Prevalence of and Factors Associated with Reoccurrence of Opportunistic Infections Among Adult HIV/AIDS Patients Attending the ART Clinic at Public Health Facilities in Arba Minch Town, Southern Ethiopia

Suboptimal adherence to antiretroviral treatment and its predictors among people living with HIV in the era of test and treat

Despite the success in scaling-up antiretroviral therapy (ART) services in Ethiopia, suboptimal adherence to ART has been an existing challenge. There is a dearth of evidence on the status of adherence to ART following the adoption of test and treat strategy in Ethiopia. This study aimed to investigate on the magnitude of suboptimal adherence and its predictors among patients taking ART. A multicenter prospective cohort study was conducted among adults aged 15 years and above who started ART between March and June 2019 in 39 health facilities (HFs) in Ethiopia. Measurements on sociodemographic, behavioral, and clinical characteristics were taken at baseline and 6- and 12-months following ART initiation. Multivariable logistic regression model using generalized estimating equations was used to identify factors associated with suboptimal adherence. In total, 1229 individuals who started ART were included in the study. The proportion of suboptimal adherence was 8.0% and 7.9% at 6- and 12-months, respectively. Younger age (adjusted odds ratio (AOR) = 2.28 (95% confidence interval (CI) 1.10, 4.74)), being single (AOR = 2.08 (95% CI 1.25, 3.48)), and being a farmer (AOR = 3.21 (95% CI 1.84, 5.61)) were associated with increased risk for suboptimal adherence. Similarly, alcohol intake (AOR = 3.31 (95% CI 2.14, 5.11)), missing clinic appointment (AOR = 5.73 (95% CI 3.76, 8.75)), having opportunistic infections (AOR = 2.86 (95% CI 1.67, 4.88)) and presence of comorbidities (AOR = 3.51 (95% CI 1.89, 6.53)) were associated with higher risk for suboptimal adherence. We observed lower rate of suboptimal adherence to ART following the implementation of test and treat strategy in Ethiopia. Various sociodemographic, clinical, and behavioral factors were found to be independent predictors of suboptimal adherence. The findings highlight the importance of person-centered adherence support based on individual characteristics.

Funding for research on cryptococcal disease: an analysis based on the G-finder report

Members of the genus Cryptococcus are the causative agents of cryptococcal meningitis, a disease mainly associated with HIV-induced immunosuppression. Patients with cryptococcal meningitis are at a serious risk of death. Most patients suffering from cryptococcosis belong to neglected populations. With reduced support for research, new therapies are unlikely to emerge. In this essay, we used the Policy Cures/G-finder platform as a reference database for funding research on cryptococcal disease. Funding for cryptococcal research started being tracked by G-finder in 2013 and has continued to appear in the annual reports ever since. In total, 15 institutions were reported as major funders for research on cryptococcal disease over the years. The US National Institutes of Health (NIH) was the main funder, followed by the UK's Wellcome Trust. The annual analysis suggested slow yearly growth in funding from 2013 to 2021. The development of new tools to prevent and fight cryptococcal disease is urgent but requires improved funding.

Time to occurrence, predictors, and patterns of opportunistic infections incidence among HIV-positive patients attending Antiretroviral Therapy Clinic of Salale University Comprehensive Specialized Hospital: A retrospective cohort study

Opportunistic infections (OIs) in HIV patients are infections that are more common or more severe as a result of HIV-mediated immunosuppression. The advances in the capacity of antiretroviral therapy (ART) have diminished the incidence of OIs. However, even in the ART era, HIV-related OIs continue to be major causes of hospitalization and mortality. Therefore, this study aims to identify time to occurrence, predictors, and patterns of OIs incidence among HIV-positive patients attending ART clinic of Salale University Comprehensive Specialized Hospital, Ethiopia. A retrospective cohort study was conducted between 1st September 2016 and 1st September 2021. All 419 patients diagnosed during the study period were recruited. Data were extracted from both patient medical records and ART logbooks. Stata-16 was used for data analysis. Follow-up time was calculated from the date of HIV diagnosis to the date of OIs occurrence or censoring. Cox proportional hazards regression model was used to identify the predictors of OIs incidence. The total person-time of the follow-up was 8656 person-months of observation. During the follow-up time, 199 (47.49%) of the patients had developed OIs. The incidence rate of OIs was 23 (95%CI: 20, 26) per 1000 person-months of observation. The median OIs free survival time was 36 (95%CI: 31, 40) months. Predictors such as residence, cd4 category, baseline hemoglobin level, ART side effects, isoniazid preventive therapy, and chronic disease comorbidity were significantly predicted OIs incidence. The study area's OIs incidence remained high, requiring prompt action. To reduce the morbidity and mortality associated with OIs, HIV-positive patients with the predictors of rural residence, low CD4 category, low baseline hemoglobin level, ART side effects, not taking IPT, and baseline chronic disease comorbidity necessitate close follow-up and monitoring. Thus, we recommend focused and evidence-informed strategies to address OIs burden and improve outcomes.