Levels of Adherence and Associated Factors Among Children on ART Over Time in Northwest, Ethiopia: Evidence from a Multicenter Follow-Up Study

Incidence and predictors of opportunistic infections among HIV-infected children on antiretroviral therapy at public health facilities of Southwest Ethiopia People Regional State, 2023: a multicenter retrospective follow-up study

BACKGROUND

Opportunistic infections (OIs) pose a significant threat to children infected with HIV. Despite advancements in antiretroviral therapy (ART), these infections continue to be a public health concern. However, there is limited evidence regarding the incidence and predictors of OIs among HIV-infected children in Ethiopia, particularly in the study area. Therefore, the objective of this study was to assess the incidence and predictors of OIs among HIV-infected children on ART at public health facilities of Southwest Ethiopia People Regional State.

METHODS

The study employed an institution-based retrospective cohort design, conducted from July 1, 2018 to July 31, 2023, among HIV-infected children aged less than 15 years. Data were extracted using the national ART intake and follow-up forms. KoboCollect version 2023.2.4 and STATA version 14.0 were used for data collection and analysis, respectively. The Kaplan-Meier survival curve was used to estimate the probability of OI-free survival time. Variables with P-value < 0.25 in the bivariable Cox proportional hazard model were selected as candidates. In multivariable analysis, P-value < 0.05 and adjusted hazard ratio (AHR) with 95% confidence interval (CI) were used to declare statistically significant predictors.

RESULTS

Of the total 409 HIV infected children, 122(29.8%) developed at least one OI, contributing to 954.95 person-years of risk. The overall incidence rate was 12.8 (95% CI: 10.7, 15.2) per 100 person-years. The OI-free survival probability at the end of the follow-up period was 0.277(95% CI: 0.139, 0.434). The commonest OI was pulmonary tuberculosis, 30.33% (95% CI: 22.7, 39.2). Non-disclosing HIV status (AHR: 2.56, 95% CI: 1.42, 4.63), children aged 10-14 years (AHR: 2.34, 95% CI: 1.10, 4.95), no history of prevention of mother-to-child transmission of HIV (AHR: 2.33, 95% CI: 1.48, 3.66), hemoglobin level < 10 mg/dL (AHR: 2.26, 95% CI: 1.37, 3.75), fair or poor adherence to ART (AHR: 1.74, 95% CI: 1.09, 2.79), and having past history of OIs (AHR: 1.61, 95% CI: 1.03, 2.55) were statistically significant predictors of OIs.

CONCLUSION AND RECOMMENDATIONS

The incidence of OIs was high in the study area. Hence, health facilities need to regularly monitor hemoglobin, enhance ART adherence, provide OI prophylaxis for at-risk children, reinforce PMTCT programs for early OI detection and management, and encourage timely and age-appropriate HIV status disclosure. Caregivers of HIV-infected children are also required to oversee and assist their children in adhering to the ART.

Adherence to Anti-Retroviral Therapy (ART) and Its Determinants Among People Living with HIV/AIDS at Bonga, Kaffa, South-West Ethiopia

Background

The scaling-up of antiretroviral therapy (ART) is the greatest accomplishment to reduce the burden of acquired immunodeficiency syndromes (AIDS) to date. However, it requires optimal adherence to be effective. Thus, this study was designed to assess the level of adherence of people living with HIV (PLWH) to ART and its determinants in one of the hardest-hit areas with HIV in Ethiopia.

Methods

A health facility-based cross-sectional study design was conducted among adult PLWH, age >18 years, and receiving ART in southwest Ethiopia. Data was collected by face-to-face interviews following the Self-Rating Scale Item for drug adherence and from participants' medical cards. The effects of variables related to socio-demographic and socio-economic factors, disease and medication, health facilities, and patients' behavior on ART adherence were analyzed using a binary logistic regression model. The data was analyzed using R software.

Results

Self-reported good adherence to ART recorded in this study was 73.1% (n =301/412). The risk of poor adherence was significantly higher among those who were divorced, merchants, used ART for longer durationsand were found in stage IV WHO pathogenesis. Contrarily, those who had a positive perception of the effectiveness of ART had significantly better adherence to ART. Longer duration on ART and frequency of pills taken, ≥3 pills per day, were significantly associated with a low CD4+ cell count (<500 cells/mm3). For each unit increase in medication frequency per day, the likelihood of having a high viral load of >1000 copies/mL was 5.35 times higher.

Conclusion

The ART adherence documented in this study was graded as moderately low. Some variables, such as clinical, medical, and behavioral, were found to affect the adherence of people living with HIV to ART. Hence, care providers should be aware of such variables in the process of treatment, follow-up, and monitoring of people living with HIV in the study area.

Association of coping mechanisms with medication adherence among young People living with HIV (PLHIV) in Klang Valley

Background

As young People Living with HIV (PLHIV) will need to take antiretroviral therapy (ART) for life, there is a need to understand their coping mechanisms in living with the disease. Lack of coping mechanisms leads to poor medication adherence and hospital follow-up, poor health outcomes and shortened life expectancy.

Objectives

This study aimed to determine the pattern of coping mechanisms in young PLHIV and its association with medication adherence.

Methods

This study was a cross-sectional study amongst young PLHIV patients (aged 20-39 years old) attending two HIV clinics in Klang Valley. Data was collected between February to August 2022. The pattern of coping strategies was assessed using the 28-item Brief Coping Orientation to Problems Experienced (COPE) questionnaire in English and Malay language, which was validated and found to have good internal consistency. Self-reported medication adherence was measured using the one-item Medical Outcomes Study (MOS) Specific Adherence Scale. Statistical analysis included descriptive statistics, single and multiple logistic regression.

Results

A total of 395 respondents were recruited for the study. The mean scores for each coping mechanism were: 1) problem-focused coping 2.98 (SD 0.62), 2) emotion-focused coping 2.40 (SD 0.48), 3) dysfunctional coping 1.84 (SD 0.44) and 4) religion/spirituality coping 3.07 (SD 0.97). The majority of the respondents (66.8%) were adherent to their ART. Respondents who had a longer duration of medication [OR:1.014 (95% CI: 1.002,1.026)] and those who adopted less religion/spirituality coping mechanisms [OR: 0.495 (95% CI:0.246, 0.997)] were found to be significantly associated with medication adherence.

Conclusion

This study revealed an overall medication adherence rate of 66.8%. Patients with longer ART duration and who adopted less religion or spirituality coping had better medication adherence. These study findings provide input into the design of intervention by clinicians and healthcare policy makers for young PLHIV in clinical practice.

Predictors of Suboptimal Adherence Among Children on Antiretroviral Therapy in Southern Ethiopia: A Multicenter Retrospective Follow-Up Study

Objectives: Despite increased access to and availability of antiretroviral therapy, the program's effectiveness is primarily affected by treatment adherence. Therefore, this study aimed to determine the magnitude and predictors of suboptimal adherence among children on ART in Southern Ethiopia. Methods: A multicenter retrospective study was conducted among human immunodeficiency virus (HIV) infected children in Gamo and South Omo zone public health facilities. To identify factors associated with suboptimal adherence, a binary logistic regression model was fitted. Variables with a p-value ≤0.25 in bivariable logistic regression analysis were included in multivariable logistic regression analysis. p-value <0.05 was used to declare statistical significance. Results: The suboptimal adherence was determined to be 30.3% (95% CI: 25.5%, 35.6%). Advanced clinical stage, hemoglobin level <10 mg/dL, unchanged initial regimen, and non-disclosure of HIV sero-status were significant predictors of suboptimal adherence. Conclusion: Suboptimal adherence is a significant public health problem in the study setting. Therefore, designing interventions towards improving adherence is needed especially for children with poor clinical characteristics.