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Edun O, Okell L, Chun H, Bissek ACZ, Ndongmo CB, Shang JD, Brou H, Ehui E, Ekra AK, Nuwagaba-Biribonwoha H, Dlamini SS, Ginindza C, Eshetu F, Misganie YG, Desta SL, Achia TNO, Aoko A, Jonnalagadda S, Wafula R, Asiimwe FM, Lecher S, Nkanaunena K, Nyangulu MK, Nyirenda R, Beukes A, Klemens JO, Taffa N, Abutu AA, Alagi M, Charurat ME, Dalhatu I, Aliyu G, Kamanzi C, Nyagatare C, Rwibasira GN, Jalloh MF, Maokola WM, Mgomella GS, Kirungi WL, Mwangi C, Nel JA, Minchella PA, Gonese G, Nasr MA, Bodika S, Mungai E, Patel HK, Sleeman K, Milligan K, Dirlikov E, Voetsch AC, Shiraishi RW, Imai-Eaton JW. HIV risk behaviour, viraemia, and transmission across HIV cascade stages including low-level viremia: Analysis of 14 cross-sectional population-based HIV Impact Assessment surveys in sub-Saharan Africa. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003030. [PMID: 38573931 PMCID: PMC10994324 DOI: 10.1371/journal.pgph.0003030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 02/25/2024] [Indexed: 04/06/2024]
Abstract
As antiretroviral treatment (ART) coverage for people living with HIV (PLHIV) increases, HIV programmes require up-to-date information about evolving HIV risk behaviour and transmission risk, including those with low-level viremia (LLV; >50 to ≤1000 copies/mL), to guide prevention priorities. We aimed to assess differences in sexual risk behaviours, distribution of viral load (VL) and proportion of transmission across PLHIV subgroups. We analysed data from Population-based HIV Impact Assessment surveys in 14 sub-Saharan African countries during 2015-2019. We estimated adjusted prevalence ratios (aPR) of self-reported HIV high-risk behaviour (multiple partners and condomless sex) across cascade stages via generalised estimation equations. We modelled the proportions of transmission from each subgroup using relative self-reported sexual risk, a Hill function for transmission rate by VL, and proportions within cascade stages from surveys and UNAIDS country estimates for 2010-2020. Compared to PLHIV with undetectable VL (≤50 copies/mL), undiagnosed PLHIV (aPR women: 1.28 [95% CI: 1.08-1.52]; men: 1.61 [1.33-1.95]) and men diagnosed but untreated (2.06 [1.52-2.78]) were more likely to self-report high-risk sex. High-risk behaviour was not significantly associated with LLV. Mean VL was similar among undiagnosed, diagnosed but untreated, and on ART but non-suppressed sub-groups. Across surveys, undiagnosed and diagnosed but untreated contributed most to transmission (40-91% and 1-41%, respectively), with less than 1% from those with LLV. Between 2010 and 2020, the proportion of transmission from individuals on ART but non-suppressed increased. In settings with high ART coverage, effective HIV testing, ART linkage, and retention remain priorities to reduce HIV transmission. Persons with LLV are an increasing share of PLHIV but their contribution to HIV transmission was small. Improving suppression among PLHIV on ART with VL ≥1000 copies/mL will become increasingly important.
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Affiliation(s)
- Olanrewaju Edun
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
| | - Lucy Okell
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
| | - Helen Chun
- U.S. Centers for Disease Control and Prevention - Division of Global HIV/TB, Center for Global Health, Atlanta, Georgia, United States of America
| | - Anne-Cecile Z. Bissek
- Division of Health Operations Research, Ministry of Public Health, Yaoundé, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé, Yaoundé, Cameroon
| | - Clement B. Ndongmo
- U.S. Centers for Disease Control and Prevention - Division of Global HIV/TB, Center for Global Health, Yaoundé, Cameroon
| | - Judith D. Shang
- U.S. Centers for Disease Control and Prevention - Division of Global HIV/TB, Center for Global Health, Yaoundé, Cameroon
| | - Hermann Brou
- ICAP, Columbia University, Abidjan, Côte d’Ivoire
| | - Eboi Ehui
- National AIDS Control Programme, Ministry of Health, Public Hygiene and Universal Health Coverage, Abidjan, Côte d’Ivoire
| | - Alexandre K. Ekra
- U.S. Centers for Disease Control and Prevention - Division of Global HIV/TB, Center for Global Health, Abidjan, Côte d’Ivoire
| | | | | | | | - Frehywot Eshetu
- U.S. Centers for Disease Control and Prevention Division of Global HIV/TB, Center for Global Health, Addis Ababa, Ethiopia
| | - Yimam G. Misganie
- Ethiopian Public Health Institute, HIV/AIDS and TB Research Directorate, Addis Ababa, Ethiopia
- School of Medicine, Zhejiang University, Hangzhou, China
| | - Sileshi Lulseged Desta
- ICAP in Ethiopia, Mailman School of Public Health, Columbia University, Addis Ababa, Ethiopia
| | - Thomas N. O. Achia
- U.S. Centers for Disease Control and Prevention - Division of Global HIV/TB, Center for Global Health, Nairobi, Kenya
| | - Appolonia Aoko
- U.S. Centers for Disease Control and Prevention - Division of Global HIV/TB, Center for Global Health, Nairobi, Kenya
| | - Sasi Jonnalagadda
- U.S. Centers for Disease Control and Prevention - Division of Global HIV/TB, Center for Global Health, Nairobi, Kenya
| | - Rose Wafula
- National AIDS and STI Control Programme, Ministry of Health, Nairobi, Kenya
| | - Fred M. Asiimwe
- U.S. Centers for Disease Control and Prevention - Division of Global HIV/TB, Center for Global Health, Maseru, Lesotho
| | - Shirley Lecher
- U.S. Centers for Disease Control and Prevention - Division of Global HIV/TB, Center for Global Health, Maseru, Lesotho
| | - Kondwani Nkanaunena
- U.S. Centers for Disease Control and Prevention - Division of Global HIV/TB, Center for Global Health, Lilongwe, Malawi
| | - Mtemwa K. Nyangulu
- U.S. Centers for Disease Control and Prevention - Division of Global HIV/TB, Center for Global Health, Lilongwe, Malawi
| | - Rose Nyirenda
- Department of HIV/AIDS, Ministry of Health, Lilongwe, Malawi
| | - Anita Beukes
- U.S. Centers for Disease Control and Prevention - Division of Global HIV/TB, Center for Global Health, Windhoek, Namibia
| | | | - Negussie Taffa
- Ministry of Health and Social Services, Windhoek, Namibia
| | - Andrew A. Abutu
- U.S. Centers for Disease Control and Prevention - Division of Global HIV/TB, Center for Global Health, Abuja, Nigeria
| | - Matthias Alagi
- U.S. Centers for Disease Control and Prevention - Division of Global HIV/TB, Center for Global Health, Abuja, Nigeria
| | - Man E. Charurat
- Center for International Health, Education, and Biosecurity (Ciheb), University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Ibrahim Dalhatu
- U.S. Centers for Disease Control and Prevention - Division of Global HIV/TB, Center for Global Health, Abuja, Nigeria
| | - Gambo Aliyu
- National Agency for the Control of AIDS, Abuja, Nigeria
| | | | - Celestine Nyagatare
- U.S. Centers for Disease Control and Prevention - Division of Global HIV/TB, Center for Global Health, Kigali, Rwanda
| | - Gallican N. Rwibasira
- HIV, STIs, Viral Hepatitis & OVDC Department, Rwanda Biomedical Center, Kigali, Rwanda
| | - Mohamed F. Jalloh
- U.S. Centers for Disease Control and Prevention - Division of Global HIV/TB, Center for Global Health, Dar es Salaam, Tanzania
| | - Werner M. Maokola
- National AIDS Control Programme, Tanzania Ministry of Health, Dar es Salaam, Tanzania
| | - George S. Mgomella
- U.S. Centers for Disease Control and Prevention - Division of Global HIV/TB, Center for Global Health, Dar es Salaam, Tanzania
| | | | - Christina Mwangi
- U.S. Centers for Disease Control and Prevention - Division of Global HIV/TB, Center for Global Health, Kampala, Uganda
| | - Jennifer A. Nel
- U.S. Centers for Disease Control and Prevention - Division of Global HIV/TB, Center for Global Health, Kampala, Uganda
| | - Peter A. Minchella
- U.S. Centers for Disease Control and Prevention Division of Global HIV/TB, Center for Global Health, Lusaka, Zambia
| | - Gloria Gonese
- Zimbabwe Technical Assistance, Training and Education Center for Health (Zim-TTECH), Harare, Zimbabwe
| | - Melodie A. Nasr
- U.S. Centers for Disease Control and Prevention - Division of Global HIV/TB, Center for Global Health, Harare, Zimbabwe
- Public Health Institute, Global Health Fellowship Program, United States of America
| | - Stephane Bodika
- U.S. Centers for Disease Control and Prevention - Division of Global HIV/TB, Center for Global Health, Atlanta, Georgia, United States of America
| | - Elisabeth Mungai
- U.S. Centers for Disease Control and Prevention - Division of Global HIV/TB, Center for Global Health, Atlanta, Georgia, United States of America
- eTeam, Somerset, New Jersey, United States of America
| | - Hetal K. Patel
- U.S. Centers for Disease Control and Prevention - Division of Global HIV/TB, Center for Global Health, Atlanta, Georgia, United States of America
| | - Katrina Sleeman
- U.S. Centers for Disease Control and Prevention - Division of Global HIV/TB, Center for Global Health, Atlanta, Georgia, United States of America
| | - Kyle Milligan
- U.S. Centers for Disease Control and Prevention - Division of Global HIV/TB, Center for Global Health, Atlanta, Georgia, United States of America
- Peraton, Herndon, Virginia, United States of America
| | - Emilio Dirlikov
- U.S. Centers for Disease Control and Prevention - Division of Global HIV/TB, Center for Global Health, Atlanta, Georgia, United States of America
| | - Andrew C. Voetsch
- U.S. Centers for Disease Control and Prevention - Division of Global HIV/TB, Center for Global Health, Atlanta, Georgia, United States of America
| | - Ray W. Shiraishi
- U.S. Centers for Disease Control and Prevention - Division of Global HIV/TB, Center for Global Health, Atlanta, Georgia, United States of America
| | - Jeffrey W. Imai-Eaton
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
- Department of Epidemiology, Center for Communicable Disease Dynamics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
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Anbessa O, Hawulte B, Dingeta T, Birhanu A. Incidence and Predictors of Severe Adverse Drug Reactions among Patients on Antiretroviral Drugs in Harari Regional State, Eastern Ethiopia. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2024; 2024:5580728. [PMID: 38283081 PMCID: PMC10817807 DOI: 10.1155/2024/5580728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 01/05/2024] [Accepted: 01/11/2024] [Indexed: 01/30/2024]
Abstract
Background The introduction of combination antiretroviral therapy improves the quality and longevity of people living with HIV/AIDS. However, adverse drug reactions associated with antiretroviral therapy compromise the resulting benefits and have been reported differently worldwide, including Ethiopia. Severe adverse drug reactions are one of the major public health concerns for the reason that they can potentially impede the benefit of antiretroviral therapy and put the patient's survival at risk. Despite many successes achieved with the introduction of the combined antiretroviral therapy, the majority of the patients on antiretroviral therapy experience adverse drug reactions associated with the drugs. Consequently, little is known about the problem in the current study area. This is, therefore, to study incidence and predictors of severe adverse drug reactions among patients on antiretroviral drugs in the Harari region, Eastern Ethiopia. The aim of this study was to assess the incidence and predictors of severe adverse drug reactions among patients on antiretroviral therapy from February 25, 2022, to March 25, 2022, in the Harari region, Eastern Ethiopia. Methods A hospital-based retrospective cohort study was conducted among 449 randomly selected medical records of people living with HIV on first-line antiretroviral therapy. Collected data were entered into EpiData version 3.1 and exported to STATA version 15 for analysis. Kaplan-Meier survival curve with log-rank test was used to compare survival curves for categorical independent variables. A p value ≤0.05 was declared as significant, and an adjusted hazard ratio was used to report the effect size using the multivariate Cox proportional hazard model. Result The overall incidence density of the severe adverse reactions was 7.22 per 1000 months (95% CI: 5.5, 9.6). After adjusting for all potential confounders using multivariable Cox proportional hazard ratio, advanced clinical diseases (AHR = 3.44; 95% CI: 1.54, 7.65), HIV/tuberculosis confections (AHR = 2.38; 95% CI: 1.23, 4.62), and being female (AHR = 3.12; 95% CI: 1.57, 6.18) were significantly associated with the experience of severe adverse drug reactions. Conclusion In this study, the incidence of severe adverse reactions was consistent with the previous studies, and advanced World Health Organization (WHO) clinical stage, HIV/TB confection, and being female were the independent predictors of the severe adverse drug reactions.
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Affiliation(s)
- Obsa Anbessa
- LonAdd Consultancy Plc Seconded by UNICEF at Harari Regional Health Bureau, Harar, Ethiopia
| | - Behailu Hawulte
- School of Public Health, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Tariku Dingeta
- School of Public Health, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Abdi Birhanu
- School of Medicine, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
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Rameto MA, Abdella S, Ayalew J, Tessema M, Bulti J, Bati F, Lulseged S. Prevalence and factors associated with inconsistent condom use among female sex workers in Ethiopia: findings from the national biobehavioral survey, 2020. BMC Public Health 2023; 23:2407. [PMID: 38049776 PMCID: PMC10694951 DOI: 10.1186/s12889-023-17253-8] [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: 06/17/2022] [Accepted: 11/17/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND The HIV prevalence among Ethiopian female sex workers (FSWs) is estimated to be around 18.5%, which implies that FSWs' sexual partners are significantly exposed to HIV infection and that may be a major factor in HIV transmission in the community. However, it has long been known that using condoms correctly and consistently is an extremely cost-effective global method for preventing HIV infection, but inconsistent condom use (ICU) would pose the greatest proximal risk of HIV acquisition and transmission. Understanding the prevalence and associated risk factors of inconsistence condom use among FSWs would inform policymakers to design programmatic interventions in the context of Ethiopia. METHODS This analysis used data from the 'National HIV and STIs Bio-behavioral Survey (NHSBS)', which was conducted between December 2019 up to May 2020 by using a respondent-driven sampling (RDS) technique among FSWs aged 15 years and older who were selling sex in selected major cities and towns in Ethiopia. A multi-level logistic regression model was fitted to assess town and individual-level variations simultaneously to adjust hierarchical variations. Statistical significance was determined by using a P-value less than 0.05 with a 95% confidence interval (CI) not including one. RESULTS Overall, 6,085 FSWs from 16 cities and towns participated in the study. The prevalence of inconsistent condom use across the 16 cities and towns was 17.1% [95% CI (16.5, 17.8)]. Inconsistent condom use was significantly higher among FSWs who had depression compared to those without depression [AOR = 1.43; 95% CI (1.13,1.82)], used any drug [AOR = 1.43; 95% CI (1.14-1.79)], had history of sexual violence [AOR = 1.75; 95% CI (1.43, 2.16)], changed sex selling location [AOR = 1.27; 95% CI (1.06, 1.51)], longer period of sex selling experience [AOR = 3.01; 95% CI (2.27, 3.99)], ever had anal sex [AOR = 2.74; 95% CI (2.15, 3.5)], had ≥ 2 non-paying sexual partner [AOR = 2.99; 95% CI(2.26, 3.95)], selling sex `in more than two cities [AOR = 3.01;95% CI (2.27, 3.99)], who lacked access to condom [AOR = 2.1; 95% CI (1.69, 2.67)], and did not have HIV knowledge [AOR = 1.39; 95% CI (1.15, 1.68)]. CONCLUSION Inconsistent condom use among FSWs is prevalent in Ethiopia and is associated with marital status, education status, depression, alcohol drinking, drug use, sexual violence, being raped, lack of knowledge about HIV, practising anal sex, selling sex in different locations, having more than two non-paying sexual partners, working in more than two cities, and lack of access to condom at the workplace. Programme interventions to enhance consistent condoms use among FSWs need to take these factors into consideration.
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Affiliation(s)
| | - Saro Abdella
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Jemal Ayalew
- Departments of Statistics, College of Natural Science, Wollo University, Dese, Ethiopia
| | | | - Jaleta Bulti
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Fayiso Bati
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Sileshi Lulseged
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Akwara E, Pinchoff J, Abularrage T, White C, Ngo TD. The Urban Environment and Disparities in Sexual and Reproductive Health Outcomes in the Global South: a Scoping Review. J Urban Health 2023:10.1007/s11524-023-00724-z. [PMID: 37052774 PMCID: PMC10100607 DOI: 10.1007/s11524-023-00724-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/08/2023] [Indexed: 04/14/2023]
Abstract
By 2050, the Global South will contain three-quarters of the world's urban inhabitants, yet no standardized categorizations of urban areas exist. This makes it challenging to compare sub-groups within cities. Sexual and reproductive health and rights (SRHR) are a critical component of ensuring that populations are healthy and productive, yet SRHR outcomes within and across urban settings vary significantly. A scoping review of the literature (2010-2022) was conducted to describe the current body of evidence on SRHR in urban settings in the Global South, understand disparities, and highlight promising approaches to improving urban SRHR outcomes. A total of 115 studies were identified, most from Kenya (30 articles; 26%), Nigeria (15; 13%), and India (16; 14%), focusing on family planning (56; 49%) and HIV/STIs (43; 37%). Findings suggest significant variation in access to services, and challenges such as gender inequality, safety, and precarious circumstances in employment and housing. Many of the studies (n = 84; 80%) focus on individual-level risks and do not consider how neighborhood environments, concentrated poverty, and social exclusion shape behaviors and norms related to SRHR. Research gaps in uniformly categorizing urban areas and key aspects of the urban environment make it challenging to understand the heterogeneity of urban environments, populations, and SRHR outcomes and compare across studies. Findings from this review may inform the development of holistic programs and policies targeting structural barriers to SRHR in urban environments to ensure services are inclusive, equitably available and accessible, and direct future research to fill identified gaps.
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Affiliation(s)
| | - Jessie Pinchoff
- Population Council, One Dag Hammarskjold Plaza, New York, NY, 10017, USA.
| | - Tara Abularrage
- Population Council, One Dag Hammarskjold Plaza, New York, NY, 10017, USA
| | - Corinne White
- Population Council, One Dag Hammarskjold Plaza, New York, NY, 10017, USA
| | - Thoai D Ngo
- Population Council, One Dag Hammarskjold Plaza, New York, NY, 10017, USA
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Ghazy RM, Al Awaidy S, Taha SHN. Trends of HIV indicators in Egypt from 1990 to 2021: time-series analysis and forecast toward UNAIDS 90-90-90 targets. BMC Public Health 2023; 23:625. [PMID: 37005670 PMCID: PMC10066021 DOI: 10.1186/s12889-023-15490-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 03/21/2023] [Indexed: 04/04/2023] Open
Abstract
BACKGROUND Infection with Human immunodeficiency virus (HIV) and the development of acquired immunodeficiency syndrome (AIDS) pose severe threats to public health across the world. This study aimed to describe and forecast the trend of HIV indicators, including progress towards the 90-90-90 targets in Egypt since 1990. METHODS The HIV indicators were graphically described, where the X axis is the time in a year and the Y axis is the value of the selected indicator for each year using data retrieved from UNAIDS. We used the Autoregressive Integrated Moving Average (ARIMA) model to forecast different HIV indicators from 2022 to 2024. RESULTS Since 1990, HIV prevalence has been < 0.01, the number of people living with HIV (PLHIV) has increased from < 500 to 30,000 with a higher male predominance since 2010, and the number of children living with HIV has increased from < 100 to 1100. The number of pregnant women who needed antiretroviral treatment (ART) to prevent maternofetal HIV transmission increased from < 500 during 2010-2014 to 780 in 2021, the percentage of women who received ART increased from 3% in 2010 to 18% in 2021, the number of children exposed to HIV who did not get infection increased from < 100 in 1990-1991 to 4900 in 2021. The number of AIDS-related deaths increased from < 100 in 1990 to < 1000 in 2021. Based on forecasting, we expect that by 2024 the number of PLHIV will be 39,325(95%CI, 33,236-37,334), 22% (95%CI, 13.0%-32.0%) of pregnant females will have access to ART, 6100(95%CI, 5714-6485) HIV exposed children will not be infected, 77.0%(95% CI 66.0%-86.0%) of the population who knew their HIV status, and 71.0% (95%CI, 61.0%-81.0%) among those who know their HIV status will be on ART. CONCLUSION HIV is moving forward fast, however, the Egyptian health authority implements different control measures to control its spread.
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Affiliation(s)
- Ramy Mohamed Ghazy
- Tropical Health Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt.
| | | | - Sarah Hamed N Taha
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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