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Tapera T, Odimegwu C, Makoni T, Mukuwapasi W, Chitiyo V, Kadziyanike G, Willis N, Mutsinze A, Mawodzeke M, Chimberengwa P, Phiri M. Intersecting Epidemics: The Predictors of Continued Utilization of HIV Care and Treatment Services During the COVID-19 Outbreak Among People Living with HIV in ZIMBABWE. AIDS Behav 2024; 28:34-46. [PMID: 37861922 PMCID: PMC11469966 DOI: 10.1007/s10461-023-04194-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2023] [Indexed: 10/21/2023]
Abstract
Globally, there have been considerable achievements towards HIV care and treatment. AIDS-related deaths have been reduced by 60% since the peak in 2004. Potentially, the fight against the HIV epidemic was made more difficult with the outbreak of COVID-19. Thus, this study examined the implications of COVID-19 in the utilization of HIV care and treatment services among people living with HIV on antiretroviral therapy (ART) in Zimbabwe. The study aimed to identify the critical factors defining the utilization of HIV services at the advent of COVID-19 using the fifth revision of the Anderson Behavioral Model of Healthcare Utilization. The study utilized a concurrent triangulation design of which only one data collection phase was used. The quantitative data was collected from 2,157 people living with HIV on antiretroviral viral therapy through a structured interviewer-administered questionnaire. On the other hand, qualitative data was collected through in-depth interviews. Regarding accessing ART refills, the study findings revealed that adolescents aged 15-19 (aOR = 2.16; 95% CI: 1.18-3.96) had higher odds of utilizing ART refills compared to their counterparts who were aged 20-24. Living in a rural area was associated with higher odds of utilizing the ART refill service (aOR = 2.20; 95% CI: 1.49-3.24). Regarding accessing viral load monitoring adults aged 25-39 (aOR = 0.41; 95% CI: 0.26-0.66) were less likely to utilize viral load monitoring compared to young people aged 20-24. Being vaccinated for COVID-19 was significantly associated with higher odds of utilizing the viral load monitoring service (aOR = 1.97; 95% CI: 1.36-2.87) than those not yet vaccinated. Living in a rural area was associated with higher odds of utilizing viral load monitoring (aOR = 1.50; 95% CI: 1.09-2.08). Regarding tuberculosis preventative therapy, adults aged 25-39 (aOR = 0.30; 95% CI: 0.20-0.47) were less likely to utilize tuberculosis preventative therapy compared to young people aged 20-24. Being vaccinated for COVID-19 was significantly associated with higher odds of utilizing tuberculosis preventative therapy (aOR = 1.59; 95% CI: 1.12-2.25) than those not yet vaccinated. Living in a rural area was associated with higher odds of utilizing tuberculosis preventive therapy (aOR = 1.58; 95% CI: 1.19-2.08). Regarding tuberculosis screening being vaccinated for COVID-19 was significantly associated with higher odds of utilizing tuberculosis screening services (aOR = 1.89; 95% CI: 1.41-2.54) than those not yet vaccinated. Although the severity of the COVID-19 pandemic has dwindled, COVID-19 appears to come and go in waves, and a few countries are still recording relatively high cases. It is therefore likely that the factors associated with utilization of HIV services identified by the study such as age, residence, type of health facility, vaccination of COVID-19 and fear of contracting COVID-19, among others, need to be included when planning to improve access to health utilization.
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Affiliation(s)
- Talent Tapera
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Clifford Odimegwu
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Tatenda Makoni
- Zimbabwe National Network of People Living With HIV (ZNNP+), Harare, Zimbabwe
| | - Waraidzo Mukuwapasi
- Zimbabwe National Network of People Living With HIV (ZNNP+), Harare, Zimbabwe
| | | | - Gilton Kadziyanike
- Zimbabwe National Network of People Living With HIV (ZNNP+), Harare, Zimbabwe
| | | | | | | | - Pugie Chimberengwa
- Organisation for Public Health Interventions and Development (OPHID), Harare, Zimbabwe
| | - Million Phiri
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Population Studies, Schools of Humanities and Social Sciences, University of Zambia, Lusaka, Zambia
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Gebreegziabher SB, Ashuro AA, Kumssa TH, Teferi MY, Alemayue EA, Datiko DG, Yimer SA, Shagre MB. Tuberculosis preventive treatment uptake among people living with HIV during COVID-19 period in Addis Ababa, Ethiopia: a retrospective data review. BMC Infect Dis 2024; 24:499. [PMID: 38760665 PMCID: PMC11100166 DOI: 10.1186/s12879-024-09403-z] [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: 07/08/2023] [Accepted: 05/13/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Screening for tuberculosis (TB) and providing TB preventive treatment (TPT) along with antiretroviral therapy is key components of human immune deficiency virus (HIV) care. The uptake of TPT during the coronavirus disease 2019 (COVID-19) period has not been adequately assessed in Addis Ababa City Administration. This study aimed at assessing TPT uptake status among People living with HIV (PLHIV) newly initiated on antiretroviral therapy during the COVID-19 period at all public hospitals of Addis Ababa City Administration, Ethiopia. METHODS A retrospective data review was conducted from April-July 2022. Routine District Health Information System 2 database was reviewed for the period from April 2020-March 2022. Proportion and mean with standard deviation were computed. Logistic regression analysis was conducted to assess factors associated with TPT completion. A p-value of < 0.05 was considered statistically significant. RESULTS A total of 1,069 PLHIV, aged 18 years and above were newly initiated on antiretroviral therapy, and of these 1,059 (99.1%) underwent screening for TB symptoms. Nine hundred twelve (86.1%) were negative for TB symptoms. Overall, 78.8% (719) of cases who were negative for TB symptoms were initiated on TPT, and of these 70.5% and 22.8% were completed and discontinued TPT, respectively. Of 719 cases who were initiated on TPT, 334 (46.5%) and 385 (53.5%) were initiated on isoniazid plus rifapentine weekly for three months and Isoniazid preventive therapy daily for six months, respectively. PLHIV who were initiated on isoniazid plus rifapentine weekly for three months were more likely to complete TPT (adjusted odds ratio [AOR],1.68; 95% confidence interval [CI], 1.01, 2.79) compared to those who were initiated on Isoniazid preventive therapy daily for six months. CONCLUSION While the proportion of PLHIV screened for TB was high, TPT uptake was low and far below the national target of achieving 90% TPT coverage. Overall a considerable proportion of cases discontinued TPT in this study. Further strengthening of the programmatic management of latent TB infection among PLHIV is needed. Therefore, efforts should be made by the Addis Ababa City Administration Health Bureau authorities and program managers to strengthen the initiation and completion of TPT among PLHIV in public hospitals.
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Affiliation(s)
| | | | | | | | | | - Daniel Gemechu Datiko
- USAID Eliminate TB Project Health Programs Group Management Sciences for Health, Addis Ababa, Ethiopia
| | - Solomon Abebe Yimer
- Vaccine Research and Development Department, Coalition for Epidemic Preparedness Innovations (CEPI), Oslo, Norway
- Faculty of Medicine, Unit for Genome Dynamics, University of Oslo, Oslo, Norway
| | - Mulatu Biru Shagre
- USAID Eliminate TB Project KNCV Tuberculosis Foundation-Ethiopia, Addis Ababa, Ethiopia
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Kahabuka MS, Woldeamanuel Y, Mbelele PM, Mpolya EA, Mpagama SG, Kessy JP, Manyazewal T. HIV viral suppression and risk of viral rebound in patients on antiretroviral therapy: a two- year retrospective cohort study in Northern Tanzania. BMC Infect Dis 2024; 24:390. [PMID: 38605325 PMCID: PMC11007878 DOI: 10.1186/s12879-024-09161-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 02/21/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND The world is moving towards the third target of the Joint United Nations Programme on HIV/AIDS to ensure most people receiving antiretroviral therapy (ART) are virologically suppressed. Little is known about viral suppression at an undetectable level and the risk of viral rebound phenomenon in sub-Saharan Africa which covers 67% of the global HIV burden.This study aimed to investigate the proportion of viral suppression at an undetectable level and the risk of viral rebound among people living with HIV receiving ART in northern Tanzania. METHODOLOGY A hospital based-retrospective study recruited people living with HIV who were on ART for at least two years at Kibong'oto Infectious Disease Hospital and Mawenzi Regional Referral Hospital in Kilimanjaro Region, Tanzania. Participants' two-year plasma HIV were captured at months 6, 12, and 24 of ART. Undetectable viral load was defined by plasma HIV of viral load (VL) less than 20copies/ml and viral rebound (VR) was considered to anyone having VL of more than 50 copies/ml after having history of undetectable level of the VL less than 20copies/ml. A multivariable log-binomial generalized linear model was used to determine factors for undetectable VL and viral VR. RESULTS Among 416 PLHIV recruited, 226 (54.3%) were female. The mean (standard deviation) age was 43.7 (13.3) years. The overall proportion of undetectable VL was 68% (95% CI: 63.3-72.3) and 40.0% had viral rebound (95% CI: 34.7-45.6). Participants who had at least 3 clinic visits were 1.3 times more likely to have undetectable VL compared to those who had 1 to 2 clinic visits in a year (p = 0.029). Similarly, participants with many clinical visits ( > = 3 visits) per year were less likely to have VR compared to those with fewer visits ( = 2 visits) [adjusted relative risk (aRR) = 0.64; 95% CI: 0.44-0.93]. CONCLUSION Participants who had fewer clinic visits per year(ART refills) were less likely to achieve viral suppression and more likely to experience viral rebound. Enhanced health education and close follow-up of PLHIV on antiretroviral therapy are crucial to reinforce adherence and maintain an undetectable viral load.
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Affiliation(s)
- Monica S Kahabuka
- College of Health Sciences, Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Addis Ababa, Ethiopia.
- Kibong'oto National Infectious Diseases Hospital, Kilimanjaro, Tanzania.
| | - Yimtubezinash Woldeamanuel
- College of Health Sciences, Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Addis Ababa, Ethiopia
| | - Peter M Mbelele
- Kibong'oto National Infectious Diseases Hospital, Kilimanjaro, Tanzania
| | - Emmanuel A Mpolya
- Department of Global Health and Biomedical Sciences, School of Life Sciences and Bioengineering, Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
- Institute for Health Metrics and Evaluation, Population Health Building/Hans Rosling Center, University of Washington, 3980 15th Avenue, 98195, Seattle, WA, USA
| | - Stellah G Mpagama
- Kibong'oto National Infectious Diseases Hospital, Kilimanjaro, Tanzania
- Department of Global Health and Biomedical Sciences, School of Life Sciences and Bioengineering, Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
| | - Jonas P Kessy
- Mawenzi Regional Referral Hospital, Kilimanjaro, Tanzania
| | - Tsegahun Manyazewal
- College of Health Sciences, Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Addis Ababa, Ethiopia
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Melak D, Bayou FD, Yasin H, Zerga AA, Wagaye B, Ayele FY, Kebede N, Mekonen AM, Asfaw AH, Tsegaw SA, Mihiretu MM, Tsega Y, Addisu E, Cherie N, Birhane T, Abegaz Z, Endawkie A, Mohammed A. Virological Suppression and its Predictors Among HIV/AIDS Patients on Antiretroviral Therapy in Ethiopia: Systematic Review and Meta-analysis. Open Forum Infect Dis 2024; 11:ofae168. [PMID: 38654969 PMCID: PMC11036161 DOI: 10.1093/ofid/ofae168] [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: 11/30/2023] [Accepted: 03/20/2024] [Indexed: 04/26/2024] Open
Abstract
Background Achieving viral load suppression is crucial for the prevention of complications and deaths related to HIV infection. Ethiopia has embraced the worldwide 95-95-95 target, but there is no national representative information regarding virological suppression. Therefore, this review aims to determine the pooled virological suppression rate and identify the pooled effect of contributing factors of viral suppression for HIV-positive patients on antiretroviral therapy in Ethiopia. Methods We systematically searched websites and databases, including online repositories, to obtain primary studies. Two reviewers assessed the quality of the included articles using the Newcastle-Ottawa Scale appraisal checklist. Publication bias was checked using Egger's regression test, the heterogeneity of the studies was assessed using I2 statistics and Q statistics, and a sensitivity analysis was performed to identify any outlier results in the included studies. The Der Simonian Laird random-effects model was used to estimate the overall proportion of viral suppression, and STATA 17 statistical software was used for all types of analysis. Results A total of 21 eligible articles primarily conducted in Ethiopia using HIV program data were used for this quantitative synthesis. The overall pooled virological suppression rate was 71% (95% CI, 64%-77%). The pooled effects of poor adherence to ART (adjusted odds ratio [AOR], 0.33; 95% CI, 0.28-0.40), body mass index (18.5-24.9 kg/m2; AOR, 1.8; 95% CI, 1.37-2.36), disclosure (AOR, 1.41; 95% CI, 1.05-1.89), absence of opportunistic infection (AOR, 1.68; 95% CI, 1.43-1.97), and high baseline viral load count (AOR, 0.65; 95% CI, 0.52-0.81) were identified as significant predictors of viral suppression. Conclusions The overall pooled percentage of virological suppression was low compared with the global target of viral suppression and the Ethiopian Public Health Institute report. Poor adherence, normal body mass index, disclosure, absence of opportunistic infection, and high baseline viral load count were factors contributing to viral suppression in Ethiopia. Responsible stakeholders should maximize their efforts to achieve the global target of virological suppression by addressing significant predictors.
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Affiliation(s)
- Dagnachew Melak
- Department of Epidemiology and Biostatistics, School of Public Health, Colleges of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Fekade Demeke Bayou
- Department of Epidemiology and Biostatistics, School of Public Health, Colleges of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Husniya Yasin
- Department of Epidemiology and Biostatistics, School of Public Health, Colleges of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Aregash Abebayehu Zerga
- Department of Public Health Nutrition, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Birhanu Wagaye
- Department of Public Health Nutrition, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Fanos Yeshanew Ayele
- Department of Public Health Nutrition, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Natnael Kebede
- Department of Health Promotion, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Asnakew Molla Mekonen
- Department of Health System Management, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Ahmed Hussien Asfaw
- Department of Public Health Nutrition, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | | | - Mengistu Mera Mihiretu
- Department of Health System Management, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Yawkal Tsega
- Department of Health System Management, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Elsabeth Addisu
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Niguss Cherie
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Tesfaye Birhane
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Zinet Abegaz
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Abel Endawkie
- Department of Epidemiology and Biostatistics, School of Public Health, Colleges of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Anissa Mohammed
- Department of Epidemiology and Biostatistics, School of Public Health, Colleges of Medicine and Health Science, Wollo University, Dessie, Ethiopia
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Asakitogum DA, Nutor JJ, Thompson RGA, Alhassan RK, Gyamerah AO. Impact of COVID-19 on people living with HIV and HIV care: A qualitative study in the Volta Region of Ghana. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003017. [PMID: 38489328 PMCID: PMC10942089 DOI: 10.1371/journal.pgph.0003017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/25/2024] [Indexed: 03/17/2024]
Abstract
The COVID-19 pandemic caused significant social changes and challenges globally, including economic slowdown and limitation of essential services. Our study explored the impact of the COVID-19 pandemic on the HIV treatment experiences and lives of people living with HIV in Ghana. Between October 2021 and January 2022, we conducted four focus group discussions with 24 people living with HIV and six in-depth interviews with healthcare providers to understand the impact of the COVID-19 epidemic on their lives and HIV treatment and care. Transcribed interviews were analyzed using thematic analysis. The COVID-19 pandemic most impacted people living with HIV economically and psychosocially. Economic challenges included loss of income/economic support, financial hardship, and material insecurities. The psychosocial impact included fear of the health impact of COVID-19 on people living with HIV and social isolation. The pandemic also impacted participants' HIV treatment and care services including change in their site of care and non-adherence to antiretroviral therapy. Clinics in particular modified HIV care services to maintain treatment and care during the pandemic. Healthcare providers also implemented direct antiretroviral therapy service delivery to clients, which reduced patient overcrowding but increased providers' workload and expenses. The COVID-19 pandemic caused economic hardship, social isolation, and changes in HIV treatment and care services for people living with HIV. It also imposed a work and financial burden on healthcare providers. However, service changes made by providers helped sustain HIV care and treatment for clients and should inform future pandemic responses in HIV services.
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Affiliation(s)
- David Ayangba Asakitogum
- Department of Family Health Care Nursing, School of Nursing, University of California San Francisco, San Francisco, California, United States of America
| | - Jerry John Nutor
- Department of Family Health Care Nursing, School of Nursing, University of California San Francisco, San Francisco, California, United States of America
| | - Rachel G. A. Thompson
- Language Center, College of Humanities, University of Ghana, Accra, Ghana
- Africa Interdisciplinary Research Institute, Accra, Ghana
| | - Robert K. Alhassan
- Centre for Health Policy and Implementation Research, Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Akua O. Gyamerah
- Department of Community Health and Health Behavior, University of Buffalo, Buffalo, New York, United States of America
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Usmael K, Manyazewal T, Mohammed H, Yimer G, Oljira L, Roba KT, Hailemariam T, Adjeme T, Tesfaye D, Bisrat H, Ngadaya E, Woldeamanuel Y. Patterns of childhood tuberculosis diagnosis in Ethiopia: A multicenter cross-sectional study. RESEARCH SQUARE 2023:rs.3.rs-3758745. [PMID: 38234744 PMCID: PMC10793511 DOI: 10.21203/rs.3.rs-3758745/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
Background Children share 12% of the global 10 million people infected with tuberculosis (TB) each year. Closing case detection gap in children remains difficult, with 56% of all children and 65% under-five with TB missed each year. We aimed to assess the patterns of childhood TB diagnosis and underlying determinants in Ethiopia when different TB diagnostic platforms are applied. Methods A multi-site, cross-sectional study was carried out in Ethiopia as part of the larger EXIT-TB study - evidence-based multiple focused integrated intensified TB screening package. Outpatient children aged ≤ 15 with cough of any duration seeking care at four healthcare facilities in Ethiopia were enrolled consecutively. Participants underwent sputum Xpert MTB/RIF and/or smear microscopy and posteroanterior chest X-ray (CXR), and their clinical and sociodemographic data were captured using a structured questionnaire. Data were analyzed using Stata version 23. Multiple regression model was computed to determine the factors that influence TB case detection, with a 95% confidence interval (CI) and p < 0.05 taken as statistically significant. Results A total of 438 children were enrolled. Of these, 399 had CXR examination of which 55 (13.8%) were suggestive of TB, 270 had Xpert MTB/RIF testing of which 32 (11.9%) were positive, and AFB smear microscopy was done for 51 children of which 2 (3.9%) were positive. Febrile children were more likely to be diagnosed with pulmonary TB than those without fever [aPR = 1.3, 95% CI (1.1-1.4)], and those with a TB contact history were more likely to be diagnosed with pulmonary TB than those with no such contacts [aPR = 1.2, 95% CI (1.1-1.3)]. Children from rural residences were more likely to be diagnosed with TB than those from urban residences [aPR = 1.3, 95% CI (1.1-1.5)]. Conclusion The findings showed that clinical diagnosis remains an important method of TB diagnosis in children and the preferred choice to avert underdiagnosis. A more sensitive TB diagnostic method for children was symptom screening, followed by CXR and Xpert MTB/RIF assay or smear microscopy. Hence, an algorithm that combines clinical, CXR, and microbiological confirmatory tests can improve the rate of pulmonary TB diagnosis in children till more accurate and cost-effective diagnostic tools are accessible. Fever, weight loss, and TB contact history are highly associated with TB positivity rates in children.
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Chakrabarti R, Agasty D, Majumdar A, Talukdar R, Bhatta M, Biswas S, Dutta S. Syndemic effect of COVID-19 outbreak on HIV care delivery around the globe: A systematic review using narrative synthesis. Health Promot Perspect 2023; 13:243-253. [PMID: 38235007 PMCID: PMC10790127 DOI: 10.34172/hpp.2023.30] [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: 06/02/2023] [Accepted: 07/10/2023] [Indexed: 01/19/2024] Open
Abstract
Background The burden of the COVID-19 pandemic on healthcare systems worldwide has been compromising the progress made in the fight against HIV. This paper aims to determine how the COVID-19 pandemic has impacted HIV comprehensive care service delivery globally as well as to consolidate the evidence and recommendations that may be useful in averting future crisis. Methods This review adheres to PRISMA guidelines. PubMed, DOAJ, Science Direct and other sources like Google Scholar and citations from included studies were searched methodically to locate studies evaluating the effects of COVID on services for HIV care. The NIH and JBI quality assessment tools were used for the quality assessment of individual studies. Results In the present review 31 eligible studies were included and the impact on HIV care cascade were summarised under six themes: Lab services, Treatment and allied services, Counselling services, Outreach services, Psycho-social impact and Implementation of sustainable strategies. The studies also presented many innovative alternatives which were lucidly highlighted in the present article. Conclusion Current evidence depicts multiple factors are responsible for the interruption of HIV care service delivery during the pandemic, especially in low resources settings. The prospective, alternative solutions that have been used to circumvent the threat have also been addressed in this review, in addition to the negative aspects that have been observed. Transition with new innovative, sustainable care paradigms may prove to be the building blocks in removing HIV-AIDS as a public health threat. Registration Open Science Framework (DOI: 10.17605/OSF.IO/74GHM).
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Affiliation(s)
| | - Debdutta Agasty
- ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Agniva Majumdar
- ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Rounik Talukdar
- ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Mihir Bhatta
- ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Subrata Biswas
- ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Shanta Dutta
- ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, India
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Gemechu A, Mihret A, Aseffa A, Howe R, Seyoum B, Mulu A. Loss to Follow-up and Death Among Individuals With Newly Diagnosed Human Immunodeficiency Virus Receiving Dolutegravir-Based First-Line Antiretroviral Treatment in Eastern Ethiopia: Implications for 95% United Nations Targets. Open Forum Infect Dis 2023; 10:ofad522. [PMID: 37953815 PMCID: PMC10638489 DOI: 10.1093/ofid/ofad522] [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: 08/12/2023] [Accepted: 10/18/2023] [Indexed: 11/14/2023] Open
Abstract
Background Loss to follow-up (LTFU) and death are unfavorable outcomes of human immunodeficiency virus (HIV) treatment. This study aimed to identify the predictors of LTFU and death among individuals with newly diagnosed HIV receiving dolutegravir (DTG)-based first-line antiretroviral treatment (ART) in eastern Ethiopia. Methods A multisite prospective cohort study was carried out between October 2020 and July 2022. New case patients who started ART were enrolled consecutively and then followed up for the next 6 months. A structured questionnaire and checklists were used to collect data. HIV viral load was determined using the Abbott RealTime HIV-1 assay. Bivariable and multivariable logistic regression models were used to identify baseline factors associated with the outcomes. Results A total of 235 people with newly diagnosed HIV were enrolled; 16.6% (95% confidence interval, 12.3%-21.9%) were lost to follow-up, and 5.9% (3.5%-9.8%) died within 6 months of follow-up. Baseline World Health Organization clinical stage I (adjusted odds ratio, 3.93 [95% confidence interval, 1.34-11.57]), low viral load (3.67 [1.09-12.36]), and body weight (1.04 [1.01-1.07]) were predictors of LTFU, whereas nonfunctional status (10.02 [1.9-51.3]) was the only factor associated with death. Conclusions LTFU and death rates among patients with DTG were relatively high, accounting for roughly a quarter of the attrition of people with newly diagnosed HIV from ART care and services. Thus, targeted interventions are required to reduce LTFU and death among individuals with HIV on ART. Further investigation is necessary to evaluate the long-term effects of DTG-based regimens on LTFU and its impact on HIV mortality rates, and qualitative research, specifically tracing LTFU, is recommended.
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Affiliation(s)
- Abdella Gemechu
- School of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Adane Mihret
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Abraham Aseffa
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Rawleigh Howe
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Berhanu Seyoum
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
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Getachew E, Adebeta T, Muzazu SGY, Charlie L, Said B, Tesfahunei HA, Wanjiru CL, Acam J, Kajogoo VD, Solomon S, Atim MG, Manyazewal T. Digital health in the era of COVID-19: Reshaping the next generation of healthcare. Front Public Health 2023; 11:942703. [PMID: 36875401 PMCID: PMC9976934 DOI: 10.3389/fpubh.2023.942703] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 01/26/2023] [Indexed: 02/17/2023] Open
Abstract
COVID-19 is one of the most deadly diseases to have stricken us in recent decades. In the fight against this disease, governments and stakeholders require all the assistance they can get from various systems, including digital health interventions. Digital health technologies are supporting the tracking of the COVID-19 outbreak, diagnosing patients, expediting the process of finding potential medicines and vaccines, and disinfecting the environment, The establishment of electronic medical and health records, computerized clinical decision support systems, telemedicine, and mobile health have shown the potential to strengthen the healthcare system. Recently, these technologies have aided the health sector in a variety of ways, including prevention, early diagnosis, treatment adherence, medication safety, care coordination, documentation, data management, outbreak tracking, and pandemic surveillance. On the other hand, implementation of such technologies has questions of cost, compatibility with existing systems, disruption in patient-provider interactions, and sustainability, calling for more evidence on clinical utility and economic evaluations to help shape the next generation of healthcare. This paper argues how digital health interventions assist in the fight against COVID-19 and their opportunities, implications, and limitations.
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Affiliation(s)
- Emnet Getachew
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Public Health, College of Health Science, Arsi University, Asella, Ethiopia
| | - Tsegaye Adebeta
- Outpatient Department, Ethiopian Airlines Medical Unit, Addis Ababa, Ethiopia
| | - Seke G. Y. Muzazu
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Enteric Diseases and Vaccines Research Unit, Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Loveness Charlie
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- KNCV TB Foundation, Challenge TB Project, Blantyre, Malawi
| | - Bibie Said
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Outpatient Department, Kibong'oto National Tuberculosis Hospital, Moshi, Kilimanjaro, Tanzania
| | - Hanna Amanuel Tesfahunei
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Public Health, Hager Biomedical Research Institute, Asmara, Eritrea
| | - Catherine Lydiah Wanjiru
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Joan Acam
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Outpatient Department, Pope John's Hospital Aber, Atapara, Uganda
| | - Violet Dismas Kajogoo
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Samrawit Solomon
- School of Public Health, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Mary Gorret Atim
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Soroti Regional Referral Hospital, Soroti, Uganda
| | - Tsegahun Manyazewal
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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10
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HIV and SARS-CoV-2 Co-Infection: From Population Study Evidence to In Vitro Studies. LIFE (BASEL, SWITZERLAND) 2022; 12:life12122089. [PMID: 36556453 PMCID: PMC9781275 DOI: 10.3390/life12122089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/06/2022] [Accepted: 12/08/2022] [Indexed: 12/15/2022]
Abstract
Human immunodeficiency virus type 1 (HIV-1) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have caused two major viral outbreaks during the last century. Two major aspects of HIV-1 and SARS-CoV-2 co-infection have been extensively investigated and deserve attention. First, the impact of the co-infection on the progression of disease caused by HIV-1 or SARS-CoV-2. Second, the impact of the HIV-1 anti-retroviral treatment on SARS-CoV-2 infection. In this review, we aim to summarize and discuss the works produced since the beginning of the SARS-CoV-2 pandemic ranging from clinical studies to in vitro experiments in the context of co-infection and drug development.
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11
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Brazier E, Ajeh R, Maruri F, Musick B, Freeman A, Wester CW, Lee M, Shamu T, Crabtree Ramírez B, d'Almeida M, Wools‐Kaloustian K, Kumarasamy N, Althoff KN, Twizere C, Grinsztejn B, Tanser F, Messou E, Byakwaga H, Duda SN, Nash D. Service delivery challenges in HIV care during the first year of the COVID-19 pandemic: results from a site assessment survey across the global IeDEA consortium. J Int AIDS Soc 2022; 25:e26036. [PMID: 36504431 PMCID: PMC9742047 DOI: 10.1002/jia2.26036] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 10/31/2022] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Interruptions in treatment pose risks for people with HIV (PWH) and threaten progress in ending the HIV epidemic; however, the COVID-19 pandemic's impact on HIV service delivery across diverse settings is not broadly documented. METHODS From September 2020 to March 2021, the International epidemiology Databases to Evaluate AIDS (IeDEA) research consortium surveyed 238 HIV care sites across seven geographic regions to document constraints in HIV service delivery during the first year of the pandemic and strategies for ensuring care continuity for PWH. Descriptive statistics were stratified by national HIV prevalence (<1%, 1-4.9% and ≥5%) and country income levels. RESULTS Questions about pandemic-related consequences for HIV care were completed by 225 (95%) sites in 42 countries with low (n = 82), medium (n = 86) and high (n = 57) HIV prevalence, including low- (n = 57), lower-middle (n = 79), upper-middle (n = 39) and high- (n = 50) income countries. Most sites reported being subject to pandemic-related restrictions on travel, service provision or other operations (75%), and experiencing negative impacts (76%) on clinic operations, including decreased hours/days, reduced provider availability, clinic reconfiguration for COVID-19 services, record-keeping interruptions and suspension of partner support. Almost all sites in low-prevalence and high-income countries reported increased use of telemedicine (85% and 100%, respectively), compared with less than half of sites in high-prevalence and lower-income settings. Few sites in high-prevalence settings (2%) reported suspending antiretroviral therapy (ART) clinic services, and many reported adopting mitigation strategies to support adherence, including multi-month dispensing of ART (95%) and designating community ART pick-up points (44%). While few sites (5%) reported stockouts of first-line ART regimens, 10-11% reported stockouts of second- and third-line regimens, respectively, primarily in high-prevalence and lower-income settings. Interruptions in HIV viral load (VL) testing included suspension of testing (22%), longer turnaround times (41%) and supply/reagent stockouts (22%), but did not differ across settings. CONCLUSIONS While many sites in high HIV prevalence settings and lower-income countries reported introducing or expanding measures to support treatment adherence and continuity of care, the COVID-19 pandemic resulted in disruptions to VL testing and ART supply chains that may negatively affect the quality of HIV care in these settings.
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Affiliation(s)
- Ellen Brazier
- Institute for Implementation Science in Population HealthCity University of New YorkNew YorkNew YorkUSA
- Graduate School of Public Health and Health PolicyCity University of New YorkNew YorkNew YorkUSA
| | - Rogers Ajeh
- Clinical Research Education Networking and ConsultancyYaoundéCameroon
| | - Fernanda Maruri
- Department of Medicine, Division of Infectious DiseasesVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Beverly Musick
- Department of Biostatistics and Health Data ScienceIndiana University School of MedicineIndianapolisIndianaUSA
| | - Aimee Freeman
- Department of EpidemiologyBloomberg School of Public HealthJohns Hopkins UniversityBaltimoreMarylandUSA
| | - C. William Wester
- Department of Medicine, Division of Infectious DiseasesVanderbilt University Medical CenterNashvilleTennesseeUSA
| | | | - Tinei Shamu
- Newlands ClinicHarareZimbabwe
- Institute of Social and Preventive Medicine (ISPM)University of BernBernSwitzerland
| | - Brenda Crabtree Ramírez
- Departamento de InfectologíaInstituto Nacional de Ciencias Médicas y NutriciónMexico CityMexico
| | | | - Kara Wools‐Kaloustian
- Department of Biostatistics and Health Data ScienceIndiana University School of MedicineIndianapolisIndianaUSA
| | - N. Kumarasamy
- VHS Infectious Diseases Medical CentreVoluntary Health ServicesChennaiIndia
| | - Keri N. Althoff
- Department of EpidemiologyBloomberg School of Public HealthJohns Hopkins UniversityBaltimoreMarylandUSA
| | | | - Beatriz Grinsztejn
- Laboratory of Clinical Research in STD/AIDS (LAPCLIN‐AIDS)Evandro Chagas National Institute of Infectious Diseases‐Oswaldo Cruz Foundation (INI/FIOCRUZ)Rio de JaneiroBrazil
| | - Frank Tanser
- Africa Health Research InstituteUniversity of KwaZulu‐NatalDurbanSouth Africa
| | - Eugène Messou
- ACONDA ‐ Centre de Prise en Charge, de Recherche et de Formation (CePReF)AbidjanCôte d'Ivoire
| | - Helen Byakwaga
- Mbarara University of Science and TechnologyMbararaUganda
| | - Stephany N. Duda
- Department of Biomedical InformaticsVanderbilt University Medical Center (VUMC)NashvilleTennesseeUSA
- Vanderbilt Institute for Clinical and Translational ResearchVanderbilt University Medical Center (VUMC)NashvilleTennesseeUSA
| | - Denis Nash
- Institute for Implementation Science in Population HealthCity University of New YorkNew YorkNew YorkUSA
- Graduate School of Public Health and Health PolicyCity University of New YorkNew YorkNew YorkUSA
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12
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Acceptance of COVID-19 vaccination and influencing factors among people living with HIV in Guangxi, China: a cross-sectional survey. BMC Infect Dis 2022; 22:471. [PMID: 35578187 PMCID: PMC9109427 DOI: 10.1186/s12879-022-07452-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 05/06/2022] [Indexed: 11/24/2022] Open
Abstract
Background Vaccination has been proven to be an effective approach against the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to determine the acceptance rate and factors influencing acceptance of COVID-19 vaccination among people living with HIV (PLWH) in Guangxi, China. Methods A cross-sectional survey was carried out in five cities in Guangxi, China from May 7 to June 1, 2021. Questionnaires on the acceptance of COVID-19 vaccination and the related factors were conducted among PLWH recruited by simple random sampling. Univariate and multivariate logistic regression analyses were performed to identify factors associated with acceptance of COVID-19 vaccination. Results Of all valid respondents (n = 903), 72.9% (n = 658) were willing to receive COVID-19 vaccination. Fear of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was the main reason for being willing to receive vaccination (76.0%), while the main reasons for not willing were the concerns about vaccine safety (54.7%) and the vaccination’s effect on antiretroviral therapy (ART) (50.6%). The most important factors influencing acceptance were the perception that vaccination is unsafe for HIV-infected people (aOR = 0.082, 95% CI = 0.024–0.282) and the poor efficacy in preventing SARS-CoV-2 infection in HIV-infected people (aOR = 0.093, 95% CI = 0.030–0.287). Other factors associated with acceptance included Zhuang ethnicity (aOR = 1.653, 95% CI = 1.109–2.465), highest education level of middle school, high school or above (aOR = 1.747, 95% CI = 1.170–2.608; aOR = 2.492, 95% CI = 1.326–4.682), and the vaccination having little effect on ART efficacy (aOR = 2.889, 95% CI = 1.378–6.059). Conclusions Acceptance rate of the COVID-19 vaccination is relatively low among PLWH compared to the general population in China, although some patients refused vaccination due to concerns about vaccine safety and vaccination affecting ART efficacy. More research is needed to investigate the impact of the COVID-19 vaccines on ART efficacy and the effectiveness in preventing SARS-CoV-2 infection among PLWH. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07452-w.
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13
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Belay W, Manyazewal T, Woldeamanuel Y, Makonnen E, Teferra S, Addissie A, Hanlon C, Haile T, Amogne W, Hailemariam D, Asaminew A, Habtamu K, Araya M, Ajeme T, Eshetu T, Bisrat H, Shiferaw K, Kassa M, Abayneh A, Ambaw F, Berhane Y, Gebremariam R, Davey G, Medhin G, Fekadu A. Impact of COVID-19 on population health and economic wellbeing in Ethiopia: A national pilot survey. ETHIOPIAN MEDICAL JOURNAL 2022; 60:32-39. [PMID: 38170151 PMCID: PMC10760987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Introduction The COVD-19 pandemic has resulted in unprecedented global health and economic crisis, particularly in countries struggling with poverty. We conducted a national survey to understand the economic and health impacts of COVID-19 in Ethiopia. Methods A pilot, population-based, cross-sectional survey was conducted among adults randomly selected from the Ethio Telecom list of mobile phone numbers. Participants underwent a comprehensive phone interview about the impact of COVID-19 on their economic well-being and the health-related risks associated with COVID-19. Results Of 4,180 calls attempted, 1194 were answered, of which a successful interview was made with 614 participants. COVID-19 affected the family income of 343 [55.9%] participants, 56 [9.1%] lost their job, 105 [17.1%] perceived high stress in their household, and 7 [1.14%] reported death in their family in the past month. The odds of having a decreased income due to COVID-19 were 2.4 times higher among self-employed [adjusted odds ratio (AOR) 2.4, 95% CI (1.58-3.77)] and 2.8 times higher among unemployed [AOR 2.8, 95% CI (1.35-5.85)] participants. Two-hundred twenty-one [36%] participants had comorbidity in their household with hypertension, 72 [11.7%], diabetes,50 [8.1%], asthma, 48 [7.8%], and other chronic diseases, 51 [8.4%]. Forty-six [7.5%] participants had COVID-like symptoms in the previous month, where cough, headache, and fatigue were the most common. Conclusion COVID-19 posed serious economic pressure on households. Self-employed and unemployed were the most affected. Continuous surveillance is needed to actively monitor the impact of COVID-19 in the community and safeguard the economic and health well-being of individuals and households.
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Affiliation(s)
- Winini Belay
- Addis Ababa University, Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa, Ethiopia
| | - Tsegahun Manyazewal
- Addis Ababa University, Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa, Ethiopia
| | - Yimtubezinash Woldeamanuel
- Addis Ababa University, Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa, Ethiopia
- Addis Ababa University, College of Health Sciences, Department of Microbiology, Parasitology, Immunology and Pathology, Addis Ababa, Ethiopia
| | - Eyasu Makonnen
- Addis Ababa University, Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa, Ethiopia
- Addis Ababa University, College of Health Sciences, Department of Pharmacology and Clinical Pharmacy, Addis Ababa, Ethiopia
| | - Solomon Teferra
- Addis Ababa University, WHO Collaborating Center for Mental Health Research and Capacity Building, Department of Psychiatry, College of Health sciences, Addis Ababa, Ethiopia
| | - Adamu Addissie
- Addis Ababa University, College of Health Sciences, School of Public Health, Addis Ababa, Ethiopia
| | - Charlotte Hanlon
- Addis Ababa University, Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa, Ethiopia
- Addis Ababa University, WHO Collaborating Center for Mental Health Research and Capacity Building, Department of Psychiatry, College of Health sciences, Addis Ababa, Ethiopia
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Centre for Global Mental Health, London, UK
| | - Tewodros Haile
- Addis Ababa University, College of Health Sciences, Department of Internal Medicine, Addis Ababa, Ethiopia
| | - Wondwossen Amogne
- Addis Ababa University, College of Health Sciences, Department of Internal Medicine, Addis Ababa, Ethiopia
| | - Damen Hailemariam
- Addis Ababa University, College of Health Sciences, School of Public Health, Addis Ababa, Ethiopia
| | - Azeb Asaminew
- Addis Ababa University, WHO Collaborating Center for Mental Health Research and Capacity Building, Department of Psychiatry, College of Health sciences, Addis Ababa, Ethiopia
| | - Kassahun Habtamu
- Addis Ababa University, College of Education and Behavioral Studies, School of Psychology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mesele Araya
- Addis Ababa University, Department of Economics, Addis Ababa, Ethiopia
| | - Tigest Ajeme
- Addis Ababa University, Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa, Ethiopia
| | - Tigist Eshetu
- Addis Ababa University, Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa, Ethiopia
| | - Haileleuel Bisrat
- Addis Ababa University, Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa, Ethiopia
| | - Kehabtimer Shiferaw
- Addis Ababa University, College of Health Sciences, School of Public Health, Addis Ababa, Ethiopia
| | - Munir Kassa
- Ministry of Health-Ethiopia, Addis Ababa, Ethiopia
| | - Aschalew Abayneh
- Ethiopian Public Health Institute, Ministry of Health, Addis Ababa, Ethiopia
| | - Fentie Ambaw
- Bahir Dar University, College of Medicine and Health Sciences, School of Public Health, Bahir Dar, Ethiopia
| | - Yemane Berhane
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Rahel Gebremariam
- Voluntary Service Overseas (VSO), Ethiopia Country Office, Addis Ababa, Ethiopia
| | - Gail Davey
- Brighton and Sussex Medical School, Global Health and Infection Department, Brighton, UK
| | - Girmay Medhin
- Addis Ababa University, Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa, Ethiopia
- Addis Ababa University, Aklilu Lemma Institute of Pathobiology, Addis Ababa, Ethiopia
| | - Abebaw Fekadu
- Addis Ababa University, Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa, Ethiopia
- Addis Ababa University, WHO Collaborating Center for Mental Health Research and Capacity Building, Department of Psychiatry, College of Health sciences, Addis Ababa, Ethiopia
- Brighton and Sussex Medical School, Global Health and Infection Department, Brighton, UK
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