Seroprevalence of HIV among pregnant women in Ethiopia: a systematic review and meta-analysis

Human Immunodeficiency Virus (HIV) viral load suppression status and associated factors among pregnant women receiving Highly Active Antiretroviral Therapy (HAART) in Ethiopia

BACKGROUND

Mothers with an undetectable viral load pose no risk of transmitting the Human Immunodeficiency Virus (HIV) to their fetuses. However, there is limited information on the HIV viral suppression status (≤ 1000 RNA copies/mL) among pregnant mothers at the national level. This study aimed to assess the HIV viral load suppression status among pregnant women and identify factors associated with unsuppressed maternal viral levels (> 1000 RNA copies/mL).

METHODS

We conducted a cross-sectional study using secondary data from the national HIV viral load data repository. The study included all pregnant women who initiated antiretroviral therapy (ART) and underwent routine HIV viral load testing. Data were collected from July 2022 to June 2023 (2015 Ethiopian Fiscal Year (EFY)). Analysis was performed using STATA v.17, with descriptive statistics (frequency, percentage, mean, and standard deviation) calculated. A mixed-effects logistic regression model was used to quantify the strength of associations between variables and HIV viral load status (suppressed vs. unsuppressed), expressed through odds ratios.Variables showing a significant association with the outcome (p < 0.02) were selected for further analysis using multiple logistic regression models.

RESULTS

The analysis included a total of 13,000 mothers with complete data from viral load tests conducted on pregnant women. The HIV viral suppression rate among these women before delivery was 96.8%. Among those with suppressed results, 96.5% had an undetectable HIV viral load. Multiple binary logistic regression analysis indicated that individuals aged 19-29 had 3.17 times higher odds (AOR 3.17, 95% CI 1.17-5.17, p = 0.002) of having an unsuppressed viral load compared to those under 19. Additionally, individuals with poor adherence to treatment had 12.6 times higher odds of experiencing unsuppressed viral loads (AOR 12.64, 95% CI 10.74-14.54, p = 0.001). However, no significant association was found between the timing of viral load testing and unsuppressed maternal HIV viral load.

CONCLUSION

The findings indicate that while the overall rates of HIV viral suppression among pregnant women are high, specific demographic factors such as age and treatment adherence play crucial roles in achieving undetectable viral loads. The data suggests a need for targeted interventions focusing on mothers age from 19 to 30 years and strategies to improve adherence to treatment regimens to enhance outcomes further.The results have significant implications for policy and clinical practices aimed at improving health outcomes for mothers and newborns affected by HIV/AIDS.

Prevalence of HIV/AIDS among pregnant women in North American region: A systematic review and meta-analysis

BACKGROUND

As a major maternal health concern, the prevalence of human immunodeficiency virus (HIV) among pregnant women was previously investigated in European, African, and Latin American regions other than the North American region. This study analyzed the prevalence of HIV among pregnant women in the North American region including 3 major countries: the USA, Canada, and Mexico.

METHODS

Relevant studies were screened from 3 online databases: Google Scholar, PubMed, and ScienceDirect using specific search keywords. Ultimately, 10 studies of the North American region were included with a total of 339,831 pregnant women residing in the USA, Canada, and Mexico.

RESULTS

The overall pooled prevalence was 0.6% (95% confidence interval [CI]: 0.4-0.8) with a high degree of heterogeneity (I2 = 97%). Pooled prevalence rates of HIV among pregnant women in Canada, Mexico, and the USA were 0.3% (95% CI: 0.1-0.5), 0.5% (95% CI: 0.2-0.8), and 2.3% (95% CI: 0.0-5.7), respectively with high degrees of heterogeneity.

CONCLUSION

The overall prevalence rate of HIV among pregnant women in the USA, Canada, and Mexico was minimal as compared with the countries of Eastern Europe, sub-Saharan Africa, or Latin America. Awareness, adequate testing and healthcare facilities, better socioeconomic, and geopolitical conditions might be crucial to lowering the prevalence of HIV among pregnant women.

Trend, spatial distribution, and factors associated with HIV testing uptake among pregnant women in Ethiopia, based on 2005-2016 Ethiopia demographic and health survey: A multivariate decomposition analysis and geographically weighted regression

INTRODUCTION

HIV testing during pregnancy is an integral component and first step of prevention for mother to child transmission, initiation of antiretroviral treatment and diagnosis of HIV/AIDS. However, Ethiopia and other sub-Saharan African countries face challenges in meeting the first target of the 95-95-95 global initiatives. This study examines trends, spatial distribution, and factors influencing HIV testing among pregnant women in Ethiopia from 2005 to 2016, using data from the Ethiopia Demographic and Health Surveys.

METHODS

The study was based on three consecutive demographic and health survey in Ethiopia. A total weighted sample of 13,020 women who gave birth within 2 year proceeding each survey year was included in each survey. Logit based decomposition analysis technique was employed to identify factors contributing to the change in HIV testing uptake among pregnant women overtime. ArcGIS version 10.7.1 and SaT Scan version 10.1software were used for the spatial analysis and geographically weighted regression.

RESULTS

HIV testing uptake among pregnant women has significantly increased from 0.51% in 2005 to 32.4% in 2016 with 2.9% annual rate of increment in Ethiopia. About 75.9% of the overall increase in HIV testing uptake among pregnant from 2005-2016 was due to increases in women's composition with knowledge of Mother to child transmission of HIV (3.2%), HIV counseling (10.3%), 4 or more antenatal care visits (31.4%), health facility delivery (6.3%), not perceiving distance from the health facility as a big problem (1.1%), and urban residence (0.6%). Spatial variation of low proportion of HIV testing was non-random in all three surveys (Moran index, p-value<0.05). Hot spot clusters exhibited in all the three waves includes Tigray and SNNPRs in 2005 and consistent hotspot areas in Benishangul-Gumuz, Somali, SNNPR, and Gambella in 2011 and 2016 EDHS. Lack of knowledge of Mother to child transmission of HIV, lack of antenatal care visit, lack of media exposure, and health facility delivery were significant predictors for the spatial variation of low proportion of HIV testing uptake across regions in Ethiopia in 2016.

CONCLUSION AND RECOMMENDATION

Over all, there has been a substantial increase in HIV testing uptake among pregnant women overtime in Ethiopia, but it still far away from achieving the 2025 HIV testing targets. Knowledge of Mother to child transmission of HIV, HIV counseling, Number of Antenatal care visit, previous place of delivery, residence and distance to health facility were significant contributing factors for the change in HIV testing uptake. There was geographical disparity in HIV testing uptake across regions in all three EDHS. Lack of knowledge of Mother to child transmission of HIV, lack of ANC visit, lack media exposure, and health facility delivery were significant predictors. Geographic-based interventions, together with broader public health strategies, are essential for advancing HIV testing uptake.

A qualitative study on reasons for women's loss and resumption of Option B plus care in Ethiopia

Loss to follow-up (LTFU) from Option B plus, a lifelong antiretroviral therapy (ART) for pregnant women living with human immunodeficiency virus (HIV), irrespective of their clinical stage and CD4 count, threatens the elimination of vertical transmission of the virus from mothers to their infants. However, evidence on reasons for LTFU and resumption after LTFU to Option B plus care among women has been limited in Ethiopia. Therefore, this study explored why women were LTFU from the service and what made them resume or refuse resumption after LTFU in Ethiopia. An exploratory, descriptive qualitative study using 46 in-depth interviews was employed among purposely selected women who were lost from Option B plus care or resumed care after LTFU, health care providers, and mother support group (MSG) members working in the prevention of mother-to-child transmission unit. A thematic analysis using an inductive approach was used to analyze the data and build subthemes and themes. Open Code Version 4.03 software assists in data management, from open coding to developing themes and sub-themes. We found that low socioeconomic status, poor relationship with husband and/or family, lack of support from partners, family members, or government, HIV-related stigma, and discrimination, lack of awareness on HIV treatment and perceived drug side effects, religious belief, shortage of drug supply, inadequate service access, and fear of confidentiality breach by healthcare workers were major reasons for LTFU. Healthcare workers' dedication to tracing lost women, partner encouragement, and feeling sick prompted women to resume care after LTFU. This study highlighted financial burdens, partner violence, and societal and health service-related factors discouraged compliance to retention among women in Option B plus care in Ethiopia. Women's empowerment and partner engagement were of vital importance to retain them in care and eliminate vertical transmission of the virus among infants born to HIV-positive women.

Seroprevalence of human immunodeficiency virus in African blood donors: a systematic review and meta-analysis

BACKGROUND

In developing countries, the safety of blood transfusions remains an important public health concern as it is associated with a higher risk of transfusion-transmissible infections (TTIs). In this study, we aimed to estimate the seroprevalence of HIV among blood donors in Africa and assess the temporal trends and regional differences within the continent through a systematic review and meta-analysis.

METHODS

Seven electronic databases (PubMed, Web of Science, Cochrane, Scopus, HINARI, Global Index Medicus and Clinical.

TRIAL

gov) were searched for relevant studies for our research. We included all primary studies that estimated the seroprevalence of HIV among blood donors in Africa with an age population from 16 to 65 years old, without language restrictions, from inception up to March 1st 2024. The pooled seroprevalence was estimated through the DerSimonian-Laird random effects model. The temporal trends and regional differences were assessed through subgroup and meta-regression analysis.

FINDINGS

We obtained 122 studies that met our inclusion criteria, comprising 7,814,996 blood donors tested for HIV. Sixty-six percent of the studies were from Western and Eastern Africa. The pooled seroprevalence of HIV among blood donors in Africa was 2.66% (95% CI: 2.17-3.20%; I2 = 99.80%, p < 0.01). The highest prevalence was observed in the Central African region, 3.28% (95% CI: 2.57%-4.06%), followed by the Eastern 3.21% (95% CI: 2.12%-4.52%), and the Western 2.66% (95% CI: 1.93%-3.49%) regions. Lower prevalences were observed in the Northern region, 0.57% (95% CI: 0.0%-2.10%), followed by the Southern African region with 0.45% (95% CI: 0.16%-0.86%). We observed a temporal decreased trend of HIV prevalence.

INTERPRETATION

The prevalence of HIV infection among African blood donors remains high and is not homogeneous across the continent. Efficient measures to strengthen HIV testing and prevent HIV transmission through blood transfusion are needed in Africa. Systematic review protocol registration: PROSPERO CRD42023395616.

FUNDING

This article was supported by National Funds through FCT - Fundação para a Ciência e a Tecnologia,I.P., within CINTESIS, R&D Unit (reference UIDP/4255/2020).

Magnitude and risk factors of mother-to-child transmission of HIV among HIV-exposed infants after Option B+ implementation in Ethiopia: a systematic review and meta-analysis

BACKGROUND

Mother-to-child transmission (MTCT) of the human immunodeficiency virus (HIV) remains a major public health challenge in Ethiopia. The objective of this review was to assess the pooled magnitude of MTCT of HIV and its risk factors among mother-infant pairs who initiated antiretroviral therapy (ART) after Option B+ in Ethiopia.

METHODS

A systematic search of literature from PubMed, Hinari, African Journals Online (AJOL), Science Direct, and Google Scholar databases was conducted from June 11, 2013 to August 1, 2023. The authors used the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines to guide the article selection process and reporting. Observational studies that reported the magnitude and/or risk factors on MTCT of HIV among mother-infant pairs who initiated ART after the implementation of Option B+ in Ethiopia were included. We applied a random-effect model meta-analysis to estimate the overall pooled magnitude and risk factors of MTCT of HIV. A funnel plot and Egger's regression test were employed to check publication bias, and heterogeneity was assessed using I2 statistics. The protocol was registered in the PROSPERO database with registration ID number CRD42022325938.

RESULT

Eighteen published articles on the magnitude of MTCT and 16 published articles on its risk factors were included in this review. The pooled magnitude of MTCT of HIV after the Option B+ program in Ethiopia was 4.05% (95% CI 3.09, 5.01). Mothers who delivered their infants at home [OR: 9.74; (95% CI: 6.89-13.77)], had not been on ART intervention [OR: 19.39; (95% CI: 3.91-96.18)], had poor adherence to ART [OR: 7.47; (95% CI: 3.40-16.45)], initiated ART during pregnancy [OR: 5.09; (95% CI: 1.73-14.97)], had WHO clinical stage 2 and above [OR: 4.95; (95% CI: 1.65-14.88]], had a CD4 count below 350 at enrolment [OR: 5.78; (95% CI: 1.97-16.98], had no or low male partner involvement [OR: 5.92; (95% CI: 3.61-9.71]] and whose partner was not on ART [OR: 8.08; (95% CI: 3.27-19.93]] had higher odds of transmitting HIV to their infants than their counterparts.

CONCLUSION

This review showed that the pooled magnitude of MTCT of HIV among mother-infant pairs who initiated ART after the Option B + program in Ethiopia is at the desired target of the WHO, which is less than 5% in breastfeeding women. Home delivery, lack of male partner involvement, advanced HIV-related disease, lack of PMTCT intervention, and poor ARV adherence were significant risk factors for MTCT of HIV in Ethiopia.

HIV seroconversion and associated factors among seronegative pregnant women attending ANC in Ethiopia: an institution-based cross-sectional study

Background

In countries with limited resources, including Ethiopia, HIV is diagnosed using a rapid serological test, which does not detect the infection during the window period. Pregnant women who test negative for HIV on the first test may seroconvert throughout pregnancy. Women who are seroconverted during pregnancy may not have received interventions, as they are considered HIV-negative unless they are retested for HIV at the end of their pregnancy. Due to limited data on HIV seroconversion, this study aimed to measure the extent of HIV seroconversion and to identify associated factors among seronegative pregnant women attending ANC in Ethiopia.

Methods

Institution-based cross-sectional study was conducted among HIV-negative pregnant women attending the ANC in Ethiopia between June and July 2020. Socio-demographic, clinical, and behavioral data were collected through face-to-face questionnaires and participants' records review. HIV retesting was performed to determine the current HIV status of pregnant women. The data collected were entered into Epi data version 4.4.1 and were exported and analyzed by SPSS version 25. A p-value < 0.25 in the bivariate analysis was entered into multivariable logistic regression analysis and a p-value of < 0.05 was considered statistically significant.

Result

Of the 494 pregnant women who tested negative for HIV on their first ANC test, six (1.2%) tested positive on repeat testing. Upon multivariable logistic regression, pregnant women who have had a reported history of sexually transmitted infections [AOR = 7.98; 95% CI (1.21, 52.82)], participants' partners reported travel history for work frequently [AOR = 6.00; 95% CI (1.09, 32.99)], and sexually abused pregnant women [AOR = 7.82; 95% CI (1.194, 51.24)] were significantly associated with HIV seroconversion.

Conclusion

The seroconversion rate in this study indicates that pregnant women who are HIV-negative in early pregnancy are at an ongoing risk of seroconversion throughout their pregnancy. Thus, this study highlights the benefit of a repeat HIV testing strategy in late pregnancy, particularly when the risk of seroconversion or new infection cannot be convincingly excluded. Therefore, repeated testing of HIV-negative pregnant women in late pregnancy provides an opportunity to detect seroconverted pregnant women to enable the timely use of ART to prevent mother-to-child transmission of HIV infection.

Systematic review and meta-analysis of seroprevalence of human immunodeficiency virus serological markers among pregnant women in Africa, 1984-2020

BACKGROUND

Human immunodeficiency virus (HIV) is a major public health concern, particularly in Africa where HIV rates remain substantial. Pregnant women are at an increased risk of acquiring HIV, which has a significant impact on both maternal and child health.

AIM

To review summarizes HIV seroprevalence among pregnant women in Africa. It also identifies regional and clinical characteristics that contribute to study-specific estimates variation.

METHODS

The study included pregnant women from any African country or region, irrespective of their symptoms, and any study design conducted in any setting. Using electronic literature searches, articles published until February 2023 were reviewed. The quality of the included studies was evaluated. The DerSimonian and Laird random-effects model was applied to determine HIV pooled seroprevalence among pregnant women in Africa. Subgroup and sensitivity analyses were conducted to identify potential sources of heterogeneity. Heterogeneity was assessed with Cochran's Q test and I2 statistics, and publication bias was assessed with Egger's test.

RESULTS

A total of 248 studies conducted between 1984 and 2020 were included in the quantitative synthesis (meta-analysis). Out of the total studies, 146 (58.9%) had a low risk of bias and 102 (41.1%) had a moderate risk of bias. No HIV-positive pregnant women died in the included studies. The overall HIV seroprevalence in pregnant women was estimated to be 9.3% [95% confidence interval (CI): 8.3-10.3]. The subgroup analysis showed statistically significant heterogeneity across subgroups (P < 0.001), with the highest seroprevalence observed in Southern Africa (29.4%, 95%CI: 26.5-32.4) and the lowest seroprevalence observed in Northern Africa (0.7%, 95%CI: 0.3-1.3).

CONCLUSION

The review found that HIV seroprevalence among pregnant women in African countries remains significant, particularly in Southern African countries. This review can inform the development of targeted public health interventions to address high HIV seroprevalence in pregnant women in African countries.

Prevalence of human immunodeficiency virus (HIV) among pregnant women in Nigeria: a systematic review and meta-analysis

OBJECTIVE

To estimate prevalence of HIV infection in Nigeria and to examine variations by geopolitical zones and study characteristics to inform policy, practice and research.

METHODS

We conducted a comprehensive search of bibliographic databases including PubMed, CINAHL, PsycINFO, Global Health, Academic Search Elite and Allied and Complementary Medicine Database (AMED) and grey sources for studies published between 1 January 2008 and 31 December 2019. Studies reporting prevalence estimates of HIV among pregnant women in Nigeria using a diagnostic test were included. Primary outcome was proportion (%) of pregnant women living with HIV infection. A review protocol was developed and registered (PROSPERO 2019 CRD42019107037).

RESULTS

Twenty-three studies involving 72 728 pregnant women were included. Ten studies were of high quality and the remaining were of moderate quality. Twenty-one studies used two or more diagnostic tests to identify women living with HIV. Overall pooled prevalence of HIV among pregnant women was 7.22% (95% CI 5.64 to 9.21). Studies showed high degree of heterogeneity (I² =97.2%) and evidence of publication bias (p=0.728). Pooled prevalence for most individual geopolitical zones showed substantial variations compared with overall prevalence. North-Central (6.84%, 95% CI 4.73 to 9.79) and South-West zones (6.27%, 95% CI 4.75 to 8.24) had lower prevalence whereas South-East zone (17.04%, 95% CI 9.01 to 29.86) had higher prevalence.

CONCLUSIONS

While robust national prevalence studies are sparse in Nigeria, our findings suggest 7 in every 100 pregnant women are likely to have HIV infection. These figures are consistent with reported prevalence rates in sub-Saharan African region. WHO has indicated much higher prevalence in Nigeria compared with our findings. This discrepancy could potentially be attributed to varied methodological approaches and regional focus of studies included in our review. The magnitude of the issue highlights the need for targeted efforts from local, national and international stakeholders for prevention, diagnosis, management and treatment.

The HIV paradox: Perinatal mortality is lower in HIV-positive mothers-A field case-control study in Ethiopia

OBJECTIVE

Sub-Saharan African countries have the highest perinatal mortality rates. Although HIV is a risk factor for perinatal death, antioretroviral therapy (ART) programs have been associated with better outcomes. We aimed to investigate how maternal HIV affects perinatal mortality.

METHODS

The authors performed a nested case-control study at Saint Luke Hospital, Wolisso, Ethiopia. Data on sociodemographic characteristics, current maternal conditions, obstetric history, and antenatal care (ANC) services utilization were collected. The association between perinatal mortality and HIV was assessed with logistic regression adjusting for potential confounders.

RESULTS

A total of 3525 birthing women were enrolled, including 1175 cases and 2350 controls. Perinatal mortality was lower among HIV-positive women (18.3% vs. 33.6%, P = 0.007). Crude analysis showed a protective effect of HIV (odds ratio, 0.442 [95% confidence interval, 0.241-0.810]), which remained after adjustment (adjusted odds ratio, 0.483 [95% confidence interval, 0.246-0.947]). Among HIV-negative women, access to ANC for women from rural areas was almost half (18.8% vs. 36.2%; P < 0.001), whereas in HIV-positive women, no differences were noted (P = 0.795).

CONCLUSION

Among HIV-positive mothers, perinatal mortality was halved and differences in access to ANC services by area were eliminated. These data highlight the benefits of integrating ANC and HIV services in promoting access to the health care system, reducing inequalities and improving neonatal mortality.

Disclosure of HIV status to sexual partner and its associated factors among pregnant women living with HIV attending prenatal care in Amhara Regional state Referral Hospitals, Ethiopia

BACKGROUND

Disclosure of Human Immunodeficiency Virus (HIV) status to sexual partners plays a significant role in the successful prevention and care of HIV infection. Pregnant women who did not reveal their HIV status to their sexual partners make the prevention and control efforts challenging. Therefore, this study was aimed to assess HIV status disclosure to sexual partners and associated factors among pregnant women living with HIV attending prenatal care in Amhara Regional state referral Hospitals, Ethiopia in 2021.

METHODS

An institution-based cross-sectional study was conducted from October 17th, 2020 to March 1st, 2021. A total of 423 pregnant women living with HIV were participated in this study. A systematic random sampling technique was used to select all eligible women. Data was collected using a semi-structured, pretested, and interviewer-administered questionnaire. EPI INFO version 7 and SPSS version 21 were used for data entry and analysis, respectively. Both univariable and multivariable logistic regression analyses were performed to find factors associated with women's disclosure status to a sexual partner. Statistical association was decided based on the adjusted odds ratio (AOR) with its 95% Confidence Interval (CI) and p-value of ≤ 0.05.

RESULTS

The prevalence of disclosure of their HIV status to their sexual partners was 73% (95% CI: 68.9%, 77.3%). Being an urban resident (AOR = 5.04, 95% CI: 2.14, 11.81), diagnosed HIV before pregnancy (AOR = 7.77, 95% CI: 3.09, 19.52), disclosing their HIV status to others (AOR = 7.01, 95% CI: 3.78, 13.25), planned pregnancy (AOR = 2.46, 95% CI: 1.32, 4.57), and having good knowledge on HIV/AIDS prevention (AOR = 2.19, 95% CI:1.22, 3.94) were found to be statistically significant with women's disclosure of their HIV status to their sexual partner.

CONCLUSION

In this study, nearly three-fourth of pregnant women disclosed their HIV status to their sexual partner. Thus, setting strategies in preventing unplanned pregnancy, HIV diagnosed before pregnancy, and increasing knowledge of HIV prevention will have significant role in escalating women's disclosure status.

Consistent condom use and its associated factors among human immunodeficiency virus-positive pregnant women in Ethiopia

Background

Consistent condom use plays a significant role in the successful protection of the transmission of human immunodeficiency virus (HIV) infection in couples with sero-discordant HIV status, mother-to-child-transmission (MTCT), and acquiring other strains in HIV-positive concordant pairs. Limited data and information about this issue are available in low-resource setting countries, including the study setting. Therefore, this study aimed to assess the level of consistent condom use and its associated factors among HIV-positive pregnant women.

Materials and methods

An institution-based cross-sectional study was done from 17 October 2020 to 1 March 2021. A total of 423 HIV-positive pregnant women were involved in this study and selected using a systematic random sampling technique. Data were collected using a semi-structured, pretested, and interviewer-administered questionnaire and then entered into EPI INFO version 7 and analyzed using Statistical Package for Social Sciences (SPSS) version 21. Logistic regressions were performed to identify factors. P-Value ≤ 0.05 denotes statistical significance.

Results

The prevalence of consistent condom use among HIV-positive pregnant women was 14.2% [95% confidence interval (CI) 10.9%, 17.5%]. Women having a higher educational status [adjusted odds ratio (AOR) = 6.33, 95% CI 1.96, 20.42], women having a CD4 count > 600 cells/mm (AOR = 4.78, 95% CI 2.08, 10.97), women testing positive for HIV during the non-pregnant state (AOR = 5.99, 95% CI 3.01, 11.94), and women disclosing their HIV status to sexual partners (AOR = 4.85, 95% CI 1.71, 13.71) were found to be statically significant with women’s consistent condom use.

Conclusion

In this study, consistent condom use among HIV-positive pregnant women was low. Women having educational status of college and above studies, women testing positive for HIV during the non-pregnant state, women disclosing their HIV status to a sexual partner, and women having a CD4 count > 600 cells/mm had better consistent condom use. Hence, giving more emphasis on health education and counseling service about HIV testing before pregnancy, and disclosing their HIV status to their sexual partners and about the need for consistent condom use during pregnancy would be important.

Prevalence of HIV and Its Co-Infection with Hepatitis B/C Virus Among Chronic Liver Disease Patients in Ethiopia

Background

The efficient use of antiretroviral drugs has significantly reduced AIDS-related morbidities and mortalities; however, mortality due to non-AIDS-related end-stage liver diseases is escalating in those living with HIV.

Objective

The study was designed to determine the prevalence of HIV and its co-infection with HBV and HCV among chronic liver disease (CLD) patients in Ethiopia.

Methods

Three hundred and forty-five CLD patients were included in this study in two groups: Hepatocellular carcinoma (HCC) (n=128) and non-HCC (n=217) patients. The non-HCC group comprised patients with advanced liver disease (n=98) and chronic hepatitis (n=119). Enzyme immunoassays were used to determine HBV and HCV infection markers. In addition, a serial rapid HIV testing algorithm was employed to screen HIV infection.

Results

Regardless of the stage of liver disease, the overall frequency of HIV was 4.3% (15/345), with a 2% (7/345) and 0.3% (1/345) of HIV/HBV and HIV/HCV co-infection rate. Of all HIV-infected patients (n=15), 46.7% (7/15) and 6.7% (1/15) were co-infected with HBV (HBsAg⁺HBcAb⁺) and HCV (anti-HCV⁺ HCV-RNA⁺), respectively, and 86.7% (13/15) exhibited a marker of HBV exposure (total HBcAb⁺). Overall, the frequency of HIV and its co-infection with HBV was more noticeable among HCC than non-HCC patients [8.6% (11/128) vs 1.8 (4/217), p=0.005 and 3.9% (5/128) vs 0.9% (2/217), p=0.1]. The rate of HIV mono-infection was 3.9% (5/128) vs 0.9% (2/217) among HCC and non-HCC patients.

Conclusion

The frequency of HIV and its co-infections with HBV/HCV exhibited an increasing pattern with the severity of the liver disease. Thus, screening all HIV-positive patients for HBV and HCV infection and all CLD patients for HIV infection and taking necessary preventive measures would be an essential strategy to prevent the progression of CLD and death related to liver disease in people living with HIV.

The Burden of HIV Infection among Pregnant Women Attending Antenatal Care in Jimma University Specialized Hospital in Ethiopia: A Retrospective Observational Study

Background

The HIV (human immunodeficiency virus) epidemic enters its fifth decade amid a global pandemic. Nearly 61% of the people newly infected with HIV live in sub-Saharan Africa (SSA). The virus is transmitted from mother to child during pregnancy, labour, delivery, and breastfeeding, warranting routine counselling at antenatal care (ANC). Hence, this study aimed to determine the prevalence and trend of HIV infection among pregnant women on ANC follow-up at Jimma University Specialized Hospital (JUSH) in Ethiopia from November 2018 to 2021.

Methods

A retrospective cross-sectional study was conducted from June 25, 2021, to November 30, 2021. A total of 634 mothers were sampled by systematic random sampling, and the data were analyzed by descriptive statistics package of SPSS software. A chi-square test was employed to assess an association between variables. Analyses outputs were summarized and presented in tables and figures.

Results

Among the sampled women (634), 96.1% received counselling services on the prevention of maternal-to-child transmission of HIV/AIDS. Around 83.1% of the mothers refused to consult their partners and were unable to persuade their surrogate or afraid to discuss HIV serostatus tests. The overall prevalence of HIV infection among pregnant mothers was 7.1% and no significant decrease in the trends of HIV prevalence over the three years study period (p value >0.05). The seroprevalence is high in urban residents (4.4%) and age group of 25–29 years (38.9%) (p value <0.05). Residence, level of education attained, and marital status of women were significantly associated (p value <0.05) with seropositivity.

Conclusion

HIV burden among ANC attendees in JUSH is high as compared to the national figure and its trend over three years is steady. Accordingly, mandatory early screening tests and community-based education are mandatory for all women and adolescent girls in the reproductive age group.

Low birth weight and associated factors among HIV positive and negative mothers delivered in northwest Amhara region referral hospitals, Ethiopia,2020 a comparative crossectional study

Background

Even though pregnancy does not affect HIV infection progression, HIV affects the pregnancy outcome. Maternal HIV infection has many untoward effects which include low birth weight which is the major cause of neonatal, infant, and under-five mortality. However, there is controversy and limited information about the effect of HIV status on birth weight around the world including Ethiopia. Therefore, this study aimed to compare the prevalence of LBW and their associated factors among HIV+ and HIV- mothers delivered in Northwest Amhara region referral hospitals.

Method

A comparative crossectional study was conducted from September 2016 to September 2019. A simple random sampling technique was used to select 474 participants. Data were collected from the mothers’ chart by using a data extraction sheet and then entered into Epi-data and exported into SPSS for analysis. Independent variables with p-values < 0.2 in the bivariable analysis were entered into multivariable logistic regression models with backward logistic regressions method to control confounders and identify the factor.

Result

The overall prevalence of LBW was 13.9% (95% CI:10.8%-17.1%). The prevalence was higher among HIV+ 17.7% (95% CI:14.1%-22.8%) than HIV- mothers 10.1% (95% CI:6.3%—13.8%). CD4 count < 200 cells/mm3 [AOR 3.2, 95%CI (1.05, 9.84)] and between 200–350 cells/mm3 [2.81, 95% CI (1,08, 7.28)], Mothers with MUAC <23 cm [AOR 3.39, 95% CI (1.41, 8.18)] and gestational age <37 weeks [AOR 7.34, 95% CI (3.02,17.80)] were significantly associated with LBW in HIV+ mothers. While, rural residence [AOR 3.93,95% CI (1.356,11.40)], PROM during current pregnancy [AOR 4.96, 95% CI (2.55, 15.83)] and gestational age <37 week [AOR 8.21, 95% CI (2.60, 25.89)] were significantly associated with LBW in HIV negative mothers.

Conclusion

The prevalence of LBW was significantly higher among HIV+ mothers as compared to HIV—mothers and this study suggests to emphasize nutritional supplementation of HIV positive mothers, needs to focus on nutritional counseling during ANC/PMTCT follow up and encourage HIV positive mothers to delay their pregnancy until their immune status improve.

Magnitudes and Correlates of Human Immunodeficiency Virus, Hepatitis B Virus, and Syphilis among Pregnant Mothers Attending Antenatal Care in Addis Ababa, Ethiopia

BACKGROUND

Human immunodeficiency virus (HIV), hepatitis B virus (HBV), and syphilis are major sexually transmitted infections (STIs) among the general population in Ethiopia, which in turn result in a wide range of adverse pregnancy outcomes. Hence, it is important to determine the seroprevalence and risk factors of HIV, HBV, and syphilis infection among pregnant mothers attending antenatal care in Addis Ababa, Ethiopia.

METHOD

A cross-sectional study was conducted among 286 pregnant women from February 1, 2021, to March 30, 2021, in four selected public hospitals in Addis Ababa. Sociodemographic, risky sociocultural, behavioral, and hospital-related factors were collected using an interview-administered questionnaire. Detection of anti-HIV antibodies, hepatitis B surface antigen (HBsAg), and rapid plasma reagin (RPR) for syphilis was conducted. A binary logistic regression analysis was used to determine predictors of STIs using SPSS version 25.

RESULT

A total of 281 pregnant mothers with a mean age of 27.5 (SD 4.6) completed the study. Among the participants, the seroprevalence rates of HIV, HBV, and syphilis were 15 (5.3%), 9 (3.2%), and 5 (1.8%), respectively. Twenty six (9.3%) of the participants tested positive for any one of the STIs, and 3 (1.1%) of the women had HIV and syphilis coinfections. History of multiple sexual partners (AOR 3.42, 95% CI: 1.6-11.63) and STIs (AOR 3.7; 95% CI: 1.70-13.45) were significantly associated with HIV infection. Likewise, history of abortion (AOR 7.65, 95% CI: 1.17-49.74), tattooing (AOR 9.72, 95% CI: 1.41-66.73), and rape (AOR 9.72, 95% CI: 1.41-66.73) were significantly associated with hepatitis B virus infection. Husband history of multiple sexual partners (AOR 20.9, 95% CI: 1.8-241.8) was significantly associated with syphilis infection. The educational level of participants, history of tattooing (AOR 6.24, 95% CI: 1.79-21.7), and history of multiple sexual partners (AOR 5.15, 95% CI: 1.68-15.7) were independent predictors of infection with any one of the STIs.

CONCLUSION

There is still a high burden of HIV, HBV, and syphilis among pregnant mothers in Ethiopia. History of multiple sexual partners, abortion, rape, and tattooing was a significant predictor of STIs.

Prevalence of HIV infection and associated factors among infants born to HIV-positive mothers in health institutions, northwest Ethiopia, 2021

Background:

Mother-to-child transmission of the HIV remains the main source of HIV infection in children. Targeting pregnant women attending antenatal care follow-up provides a unique opportunity for implementing prevention of mother-to-child transmission programs against HIV infection in newborn babies.

Objective:

The objective of this study was to assess the prevalence of HIV infection and associated factors among infants born to HIV-positive mothers in the prevention of mother-to-child transmission clinic in the Gondar city health institutions, Northwest Ethiopia, 2021.

Methods:

Documents were reviewed at the facility. Infants who had been exposed to HIV were enrolled in the study from 1 May–20 June 2021 prevention of mother-to-child transmission service in Gondar health institutions. To collect data from the charts, a structured data extraction tool was developed. The data were entered and analyzed with SPSS version 25 software. Both bivariate and multivariate logistic regression models were fitted to identify factors associated with HIV infection. The crude and adjusted odds ratios with a 95% confidence interval were calculated to determine the significance level.

Result:

The prevalence of HIV infection among infants born to HIV-positive mothers at the prevention of mother-to-child transmission level was found to be 8.1% (95% confidence interval = 7.3–12.9). Mixed infant feeding practice (adjusted odds ratio = 5.15, 95% confidence interval = 1.82–14.56), mothers’ lack of education (adjusted odds ratio = 3.43, 95% confidence interval = 2.26–5.0), absence of antenatal care follow-up (adjusted odds ratio = 1.82, 95% confidence interval = 1.17–4.02), and home delivery (adjusted odds ratio = 2.24, 95% confidence interval = 2.10–7.45) were statistically significantly associated with infants’ HIV infection.

Conclusion:

The prevalence of HIV infection in babies born to HIV-positive mothers was found to be high. Significant factors include mixed infant feeding practice, mothers’ lack of education, antenatal care follow-up, and home delivery. We also proposed that skilled delivery care and community education could reduce HIV transmission from mother to child.

HIV test coverage among pregnant women in Ethiopia: A systematic review and meta-analysis

Introduction: A human immunodeficiency virus (HIV) test during pregnancy is the gateway to the prevention of mother-to-child transmission (PMTCT) of HIV. Estimating the national uptake of HIV tests among pregnant women is an important course of action. Thus, we pooled the information about the national uptake of HIV tests and determined the significant factors among pregnant women in Ethiopia.Methods: We searched PubMed, Scopus, Web of Science, and Google Scholar databases. We also searched for cross-references to get additional relevant studies, and included cross-sectional, case-control and cohort study studies. We applied a random-effects model meta-analysis to pool the national data of uptake of HIV tests. Galbraith's plot and Egger's regression test were employed to check publication bias, and heterogeneity was assessed using I ² statistics. The protocol registered is found in the PROSPERO database with the registration number CRD42019129166.Results: In total, 22 articles with 13 818 pregnant women study participants were involved. The national uptake of HIV tests among pregnant women was 79.6% (95% CI 73.9-85.4). Living in urban areas (AOR 2.8; 95% CI 1.1-4.6), previous HIV tests (AOR 4.6; 95% CI 1.2-8.0), and comprehensive knowledge on mother-to-child transmission (MTCT) (AOR 2.61; 95% CI 1.5-3.7) and PMTCT of HIV (AOR 2.1; 95% CI 1.5-2.8) were associated with increased practice of HIV tests.Conclusion: This review showed that HIV test coverage among pregnant women was approximately 80% and substantially lower than the national recommendation. Addressing HIV-related health services for rural women and providing health information on MTCT and PMTCT of HIV to increase HIV testing coverage is required.

HIV-positive status disclosure to a sexual partner and associated factors among HIV-positive pregnant women attending antenatal care in Dire Dawa, Ethiopia: A cross-sectional study

INTRODUCTION

Pregnant women who disclose their HIV-positive status to their sexual partners have played an important role in reducing the risk of HIV/AIDS transmission to the baby during the antepartum, intrapartum, and postnatal periods. Studies are limited in the current study area in a similar arena. Therefore, this study aimed to assess the proportion of HIV-positive status disclosure and its associated factors among pregnant women.

METHODS

A facility-based cross-sectional study was conducted among 156 HIV-positive pregnant women in Dire Dawa administrative from March 12th to May 10th, 2020. Data were generated using a pretested structured questionnaire through face-to-face interviews. Binary logistic regression analysis was employed to identify the predictor variables associated with the disclosure of HIV-positive status among pregnant women to their sexual partners. Finally, the adjusted odds ratio with 95% confidence intervals at P-value< 0.05 was considered statistically significant.

RESULTS

Of the total, 135 (86.5%) of HIV-positive pregnant women disclosed their HIV status to their sexual partner. Christian followers (both Orthodox and Protestant) [AOR = 8.8, 95% CI: 2.3. 34] more likely to disclose HIV status to their sexual partner than those Muslims. Those participants who started practicing safer sex [AOR = 17.6, 95% CI: 4-77] and those women who had a smooth relationship before the HIV disclosure were [AOR = 14.7, 95% CI: 3-68.6] more likely to disclose HIV status to their sexual partner than their counterparts, respectively.

CONCLUSIONS

The proportion of HIV serostatus disclosure by HIV-positive pregnant women attending antenatal care services to their sexual partners was encouraging. However, this does not mean that there is no need for further awareness and intervention. Hence, interventions to boost and support women in safely disclosing their HIV-positive status are needed.

Acceptance Of HIV Testing And Associated Factors Among Pregnant Women Attending Antenatal Care In Gunino Health Center, Southern Ethiopia 2019: An Institutional Based Cross-Sectional Study

BACKGROUND

Acceptance of human immune virus testing is an entry point of intervention to end mother to child transmission of the virus among pregnant women.

METHODS

Institutional based cross-sectional study design with a sample size of 340 was conducted from May 20 to June 15, 2019. The data were collected by using systematic random sampling technique of interviewer administered questionnaire. Those candidate variables at bivariate analysis with a p-value <0.25 were moved to the multivariate logistic regression model to control for potential confounding variables, and P-value <0.05 at multivariate analysis was considered as cutoff point.

RESULT

Among the total of 340 pregnant women who participated with a response rate of 96%, 234 (68.8%) accepted testing. The odds of acceptance of human immune virus testing was higher among respondents who had awareness about mother to child transmission (AOR=2.602, 95%; CI:1.408-4.809) than their counterparts. It was also higher among respondents who had perceived the benefit of testing (AOR=1.838, 95%; CI:1.089-3.104) than those who did not perceive the benefit of testing. Participants who were knowledgeable about the prevention of mother to child transmission were more likely to accept testing (AOR=1.715, 95%; CI:1.030-2.855) than their counterparts. Besides, the odds of acceptance of testing among pregnant women who attended two and above antenatal appointments were higher (AOR= 2.485, 95%; CI:1.462-4.224) than participants who attended only one appointment. Participants who had no formal education (AOR=0.393, 95%; CI:0.160-0.967) and had a primary level of education (AOR=0.357,95%; CI:0.152-0.842) were less likely to accept human immune virus testing than women who had a diploma and above level of educational status.

CONCLUSION

Acceptance of human immune virus testing among pregnant women attending antenatal care clinics was relatively low. Antenatal caregivers should place emphasis on reducing barriers to testing, like lack of awareness, knowledge, and educational background.

Factors Associated with Compliance with World Health Organization-Recommended Infant-Feeding Practices by Mothers with HIV Infection in Northwest Ethiopia

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Even though World Health Organization (WHO) recommends infant feeding options for HIV exposed infants, level of recommended infant feeding practices was still low in Ethiopia.

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This institutional study was done in prevention of mother-to-child transmission (PMTCT) clinic services among HIV exposed infants and having follow up in this clinics.

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Recommended infant feeding practices is an options to tackle vertical HIV infections especially for developing countries.

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Generally, prevalence of recommended infant feeding among HIV exposed infants in the study area was sub optimal. Mother's educational status, attendance to antenatal visits attendance to postnatal follow up and disclosure of mother's HIV status to their spouse were the predictors of recommended infant feeding practices.

Background

The World Health Organization has recommended either exclusive replacement feeding or exclusive breastfeeding options for HIV-exposed infants for the first 6 months of life.

Objective

The purpose of this study was to assess the factors associated with noncompliance with these recommendations among a population of HIV-infected mothers of young infants in Bahir Dar City, Amhara Regional State, Ethiopia.

Methods

An institutional based cross-sectional study was conducted from March 1 to May 15, 2018. A structured interview was conducted with 213 HIV-positive mothers. Descriptive statistics were used to show the frequency distributions of factors associated with noncompliance with World Health Organization-recommended infant-feeding practices. Both bivariate and multivariate logistic regression analyses were performed to identify the variables predictive of infant-feeding practices.

Results

All mothers were undergoing antiretroviral therapy. Only 83.5% claimed to be following World Health Organization-recommended infant-feeding practices. Bivariate analysis showed that high school or greater educational status [Adjusted odds ratio (AOR) = 3.6 (95% CI = 4.2, 9.5)], having attended antenatal visits [AOR = 6.7 (95% CI = 5.6, 10.9)] and postnatal follow-up visits [AOR = 6.9 (95% CI = 4.2, 9.3)], and disclosure of HIV status to their spouse [AOR = 8.2 (95% CI = 6.2, 10.7)] were associated with adherence to recommended infant-feeding practices.

Conclusions

The prevalence of recommended infant feeding practices among HIV-exposed infants in the study area was suboptimal compared with the ≥90% recommended by the World Health Organization. Higher educational status of the mother, antenatal and postnatal follow-ups, and disclosure of HIV status to spouses were predictors of adherence to the recommended infant-feeding practices. Although not yet proven in a prospective clinical trial, providing more education for women, improving attendance at antenatal and postnatal follow-up visits, encouraging the disclosure of HIV status to spouses, and educating mothers about proper infant-feeding options during follow-up visits may all be useful to increase compliance.