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Kebede HK, Gesesew HA, Gebremedhin AT, Ward P. The impact of armed conflicts on HIV treatment outcomes in Sub-Saharan Africa: a systematic review and meta-analysis. Confl Health 2024; 18:40. [PMID: 38760792 PMCID: PMC11100029 DOI: 10.1186/s13031-024-00591-8] [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: 10/02/2023] [Accepted: 03/28/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Despite the fact that Sub-Saharan Africa bears a disproportionate burden of armed conflicts and HIV infection, there has been inadequate synthesis of the impact of armed conflict on HIV treatment outcomes. We summarized the available evidence on the impact of armed conflicts on HIV treatment outcomes in Sub-Saharan Africa from 2002 to 2022. METHODS We searched four databases; MEDLINE, PubMed, CINHAL, and Scopus. We also explored grey literature sources and reviewed the bibliographies of all articles to identify any additional relevant studies. We included quantitative studies published in English from January 1, 2002 to December 30, 2022 that reported on HIV treatment outcomes for patients receiving antiretroviral therapy (ART) in conflict and post-conflict areas, IDP centers, or refugee camps, and reported on their treatment outcomes from sub-Saharan Africa. Studies published in languages other than English, reporting on non-ART patients and reporting on current or former military populations were excluded. We used EndNote X9 and Covidence to remove duplicates, extracted data using JBI-MAStARI, assessed risk of bias using AHRQ criteria, reported results using PRISMA checklist, and determined Statistical heterogeneity using Cochran Q test and Higgins I2, R- and RevMan-5 software were used for meta-analysis. RESULTS The review included 16 studies with participant numbers ranging from 102 to 2572. Lost To Follow-Up (LTFU) percentages varied between 5.4% and 43.5%, virologic non-suppression rates ranged from 25 to 33%, adherence rates were over 88%, and mortality rates were between 4.2% and 13%. A pooled meta-analysis of virologic non-suppression rates from active conflict settings revealed a non-suppression rate of 30% (0.30 (0.26-0.33), I2 = 0.00%, p = 0.000). In contrast, a pooled meta-analysis of predictors of loss to follow-up (LTFU) from post-conflict settings identified a higher odds ratio for females compared to males (1.51 (1.05, 2.17), I2 = 0%, p = 0.03). CONCLUSION The review highlights a lack of research on the relationship between armed conflicts and HIV care outcomes in SSA. The available documents lack quality of designs and data sources, and the depth and diversity of subjects covered.
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Affiliation(s)
- Hafte Kahsay Kebede
- Tigray Health Research Institute, Mekelle, Tigray, Ethiopia.
- College of Health Sciences, Mekelle University, Mekelle, 231, Ethiopia.
- Research Centre for Public Health, Equity, and Human Flourishing, Torrens University Australia, Adelaide, 5000, Australia.
| | - Hailay Abrha Gesesew
- College of Health Sciences, Mekelle University, Mekelle, 231, Ethiopia
- Research Centre for Public Health, Equity, and Human Flourishing, Torrens University Australia, Adelaide, 5000, Australia
| | - Amanuel Tesfay Gebremedhin
- Curtin School of Population Health, Curtin University, Bentley, WA, Australia
- School of Nursing and Midwifery, Edith Cowan University, Perth, Australia
| | - Paul Ward
- Research Centre for Public Health, Equity, and Human Flourishing, Torrens University Australia, Adelaide, 5000, Australia
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Birhanu MY, Bekele GM, Yirdaw G, Demissie BS, Getahun GK, Jemberie SS. Incidence and predictors of loss to follow-up among Ethiopian children on antiretroviral therapy: a systematic review and meta-analysis. BMC Public Health 2024; 24:169. [PMID: 38218779 PMCID: PMC10787475 DOI: 10.1186/s12889-023-17333-9] [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: 03/01/2023] [Accepted: 11/25/2023] [Indexed: 01/15/2024] Open
Abstract
INTRODUCTION Loss of follow-up (LTFU) from ART regular follow-up is one of the key acknowledged causes for the development of ART-resistant virus strains currently. It becomes a major weakness for the successful implementation of HIV care and treatment programs mainly in Sub-Saharan Africa but also globally. About 20-40% of children on ART loss their regular ART follow-up annually. Because of the inconsistency of the prior publications' findings, policymakers, programmers, and healthcare providers find it difficult to intervene. Hence, this study was conducted to provide a pooled incidence and identify the predictors of LTFU among children on ART in Ethiopia. METHODS Articles were searched from PubMed/ MEDLINE, CINAHL, EMBASE, Google Scholar, and Science Direct, as well as organizational records and websites. This review included both retrospective and prospective follow-up studies published in English. The data were extracted using Microsoft Excel and exported into Stata™ Version 17.0 for further processing and analysis. The presence of heterogeneity was assessed using forest plots with the I2 test. To identify the source of heterogeneity subgroup analysis, meta-regression, publication bias, and sensitivity analysis were computed. The pooled incidence of LTFU was estimated using a random effects meta-analysis model with the DerSimonian-laired method. To identify the predictors, a 95% confidence interval with relative risk was used to declare the presence or absence of an association. RESULTS In this systematic review and Meta-analysis, nine studies with a total of 3336 children were included. The pooled incidence of LTFU from ART was 5.83 (95% CI: 3.94, 7.72) per 100 children-years of observation with I2: 83% & p-value < 0.001. Those children who were from rural were had a 1.65 (95% CI: 1.06, 2.52) times higher chance of getting LTFU when compared with their counterparts. Children who had poor ART adherence had a 2.03 (95% CI: 1.23, 3.34) times higher chance of experiencing LTFU of ART than children having good ART adherence. CONCLUSIONS Among Ethiopian children on ART, one out of 167 had the risk of experiencing LTFU. Being rural dwellers and having poor ART adherence were the identified predictors of LTFU. Close follow-up and phone message text should be used to have good ART adherence among rural dwellers to meet the predetermined goal of ART.
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Affiliation(s)
- Molla Yigzaw Birhanu
- Department of Public Health, College of Health Sciences, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia.
| | - Getamesay Molla Bekele
- Department of Gynecology and Obstetric, School of Medicine, Debre Markos University, Debre Markos, Ethiopia
| | - Getasew Yirdaw
- Department of Environmental Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Bekele Simegn Demissie
- Department of Public Health, St.Lideta College of Health Science and Business, Addis Ababa, Ethiopia
| | - Genanew Kassie Getahun
- Department of Public Health, Menelik II Medical and Health Science College, Addis Ababa, Ethiopia
| | - Selamawit Shita Jemberie
- Department of Midwifery, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
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Gemechu A, Mihret A, Aseffa A, Howe R, Seyoum B, Mulu A. Loss to Follow-up and Death Among Individuals With Newly Diagnosed Human Immunodeficiency Virus Receiving Dolutegravir-Based First-Line Antiretroviral Treatment in Eastern Ethiopia: Implications for 95% United Nations Targets. Open Forum Infect Dis 2023; 10:ofad522. [PMID: 37953815 PMCID: PMC10638489 DOI: 10.1093/ofid/ofad522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 10/18/2023] [Indexed: 11/14/2023] Open
Abstract
Background Loss to follow-up (LTFU) and death are unfavorable outcomes of human immunodeficiency virus (HIV) treatment. This study aimed to identify the predictors of LTFU and death among individuals with newly diagnosed HIV receiving dolutegravir (DTG)-based first-line antiretroviral treatment (ART) in eastern Ethiopia. Methods A multisite prospective cohort study was carried out between October 2020 and July 2022. New case patients who started ART were enrolled consecutively and then followed up for the next 6 months. A structured questionnaire and checklists were used to collect data. HIV viral load was determined using the Abbott RealTime HIV-1 assay. Bivariable and multivariable logistic regression models were used to identify baseline factors associated with the outcomes. Results A total of 235 people with newly diagnosed HIV were enrolled; 16.6% (95% confidence interval, 12.3%-21.9%) were lost to follow-up, and 5.9% (3.5%-9.8%) died within 6 months of follow-up. Baseline World Health Organization clinical stage I (adjusted odds ratio, 3.93 [95% confidence interval, 1.34-11.57]), low viral load (3.67 [1.09-12.36]), and body weight (1.04 [1.01-1.07]) were predictors of LTFU, whereas nonfunctional status (10.02 [1.9-51.3]) was the only factor associated with death. Conclusions LTFU and death rates among patients with DTG were relatively high, accounting for roughly a quarter of the attrition of people with newly diagnosed HIV from ART care and services. Thus, targeted interventions are required to reduce LTFU and death among individuals with HIV on ART. Further investigation is necessary to evaluate the long-term effects of DTG-based regimens on LTFU and its impact on HIV mortality rates, and qualitative research, specifically tracing LTFU, is recommended.
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Affiliation(s)
- Abdella Gemechu
- School of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Adane Mihret
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Abraham Aseffa
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Rawleigh Howe
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Berhanu Seyoum
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
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Buju RT, Akilimali PZ, Tran NT, Kamangu EN, Mesia GK, Kayembe JMN, Situakibanza HN. Determinants of Survival of HIV Patients Receiving Dolutegravir: A Prospective Cohort Study in Conflict-Affected Bunia, Democratic Republic of Congo. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10220. [PMID: 36011850 PMCID: PMC9407849 DOI: 10.3390/ijerph191610220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/15/2022] [Accepted: 08/16/2022] [Indexed: 06/15/2023]
Abstract
This study aims to determine the factors influencing HIV-related mortality in settings experiencing continuous armed conflict atrocities. In such settings, people living with HIV (PLHIV), and the partners of those affected may encounter specific difficulties regarding adherence to antiretroviral therapy (ART), and retention in HIV prevention, treatment, and care programs. Between July 2019 and July 2021, we conducted an observational prospective cohort study of 468 PLHIV patients treated with Dolutegravir at all the ART facilities in Bunia. The probability of death being the primary outcome, as a function of time of inclusion in the cohort, was determined using Kaplan-Meier plots. We used the log-rank test to compare survival curves and Cox proportional hazard modeling to determine mortality predictors from the baseline to 31 July 2021 (endpoint). The total number of person-months (p-m) was 3435, with a death rate of 6.70 per 1000 p-m. Compared with the 35-year-old reference group, older patients had a higher mortality risk. ART-naïve participants at the time of enrollment had a higher mortality risk than those already using ART. Patients with a high baseline viral load (≥1000 copies/mL) had a higher mortality risk compared with the reference group (adjusted hazard ratio = 6.04; 95% CI: 1.78-20.43). One-fourth of deaths in the cohort were direct victims of armed conflict, with an estimated excess death of 35.6%. Improving baseline viral load monitoring, starting ART early in individuals with high baseline viral loads, the proper tailoring of ART regimens and optimizing long-term ART, and care to manage non-AIDS-related chronic complications are recommended actions to reduce mortality. Not least, fostering women's inclusion, justice, peace, and security in conflict zones is critical in preventing premature deaths in the general population as well as among PLHIV.
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Affiliation(s)
- Roger T. Buju
- Department of Public Health, Faculty of Medicine, University of Bunia, Bunia P.O. Box 292, Congo
| | - Pierre Z. Akilimali
- Department of Biostatistics and Epidemiology, Kinshasa School of Public Health, University of Kinshasa, Kinshasa P.O. Box 11850, Congo
| | - Nguyen-Toan Tran
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, P.O. Box 123, Sydney, NSW 2007, Australia
- Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, 1206 Genève, Switzerland
| | - Erick N. Kamangu
- Département des Sciences de Base, School of Medicine, University of Kinshasa, Kinshasa P.O. Box 11850, Congo
| | - Gauthier K. Mesia
- Unité de Pharmacologie Clinique et Pharmacovigilance, School of Medicine, University of Kinshasa, Kinshasa P.O. Box 11850, Congo
| | - Jean Marie N. Kayembe
- Department Internal Medicine, School of Medicine, University of Kinshasa, Kinshasa P.O. Box 11850, Congo
| | - Hippolyte N. Situakibanza
- Department Internal Medicine, School of Medicine, University of Kinshasa, Kinshasa P.O. Box 11850, Congo
- Department of Tropical Medicine, Infectious and Parasitic Diseases, School of Medicine, University of Kinshasa, Kinshasa P.O. Box 11850, Congo
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