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Tesfay S, Ayele F, Fissahaye B, Asmerom H, Gebremichael B. Level of antiretroviral therapy adherence and associated factors during COVID-19 pandemic era in public hospitals of Jigjiga City eastern Ethiopia: a cross-sectional study. Front Public Health 2024; 12:1363903. [PMID: 38855457 PMCID: PMC11156993 DOI: 10.3389/fpubh.2024.1363903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 05/07/2024] [Indexed: 06/11/2024] Open
Abstract
Background Coronavirus-19 disease is more severe in patients on antiretroviral therapy (ART). Low-income countries, such as those in Sub-Saharan Africa, are particularly vulnerable to the virus' spread. However, there is little information on antiretroviral therapy (ART) use in Ethiopia during the pandemic, particularly in the study area. Therefore, this study aimed to assess the level of antiretroviral treatment adherence and associated factors during the COVID-19 pandemic era in public hospitals in Jigjiga City, Somalia, and Eastern Ethiopia. Methods An institution-based cross-sectional study was conducted among 382 randomly selected HIV patients on antiretroviral therapy (ART) follow-up in public hospitals in Jigjiga City from March 1-30, 2022. The data was collected through face-to-face interviews and a review of the patient's record. To explore the relationship between variables, both bivariate and multivariable logistic regression analyses were performed. The adjusted odds ratio (AOR) was utilized, along with a 95% confidence interval, to assess the strength and direction of the association. Statistical significance was considered at p < 0.05. Results The antiretroviral therapy (ART) adherence rate of HIV patients was 76.9% (95% CI, 71.9-82). Disclosing HIV status to sexual partners [AOR = 2.3, (95% CI (1.22-4.19)], having communication with health care providers' [AOR = 3.2, (95% CI (1.57-6.53)], having no history of current substance use [AOR = 2.6, (95% CI (1.45-4.63)], and patients who did not fear COVID-19 infection [AOR = 5.8 (95% CI (11-10.98)] were significantly associated with antiretroviral therapy (ART) adherence. Conclusion In this study, the level of antiretroviral therapy (ART) adherence was poor in comparison to the expected level. Patients' adherence status was favorably related to disclosing their status to families and having contact with their healthcare providers, whereas worrying about COVID-19 pandemic infection and current substance use was adversely associated.
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Affiliation(s)
| | - Firayad Ayele
- School of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Birhane Fissahaye
- School of Nursing and Midwifery, College of Health and Medical Sciences, Aksum University, Tigray, Ethiopia
| | - Haftu Asmerom
- School of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Berhe Gebremichael
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Mutai CK, McSharry PE, Ngaruye I, Musabanganji E. Use of unsupervised machine learning to characterise HIV predictors in sub-Saharan Africa. BMC Infect Dis 2023; 23:482. [PMID: 37468851 DOI: 10.1186/s12879-023-08467-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 07/17/2023] [Indexed: 07/21/2023] Open
Abstract
INTRODUCTION Significant regional variations in the HIV epidemic hurt effective common interventions in sub-Saharan Africa. It is crucial to analyze HIV positivity distributions within clusters and assess the homogeneity of countries. We aim at identifying clusters of countries based on socio-behavioural predictors of HIV for screening. METHOD We used an agglomerative hierarchical, unsupervised machine learning, approach for clustering to analyse data for 146,733 male and 155,622 female respondents from 13 sub-Saharan African countries with 20 and 26 features, respectively, using Population-based HIV Impact Assessment (PHIA) data from the survey years 2015-2019. We employed agglomerative hierarchical clustering and optimal silhouette index criterion to identify clusters of countries based on the similarity of socio-behavioural characteristics. We analyse the distribution of HIV positivity with socio-behavioural predictors of HIV within each cluster. RESULTS Two principal components were obtained, with the first describing 62.3% and 70.1% and the second explaining 18.3% and 20.6% variance of the total socio-behavioural variation in females and males, respectively. Two clusters per sex were identified, and the most predictor features in both sexes were: relationship with family head, enrolled in school, circumcision status for males, delayed pregnancy, work for payment in last 12 months, Urban area indicator, known HIV status and delayed pregnancy. The HIV positivity distribution with these variables was significant within each cluster. CONCLUSIONS /FINDINGS The findings provide a potential use of unsupervised machine learning approaches for substantially identifying clustered countries based on the underlying socio-behavioural characteristics.
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Affiliation(s)
- Charles K Mutai
- African Center of Excellence in Data Science, University of Rwanda, Kigali, BP 4285, Rwanda.
- Department of Mathematics, Physics and Computing, Moi University, Eldoret, Kenya.
| | - Patrick E McSharry
- African Center of Excellence in Data Science, University of Rwanda, Kigali, BP 4285, Rwanda
- College of Engineering, Carnegie Mellon University Africa, Kigali, BP 6150, Rwanda
- Oxford-Man Institute of Quantitative Finance, Oxford University, Oxford, OX2 6ED, UK
| | - Innocent Ngaruye
- College of Science and Technology, University of Rwanda, Kigali, Rwanda
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Relationship of HLA-B alleles on susceptibility to and protection from HIV infection in Turkish population. North Clin Istanb 2023; 10:67-73. [PMID: 36910436 PMCID: PMC9996654 DOI: 10.14744/nci.2021.00018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/02/2021] [Accepted: 08/19/2021] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Many human leukocyte antigen (HLA)-B alleles are associated with an increased risk of Acquired Immune Deficiency Syndrome (AIDS) and Human Immunodeficiency Virus (HIV) progression; however, their distribution varies among different racial/ethnic groups. Abacavir used in the treatment of AIDS significantly increases the risk of hypersensitivity reactions in patients with HLA-B*57:01. The aim of this study was to determine the distribution of HIV-associated HLA-B subgroups (high and low resolution) and HLA-B*57:01 associated with Abacavir sensitivity in Turkiye. METHODS This retrospective case-control study consisted of 416 (F/M:111/305) HIV positive patients and 416 (F/M:111/305) healthy controls. HLA-B alleles were identified using Luminex based low-resolution method and further subgrouped by sequence-based high-resolution typing. RESULTS Our data showed that in patients with HIV-1 infection, HLA-B*15, *35, and *51 allele frequencies were higher, while the HLA-B*07, *14 and *55 allele frequencies were lower as compared to the controls. It was determined that HLA-B*15:01, *35:01, *35:08, and *51:01 alleles frequencies were higher in the patients with HIV-1 infection compared to the controls as HLA-B*07:02, *14:01, *44:01, and *55:01 allele frequencies were detected low. HLA-B*57:01 allele positivity, which is important in Abacavir hypersensitivity, was lower than controls, and this difference was not statistically significant. CONCLUSION Our results suggest that, HLA-B*07, *14, and *55 alleles and HLA-B*07:02, *14:01, *44:01, and *55:01 subgroups might have a protective effect, while HLA-B*15, *35, and *51 alleles and HLA-B*15:01, *35:01, *35:08, and *51:01 subgroups might play a role in susceptibility to HIV-1 infection.
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Ornos EDB, Tantengco OAG, Abad CLR. Global Online Interest in HIV/AIDS care Services in the time of COVID-19: A Google Trends Analysis. AIDS Behav 2022; 27:1998-2004. [PMID: 36441409 PMCID: PMC9707175 DOI: 10.1007/s10461-022-03933-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2022] [Indexed: 11/30/2022]
Abstract
The Covid-19 pandemic has compounded the challenge of HIV/AIDS elimination, creating difficulties in accessing HIV care services such as early testing and treatment. This paper characterized the global online interest in HIV care services-related search terms before and during the pandemic. Global online search interest for HIV was measured using the Google Trends™ database. Spearman's rank-order correlation correlated country-specific characteristics and HIV prevalence data with the search volume index (SVI). We found a significant decrease in the global online search interest for HIV/AIDS care services-related search terms during the Covid-19 pandemic. The top countries with the highest online interest for "HIV/AIDS" search terms were Zambia, Eswatini, Malawi, Lesotho, and Zimbabwe. In addition, search volume indices for HIV correlated positively with HIV prevalence and negatively with GDP, GDP per capita, and the number of physicians. This result highlights that resource-poor countries with a high prevalence of HIV have a high online interest in HIV/AIDS. Therefore, there is a need to improve internet access, the quality of HIV-related health information, and online health literacy to improve health-seeking behavior, especially in areas with a high disease burden. Overall, our study shows that the infodemiologic approach through Google Trends™ can be used to assess the online interest of the public toward HIV infection and related healthcare services.
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Affiliation(s)
- Eric David B. Ornos
- College of Medicine, University of the Philippines Manila, Manila, Philippines
| | | | - Cybele Lara R. Abad
- Section of Infectious Diseases, Department of Medicine, Philippine General Hospital, University of the Philippines, Manila, Philippines
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Prevalence for the Disclosure of HIV Status to Sexual Partners and Its Determinants among Adults under cART in Amhara Region, Northwest Ethiopia. J Trop Med 2022; 2022:9941380. [PMID: 35846071 PMCID: PMC9283073 DOI: 10.1155/2022/9941380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 06/14/2022] [Accepted: 06/16/2022] [Indexed: 12/03/2022] Open
Abstract
Background Globally, the transmission of HIV from one individual to another causes 1.8 million new infections each year, 36.7 million people living with HIV, and one million people died from HIV-related illnesses. The objective of this study was to determine the prevalence of the disclosure of HIV status to sexual partners and its determinants among adults under cART in the Amhara Region, northwest Ethiopia. Methods A retrospective study design was conducted on 792 randomly selected samples. The study was conducted in the Amhara Region, from 2015 to 2020. A binary logistic regression modeling was used for data analysis. The data were collected using a stratified random sampling technique where the residential areas were considered strata. Data were collected by trained health practitioners in the ART section in Felege Hiwot Teaching and Specialized Hospital. The hospital is a referral in which many patients from different districts and zonal hospitals in the region are referred to this hospital. Results The rate of disclosure of HIV status to sexual partners in this study was 21%, which is very low compared to the average rate of disclosure in developing countries. Among the predictors, age of patients (AOR = 1.02, 95% CI:(1.001,1.120); p-value = 0.004); number of baseline CD4 cell count (AOR = 0.980; 95% CI: (0.764, 0.991); p-value<0.01); number of hospital visits (AOR = 1.01; 95% CI: (1.001, 1.034); p-value < 0.01); marital status (living with partner) (AOR = 1.01; 95% CI: (1.003, 1.112); p-value = 0.006); female HIV-positive adults (AOR = 1.01; 95% CI: (1.001, 1.021); p-value = 0.007); rural residence (AOR = 0.98; 95% CI: (0.96, 0.99); p-value = 0.004); non-educated adult patients (AOR = 0.950, 95% CI: (0.92. 0.98); p-value = 0.003); cART non-adherent adult patients (AOR = 0.940, 95% CI: (0.61. 0.97); p-value < 0.001); non-opportunistic infectious diseases (AOR = 1.062, 95% CI: (1.049. 1.191); p-value = 0.002); and non-existence of social violence (AOR = 1.012, 95% CI: (1.008, 1.); p-value < 0.01) significantly affected the variable of interest. Of these, the number of CD4 cell count, male HIV-positive adults, rural residence, and existence of social violence negatively affected the variable of interest. Conclusions Some groups of HIV patients did not disclose their level of HIV status to their sexual partners. Health-related education is recommended for patients who did not disclose their HIV status to sexual partners. This helps to reduce the transmission of HIV from infected individuals to noninfected ones and from mother-to-child HIV transmission.
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Use of machine learning techniques to identify HIV predictors for screening in sub-Saharan Africa. BMC Med Res Methodol 2021; 21:159. [PMID: 34332540 PMCID: PMC8325403 DOI: 10.1186/s12874-021-01346-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 07/13/2021] [Indexed: 11/17/2022] Open
Abstract
Aim HIV prevention measures in sub-Saharan Africa are still short of attaining the UNAIDS 90–90-90 fast track targets set in 2014. Identifying predictors for HIV status may facilitate targeted screening interventions that improve health care. We aimed at identifying HIV predictors as well as predicting persons at high risk of the infection. Method We applied machine learning approaches for building models using population-based HIV Impact Assessment (PHIA) data for 41,939 male and 45,105 female respondents with 30 and 40 variables respectively from four countries in sub-Saharan countries. We trained and validated the algorithms on 80% of the data and tested on the remaining 20% where we rotated around the left-out country. An algorithm with the best mean f1 score was retained and trained on the most predictive variables. We used the model to identify people living with HIV and individuals with a higher likelihood of contracting the disease. Results Application of XGBoost algorithm appeared to significantly improve identification of HIV positivity over the other five algorithms by f1 scoring mean of 90% and 92% for males and females respectively. Amongst the eight most predictor features in both sexes were: age, relationship with family head, the highest level of education, highest grade at that school level, work for payment, avoiding pregnancy, age at the first experience of sex, and wealth quintile. Model performance using these variables increased significantly compared to having all the variables included. We identified five males and 19 females individuals that would require testing to find one HIV positive individual. We also predicted that 4·14% of males and 10.81% of females are at high risk of infection. Conclusion Our findings provide a potential use of the XGBoost algorithm with socio-behavioural-driven data at substantially identifying HIV predictors and predicting individuals at high risk of infection for targeted screening. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-021-01346-2.
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Merzouki A, Estill J, Orel E, Tal K, Keiser O. Clusters of sub-Saharan African countries based on sociobehavioural characteristics and associated HIV incidence. PeerJ 2021; 9:e10660. [PMID: 33520455 PMCID: PMC7812934 DOI: 10.7717/peerj.10660] [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: 04/24/2020] [Accepted: 12/07/2020] [Indexed: 11/20/2022] Open
Abstract
Introduction HIV incidence varies widely between sub-Saharan African (SSA) countries. This variation coincides with a substantial sociobehavioural heterogeneity, which complicates the design of effective interventions. In this study, we investigated how sociobehavioural heterogeneity in sub-Saharan Africa could account for the variance of HIV incidence between countries. Methods We analysed aggregated data, at the national-level, from the most recent Demographic and Health Surveys of 29 SSA countries (2010–2017), which included 594,644 persons (183,310 men and 411,334 women). We preselected 48 demographic, socio-economic, behavioural and HIV-related attributes to describe each country. We used Principal Component Analysis to visualize sociobehavioural similarity between countries, and to identify the variables that accounted for most sociobehavioural variance in SSA. We used hierarchical clustering to identify groups of countries with similar sociobehavioural profiles, and we compared the distribution of HIV incidence (estimates from UNAIDS) and sociobehavioural variables within each cluster. Results The most important characteristics, which explained 69% of sociobehavioural variance across SSA among the variables we assessed were: religion; male circumcision; number of sexual partners; literacy; uptake of HIV testing; women’s empowerment; accepting attitude toward people living with HIV/AIDS; rurality; ART coverage; and, knowledge about AIDS. Our model revealed three groups of countries, each with characteristic sociobehavioural profiles. HIV incidence was mostly similar within each cluster and different between clusters (median (IQR); 0.5/1000 (0.6/1000), 1.8/1000 (1.3/1000) and 5.0/1000 (4.2/1000)). Conclusions Our findings suggest that the combination of sociobehavioural factors play a key role in determining the course of the HIV epidemic, and that similar techniques can help to predict the effects of behavioural change on the HIV epidemic and to design targeted interventions to impede HIV transmission in SSA.
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Affiliation(s)
- Aziza Merzouki
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Janne Estill
- Institute of Global Health, University of Geneva, Geneva, Switzerland.,Institute of Mathematical Statistics and Actuarial Science, University of Bern, Bern, Switzerland
| | - Erol Orel
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Kali Tal
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Olivia Keiser
- Institute of Global Health, University of Geneva, Geneva, Switzerland
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Legesse TA, Reta MA. Adherence to Antiretroviral Therapy and Associated Factors among People Living with HIV/AIDS in Hara Town and Its Surroundings, North-Eastern Ethiopia: A Cross-Sectional Study. Ethiop J Health Sci 2020; 29:299-308. [PMID: 31447498 PMCID: PMC6689727 DOI: 10.4314/ejhs.v29i3.2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background Adherence is the most important factor in determining Antiretroviral Therapy (ART) treatment success and long-term viral suppression. Nonadherence to ART led to the human Immunodeficiency Virus (HIV) related morbidity and mortality. Moreover, it intensifies the risk of the emerging drug resistant HIV strains. This study aimed to assess the level of ART adherence and to identify its predictive associated factors among people living with HIV/AIDS in Hara Town and its surroundings, North-Eastern Ethiopia. Methods An institutional facility based cross-sectional study was conducted from April-May 2017. A total of 454 individuals were on ART follow-up in the selected ART-clinic, and only 418 patients were recruited. Bivariate and multivariate logistic regression analyses were carried out to identify associated factors. Odds ratio and 95% Confidence Interval (CI) were calculated to determine the level of significance. Results The level of ART adherence in the study setting was 300 (71.8%). Participants who had not disclosed their HIV status to their families were 88% less likely to adhere to their ART medication than those who had disclosed their HIV status ((Odds ratio (OR): 0.12, 95%CI:0.05–0.58; p<0.001). On the other hand, participants who had not encountered drug side effects were 2.69 times more likely to adhere to their ART medication than those who had ever encountered drug side effects (OR: 2.69, 95%CI:1.27–5.05; p<0.001). Conclusion A very low level of ART adherence was shown in the study population. It was below the recommended good adherence standard. Therefore, patients should get adequate and comprehensive ART adherence counselling before initiation ART treatment and during the follow-up time.
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Affiliation(s)
- Tesfaye Aychew Legesse
- Department of Nursing, Faculty of Health Sciences, Woldia University; P.O. Box 400; Woldia, Ethiopia
| | - Melese Abate Reta
- Department of Medical Laboratory Science, Faculty of Health Sciences, Woldia University; P.O. Box 400; Woldia, Ethiopia
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Baranczuk Z, Estill J, Blough S, Meier S, Merzouki A, Maathuis MH, Keiser O. Socio-behavioural characteristics and HIV: findings from a graphical modelling analysis of 29 sub-Saharan African countries. J Int AIDS Soc 2019; 22:e25437. [PMID: 31854506 PMCID: PMC6921084 DOI: 10.1002/jia2.25437] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 11/20/2019] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Socio-behavioural factors may contribute to the wide variance in HIV prevalence between and within sub-Saharan African (SSA) countries. We studied the associations between socio-behavioural variables potentially related to the risk of acquiring HIV. METHODS We used Bayesian network models to study associations between socio-behavioural variables that may be related to HIV. A Bayesian network consists of nodes representing variables, and edges representing the conditional dependencies between variables. We analysed data from Demographic and Health Surveys conducted in 29 SSA countries between 2010 and 2016. We predefined and dichotomized 12 variables, including factors related to age, literacy, HIV knowledge, HIV testing, domestic violence, sexual activity and women's empowerment. We analysed data on men and women for each country separately and then summarized the results across the countries. We conducted a second analysis including also the individual HIV status in a subset of 23 countries where this information was available. We presented summary graphs showing associations that were present in at least six countries (five in the analysis with HIV status). RESULTS We analysed data from 190,273 men (range across countries 2295 to 17,359) and 420,198 women (6621 to 38,948). The two variables with the highest total number of edges in the summary graphs were literacy and rural/urban location. Literacy was negatively associated with false beliefs about AIDS and, for women, early sexual initiation, in most countries. Literacy was also positively associated with ever being tested for HIV and the belief that women have the right to ask their husband to use condoms if he has a sexually transmitted infection. Rural location was positively associated with false beliefs about HIV and the belief that beating one's wife is justified, and negatively associated with having been tested for HIV. In the analysis including HIV status, being HIV positive was associated with female-headed household, older age and rural location among women, and with no variables among men. CONCLUSIONS Literacy and urbanity were strongly associated with several factors that are important for HIV acquisition. Since literacy is one of the few variables that can be improved by interventions, this makes it a promising intervention target.
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Affiliation(s)
- Zofia Baranczuk
- Institute of Global HealthUniversity of GenevaGenevaSwitzerland
- Department of PsychologyUniversity of ZurichZurichSwitzerland
- Institute of MathematicsUniversity of ZurichZurichSwitzerland
| | - Janne Estill
- Institute of Global HealthUniversity of GenevaGenevaSwitzerland
- Institute of Mathematical Statistics and Actuarial ScienceUniversity of BernBernSwitzerland
| | - Sara Blough
- Institute of Global HealthUniversity of GenevaGenevaSwitzerland
- Rollins School of Public HealthEmory UniversityAtlantaGAUSA
| | - Sonja Meier
- Seminar for StatisticsETH ZürichZurichSwitzerland
| | - Aziza Merzouki
- Institute of Global HealthUniversity of GenevaGenevaSwitzerland
| | | | - Olivia Keiser
- Institute of Global HealthUniversity of GenevaGenevaSwitzerland
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Muchabaiwa L, Mbonigaba J. Impact of the adolescent and youth sexual and reproductive health strategy on service utilisation and health outcomes in Zimbabwe. PLoS One 2019; 14:e0218588. [PMID: 31237891 PMCID: PMC6592535 DOI: 10.1371/journal.pone.0218588] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 06/06/2019] [Indexed: 11/18/2022] Open
Abstract
Poor reproductive health among youth and adolescents threatens their future health and economic wellbeing in Zimbabwe amidst a high HIV/AIDS prevalence. This study evaluates the impact of a multi-pronged adolescent sexual and reproductive health (ASRH) strategy implemented by government of Zimbabwe between 2010 and 2015 to improve ASRH in terms of the uptake of condoms and HIV testing as well as outcomes in terms of sexually transmitted infection (STI) prevalence and HIV prevalence. We combine the difference in difference and propensity score matching methods to analyse repeated Zimbabwe demographic health survey cross-sectional datasets. Young people aged 15–19 years at baseline in 2010, who were exposed for the entire five-year strategy are designated as the treatment group and young adults aged 25–29 at baseline as the control. We find that the ASRH strategy increased HIV testing amongst youth by 36.6 percent, whilst treatment of STIs also increased by 30.4 percent. We also find that the HIV prevalence trajectory was reduced by 0.7 percent. We do not find evidence of impact on condom use and STI prevalence. The findings also suggest that although HIV testing increased for all socio-economic groups that were investigated, the effect was not the same. Lastly, we do not find evidence supporting that more resources translate to better ASRH outcomes. We recommend designing future ASRH strategies in a way that differentiates service delivery for youths in HIV hotspots, rural areas and out of school. We also recommend improving the strategy’s coordination and monitoring, as well as aligning and enforcing government policies that promote sexual and reproductive health rights.
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Affiliation(s)
- Lazarus Muchabaiwa
- Economics Department, School of Accounting, Economics and Finance, University of KwaZulu-Natal, Durban, South Africa
- Economics Department, Bindura University of Science Education, Bindura, Zimbabwe
- * E-mail:
| | - Josue Mbonigaba
- Economics Department, School of Accounting, Economics and Finance, University of KwaZulu-Natal, Durban, South Africa
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Joshi RK, Mehendale SM. Determinants of consistently high HIV prevalence in Indian Districts: A multi-level analysis. PLoS One 2019; 14:e0216321. [PMID: 31063471 PMCID: PMC6504102 DOI: 10.1371/journal.pone.0216321] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 04/19/2019] [Indexed: 01/12/2023] Open
Abstract
Introduction Factors associated with persistently high Human Immunodeficiency Virus (HIV) prevalence levels in several districts of India are not well understood. This study was undertaken to determine the association of socio-demographic characteristics, economic factors, awareness about HIV and Sexually Transmitted Infections (STIs), and condom use with consistently high HIV prevalence in the Indian districts and to ascertain whether these associations differed across various regions of India. Methods This study was carried out including all 640 districts of India. Secondary analysis of data obtained from the Census of India-2011, HIV Sentinel Surveillance in India and District Level Household Survey-III was done. Population profile, socio-economic characteristics, levels of HIV/STI/condom awareness and condom use, were compared between the districts with and without consistently high HIV prevalence. Due to the presence of collinearity among predictor variables, we used principal component analysis and the principal component scores were included as covariates for further analysis. Considering the districts at level 1 and the regions at level 2, multi-level analysis was done by generalised linear mixed models. Variance partition coefficient and median odds ratio were also calculated. Results Sixty-three districts with consistently high HIV prevalence were found clustered in the South and the North-east regions of India. Population size, density and urbanisation were found to be positively associated with consistently high HIV prevalence in these districts. Higher levels of literacy, better socio-economic status, higher proportion of population in reproductive age group and late marriages were positively associated with consistently high HIV prevalence in all regions of India except in the Southern region. Higher levels of knowledge about the role of condoms in HIV prevention and condom use were associated with low HIV prevalence at the district level. Conclusions Considerable heterogeneity among factors associated with consistently high HIV prevalence at the district level in different regions of India necessitates special region-specific strategies for HIV control. Increasing awareness about HIV alone is not sufficient for controlling the HIV epidemic and there is a need to raise knowledge levels about preventive measures against HIV and promote the use of condoms amongst population.
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Affiliation(s)
- Rajneesh Kumar Joshi
- Symbiosis International University, Pune, India
- National AIDS Research Institute (ICMR), Pune, India
- * E-mail:
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Relationship among HIV/AIDS Prevalence, Human Capital, Good Governance, and Sustainable Development: Empirical Evidence from Sub-Saharan Africa. SUSTAINABILITY 2019. [DOI: 10.3390/su11051348] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
: Sub-Saharan Africa is regarded as the region that accommodates about 75% of the world HIV/AIDS prevalence as of 2016. Research on the relationship between the epidemic and sustainable development is scant in this part of the world, as available literature is dominated by studies that focus on HIV and economic growth. Therefore, this study examines the relationship between sustainable development and HIV/AIDS prevalence, along with other determinants of sustainable development, such as good governance and human capital in 26 sub-Saharan Africa countries over a 27-year period from 1990—2016. The pooled mean group (PMG) estimator was employed for analysis after it was confirmed by the Hausman test for the estimation of the relationship among the variables. The results revealed a unidirectional long-run and significant relationship between HIV/AIDS prevalence and sustainable development, human capital and good governance, and human capital and sustainable development. Also, a bidirectional long-run relationship was found between good governance and HIV/AIDS prevalence. Estimation of subgroups provides a robustness check for our findings. Therefore, the paper gives new insight to the government of sub-Saharan Africa countries and major stakeholders about how to attain sustainable development in the region, while intensifying efforts on reducing HIV/AIDS prevalence, and at the same time ensuring effective good governance and human capital development.
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Ibrahim SA, Sabitu K, Abubakar A, Poggensee G, Ibrahim S, Riyad M, Bashorun A, Sudawa AU, Ibrahim BS, Mohammed H, Ezeudu C, Abubakar AA, Nsubuga P, Nguku P. Demographic factors associated with HIV infection between low and high prevalence areas in Nigeria, 2015. Pan Afr Med J 2019; 32:11. [PMID: 30984330 PMCID: PMC6445329 DOI: 10.11604/pamj.supp.2019.32.1.13330] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 12/18/2017] [Indexed: 11/11/2022] Open
Abstract
Introduction Sub-Saharan Africa accounts for 66% of 36.7 million individuals living with HIV in 2015 with Nigeria having the second highest prevalence in Africa. The study aimed to find the prevalence and socio-demographic factors associated with HIV infection and compare these findings between high and low prevalence areas. Methods We conducted a cross-sectional study among adults aged 15 to 49 years from March to April 2015. We administered a questionnaire to collect linked anonymous data on socio-demographic and socio-cultural characteristics and screened all respondents for HIV infection. We defined a high HIV prevalence area as area with prevalence consistently above 5% and an area with prevalence consistently below 2% as low prevalence area. We performed univariate, bivariate and logistic regration analysis to assess factors associated with HIV infection. Results We screened and interviewed all 480 respondents. Majority 344 (71.7%) were females, mean age was 30.1 years (±7.4 years), high proportion were employed 246 (51.2%). In high HIV prevalence area, aged <30 years (Adjusted Odd Ratio (AOR) = 4.2, 95% Confidence Interval (CI) = 1.1-20.4) and being employed (AOR= 3.7, 95% CI=1.0-58.8) increased the likelihood of HIV infection. In low HIV prevalence area, lack of education (AOR=7.1, 95% CI= 0.9-32) was the only predictor of HIV infection. Conclusion Interplay of socio-demographic factors was responsible for differences in HIV prevalence. To further decrease prevalence in low prevalence areas (below 1%), government should make universal basic education mandatory and in high prevalence areas, interventions should target the young and the employed.
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Affiliation(s)
| | - Kabir Sabitu
- Nigeria Field Epidemiology and Laboratory Training Program (NFELTP).,Ahmadu Bello University, Zaria, Nigeria
| | - Aisha Abubakar
- Nigeria Field Epidemiology and Laboratory Training Program (NFELTP).,Ahmadu Bello University, Zaria, Nigeria
| | | | | | - Mahammad Riyad
- Nigeria Field Epidemiology and Laboratory Training Program (NFELTP)
| | | | | | | | - Hauwa Mohammed
- Nigeria Field Epidemiology and Laboratory Training Program (NFELTP)
| | - Chinyere Ezeudu
- Nigeria Field Epidemiology and Laboratory Training Program (NFELTP)
| | | | - Peter Nsubuga
- Global Public Health Solutions, Atlanta, Georgia, USA
| | - Patrick Nguku
- Nigeria Field Epidemiology and Laboratory Training Program (NFELTP)
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14
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Adeyinka DA, Evans MR, Ozigbu CE, van Woerden H, Adeyinka EF, Oladimeji O, Aimakhu C, Odoh D, Chamla D. Understanding the Influence of Socioeconomic Environment on Paediatric Antiretroviral Treatment Coverage: Towards Closing Treatment Gaps in Sub-Saharan Africa. Cent Eur J Public Health 2017; 25:55-63. [PMID: 28399356 DOI: 10.21101/cejph.a4479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 04/28/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Many sub-Saharan African countries have massively scaled-up their antiretroviral treatment (ART) programmes, but many national programmes still show large gaps in paediatric ART coverage making it challenging to reduce AIDS-related deaths among HIV-infected children. We sought to identify enablers of paediatric ART coverage in Africa by examining the relationship between paediatric ART coverage and socioeconomic parameters measured at the population level so as to accelerate reaching the 90-90-90 targets. METHODS Ecological analyses of paediatric ART coverage and socioeconomic indicators were performed. The data were obtained from the United Nations agencies and Forum for a new World Governance reports for the 21 Global Plan priority countries in Africa with highest burden of mother-to-child HIV transmission. Spearman's correlation and median regression were utilized to explore possible enablers of paediatric ART coverage. RESULTS Factors associated with paediatric ART coverage included adult literacy (r=0.6, p=0.004), effective governance (r=0.6, p=0.003), virology testing by 2 months of age (r=0.9, p=0.001), density of healthcare workers per 10,000 population (r=0.6, p=0.007), and government expenditure on health (r=0.5, p=0.046). The paediatric ART coverage had a significant inverse relationship with the national mother-to-child transmission (MTCT) rate (r=-0.9, p<0.001) and gender inequality index (r=-0.6, p=0.006). Paediatric ART coverage had no relationship with poverty and HIV stigma indices. CONCLUSIONS Low paediatric ART coverage continues to hamper progress towards eliminating AIDS-related deaths in HIV-infected children. Achieving this requires full commitment to a broad range of socioeconomic development goals.
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Affiliation(s)
- Daniel A Adeyinka
- National AIDS and STIs Control Programme, Department of Public Health, Federal Ministry of Health, Abuja, Nigeria
| | - Meirion R Evans
- Institute of Primary Care and Public Health, Cardiff University, Cardiff, UK
| | - Chamberline E Ozigbu
- National AIDS and STIs Control Programme, Department of Public Health, Federal Ministry of Health, Abuja, Nigeria
| | - Hugo van Woerden
- Institute of Primary Care and Public Health, Cardiff University, Cardiff, UK.,Public Health Directorate, National Health Service, Highland, Inverness, UK
| | - Esther F Adeyinka
- Department of Nursing, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - Olanrewaju Oladimeji
- Liverpool School of Tropical Medicine, Liverpool, UK.,Centre for Community Health Care, Research and Development, Abuja, Nigeria
| | - Chris Aimakhu
- Department of Obstetrics and Gynaecology, University College Hospital, Ibadan, Nigeria.,College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Deborah Odoh
- National AIDS and STIs Control Programme, Department of Public Health, Federal Ministry of Health, Abuja, Nigeria
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15
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Rahman MS, Mondal MNI, Islam MR, Rahman MM, Hoque MN, Alam MS. Determinant factors of tobacco use among ever-married men in Bangladesh. DRUG HEALTHCARE AND PATIENT SAFETY 2015; 7:77-85. [PMID: 25999762 PMCID: PMC4435047 DOI: 10.2147/dhps.s80864] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background The burden of tobacco use is shifting from developed to developing countries. This study aimed to explore the different types of tobacco use, and to identify the determinant factors associated with the tobacco use among ever-married men in Bangladesh. Data and methods Data of 3,771 ever-married men, 15–54 years of age were extracted from the Bangladesh Demographic and Health Survey 2007. Prevalence rate, chi-square (χ2) test, and binary logistic regression analysis were used as the statistical tools to analyze the data. Results Tobacco use through smoking (58.68%) was found to be higher than that of chewing (21.63%) among men, which was significantly more prevalent among the poorest, less educated, and businessmen. In bivariate analysis, all the socioeconomic factors were found significantly associated with tobacco use; while in multivariate analysis, age, education, wealth index, and occupation were identified as the significant predictors. Conclusion Tobacco use was found to be remarkably common among males in Bangladesh. The high prevalence of tobacco use suggests that there is an urgent need for developing intervention plans to address this major public health problem in Bangladesh.
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Affiliation(s)
- Md Shafiur Rahman
- Department of Public Health, First Capital University of Bangladesh, Chuadanga, Bangladesh ; Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, Bangladesh
| | - Md Nazrul Islam Mondal
- Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, Bangladesh
| | - Md Rafiqul Islam
- Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, Bangladesh
| | - Md Mizanur Rahman
- Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, Bangladesh
| | - M Nazrul Hoque
- Hobby Center for Public Policy, University of Houston, Houston, TX, USA
| | - Md Shamsher Alam
- Faculty of Ecology, Peoples' Friendship University of Russia, Moscow, Russia
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16
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Mondal MNI, Shitan M. Author's Response: Regarding the Relative Importance of Demographic, Socioeconomic and Health Factors on Life Expectancy in Low- and Lower-Middle-Income Countries. J Epidemiol 2015; 25:460. [PMID: 25986157 PMCID: PMC4444502 DOI: 10.2188/jea.je20150046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Md Nazrul Islam Mondal
- Laboratory of Computational Statistics and Operations Research, Institute for Mathematical Research, University Putra Malaysia
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17
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Islam Mondal MN, Nasir Ullah MMM, Khan MN, Islam MZ, Islam MN, Moni SY, Hoque MN, Rahman MM. Socioeconomic and Demographic Disparities in Knowledge of Reproductive Healthcare among Female University Students in Bangladesh. Int J MCH AIDS 2015; 4:32-9. [PMID: 27622005 PMCID: PMC4948130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Reproductive health (RH) is a critical component of women's health and overall well-being around the world, especially in developing countries. We examine the factors that determine knowledge of RH care among female university students in Bangladesh. METHODS Data on 300 female students were collected from Rajshahi University, Bangladesh through a structured questionnaire using purposive sampling technique. The data were used for univariate analysis, to carry out the description of the variables; bivariate analysis was used to examine the associations between the variables; and finally, multivariate analysis (binary logistic regression model) was used to examine and fit the model and interpret the parameter estimates, especially in terms of odds ratios. RESULTS The results revealed that more than one-third (34.3%) respondents do not have sufficient knowledge of RH care. The χ (2)-test identified the significant (p < 0.05) associations between respondents' knowledge of RH care with respondents' age, education, family type, watching television; and knowledge about pregnancy, family planning, and contraceptive use. Finally, the binary logistic regression model identified respondents' age, education, family type; and knowledge about family planning, and contraceptive use as the significant (p < 0.05) predictors of RH care. CONCLUSIONS AND GLOBAL HEALTH IMPLICATIONS Knowledge of RH care among female university students was found unsatisfactory. Government and concerned organizations should promote and strengthen various health education programs to focus on RH care especially for the female university students in Bangladesh.
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Affiliation(s)
- Md. Nazrul Islam Mondal
- Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi 6205, Bangladesh
| | | | - Md. Nuruzzaman Khan
- Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi 6205, Bangladesh
| | | | - Md. Nurul Islam
- Department of Statistics, University of Rajshahi, Rajshahi 6205, Bangladesh
| | - Sabiha Yasmin Moni
- Department of Pharmacology and Therapeutics, Rajshahi Medical College, Rajshahi 6200, Bangladesh
| | - Md. Nazrul Hoque
- Hobby Center for Public Policy, University of Houston, Houston, TX 77204-5021, USA
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Mondal MNI, Nazrul HM, Chowdhury MRK, Howard J. Socio-demographic factors affecting knowledge level of Tuberculosis patients in Rajshahi City, Bangladesh. Afr Health Sci 2014; 14:855-65. [PMID: 25834494 DOI: 10.4314/ahs.v14i4.13] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The Tuberculosis (TB) control program in Bangladesh is still unsatisfactory due to insufficient knowledge and stigma about TB. Patients with low knowledge may be at higher risk of experiencing delays in diagnosis and appropriate treatment. OBJECTIVES The aims of this study were to identify the knowledge levels of TB and investigate the factors associated with knowledge level among the TB patients in Bangladesh. METHODS A cross-sectional study was conducted at Rajshahi City, Bangladesh. A total of 384 TB patients were interviewed through a pretested, structured questionnaire using purposive sampling techniques. Logistic regression analysis was used to evaluate the effects of selected socio-demographic factors on TB knowledge level. RESULTS The results revealed that pulmonary TB patients had greater knowledge than that of extra-pulmonary patients, and that sex, age, educational status and TB type were significantly associated with knowledge level. CONCLUSIONS In general, males and young adults, ages 21-35, had greater awareness about transmission and prevention of TB than females and adults over 35. Individuals with higher education and urban area patients were comparatively better informed about TB infection. Patients with greater knowledge about TB were also less likely to experience delays in seeking treatment.
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Mondal MNI, Hoque N, Chowdhury MRK, Hossain MS. Factors associated with misconceptions about HIV transmission among ever-married women in Bangladesh. Jpn J Infect Dis 2014; 68:13-9. [PMID: 25420661 DOI: 10.7883/yoken.jjid.2013.323] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The human immunodeficiency virus (HIV) epidemic continues to be associated with misconceptions and misinformed opinions, which increase the risk of HIV transmission. Therefore, the present study aimed to identify the determinant factors among different socioeconomic and demographic factors affecting misconceptions about HIV transmission among ever-married women in Bangladesh. Data and necessary information of 9,272 ever-married women were extracted from the Bangladesh Demographic and Health Survey 2011. Three types of misconceptions were considered. Both bivariate and multivariate analyses were used as the statistical tools to determine the factors affecting misconceptions about HIV transmission. The results revealed that misconceptions are more prevalent among women who are older, less educated, have husbands who are less educated, live in rural areas, have poor economic conditions, and have less access to mass media. The respondent's age, education, husband's education, place of residence, wealth index, and exposure to mass media are significantly associated with the misconceptions. Finally, logistic regression analysis identified age, education, place of residence, wealth index, and exposure to mass media as significant predictors. Because socioeconomic factors are the key determinants of misconceptions about HIV transmission, intervention programs should be aimed at HIV prevention via education and awareness programs to reduce misconceptions as important parts of the prevention strategy.
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MONDAL MNI, SHITAN M. Impact of Socio-Health Factors on Life Expectancy in the Low and Lower Middle Income Countries. IRANIAN JOURNAL OF PUBLIC HEALTH 2013; 42:1354-62. [PMID: 26060637 PMCID: PMC4441932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 09/10/2013] [Indexed: 11/23/2022]
Abstract
BACKGROUND This study is concerned with understanding the impact of demographic changes, socioeconomic inequalities, and the availability of health factors on life expectancy (LE) in the low and lower middle income countries. METHODS The cross-country data were collected from 91 countries from the United Nations agencies in 2012. LE is the response variable with demographics (total fertility rate, and adolescent fertility rate), socioeconomic status (mean year of schooling, and gross national income per capita), and health factors (physician density, and HIV prevalence rate) are as the three main predictors. Stepwise multiple regression analysis is used to extract the main factors. RESULTS The necessity of more healthcare resources and higher levels of socioeconomic advantages are more likely to increase LE. On the other hand, demographic changes and health factors are more likely to increase LE by way of de-cease fertility rates and disease prevalence. CONCLUSION These findings suggest that international efforts should aim at increasing LE, especially in the low income countries through the elimination of HIV prevalence, adolescent fertility, and illiteracy.
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Affiliation(s)
- Md. Nazrul Islam MONDAL
- 1. Laboratory of Computational Statistics and Operations Research, Institute for Mathematical Research University Putra Malaysia, 43400 UPM Serdang, Selangor Darul Ehsan, Malaysia
- 2. Dept. of Population Science and Human Resource Development; University of Rajshahi, Rajshahi, Bangladesh
| | - Mahendran SHITAN
- 1. Laboratory of Computational Statistics and Operations Research, Institute for Mathematical Research University Putra Malaysia, 43400 UPM Serdang, Selangor Darul Ehsan, Malaysia
- 3. Dept. of Mathematics, Faculty of Science, University Putra Malaysia; 43400 UPM Serdang, Selangor Darul Ehsan, Malaysia
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Tumwine JK. Nodding syndrome, infections and sexuality. Afr Health Sci 2013; 13:i-iv. [PMID: 24235965 DOI: 10.4314/ahs.v13i2.94043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- James K Tumwine
- African Health Sciences, Makerere University, College of Health Sciences
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