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Argaw GS, Gelaye KA, Lakew AM, Aragaw FM, Chekol YM, Tesfie TK, Gelaw NB. Survival and predictors of mortality among HIV-infected adults after initiation of antiretroviral therapy in Eastern Ethiopia Governmental hospitals, from January 2015 to December 2021 (multi-center retrospective follow-up study). BMC Infect Dis 2024; 24:1352. [PMID: 39592986 PMCID: PMC11600927 DOI: 10.1186/s12879-024-10225-2] [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: 04/26/2024] [Accepted: 11/14/2024] [Indexed: 11/28/2024] Open
Abstract
BACKGROUND Human Immune Deficiency Virus (HIV) remains the leading cause of morbidity and mortality globally. It can lead to Acquired Immunodeficiency Syndrome (AIDS), which results in gradual deterioration and failure of the immune system. As the immune system becomes compromised, the patient becomes highly susceptible to life-threatening infection which ends with early death. Even though Antiretroviral Therapy (ART) significantly decreases mortality as a whole, the rate of death is still the highest, especially in the first and second years of ART initiation. The study aims to assess the survival and predictors of mortality among HIV-infected adults after initiation of antiretroviral therapy in Jigjiga City Governmental Hospitals, Eastern Ethiopia. METHOD Institution-based Retrospective follow-up study was employed among ART patients from January 1, 2015, to December 31, 2021. Data were cleaned and entered in Epi-data version 3.1 and exported to STATA 14 for further analysis. Kaplan-Meier and Log-Rank tests were applied to compare survival differences among categories of different variables. In bi-variable analysis, P-values < 0.20 were included in a multivariable analysis. A multivariable Cox regression model was used to measure the risk of death identify the and significant predictors of death. Variables that a P-value < 0.05 were considered statistically significant predictors of mortality. RESULT In this study 466(53.34%) participants were male and 552(65.56%) were urban residents about 91(10.81%) have died with an overall incidence rate of 3.92 (95% CI (2.43-5.41)) per 100-person year of observation. The overall survival probability of the study group was 83.97%. In the multivariable Cox regression analysis, baseline World Health Organization (WHO) stage III/IV (AHR = 2.42(1.43-4.09)) have no caregiver (AHR = 2.23; 95% CI (1.16-4.29)), being bedridden functional status (AHR = 2.18; 95% CI (1.01-4.72)), and poor last known adherence level (AHR = 4.23; 95%CI (2.39-7.47)) were found to be significant predictors of mortality. CONCLUSION The incidence of death was relatively high, especially in the second year of ART. Baseline clinical WHO stage III/IV, bedridden functional status at enrolment, and absence of caregiver, poor level of recent adherence were found to be independent predictors of mortality. Patients with these risk factors need special attention and are crucial to reducing the rate of mortality.
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Affiliation(s)
- Girum Shibeshi Argaw
- Department of Nursing, College of Medicine & Health Sciences, Jigjiga University, Jijiga, Ethiopia.
| | - Kasahun Alemu Gelaye
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ayenew Molla Lakew
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Fnatu Mamo Aragaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yazachew Moges Chekol
- Department of Health Information, Mizan Aman College of Health Science, Mizan-Aman, Ethiopia
| | - Tigabu Kidie Tesfie
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Negalign Byadge Gelaw
- Department of Public Health, Mizan Aman College of Health Science, Mizan Aman, Ethiopia
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Jiwa NA, Ketang’enyi E, Nganyanyuka K, Mbwanji R, Mwenisongole D, Masuka E, Brown M, Charles M, Mwasomola DL, Nyangalima T, Olomi W, Komba L, Gwimile J, Kasambala B, Mwita L. Factors associated with the acceptability of Lopinavir/Ritonavir formulations among children living with HIV/AIDS attending care and treatment clinics in Mbeya and Mwanza, Tanzania. PLoS One 2024; 19:e0292424. [PMID: 38165867 PMCID: PMC10760675 DOI: 10.1371/journal.pone.0292424] [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: 03/23/2023] [Accepted: 09/20/2023] [Indexed: 01/04/2024] Open
Abstract
INTRODUCTION Children living with chronic illnesses are offered formulations based on manufacturer and distributor research. The aim of this study is to better understand the perspectives of children and their caregivers in accepting Lopinavir/ritonavir (LPV/r) formulations. METHODS 362 participants were recruited from two pediatric HIV/AIDS clinics in Mbeya and Mwanza, Tanzania, from December 2021 to May 2022. A translated questionnaire was piloted and validated at both clinics, followed by the implementation of a cross-sectional study. RESULTS 169 participants (47.1%) reported general difficulties in swallowing, regardless of formulation, while 34.3% and 38.5% reported vomiting tablets and syrups, respectively. Statistical significance is shown to support that children can swallow medications if they can eat stiffened porridge (Ugali). This correlated with the lower incidence of younger children being able to swallow compared to older children (above six years of age). Children older than six years preferred taking tablets (independent of daily dosage) better than other formulations. Significantly, older children who attend school were associated with high odds of swallowing medicine (AOR = 3.06, 95%CI; 1.32-7.05); however, age was not found to be statistically related to ease of administration for Lopinavir/Ritonavir in this study. CONCLUSIONS Lopinavir/Ritonavir tablets remain the most accepted formulation among children and adolescents with HIV/AIDS. This study highlights the impact of various factors affecting the acceptability of pediatric formulation, suggesting that children younger than six years, unable to eat Ugali and not attending schools may be most vulnerable regarding their ability to accept Lopinavir/Ritonavir formulations. Further studies are needed to assess the acceptability of other medications in chronically ill children.
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Affiliation(s)
| | | | | | - Ruth Mbwanji
- Baylor College of Medicine Children’s Foundation, Mwanza, Tanzania
| | | | - Eutropia Masuka
- Baylor College of Medicine Children’s Foundation, Mwanza, Tanzania
| | - Mary Brown
- Baylor College of Medicine Children’s Foundation, Mwanza, Tanzania
| | - Mary Charles
- Baylor College of Medicine Children’s Foundation, Mwanza, Tanzania
| | | | | | - Willyhelmina Olomi
- National Institute of Medical Research (NIMR)- Mbeya Medical Research Center (MMRC), Mbeya, Tanzania
| | - Lilian Komba
- Baylor College of Medicine Children’s Foundation, Mwanza, Tanzania
| | - Judith Gwimile
- Baylor College of Medicine Children’s Foundation, Mwanza, Tanzania
| | - Bertha Kasambala
- Baylor College of Medicine Children’s Foundation, Mwanza, Tanzania
| | - Lumumba Mwita
- Baylor College of Medicine Children’s Foundation, Mwanza, Tanzania
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Kamori D, Barabona G, Rugemalila J, Maokola W, Masoud SS, Mizinduko M, Sabasaba A, Ruhago G, Sambu V, Mushi J, Mgomella GS, Mcollogi JJ, Msafiri F, Mugusi S, Boniface J, Mutagonda R, Mlunde L, Amani D, Mboya E, Mahiti M, Rwebembera A, Ueno T, Pembe A, Njau P, Mutayoba B, Sunguya B. Emerging integrase strand transfer inhibitor drug resistance mutations among children and adults on ART in Tanzania: findings from a national representative HIV drug resistance survey. J Antimicrob Chemother 2023; 78:779-787. [PMID: 36680436 DOI: 10.1093/jac/dkad010] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 01/03/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Despite the scale-up of ART and the rollout in Tanzania of dolutegravir, an integrase strand transfer inhibitor (INSTI), treatment success has not been fully realized. HIV drug resistance (HIVDR), including dolutegravir resistance, could be implicated in the notable suboptimal viral load (VL) suppression among HIV patients. OBJECTIVES To determine the prevalence and patterns of acquired drug resistance mutations (DRMs) among children and adults in Tanzania. METHODS A national cross-sectional HIVDR survey was conducted among 866 children and 1173 adults. Genotyping was done on dried blood spot and/or plasma of participants with high HIV VL (≥1000 copies/mL). HIV genes (reverse transcriptase, protease and integrase) were amplified by PCR and directly sequenced. The Stanford HIVDR Database was used for HIVDR interpretation. RESULTS HIVDR genotyping was performed on blood samples from 137 participants (92 children and 45 adults) with VL ≥ 1000 copies/mL. The overall prevalence of HIV DRMs was 71.5%, with DRMs present in 78.3% of children and 57.8% of adults. Importantly, 5.8% of participants had INSTI DRMs including major DRMs: Q148K, E138K, G118R, G140A, T66A and R263K. NNRTI, NRTI and PI DRMs were also detected in 62.8%, 44.5% and 8% of participants, respectively. All the participants with major INSTI DRMs harboured DRMs targeting NRTI backbone drugs. CONCLUSIONS More than 7 in 10 patients with high HIV viraemia in Tanzania have DRMs. The early emergence of dolutegravir resistance is of concern for the efficacy of the Tanzanian ART programme.
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Affiliation(s)
- Doreen Kamori
- Muhimbili University of Health and Allied Sciences, P.O. Box 650001, Dar es Salaam, Tanzania
| | - Godfrey Barabona
- Muhimbili University of Health and Allied Sciences, P.O. Box 650001, Dar es Salaam, Tanzania.,Joint Research Center for Human Retrovirus Infection, Kumamoto University, Kumamoto, Japan
| | - Joan Rugemalila
- Internal Medicine Department, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Werner Maokola
- National AIDS Control Programme, Directorate of Preventive Services, Ministry of Health, Dodoma, Tanzania
| | - Salim S Masoud
- Muhimbili University of Health and Allied Sciences, P.O. Box 650001, Dar es Salaam, Tanzania
| | - Mucho Mizinduko
- Muhimbili University of Health and Allied Sciences, P.O. Box 650001, Dar es Salaam, Tanzania
| | - Amon Sabasaba
- Muhimbili University of Health and Allied Sciences, P.O. Box 650001, Dar es Salaam, Tanzania
| | - George Ruhago
- Muhimbili University of Health and Allied Sciences, P.O. Box 650001, Dar es Salaam, Tanzania
| | - Veryeh Sambu
- National AIDS Control Programme, Directorate of Preventive Services, Ministry of Health, Dodoma, Tanzania
| | - Jeremiah Mushi
- National AIDS Control Programme, Directorate of Preventive Services, Ministry of Health, Dodoma, Tanzania
| | - George S Mgomella
- Division of Global HIV & Tuberculosis, US Centers for Disease Control and Prevention, Dar es Salaam, Tanzania
| | - James J Mcollogi
- National AIDS Control Programme, Directorate of Preventive Services, Ministry of Health, Dodoma, Tanzania
| | - Frank Msafiri
- Muhimbili University of Health and Allied Sciences, P.O. Box 650001, Dar es Salaam, Tanzania
| | - Sabina Mugusi
- Muhimbili University of Health and Allied Sciences, P.O. Box 650001, Dar es Salaam, Tanzania
| | - Jullu Boniface
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Ritah Mutagonda
- Muhimbili University of Health and Allied Sciences, P.O. Box 650001, Dar es Salaam, Tanzania
| | - Linda Mlunde
- Muhimbili University of Health and Allied Sciences, P.O. Box 650001, Dar es Salaam, Tanzania
| | - Davis Amani
- Muhimbili University of Health and Allied Sciences, P.O. Box 650001, Dar es Salaam, Tanzania
| | - Erick Mboya
- Muhimbili University of Health and Allied Sciences, P.O. Box 650001, Dar es Salaam, Tanzania
| | - Macdonald Mahiti
- Muhimbili University of Health and Allied Sciences, P.O. Box 650001, Dar es Salaam, Tanzania
| | - Anath Rwebembera
- National AIDS Control Programme, Directorate of Preventive Services, Ministry of Health, Dodoma, Tanzania
| | - Takamasa Ueno
- Muhimbili University of Health and Allied Sciences, P.O. Box 650001, Dar es Salaam, Tanzania.,Joint Research Center for Human Retrovirus Infection, Kumamoto University, Kumamoto, Japan
| | - Andrea Pembe
- Muhimbili University of Health and Allied Sciences, P.O. Box 650001, Dar es Salaam, Tanzania
| | - Prosper Njau
- National AIDS Control Programme, Directorate of Preventive Services, Ministry of Health, Dodoma, Tanzania
| | - Beatrice Mutayoba
- National AIDS Control Programme, Directorate of Preventive Services, Ministry of Health, Dodoma, Tanzania
| | - Bruno Sunguya
- Muhimbili University of Health and Allied Sciences, P.O. Box 650001, Dar es Salaam, Tanzania.,Joint Research Center for Human Retrovirus Infection, Kumamoto University, Kumamoto, Japan
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