A Systematic Review and Meta-Analysis on Depression and Associated Factors among Adult HIV/AIDS-Positive Patients Attending ART Clinics of Ethiopia: 2021.

BackgroundPeople living with HIV/AIDS (PLWHA) are frequently confronted with severe social issues such as rejection, abandonment, criticism, and stigma. This would negatively affect their quality of life. Several studies have been conducted so far to assess factors affecting the health-related quality of life among people living with HIV/AIDS who are on antiretroviral therapy (ART) in Ethiopia. However, to our knowledge, there is no previous study that has summarized the results of the studies that investigated health-related quality of life (HRQOL) among PLWHA in Ethiopia. Therefore, the purpose of this review was to estimate the pooled prevalence of HRQOL and its association with social support among people living with HIV/AIDS (PLWHA) on ART in Ethiopia.MethodsA systematic search was carried out using several electronic databases (PubMed, Science Direct, Web of Science, and Cochrane electronic), Google Scholar, Google, and a manual search of the literature on health-related quality of life among people living with HIV/AIDS who are on ART. A Microsoft Excel data extraction sheet was used to extract pertinent data from an individual study. To assess the heterogeneity of primary articles, the Cochrane Q test statistics and the I2 test were carried out, and a random effects meta-analysis was used to estimate the pooled prevalence of HRQOL.ResultOut of the 493 articles reviewed, ten with a total of 3257 study participants were eligible for meta-analysis. The pooled prevalence of HRQOL among people living with HIV/AIDS who are on antiretroviral therapy in Ethiopia was 45.27%. We found that strong perceived social support was significantly associated with higher levels of subjectively perceived HRQOL. PLWHA who were on ART and had good social support were four times more likely to report higher HRQOL when compared to their counterparts [AOR = 4.01, 95% CI 3.07–5.23].ConclusionA substantial number of PLWHA had poor HRQOL in Ethiopia. Social support was significantly associated with HRQOL among people living with HIV/AIDS. Hence, it’s recommended to encourage suitable intervention at every follow-up visit, and psycho-social support is also warranted to improve the quality of life.

ObjectiveThis study aimed to pool the prevalence of virological failure and associated factors.DesignSystematic review and meta-analysis.Primary outcome measurePrevalence of virological failure.Secondary outcome measureFactors affecting virological failure.AnalysisThe extracted data were exported...

The effect of dolutegravir (DTG)-based regimens on reducing attrition from care among women enrolled in the prevention of mother-to-child transmission (PMTCT) care program is unknown. Therefore, this study aimed to compare the incidence of attrition among women exposed to DTG-based with those exposed to efavirenz (EFV)-based first-line antiretroviral therapy (ART) in Ethiopia. An uncontrolled before-and-after study was conducted involving 932 women (with 466 on EFV-based and 466 on DTG-based regimens) who were enrolled in the PMTCT care program from September 2015 to February 2023. The outcome variable was attrition (i.e., maternal death or loss to follow-up before their infants' final HIV status was determined). A Kaplan-Meier estimator was employed to estimate the probability of attrition. The Cox proportional hazards regression model was fitted to identify predictor variables. The adjusted hazard ratio (aHR) with the corresponding 95% confidence interval (CI) was calculated to examine the risk difference in the comparison groups. The cumulative incidence of attrition among women was 5.2% (3.0% for those placed in the DTG-based regimen arm and 7.3% for those placed in the EFV-based regimen arm). Women on DTG-based regimens had a 57% (aHR: 0.43; 95% CI: 0.23-0.80) lower risk of attrition from care compared to those on EFV-based regimens. Women who delivered their infants at home (aHR: 2.35; 95% CI: 1.14-4.85), had poor/fair adherence (aHR: 3.23; 95% CI: 1.62-6.45), had unsuppressed/unknown viral load status (aHR: 2.61; 95% CI: 1.42-4.79), and did not disclose their status to partners (aHR: 2.56; 95% CI: 1.34-4.92) had a higher risk of attrition from PMTCT care compared to their counterparts. The cumulative incidence of attrition among women receiving PMTCT care is optimal. In addition, the risk of attrition among women receiving DTG-based regimens is lower than that among women receiving EFV-based regimens. Thus, DTG-based first-line ART regimen supplementation should be sustained to achieve a national retention target of 95% and above.

This study was aimed at developing a risk score prediction model for bacteriologically confirmed tuberculosis (TB) among adults with HIV receiving antiretroviral therapy in Ethiopia. An institutional-based retrospective follow-up study was conducted among 569 adults with HIV on ART. We used demographic and clinical prognostic factors to develop a risk prediction model. Model performance was evaluated by discrimination and calibration using the area under the receiver operating characteristic (AUROC) curve and calibration plot. Bootstrapping was used for internal validation. A decision curve analysis was used to evaluate the clinical utility. Opportunistic infection, functional status, anemia, isoniazid preventive therapy, and WHO clinical stages were used to develop risk prediction. The AUROC curve of the original model was 87.53% [95% confidence interval (CI): 83.88-91.25] and the calibration plot ( P -value = 0.51). After internal validation, the AUROC curve of 86.61% (95% CI: 82.92-90.29%) was comparable with the original model, with an optimism coefficient of 0.0096 and good calibration ( P -value = 0.10). Our model revealed excellent sensitivity (92.65%) and negative predictive value (NPV) (98.60%) with very good specificity (70.06%) and accuracy (72.76%). After validation, accuracy (74.85%) and specificity (76.27%) were improved, but sensitivity (86.76%) and NPV (97.66%) were relatively reduced. The risk prediction model had a net benefit up to 7.5 threshold probabilities. This prognostic model had very good performance. Moreover, it had very good sensitivity and excellent NPV. The model could help clinicians use risk estimation and stratification for early diagnosis and treatment to improve patient outcomes and quality of life.

BackgroundOver 420,000 people have initiated life-saving antiretroviral therapy (ART) in Ethiopia; however, lost-to-follow-up (LTFU) rates continues to be high. A clinical decision tool is needed to identify patients at higher risk for LTFU to provide individualized risk prediction to intervention. Therefore, this study aimed to develop and validate a statistical risk prediction tool that predicts the probability of LTFU among adult clients on ART.MethodsA retrospective follow-up study was conducted among 432 clients on ART in Gondar Town, northwest, Ethiopia. Prognostic determinates included in the analysis were determined by multivariable logistic regression. The area under the receiver operating characteristic (AUROC) and calibration plot were used to assess the model discriminative ability and predictive accuracy, respectively. Individual risk prediction for LTFU was determined using both regression formula and score chart rule. Youden index value was used to determine the cut-point for risk classification. The clinical utility of the model was evaluated using decision curve analysis (DCA).ResultsThe incidence of LTFU was 11.19 (95% CI 8.95–13.99) per 100-persons years of observation. Potential prognostic determinants for LTFU were rural residence, not using prophylaxis (either cotrimoxazole or Isoniazid or both), patient on appointment spacing model (ASM), poor drug adherence level, normal Body mass index (BMI), and high viral load (viral copies > 1000 copies/ml). The AUROC was 85.9% (95% CI 82.0–89.6) for the prediction model and the risk score was 81.0% (95% CI 76.7–85.3) which was a good discrimination probability. The maximum sensitivity and specificity of the probability of LTFU using the prediction model were 72.07% and 83.49%, respectively. The calibration plot of the model was good (p-value = 0.350). The DCA indicated that the model provides a higher net benefit following patients based on the risk prediction tool.ConclusionThe incidence of LTFU among clients on ART in Gondar town was high (> 3%). The risk prediction model presents an accurate and easily applicable prognostic prediction tool for clients on ART. A prospective follow-up study and external validation of the model is warranted before using the model.

IntroductionDietary diversity is the utilization of food and food groups consumed by individuals over 24 h, which is an indicator of a diet’s micronutrient adequacy. Dietary management in people with HIV patients is the key to sustaining their day-to-day activities and contributing to their lively hood. The level of dietary diversity among HIV-positive patients in Ethiopia shows considerable variation, ranging from 29 to 71.3%. This study aimed to assess the pooled prevalence of low dietary diversity and associated factors among HIV-positive patients attending ART clinics in Ethiopia.MethodMultiple international database searching methods (articles found in PubMed/MEDLINE, Google scholar Africa, Hinari journal online, Embase, Scopus) and Ethiopian university repository online have been covered in this systemic review and meta-analysis. Data were extracted using Microsoft excel and analyzed by using the Stata version 14 software program. The heterogeneity between studies and publication bias was detected by using the I2 test and a funnel plot test respectively.ResultsThe pooled prevalence of low dietary diversity among People with HIV patients on antiretroviral therapy in Ethiopia was 55.9% 95% CI (45.73, 66.09) based on the random effect analysis. This systemic review and meta-analysis showed that only HIV positive patients with an antiretroviral therapy duration of less than one year (AOR = 2.3, 95% CI 1.3, 4.1), and having low wealth quintile (AOR = 2.5, 95% CI 1.5, 4.4) were factors significantly associated with low dietary diversity among People with HIV patients on ant-retroviral therapy clinics of Ethiopia.Conclusion and recommendationThe overall pooled prevalence of low dietary diversity among People with HIV patients attending antiretroviral therapy clinics in Ethiopia was high. We strongly recommend holistic nutritional interventions to address nutritional problems and promote the overall health status of HIV-positive patients in Ethiopia.

Globally, Tuberculosis (TB) is the main cause of morbidity and mortality among infectious disease. TB and Human Immune Virus (HIV) are the two deadly pandemics which interconnected each other tragically, and jeopardize the lives of children; particularly in Sub-Saharan Africa. Therefore, this review was aimed to determine the aggregated national pooled incidence of tuberculosis among HIV- infected children and its predictors in Ethiopia. An electronic search engine (HINARI, PubMed, Scopus, web of science), Google scholar and free Google databases were searched to find eligible studies. Quality of the studies was checked using the Joanna Briggs Institute (JBI) quality assessment checklists for cohort studies. Heterogeneity between studies was evaluated using Cochrane Q-test and the I2 statistics. This review revealed that the pooled national incidence of tuberculosis among children with HIV after initiation of ART was 3.63% (95% CI: 2.726-4.532) per 100-person-years observations. Being Anemic, poor and fair ART adherence, advanced WHO clinical staging, missing of cotrimoxazole and isoniazid preventing therapy, low CD4 cell count, and undernutrition were significant predictors of tuberculosis incidence. The study result indicated that the incidence of TB among HIV- infected children is still high. Therefore, parents/guardians should strictly follow and adjust nutritional status of their children to boost immunity, prevent undernutrition and opportunistic infections. Cotrimoxazole and isoniazid preventive therapy need to continually provide for HIV- infected children for the sake of enhancing CD4/immune cells, reduce viral load, and prevent from advanced disease stages. Furthermore, clinicians and parents strictly follow ART adherence.

Dyslipidemia is a common public health problem in people living with human immunodeficiency virus (HIV) who are receiving antiretroviral therapy and increases the risk of cardiovascular disease. Although evidence indicates that the prevalence of dyslipidemia is high, estimated pooled data are not well documented. Therefore, we aimed to estimate the pooled prevalence of dyslipidemia in adult people living with HIV receiving antiretroviral therapy in Ethiopia. We conducted a systematic review and meta-analysis of the literature. The following databases and grey literature were searched: PubMed, WorldCat, ScienceDirect, DOAG, African Journals Online, Google Scholar, and African Index Medicine. We included all comparative epidemiological studies that reported the prevalence of high concentration of total cholesterol, triglycerides, and low density lipoprotein, and low concentration of high density lipoprotein cholesterol that were published between January 2003 and July 2023. The random effects model was used to pool the outcome of interest. Additionally, subgrouping, sensitivity analyses, and funnel plots were performed. R software Version 4.2.1 was used for statistical analysis. Seventeen studies with a total of 3929 participants were included in the meta-analysis. The pooled prevalence of dyslipidemia, high total cholesterol, high triglyceride, elevated level of low density lipoprotein and low level of high density lipoprotein cholesterol were 69.32% (95% CI: 63.33, 74.72), 39.78% (95%CI: 32.12, 47.96), 40.32% (95%CI: 34.56, 46.36), 28.58% (95%CI: 21.81, 36.46), and 36.17% (95%CI: 28.82, 44.24), respectively. Age and body mass index were associated with high total cholesterol, triglyceride, and low-density lipoprotein cholesterol levels. The authors concluded that the prevalence of dyslipidemia in Ethiopia is high in people living with HIV receiving antiretroviral therapy. Early detection of dyslipidemia and its integration into treatment are essential for preventing cardiovascular disease. Protocol registered with PROSPERO (CRD42023440125).

The aim of this study was to evaluate HIV-1 drug resistance among patients failing first-line antiretroviral therapy in Ethiopia. A total of 699 adults infected with HIV (aged ≥15 years) who failed first-line Antiretroviral Therapy (ART) were recruited between 2017 and 2019 from 63 ART-providing sites in Ethiopia. Treatment failure was defined as patients with two consecutive viral loads (VLs) ≥1000 copies/mL within six months of follow-up. The pol gene region of HIV-1 was amplified and sequenced using an in-house assay of the Chinese Center for Disease Prevention and Control. The Stanford HIVDB v9.0 algorithm was used for identification of resistance mutations. Resistance mutations were characterized according to the 2019 International AIDS Society-USA mutation list. P values of <0.05 were considered statistically significant during multivariate analysis, which was done using SPSS v26.0 (SPSS Inc., Chicago, IL). Overall, HIV drug resistance (HIVDR) among patients failing first-line therapy in Ethiopia was 77.8%. Non-nucleoside/tide reverse transcriptase inhibitors (NNRTI) and NRTI resistance were 75.7% and 71.2%, respectively. Neverapine (NVP) and Efavirenz (EFV) accounted for 74.2% and 60.8% of HIVDR, respectively. About half (48.1%) of NRTI-associated mutations were responsible for Abacavir resistance, while 34% were responsible for multi-NRTI resistance. Mutations responsible for resistance to the commonly used EFV and NVP accounted for 62.9%, while resistance to Etravirine, Doravirine, and Rilivirine, which were not part of the country's ART program, were 37.1%, and can be explained by cross-resistance within the drug class. Protease Inhebitor(PI)associated resistance was detected in only 1.6% of the study's participants. The most common mutations identified were M184V (30.1%), K103N (18.7%), Y181C (13.6%), and K65R (12.1%). In a multivariate logistic regression analysis, predictors of HIVDR were prior ART exposure (adjusted odds ratio [AOR]=2.3; 95% confidence interval [CI]=1.8, 3.6), absence of HIV status disclosure (AOR=2.05; 95%CI=1.26, 3.35), CD4 count of ≤200 cells/mm3 (AOR=1.94; 95%CI=1.21, 3.12), and bedridden status (AOR=4.16; 95% CI=3.21, 5.16). The high-levels of HIVDR among patients with failure of first-line ART in Ethiopia calls for individualized HIVDR testing. Mutations associated with multi-NRTI and NNRTI cross-resistance may alert the program for considering drugs of higher genetic barrier targeting protease and other regions. Patients with low CD4 count and those who are bedridden should be given special attention for the potential development of HIVDR during clinical management.

Under nutrition and human immune deficiency virus/HIV have a vicious cycle. This study aimed to assess the pooled prevalence of under nutrition and determinants among adults receiving antiretroviral therapy in Ethiopia. Google scholar, PubMed, Cochrane library and web of science data bases were searched. Studies were assessed using risk of bias assessment tool. The heterogeneity of study was assessed using I2 test statistics. Data were pooled and a random effect meta-analysis model was fitted to provide the prevalence of under nutrition. Twenty-one studies that satisfy the eligibility criteria were included. The pooled prevalence of under nutrition among adults receiving ART was 27.4% (95% CI: 24.4-31.4). The pooled analysis showed that lack of RUTF was more likely to lead to under nutrition [AOR=2.34 (95%CI: 1.85- 3.85)]. Also under nutrition was more likely among adults receiving ART with WHO clinical stage four [AOR=2.01 (95%CI: 1.91- 3.82). The pooled prevalence of under nutrition was high and Lack of RUTF as well as WHO clinical stage 4 showed significant associations with under nutrition. This finding has implication to develop policy to improve under nutrition and to continue RUTF supplement program as an integral part of HIV/AIDS continuum of care.

Background: Treatment failure (TF) among patients receiving antiretroviral therapy (ART) against human immunodeficiency virus (HIV) impacts on treatment outcome and is becoming a public health concern globally. However, magnitude of TF and factors leading to it are poorly defined in the context of Ethiopia. Thus, the aim of this study was to determine the magnitude of TF and assess its determinants among HIV-infected patients on ART in Ethiopia. Methods: A prospective and retrospective study was conducted from March 2016 to 2017. Retrospective clinical and laboratory data were captured from patients’ medical record. Socio-demographics and explanatory variables of participants were collected using pre-tested structured questionnaire and study participants were followed for additional 6 month after baseline viral load has been done to classify virologic failure (VF). Multiple logistic regression was conducted to assess risk factors associated with TF. Statistical significance was set at P-value less than 0.05. Results: A total of 9,284 adults taking ART from a nationally representative 63 health facilities were included in the study. Viral Load Suppression (VLS) (VL1000 copies/ml at baseline of the study were re-suppressed after six months of enhanced adherence and counseling, leading TF among population on ART in Ethiopia to be 983 (11%). Immunologic and clinical failure was significantly improved from 21.5% and 16.5% at ART initiation to 576 (6.2%) and 470 (5.0%) at baseline of the study, respectively. Medication adherence, disclosure of HIV status, missed appointment to ART, history of ART exposure prior to initiation, residency and marital status had significant association with TF. Conclusions: The high level of VLS (88.1%) could explain the success of ART program in Ethiopia towards achieving the UNAIDS global target on viral suppression. TF among population taking ART in Ethiopia is still a public health concern, since 11% of virally failed population is maintained on failed first-line regimen. However, a significant improvement on immunologic and clinical outcome after ART initiation was maintained. Close follow-up of medication adherence, ensuring disclosure of HIV status, regular appointment follow-up to ART could significantly improve the treatment outcome of population on ART in Ethiopia.

Introduction: Depression is a common and debilitating mental health issue among refugees in East Africa, who face numerous challenges. However, there is a lack of systematic reviews and meta-analyses that have explored the pooled prevalence and associated factors of depression among refugees in East Africa. This study aims to investigate the pooled prevalence of depression and its associated factors among refugees living in East Africa.MethodsA systematic search was conducted across several databases, including PubMed/MEDLINE, CINAHL, ScienceDirect, African Journals of Online (AJOL), and Google Scholar. The quality of the included studies was assessed using a Joanna Briggs Institute (JBI) quality appraisal tool. Statistical analysis was carried out using STATA-17 software packages, and a meta-analysis was conducted using a random-effects model. Heterogeneity among the studies was assessed using the I2 statistic. Publication bias was evaluated using the DOI plot, Luis Furuya Kanamori (LFK) index, and Egger’s test. For associated factors of depression, effect sizes (odds ratio) with 95% confidence intervals were analyzed.ResultA total of eight studies involving 6,388 participants were included in this systematic review and meta-analysis, all of which were assessed to have a low risk of bias. The pooled prevalence of depression was 50.60%, with a 95% CI (35.49%, 65.71). Regarding factors associated with depression; being female [(OR = 2.01; 95% CI (1.06, 3.82)], having poor social support [OR 5.88; 95% CI (2.53, 13.67)], and experienced eight or more traumatic events [OR = 3.31;95% CI (1.74, 6.31) were positively associated factors with depression.ConclusionThe pooled prevalence of depression among refugees in East Africa was found to be significantly high. Female participants, poor social support, and experienced eight or more traumatic events were factors affecting depression among refugees in East Africa. Therefore, policymakers and health personnel in East Africa should prioritize addressing the needs of female participants, individuals with poor social support, and those who have experienced eight or more traumatic events.

ObjectiveTo make healthcare programmes more patient-centred and efficient in light of limited resources, it is crucial to ensure patient satisfaction. There is limited information on the overall level of satisfaction...

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. 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. 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. 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.

Background: High rates of disease progression and HIV drug resistance (HIVDR) among adults taking highly active antiretroviral treatment (HAART) in Sub-Saharan Africa were previously documented. However, children were generally not considered despite their greater risk. Hence, this study was aimed to evaluate HIV-1 disease progression and drug resistance mutation among children on first-line antiretroviral therapy in Ethiopia. Method: A longitudinal study was conducted among 551 HIV-positive children (<15 years old) recruited between 2017 and 2019 at 40 antiretroviral treatment delivery sites in Ethiopia. Disease progression was retrospectively measured over a 12-year (2007-2019) follow-up as the progress towards immunosuppression. Two consecutive viral load (VL) tests were conducted in 6-month intervals to assess virologic failure (VF). For children with VF, HIV-1 genotyping and sequencing was performed for the pol gene region using in-house assay validated at the Chinese Center for Disease Control and Prevention, and the Stanford HIVDB v9.0 algorithm was used for identification of drug resistance mutations. The Kaplan-Meier analysis and Cox proportional hazards regression model were used to estimate the rate and predictors of disease progression, respectively. Results: The disease progression rate was 6.3 per 100 person-years-observation (95% CI = 4.21-8.53). Overall immunosuppression (CD4 count < 200 cells/mm3) during the 12-year follow-up was 11.3% (95% CI = 7.5-15.1). Immunosuppression was significantly increased as of the mean duration of 10.5 (95% CI = 10.1-10.8) years (38.2%) to 67.8% at 12 years (p < 0.001). Overall, 14.5% had resistance to at least one drug, and 6.2% had multi-drug resistance. A resistance of 67.8% was observed among children with VF. Resistance to non-nucleotide reverse transcriptase inhibitors (NNRTI) and nucleotide reverse transcriptase inhibitors (NRTI) drugs were 11.4% and 10.1%, respectively. Mutations responsible for NRTI resistance were M184V (30.1%), K65R (12.1%), and D67N (5.6%). Moreover, NNRTI-associated mutations were K103N (14.8%), Y181C (11.8%), and G190A (7.7%). Children who had a history of opportunistic infection [AHR (95% CI) = 3.4 (1.8-6.2)], vitamin D < 20 ng/mL [AHR (95% CI) = 4.5 (2.1-9.9)], drug resistance [AHR (95% CI) = 2.2 (1.4-3.6)], and VF [AHR (95% CI) = 2.82 (1.21, 3.53)] had a higher hazard of disease progression; whereas, being orphan [AOR (95% CI) = 1.8 (1.2-3.1)], history of drug substitution [(AOR (95% CI) = 4.8 (2.1-6.5), hemoglobin < 12 mg/dL [AOR (95% CI) = 1.2 (1.1-2.1)] had higher odds of developing drug resistance. Conclusions: Immunosuppression was increasing over time and drug resistance was also substantially high. Enhancing routine monitoring of viral load and HIVDR and providing a vitamin-D supplement during clinical management could help improve the immunologic outcome. Limiting HAART substitution is also crucial for children taking HAART in Ethiopia.