline-directed intervention of identified risk factors should be in place to improve overall prognosis and increase quality-adjusted life years.
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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
| | - Aklilu Habte
- School of Public Health, College of Medicine and Health Sciences, Wachemo University, Hosanna, Ethiopia
| | - Gizachew Ambaw Kassie
- School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Abebe Sorsa Badacho
- School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
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Kidie AA, Masresha SA, Bizuneh FK. Statistical analysis on the incidence and predictors of death among second-line ART patients in public hospitals of North Wollo and Waghemira Zones, Ethiopia, 2021. Sci Rep 2024; 14:10893. [PMID: 38740783 DOI: 10.1038/s41598-024-60119-1] [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: 01/03/2024] [Accepted: 04/18/2024] [Indexed: 05/16/2024] Open
Abstract
Acquired immune deficiency virus, caused by the human immunodeficiency virus, is a significant global health concern. Sub-Saharan Africa particularly Ethiopia faces a high prevalence of human immunodeficiency virus. In low-income settings like Ethiopia, early mortality rates are elevated due to severe opportunistic infections and advanced disease at Anti-retroviral treatment initiation. Despite available treatments, delayed treatment initiation among Human Immunodeficiency Virus -infected individuals in Africa, including Ethiopia, leads to disease progression and increased mortality risk. This study aimed to identify the factors contributing to the death of HIV patients under treatment at second line regimen in public hospitals of North Wollo and Waghemira Zones. A retrospective cohort study with 474 patients was conducted in selected hospitals of North Wollo and Waghemira Zones. A parametric Weibull regression model was employed, and the adjusted hazard ratio served as the measure of association. Variables significantly affected the outcome of the study was determined at a p-value < 0.05, along with a 95% confidence interval for the variables. The patients were within the average age of 38.6(standard deviation ± 12.5) years and majority (45.57%) had no formal education. The overall death incidence rate among second-line anti-retroviral treatment patients was 1.98 per 100-person years [95% CI 1.4-2.9%]. Poor adherence to antiretroviral treatment, male gender, and being underweight significantly increased the hazard of death. Conversely, increased anti-retroviral treatment duration had a significant and negative impact, reducing the hazard of death among patients. The study reveals a high incidence of death among second line anti-retroviral treatment users. Independent predictors include poor adherence, male gender, and underweight status, all significantly increasing the risk of death. On the positive side, the hazard of death decreases with longer anti-retroviral treatment duration. A critical concern and counseling should be given for better ART adherence, to change their nutritional status and for males.
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Affiliation(s)
- Atitegeb Abera Kidie
- Department of Public Health, College of Health Science, Woldia University, Woldia, Ethiopia.
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Grønningen E, Nanyaro M, Blomberg B, Hassan S, Ngadaya E, Mustafa T. Mortality among extrapulmonary tuberculosis patients in the HIV endemic setting: lessons from a tertiary level hospital in Mbeya, Tanzania. Sci Rep 2024; 14:10916. [PMID: 38740851 DOI: 10.1038/s41598-024-61589-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 05/07/2024] [Indexed: 05/16/2024] Open
Abstract
Extrapulmonary tuberculosis (EPTB) has received less attention than pulmonary tuberculosis due to its non-contagious nature. EPTB can affect any organ and is more prevalent in people living with HIV. Low- and middle-income countries are now facing the double burden of non-communicable diseases (NCDs) and HIV, complicating the management of patients with symptoms that could be compatible with both EPTB and NCDs. Little is known about the risk of death of patients presenting with symptoms compatible with EPTB. We included patients with a clinical suspicion of EPTB from a tertiary level hospital in Mbeya, Tanzania, to assess their risk of dying. A total of 113 (61%) patients were classified as having EPTB, and 72 (39%) as having non-TB, with corresponding mortality rates of 40% and 41%. Associated factors for mortality in the TB groups was hospitalization and male sex. Risk factors for hospitalization was having disease manifestation at any site other than lymph nodes, and comorbidities. Our results imply that NCDs serve as significant comorbidities amplifying the mortality risk in EPTB. To strive towards universal health coverage, focus should be on building robust health systems that can tackle both infectious diseases, such as EPTB, and NCDs.
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Affiliation(s)
- Erlend Grønningen
- Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, 5020, Bergen, Norway.
- Department of Thoracic Medicine, Haukeland University Hospital, 5021, Bergen, Norway.
| | - Marywinnie Nanyaro
- National Institute for Medical Research, Muhimbili Medical Research Centre, Dar es Salaam, United Republic of Tanzania
| | - Bjørn Blomberg
- Department of Clinical Science, Faculty of Medicine, University of Bergen, 5020, Bergen, Norway
- Department of Medicine, National Center for Tropical Infectious Diseases, Haukeland University Hospital, 5021, Bergen, Norway
| | - Shoaib Hassan
- Department of Clinical Science, Faculty of Medicine, University of Bergen, 5020, Bergen, Norway
| | - Esther Ngadaya
- National Institute for Medical Research, Muhimbili Medical Research Centre, Dar es Salaam, United Republic of Tanzania
| | - Tehmina Mustafa
- Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, 5020, Bergen, Norway
- Department of Thoracic Medicine, Haukeland University Hospital, 5021, Bergen, Norway
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Derseh NM, Agimas MC, Aragaw FM, Birhan TY, Nigatu SG, Alemayehu MA, Tesfie TK, Yehuala TZ, Godana TN, Merid MW. Incidence rate of mortality and its predictors among tuberculosis and human immunodeficiency virus coinfected patients on antiretroviral therapy in Ethiopia: systematic review and meta-analysis. Front Med (Lausanne) 2024; 11:1333525. [PMID: 38707189 PMCID: PMC11066242 DOI: 10.3389/fmed.2024.1333525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 03/26/2024] [Indexed: 05/07/2024] Open
Abstract
Background Tuberculosis (TB) is the leading cause of death among HIV-infected adults and children globally. Therefore, this study was aimed at determining the pooled mortality rate and its predictors among TB/HIV-coinfected patients in Ethiopia. Methods Extensive database searching was done via PubMed, EMBASE, SCOPUS, ScienceDirect, Google Scholar, and Google from the time of idea conception on March 1, 2023, to the last search via Google on March 31, 2023. A meta-analysis was performed using the random-effects model to determine the pooled mortality rate and its predictors among TB/HIV-coinfected patients. Heterogeneity was handled using subgroup analysis, meta-regression, and sensitivity analysis. Results Out of 2,100 records, 18 articles were included, with 26,291 total patients. The pooled incidence rate of mortality among TB/HIV patients was 12.49 (95% CI: 9.24-15.74) per 100 person-years observation (PYO); I2 = 96.9%. The mortality rate among children and adults was 5.10 per 100 PYO (95% CI: 2.15-8.01; I2 = 84.6%) and 15.78 per 100 PYO (95% CI: 10.84-20.73; I2 = 97.7%), respectively. Age ≥ 45 (pooled hazard ratios (PHR) 2.58, 95% CI: 2.00- 3.31), unemployed (PHR 2.17, 95% CI: 1.37-3.46), not HIV-disclosed (PHR = 2.79, 95% CI: 1.65-4.70), bedridden (PHR 5.89, 95% CI: 3.43-10.12), OI (PHR 3.5, 95% CI: 2.16-5.66), WHO stage IV (PHR 3.16, 95% CI: 2.18-4.58), BMI < 18.5 (PHR 4.11, 95% CI: 2.28-7.40), anemia (PHR 4.43, 95% CI: 2.73-7.18), EPTB 5.78, 95% CI: 2.61-12.78 significantly affected the mortality. The effect of TB on mortality was 1.95 times higher (PHR 1.95, 95% CI: 1.19-3.20; I2 = 0) than in TB-free individuals. Conclusions The mortality rate among TB/HIV-coinfected patients in Ethiopia was higher compared with many African countries. Many clinical factors were identified as significant risk factors for mortality. Therefore, TB/HIV program managers and clinicians need to design an intervention early.
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Affiliation(s)
- Nebiyu Mekonnen Derseh
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Muluken Chanie Agimas
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Fantu Mamo Aragaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tilahun Yemanu Birhan
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Solomon Gedlu Nigatu
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Meron Asmamaw Alemayehu
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tigabu Kidie Tesfie
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tirualem Zeleke Yehuala
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tilahun Nega Godana
- Department of Internal Medicine, School of Medicine, University of Gondar Comprehensive Specialized Hospital, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mehari Woldemariam Merid
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Bantie B, Gebeyehu NA, Adella GA, Kassie GA, Mengstie MA, Abebe EC, Seid MA, Gesese MM, Tegegne KD, Anley DT, Zemene MA, Dessie AM, Feleke SF, Dejenie TA, Kebede YS, Chanie ES, Kerebeh G, Bayih WA, Moges N. Trends of Body Mass Index changes among adults on antiretroviral therapy in Northwest Ethiopia: a longitudinal data analysis. Sci Rep 2024; 14:5265. [PMID: 38438418 PMCID: PMC10912088 DOI: 10.1038/s41598-024-53701-0] [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: 07/14/2023] [Accepted: 02/03/2024] [Indexed: 03/06/2024] Open
Abstract
Nutritional status is considered a major diagnostic and prognostic indicator of HIV/AIDS in adults. In this aspect, current HIV-treatment guidelines, particularly in low-income countries, recommend the regular monitoring of body mass index (BMI) to determine patients' clinical response to antiretroviral therapy (ART). However, data regarding the change in BMI status of HIV-positive adults on ART following the implementation of the test and treat strategy were limited in Ethiopia. Hence, this study is aimed at investigating the trends of BMI change over time and its associated factors among HIV-positive adults in Northwest Ethiopia. A retrospective longitudinal study was conducted among 404 randomly selected HIV-positive adults receiving ART in Felegehiwot Comprehensive Specialized Hospital (FHCSH), Northern Ethiopia. Data were extracted from the medical record charts of study participants, entered into Epi-data 4.6 software, and exported to Stata 14.2 software for analysis. A generalized estimating equation (GEE) model was fitted to determine the change in BMI status over time and its predictors in HIV-positive adults. The level of significance was declared at a p-value of < 0.05. More than half (201, or 51.73%) of the total 404 participants were female. In the cohort, both the baseline and follow-up mean body mass index levels of the participants fell in the normal range and increased from 20.34 (standard deviation/SD ± 2.8) to 21.41 (SD ± 3.13). The individual profile plots of 50 participants indicated that there is considerable variability in weight change across individuals. Duration of ART follow-up (β = 0.203, 95% confidence interval (CI) 0.16 to 0.24), unemployment (β = - 0.96, 95% CI 1.67 to - 0.25), WHO stage III/IV HIV disease (β = - 0.92, 95% CI - 1.57 to - 0.35),and Tenofovir/Lamivudine/Dolutegravir (TDF/3TC/DTG)ART regimen (β = 0.95, 95% CI 0.32 to 1.57) were identified as significant predictors of change in the BMI status of participants. Likewise, the interaction of TDF/3TC/DTG ART regimen * follow-up duration (β = 2.16, 95% CI 1.84 to 2.84), WHO stage III/IV clinical disease * follow-up duration (β = - 1.43, 95% CI - 1.71 to - 1.15) and TB/HIV co-infection * follow-up duration (β = 1.89, 95% CI 1.57 to 2.87) significantly affects the trend in BMI change status of HIV-positive adults. In this study, the BMI status of HIV-positive adults receiving ART increased with a linear trend. Unemployment, stage III/IV HIV diseases, and Tenofovir/Lamivudine/Efavirenz (TDF/3TC/EFV) ART-drug regimen decreases the mean BMI status of HIV-positive adults. Special consideration and strict follow-up need to be given to those individuals with advanced HIV/AIDS diseases and other identified risk group.
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Affiliation(s)
- Berihun Bantie
- Department of Comprehensive Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia.
| | - Natnael Atnafu Gebeyehu
- Department of Midwifery, College of Medicine and Health Science, Wolaita Sodo University, Wolaita, Ethiopia
| | - Getachew Asmare Adella
- Department of Reproductive Health and Nutrition, School of Public Health, Woliata Sodo University, Sodo, Ethiopia
| | - Gizachew Ambaw Kassie
- Department of Epidemiology and Biostatistics, School of Public Health, Woliata Sodo University, Sodo, Ethiopia
| | - Misganaw Asmamaw Mengstie
- Department of Biochemistry, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Endeshaw Chekol Abebe
- Department of Biochemistry, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Mohammed Abdu Seid
- Unit of Physiology, Department of Biomedical Science, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Molalegn Mesele Gesese
- Department of Midwifery, College of Medicine and Health Science, Wolaita Sodo University, Wolaita, Ethiopia
| | - Kirubel Dagnaw Tegegne
- Department of Nursing, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Denekew Tenaw Anley
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Melkamu Aderajew Zemene
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Anteneh Mengist Dessie
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Sefineh Fenta Feleke
- Department of Public Health, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Tadesse Asmamaw Dejenie
- Department of Medical Biochemistry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yenealem Solomon Kebede
- Department of Medical Laboratory Science, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Ermias Sisay Chanie
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Gashaw Kerebeh
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Wubet Alebachew Bayih
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Natnael Moges
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Mekonnen E, Arega M, Belay DM, Birhanu D, Tesfaw T, Ayele H, Bishaw KA. Time to death and its predictors among under-five children on antiretroviral treatment in public hospitals of Addis Ababa, Addis Ababa, Ethiopia, a retrospective follow up study. PLoS One 2023; 18:e0288475. [PMID: 37471340 PMCID: PMC10358914 DOI: 10.1371/journal.pone.0288475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 06/27/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Child mortality remains a global public health problem, particularly in Sub-Saharan Africa. After initiating ART, the mortality rate among HIV-infected children in Ethiopia was 12-17 deaths per 1000 child-year. OBJECTIVE To determine the time to death and its predictors among under-five children on antiretroviral treatment in public hospitals of Addis Ababa, Ethiopia, from April 12, 2017, to May 12, 2022. METHOD An institution-based retrospective follow-up study was conducted among 415 HIV-infected children at selected public hospitals of the Addis Ababa town administration. Computer generated simple random sampling technique was used to select each sampling unit. Data was extracted using a structured data extraction checklist. Data were entered into EPI data 4.2 and analyzed using STATA 14. The child mortality rate was calculated. The Cox proportional hazards regression model was fitted to identify predictor factors. The result of the study was presented using text, tables, graphs, and charts. An adjusted hazard ratio with a 95% confidence interval and a p-value less than 0.05 was used to declare the level of significance. RESULT A total of 415 (97.42%) of the 426 children on ART were included for analysis. Of these, 41(9.88%) children were died during the following period. The study participants were followed for a total of 8237 person- months of risk time. The overall mortality rate was 4.98 (95% CI: 3.67-6.77) per 1000 child-months. The estimated survival after starting ART was 61.42% at 56 months of follow-up. Severe underweight (AHR = 3.19; 95% CI: 1.32-7.71), tuberculosis (AHR = 3.86; CI: 1.76-8.47), low hemoglobin level (AHR = 2.51; CI: 1.02-6.20), and advanced WHO clinical stages at enrolment (AHR = 3.38; CI: 1.08-10.58) were predictors of death among HIV-infected under-five children on ART. CONCLUSION The incidence of mortality was 4.98 per 1000 child-months. Severe underweight, tuberculosis infection, low hemoglobin level, and advanced WHO clinical stages at enrolment were predictors of death among under-five children on ART.
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Affiliation(s)
- Enyew Mekonnen
- Department Midwifery, Saint Peter Specialized Hospital, Federal Minster of Health, Addis Ababa, Ethiopia
| | - Mikias Arega
- Department of Midwifery, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Dawit Misganaw Belay
- Department of Midwifery, College of Health Sciences, Assosa University, Assosa, Ethiopia
| | - Dires Birhanu
- Department of Nursing, College of Health Science, Dilla University, Dilla, Ethiopia
| | - Tadlo Tesfaw
- Department of Midwifery, Debre Tabor Health Science College, Amhara Regional Health Bureau, Bahir Dar, Ethiopia
| | - Habtamu Ayele
- Department of Midwifery, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Keralem Anteneh Bishaw
- Department of Midwifery, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
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Ulvund I, Dadi GB, Gutteberg A. 'I am struggling to survive' - limited living conditions increase the burden of HIV: A qualitative study. Glob Public Health 2023; 18:2280049. [PMID: 37967520 DOI: 10.1080/17441692.2023.2280049] [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: 03/20/2023] [Accepted: 11/01/2023] [Indexed: 11/17/2023]
Abstract
The human immunodeficiency virus (HIV) continues to have life-limiting health consequences for many individuals and remains a significant threat to global public health. This qualitative study explores the experiences of people living with HIV in Sidama, Ethiopia. Interviews with 19 adults recruited from an HIV outpatient clinic were conducted using a semi-structured interview guide. The analysis method used was systematic text condensation. The results reveal that an HIV diagnosis triggered strong emotions. Economic concerns, stigma, and discrimination also increased the burden of a diagnosis, which could lead to a loss of income or housing. Consequently, informants' ability to maintain a regular life and receive social and psychological support was reduced. Religious faith provided strength to informants, though they stated that some religious leaders do not support antiretroviral therapy. Understanding the everyday challenges of people living with HIV is crucial for health professionals and health programme developers working to promote health and enable people to follow their recommended course of treatment. Person-centred care is recommended. In particular, the poorest should receive attention. It is also crucial to reduce stigma and discriminatory attitudes towards people living with HIV and to motivate faith leaders to prevent HIV stigma and support antiretroviral therapy.
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Affiliation(s)
- Ingeborg Ulvund
- Faculty of Health Sciences and Social Care, Molde University College, Specialized University in Logistics, Molde, Norway
| | - Gezahegn Bekele Dadi
- School of Nursing, Hawassa University-College of Medicine & Health Science, Hawassa, Ethiopia
| | - Anne Gutteberg
- Faculty of Health Sciences and Social Care, Molde University College, Specialized University in Logistics, Molde, Norway
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Association Between Body Mass Index Variation and Early Mortality Among 834 Ethiopian Adults Living with HIV on ART: A Joint Modelling Approach. Infect Dis Ther 2023; 12:227-244. [PMID: 36443546 PMCID: PMC9868028 DOI: 10.1007/s40121-022-00726-5] [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: 09/23/2022] [Accepted: 11/03/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Body mass index (BMI) is a simple and cost-effective tool for monitoring the clinical responses of patients living with human immunodeficiency virus (HIV) after antiretroviral therapy (ART) initiation, especially in resource-limited settings where access to laboratory tests are limited. Current evidence on the association between longitudinal BMI variation and clinical outcomes among adults living with HIV receiving ART is essential to inform clinical guidelines. Therefore, this study examines the association between BMI variation and premature mortality in adults living with HIV on ART. METHODS An institution-based retrospective cohort study was conducted among 834 adults living with HIV receiving ART from June 2014 to June 2020 at Debre Markos Comprehensive Specialized Hospital in Northwest Ethiopia. We first identified predictors of mortality and BMI variation using proportional hazards regression and linear mixed models, respectively. Then, the two models were combined to form an advanced joint model to examine the effect of longitudinal BMI variation on mortality. RESULTS Of the 834 participants, 49 (5.9%) died, with a mortality rate of 4.1 (95% CI 3.1, 5.4) per 100 person-years. A unit increase in BMI after ART initiation corresponded to an 18% reduction in mortality risk. Patients taking tuberculosis preventive therapy (TPT), mild clinical disease stage, and changing ART regimens were at lower risk of death. However, patients with ambulatory/bedridden functional status were at higher risk of death. Regarding BMI variation over time, patients presenting with opportunistic infections (OIs), underweight patients, patients who started a Dolutegravir (DGT)-based ART regimen, and those with severe immunodeficiency had a higher BMI increase over time. However, patients from rural areas and overweight/obese patients experienced a lower BMI increase over time. CONCLUSION BMI improvement after ART initiation was strongly associated with a lower mortality risk, regardless of BMI category. This finding implies that BMI may be used as a better predictor tool for death risk in adults living with HIV in Ethiopia. Additionally, patients who took a DGT-based ART regimen had a higher BMI increase rate over time, which aligns with possible positive effects, such as weight gain, of the DGT-based ART regimen in developing countries.
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Tamí-Maury I, Tundealao S, Guzman J, Noé-Díaz V, Markham C, Vigil K. Developing and pre-testing a digital decision-tree smartphone application for smoking prevention and cessation among HIV care providers. Digit Health 2023; 9:20552076231179029. [PMID: 37312958 PMCID: PMC10259109 DOI: 10.1177/20552076231179029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 05/12/2023] [Indexed: 06/15/2023] Open
Abstract
Objectives The diagnosis and continuous care of chronic conditions such as HIV infection present potential teachable moments for delivering smoking prevention and cessation interventions for patients. We designed and pre-tested a prototype of a smartphone application(app), Decision-T, specifically designed to assist healthcare providers when providing personalized smoking prevention and cessation services to their patients. Methods We developed the Decision-T app based on transtheoretical algorithm for smoking prevention and cessation following the 5-A's model. We employed a mixed-methods approach among 18 HIV-care providers recruited from Houston Metropolitan Area for pre-testing the app. Each provider participated in three mock sessions, and the average time spent at each session was measured. We measured accuracy by comparing the smoking prevention and cessation treatment offered by the HIV-care provider using the app to that chosen by the tobacco specialist who designed the case. The system usability scale (SUS) was used to assess usability quantitatively , while individual interview transcripts were analyzed to determine usability qualitatively. STATA-17/SE and Nvivo-V12 were used for quantitative and qualitative analysis, respectively. Results The average time for completing each mock session was 5 min 17 s. The participants achieved an overall average accuracy of 89.9%. The average SUS score achieved was 87.5(±10.26). After analyzing the transcripts, five themes (app's contents are beneficial and straightforward, design is easy to understand, user's experience is uncomplicated, tech is intuitive, and app needs improvements) emerged. Conclusions The decision-T app can potentially increase HIV-care providers' engagement in offering smoking prevention and cessation behavioral and pharmacotherapy recommendations to their patients briefly and accurately.
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Affiliation(s)
- Irene Tamí-Maury
- School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Samuel Tundealao
- School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Jenna Guzman
- School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Valeri Noé-Díaz
- Department of Psychology, Universidad Intercontinental, México City, Mexico
| | - Christine Markham
- School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Karen Vigil
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
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Leshargie CT, Demant D, Burrowes S, Frawley J. Incidence and predictors of mortality among adolescents on antiretroviral therapy in Amhara Region, Ethiopia: a retrospective cohort analysis. BMJ Open 2022; 12:e063879. [PMID: 36351711 PMCID: PMC9664312 DOI: 10.1136/bmjopen-2022-063879] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE This study aimed to assess the incidence and predictors of mortality in adolescents receiving antiretroviral therapy (ART) in Ethiopia's Amhara Region. DESIGN We conducted an institution-based retrospective follow-up study. SETTINGS The study was conducted at Amhara Region's comprehensive specialised hospitals in Ethiopia. PARTICIPANTS We included 961 randomly selected medical records of adolescents receiving ART between January 2005 and June 2020. PRIMARY AND SECONDARY OUTCOMES The incidence of mortality since ART treatment initiation served as the primary outcome, and predictors of mortality served as secondary outcomes. We used Cox proportional hazard regression to examine the relationship between mortality and its predictors. Variables with p values<0.05 in the multivariable analysis were considered statistically significant mortality predictors. Adjusted HR (aHR) with 95% CI was used to measure the strength of association. RESULTS More than half (n=496, 53.5%) of the adolescents living with HIV (ALHIV) were girls. The adolescent mortality rate was 1.52 (95% CI: 1.04 to 1.53) per 100 person-years throughout the follow-up period of 81 583 adolescent months. Mortality was higher for ALHIV who had not received formal education (aHR: 3.27, 95% CI: 1.36 to 7.87), had widowed parents (aHR: 1.85, CI: 95% 1.01 to 3.56) or received no social support (aHR: 2.81, 95% CI: 1.69 to 4.67). Adolescents who had opportunistic infections (OIs) at ART initiation (aHR: 1.94, 95% CI: 1.19 to 3.14), low haemoglobin (Hgb/g/l) levels (aHR: 2.17, 95% CI: 1.08 to 4.18), a bedridden functional status (aHR: 3.11, 95% CI: 1.64 to 5.72), stage IV clinical staging (aHR: 3.03, 95% CI: 1.46 to 6.30), non-disclosing status (aHR: 2.24, 95% CI:1.36 to 3.69) and CD4 count 200-350 cells/mm3 (aHR: 2.17, 95% CI: 1.08 to 4.18) also had a higher risk of death. Not receiving cotrimoxazole preventive therapy (aHR: 1.85, 95% CI: 1.07 to 3.22) and poor adherence to ART (aHR: 2.24, 95% CI: 1.27 to 3.95), compared with adherent, was associated with higher mortality risk. Changed treatment regimens were associated with lower mortality (aHR: 0.59, 95% CI: 0.35 to 0.98). CONCLUSIONS Our study found a lower mortality rate for adolescents with HIV than previous Ethiopian studies, but our significant mortality predictors were similar to those found in earlier studies of adults and adolescents. Our findings reveal a potential point for health service improvement in Ethiopia: incorporating monitoring of Hgb levels into patient follow-up care, supporting recommendations that clinicians emphasise managing OIs and providing counselling services to improve adherence.
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Affiliation(s)
- Cheru Tesema Leshargie
- Department of Public Health, College of Health Science, Debre Markos University, Debre Markos, Amhara, Ethiopia
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Daniel Demant
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | | | - Jane Frawley
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
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Buju RT, Akilimali PZ, Tran NT, Kamangu EN, Mesia GK, Kayembe JMN, Situakibanza HN. Determinants of Survival of HIV Patients Receiving Dolutegravir: A Prospective Cohort Study in Conflict-Affected Bunia, Democratic Republic of Congo. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10220. [PMID: 36011850 PMCID: PMC9407849 DOI: 10.3390/ijerph191610220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/15/2022] [Accepted: 08/16/2022] [Indexed: 06/15/2023]
Abstract
This study aims to determine the factors influencing HIV-related mortality in settings experiencing continuous armed conflict atrocities. In such settings, people living with HIV (PLHIV), and the partners of those affected may encounter specific difficulties regarding adherence to antiretroviral therapy (ART), and retention in HIV prevention, treatment, and care programs. Between July 2019 and July 2021, we conducted an observational prospective cohort study of 468 PLHIV patients treated with Dolutegravir at all the ART facilities in Bunia. The probability of death being the primary outcome, as a function of time of inclusion in the cohort, was determined using Kaplan-Meier plots. We used the log-rank test to compare survival curves and Cox proportional hazard modeling to determine mortality predictors from the baseline to 31 July 2021 (endpoint). The total number of person-months (p-m) was 3435, with a death rate of 6.70 per 1000 p-m. Compared with the 35-year-old reference group, older patients had a higher mortality risk. ART-naïve participants at the time of enrollment had a higher mortality risk than those already using ART. Patients with a high baseline viral load (≥1000 copies/mL) had a higher mortality risk compared with the reference group (adjusted hazard ratio = 6.04; 95% CI: 1.78-20.43). One-fourth of deaths in the cohort were direct victims of armed conflict, with an estimated excess death of 35.6%. Improving baseline viral load monitoring, starting ART early in individuals with high baseline viral loads, the proper tailoring of ART regimens and optimizing long-term ART, and care to manage non-AIDS-related chronic complications are recommended actions to reduce mortality. Not least, fostering women's inclusion, justice, peace, and security in conflict zones is critical in preventing premature deaths in the general population as well as among PLHIV.
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Affiliation(s)
- Roger T. Buju
- Department of Public Health, Faculty of Medicine, University of Bunia, Bunia P.O. Box 292, Congo
| | - Pierre Z. Akilimali
- Department of Biostatistics and Epidemiology, Kinshasa School of Public Health, University of Kinshasa, Kinshasa P.O. Box 11850, Congo
| | - Nguyen-Toan Tran
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, P.O. Box 123, Sydney, NSW 2007, Australia
- Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, 1206 Genève, Switzerland
| | - Erick N. Kamangu
- Département des Sciences de Base, School of Medicine, University of Kinshasa, Kinshasa P.O. Box 11850, Congo
| | - Gauthier K. Mesia
- Unité de Pharmacologie Clinique et Pharmacovigilance, School of Medicine, University of Kinshasa, Kinshasa P.O. Box 11850, Congo
| | - Jean Marie N. Kayembe
- Department Internal Medicine, School of Medicine, University of Kinshasa, Kinshasa P.O. Box 11850, Congo
| | - Hippolyte N. Situakibanza
- Department Internal Medicine, School of Medicine, University of Kinshasa, Kinshasa P.O. Box 11850, Congo
- Department of Tropical Medicine, Infectious and Parasitic Diseases, School of Medicine, University of Kinshasa, Kinshasa P.O. Box 11850, Congo
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Socio-Economic and Demographic Factors Associated with Knowledge and Attitude of HIV/AIDS among Women Aged 15–49 Years Old in Indonesia. Healthcare (Basel) 2022; 10:healthcare10081545. [PMID: 36011201 PMCID: PMC9408652 DOI: 10.3390/healthcare10081545] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 08/08/2022] [Accepted: 08/11/2022] [Indexed: 12/03/2022] Open
Abstract
Women’s susceptibility to HIV/AIDS infection is related to socio-economic and demographic factors. This study sought to analyze socio-economic and demographic factors related to knowledge and attitude of HIV/AIDS among women aged 15–49 years old in Indonesia. We conducted a secondary data analysis using the 2017 Indonesian Demographic and Health Survey (IDHS). Among 49,627 women, our study analyzed 25,895 women aged 15–49 years familiar with HIV terminology. Multiple logistic regression was utilized to analyze associations between socio-economic and demographic factors with knowledge and attitudes toward HIV/AIDS. Women’s age, education level, wealth quintile, residential area and region, access to information, owning cell phones and autonomy were significantly associated with positive knowledge and attitudes toward HIV/AIDS. These findings revealed that several demographical and social factors contribute to knowledge and attitudes toward HIV/AIDS among women aged 15–49 years in Indonesia.
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Amour MA, Shayo GA, Matee MM, Machumi L, Rugarabamu A, Aris EA, Sunguya BF, Mugusi FM. Predictors of mortality among adolescents and young adults living with HIV on antiretroviral therapy in Dar es Salaam, Tanzania: a retrospective cohort study. J Int AIDS Soc 2022; 25:e25886. [PMID: 35192739 PMCID: PMC8863353 DOI: 10.1002/jia2.25886] [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: 04/26/2021] [Accepted: 01/21/2022] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Global AIDS-related deaths have declined by only 10% among adolescents since its peak in 2003. This is disproportionately low compared to a decline of 74% among children aged 0-9 years old. We determined the magnitude of, and predictors of mortality among adolescents and young adults living with HIV on antiretroviral therapy (ART) in Dar-es-Salaam, Tanzania. METHODS A retrospective cohort study was conducted among adolescents (aged 10-19) and young adults (aged 20-24) living with HIV and enrolled in care and treatment centres in Dar es Salaam, Tanzania between January 2015 and December 2019. Data were analysed using STATA version 16. Cumulative hazard curves were used to estimate and illustrate 1-year mortality. Predictors for mortality were assessed by the Fine and Gray competing risk regression model. Sub-hazard ratios (SHR) and 95% confidence intervals (95% CI) were then reported. RESULTS A total of 15,874 young people living with HIV were included: 4916 (31.3%) were adolescents and 10,913 (68.7%) were young adults. A total of 3843 (77.5%) adolescents and 9517 (87.2%) young adults were female. Deaths occurred in 2.3% (114/4961) of adolescents and 1.2% (135/10,913) of young adults (p < 0.001). Over a follow-up of 9292 person-years, the mortality rate was 3.8 per 100 person years [95% CI 3.2-4.6/100 person-years] among adolescents and 2.1 per 100 person-years among young adults [95% CI 1.8-2.5/100 person-years]. Independent predictors of mortality among adolescents were male sex (adjusted (SHR) aSHR = 1.90, 95% CI: 1.3-2.8), CD4 count < 200 cells/mm3 (aSHR = 2.7, 95% CI: 1.4-5.0) and attending a private health facility (aSHR = 1.7, 95% CI: 1.1-2.5). Predictors of mortality among young adults were CD4 count < 200 cells/mm3 (aSHR = 2.8, 95% CI 1.7-4.5), being underweight (aSHR = 2.1, 95% CI: 1.4-3.3) and using nevirapine-based therapy (aHR = 8.3, 95% CI: 3.5-19.5). CONCLUSIONS The mortality rate for persons living with HIV and on ART in Tanzania was significantly higher in adolescents than young adults. Age- and sex-specific risk factors identify targets for intervention to reduce mortality among affected adolescents and young adults.
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Affiliation(s)
- Maryam A Amour
- Department of Community Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Grace A Shayo
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Mecky M Matee
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Lameck Machumi
- Management and Development for Health, Dar es Salaam, Tanzania
| | | | - Eric A Aris
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Bruno F Sunguya
- Department of Community Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Ferdinand M Mugusi
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Mbewe N, Vinikoor MJ, Fwoloshi S, Mwitumwa M, Lakhi S, Sivile S, Yavatkar M, Lindsay B, Stafford K, Hachaambwa L, Mulenga L, Claassen CW. Advanced HIV disease management practices within inpatient medicine units at a referral hospital in Zambia: a retrospective chart review. AIDS Res Ther 2022; 19:10. [PMID: 35193598 PMCID: PMC8862513 DOI: 10.1186/s12981-022-00433-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 02/02/2022] [Indexed: 12/04/2022] Open
Abstract
Background Zambia recently achieved UNAIDS 90-90-90 treatment targets for HIV epidemic control; however, inpatient facilities continue to face a large burden of patients with advanced HIV disease and HIV-related mortality. Management of advanced HIV disease, following guidelines from outpatient settings, may be more difficult within complex inpatient settings. We evaluated adherence to HIV guidelines during hospitalization, including opportunistic infection (OI) screening, treatment, and prophylaxis. Methods We reviewed inpatient medical records of people living with HIV (PLHIV) admitted to the University Teaching Hospital in Lusaka, Zambia between December 1, 2018 and April 30, 2019. We collected data on patient demographics, antiretroviral therapy (ART), HIV biomarkers, and OI screening and treatment—including tuberculosis (TB), Cryptococcus, and OI prophylaxis with co-trimoxazole (CTX). Screening and treatment cascades were constructed based on the 2017 WHO Advanced HIV Guidelines. Results We reviewed files from 200 charts of patients with advanced HIV disease; of these 92% (184/200) had been on ART previously; 58.1% (107/184) for more than 12 months. HIV viral load (VL) testing was uncommon but half of VL results were high. 39% (77/200) of patients had a documented CD4 count result. Of the 172 patients not on anti-TB treatment (ATT) on admission, TB diagnostic tests (either sputum Xpert MTB/RIF MTB/RIF or urine TB-LAM) were requested for 105 (61%) and resulted for 60 of the 105 (57%). Nine of the 14 patients (64%) with a positive lab result for TB died before results were available. Testing for Cryptococcosis was performed predominantly in patients with symptoms of meningitis. Urine TB-LAM testing was rarely performed. Conclusions At a referral hospital in Zambia, CD4 testing was inconsistent due to laboratory challenges and this reduced recognition of AHD and implementation of AHD guidelines. HIV programs can potentially reduce mortality and identify PLHIV with retention and adherence issues through strengthening inpatient activities, including reflex VL testing, TB-LAM and serum CrAg during hospitalization.
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