Antiretroviral Therapy Follow-up Research Articles

The effect of late presentation on HIV related mortality among adolescents in public hospitals of north showa zone Oromiya, Ethiopia; 2022: a retrospective cohort study

BackgroundLate human immunodeficiency virus (HIV) diagnosis is the most prominent cause of HIV/AIDS-related mortality and also increases the risk of transmission and spread of the disease in society. Adolescents are the most vulnerable population’s age group for HIV infection in several settings, but expanding access to early HIV testing remains a challenge. Consequently, a significant proportion of adolescents are still dying of HIV-related causes, and the current study aimed at assessing the effect of late presentation on HIV-related mortality among adolescents living with HIV.MethodsAn institutional-based retrospective cohort study was conducted from August 21–November 21, 2022, at selected public hospitals in the North Showa Zone of Oromiya, Ethiopia. All adolescents living with HIV who had received no ART and presented for ART follow-up at public hospitals from September 1, 2012, to August 31, 2021, were included in the study. Data entry was done by Epi-data version 3.1.1 software and exported to Stata version 16 for further analysis. Both bi-variable and multivariable analyses were performed using the Cox proportional hazard model to compare the HIV-related mortality of early and late-presented adolescents using an adjusted hazard ratio at a 95% confidence interval (CI).ResultsA total of 341 medical records of adolescents were included in the study, contributing an overall incidence rate of 3.15 (95% CI: 2.21–4.26) deaths per 100 person-years of observation throughout the total follow-up period of 1173.98 person-years. Adolescents with late presentation for HIV care had three times the higher hazard of mortality (adjusted hazard ratio (aHR) = 3.00; 95% CI: 1.22–7.37) as compared to those with early presentation for HIV/AIDS care. Adolescents within the age range of 15–19 years old (aHR = 3.56; 95% CI: 1.44–8.77), rural residence (aHR = 2.81; 95% CI: 1.39–5.68), poor adherence to ART (aHR = 3.17; 95% CI: 1.49–6.76), and being anemic (aHR = 3.09; 95% CI: 1.52–6.29) were other independent predictors of HIV-related mortality.ConclusionThe study found a substantial link between HIV late presentation to care and mortality among adolescents. Residence, age, antiretroviral therapy (ART) medication adherence, and anemia status were also found to be other independent predictors of HIV-related mortality. To achieve the ultimate aim of lowering mortality among adolescents living with HIV, rigorous emphasis must be placed on early presentation for HIV/AIDS care. In addition, counseling on adherence and prompt diagnosis and treatment of anemia are highly recommended to reduce mortality.

Trends of Body Mass Index changes among adults on antiretroviral therapy in Northwest Ethiopia: a longitudinal data analysis

Nutritional status is considered a major diagnostic and prognostic indicator of HIV/AIDS in adults. In this aspect, current HIV-treatment guidelines, particularly in low-income countries, recommend the regular monitoring of body mass index (BMI) to determine patients' clinical response to antiretroviral therapy (ART). However, data regarding the change in BMI status of HIV-positive adults on ART following the implementation of the test and treat strategy were limited in Ethiopia. Hence, this study is aimed at investigating the trends of BMI change over time and its associated factors among HIV-positive adults in Northwest Ethiopia. A retrospective longitudinal study was conducted among 404 randomly selected HIV-positive adults receiving ART in Felegehiwot Comprehensive Specialized Hospital (FHCSH), Northern Ethiopia. Data were extracted from the medical record charts of study participants, entered into Epi-data 4.6 software, and exported to Stata 14.2 software for analysis. A generalized estimating equation (GEE) model was fitted to determine the change in BMI status over time and its predictors in HIV-positive adults. The level of significance was declared at a p-value of < 0.05. More than half (201, or 51.73%) of the total 404 participants were female. In the cohort, both the baseline and follow-up mean body mass index levels of the participants fell in the normal range and increased from 20.34 (standard deviation/SD ± 2.8) to 21.41 (SD ± 3.13). The individual profile plots of 50 participants indicated that there is considerable variability in weight change across individuals. Duration of ART follow-up (β = 0.203, 95% confidence interval (CI) 0.16 to 0.24), unemployment (β = − 0.96, 95% CI 1.67 to − 0.25), WHO stage III/IV HIV disease (β = − 0.92, 95% CI − 1.57 to − 0.35),and Tenofovir/Lamivudine/Dolutegravir (TDF/3TC/DTG)ART regimen (β = 0.95, 95% CI 0.32 to 1.57) were identified as significant predictors of change in the BMI status of participants. Likewise, the interaction of TDF/3TC/DTG ART regimen * follow-up duration (β = 2.16, 95% CI 1.84 to 2.84), WHO stage III/IV clinical disease * follow-up duration (β = − 1.43, 95% CI − 1.71 to − 1.15) and TB/HIV co-infection * follow-up duration (β = 1.89, 95% CI 1.57 to 2.87) significantly affects the trend in BMI change status of HIV-positive adults. In this study, the BMI status of HIV-positive adults receiving ART increased with a linear trend. Unemployment, stage III/IV HIV diseases, and Tenofovir/Lamivudine/Efavirenz (TDF/3TC/EFV) ART-drug regimen decreases the mean BMI status of HIV-positive adults. Special consideration and strict follow-up need to be given to those individuals with advanced HIV/AIDS diseases and other identified risk group.

Predictors associated with CD4 cell count changes over time among HIV-infected children on anti-retroviral therapy follow-up in Mekelle General Hospital, Northern Ethiopia, 2019: a retrospective longitudinal study

IntroductionAIDS continues to be a serious global public health issue. It targets CD4 cells and immunological cells, which are in charge of the body's resistance against pathogenic pathogens. In situations with limited resources, CD4 cell measurement is essential for assessing treatment responses and clinical judgments in HIV-infected children receiving Anti-Retroviral Therapy (ART). The volatility of CD4 cells during ART follow-up is still largely uncharacterized, and there are few new datasets on CD4 cell changes over time. Therefore, the purpose of this analysis was to identify the factors that were predictive of CD4 cell count changes over time in children who started ART at Mekelle General Hospital in northern Ethiopia.MethodsA retrospective follow-up study was done. 437 patients in Mekelle general hospital, northern Ethiopia, from 2014–2016 were involved. All patients who have started anti-retrieval treatment (ART) and measured their CD4 cell count at least twice, including the baseline and those who initiated ART treatment, were included in the study population. An exploratory data analysis and linear mixed model analysis were used to explore the predictors of CD4 cell count change in patients and consider variability within and between patients.ResultsThis study found the correlation variation explained in cells accounted for between patients was 61.3%, and the remaining 38.7% variation existed within. This indicates that there is a substantial change in random slope and intercept between and within patients. WHO clinical stage IV (β = -1.30, 95% CI: -2.37, -0.23), co-infection HIV/TB (β = -1.78, 95% CI: -2.58, -0.98), children aged 2–5 (β = -0.43; 95% CI: -0.82, -0.04), and 6–14 years (β = -1.02; 95% CI: -1.47, -0.56), non-opportunistic infection (β = 1.33, 95% CI: 0.51, 2.14), and bedridden functional status (β = -1.74, 95% CI: -2.81, -0.68) were predictors of cell changes over time.ConclusionsThis study found that patients receiving ART experienced a significant change in CD4 cells over time. Because 61.3% of the variation in CD4 cells explained between patients and the remaining 38.7% within patients, such nested data structures are often strong correlation evidence. Co-infection of HIV/TB, functional status, age category of children, WHO clinical stage, and opportunistic infections are potential predictors of CD4 cells count change.Hence, special guidance and attention is also required, especially for those patients who have an opportunistic infections, higher WHO clinical stages, co-infections with HIV and TB, and bedridden functional status.

Level Of ART Adherence and associated factors among People Living with HIV in the Context of Early Antiretroviral therapy initiation In Wolaita Sodo Town, Ethiopia: Cross-sectional study.

Early antiretroviral therapy initiation is WHO recommendation for fasten viral suppression and for prevention of further viral transmission sexually. There is no evidence showing the level of adherence to antiretroviral therapy (ART) after initiation of the universal test and treat (UTT) strategy in Ethiopia, including study area. This study was aimed to determine the level of ART adherence and associated factors among HIV/AIDS patients in context of Universal test and treat strategy. A Health facility-based study was conducted on 352 people living with HIV who started their ART follow-up after application of universal test and treat strategy in Ethiopia from 15 April to 5 June 2020. Systematic random sampling method was used to select the study participants. Interviewer administered questionnaire was used to collect data and collected data were entered directly in to SPSS version 21 and analyzed. Both bivariate and multivariate logistic regression analyses were done. Strength and direction of association was determined by using AOR with 95%CI. The total 352 participants included the study. The overall level of adherence was 290 (82.4%). Commonly used ART regimen was TDF+3TC+EFV, 201(57.1%). In bivariate analysis, type of health institutions COR 2.934(1.388, 6.200), age level of 18-27 COR .357(.133, .959), current viral load in log scale COR= .357(.133, .959) and change of ART medication COR= 8.088(1.973, 33.165) were associated with medication adherence. Health institution type AOR = 2.615(1.147, 5.9600) and change of ART medication AOR= 7.267 (1.683, 31.384) were independent predictors of ART adherence. Low level of ART adherence was detected in this study. It was below the recommended good adherence standard and 90-90-90 target strategy. Therefore, patients should get adequate and comprehensive ART adherence counseling before initiation ART treatment and during the follow-up time.

Nutritional status and its determinants among adolescents with HIV on anti-retroviral treatment in low- and middle-income countries: a systematic review and meta-analysis

PurposeThis review aimed to determine what methods are used to assess nutritional status, the levels of nutritional status, determinants of undernutrition, and nutritional interventions employed for adolescents with HIV on Anti-Retroviral Therapy follow-up in Low- and Middle-Income countries.MethodsEstablished methods were used to systematically identify and retrieve studies published in five databases between January 2000 to May 2021, and citation searching. Quality was appraised and findings were synthesized using narrative analysis and meta-analysis.ResultBody Mass Index is the major indicator of nutritional status. The pooled prevalence of stunting, wasting, and overweight were 28.0%, 17.0%, and 5.0%, respectively. Adolescent males are 1.85 and 2.55 times more likely than adolescent females to suffer from both stunting and wasting at AOR = 1.85 (95%:1.47, 2.31) and AOR = 2.55 (95%: 1.88, 3.48), respectively. Similarly, adolescents with a history of opportunistic infections were 2.97 times more likely to be stunted than uninfected adolescents, AOR = 2.97 (95%:1.73, 5.12). One single intervention study found significant improvements in anthropometric status after nutritional supplementation.Conclusion and recommendationThe few studies that have been conducted on nutritional status in adolescents living with HIV in low- and middle-income countries indicate that stunting and wasting are common in this population. Avoiding opportunistic infections is an important protective factor but the review highlighted the generally inadequate and fragmented nature of nutritional screening and support programs. Development of comprehensive and integrated systems for nutritional assessment and intervention services during ART follow-up should be prioritized to improve adolescent clinical outcomes and survival.

Health related quality of life of HIV-positive women on ART follow-up in north Shewa zone public hospitals, central Ethiopia: Evidence from a cross-sectional study

BackgroundEvidence revealed that there is a statistically significant gender difference in Health-related quality of life (HRQoL) among HIV-positive people on Antiretroviral therapy (ART). Consequently, HIV-positive women have low scores in all HRQoL domains than men. Despite this fact, previous studies in Ethiopia focused on general HIV-positive people and paid less attention to HIV-positive women. Therefore, this study was intended to measure HRQoL and associated factors among HIV-positive women on ART follow-up in north Shewa zone public hospitals, central Ethiopia. MethodsAn institution-based cross-sectional study was conducted from February 01-April 30, 2022. Four hundred twenty-six women on ART were included using a systematic random sampling technique. Face-to-face interviews and medical record reviews were used to collect data. Both bivariable and multiple linear regressions were computed to identify the factors associated with HRQoL. A p-value <0.05 was used to assert statistically significant variables in multiple linear regression analysis. ResultsThe overall mean (SD) score of the HRQoL was 11.84 (2.44). And, 44.7% [95% CI: 40.3, 49.5] of the women have poor HRQoL. In multiple linear regression analysis, factors like depression (β = −0.35), Post-Traumatic Stress Disorder (PTSD) (β = −0.16), age (β = −0.07), rural residence (β = −0.52), and bedridden functional status (β = −1.02) were inversely associated with HRQoL. Oppositely, good treatment adherence (β = 0.46) was positively associated with overall HRQoL, keeping other factors constant. ConclusionThis study reveals a high magnitude of poor HRQoL among HIV-positive women. Therefore, as HRQoL domains are comprehensive indicators of living status, healthcare service providers should be dedicated to screening and supporting HIV-positive women with poor HRQoL. Additionally, healthcare providers should also pay special attention to routine PTSD screening and management for HIV-positive women due to its detrimental effect on HRQoL.

Incidence and predictors of loss to follow-up among adult HIV-infected patients taking antiretroviral therapy at North Shewa zone public Hospitals, Northeast Ethiopia: A retrospective follow-up study.

Patients who are lost to follow-up while on treatment compromise their own health and the long-term success of antiretroviral therapy (ART) programs. Besides, loss to follow-up (LTFU) increases HIV-related morbidity and mortality. Therefore, this study aimed to determine the incidence of LTFU and its predictors among adult HIV positive patients on anti-retroviral therapy at North Shoa zone public hospitals, Northeast Ethiopia. A retrospective follow up study of 517 people living with HIV/AIDS and attending an ART clinic between 2015 and 2020 was conducted at North Shewa zone, public hospitals. Kaplan-Meier failure function together with log rank test was used to compare failure function. Multivariable Cox proportion hazards regression model was used to determine predictors of LTFU. The incidence density rate of lost to follow up among HIV positive adult on ART was found to be 8.9 per 100 adult years observation (95%CI; 7.45, 10.68). In multivariable cox proportional regression analysis, WHO clinical stage-IV (AHR = 1.50; 95% CI: 1.08, 3.75), comorbidity disease (AHR = 0.54; 95% CI; 0.30, 0.97), body mass index less than 18kg/m2 (AHR = 1.60; 95% CI; 1.02, 2.51), cotrimoxazole preventive therapy (AHR = 1.57; 95% CI;1.09, 2.53), and a low CD4 count (AHR = 1.66; 95% CI; 1.29, 3.49) were found to be a significant predictors of lost to follow up. The current study showed that the incidence rate of loss to ART follow-up was high. Body mass index score less than 18kg/m2, advanced WHO clinical stage, CD4<200cell/mm3, had comorbidity disease, and cotrimoxazole therapy were a significant predictors of lost to ART follow up. Therefore, appropriate mitigation measures in the at-risk group need to be instigated to advance retention rate.

Adipokines as New Biomarkers of Immune Recovery: Apelin Receptor, RBP4 and ZAG Are Related to CD4+ T-Cell Reconstitution in PLHIV on Suppressive Antiretroviral Therapy.

A significant proportion of people living with HIV (PLHIV) who successfully achieve virological suppression fail to recover CD4+ T-cell counts. Since adipose tissue has been discovered as a key immune organ, this study aimed to assess the role of adipokines in the HIV immunodiscordant response. This is a multicenter prospective study including 221 PLHIV starting the first antiretroviral therapy (ART) and classified according to baseline CD4+ T-cell counts/µL (controls > 200 cells/µL and cases ≤ 200 cells/µL). Immune failure recovery was considered when cases did not reach more than 250 CD4+ T cells/µL at 144 weeks (immunological nonresponders, INR). Circulating adipokine concentrations were longitudinally measured using enzyme-linked immunosorbent assays. At baseline, apelin receptor (APLNR) and zinc-alpha-2-glycoprotein (ZAG) concentrations were significantly lower in INRs than in immunological responders (p = 0.043 and p = 0.034), and they remained lower during all ART follow-up visits (p = 0.044 and p = 0.028 for APLNR, p = 0.038 and p = 0.010 for ZAG, at 48 and 144 weeks, respectively). ZAG levels positively correlated with retinol-binding protein 4 (RBP4) levels (p < 0.01), and low circulating RBP4 concentrations were related to a low CD4+ T-cell gain (p = 0.018 and p = 0.039 at 48 and 144 weeks, respectively). Multiple regression adjusted for clinical variables and adipokine concentrations confirmed both low APLNR and RBP4 as independent predictors for CD4+ T cells at 144 weeks (p < 0.001). In conclusion, low APLNR and RBP4 concentrations were associated with poor immune recovery in treated PLHIV and could be considered predictive biomarkers of a discordant immunological response.

Growth and the pubertal growth spurt in South African adolescents living with perinatally-acquired HIV infection.

The majority children living with HIV infection now survive into adulthood because of effective antiretroviral therapy (ART), but few data exist on their growth during adolescent years. This study investigated growth patterns and evaluated factors associated with suboptimal growth in adolescents with perinatally-acquired HIV infection. This retrospective cohort study included HIV-infected adolescents, aged 13 to 18 years, with at least 5 years of ART follow-up at a large HIV clinic in the Gauteng Province, South Africa. Weight-for-age Z-scores (WAZ), height-for-age Z-scores (HAZ) and body mass index (BMI)-for-age Z-scores were calculated using World Health Organization (WHO) growth standards. Growth velocity graphs were generated utilising the mean height change calculated at 6-monthly intervals, using all available data after ART initiation, to calculate the annual change. Other collected data included WHO HIV disease staging, CD4%, HIV viral loads (VLs), ART regimens and tuberculosis co-infection. Included were 288 children with a median age of 6.5 years (IQR 4.2;8.6 years) at ART initiation, and 51.7% were male. At baseline the majority of children had severe disease (92% WHO stages 3&4) and were started on non-nucleoside reverse transcriptase inhibitor-based regimens (79.2%). The median CD4% was 13.5% (IQR 7.9;18.9) and median HIV viral load log 5.0 (IQR 4.4;5.5). Baseline stunting (HAZ <-2) was prevalent (55.9%), with a median HAZ of -2.2 (IQR -3.1;-1.3). The median WAZ was -1.5 (IQR -2.5;-0.8), with 29.2% being underweight-for-age (WAZ <-2). The peak height velocity (PHV) in adolescents with baseline stage 3 disease was higher than for those with stage 4 disease. Being older at ART start (p<0.001) and baseline stunting (p<0.001) were associated with poorer growth, resulting in a lower HAZ at study exit, with boys more significantly affected than girls (p<0.001). Suboptimal growth in adolescents with perinatally-acquired HIV infection is a significant health concern, especially in children who started ART later in terms of age and who had baseline stunting and is more pronounced in boys than in girls.

Profilaksis isoniazid merupakan faktor protektif kejadian tuberkulosis pasien HIV/AIDS di klinik VCT RSUP Sanglah Denpasar

Background: Human Immunodeficiency Virus (HIV) infection can increase susceptibility to Mycobacterium tuberculosis (TB) infection. Since Anti Retroviral Therapy (ART) alone is not enough to reduce the risk of TB in HIV patient, a special interventions are needed, namely Isoniazid Preventive Therapy (IPT). In Indonesia, this strategy has not been fully implemented. Therefore, it is necessary to do a research on protective role of IPT against the incidence of TB in HIV/AIDS patients. Objective: To determine the protective role of IPT in the incidence of TB in patients with HIV/AIDS at the Voluntary and Counseling Test (VCT) Clinic at Sanglah Hospital, Denpasar from 2014 to 2016. Methods: An observational analytic study with retrospective cohort design was done. All patients who were on HAART therapy and received IPT within the study period were included. The research population were HIV patients who were enrolled in ART follow-up care. Result: The study found a significant protection effects of IPT on TB incidence [RR: 2.05; 95% IK 1.78-2.37; p=0.02). There was no TB incidence at patients who have received IPT. Conclusion: Isoniazid Preventive Therapy (IPT) has a significant protection effect on TB incidence. Keywords: IPT, Risk of TB, HIV infection.

ART Adherence Among People Living with HIV Seeking Services from Public Health Facilities in Western Ethiopia.

BackgroundThe burden of COVID-19 is more severe among the elderly and patients affected with chronic medical conditions like diabetes, cardiovascular diseases, and HIV/AIDS. There is no study regarding the level of adherence to antiretroviral therapy (ART) during the time of COVID-19 in Ethiopia. So, this study aimed to assess the level of HIV positive patient’s adherence to ART treatment and associated factors in Nekemte public health facilities, Western Ethiopia.MethodsThis study was conducted in Nekemte public health facilities, Western Ethiopia from August 1, 2020 to September 30, 2020. A facility-based cross-sectional study was employed among HIV positive patients on ART treatment. A single proportion formula was used to calculate a sample size of 384 . A systematic random sampling technique was employed to select the sample population. Face-to-face interview questionnaires were used during data collection. A binary logistic regression model was fitted to identify factors associated with dependent factor, and an adjusted odds ratio (AOR) was used to estimate the strength of the association between dependent and independent variables.ResultsA total of 361 HIV positive patients have participated in the study, yielding a response rate of 94%. The mean age of the participants was 33.8 (SD ±9.8) years. Seventy-seven (21.3%) HIV-positive patients had not adhered to ART follow-up. The study found that living in rural areas (AOR=3.37, 95% CI=1.80–6.24), age less than 25 years (AOR=3.41, 95% CI=1.26–9.21), and substance use (AOR=5.42, 95% CI=1.8–16.29) were independent predictors of poor adherence to ART.ConclusionGenerally, non-adherence to antiretroviral treatment among people living with HIV during the pandemic outbreak was high in the study area. A home-based delivery of ART treatment and improving retention mechanism during pandemics is highly recommended for concerned bodies. In addition, counseling on avoidance of substance use should be strengthened to increase retention on treatment.

Incidence and Predictors of Severe Adverse Drug Reaction Among Patients on Antiretroviral Therapy in Tigray, Ethiopia: A Retrospective Cohort Study.

BackgroundThe aim of the present study was to assess the incidence and predictors of severe adverse drug reactions among patients on antiretroviral therapy (ART) in Tigray, North Ethiopia.MethodsWe employed four years retrospective cohort study using a structured data extraction sheet. The study populations were HIV patients on ART follow-up from January 2017 to February 2020 in the study area. Severe adverse drug reaction (ADR) was an outcome variable and defined as having any one of the complaints related to ARV drug reaction due to regimen change, discontinuation, and/or in-patient care. Data were collected using a structured data extraction sheet. A Cox proportional hazard regression model was used to determine the relationship between the predictors and the outcome variable. The mean survival time of the cohort was estimated using the Kaplan–Meier method.ResultsThe incidence rate of ADRs was 3.6 (95%CI: 2.9–4.35) per 100-person years. HIV patients with no formal education (adjusted hazard ratio=1.58, 95%CI: 1.03–2.41), with experience of regimen change (adjusted hazard ratio=1.59, 95%CI: 1.12–2.91), who ever took other medication (adjusted hazard ratio=1.49, 95%CI: 1.05–2.15) and with lower body mass index (adjusted hazard ratio=3.24, 95%CI: 1.18–4.91) were more likely to develop severe adverse drug reaction.ConclusionADRs were diagnosed an inconsiderable number of HIV patients on ART and factors were patient and drug-related. To minimize it, special attention is sought for patients with no formal education, previous regime change, whoever took other medication, and who have lower body mass index levels.

Survival of HIV/AIDS patients treated under ART follow-up at the University hospital, northwest Ethiopia

IntroductionThe survival of HIV/AIDS patients on antiretroviral therapy (ART) is determined by a number of factors, including economic, demographic, behavioral, and institutional factors. Understanding the survival time and its trend is crucial to developing policies that will result in changes. The aim of this study was to compare the survival estimates of different subgroups and look into the predictors of HIV/AIDS patient survival.MethodsA retrospective cohort study of HIV/AIDS patients receiving ART at the University of Gondar teaching hospital was carried out. To compare the survival of various groups, a Kaplan-Meier survival analysis was performed. The Cox proportional hazards model was used to identify factors influencing HIV/AIDS patient survival rates.ResultsIn the current study, 5.91% of the 354 HIV/AIDS patients under ART follow-up were uncensored or died. Age (HR = 1.051) and lack of formal education (HR = 5.032) were associated with lower survival rate, whereas family size of one to two (HR = 0.167), three to four (HR = 0.120), no alcoholic consumption (HR = 0.294), no smoking and chat use (HR = 0.101), baseline weight (HR = 0.920), current weight (HR = 0.928), baseline CD4 cell count (HR = 0.990), baseline hemoglobin (HR = 0.800), and no TB diseases were associated with longer survival rate.ConclusionsFewer deaths were reported in a study area due to high patient adherence, compared to previous similar studies. Age, educational status, family size, alcohol consumption, tobacco and chat usage, baseline and current weight, baseline CD4 cell count, baseline hemoglobin, and tuberculosis (TB) diseases were all significant predictors of survival of HIV/AIDS patients.

Long-term virological outcomes in women who started option B+ care during pregnancy for prevention of mother-to-child transmission of HIV in Dar es Salaam, Tanzania: a cohort study

Option B+ marked a milestone in prevention of mother-to-child transmission (PMTCT) of HIV by recommending lifelong antiretroviral therapy (ART) for all pregnant women with HIV. Nevertheless, concerns remain regarding long-term outcomes in settings with a high HIV burden. We analysed long-term virological outcomes in women enrolled on option B+ in Tanzania. In this prospective cohort study, we extracted data for pregnant women with HIV starting PMTCT care between Oct 1, 2014, and Sept 30, 2016, in routine health-care settings in Dar es Salaam, Tanzania, from national HIV and district health information system databases. We then excluded women who exited study sites before 6 months of ART follow-up and women who did not have a viral load test. Women were followed up until March 8, 2019. We used Poisson generalised estimating equations to examine trends in HIV viral suppression (<400 copies per mL) and virological failure (≥400 copies per mL), reporting relative risks (RRs) and 95% CIs adjusted for maternal age, gestational age, and several clinical characteristics. We identified 15 586 pregnant women with HIV, of whom 10 161 were eligible for follow-up. Women were followed up for a median of 37 months (IQR 31-45) and a maximum of 53 months. The median age at PMTCT initiation was 31 years (IQR 27-35). At PMTCT enrolment, 1245 (17·0%) of 7318 women with available data were in their third trimester, 4901 (48·2%) of 10 161 women started ART at least 1 month before PMTCT enrolment, and 3380 (33·4%) of 10 131 women with available data had advanced HIV. Overall, a viral suppression rate of 88·2% (95% CI 87·8-88·7) was observed over the entire follow-up period, ranging from 85·1% (84·3-85·9) in viral load tests done at 0-11 months to 90·6% (89·7-91·4) at 36 months or longer since PMTCT enrolment. In a complete-case analysis (ie, including patients with <30% missing data; n=7306), the risk of virological failure among women who remained in HIV care decreased over time (adjusted RR 0·87 [95% CI 0·80-0·95] at 12-23 months since PMTCT enrolment; 0·65 [0·59-0·72] at 24-35 months; and 0·63 [0·55-0·71] at ≥36 months vs at 0-11 months). Younger women (aged <20 years: 1·76 [1·40-2·23] vs aged 30-39 years) and those starting PMTCT late in pregnancy (third trimester: 1·28 [1·10-1·50] vs first trimester) or with advanced HIV (1·33 [1·16-1·51] vs without advanced HIV) had increased risk of virological failure. Women who attended an antenatal care facility where more than 50% of attendees received couples HIV testing had a decreased risk of virological failure (adjusted RR 0·81 [0·65-0·99] vs <50% having couples testing). High rates of viral suppression among women starting option B+ who remain in HIV care are sustainable, and might increase, at least up to 53 months. This rate might be further improved by addressing challenges of adolescent mothers, late presenters, and couples HIV testing at antenatal care. Swedish International Development Agency.

Renal function in a cohort of HIV-infected patients initiating antiretroviral therapy in an outpatient setting in Ethiopia.

To evaluate the prevalence and associated factors of abnormal renal function among Ethiopian HIV-infected patients at baseline prior to initiation of antiretroviral therapy (ART) and during follow-up. We conducted a retrospective observational cohort study of HIV infected patients who initiated ART at the outpatient ART clinic of Mehal Meda Hospital of North Shewa, Ethiopia from January 2012 to August 2018. Demographic and clinical data were abstracted from the medical records of patients. Renal function was assessed by estimated glomerular filtration rate (eGFR) calculated using the Modification of Diet in Renal Disease (MDRD) equation. Univariate and multivariate analysis were conducted to determine the factors associated with abnormal renal function at baseline and during follow-up. Among 353 patients, 70 (19.8%) had baseline eGFR <60 ml/min/1.73m2 and 102 (28.9%) had eGFR = 60-89.9 ml/min/1.73m2. Factors associated with baseline renal impairment (eGFR <60 ml/min/1.73m2) included female sex (AOR = 3.52, CI 1.75-7.09), CD4 count < 200 cells/mm3 (AOR = 2.75, CI 1.40-5.42), BMI < 25 Kg/m2 (AOR = 3.04, CI 1.15-8.92), low hemoglobin (AOR = 2.19, CI 1.16-4.09) and high total cholesterol (AOR = 3.15, CI 1.68-5.92). After a median of 3.0 years of ART, the mean eGFR declined from 112.9 ± 81.2 ml/min/1.73m2 at baseline to 93.9 ± 60.6 ml/min/1.73m2 (P < 0.001). The prevalence of renal impairment increased from 19.8% at baseline to 22.1% during follow-up. Of 181 patients with baseline normal renal function, 49.7% experienced some degree of renal impairment. Older age (AOR = 3.85, 95% CI 2.03-7.31), female sex (AOR = 4.18, 95% CI 2.08-8.40), low baseline CD4 (AOR = 2.41, 95% CI 1.24-4.69), low current CD4 count (AOR = 2.32, 95% CI 1.15-4.68), high BMI (AOR = 2.91, 95% CI 1.49-5.71), and low hemoglobin (AOR = 3.38, 95% CI 2.00-7.46) were the factors associated with renal impairment during follow-up. Impaired renal function was common in HIV-infected patients initiating ART in an outpatient setting in Ethiopia, and there appears to be a high prevalence of renal impairment after a median ART follow-up of 3 years. There is a need for assessment of renal function at baseline before ART initiation and regular monitoring of renal function for patients with HIV during follow-up.

Risk analysis of immunological failure of antiretroviral therapy in HIV/AIDS patients in Taizhou prefecture, 2006-2019

Objective: To analyze the immunological failure of antiretroviral therapy (ART), its association with baseline anemia and related factors in HIV/AIDS patients in Taizhou prefecture, during 2006-2019. Methods: A retrospective cohort study was conducted among HIV/AIDS patients under ART. Cox regression model was used to analyze predictors of immunological failure and logistic regression model was used to analyze factors of baseline anemia. Results: A total of 2 904 HIV/AIDS patients were enrolled with a median time of 28 (P(25)-P(75):12-53) months follow-up of ART, in which 177 cases (6.1%) were identified as immunological failure with a failure rate of 2.17 per 100 person-years. The cumulative incidence rates of immunological failure in the first, third, fifth, and tenth years were 5.49%, 6.94%, 7.30% and 8.82%, respectively. Results of multivariate logistic regression analysis showed that for the risk of baseline anemia, ≥66 years old group had 4.17 times higher risk than 18-25 years old group (95%CI: 1.68-10.33), males had 0.67 times higher risk than females (95%CI: 0.50-0.89), and CD(4)(+)T cell counts (CD(4))<200 cells/μl group had 4.35 times higher risk than CD(4)≥350 cells/μl group (95%CI: 2.81-6.72), baseline white blood cells<4.0×10(9) cells/L group had 1.73 times higher risk than 4.0×10(9) cells/L-9.9×10(9) cells/L group (95%CI: 1.31-2.29), baseline platelet counts <100×10(9) cells/L and >300×10(9) cells/L groups had 2.02 times and 4.45 times higher risk than 100×10(9) cells/L-299×10(9) cells/L group (95%CI: 1.36-3.01, 95%CI: 3.05-6.50), respectively. WHO classified stage Ⅲ/Ⅳ group had 2.15 times higher risk than WHO classified stageⅠ/Ⅱ group (95%CI: 1.61-2.87), while heterosexual transmission group had 2.03 times higher risk than homosexual transmission group (95%CI: 1.42-2.92). Results of multivariate cox proportional risk regression showed that for the risk of immunological failure, baseline anemia group had 1.77 times higher risk than no anemia group (95%CI: 1.20-2.60), WHO classified stage Ⅲ/Ⅳ group had 1.66 times higher risk than WHO classified stage Ⅰ/Ⅱ group (95%CI: 1.10-2.48), and withdrawal of follow up and death groups had 3.18 times and 4.61 times higher risks than treatment group (95%CI: 1.96-5.19, 95%CI: 2.98-7.13), respectively. Conclusions: The immunological effect of ART among HIV/AIDS patients in Taizhou prefecture was affected by multiple factors, including anemia, clinical stage and follow-up status. Enhancing surveillance of baseline anemia and timely correction of anemia in elder group can help improve treatment outcome of HIV/AIDS patients.

Knowledge, practice and correlates of sleep hygiene among people living with HIV/AIDS attending anti-retroviral therapy at Zewditu Memorial Hospital, Addis Ababa, Ethiopia: a cross-sectional study

BackgroundSleep hygiene is a series of behavioral practices that can be performed by individuals with sleep complaints to prevent or reverse sleep difficulties. The feasibility, cost-effectiveness, absence of side effects and immediate responses to sleep problems make sleep hygiene practices more applicable than other treatment options for people living with HIV/AIDS. However, there is no evidence regarding sleep hygiene awareness and its practice in people with HIV/AIDS in Ethiopia.ObjectivesThis study aimed to assess the knowledge, practice and correlates of sleep hygiene among adults attending outpatient anti-retroviral treatment at Zewditu Memorial Hospital.MethodsThis was an institutional based cross-sectional study conducted from 1st of May to 16th of June 2018 amongst people attending anti-retroviral therapy follow-up at Zewditu Memorial Hospital. Systematic random sampling technique was used to recruit a total of 396 study participants. Data were collected using interviewer-administered questionnaire. The Sleep Hygiene Index was used to measure the level of sleep hygiene of study participants. Binary logistic regression analysis was conducted to identify factors associated with sleep hygiene practice. In the multi-variable analysis, variables with P-values of less than 0.05 were considered as significant correlates of sleep hygiene practice with 95% confidence interval.ResultsThe findings of this study showed that there are limitations regarding the knowledge and practice of sleep hygiene of people with HIV/AIDS in Ethiopia. None of the participants attended training regarding sleep hygiene. More than half (51.3%) had poor sleep hygiene practice. Female sex [AOR = 5.80:95% CI (3.12, 10.7)], being single [AOR =2.29:95% CI (0.13, 9.51)], depression [AOR = 2.93: 95% CI (1.73, 4.96)] and current khat use [AOR = 3.30; 95% CI (1.67, 6.50)] were identified as statistically significant correlates of poor sleep hygiene practice.ConclusionsKnowledge regarding sleep hygiene is poor, and its practices are incorrect amongst people living with HIV/AIDS in Ethiopia. These findings demonstrate a need for professionals to play a major role in addressing this problem by integrating sleep hygiene as an added treatment modality to the HIV/AIDS care service. Designing training programs and awareness creation strategies for people with HIV/AIDS to improve their sleep hygiene practice is also highly recommended.

Protein Status and CD4+ Cell Count in HIV Patients on Highly Active Anti-Retroviral Therapy

Background of Study: Malnutrition is associated with repeated opportunistic infections, rapid disease progression, and an increase in the incidence of human immunodeficiency virus (HIV) related mortality. The ability of anti-retroviral therapy (ART) in boosting the immune system depends on the nutritional status of the HIV patient. Aim: The study aimed at investigating the protein status and CD4+ cell counts in HIV patients taking highly active ART. Materials and Methods: The case-control study comprising of a total of 80 participants, compared the protein status and CD4+ cell count among baseline (ART-naïve n=20), switch (ART-resistant n=20), ART follow-up (n=20) patients, and apparently healthy controls (n=20). Results: The total protein of baseline patients was significantly (P&lt;0.01) higher than that of the switch, follow-up, and controls. The CD4+ cell count of baseline patients was significantly (P=0.000) low compared to follow-up patients and controls. Total protein level and CD4+ cell count of switch patients were significantly (P=0.000) lower than that of follow-up patients and controls. Total protein of follow-up patients was significantly (P&lt;0.02) higher than that of controls, while the CD4+ cell count of follow-up patients was significantly (P=0.000) lower than that of controls. Conclusion: The present study observed low protein along with low CD4+ cell count in switch patients, while a good outcome was observed in follow up patients.

Bayesian Modelling on Incidence of Pregnancy among HIV/AIDS Patient Women at Adare Hospital, Hawassa, Ethiopia

HIV/AIDS is the most serious diseases human kind has ever faced and a public problem, particularly, for women of childbearing age. For HIV infected women, the prospects of getting pregnant and having an HIV negative baby could be significantly improved with the increasing of the availability of Antiretroviral Therapy (ART). Even though, ART treatment has shown significant effect of clinical importance to reduce the risk of mother to child transmission of HIV but, HIV infected Women remain poorly understood or they fear to be pregnant and having HIV negative child. To the authors’ knowledge, no study examined incidence of pregnancy among women on ART follow-up in Ethiopia. In response, we conducted a study to explore the incidence and potential predictors of pregnancy. The objective of this study was to investigate the incidence of pregnancy among HIV/AIDS patient women under ART follow-up. A retrospective cohort study was conducted based on secondary data that reviews or visits medical chart of HIV/ADIS patient women aged 15-49 years under ART follow-up from April 2008 to February 2015. Out of 720 total patient women, a sample of size 328 was selected by using simple random sampling technique. Bayesian estimation were used for binary logistic regression model to identify the significant factors of incidence of pregnancy. The Gibbs sampler algorithm was implemented by WinBUGS software to solve approximate properties of the marginal posterior distributions for each parameter in Bayesian estimation. The results of this study revealed 21.3% of women got pregnancy during the follow-up. From Bayesian logistic regression analysis, significant predictors of incidence of pregnancy were: WHO clinical stage, marital status, contraception use, number of child alive before ART follow-up, CD4 cell count, time of Antiretroviral Therapy (ART) follow-up, educational level, spouse's HIV status, occupation and age (at p=0.05). In this study, when age of the women increased, the probability of becoming pregnant was decreased and advanced WHO clinical stage were associated with decreased incidence of pregnancy. Time on ART was a strong predictor of becoming pregnant: longer time on ART was associated with increased probability of becoming pregnant. Educational level of women was positively related with incidence of pregnancy that is, women who had college and above educational level was more likely to become pregnant. When CD4 count increased, incidence of pregnancy also increased and married women had more chance to become pregnant. The predictors identified in this study can be used to care for those HIV/AIDS patient women who want to have baby.

Health Provider Perspectives of Health Facility Preparedness and Organization in Implementation of Option B+ among Pregnant and Lactating Women in Central Uganda: A Qualitative Study.

Introduction:Uganda adopted Option B+ for prevention of mother-to-child transmission (PMTCT) of HIV in 2012. However, there is limited data on preparedness and organization of Option B+ services. These data are critical in informing PMTCT programs and provision of universal antiretroviral therapy (ART) for all populations. This study explored health providers’ experiences of preparedness and organization of Option B+ services in Central Uganda.Methods:Key informant interviews with 54 health providers from 6 health facilities in 3 districts were conducted. Thematic approach was employed to analyze data.Results:Themes identified on preparedness were training of frontline health providers and provision of Option B+ guidelines, supervision and mentorship, and provision of essential medicines and medical health supplies, whereas those concerning organization were HIV counseling and testing, ART initiation, follow-up, and patient support mechanisms. Innovations like use of expert clients, assessing women’s readiness to start Option B+, and retaining women in antenatal care clinic depending on the need are important in provision of Option B+.Conclusion:This study provides insights into preparedness and organization of Option B+ services which are important in provision of Option B+ and universal ART for all populations. Research around models of follow-up is recommended.