Adherence to antiretroviral therapy and its associated factors among HIV positive patients in Nekemte public health institutions, West Ethiopia

A Meta-Analysis of Prevalence and Moderating Factors of Malnutrition Among People Living With HIV Across Countries

ABSTRACT

Malnutrition is a critical issue for people living with HIV (PLWH), affecting their immune function, health outcomes, and response to antiretroviral therapy. This meta-analysis assessed the prevalence of malnutrition among PLWH and explored key moderating factors across countries. A systematic search of six databases-Cumulative Index to Nursing and Allied Health Literature, Embase, ProQuest, PubMed, Scopus, and Web of Science, included 103 studies involving 240,879 PLWH. The pooled prevalence of malnutrition was 16.6% (95% confidence interval = 14.1-19.5). Subgroup analysis revealed higher prevalence in Southeast Asia (31.1%), PLWH with primary education (37.7%), those on antiretroviral therapy for over a year (51.7%), and World Health Organization Stage 3 (36.4%). Meta-regression identified alcohol consumption, smoking, hepatitis, and tuberculosis as significant moderators. The prevalence of malnutrition among PLWH is substantial, with several moderating factors identified. Addressing malnutrition among PLWH requires routine nutritional assessments and targeted interventions to improve health outcomes and quality of life for PLWH globally.

Growth and body composition of adolescents and young adults with perinatal HIV infection: a systematic review and meta-analysis

INTRODUCTION

Approximately 1.3 million pregnancies are exposed to HIV perinatally each year, with transmission rates ranging from 4 to 21%, despite 85% antiretroviral therapy (ART) coverage among pregnant women. While ART has significantly reduced mother-to-child transmission, recent studies indicate an increased risk of chronic conditions among perinatally HIV-infected youth. There is a critical need for further research on the growth and health of these populations to inform effective health interventions. Therefore, the aim of this study is to critically evaluate observational research assessing the growth and body composition of perinatally HIV-infected adolescents and young adults.

METHODS

We conducted a systematic review using the MEDLINE (by PubMed), Embase, Central (by Cochrane Library), Latin American and Caribbean Health Science Information (LILACS) and Web of Science databases. The initial search was conducted on November 24, 2022, and updated on June 3, 2024. We included cohort studies that evaluated perinatally HIV-infected adolescents (aged 10 to 19 years) and young adults (aged 20 to 24 years). A meta-analysis was performed to estimate the prevalence of stunting (HAZ < -2) and underweight (BAZ < -2). Additionally, we conducted meta-analyses for the mean values of HAZ and BAZ in the population after the follow-up period, as well as for the mean change in HAZ and BAZ post-follow-up.

RESULTS

Our search strategy retrieved 11,017 documents. After excluding duplicates, we analyzed 9,273 titles and abstracts. A full-text review of the remaining 87 records was conducted. Following the updated search, we identified 6 publications from 4 studies, resulting in a total of 14 studies and 16 publications. Nine studies focused exclusively on adolescents, while three evaluated both children and adolescents, and three included both adolescents and young adults. We estimated a prevalence of stunting at 26% (95% CI: 0.23-0.29) and underweight at 14% (95% CI: 0.12-0.17). In this population, the mean HAZ was -1.58 (95% CI: -1.90; -1.27), and the mean BAZ was -0.34 (95% CI: -0.61; -0.06). Additionally, we identified an increase of 0.55 (95% CI: 0.07; 1.03) in mean HAZ and 0.12 (95% CI: -0.56; 0.79) in mean BAZ after the follow-up period.

CONCLUSIONS

Our study highlights significant growth and body composition challenges among perinatally HIV-infected adolescents and young adults, with concerning rates of stunting and underweight. Although there was a modest increase in height-for-age, persistent challenges in achieving optimal growth remain. The slight improvement in BMI is insufficient to fully address underweight concerns. The limited number of studies and their inherent limitations restrict the ability to draw consistent conclusions regarding the effects and magnitude of exposure on anthropometric outcomes. Further research is needed to better elucidate these relationships.

TRIAL REGISTRATION

CRD42022372837.

Non-Adherence to Anti-Retroviral Therapy Among Adult People Living with HIV in Ethiopia: Systematic Review and Meta-Analysis

Human immunodeficiency virus remains a global public health problem. Despite efforts to determine the prevalence of non-adherence to ART and its predictors in Ethiopia, various primary studies presented inconsistent findings. Therefore, this review aimed to determine the pooled prevalence of non-adherence to ART and identify its predictors. We have searched PubMed, Google Scholar and Web of Science databases extensively for all available studies. A weighted inverse-variance random-effects model was used to compute the overall non-adherence to ART. The pooled prevalence of non-adherence to ART was 20.68% (95% CI: 17.74, 23.61); I2 = 98.40%; p < 0.001). Educational level of primary school and lower [AOR = 3.5, 95%CI: 1.7, 7.4], taking co-medications [AOR = 0.45, 95%CI: 0.35, 0.59], not using memory aids [AOR = 0.30, 95%CI: 0.13, 0.71], depression [AOR = 2.0, 95%CI: 1.05, 3.79], comorbidity [AOR = 2.12, 95%CI: 1.16, 3.09), under-nutrition [AOR = 2.02, 95%CI: 1.20, 3.43], not believing on ART can control HIV [AOR = 2.31, 95%CI: 1.92, 2.77], lack of access to health facilities [AOR = 3.86, 95%CI: 1.10, 13.51] and taking ART pills uncomfortably while others looking [AOR = 5.21, 95%CI: 2.56, 10.53] were significantly associated with non-adherence to anti-retroviral therapy. The overall pooled prevalence of non-adherence to ART was considerably high in Ethiopia. Educational status, taking co-medications, not using memory aids, depression, comorbidity, under nutrition, not believing on anti-retroviral therapy controls HIV, lack of access to health facilities and taking ART pills uncomfortably were independent predictors of non-adherence to ART in Ethiopia. Therefore, healthcare providers, adherence counselors and supporters should detect non-adherence behaviors and patients' difficulties with ART early, and provide intensive counseling to promote adherence.

Factors affecting optimal adherence to antiretroviral therapy and viral suppression amongst HIV-infected prisoners in South Ethiopia: a comparative cross-sectional study

BACKGROUND

Maintaining optimal adherence and viral suppression in people living with HIV (PLWH) is essential to ensure both preventative and therapeutic benefits of antiretroviral therapy (ART). Prisoners bear a particularly high burden of HIV infection and are highly likely to transmit to others during and after incarceration. However, the level of treatment adherence and viral suppression in incarcerated populations in low-income countries is unknown. This study aimed to determine factors affecting optimal adherence to antiretroviral therapy and viral suppression amongst HIV-infected prisoners in South Ethiopia.

METHODS

A comparative cross-sectional study was conducted between June 1, 2019 and May 31, 2020 to compare the level of adherence and viral suppression between incarcerated and non-incarcerated PLWH. Patient information including demographic, socio-economic, behavioral, and incarceration-related characteristics were collected using a structured questionnaire. Medication adherence was assessed according to self-report and pharmacy refill. Plasma viral load measurements undertaken within the study period were prospectively extracted to determine viral suppression. Univariate and multivariate logistic and fractional regression models were used to analyse data.

RESULTS

Seventy-four inmates living with HIV (ILWH) and 296 non-incarcerated PLWH participated in the study. While ILWH had a significantly higher pharmacy refill adherence compared to non-incarcerated PLWH (89 vs 75%), they had a slightly lower dose adherence (81% vs 83%). The prevalence of viral non-suppression was also slightly higher in ILWH (6.0%; 95% confidence interval (CI): 1.7-14.6%) compared to non-incarcerated PLWH (4.5%; 95%CI: 2.4-7.5%). Overall, missing ART appointments, dissatisfaction with ART services, inability to comply with a specified medication schedule, and types of methods used to monitor the schedule (e.g., news time on radio/TV or other social cues) were significantly associated with non-adherence according to self-report. In ILWH specifically, accessing ART services from a hospital, inability to properly attend clinic appointments, depressive symptoms, and lack of social support predicted NA. Viral non-suppression was significantly higher in males, people of age 31to 35 years and in those who experienced social stigma, regardless of their incarceration status.

CONCLUSIONS

Sub-optimal dose adherence and viral suppression are generally higher in HIV-infected prisoners in South Ethiopia compared to their non-incarcerated counterparts. A multitude of factors were found to be responsible for this requiring multilevel intervention strategies focusing on the specific needs of prisoners.

Characteristics and impacts ofSystematic review nutritional programmes to address undernutrition of adults living with HIV in sub-Saharan Africa: a systematic review of evidence

OBJECTIVES

Although some studies have identified various challenges affecting nutritional programmes to effectively tackle undernutrition among people living with HIV, evidence about the characteristics and impacts of these programmes on weight-related nutritional outcomes varies based on country contexts, specific programme goals and the implementation processes. This systematic review sought to synthesise evidence on the characteristics and impact of nutritional programmes on weight-related nutritional outcomes of people living with HIV in sub-Saharan Africa.

DESIGN

Systematic review.

DATA SOURCES

We searched for primary studies published in the following databases: Web of Science, Medline, Scopus, ScienceDirect, ProQuest and Google Scholar, supplemented by checking reference lists of included papers.

ELIGIBILITY CRITERIA

Studies published from 2005 to 10 July 2020 and reporting on the weight-related nutritional outcomes of undernourished people enrolled in nutritional programmes in HIV care in sub-Saharan Africa were included.

DATA EXTRACTION AND SYNTHESIS

Data were extracted using a data extraction proforma. Weight-related nutritional outcomes of people living with HIV before and after enrolment in a nutritional programme were compared and narratively synthesised.

RESULTS

Sixteen studies assessing the impact of nutritional programmes in HIV care on weight-related nutritional outcomes were included. Of these, 13 examined nutritional programmes implemented in health facilities and the remaining three were delivered outside of health facilities. Nutritional recovery (defined differently in the studies) ranged from 13.1% to 67.9%. Overall programme failure rate, which included default after enrolment in a nutritional programme or non-response, ranged from 37.6% to 48.0%. More specifically, non-response to a nutritional programme ranged from 21.0% to 67.4% and default from the programme ranged from 19.0% to 70.6%. Key sociodemographic, clinical and nutritional characteristics that affect nutritional recovery, non-response and default were also identified.

CONCLUSIONS AND RECOMMENDATIONS

Nutritional programmes in HIV care have led to some improvements in weight-related nutritional outcomes among people living with HIV. However, the programmes were characterised by a high magnitude of default and non-response. To improve desired weight-related nutritional outcomes of people living with HIV, a holistic approach that addresses longer-term determinants of undernutrition is needed.

PROSPERO REGISTRATION NUMBER

CRD42020196827.