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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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Zondi S, Cele L, Mathibe M, Mogale M. Virological non-suppression and associated factors among adult patients receiving antiretroviral therapy at selected health facilities in uMgungundlovu district of KwaZulu Natal, South Africa: a cross-sectional study. Pan Afr Med J 2024; 47:96. [PMID: 38799193 PMCID: PMC11126752 DOI: 10.11604/pamj.2024.47.96.42338] [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: 12/05/2023] [Accepted: 01/09/2024] [Indexed: 05/29/2024] Open
Abstract
Introduction virological non-suppression is not only associated with increased risk of transmission of the Human Immunodeficiency virus (HIV) to others; perinatally and sexually, but it also decreases the life expectancy among the individuals who are on antiretroviral therapy (ART). This study sought to determine the level of virological non-suppression among ART patients from selected health facilities of a sub-district in uMgungundlovu district. This sub-district has high HIV transmission rates in KwaZulu Natal (KZN) and had one of the highest HIV prevalence in the district in 2018; population weighted HIV prevalence of 36.3% among men and women aged 15-49 years old, which was twice the average national prevalence of 18.8%. Methods this descriptive, cross-sectional, and quantitative study was conducted among participants who were HIV-positive, 18 years old and above, and initiated on ART between January 2017 and January 2019 at selected PHC facilities of Vulindlela sub district. Health facility treatment registers, patient medical files and face-to-face interviews were used to collect the data and these were captured onto an Excel spreadsheet, cleaned, coded before importation into Epiinfo 17 for statistical analyses. Logistic regression analyses were conducted to investigate the factors associated with virological non-suppression. Results the study found a majority of participants were females (240/401 (60%)). The mean age of the participants was 38.1 (SD=11.2), with most participants who were between the ages of 29 and 39 years old (167 (41.7%)). Virological non-suppression was observed among 10% (40/401) of participants. The odds of virological non-suppression were higher among participants who were married (aOR 4.76, 95% CI 1.49-15.19; p=0.008). Conclusion a virological non-suppression of 10% translates to viral suppression of 90%, which is below the target of UNAIDS 95-95-95 strategy. Hiding and skipping medication indicate how non-disclosure continues to hinder HIV treatment adherence. High odds of virological non-suppression among married participants indicate non-disclosure of the positive HIV status, or lack in spousal support.
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Affiliation(s)
- Slindile Zondi
- Department of Public Health, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa
| | - Lindiwe Cele
- Department of Public Health, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa
- Epidemiology and Biostatistics Unit, Department of Public Health, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa
| | - Mmampedi Mathibe
- Department of Public Health, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa
- Epidemiology and Biostatistics Unit, Department of Public Health, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa
| | - Mabina Mogale
- Department of Public Health, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa
- Epidemiology and Biostatistics Unit, Department of Public Health, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa
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Izudi J, Cattamanchi A, Castelnuovo B, King R. Barriers and facilitators to viral load suppression among people living with HIV following intensive adherence counseling in Kampala, Uganda: A qualitative study. Soc Sci Med 2024; 343:116595. [PMID: 38242033 DOI: 10.1016/j.socscimed.2024.116595] [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: 07/07/2023] [Revised: 12/08/2023] [Accepted: 01/10/2024] [Indexed: 01/21/2024]
Abstract
We explored the barriers and facilitators to viral load (VL) suppression after three or more intensive adherence counseling (IAC) sessions among adolescents and adults living with human immunodeficiency virus (HIV) on a first-line anti-retroviral therapy (ART) with initially unsuppressed VL in Kampala, Uganda. Using a qualitative study, data were collected through in-depth interviews with people living with HIV (PLHIV) with unsuppressed and suppressed VL and caregivers of younger adolescents living with HIV after three or more IAC sessions. We held key informant interviews with health workers involved in IAC implementation, namely ART/HIV focal persons, IAC Team Leaders, and linkage facilitators. Guided by the socioecological model, we performed content analysis and reported the findings using themes along with the participants' quotes. We studied 24 participants and found the individual-level barriers as forgetting to take HIV medications, high pill burden, medication side effects, a lack of food, and HIV-related psychological distress. Undisclosed HIV status and broken families were the barriers at the interpersonal level. Institutional-level barriers included insufficient HIV and ART counseling. Stigma was considered a community-level barrier while nonadherence to HIV treatment guidelines was a policy-level barrier. Facilitators included personal reminders, knowing the importance of taking treatment, and the ability to deal with side effects of HIV medications at the personal level; treatment support, peer support clubs, and incentivized treatment at the interpersonal level; and mental health support club and explaining during counseling that HIV is a chronic disease at the institutional level. We found an unsuppressed VL after completing IAC was due to several barriers at the personal, interpersonal, health systems, community, and policy levels. Achieving ≥95% VL suppression necessitates tackling the barriers to VL suppression and scaling up the facilitators by HIV control programs.
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Affiliation(s)
- Jonathan Izudi
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Uganda; University of California Global Health Institute (UCGHI), University of California San Francisco, San Francisco, CA, USA.
| | - Adithya Cattamanchi
- Division of Pulmonary Diseases and Critical Care Medicine, University of California Irvine, Irvine, CA, USA
| | - Barbara Castelnuovo
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Uganda
| | - Rachel King
- Institute for Global Health Sciences, Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
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Nanyeenya N, Nakanjako D, Makumbi F, Nakigozi G, Nalugoda F, Kigozi G, Nasuuna E, Kibira SPS, Nabadda S, Kiyaga C, Huzaifah M, Kiwanuka N. Effectiveness of intensive adherence counselling in achieving an undetectable viral load among people on antiretroviral therapy with low-level viraemia in Uganda. HIV Med 2024; 25:245-253. [PMID: 37853605 PMCID: PMC11047222 DOI: 10.1111/hiv.13568] [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: 05/14/2023] [Accepted: 09/29/2023] [Indexed: 10/20/2023]
Abstract
INTRODUCTION Uganda was using a threshold of 1000 copies/mL to determine viral non-suppression for antiretroviral therapy monitoring among people living with HIV, prior to this study. It was not clear whether people living with HIV with low-level viraemia (LLV, ≥50 to <1000 copies/mL) would benefit from intensive adherence counselling (IAC). The purpose of this study was to determine the effectiveness of IAC among people living with HIV, receiving antiretroviral therapy, and with LLV in Uganda, to guide key policy decisions in HIV care, including the review of the viral load (VL) testing algorithm. METHODS This cluster-randomized clinical trial comprised adults from eight HIV clinics who were living with HIV, receiving ART, and had recent VL results indicating LLV (tested from July 2022 to October 2022). Participants in the intervention arm clinics received three once-monthly sessions of IAC, and those in the comparison non-intervention arm clinics received the standard of care. At the end of the study, all participants were re-tested for VL to determine the proportions of those who then had an undetectable VL (<50 copies/mL). We assessed the statistical association between cross-tabulated variables using Fisher's exact test and then modified Poisson regression. RESULTS A total of 136 participants were enrolled into the study at eight HIV clinics. All 68 participants in the intervention arm completed all IAC sessions. Only one participant in the non-intervention arm was lost to follow-up. The average follow-up time was 3.7 months (standard deviation [SD] 0.2) and 3.5 months (SD 0.1) in the intervention and non-intervention arms, respectively. In total, 59 (43.7%) of 135 people living with HIV achieved an undetectable VL during the study follow-up period. The effect of IAC on attaining an undetectable VL among people with LLV was nearly twice as high in the intervention arm (57.4%) than in the non-intervention arm (29.9%): adjusted risk ratio 1.9 (95% confidence interval 1.0-3.5), p = 0.037. CONCLUSION IAC doubled the likelihood of an undetectable VL among people living with HIV with LLV. Therefore, IAC has been instituted as an intervention to manage people living with HIV with LLV in Uganda, and this should also be adopted in other Sub-Saharan African countries with similar settings. CLINICALTRIALS GOV IDENTIFIER NCT05514418.
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Affiliation(s)
- Nicholus Nanyeenya
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
- Ministry of Health Central Public Health Laboratories, Kampala, Uganda
| | - Damalie Nakanjako
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Fredrick Makumbi
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | | | | | | | - Esther Nasuuna
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Simon P S Kibira
- Department of Community Health and Behavioral Sciences, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Susan Nabadda
- Ministry of Health Central Public Health Laboratories, Kampala, Uganda
| | - Charles Kiyaga
- Ministry of Health Central Public Health Laboratories, Kampala, Uganda
| | - Mutyaba Huzaifah
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Noah Kiwanuka
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
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Quaker AS, Shirima LJ, Msuya SE. Trend and factors associated with non-suppression of viral load among adolescents on ART in Tanzania: 2018-2021. FRONTIERS IN REPRODUCTIVE HEALTH 2024; 6:1309740. [PMID: 38292142 PMCID: PMC10823012 DOI: 10.3389/frph.2024.1309740] [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: 10/08/2023] [Accepted: 01/02/2024] [Indexed: 02/01/2024] Open
Abstract
Background Tanzania is one of the countries with a high burden of HIV. It has an estimated 1.4 million people living with HIV in 2021. Adolescents living with HIV on antiretroviral therapy (ART) have worse treatment adherence, viral suppression, and mortality rates compared to adults. This study aim was to determine the trend of non-suppression among adolescents on ART in Tanzania from 2018 to 2021 and latest associated predictors. Methodology The study utilized data of adolescents (10-19 years) receiving ART in Tanzania mainland for the period of 2018-2021 from the National Care and Treatment Centers database. The primary outcome of interest was non-suppression of viral load, defined as a VL above 1,000 copies/ml. The study employed multivariable logistic regression models to identify factors associated with non-suppression of VL. STATA 15 statistical software was used to analyze the data. Results Records of 65,942 adolescents present in the CTC database Tanzania were analyzed. Approximately more than half were female 38,544 (58.5%). The proportion of non-suppression was 34.5%, 23.3%, 12.1%, and 9.7% for the years 2018-2021, respectively. After adjusting for other factors, adolescents with a history of poor adherence to ART in the last six months had higher odds of non-suppression (OR = 1.95, 95% CI = 1.64, 2.31). Adolescents on second or third line ART regimens were almost two times more likely to be non-suppressed compared to those on first-line regimens (OR = 2.85, 95% CI = 2.52, 3.23). Girls had lower odds of non-suppression compared to boys (OR = 0.91, 95% CI = 0.84, 0.98), and similarly, patients attending hospitals had lower odds compared to those attending dispensaries (OR = 0.79, 95% CI = 0.72, 0.87). Conclusion Being female, having good history of adherence over the last six months, and attending hospital level was significantly associated with lower levels of non-suppression, while being on second line ART or attending lower health facilities increased the odds of non-suppression. Efforts to enhance the quality and capacity of health services at lower-level facilities (dispensaries and health centers) should be prioritized, as well as promoting gender-sensitive approaches that take into account the unique needs and experiences of adolescent girls and boys are needed to improve VL suppression among this population.
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Affiliation(s)
- Andrewleon S. Quaker
- Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Regional Health Management Team, Regional Secretariat, Kilimanjaro, Tanzania
| | - Laura J. Shirima
- Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Sia E. Msuya
- Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
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Lejone TI, Mahomed O. Magnitude and Determinants of Virological Failure Among Patients >15 Years on Anti-Retroviral Therapy in Rural Lesotho Between 2015 and 2019 - A Retrospective Cohort Study. HIV AIDS (Auckl) 2023; 15:611-620. [PMID: 37849794 PMCID: PMC10577259 DOI: 10.2147/hiv.s424277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 09/10/2023] [Indexed: 10/19/2023] Open
Abstract
Background Lesotho has the second-highest HIV prevalence globally at an estimated 23%, with approximately 87% of the population between 15 and 59 years of age reported to be receiving antiretroviral treatment. There is an urgent need to increase access to effective ART due to increasing rates of first- and second-line treatment failure. Sustaining successful treatment and limiting the development of virological failure is essential, hence the need for early detection of increased viral load indicating drug resistance or rapid progression of viral replication. Aim The aim of the study was to determine the proportion of patients with HIV with virological failure and to identify factors associated with virological failure in two districts of Lesotho. Methods A retrospective cohort study was conducted in two districts (Butha-Buthe and Mokhotlong) in Lesotho. Data for all patients (age ≥15 years) in the viral load (VL) monitoring database with at least two consecutive viral load results between December 2015 and December 2019 from 22 health facilities were extracted. Descriptive data were presented using tables and figures. Bivariate and multivariate analyses were performed. A p-value < 0.05 was considered a statistically significant association. Results Only 4% (n = 913) of the study participants had virological failure. Longer time on treatment >65 months (AOR: 1.85 CI: 1.59-2.15) and being on second-line ART regimen (AOR: 75.23 95% CI: 75.00-99.15) were significantly (p < 0.001) associated with virological failure. Conclusion Virological failure among the study participants is lower compared to other settings. The study identified duration on treatment, treatment regimen as high risk for virological failure. Targeted interventions should be developed for these high-risk group individuals, with continuous monitoring of virological response and appropriate drug switching to clients to achieve improved outcomes.
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Affiliation(s)
- Thabo Ishmael Lejone
- SolidarMed, Lesotho, South Africa
- Discipline of Public Health Medicine, University of KwaZulu Natal, Durban, South Africa
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Esber AL, Dear NF, King D, Francisco LV, Sing'oei V, Owuoth J, Maswai J, Iroezindu M, Bahemana E, Kibuuka H, Shah N, Polyak CS, Ake JA, Crowell TA. Achieving the third 95 in sub-Saharan Africa: application of machine learning approaches to predict viral failure. AIDS 2023; 37:1861-1870. [PMID: 37418549 DOI: 10.1097/qad.0000000000003646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2023]
Abstract
OBJECTIVE Viral failure in people with HIV (PWH) may be influenced by multiple sociobehavioral, clinical, and context-specific factors, and supervised learning approaches may identify novel predictors. We compared the performance of two supervised learning algorithms to predict viral failure in four African countries. DESIGN Cohort study. METHODS The African Cohort Study is an ongoing, longitudinal cohort enrolling PWH at 12 sites in Uganda, Kenya, Tanzania, and Nigeria. Participants underwent physical examination, medical history-taking, medical record extraction, sociobehavioral interviews, and laboratory testing. In cross-sectional analyses of enrollment data, viral failure was defined as a viral load at least 1000 copies/ml among participants on antiretroviral therapy (ART) for at least 6 months. We compared the performance of lasso-type regularized regression and random forests by calculating area under the curve (AUC) and used each to identify factors associated with viral failure; 94 explanatory variables were considered. RESULTS Between January 2013 and December 2020, 2941 PWH were enrolled, 1602 had been on antiretroviral therapy (ART) for at least 6 months, and 1571 participants with complete case data were included. At enrollment, 190 (12.0%) had viral failure. The lasso regression model was slightly superior to the random forest in its ability to identify PWH with viral failure (AUC: 0.82 vs. 0.75). Both models identified CD4 + count, ART regimen, age, self-reported ART adherence and duration on ART as important factors associated with viral failure. CONCLUSION These findings corroborate existing literature primarily based on hypothesis-testing statistical approaches and help to generate questions for future investigations that may impact viral failure.
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Affiliation(s)
- Allahna L Esber
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Nicole F Dear
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - David King
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Leilani V Francisco
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Valentine Sing'oei
- U.S. Army Medical Research Directorate - Africa
- HJF Medical Research International, Kisumu
| | - John Owuoth
- U.S. Army Medical Research Directorate - Africa
- HJF Medical Research International, Kisumu
| | - Jonah Maswai
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring
- U.S. Army Medical Research Directorate - Africa, Kericho, Kenya
| | - Michael Iroezindu
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring
- HJF Medical Research International, Abuja, Nigeria
| | - Emmanuel Bahemana
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring
- HJF Medical Research International, Mbeya, Tanzania
| | - Hannah Kibuuka
- Makerere University-Walter Reed Project, Kampala, Uganda
| | - Neha Shah
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring
| | - Christina S Polyak
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Julie A Ake
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring
| | - Trevor A Crowell
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
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Masresha SA, Kidie AA, Alen GD, Mulaw GF, Feleke FW, Kassaw MW, Dejene TM. Virological failure and its predictors among human immunodeficiency virus infected individuals on second line antiretroviral treatment in North-East Ethiopia, 2021. Pharmacoepidemiol Drug Saf 2023; 32:978-987. [PMID: 36974512 DOI: 10.1002/pds.5625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 02/25/2023] [Accepted: 03/24/2023] [Indexed: 03/29/2023]
Abstract
INTRODUCTION Acquired immune deficiency syndrome (AIDS) becomes a manageable chronic disease due to the presence of effective prevention, diagnosis, treatment, and care accesses. Viral load cascade analyses are important to identify gaps in human immunodeficiency virus (HIV)/AIDS treatment and care for quality improvements. OBJECTIVE Time to Virological Failure and its Predictors among HIV Infected Individuals on Second Line Antiretroviral Treatment (SLART) in North-East Ethiopia, 2021. METHODS Institution-based retrospective follow-up study was conducted on 474 HIV-infected individuals who were on SLART between September 2016 and April 2020. A universal sampling technique was used to recruit study participants. Data were entered by EpiData-3.3.1 and analyzed by STATA-14. Cox proportional hazard assumptions were checked to determine the effect of predictor variables on virological failure (VF). The study was conducted from February 1 to April 30, 2021. RESULTS The rate of VF in this study was 15.4% with an incidence rate of 4.93 per 100 person-years. As participants' age and duration of ART use increased by 1 year the hazards of VF was reduced by 2.9% (AHR: 0.971, 95% CI: 0.945, 0.995) and 10.6% (AHR: 0.894, 95% CI: 0.828, 0.963), respectively. The hazards of VF were twice higher among those who were on a non-protease inhibitor-based regimen. Individuals who had a history of making enhanced adherence counseling (EAC) sessions during SLART had three times more risk to develop VF (AHR: 3.374, 95% CI: 1.790, 6.361). CONCLUSION AND RECOMMENDATIONS The rate of VF among SLART users was high. Keeping SLART users on PI-based regimens may improve virological outcomes in HIV care and treatment. Making EAC sessions effective in promoting better ART adherence might reduce VF.
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Affiliation(s)
| | | | - Gedefaw Diress Alen
- Department of Public Health, Debre Markos University, Debre Markos, Ethiopia
| | | | | | | | - Tadesse Mamo Dejene
- Department of Public Health, Debre Berhan University, Debre Berhan, Ethiopia
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Melak D, Wedajo S, Dewau R. Time to Viral Re-suppression and Its Predictors among Adults on Second-Line Antiretroviral Therapy in South Wollo Zone Public Hospitals: Stratified Cox Model. HIV AIDS (Auckl) 2023; 15:411-421. [PMID: 37431501 PMCID: PMC10329832 DOI: 10.2147/hiv.s406372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 06/09/2023] [Indexed: 07/12/2023] Open
Abstract
Background Even though there are many patients on second-line antiretroviral therapy (ART) in Ethiopia, there is a paucity of evidence on the rate of viral resuppression and its predictors. Therefore, this study aimed to determine a time to viral resuppression and identify predictors among adults on second-line ART in South Wollo public hospitals, northeast Ethiopia. Methods A retrospective-cohort study design was employed using patients enrolled in second-line ART from August 28, 2016 to April 10, 2021. Data were collected using a structured data-extraction checklist with a sample size of 364 second-line ART patients from February 16 to March 30, 2021. EpiData 4.6 was used for data entry and Stata 14.2 was used for analysis. The Kaplan-Meier method was used for estimating time to viral resuppression. The Shönfield test was used to check the proportional-hazard assumption, and the "no interaction" stratified Cox assumption was checked using the likelihood-ratio test. A stratified Cox model was applied to identify predictors of viral resuppression. Results Median time to viral re-suppression in patients on a second-line regimen was 10 (IQR 7-12) months. BeingFemale (AHR 1.31, 95% CI 1.01-1.69), low viral load count at switch (AHR 1.98, 95% CI 1.26-3.11), normal-range BMI at switch (AHR 1.42, 95% CI 1.03-1.95), and lopinavir-based second-line regimen (AHR 1.72, 95% CI 1.15-2.57) were significant predictors of early time to viral resuppression after stratification by WHO stage and adherence level. Conclusion Median time to viral re-suppression after switching to second-line ART was 10 months. In the stratified Cox model, female sex, baseline viral copies, second-line regimen type, and BMI at switch were statistically significant predictors of time to viral resuppression. Different stakeholders working on the HIV program should maintain viral resuppression by addressing significant predictors, and ART clinicians should consider ritonavir-boosted lopinavir based second-line ART for newly switched patients.
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Affiliation(s)
- Dagnachew Melak
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Shambel Wedajo
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Reta Dewau
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Toska E, Zhou S, Chen-Charles J, Gittings L, Operario D, Cluver L. Factors Associated with Preferences for Long-Acting Injectable Antiretroviral Therapy Among Adolescents and Young People Living with HIV in South Africa. AIDS Behav 2023; 27:2163-2175. [PMID: 36622486 PMCID: PMC9827015 DOI: 10.1007/s10461-022-03949-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2022] [Indexed: 01/10/2023]
Abstract
Long-acting injectable anti-retroviral therapy (LAART) may overcome barriers to long-term adherence and improve the survival of adolescents and young people living with HIV (AYLHIV). Research on the acceptability of LAART for this age-group is limited. We asked 953 AYLHIV about their preferred (theoretical) ART mode of delivery (pill, injectable, or other) in 2017-2018, before LAART was available or known to AYLHIV in South Africa. One in eight (12%) AYLHIV preferred LAART over single or multiple pill regimens. In multivariate analyses, six factors were associated with LAART preference: medication stock-outs (aOR = 2.56, 95% CI 1.40-4.68, p = 0.002), experiencing side-effects (aOR = 1.84, 95% CI 1.15-2.97, p = 0.012), pill-burden (aOR = 1.88, 95% CI 1.20-2.94, p = 0.006), past-year treatment changes (aOR = 1.63, 95% CI 1.06-2.51, p = 0.025), any HIV stigma (aOR = 2.22, 95% CI 1.39-3.53, p ≤ 0.001) and recent ART initiation (aOR = 2.02, 95% CI 1.09-3.74, p = 0.025). In marginal effects modelling, 66% of adolescents who experienced all factors were likely to prefer LAART, highlighting the potential high acceptability of LAART among adolescents and young people living with HIV struggling to adhere and have good HIV treatment outcomes. Adolescent boys who reported high ART pill burden were more likely to prefer LAART than their female peers in moderation analyses, suggesting that LAART may be particularly important to improve treatment outcomes among male AYLHIV as they become older. Adding LAART to existing treatment options for AYLHIV, particularly higher risk groups, would support AYLHIV to attain and sustain viral suppression-the third 95, and reduce their risk of AIDS-related mortality.
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Affiliation(s)
- Elona Toska
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa.
- Department of Sociology, University of Cape Town, Cape Town, South Africa.
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK.
- Centre for Social Science Research, Leslie Social Sciences Building, University of Cape Town, 4.89, Rondebosch, Cape Town, 7700, South Africa.
| | - Siyanai Zhou
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Jenny Chen-Charles
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Lesley Gittings
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
- School of Health Studies, Faculty of Health Sciences, Western University, London, Canada
| | - Don Operario
- Rollins School of Public Health, Emory University, Atlanta, USA
| | - Lucie Cluver
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
- Department of Child and Adolescent Psychiatry, University of Cape Town, Cape Town, UK
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11
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Wanjala SW, Nyongesa MK, Mapenzi R, Luchters S, Abubakar A. A qualitative inquiry of experiences of HIV-related stigma and its effects among people living with HIV on treatment in rural Kilifi, Kenya. Front Public Health 2023; 11:1188446. [PMID: 37427260 PMCID: PMC10324964 DOI: 10.3389/fpubh.2023.1188446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/25/2023] [Indexed: 07/11/2023] Open
Abstract
Background The pervasiveness of HIV-related stigma and discrimination, and its consequences on HIV prevention and treatment, have been well documented. However, little is known about the lived experiences of HIV-related stigma and its effects among the general adult population living with HIV in rural African settings. This study set out to explore this knowledge gap. Methods From April to June 2018, we conducted in-depth interviews with a convenience sample of 40 adults living with HIV aged 18-58 years in Kilifi, Kenya. A semi-structured interview guide was used to explore experiences of HIV-related stigma and its impact on these adults. A framework approach was used to analyze the data using NVIVO 11 software. Results Participants reported experiences of HIV-related stigma in its various forms (anticipated, perceived, internalised, and enacted), as well as its effects on HIV treatment and social and personal spheres. The internalisation of stigma caused by enacted stigma impacted care-seeking behavior resulting in worse overall health. Anxiety and depression characterized by suicidal ideation were the results of internalised stigma. Anticipated stigma prompted HIV medication concealment, care-seeking in remote healthcare facilities, and care avoidance. Fewer social interactions and marital conflicts resulted from perceived stigma. Overall, HIV-related stigma resulted in partial and non-disclosure of HIV seropositivity and medication non-adherence. At a personal level, mental health issues and diminished sexual or marital prospects (for the unmarried) were reported. Conclusion Despite high awareness of HIV and AIDS among the general population in Kenya, adults living with HIV in rural Kilifi still experience different forms of HIV-related stigma (including self-stigma) that result in a raft of social, personal, and HIV-treatment-related consequences. Our findings underscore the urgent need to reevaluate and adopt more effective strategies for implementing HIV-related anti-stigma programs at the community level. Addressing individual-level stigma will require the design of targeted interventions. To improve the lives of adults living with HIV in Kilifi, the effects of HIV-related stigma, particularly on HIV treatment, must be addressed.
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Affiliation(s)
- Stanley W. Wanjala
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Social Sciences, School of Humanities and Social Sciences, Pwani University, Kilifi, Kenya
| | - Moses K. Nyongesa
- Neuroassessment Group, KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Rachael Mapenzi
- Neuroassessment Group, KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
| | - Stanley Luchters
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Centre for Sexual Health and HIV AIDS Research (CeSHHAR), Harare, Zimbabwe
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Amina Abubakar
- Neuroassessment Group, KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
- Department of Public Health, School of Human and Health Sciences, Pwani University, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
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12
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Boakye P, Safowaa A. Prevalence and predictors of viral load suppression in adults living with HIV in the western region of Ghana: A cross-sectional study. AIMS Public Health 2023; 10:469-479. [PMID: 37304596 PMCID: PMC10251059 DOI: 10.3934/publichealth.2023033] [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: 12/30/2022] [Revised: 05/05/2023] [Accepted: 05/23/2023] [Indexed: 06/13/2023] Open
Abstract
Background Although antiretroviral therapy is beneficial and available free of cost to patients, several roadblocks still prevent patients from reaching viral suppression. This research aimed to determine the prevalence rate of viral suppression among people living with HIV in the western region of Ghana and identify the factors contributing to viral non-suppression. Methods A cross-sectional study was conducted on 7199 HIV-positive adults. All data from the Sekondi Public Health Laboratory database was exported to Microsoft Excel and then verified and filtered before being exported to STATA 16.1. Viral non-suppression was modeled statistically using logistic regression. Results Viral load suppression was achieved in 5465 (75.91%) study participants who received antiretroviral treatment. However, 1734 participants (24.0%) did not achieve viral suppression. Patients with poor adherence to ARV (AOR 0.30; 95% CI 0.16, 0.58) and fair adherence to ARV (AOR 0.23; 95% CI 0.12, 0.45) were associated with a lower odd of viral non-suppression. Patients with six (6) months to two (2) years of treatment before viral load testing (AOR 0.67; 95% CI 0.46, 0.98) were also associated with a lower likelihood of viral non-suppression. Conclusions The rate of non-suppression was high, and the suppression rate fell short of the UNAIDS target. Poor ARV adherence, fair ARV adherence, and a treatment duration of six (6) months to two (2) years before viral load testing appear to be obstacles to viral load suppression. The research findings seem to suggest that viral load testing supports viral non-suppression. Therefore, using viral load tests to monitor medication's effects on health can motivate patients to adhere to their prescribed medication regimen. More research is needed to determine whether viral load testing can improve adherence. Given the high rate of virologic failure, the study highlights the importance of identifying antiretroviral resistance patterns.
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Affiliation(s)
- Philip Boakye
- Department of Epidemiology and Biostatistics, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Department of Research in Epidemiology, Biostatistics and Informatics, Koachie Health Systems, Accra, Ghana
| | - Adwoa Safowaa
- Department of Epidemiology and Biostatistics, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Faculty of Health and Medical Sciences, Presbyterian University, Agogo, Ghana
- Department of Research in Epidemiology, Biostatistics and Informatics, Koachie Health Systems, Accra, Ghana
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Tomescu S, Crompton T, Adebayo J, Akpan F, Dauda DS, Allen Z, Ondura EO, Wose Kinge C, Chasela C, Pisa P. Factors associated with viral load non-suppression in people living with HIV on ART in Nigeria: cross-sectional analysis from 2017 to 2021. BMJ Open 2023; 13:e065950. [PMID: 37169497 DOI: 10.1136/bmjopen-2022-065950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
OBJECTIVES Identify factors (demographic and clinical) associated with a non-suppressed viral load (VL) of people living with HIV (PLHIV) on antiretroviral therapy (ART) in Nigeria. DESIGN Cross-sectional study. SETTING Sixteen US Agency for International Development supported states in Nigeria. PARTICIPANTS 585 632 PLHIV on ART. PRIMARY OUTCOME MEASURES VL non-suppression (defined as having a VL of at least 1000 HIV RNA copies per mL of plasma). χ2 testing and multivariable modified Poisson regression with robust variance estimates were conducted on routinely collected ART programme data. RESULTS Sixty-six per cent of the study population were females. The largest age groups were 25-34 and 35-44, accounting for 32.1% and 31.1%, respectively. Males had a 9% greater likelihood (adjusted prevalence ratio, APR=1.09) of being non-suppressed. The age groups below 60+ (APR=0.67) had a higher likelihood of a non-suppressed VL, with the highest in the 0-14 age group (APR=2.38). Clients enrolled at tertiary and secondary level facilities had the greatest likelihood of a non-suppressed VL. Clients who started ART between 2010 and 2015 had the greatest likelihood of viral non-suppression (APR=6.19). A shorter time on ART (<1 year (APR=3.92)) was associated with a higher likelihood of a non-suppressed VL. Clients receiving care at private facilities had a lower likelihood of viral non-suppression in the adjusted model. Clients in the Edo (APR=2.66) and Niger (APR=2.54) states had the greatest likelihood of viral non-suppression. CONCLUSIONS Targeting males, clients of younger age, those on treatment for less than 3 years, clients at tertiary and secondary health facilities, small and medium facilities, and clients in the Edo, Niger and Borno states for interventions could lead to improvements in VL suppression in Nigeria. The independent factors associated with a non-suppressed VL can guide improvements in ART programme development and VL suppression of PLHIV on ART in Nigeria.
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Affiliation(s)
- Silviu Tomescu
- Strategic Information, Right to Care, Centurion, Gauteng, South Africa
| | - Thomas Crompton
- Strategic Information, Right to Care, Centurion, Gauteng, South Africa
| | - Jonathan Adebayo
- Strategic Information, Right to Care, Centurion, Gauteng, South Africa
| | - Francis Akpan
- Strategic Information, Right to Care, Centurion, Gauteng, South Africa
| | | | | | | | - Constance Wose Kinge
- Implementation Science, Right to Care, Centurion, Gauteng, South Africa
- Department of Epidemiology and Biostatistics, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
| | - Charles Chasela
- Implementation Science, Right to Care, Centurion, Gauteng, South Africa
- Department of Epidemiology and Biostatistics, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
| | - Pedro Pisa
- Strategic Information, Right to Care, Centurion, Gauteng, South Africa
- Department of Human Nutrition and Dietetics, University of Pretoria, Pretoria, South Africa
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14
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Mamo DN, Yilma TM, Fekadie M, Sebastian Y, Bizuayehu T, Melaku MS, Walle AD. Machine learning to predict virological failure among HIV patients on antiretroviral therapy in the University of Gondar Comprehensive and Specialized Hospital, in Amhara Region, Ethiopia, 2022. BMC Med Inform Decis Mak 2023; 23:75. [PMID: 37085851 PMCID: PMC10122289 DOI: 10.1186/s12911-023-02167-7] [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: 10/15/2022] [Accepted: 04/04/2023] [Indexed: 04/23/2023] Open
Abstract
BACKGROUND Treatment with effective antiretroviral therapy (ART) reduces viral load as well as HIV-related morbidity and mortality in HIV-positive patients. Despite the expanded availability of antiretroviral therapy around the world, virological failure remains a serious problem for HIV-positive patients. Thus, Machine learning predictive algorithms have the potential to improve the quality of care and predict the needs of HIV patients by analyzing huge amounts of data, and enhancing prediction capabilities. This study used different machine learning classification algorithms to predict the features that cause virological failure in HIV-positive patients. METHOD An institution-based secondary data was used to conduct patients who were on antiretroviral therapy at the University of Gondar Comprehensive and Specialized Hospital from January 2020 to May 2022. Patients' data were extracted from the electronic database using a structured checklist and imported into Python version three software for data pre-processing and analysis. Then, seven supervised classification machine-learning algorithms for model development were trained. The performances of the predictive models were evaluated using accuracy, sensitivity, specificity, precision, f1-score, and AUC. Association rule mining was used to generate the best rule for the association between independent features and the target feature. RESULT Out of 5264 study participants, 1893 (35.06%) males and 3371 (64.04%) females were included. The random forest classifier (sensitivity = 1.00, precision = 0.987, f1-score = 0.993, AUC = 0.9989) outperformed in predicting virological failure among all selected classifiers. Random forest feature importance and association rules identified the top eight predictors (Male, younger age, longer duration on ART, not taking CPT, not taking TPT, secondary educational status, TDF-3TC-EFV, and low CD4 counts) of virological failure based on the importance ranking, and the CD-4 count was recognized as the most important predictor feature. CONCLUSION The random forest classifier outperformed in predicting and identifying the relevant predictors of virological failure. The results of this study could be very helpful to health professionals in determining the optimal virological outcome.
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Affiliation(s)
- Daniel Niguse Mamo
- Department of Health Informatics, College of Medicine and Health Sciences, School of Public Health, Arbaminch University, Arbaminch, Ethiopia.
| | - Tesfahun Melese Yilma
- Department of Health Informatics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Makida Fekadie
- Department of Health Informatics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Yakub Sebastian
- College of Engineering, IT, and Environment, Charles Darwin University, Casuarina, Australia
| | - Tilahun Bizuayehu
- Department of Internal Medicine, School of Medicine, University of Gondar, Gondar, Ethiopia
| | - Mequannent Sharew Melaku
- Department of Health Informatics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Agmasie Damtew Walle
- Department of Health Informatics, college of health science, Mettu University, Mettu, Ethiopia
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15
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Berihun H, Bazie GW, Beyene A, Zewdie A, Kebede N. Viral suppression and associated factors among children tested for HIV viral load at Amhara Public Health Institute, Dessie Branch, Ethiopia: a cross-sectional study. BMJ Open 2023; 13:e068792. [PMID: 36720566 PMCID: PMC9890760 DOI: 10.1136/bmjopen-2022-068792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE This study aims to assess viral suppression and associated factors among children tested for HIV viral load at the Amhara Public Health Institute, Dessie Branch, Ethiopia. DESIGN An institutional cross-sectional study was conducted. An observational checklist was used to collect the data. Data were entered into EpiData and analysed using SPSS (V.25). The data were analysed descriptively. Variables with p=0.25 from the bivariable analysis were entered into a multivariable logistic regression model, and significant variables (p=0.05) were retained in the multivariable model. SETTING AND PARTICIPANTS This cross-sectional study was conducted among 522 randomly selected children tested for HIV viral load at the Amhara Public Health Institute, Dessie Branch, Ethiopia. The study included children under the age of 15 years with complete records. RESULTS Viral suppression was 73% (95% CI: 60.41% to 77.63%). Treatment duration on antiretroviral therapy (adjusted OR (AOR)=0.207; 95% CI: 0.094 to 0.456) and regimen substitution (AOR=0.490; 95% CI: 0.306 to 0.784) were significantly associated with viral suppression rate. CONCLUSIONS In this study, the overall magnitude of viral suppression in Amhara Public Health Institute, Dessie Branch is low as compared with the WHO's 95% viral suppression target. Viral suppression was significantly associated with antiretroviral therapy duration and regimen substitution.
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Affiliation(s)
- Hailu Berihun
- Department of Public Health, Zemen Postgraduate College of Health Science, Dessie, Ethiopia
| | - Getaw Walle Bazie
- Department of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Altaseb Beyene
- Department of Biomedical Science, Wollo University, Dessie, Ethiopia
| | - Amare Zewdie
- Department of Public Health, Wolkite University, Wolkite, Ethiopia
| | - Natnael Kebede
- Department of Health Promotion, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Mugo C, Kohler P, Kumar M, Badia J, Kibugi J, Wamalwa DC, Agot K, John-Stewart GC. Individual-, Interpersonal- and Institutional-Level Factors Associated with HIV Stigma Among Youth in Kenya. AIDS Behav 2023:10.1007/s10461-023-03982-9. [PMID: 36646929 PMCID: PMC9843110 DOI: 10.1007/s10461-023-03982-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2023] [Indexed: 01/18/2023]
Abstract
HIV stigma remains a barrier in achieving optimal HIV treatment. We studied the prevalence and predictors of HIV stigma among adolescents and youth with HIV (AYWHIV) ages 15-24 years in Western Kenya. Of 1011 AYWHIV, 69% were female with a median age of 18 years. Most (59%) attended adolescent clinic days, and 40% attended support groups. One-quarter (27%) had experienced physical, 18% emotional, and 7% sexual violence. The majority of AYWHIV (88%) reported disclosure concerns, 48% reported perceived community stigma, 36% experienced, and 24% internalized stigma. Compared to AYWHIV attending adolescent clinics, those in general/adult clinics had higher internalized stigma. Similarly, having dropped out of school was associated with higher internalized stigma. AYWHIV in sexual relationships had higher experienced stigma and disclosure concerns. Lastly, exposure to violence was associated with higher experienced, internalized, perceived community stigma and disclosure concerns. These risk factors can be targeted when developing stigma-prevention interventions.
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Affiliation(s)
- Cyrus Mugo
- Department of Research and Programs, Kenyatta National Hospital, Hospital Road, P.O. Box 00202, Nairobi, Kenya.
- Department of Epidemiology, University of Washington, Seattle, WA, USA.
| | - Pamela Kohler
- Department of Child, Family, and Population Health Nursing, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Manasi Kumar
- Department of Research and Programs, Kenyatta National Hospital, Hospital Road, P.O. Box 00202, Nairobi, Kenya
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
- Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
| | - Jacinta Badia
- Impact Research and Development Organization, Kisumu, Kenya
| | - James Kibugi
- Impact Research and Development Organization, Kisumu, Kenya
| | - Dalton C Wamalwa
- Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Kawango Agot
- Impact Research and Development Organization, Kisumu, Kenya
| | - Grace C John-Stewart
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Pediatrics, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
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17
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Erjino E, Abera E, Lemma Tirore L. Time to Viral Load Suppression and Its Predictors Among Adult Patients on Antiretro Viral Therapy in Nigist Eleni Mohammed Memorial Comprehensive Specialized Hospital, Hossana, Southern Ethiopia. HIV AIDS (Auckl) 2023; 15:157-171. [PMID: 37101858 PMCID: PMC10124622 DOI: 10.2147/hiv.s408565] [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: 03/03/2023] [Accepted: 04/16/2023] [Indexed: 04/28/2023] Open
Abstract
Background Unsuppressed viral load count in patients on anti-retroviral therapy is linked to poorer survival and increased transmission of the virus. Despite efforts made in Ethiopia, the viral load suppression rate is still low. Objective To estimate time to viral load suppression and predictors of viral load suppression among adults on anti-retroviral therapy in Nigist Elen Mohamed Memorial Comprehensive Specialized Hospital, 2022. Materials and Methods A retrospective follow-up study was conducted among 297 adults on anti-retroviral therapy from January 1, 2016, to December 31, 2021. A simple random sampling technique was used to select study participants. The data were analyzed using STATA 14. Cox regression model was used. The adjusted hazard ratio with 95% CI was estimated. Results A total of 296 records of patients on anti-retroviral therapy were included in this study. The incidence of viral load suppression was 9.68 per 100-person months. The median time for viral load suppression was 9 months. Patients with baseline CD4 ≥200 cell/mm3 (AHR: 1.87; 95% CI = 1.34, 2.63), who had no opportunistic infections (AHR = 1.84; 95% CI = 1.34, 2.52), who were on WHO clinical stage-I or II (AHR = 2.12; 95% CI = 1.18, 3.79) and who have taken tuberculosis preventive therapy (AHR = 2.24; 95% CI = 1.66, 3.02) had higher hazards of viral load suppression. Conclusion The median time for viral load suppression was 9 months. Patients who had no opportunistic infection, with higher CD4 count, on WHO clinical stage-I or II, who have taken tuberculosis preventive therapy had higher hazards of viral load suppression. Careful monitoring and counseling of patients with CD4 levels lower than 200 cells/mm3 are necessary. Careful monitoring and counseling of patients in advanced WHO clinical stages, with lower CD4 count levels and with opportunistic infections is crucial. Strengthening the provision of tuberculosis preventive therapy is warranted.
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Affiliation(s)
- Eshetu Erjino
- Department of Public Health, College of Medicine and Health Sciences, Wachemo University, Hossana, Sothern Ethiopia
| | - Ermias Abera
- Department of Public Health, College of Medicine and Health Sciences, Wachemo University, Hossana, Sothern Ethiopia
| | - Lire Lemma Tirore
- Department of Public Health, College of Medicine and Health Sciences, Wachemo University, Hossana, Sothern Ethiopia
- Correspondence: Lire Lemma Tirore, Email
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Hlophe LD, Tamuzi JL, Shumba CS, Nyasulu PS. Barriers and facilitators to anti-retroviral therapy adherence among adolescents aged 10 to 19 years living with HIV in sub-Saharan Africa: A mixed-methods systematic review and meta-analysis. PLoS One 2023; 18:e0276411. [PMID: 37200399 DOI: 10.1371/journal.pone.0276411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 05/02/2023] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND Human Immunodeficiency Virus (HIV) significantly affects adolescents globally, with the sub-Saharan Africa (SSA) reporting a high burden of the disease. HIV testing, treatment, and retention to care are low among adolescents. We conducted a mixed-method systematic review to assess anti-retroviral therapy (ART) adherence; barriers and facilitators to ART adherence and ART outcomes among adolescents living with HIV and on ART in sub-Saharan Africa. METHODS We conducted searches in four scientific databases for studies conducted between 2010 and March 2022 to identify relevant primary studies. Studies were screened against inclusion criteria and assessed for quality, and data was extracted. Meta-analysis of rates and odd ratios was used to plot the quantitative studies and meta-synthesis summarized the evidence from qualitative studies. RESULTS A total of 10 431 studies were identified and screened against the inclusion/ exclusion criteria. Sixty-six studies met the inclusion criteria (41 quantitative, 16 qualitative, and 9 mixed-methods study designs). Fifty-three thousand two hundred and seventeen (53 217) adolescents (52 319 in quantitative studies and 899 in qualitative studies) were included in the review. Thirteen support focused interventions for improved ART adherence were identified from quantitative studies. The plotted results from the meta-analysis found an ART adherence rate of 65% (95%CI 56-74), viral load suppression was 55% (95%CI 46-64), un-suppressed viral load rate of 41% (95%CI 32-50), and loss to follow up of 17% (95%CI 10-24) among adolescents. Meta-synthesis found six themes of barriers to ART (social, patient-based, economic, health system-based, therapy-based, and cultural barriers) in both the qualitative and quantitative studies, and three themes of facilitators to ART were also identified (social support, counselling, and ART education and secrecy or confidentiality) from qualitative studies. CONCLUSION ART adherence remains low among adolescents in SSA despite multiple interventions implemented to improve ART adherence. The low adherence rate may hinder the attainment of the UNAIDS 2030 targets. Additionally, various barriers to ART adherence due to lack of support have been reported among this age group. However, interventions aimed at improving social support, educating, and counselling adolescents may improve and sustain ART adherence. TRIAL REGISTRATION Systematic review registration: PROSPERO CRD42021284891.
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Affiliation(s)
- Londiwe D Hlophe
- Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Department of Environmental Health Sciences, Faculty of Health Sciences, University of Eswatini, Mbabane, Kingdom of Eswatini
| | - Jacques L Tamuzi
- Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | | | - Peter S Nyasulu
- Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Anito AA, Lenjebo TL, Woticha E, Solomon F. Magnitude of Viral Load Suppression and Associated Factors among Clients on Antiretroviral Therapy in Public Hospitals of Hawassa City Administration, Ethiopia. HIV AIDS (Auckl) 2022; 14:529-538. [PMID: 36425750 PMCID: PMC9680672 DOI: 10.2147/hiv.s387787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 11/11/2022] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND A majority of clients on first-line antiretroviral therapy with an initial high viral load will resuppress following an adherence intervention. Some sociodemographic and clinical characteristics were found to affect resuppression. Few reports on the outcome of the intervention and its associated factors in our country, with inconsistent results and some missed clinical factors of potential association, have compelled this study. The study aimed to assess the proportion of viral load suppression and associated factors among clients on antiretroviral therapy in public hospitals of Hawassa City Administration, Ethiopia. METHODS An institution-based cross-sectional study with retrospective document review was conducted among 342 participants on antiretroviral therapy enrolled for counseling since its start in November 2016. Data were captured using a pretested and structured checklist from all client charts with complete data, entered into EpiData 3.1.0 and exported to SPSS 27 for analysis. The proportion of viral load suppression was determined. Bivariate and multivariate logistic regressions were performed to identify associated factors. Statistical significance was determined at a 95% CI and P<0.05. RESULTS The proportion of viral load suppression was found to be 40.9% (35.7%-46.5%). Nevirapine-based antiretroviral treatment regimens (AOR 0.125, 95% CI 0.034-0.464), malnutrition (AOR 0.565, 95% CI 0.329-0.971), poor adherence (AOR 0.504, 95% CI 0.287-0.886), lower CD4 count (AOR 0.149, 95% CI 0.071, 0.314), and fewer counseling sessions (AOR 0.330, 95% CI 0.149-0.729) were significantly associated with viral load suppression. CONCLUSION The proportion of viral load suppression is lower than that recommended by the World Health Organization. Nevirapine-based regimens, poor nutritional status, poor adherence, lower CD4 count, and fewer counseling sessions risk a lower proportion of viral load suppression. This calls for the need to devise strategies to address these factors and to revisit program implementation.
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Affiliation(s)
| | | | - Eskinder Woticha
- School of Public Health, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Fithamlak Solomon
- School of Medical Laboratory, Wolaita Sodo University, Wolaita Sodo, Ethiopia
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Alemu A, Meskele M, Darebo TD, Beyene Handiso T, Abebe A, Paulos K. Perceived HIV Stigma and Associated Factors Among Adult ART Patients in Wolaita Zone, Southern Ethiopia. HIV/AIDS - RESEARCH AND PALLIATIVE CARE 2022; 14:487-501. [DOI: 10.2147/hiv.s372738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 10/30/2022] [Indexed: 11/09/2022]
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21
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Jaleta F, Bekele B, Kedir S, Hassan J, Getahun A, Ligidi T, Garoma G, Itefa K, Gerenfes T, Botore A, Kenate B, Dagafa G, Muleta D. Predictors of unsuppressed viral load among adults on follow up of antiretroviral therapy at selected public and private health facilities of Adama town: unmached case-control study. BMC Public Health 2022; 22:1770. [PMID: 36123609 PMCID: PMC9484167 DOI: 10.1186/s12889-022-14169-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 09/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the scale up of antiretroviral therapy (ART), unsuppressed viral load among population taking ART in private and public health facilities is still a public health concern increasing the risk of treatment failure. Studies comprehensively assessing significant predictors of non-suppressed viral load among patients on follow up of AR in public and private health facilities are limited. The objective of the study was to identify predictors of unsuppressed viral load among adult patients taking antiretroviral therapy at selected public and private health facilities of Adama town, East shewa zone, Ethiopia. METHODS An unmatched case-control study was conducted from April 15 /2021 to May 20/2021. A total sample size of 347 patients consisting 116 cases and 231 controls was selected from electronic database among patients who started ART from September 2015 to August 2020. Data were collected using checklist from patient medical records and analyzed by SPSS. The association of dependent and independent variables was determined using multivariate analysis with 95% confidence interval and P - value in logistic regression model to identify independent predictors. RESULT From the total 347 participants, 140 (40.3%) of them were males and 207 (59.7%) were females. In multivariate logistic regression, CD4 count < 100 [(AOR:1.22, 95% CI: 1.4-7.3)], CD4 100-200[(AOR: 2.58 95% CI: 1.06-8.28)], Fair Adherence [(AOR: 2.44, 95% CI: 1.67-4.82)], poor adherence [(AOR: 1.11, 95% CI: 1.7-6.73)], History of Cotrimoxazole Therapy (CPT) use and not used [(AOR: 2.60, 95% CI: 1.23-5.48)] and History of drug substitution [(AOR:. 361, 95% CI: .145-.897)] were independent predictors of unsuppressed viral load with the p-value less than 0.05. CONCLUSION AND COMMENDATION In this study, Baseline CD4, adherence, History of CPT used and history of drug substitution was predictors of unsuppressed viral load. Monitoring immunological response through scheduled CD4 tests is essential to maintain immunity of the patients preventing diseases progression. Intensive adherence support and counseling should conclusively be provided through effective implementation of ART programs by providers would enhance viral suppression ensuring the quality of care and treatment.
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Affiliation(s)
- Fraol Jaleta
- Department of Public Health Emergency Preparedness and Research, Adama Public Health Research and Referral Laboratory Center, Adama, Ethiopia.
| | - Bayissa Bekele
- Department of Public Health Emergency Preparedness and Research, Adama Public Health Research and Referral Laboratory Center, Adama, Ethiopia
| | - Soriya Kedir
- Department of Public Health Emergency Preparedness and Research, Adama Public Health Research and Referral Laboratory Center, Adama, Ethiopia
| | - Jemal Hassan
- Department of Public Health and Water Analysis, Adama Public Health Research and Referral Laboratory Center, Adama, Ethiopia
| | - Asnakech Getahun
- Department of Referral Diagnosis, Adama Public Health Research and Referral laboratory Center, Adama, Ethiopia
| | - Tadesse Ligidi
- Department of Capacity Building, Adama Public Health Research and Referral laboratory Center, Adama, Ethiopia
| | - Getinet Garoma
- Department of Capacity Building, Adama Public Health Research and Referral laboratory Center, Adama, Ethiopia
| | - Kiflu Itefa
- Department of Referral Diagnosis, Adama Public Health Research and Referral laboratory Center, Adama, Ethiopia
| | - Tadesse Gerenfes
- Department of Bio Safety and Bio Security, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Abera Botore
- Department of Public Health Emergency Preparedness and Research, Oromia Regional Health Bureau, Addis Ababa, Ethiopia
| | - Berhanu Kenate
- Department of Public Health Emergency Preparedness and Research, Oromia Regional Health Bureau, Addis Ababa, Ethiopia
| | - Gutu Dagafa
- Department of Anesthesiology, Myungsung Christian Medical Hospital, Addis Ababa, Ethiopia
| | - Daba Muleta
- Chief Executive Officer at Adama Public Health Research and Referral Center, Adama, Ethiopia
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Soogun AO, Kharsany ABM, Zewotir T, North D, Ogunsakin E, Rakgoale P. Spatiotemporal Variation and Predictors of Unsuppressed Viral Load among HIV-Positive Men and Women in Rural and Peri-Urban KwaZulu-Natal, South Africa. Trop Med Infect Dis 2022; 7:232. [PMID: 36136643 PMCID: PMC9502339 DOI: 10.3390/tropicalmed7090232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/26/2022] [Accepted: 08/26/2022] [Indexed: 02/05/2023] Open
Abstract
Unsuppressed HIV viral load is an important marker of sustained HIV transmission. We investigated the prevalence, predictors, and high-risk areas of unsuppressed HIV viral load among HIV-positive men and women. Unsuppressed HIV viral load was defined as viral load of ≥400 copies/mL. Data from the HIV Incidence District Surveillance System (HIPSS), a longitudinal study undertaken between June 2014 to June 2016 among men and women aged 15−49 years in rural and peri-urban KwaZulu-Natal, South Africa, were analysed. A Bayesian geoadditive regression model which includes a spatial effect for a small enumeration area was applied using an integrated nested Laplace approximation (INLA) function while accounting for unobserved factors, non-linear effects of selected continuous variables, and spatial autocorrelation. The prevalence of unsuppressed HIV viral load was 46.1% [95% CI: 44.3−47.8]. Predictors of unsuppressed HIV viral load were incomplete high school education, being away from home for more than a month, alcohol consumption, no prior knowledge of HIV status, not ever tested for HIV, not on antiretroviral therapy (ART), on tuberculosis (TB) medication, having two or more sexual partners in the last 12 months, and having a CD4 cell count of <350 cells/μL. A positive non-linear effect of age, household size, and the number of lifetime HIV tests was identified. The higher-risk pattern of unsuppressed HIV viral load occurred in the northwest and northeast of the study area. Identifying predictors of unsuppressed viral load in a localized geographic area and information from spatial risk maps are important for targeted prevention and treatment programs to reduce the transmission of HIV.
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Affiliation(s)
- Adenike O. Soogun
- Department of Statistics, School of Mathematics, Statistics and Computer Science, College of Agriculture Engineering and Science, University of KwaZulu-Natal, Durban 4001, South Africa
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban 4001, South Africa
| | - Ayesha B. M. Kharsany
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban 4001, South Africa
- School of Laboratory Medicine & Medical Science, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban 4001, South Africa
| | - Temesgen Zewotir
- Department of Statistics, School of Mathematics, Statistics and Computer Science, College of Agriculture Engineering and Science, University of KwaZulu-Natal, Durban 4001, South Africa
| | - Delia North
- Department of Statistics, School of Mathematics, Statistics and Computer Science, College of Agriculture Engineering and Science, University of KwaZulu-Natal, Durban 4001, South Africa
| | - Ebenezer Ogunsakin
- Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban 4001, South Africa
| | - Perry Rakgoale
- Department of Geography, School of Agriculture, Earth, and Environmental Science, University of KwaZulu-Natal, Durban 4001, South Africa
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Gordon TP, Talbert M, Mugisha MK, Herbert AE. Factors associated with HIV viral suppression among adolescents in Kabale district, South Western Uganda. PLoS One 2022; 17:e0270855. [PMID: 35980902 PMCID: PMC9387807 DOI: 10.1371/journal.pone.0270855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 06/19/2022] [Indexed: 11/18/2022] Open
Abstract
Background The goal of antiretroviral therapy is to achieve sustained human immune deficiency virus (HIV) viral suppression. However, research on factors associated with viral load suppression among adolescents in low and middle-income countries is limited. The objectives of this study were to determine HIV viral suppression levels among adolescents in Kabale district and the associated clinical, adherence and psychosocial factors. Methods Cross-sectional and retrospective cohort study designs were used. Two hundred and forty-nine adolescents living with HIV that attended clinics between September and October 2019 at nine health facilities were interviewed and their medical records reviewed. A data abstraction tool was used to collect clinical data from adolescent’s clinical charts, face to face interviews were conducted using semi-structured questionnaire adopted from the HEADS tool and in-depth interviews conducted with ten key informants. Qualitative data was analyzed using thematic content analysis. Logistic regression was used to determine the magnitude by which clinical and psychosocial factors influence viral load suppression. Odds Ratios (ORs) were used for statistical associations at 95% confidence interval considering statistical significance for p-values less than 0.05. Qualitative data collected from Key informants to support our quantitative findings was analyzed using thematic content analysis. Results HIV viral suppression among (n = 249) adolescents was at 81%. Having no severe opportunistic infections was associated with viral load suppression among adolescent living with HIV (OR = 1.09; 95%CI [1.753–4.589]; p<0.001) as well as having no treatment interruptions (OR = 0.86; 95% CI [2.414–6.790]; p = 0.004). Belonging to a support group (OR = 1.01; 95% CI [1.53–4.88]; P = 0.020), having parents alive (OR = 2.04; 95% CI[1.02–4.12]; P = 0.047) and having meals in a day (OR = 5.68; C.I = 2.38–6.12, P = 0.010), were significantly associated to viral load suppression. The findings also indicated that long distances from health facilities, transport challenges and unprofessional conduct of health workers that make adolescent unwelcome at health facilities negatively affected viral suppression among adolescents. Conclusion The findings indicate that HIV viral suppression among adolescents on ART was at 81%. Kabale district was likely not to achieve the third 90 of the UNAIDS 90-90-90 global target for this population category. The findings further indicate that having no severe opportunistic infection and no treatment interruptions, good nutrition status, peer support and support from significant others, were highly associated with viral load suppression.
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Affiliation(s)
- Tugume Peterson Gordon
- Department of Public Health, Faculty of Health Sciences and Nursing, Bishop Stuart University, Mbarara, Uganda
- * E-mail:
| | - Muhwezi Talbert
- Department of Public Health, Faculty of Health Sciences and Nursing, Bishop Stuart University, Mbarara, Uganda
| | | | - Ainamani Elvis Herbert
- Department of Public Health, Faculty of Health Sciences and Nursing, Bishop Stuart University, Mbarara, Uganda
- Department of Mental Health, Kabale University School of Medicine, Kabale, Uganda
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Sendaula E, Buwembo M, Opio D. Clinical profile of HIV-infected adults receiving a holistic approach of care model in Nakawa, Kampala District. PLoS One 2022; 17:e0272039. [PMID: 35881616 PMCID: PMC9321371 DOI: 10.1371/journal.pone.0272039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 07/12/2022] [Indexed: 11/26/2022] Open
Abstract
People Living with HIV (PLHIV) are often dealing with a range of issues that make life more difficult because of the limited emotional, spiritual, psychological, social, physical and clinical support which consequently lead to poor physical health and quality of life. The holistic care of individuals infected with HIV/AIDS involves promoting psychological and physiological well-being as well as fostering socio-cultural relationships and supporting the fulfillment of spiritual aspirations. We conducted a retrospective cross-sectional study among HIV-infected patients receiving a holistic approach of care model from January 2015 to December 2018 in Kampala district, Uganda. The study involved adult individuals aged 18 and above from whom demographics and other information were obtained. All eligible participants were selected using stratified random sampling from the parishes and systematic random sampling to select study participants. We investigated the clinical profile and the factors associated with viral load suppression among HIV-infected patients receiving a holistic approach of care model in Kampala District. The data was analyzed using STATA version 13. 0. Results: A total of 910 patients were enrolled. 676 (74.3%) were female; 453 (49.8%) were between 18 and 39 years. 324 (35.6%) were either overweight or obese. 769 (84.5%) had viral load beyond detectable limits, 904 (99.3%) were adhering to HIV treatment. 867(95.3%) were virally suppressed. The age group 40–59 years (Adjusted Odds Ratio (aOR) = 2.85, 95% Confidence Interval (CI):1.36–5.97, P = 0.005) and good adherence (aOR = 12.9, 95%CI:1.86–81.07, P = 0.009) were significantly associated with viral load suppression. Conclusion: The holistic care model supports patients in all facets of their lives, resulting into improved treatment outcomes. Our findings show that age and adherence are linked to viral load suppression among HIV-infected adults receiving a holistic approach of care model.
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Affiliation(s)
- Emmanuel Sendaula
- Reach Out Mbuya Community Health Initiative, Kampala, Uganda
- * E-mail:
| | - Michael Buwembo
- Reach Out Mbuya Community Health Initiative, Kampala, Uganda
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25
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Mhlanga TT, Jacobs BKM, Decroo T, Govere E, Bara H, Chonzi P, Sithole N, Apollo T, Van Damme W, Rusakaniko S, Lynen L, Makurumidze R. Virological outcomes and risk factors for non-suppression for routine and repeat viral load testing after enhanced adherence counselling during viral load testing scale-up in Zimbabwe: analytic cross-sectional study using laboratory data from 2014 to 2018. AIDS Res Ther 2022; 19:34. [PMID: 35810317 PMCID: PMC9270749 DOI: 10.1186/s12981-022-00458-z] [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: 12/31/2021] [Accepted: 06/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Since the scale-up of routine viral load (VL) testing started in 2016, there is limited evidence on VL suppression rates under programmatic settings and groups at risk of non-suppression. We conducted a study to estimate VL non-suppression (> 1000 copies/ml) and its risk factors using "routine" and "repeat after enhanced adherence counselling (EAC)" VL results. METHODS We conducted an analytic cross-sectional study using secondary VL testing data collected between 2014 and 2018 from a centrally located laboratory. We analysed data from routine tests and repeat tests after an individual received EAC. Our outcome was viral load non-suppression. Bivariable and multivariable logistic regression was performed to identify factors associated with having VL non-suppression for routine and repeat VL. RESULTS We analysed 103,609 VL test results (101,725 routine and 1884 repeat test results) collected from the country's ten provinces. Of the 101,725 routine and 1884 repeat VL tests, 13.8% and 52.9% were non-suppressed, respectively. Only one in seven (1:7) of the non-suppressed routine VL tests had a repeat test after EAC. For routine VL tests; males (vs females, adjusted odds ratio (aOR) = 1.19, [95% CI 1.14-1.24]) and adolescents (10-19 years) (vs adults (25-49 years), aOR = 3.11, [95% CI 2.9-3.31]) were more at risk of VL non-suppression. The patients who received care at the secondary level (vs primary, aOR = 1.21, [95% CI 1.17-1.26]) and tertiary level (vs primary, aOR = 1.63, [95% CI 1.44-1.85]) had a higher risk of VL non-suppression compared to the primary level. Those that started ART in 2014-2015 (vs < 2010, aOR = 0.83, [95% CI 0.79-0.88]) and from 2016 onwards (vs < 2010, aOR = 0.84, [95% CI 0.79-0.89]) had a lower risk of VL non-suppression. For repeat VL tests; young adults (20-24 years) (vs adults (25-49 years), (aOR) = 3.48, [95% CI 2.16 -5.83]), adolescents (10-19 years) (vs adults (25-49 years), aOR = 2.76, [95% CI 2.11-3.72]) and children (0-9 years) (vs adults (25-49 years), aOR = 1.51, [95% CI 1.03-2.22]) were at risk of VL non-suppression. CONCLUSION Close to 90% suppression in routine VL shows that Zimbabwe is on track to reach the third UNAIDS target. Strategies to improve the identification of clients with high routine VL results for repeating testing after EAC and ART adherence in subpopulations (men, adolescents and young adolescents) at risk of viral non-suppression should be prioritised.
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Affiliation(s)
| | | | - Tom Decroo
- Institute of Tropical Medicine, Antwerp, Belgium.,Research Foundation of Flanders, Brussels, Belgium
| | - Emma Govere
- Harare City Council, Department of Health, Harare, Zimbabwe
| | - Hilda Bara
- Harare City Council, Department of Health, Harare, Zimbabwe
| | - Prosper Chonzi
- Harare City Council, Department of Health, Harare, Zimbabwe
| | - Ngwarai Sithole
- AIDS & TB Unit, Ministry of Health & Child Care, Harare, Zimbabwe
| | - Tsitsi Apollo
- AIDS & TB Unit, Ministry of Health & Child Care, Harare, Zimbabwe
| | - Wim Van Damme
- Institute of Tropical Medicine, Antwerp, Belgium.,Gerontology, Faculty of Medicine & Pharmacy, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | | | | | - Richard Makurumidze
- Institute of Tropical Medicine, Antwerp, Belgium. .,Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe. .,Gerontology, Faculty of Medicine & Pharmacy, Vrije Universiteit Brussel (VUB), Brussels, Belgium.
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O. Soogun A, B.M. Kharsany A, Zewotir T, North D. Spatial Variation and Factors Associated with Unsuppressed HIV Viral Load among Women in an HIV Hyperendemic Area of KwaZulu-Natal, South Africa. Infect Dis (Lond) 2022. [DOI: 10.5772/intechopen.105547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
New HIV infections among young women remains exceptionally high and to prevent onward transmission, UNAIDS set ambitious treatment targets. This study aimed to determine the prevalence, spatial variation and factors associated with unsuppressed HIV viral load at ≥400 copies per mL. This study analysed data from women aged 15–49 years from the HIV Incidence Provincial Surveillance System (HIPSS) enrolled in two sequential cross-sectional studies undertaken in 2014 and 2015 in rural and peri-urban KwaZulu-Natal, South Africa. Bayesian geoadditive model with spatial effect for a small enumeration area was adopted using Integrated Nested Laplace Approximation (INLA) function to analyze the findings. The overall prevalence of unsuppressed HIV viral load was 45.2% in 2014 and 38.1% in 2015. Factors associated with unsuppressed viral load were no prior knowledge of HIV status, had a moderate-to-low perception of acquiring HIV, not on antiretroviral therapy (ART), and having a low CD4 cell count. In 2014, women who ever consumed alcohol and in 2015, ever ran out of money, had two or more lifetime sexual partners, ever tested for tuberculosis, and ever diagnosed with sexually transmitted infection were at higher risk of being virally unsuppressed. The nonlinear effect showed that women aged 15 to 29 years, from smaller households and had fewer number of lifetime HIV tests, were more likely to be virally unsuppressed. High viral load risk areas were the north-east and south-west in 2014, with north and west in 2015. The findings provide guidance on identifying key populations and areas for targeted interventions.
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27
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Elashi BAY, van Wyk BE. Factors associated with viral suppression among adolescents on antiretroviral therapy in Free State province, South Africa. South Afr J HIV Med 2022; 23:1356. [PMID: 35923610 PMCID: PMC9257832 DOI: 10.4102/sajhivmed.v23i1.1356] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 02/22/2022] [Indexed: 11/05/2022] Open
Abstract
Background In 2019, about 1.7 million adolescents between the ages of 10 and 19 years were living with HIV worldwide, of which 170 000 were newly infected with HIV in 2019. South Africa has the highest number of persons living with HIV. Although there has been major improvement in access to antiretroviral therapy (ART), it is still unclear what proportion of adolescents (aged 10–19 years) are virally suppressed in the provinces of South Africa. Objectives To determine the prevalence of and the factors associated with viral suppression among adolescents (10–19 years) on ART in the Thabo Mofutsanyane District Municipality of the Free State province of South Africa. Method A retrospective cross-sectional analysis of demographic, clinical and treatment-related information that were extracted from an electronic database was conducted using Statistical Package for the Social Sciences version 26. Results The median duration on ART was 6.58 years. Although 78% (n = 4520) of adolescents living with HIV who were on ART achieved viral suppression (< 1000 copies/mL), only 9.5% (n = 430) were fully suppressed at < 50 copies/mL. In multivariate analysis, the odds of being virally suppressed reduced with increasing age at ART initiation. Adolescents with CD4 counts greater than 500 cells/mm3 at baseline had a higher odds ratio of viral suppression (adjusted odds ratio [AOR]: 1.77; confidence interval [CI]: 1.28–2.47). The odds of viral suppression were significantly lower among those not retained in care (AOR: 0.45; CI: 0.35–0.58). Conclusion Tailored interventions should be developed to improve viral suppression among adolescents on ART.
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Affiliation(s)
- Balsam A Y Elashi
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
| | - Brian E van Wyk
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
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28
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Long-term HIV treatment outcomes and associated factors in sub-Saharan Africa: multi-country longitudinal cohort analysis. AIDS 2022; 36:1437-1447. [PMID: 35608116 DOI: 10.1097/qad.0000000000003270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE In a multicountry prospective cohort of persons with HIV from six countries between 2007 and 2015, we evaluated long-term outcomes of first-line non-nucleoside reverse-transcriptase inhibitor-based antiretroviral therapy (ART), and risk factors for loss-to-follow-up, mortality, virological failure, and incomplete CD4+ T-cell recovery. METHODS We calculated cumulative incidence of lost-to-follow-up, death, virological failure (VL ≥ 1000 cps/ml) and incomplete CD4+ T-cell recovery (<500 cells/μl) at successive years, using Kaplan-Meier and Cox regression. RESULTS Of 2735 participants, 58.0% were female, median age was 37 (interquartile range [IQR] 32-43) years, and median pre-ART CD4+ T-cell count was 135 (IQR 63-205)/μl. Total follow-up time was 7208 person-years (median 24.3 months, IQR 18.7-58.3). Deaths by any cause and loss to follow-up occurred mostly during the first year of ART (84%, 201/240 and 56%, 199/353, respectively). During their first 6 years of ART, 71% (95% confidence interval [CI] 69.0-73.7) were retained on first-line, and among those 90-93% sustained viral suppression (<1000 cps/ml); CD4+ T-cell recovery was incomplete in 60% (220/363) of participants. The risk factors associated with poor outcomes during long-term ART were: for loss-to-follow-up, recent VL ≥1000 cps/ml, recent CD4+ T-cell count ≤50 cells/μl, age <30 years, being underweight; for mortality, recent CD4+ T-cell count ≤50 cells/μl; and, for virological failure, age <40 years, recent CD4+ T-cell count ≤200 cells/μl, poor adherence, male sex, and low-level viremia. CONCLUSION To achieve long-term ART success towards the UNAIDS targets, early ART initiation is crucial, coupled with careful monitoring and retention support, particularly in the first year of ART. Male and youth-centred care delivery models are needed to improve outcomes for those vulnerable groups.
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Nyongesa MK, Mwatasa MH, Kagonya VA, Mwambingu G, Ngetsa C, Newton CRJC, Abubakar A. HIV virological non-suppression is highly prevalent among 18- to 24-year-old youths on antiretroviral therapy at the Kenyan coast. BMC Infect Dis 2022; 22:449. [PMID: 35545757 PMCID: PMC9092782 DOI: 10.1186/s12879-022-07428-w] [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: 09/17/2021] [Accepted: 04/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In sub-Saharan Africa, data on virologic outcomes of young people living with HIV (YLWH) enrolled on antiretroviral therapy (ART) remains scarce. In this study, we describe the prevalence of HIV virological non-suppression (VNS) and its associated factors among YLWH aged 18-24 years from the Kenyan coast. METHODS Data were analyzed for 384 YLWH who participated in a larger cross-sectional study conducted between November 2018 and September 2019 in two counties at the Kenyan coast (Kilifi and Mombasa). Descriptive statistics were used to summarize sample characteristics and logistic regression was used for statistical modeling of factors associated with VNS. In this study, VNS was defined as plasma viral load ≥ 1000 copies/mL. RESULTS Among these YLWH with a mean age of 20.7 years (SD = 2.2); 55.5% females, the overall prevalence of VNS was 32.0% (95% Confidence interval (95% CI): 27.5, 36.9%). In the multivariable logistic regression analysis, being from a largely rural setting (adjusted Odds Ratio (aOR) 1.73, 95% CI 1.10, 2.71; p = 0.02), underweight (aOR 1.87, 95% CI 1.16, 3.01; p = 0.01) and low self-reported ART adherence (aOR 2.83, 95% CI 1.34, 6.00; p = 0.01) were significantly associated with higher odds of VNS in YLWH. CONCLUSIONS In this study, high levels of VNS were observed among YLWH and this was significantly associated with rural residency, nutritional and ART adherence problems. ART adherence counselling and nutritional support and education should be intensified in this setting targeting YLWH residing mostly in rural areas. Given the high frequency of VNS, there is need to closely monitor viral load and profile HIV drug resistance patterns in youths from the Kenyan coast with confirmed virologic failure. The latter will help understand whether drug resistance also contributes to poor viral suppression in addition to, or exclusive of suboptimal ART adherence.
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Affiliation(s)
- Moses K. Nyongesa
- grid.33058.3d0000 0001 0155 5938KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Box 230, Kilifi, Kenya ,grid.12380.380000 0004 1754 9227Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Mwaganyuma H. Mwatasa
- grid.33058.3d0000 0001 0155 5938KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Box 230, Kilifi, Kenya
| | - Vincent A. Kagonya
- grid.33058.3d0000 0001 0155 5938KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Box 230, Kilifi, Kenya
| | - Gabriel Mwambingu
- grid.33058.3d0000 0001 0155 5938KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Box 230, Kilifi, Kenya
| | - Caroline Ngetsa
- grid.33058.3d0000 0001 0155 5938KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Box 230, Kilifi, Kenya
| | - Charles R. J. C. Newton
- grid.33058.3d0000 0001 0155 5938KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Box 230, Kilifi, Kenya ,grid.449370.d0000 0004 1780 4347Department of Public Health, Pwani University, Kilifi, Kenya ,grid.4991.50000 0004 1936 8948Department of Psychiatry, University of Oxford, Oxford, UK
| | - Amina Abubakar
- grid.33058.3d0000 0001 0155 5938KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Box 230, Kilifi, Kenya ,grid.449370.d0000 0004 1780 4347Department of Public Health, Pwani University, Kilifi, Kenya ,grid.4991.50000 0004 1936 8948Department of Psychiatry, University of Oxford, Oxford, UK ,grid.470490.eInstitute for Human Development, Aga Khan University, Nairobi, Kenya
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Nardell MF, Adeoti O, Peters C, Kakuhikire B, Govathson-Mandimika C, Long L, Pascoe S, Tsai AC, Katz IT. Men missing from the HIV care continuum in sub-Saharan Africa: a meta-analysis and meta-synthesis. J Int AIDS Soc 2022; 25:e25889. [PMID: 35324089 PMCID: PMC8944222 DOI: 10.1002/jia2.25889] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 02/01/2022] [Indexed: 02/03/2023] Open
Abstract
Introduction Men are missing along the HIV care continuum. However, the estimated proportions of men in sub‐Saharan Africa meeting the UNAIDS 95‐95‐95 goals vary substantially between studies. We sought to estimate proportions of men meeting each of the 95‐95‐95 goals across studies in sub‐Saharan Africa, describe heterogeneity, and summarize qualitative evidence on factors influencing care engagement. Methods We systematically searched PubMed and Embase for peer‐reviewed articles published between 1 January 2014 and 16 October 2020. We included studies involving men ≥15 years old, with data from 2009 onward, reporting on at least one 95‐95‐95 goal in sub‐Saharan Africa. We estimated pooled proportions of men meeting these goals using DerSimonion‐Laird random effects models, stratifying by study population (e.g. studies focusing exclusively on men who have sex with men vs. studies that did not), facility setting (healthcare vs. community site), region (eastern/southern Africa vs. western/central Africa), outcome measurement (e.g. threshold for viral load suppression), median year of data collection (before vs. during or after 2017) and quality criteria. Data from qualitative studies exploring barriers to men's HIV care engagement were summarized using meta‐synthesis. Results and discussion We screened 14,896 studies and included 129 studies in the meta‐analysis, compiling data over the data collection period. Forty‐seven studies reported data on knowledge of serostatus, 43 studies reported on antiretroviral therapy use and 74 studies reported on viral suppression. Approximately half of men with HIV reported not knowing their status (0.49 [95% CI, 0.41–0.58; range, 0.09–0.97]) or not being on treatment (0.58 [95% CI, 0.51–0.65; range, 0.07–0.97]), while over three‐quarters of men achieved viral suppression on treatment (0.79 [95% CI, 0.77–0.81; range, 0.39–0.97]. Heterogeneity was high, with variation in estimates across study populations, settings and outcomes. The meta‐synthesis of 40 studies identified three primary domains in which men described risks associated with engagement in HIV care: perceived social norms, health system challenges and poverty. Conclusions Psychosocial and systems‐level interventions that change men's perceptions of social norms, improve trust in and accessibility of the health system, and address costs of accessing care are needed to better engage men, especially in HIV testing and treatment.
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Affiliation(s)
- Maria F Nardell
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Oluwatomi Adeoti
- Department of Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - Carson Peters
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Bernard Kakuhikire
- Faculty of Business and Management Sciences, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Caroline Govathson-Mandimika
- Health Economics and Epidemiology Research Office, University of the Witwatersrand, Johannesburg, South Africa.,Department of Internal Medicine, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Lawrence Long
- Health Economics and Epidemiology Research Office, University of the Witwatersrand, Johannesburg, South Africa.,Department of Internal Medicine, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa.,Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Sophie Pascoe
- Health Economics and Epidemiology Research Office, University of the Witwatersrand, Johannesburg, South Africa.,Department of Internal Medicine, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Alexander C Tsai
- Harvard Medical School, Boston, Massachusetts, USA.,Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, USA.,Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ingrid T Katz
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Global Health Institute, Cambridge, Massachusetts, USA
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Maena J, Banke-Thomas A, Mukiza N, Kuteesa CN, Kakumba RM, Kataike H, Kizito S, Babirye JA, Nakalega R. Determinants of viral load non-suppression among adolescents in Mbale District, Eastern Rural Uganda. AIDS Res Ther 2021; 18:91. [PMID: 34863196 PMCID: PMC8642852 DOI: 10.1186/s12981-021-00408-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 10/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adolescents are lagging behind in the "third 95" objective of the Joint United Nations Program on HIV/AIDS requiring 95% of individuals on antiretroviral therapy (ART) to have viral load (VL) suppression. This study aimed to describe factors associated with viral non-suppression among adolescents in Mbale district, Uganda. METHODS We conducted a retrospective review of routinely collected HIV programme records. Data such as age, education, ART Regimen, ART duration, WHO Clinical stage, comorbidities, etc., were extracted from medical records for the period January 2018 to December 2018. Descriptive analysis was done for continuous variables using means and frequencies to describe study sample characteristics, and to determine the prevalence of outcome variables. We used logistic regression to assess factors associated with VL non-suppression among adolescents. RESULTS The analysis included 567 HIV-infected adolescents, with 300 (52.9%) aged between 13 to 15 years, 335 (59.1%) female, and mean age of 15.6 years (interquartile range [IQR] 13.5-17.8. VL non-suppression was 31.4% (178/567). Male sex (AOR = 1.78, 95% CI 1.06, 2.99; p < 0.01), age 16-19 years (AOR = 1.78, 95% CI 1.06, 2.99; p < 0.05), No formal education (AOR = 3.67, 95% CI 1.48-9.09; p < 0.01), primary education (AOR = 2.23, 95% CI 1.05-2.32; p < 0.01), ART duration of > 12 months to 5 years (AOR = 3.20, 95% CI 1.31-7.82; p < 0.05), ART duration > 5 years (AOR = 3.47, 95% CI 1.39- 8.66; p < 0.01), WHO Clinical Stage II (AOR = 0.48, 95% CI: 0.28, 0.82; p < 0.01), second-line ART regimen (AOR = 2.38, 95% CI 1.53-3.72; p < 0.001) and comorbidities (AOR = 3.28, 95% CI 1.20-9.00; p < 0.05) were significantly associated with viral non-suppression. CONCLUSIONS VL non-suppression among adolescents was almost comparable to the national average. VL non-suppression was associated with being male, age 16-19 years, education level, duration on ART therapy, WHO Clinical Staging II, second-line ART regimen, and presence of comorbidities. Adolescent-friendly strategies to improve VL suppression e.g. peer involvement, VL focal persons to identify and actively follow-up non-suppressed adolescents, patient education on VL suppression and demand creation for ART are needed, especially for newly-initiated adolescents and adolescents on ART for protracted periods, to foster attainment of the UNAIDS 95-95-95 targets.
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Affiliation(s)
- Joel Maena
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration Kampala, Kampala, Uganda.
| | - Aduragbemi Banke-Thomas
- Department of Public Health and Preventive Medicine, School of Medicine, University of Liverpool, Liverpool, UK
| | | | | | | | - Hajira Kataike
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration Kampala, Kampala, Uganda
| | - Samuel Kizito
- Department of Global Health, School of Public Health, Boston University, Boston, USA
| | - Juliet Allen Babirye
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration Kampala, Kampala, Uganda
| | - Rita Nakalega
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration Kampala, Kampala, Uganda
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Acharya S, Parthasarathy M, Palkar A, Keskar P, Setia MS. Barriers for Antiretroviral Therapy Adherence and Viral Suppression in Members of the Key Population in Mumbai, India: Implications for Interventions. Indian J Dermatol 2021; 66:378-385. [PMID: 34759396 PMCID: PMC8530040 DOI: 10.4103/ijd.ijd_640_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Poor adherence to antiretroviral therapy (ART) is associated with poor virologic control and drug resistance in people living with HIV/AIDS. Some barriers to ART adherence are cost, lack of information, stigma, or dissatisfaction with health services. Aims and Objectives: To study the association between barriers for ART adherence and viral suppression, and explore the role of "missing ART dose" as a potential mediator in high-risk groups. Materials and Methods: Demographic, clinical, and behavioral data from 50 "virally suppressed" (viral load [VL] <1000 copies/ml) and 48 "not suppressed" (VL > 1000 copies/ml) individuals belonging to the key population in Mumbai were collected. Sociodemographic, behavioral, and other characteristics were compared, and mediation analysis was used to identify the mediator in the pathway to viral suppression. Results: Those who had missed their ART at least once in the past three months (37% versus 60%, P = 0.03) and stayed alone were less likely to be virally suppressed (31% versus 69%, P = 0.002). Individuals who had negative perception about ART (adjusted odds ratio [aOR]: 0.11, 95% confidence interval [CI]: 0.02, 0.47; P = 0.002), poor ART-related knowledge/behaviors (aOR: 0.14, 95% CI: 0.03, 0.60; P = 0.007), and poor pill taking practices (aOR: 0.10, 95% CI: 0.02, 0.61; P = 0.01) were significantly less likely to be virally suppressed. The mediation pathway "adherence theme > missed ART in the past three months > viral suppression" was significant in these themes. Conclusions: The factors associated with low viral suppression were knowledge/behaviors, perceptions about ART, and poor pill taking practices. Thus, it is important to provide correct information about ART, its effects, side effects, and potential limitations to marginalized population. Involving brothel keepers and Gurus (head of male-to-female transgendered people/Hijras clans), and technology enabled customized counseling sessions will be helpful.
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Affiliation(s)
- Shrikala Acharya
- Mumbai Districts AIDS Control Society, Mumbai, Maharashtra, India
| | | | - Amol Palkar
- Mumbai Districts AIDS Control Society, Mumbai, Maharashtra, India
| | - Padmaja Keskar
- Mumbai Districts AIDS Control Society, Mumbai, Maharashtra, India
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Abdullahi SB, Ibrahim OR, Okeji AB, Yandoma RI, Bashir I, Haladu S, Idris SA, Oseni TIA, Suleiman BM, Yahaya M, Aworh MK, Sufiyan MB. Viral suppression among HIV-positive patients on antiretroviral therapy in northwestern Nigeria: an eleven-year review of tertiary care centre records, January 2009-December 2019. BMC Infect Dis 2021; 21:1031. [PMID: 34600477 PMCID: PMC8487150 DOI: 10.1186/s12879-021-06722-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 09/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Human Immuno-Deficiency Virus (HIV) remains one of the world's significant public health challenges. Viral suppression is the key indicator for treatment success in People living with HIV (PLHIV). We determined the level of viral suppression, and its associated factors among PLHIV attending Federal Medical Centre Katsina (FMC Katsina), Nigeria. METHODS This retrospective descriptive cross-sectional study was conducted on 913 HIV positive adults enrolled in care between January 2009 and December 2019. Information on socio-demographics, clinical, immunological, Viral load (VL), and other relevant parameters were extracted from the patients' care records. The primary outcome was the proportion of patients that achieved viral suppression. We also analyzed variables that were associated with VL suppression. RESULTS Of 913, records of 831 (91.0%) registered patients were analyzed. During the period, 751 (90.4%) achieved viral suppression, 427 (51.4%) had CD4 counts ≥ 500 and 477 (57.4%) were on HAART for ≥ 5 years. Majority, 793 (95.4%) were on first-line HAART regimen (Tenofovir-Lamivudine-Dolutegravir or Abacavir-Lamivudine-Dolutegravir), and 809 (97.4%) in the non-advanced stage (WHO stages 1 and 2). The median (interquartile range) of viral load was 20 (20-40) vs 19,989 (3311-110,340) cp/ml in virally suppressed, and unsuppressed respectively. Factors associated with viral suppression included being unemployed (Adjusted OR [AOR] 4.9, 95% CI 2.771, 8.539), educated (AOR 4.2, 95% CI 1.098, 16.223), having a baseline CD4 count ≥ 500 cells/µl (AOR 2.7, 95% CI 1.588, 4.625), and being on first line HAART regimen [AOR 7.0, 95% CI 3.220, 15.648]. CONCLUSIONS Our study demonstrated a good viral suppression among PLHIV on HAART. Variables associated with viral suppression included unemployment, formal education, high baseline CD4 count, and first line HAART regimen.
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Affiliation(s)
- Suleiman Bello Abdullahi
- Department of Family Medicine, Federal Medical Centre, Murtala Mohammed Way (Jibia Bypass), P. M. B: 2121, Katsina, Nigeria. .,Nigeria Field Epidemiology and Laboratory Training Programme, Abuja, Nigeria.
| | | | | | - Rabilu Iliyasu Yandoma
- Department of Family Medicine, Federal Medical Centre, Murtala Mohammed Way (Jibia Bypass), P. M. B: 2121, Katsina, Nigeria
| | - Ibrahim Bashir
- Department of Haematology and Blood Transfusion, Federal Medical Centre, Katsina, Nigeria
| | - Suleiman Haladu
- Nigeria Field Epidemiology and Laboratory Training Programme, Abuja, Nigeria
| | | | - T I A Oseni
- Department of Family Medicine, Ambrose Alli University, Ekpoma, Nigeria
| | | | - Mohammed Yahaya
- Department of Medical Microbiology and Parasitology, Usmanu Danfodiyo University, Sokoto, Nigeria
| | - Mabel Kamweli Aworh
- Nigeria Field Epidemiology and Laboratory Training Programme, Abuja, Nigeria
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Simms V, Bernays S, Chibanda D, Chinoda S, Mutsinze A, Beji‐Chauke R, Mugurungi O, Apollo T, Sithole D, Verhey R, Weiss HA, Willis N. Risk factors for HIV virological non-suppression among adolescents with common mental disorder symptoms in Zimbabwe: a cross-sectional study. J Int AIDS Soc 2021; 24:e25773. [PMID: 34402199 PMCID: PMC8368838 DOI: 10.1002/jia2.25773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 06/10/2021] [Accepted: 07/05/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Adolescents are at increased risk of HIV virological non-suppression compared to adults and younger children. Common mental disorders such as anxiety and depression are a barrier to adherence and virological suppression. The aim of this study was to identify factors associated with virological non-suppression among adolescents living with HIV (ALWH) in Zimbabwe who had symptoms of common mental disorders. METHODS We utilized baseline data from a cluster-randomized controlled trial of a problem-solving therapy intervention to improve mental health and HIV viral suppression of ALWH. Sixty clinics within 10 districts were randomized 1:1 to either the intervention or control arm, with the aim to recruit 14 adolescents aged 10 to 19 per clinic. Adolescents were eligible if they scored ≥7 on the Shona Symptom Questionnaire measuring symptoms of common mental disorders. Multivariable mixed-effects logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (95% CI) for factors associated with non-suppression, defined as viral load ≥1000 copies/mL. RESULTS Between 2 January and 21 March 2019 the trial enrolled 842 participants aged 10 to 19 years (55.5% female, 58.8% aged <16). Most participants (N = 613) were taking an NNRTI-based ART regimen (13 PI-based, 216 unknown) and median duration on ART was six years (IQR three to nine years, 240 unknown). Of the 833 with viral load data 292 (35.1%) were non-suppressed. Virological non-suppression was independently associated with male sex (adjusted OR (aOR) = 1.43, 95% CI 1.04 to 1.97), and with not knowing one's own HIV status (aOR = 1.77, 95% CI 1.08 to 2.88), or knowing one's status but not disclosing it to anyone (aOR = 1.99, 95% CI 1.36 to 2.93), compared to adolescents who knew their status and had disclosed it to someone. CONCLUSIONS ALWH with symptoms of common mental disorders have high prevalence of virological non-suppression in Zimbabwe, especially if they do not know their status or have not disclosed it. In general adolescents should be informed of their HIV status, with encouragement on the beneficial health and social effects of viral suppression, to incentivise adherence. Efforts to strengthen the operationalization of disclosure guidelines for adolescents should now be prioritized.
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Affiliation(s)
- Victoria Simms
- MRC International Statistics and Epidemiology GroupLondon School of Hygiene & Tropical MedicineLondonUK
| | - Sarah Bernays
- London School of Hygiene & Tropical MedicineLondonUK
| | - Dixon Chibanda
- London School of Hygiene & Tropical MedicineLondonUK
- Friendship BenchHarareZimbabwe
- Department of PsychiatryUniversity of Zimbabwe College of Health SciencesHarareZimbabwe
| | | | | | | | - Owen Mugurungi
- AIDS & TB UnitMinistry of Health and Child CareHarareZimbabwe
| | - Tsitsi Apollo
- AIDS & TB UnitMinistry of Health and Child CareHarareZimbabwe
| | - Dorcas Sithole
- Mental Health ServicesMinistry of Health and Child CareHarareZimbabwe
| | | | - Helen A Weiss
- MRC International Statistics and Epidemiology GroupLondon School of Hygiene & Tropical MedicineLondonUK
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Cini Oliveira M, de Araujo Eleuterio T, de Andrade Corrêa AB, da Silva LDR, Rodrigues RC, de Oliveira BA, Martins MM, Raymundo CE, de Andrade Medronho R. Fatores associados ao óbito em casos confirmados de COVID-19 no estado do Rio de Janeiro. BMC Infect Dis 2021; 21:687. [PMID: 34271868 PMCID: PMC8283387 DOI: 10.1186/s12879-021-06384-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 06/17/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND COVID-19 can occur asymptomatically, as influenza-like illness, or as more severe forms, which characterize severe acute respiratory syndrome (SARS). Its mortality rate is higher in individuals over 80 years of age and in people with comorbidities, so these constitute the risk group for severe forms of the disease. We analyzed the factors associated with death in confirmed cases of COVID-19 in the state of Rio de Janeiro. This cross-sectional study evaluated the association between individual demographic, clinical, and epidemiological variables and the outcome (death) using data from the Unified Health System information systems. METHODS We used the extreme boosting gradient (XGBoost) model to analyze the data, which uses decision trees weighted by the estimation difficulty. To evaluate the relevance of each independent variable, we used the SHapley Additive exPlanations (SHAP) metric. From the probabilities generated by the XGBoost model, we transformed the data to the logarithm of odds to estimate the odds ratio for each independent variable. RESULTS This study showed that older individuals of black race/skin color with heart disease or diabetes who had dyspnea or fever were more likely to die. CONCLUSIONS The early identification of patients who may progress to a more severe form of the disease can help improve the clinical management of patients with COVID-19 and is thus essential to reduce the lethality of the disease.
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Affiliation(s)
| | - Tatiana de Araujo Eleuterio
- Instituto de Estudos em Saúde Pública / Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
- Faculdade de Enfermagem, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil
| | | | - Lucas Dalsenter Romano da Silva
- Departamento de Medicina Preventiva, Instituto de Estudos em Saúde Pública / Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | | | | | - Marlos Melo Martins
- Department of Child Neurology, Martagão Gesteira Institute of Childcare and Pediatrics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Carlos Eduardo Raymundo
- Instituto de Estudos em Saúde Pública / Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Roberto de Andrade Medronho
- Instituto de Estudos em Saúde Pública / Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
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Mugglin C, Kläger D, Gueler A, Vanobberghen F, Rice B, Egger M. The HIV care cascade in sub-Saharan Africa: systematic review of published criteria and definitions. J Int AIDS Soc 2021; 24:e25761. [PMID: 34292649 PMCID: PMC8297382 DOI: 10.1002/jia2.25761] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 05/14/2021] [Accepted: 05/25/2021] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION The HIV care cascade examines the attrition of people living with HIV from diagnosis to the use of antiretroviral therapy (ART) and suppression of viral replication. We reviewed the literature from sub-Saharan Africa to assess the definitions used for the different steps in the HIV care cascade. METHODS We searched PubMed, Embase and CINAHL for articles published from January 2004 to December 2020. Longitudinal and cross-sectional studies were included if they reported on at least one step of the UNAIDS 90-90-90 cascade or two steps of an extended 7-step cascade. A step was clearly defined if authors reported definitions for numerator and denominator, including the description of the eligible population and methods of assessment or measurement. The review protocol has been published and registered in Prospero. RESULTS AND DISCUSSION Overall, 3364 articles were screened, and 82 studies from 19 countries met the inclusion criteria. Most studies were from Southern (38 studies, 34 from South Africa) and East Africa (29 studies). Fifty-eight studies (71.6%) were longitudinal, with a median follow-up of three years. The medium number of steps covered out of 7 steps was 3 (interquartile range [IQR] 2 to 4); the median year of publication was 2015 (IQR 2013 to 2019). The number of different definitions for the numerators ranged from four definitions (for step "People living with HIV") to 21 (step "Viral suppression"). For the denominators, it ranged from three definitions ("Diagnosed and aware of HIV status") to 14 ("Viral suppression"). Only 12 studies assessed all three of the 90-90-90 steps. Most studies used longitudinal data, but denominator-denominator or denominator-numerator linkages over several steps were rare. Also, cascade data are lacking for many countries. Our review covers the academic literature but did not consider other data, such as government reports on the HIV care cascade. Also, it did not examine disengagement and reengagement in care. CONCLUSIONS The proportions of patients retained at each step of the HIV care cascade cannot be compared between studies, countries and time periods, nor meta-analysed, due to the many different definitions used for numerators and denominators. There is a need for standardization of methods and definitions.
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Affiliation(s)
- Catrina Mugglin
- Institute of Social and Preventive Medicine (ISPM)University of BernBernSwitzerland
| | - Delia Kläger
- Institute of Social and Preventive Medicine (ISPM)University of BernBernSwitzerland
| | - Aysel Gueler
- Institute of Social and Preventive Medicine (ISPM)University of BernBernSwitzerland
| | - Fiona Vanobberghen
- Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineLondonUK
- Swiss Tropical and Public Health InstituteBaselSwitzerland
- University of BaselBaselSwitzerland
| | - Brian Rice
- Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineLondonUK
| | - Matthias Egger
- Institute of Social and Preventive Medicine (ISPM)University of BernBernSwitzerland
- Centre for Infectious Disease Epidemiology and Research (CIDER)University of Cape TownCape TownSouth Africa
- Population Health SciencesBristol Medical SchoolUniversity of BristolBristolUK
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Mehari EA, Muche EA, Gonete KA. Virological Suppression and Its Associated Factors of Dolutegravir Based Regimen in a Resource-Limited Setting: An Observational Retrospective Study in Ethiopia. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2021; 13:709-717. [PMID: 34234572 PMCID: PMC8254547 DOI: 10.2147/hiv.s316776] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/09/2021] [Indexed: 11/23/2022]
Abstract
Background Toxicity, treatment failure, and resistance to existing HIV treatment regimens have become a challenge in resource-limited settings. As a result, a dolutegravir based regimen has recently been utilized. However, there is a paucity of evidence in sub-Saharan countries regarding its virological suppression. Thus, this study aimed to assess virological suppression and associated factors of dolutegravir based regimen. Methods A retrospective follow-up study was conducted on 349 individuals. They were selected using a systematic random sampling technique among all treatment-experienced adult HIV patients who were on a dolutegravir based regimen. From this, 81.4% of them were virologically suppressed before the initiation of dolutegravir based regimen. The study was carried out at twelve months of therapy after shifting to dolutegravir based regimen (TDF-3TC-DTG) during the period May 2018–August 2020 at Debre Markos referral hospital. Retrospective data before and after dolutegravir based regimen initiation were collected from their medical records. The time on dolutegravir based regimen was one year. Bivariable and multivariable logistic regression was used to identify factors. Variables with p <0.05 were considered statistically significant. Results From a total of 359, 349 participated (97.2%) in the study, and the mean age of the participants was 40.28 ±11.6 years. Totally, 192 (55.0%) of them were female. The proportion of virological suppression was 92%. Good adherence (participants who reported an intake of ≥95% of the prescribed medication) (AOR=6.2, 95% CI: 1.93, 20.11) and overall duration of ART (AOR=1.02, 95% CI: 1.01, 1.04) were associated with virological suppression. Conclusion Dolutegravir based regimen maintains high virological suppression. Adherence and duration of ART were associated with virological suppression. Therefore, designing effective mechanisms to maintain virological suppression is important.
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Affiliation(s)
- Eden Abetu Mehari
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Esileman Abdela Muche
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kedir Abdela Gonete
- Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Badejo O, Noestlinger C, Jolayemi T, Adeola J, Okonkwo P, Van Belle S, Wouters E, Laga M. Multilevel modelling and multiple group analysis of disparities in continuity of care and viral suppression among adolescents and youths living with HIV in Nigeria. BMJ Glob Health 2021; 5:bmjgh-2020-003269. [PMID: 33154102 PMCID: PMC7646327 DOI: 10.1136/bmjgh-2020-003269] [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: 07/01/2020] [Revised: 10/05/2020] [Accepted: 10/07/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Substantial disparities in care outcomes exist between different subgroups of adolescents and youths living with HIV (AYLHIV). Understanding variation in individual and health facility characteristics could be key to identifying targets for interventions to reduce these disparities. We modelled variation in AYLHIV retention in care and viral suppression, and quantified the extent to which individual and facility characteristics account for observed variations. METHODS We included 1170 young adolescents (10-14 years), 3206 older adolescents (15-19 years) and 9151 young adults (20-24 years) who were initiated on antiretroviral therapy (ART) between January 2015 and December 2017 across 124 healthcare facilities in Nigeria. For each age group, we used multilevel modelling to partition observed variation of main outcomes (retention in care and viral suppression at 12 months after ART initiation) by individual (level one) and health facility (level two) characteristics. We used multiple group analysis to compare the effects of individual and facility characteristics across age groups. RESULTS Facility characteristics explained most of the observed variance in retention in care in all the age groups, with smaller contributions from individual-level characteristics (14%-22.22% vs 0%-3.84%). For viral suppression, facility characteristics accounted for a higher proportion of variance in young adolescents (15.79%), but not in older adolescents (0%) and young adults (3.45%). Males were more likely to not be retained in care (adjusted OR (aOR)=1.28; p<0.001 young adults) and less likely to achieve viral suppression (aOR=0.69; p<0.05 older adolescent). Increasing facility-level viral load testing reduced the likelihood of non-retention in care, while baseline regimen TDF/3TC/EFV or NVP increased the likelihood of viral suppression. CONCLUSIONS Differences in characteristics of healthcare facilities accounted for observed disparities in retention in care and, to a lesser extent, disparities in viral suppression. An optimal combination of individual and health services approaches is, therefore, necessary to reduce disparities in the health and well-being of AYLHIV.
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Affiliation(s)
- Okikiolu Badejo
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium .,APIN Public Health Initiative, Abuja, Nigeria.,Department of Sociology, University of Antwerp, Antwerpen, Belgium
| | | | | | | | | | - Sara Van Belle
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Edwin Wouters
- Department of Sociology, University of Antwerp, Antwerpen, Belgium
| | - Marie Laga
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
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Amico KR, Crawford J, Ubong I, Lindsey JC, Gaur AH, Horvath K, Goolsby R, Mueller Johnson M, Dallas R, Heckman B, Filipowicz T, Polier M, Rupp BM, Hudgens M. Correlates of High HIV Viral Load and Antiretroviral Therapy Adherence Among Viremic Youth in the United States Enrolled in an Adherence Improvement Intervention. AIDS Patient Care STDS 2021; 35:145-157. [PMID: 33960843 DOI: 10.1089/apc.2021.0005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
A sizable portion of youth (ages 13-24) living with HIV in the United States have unsuppressed viral load. The AIDS Interventions (ATN) 152 study [evaluating the Triggered Escalating Real-Time Adherence (TERA) intervention] baseline data were examined to identify correlates of high viremia (>5000 copies/mL) and self-reported adherence, which can help in planning of differentiated services for viremic youth. Depression, HIV-stigma, and cannabis use were common in this sample of 87 youth. Almost half (48%) had high viremia, which associated with enacted stigma, moderate- to high-risk alcohol use, mental health diagnosis, and age ≥21. Self-reported adherence was related to viral load and associated with mental and physical health functioning, depression, social support, self-confident decision-making, total and internalized stigma, adherence motivation, and report of a missed a care visit in the past 6 months. Mental health emerged as a common correlate of viral load and adherence. Clinical Trial Registration number: NCT03292432.
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Affiliation(s)
- K. Rivet Amico
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Jessica Crawford
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Ini Ubong
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Jane C. Lindsey
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Aditya H. Gaur
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Keith Horvath
- Department of Clinical Psychology, San Diego State University, San Diego, California, USA
| | - Rachel Goolsby
- Department of Biostatistics, Gillings School of Public Health, Collaborative Studies Coordinating Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Megan Mueller Johnson
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Ronald Dallas
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Barbara Heckman
- Frontier Science and Technology Research Foundation, Amherst, New York, USA
| | - Teresa Filipowicz
- Department of Biostatistics, Gillings School of Public Health, Collaborative Studies Coordinating Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Melissa Polier
- Department of Biostatistics, Gillings School of Public Health, Collaborative Studies Coordinating Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Betty M. Rupp
- Department of Biostatistics, Gillings School of Public Health, Collaborative Studies Coordinating Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Michael Hudgens
- Department of Biostatistics, Gillings School of Public Health, Collaborative Studies Coordinating Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Plymoth M, Sanders EJ, Van Der Elst EM, Medstrand P, Tesfaye F, Winqvist N, Balcha T, Björkman P. Socio-economic condition and lack of virological suppression among adults and adolescents receiving antiretroviral therapy in Ethiopia. PLoS One 2020; 15:e0244066. [PMID: 33320900 PMCID: PMC7737988 DOI: 10.1371/journal.pone.0244066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 12/02/2020] [Indexed: 12/25/2022] Open
Abstract
Introduction The potential impact of socio-economic condition on virological suppression during antiretroviral treatment (ART) in sub-Saharan Africa is largely unknown. In this case-control study, we compared socio-economic factors among Ethiopian ART recipients with lack of virological suppression to those with undetectable viral load (VL). Methods Cases (VL>1000 copies/ml) and controls (VL<150 copies/ml) aged ≥15years, with ART for >6 months and with available VL results within the last 3 months, were identified from registries at public ART clinics in Central Ethiopia. Questionnaire-based interviews on socio-economic characteristics, health condition and transmission risk behavior were conducted. Univariate variables associated with VL>1000 copies/ml (p<0.25) were added to a multivariable logistic regression model. Results Among 307 participants (155 cases, 152 controls), 61.2% were female, and the median age was 38 years (IQR 32–46). Median HIV-RNA load among cases was 6,904 copies/ml (IQR 2,843–26,789). Compared to controls, cases were younger (median 36 vs. 39 years; p = 0.004), more likely to be male (46.5% vs. 30.9%; p = 0.005) and had lower pre-ART CD4 cell counts (170 vs. 220 cells/μl; p = 0.009). In multivariable analysis of urban residents (94.8%), VL>1000 copies/ml was associated with lower relative wealth (adjusted odds ratio [aOR] 2.98; 95% CI 1.49–5.94; p = 0.016), geographic work mobility (aOR 6.27, 95% CI 1.82–21.6; p = 0.016), younger age (aOR 0.94 [year], 95% CI 0.91–0.98; p = 0.011), longer duration of ART (aOR 1.19 [year], 95% CI 1.07–1.33; p = 0.020), and suboptimal (aOR 3.83, 95% CI 1.33–10.2; p = 0.048) or poor self-perceived wellbeing (aOR 9.75, 95% CI 2.85–33.4; p = 0.012), after correction for multiple comparisons. High-risk sexual behavior and substance use was not associated with lack of virological suppression. Conclusion Geographic work mobility and lower relative wealth were associated with lack of virological suppression among Ethiopian ART recipients in this predominantly urban population. These characteristics indicate increased risk of treatment failure and the need for targeted interventions for persons with these risk factors.
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Affiliation(s)
- Martin Plymoth
- Clinical Infection Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden
- * E-mail: ,
| | - Eduard J. Sanders
- Centre for Geographic Medicine Research, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
- Nuffield Department of Clinical Medicine, University of Oxford, Headington, United Kingdom
| | - Elise M. Van Der Elst
- Centre for Geographic Medicine Research, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
| | - Patrik Medstrand
- Clinical Virology, Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Fregenet Tesfaye
- Clinical Infection Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Niclas Winqvist
- Clinical Infection Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Taye Balcha
- Clinical Infection Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Per Björkman
- Clinical Infection Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden
- Department of Infectious Diseases, Skåne University Hospital, Malmö, Sweden
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Zenebe Haftu A, Desta AA, Bezabih NM, Bayray Kahsay A, Kidane KM, Zewdie Y, Woldearegay TW. Incidence and factors associated with treatment failure among HIV infected adolescent and adult patients on second-line antiretroviral therapy in public hospitals of Northern Ethiopia: Multicenter retrospective study. PLoS One 2020; 15:e0239191. [PMID: 32986756 PMCID: PMC7521713 DOI: 10.1371/journal.pone.0239191] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 09/01/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND This study aimed to determine the incidence and factors associated with treatment failure among HIV infected adolescent and adult patients on second-line antiretroviral therapy (ART) in public hospitals of Northern Ethiopia. METHODS A retrospective study was conducted from September 1, 2007 to July 30, 2017 on 227 patients. The data were extracted using a retrieval checklist from the patient's charts. The incidence rate of treatment failure was calculated using Kaplan-Meier methods and Cox proportional hazard model was used to assess factors associated with treatment failure. RESULT The study subjects were followed for a total observation of 788.58 person-years with a median follow-up period of 35 (IQR: 17-60) months after switching to second-line ART. About 57 (25.11%) patients developed treatment failure, out of which, 32 (56.14%) occurred during the first two years. The overall incidence of second-line treatment failure was 72.3 per 1000 person years (95%CI: 55.75-93.71) of observation. The Kaplan-Meier estimates of cumulative treatment failure after 1, 2, and around 10 years of follow-up were 12.31% (95%CI: 8.60-17.45%), 14.99% (95%CI: 10.82%-20.57%), and 48.67% (95%CI: 32.45-67.81%) respectively. Age >45 years AHR = 3.33, 95%CI = 1.33-8.31), WHO stage IV (AHR = 3.63, 95%CI = 1.72-7.67), CD4 count <100 cells/mm3 (AHR = 3.79, 95%CI = 1.61-8.91), TB co-morbidity (AHR = 3.39 95%CI = 1.91-6.01) and poor adherence level (AHR = 3.63, 95% CI = 1.89-6.96) at the start of second line ART were significantly associated with second-line ART failure. CONCLUSION Incidence of second-line ART treatment failure in the first 2 years of follow-up was high. The rate of second-line ART failure was higher in patients who started second-line ART with poor drug adherence, CD4 count <100 cells/mm3, TB co-morbidity, age >45 years, and being in WHO stage IV. Therefore, intensive counseling and adherence support should be given along with strong TB screening. Moreover, the government of Ethiopia should consider endorsing third-line ART drugs after careful cost-benefit analysis.
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Affiliation(s)
| | | | | | - Alemayehu Bayray Kahsay
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | | | - Yodit Zewdie
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
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Desta AA, Kidane KM, Bahta YW, Ajemu KF, Woldegebriel AG, Berhe AA, Bezabih NM, Woldu AB, Woldearegay TW. Determinants of immunological recovery following HAART among severely immunosuppressed patients at enrolment to care in Northern Ethiopia: a retrospective study. BMJ Open 2020; 10:e038741. [PMID: 32868365 PMCID: PMC7462238 DOI: 10.1136/bmjopen-2020-038741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE This study aimed to identify determinants of immunological recovery following highly active antiretroviral therapy (HAART) among severely immunosuppressed patients at enrolment to care in Northern Ethiopia. METHODS A retrospective study. SETTING The study was done in Tigray Region, Northern Ethiopia. PARTICIPANTS The study was done among severely immunosuppressed (<200 CD4 cells/mm3) individuals at initial enrolment to care and whose samples were sent for viral load determination from April 2015 to March 2019 in Tigray Health Research Institute. MAIN OUTCOMES The main outcome variable was immunological recovery, modelled using binary logistic regression. RESULTS Among the 9687 patients with severe immunosuppression at enrolment, 2746 (28.35%, 95% CI 27.45% to 29.26%) had immunological recovery following HAART for at least 6 months. Male gender (adjusted OR (AOR)=0.50, p<0.001), age 20-34 years old (AOR=0.33, p<0.001), age ≥50 years old (AOR=0.26, p<0.001), WHO clinical stage III (OR=0.68, p=0.036) and viral non-suppression (AOR=0.38, p<0.001) were strong predictors of immunological failure. CONCLUSIONS Immunological recovery following HAART was low among severely immunosuppressed individuals at enrolment to care. Gender, age, WHO stage III and viral non-suppression were determinants of immunological recovery. Male patients, adolescents and virally non-suppressed patients should be identified as groups at higher risk for immunological failure. Therefore, greater support and intensive counselling should be prioritised among adolescents, men and virally non-suppressed patients for better immunological recovery.
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Affiliation(s)
- Abraham Aregay Desta
- Public Health Research, Tigray Health Research Institute, Mekelle, Tigray, Ethiopia
| | | | - Yemane Weldu Bahta
- Microbiology, Mekelle University College of Health Sciences, Mekelle, Tigray, Ethiopia
| | | | | | | | | | - Awtachew Berhe Woldu
- Biostatistics School of Public Health, Mekelle University College of Health Sciences, Mekelle, Tigray, Ethiopia
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Determinants of Virologic Failure among Adult HIV Patients on First-Line Antiretroviral Therapy at Waghimra Zone, Northern Ethiopia: A Case-Control Study. ADVANCES IN PUBLIC HEALTH 2020. [DOI: 10.1155/2020/1929436] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction. The primary goal of antiretroviral therapy (ART) is to reduce the viral load in HIV-infected patients to promote quality of life, as well as to reduce HIV-related morbidity and mortality. A high rate of virologic failure was reported in Waghimra Zone, Northwest Ethiopia, in viral load assessment conducted among HIV-infected patients on ART in the Amhara region. However, there is limited evidence on the determinants of virological failure in the study area. This study aimed to identify the determinants of virological failure among HIV-infected patients on antiretroviral therapy in Waghimra zone, Northern Ethiopia, 2019. Methods. An institutional-based unmatched case-control study was conducted from May 21 to June 30, 2019. Cases were people living with HIV (PLHIV) on ART who had already experienced virological failure; controls were those without virological failure. Data were extracted from 92 cases and 184 controls through chart review using a pretested and structured checklist. The data were entered using Epi Info version 7 and exported to SPSS version 20 for analysis. A multivariate logistic regression analysis was carried out to identify factors associated with virological failure, and variables with a P value <0.05 were considered statistically significant. Results. This study revealed that poor adherence to ART (adjusted odds ratio (AOR) = 4.24, 95% confidence interval (CI): 2.17, 8.31), taking ART for longer than five years (AOR = 3.11, 95% CI: 1.17, 8.25), having drug toxicity (AOR = 3.34, 95% CI: 1.54, 7.23), age of PLHIV ≥ 35 years (AOR = 2.45, 95% CI: 1.29,4.64), and recent CD4 count <200 cells/mm³ (AOR = 3.06, 95% CI: 1.52, 6.13) were factors associated with virologic failure. Conclusion and Recommendation. This study showed that poor adherence to treatment, longer duration on ART, experiencing drug toxicity, older age, and recent CD4 <200 cell/mm³ are factors that increase the risk of virologic failure.
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Aregay AD, Kidane KM, Aregay AB, Fenta KA, Woldegebriel AG, Godefay H, Woldearegay TW. Prediction of CD4 T-Lymphocyte Count Using WHO Clinical Staging among ART-Naïve HIV-Infected Adolescents and Adults in Northern Ethiopia: A Retrospective Study. AIDS Res Treat 2020; 2020:2163486. [PMID: 32411452 PMCID: PMC7210527 DOI: 10.1155/2020/2163486] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 03/26/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND WHO clinical staging has long been used to assess the immunological status of HIV-infected patients at initiation of antiretroviral therapy and during treatment follow-up. In setups where CD4 count determination is not readily available, WHO clinical staging is a viable option. However, correlation between CD4 count and WHO clinical staging is not known in an Ethiopian setting, and hence, the main aim of this study was to assess predictability of CD4 T-lymphocyte count using WHO clinical staging among ART-naïve HIV-infected adolescents and adults in northern Ethiopia. METHODS A retrospective cross-sectional study was done in the Tigray Region, Ethiopia, from April 2015 to January 2019 from a secondary database of 19525 HIV-infected patients on antiretroviral treatment. Analysis was done using STATA-14.0 to estimate the frequencies, mean, and median of CD4 T-cell count in each WHO stages. Sensitivity, specificity, positive predictive value, negative predictive value, kappa test, and correlations were calculated to show the relationships between WHO stages and CD T-cell count. RESULTS The sensitivity of WHO clinical staging to predict CD4 T-cell counts of <200 cells/μl was 94.17% with a specificity of 3.62%. The PPV was 49.03%, and the NPV was 3.62%. The sensitivity of WHO clinical staging to predict CD4 T-cell counts of <350 cells/μl was 94.75% with a specificity of 3.00%. The PPV was 75.81%, and the NPV was 15.09%. Similarly, the sensitivity of WHO clinical staging to predict CD4 T-cell counts of <500 cells/μl was 95.03% with a specificity of 2.73% and the PPV and NPV were 88.32% and 6.62%, respectively. The kappa agreement of WHO clinical stages was also insignificant when compared with the disaggregated CD4 counts in different categories. The correlation of WHO clinical staging was inversely associated with the CD4 count, and the magnitude of the correlation was 5.22%. CONCLUSIONS The WHO clinical staging had high sensitivity but low specificity in predicting patients with CD4 count <200 cells/μl, <350 cells/μl, and <500 cells/μl. There was poor correlation and agreement between CD4 T-lymphocyte count and WHO clinical staging. Therefore, WHO clinical staging alone may not provide accurate information on the immunological status of patients, and hence, it is better to use the CDC definition rather than the WHO clinical definition.
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Affiliation(s)
| | | | | | | | | | - Hagos Godefay
- Tigray Regional Health Bureau, Mekelle, Tigray, Ethiopia
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Desta AA, Kidane KM, Woldegebriel AG, Ajemu KF, Berhe AA, Zgita DN, Teweldemedhn LW, Woldegebriel LL, Bezabih NM, Woldearegay TW. Level of Adherence and Associated Factors Among HIV-Infected Patients on Antiretroviral Therapy in Northern Ethiopia: Retrospective Analysis. Patient Prefer Adherence 2020; 14:1585-1594. [PMID: 32943850 PMCID: PMC7481295 DOI: 10.2147/ppa.s268395] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 08/18/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Poor adherence to ART increases viremia, which leads to disease progression and transmission of drug-resistant HIV strains. This study aimed to assess the level of ART adherence and associated factors among adolescents and adult patients enrolled in ART care in Northern Ethiopia. METHODS A retrospective analysis was conducted among 19,525 patients from April 2015 to March 2019. Data verification and filtration were done in Excel 2013 before exporting to STATA 14.0. Ordinal logistic regression was used to analyze the data. RESULTS About 94.84%, 95% CI (94.52%, 95.14%) of the study subjects were in good adherence. However, about 1.46%, 95% CI (1.30%, 1.64%) and 3.70%, 95% CI (3.44%, 3.97%) of them had poor and fair adherence respectively. In the adjusted analysis, being male (AOR = 0.75; 95% CI: 0.0.65, 0.87), patients from general hospitals (AOR = 0.52; 95% CI: 0.39, 0.69), WHO staging IV (AOR = 0.57; 95% CI: 0.41, 0.81) and non-suppressed viral load (VL) status (AOR = 0.54; 95% CI: 0.47, 0.63) were negatively associated with good adherence. Whereas, age of 50+ years old (AOR = 1.68; 95% CI: 1.13, 2.50), recent CD4 count of 200-499 (AOR = 1.45; 95% CI: 1.21, 1.74) and recent CD4 count of 500 and above (AOR = 1.84; 95% CI: 1.47, 2.32) were positively associated with good ART drug adherence. CONCLUSION There was a higher level of adherence compared to the previous studies conducted in Ethiopia. Being male, patients from general hospitals, WHO staging II, II and IV and non-suppressed VL status were negatively associated with good adherence. Whereas, older ages, recent CD4 count of 200-499 and ≥500 CD4 count were positively associated with good ART drug adherence. The health system should recognize a higher need of younger age groups and males to design targeted counseling and support to encourage consistently high levels of adherence for a better ART treatment outcome.
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Affiliation(s)
- Abraham Aregay Desta
- Tigray Health Research Institute, Mekelle, Tigray, Ethiopia
- Correspondence: Abraham Aregay Desta Email
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