Despite global progress in reducing HIV-related morbidity and mortality, preventable deaths persist, particularly in sub-Saharan Africa. Ethiopia has achieved near-universal antiretroviral therapy (ART) coverage, yet survival outcomes and predictors of mortality in the era of 'test and treat' remain underexplored. This study examined survival rates and predictors of mortality among people living with HIV (PLHIV) on ART in Ethiopia between 2016 and 2023. We conducted a retrospective open cohort study. 65 public health facilities across Ethiopia. Kaplan-Meier survival analysis and multivariable Cox proportional hazards regression were applied. Statistical significance was set at p<0.05. The analysis included 33 416 PLHIV enrolled in care and treatment from 2016 to 2023. In the current study, baseline is defined as the start date of ART treatment. The primary outcome was survival status at the end of follow-up, defined as death versus alive. Among 33 416 PLHIV, 2659 deaths (8.6%) were documented during 85 972 person-years of follow-up, yielding a mortality incidence rate of 3.09 per 100 person-years. Most deaths occurred within the first 12 months of ART initiation. Independent predictors of mortality included age (≥35 years), bedridden (AHR 2.46, 95% CI 1.78 to 3.40) and ambulatory status (AHR 2.33, 95% CI 1.84 to 2.95), WHO stage IV (AHR 1.40, 95% CI 1.02 to 1.91), having opportunistic infections (AHR 1.41, 95% CI 1.13 to 1.76) and baseline CD4 <200 cells/mm³ (AHR 3.08, 95% CI 2.31 to 4.09). Receipt of tuberculosis preventive therapy (TPT) was protective (AHR 0.36, 95% CI 0.30 to 0.43). The results show that many people appear to start ART late. Factors such as impaired functional status, the presence of opportunistic infections and older age appear to have further compounded risk, while TPT appears to be strongly protective. Improving early diagnosis, timely ART initiation and TPT uptake could further support better outcomes.

Loss to follow-up (LTFU) from antiretroviral therapy (ART) remains a major public health concern worldwide, including in Ethiopia. However, nationally representative pooled cohort data on LTFU among adults receiving ART are limited. To address this gap, we conducted a meta-analysis to estimate the incidence and identify predictors of LTFU among adults on ART in Ethiopia. This systematic review and meta-analysis adhered to the PRISMA guidelines. Relevant studies were identified through a comprehensive search of multiple databases, including PubMed, CINAHL, Scopus, EMBASE, and Google Scholar. Data analysis for pooled estimates of incidence and predictors was performed using STATA version 17 with the DerSimonian and Laird random-effects model. Heterogeneity was assessed using Cochrane’s Q-test and the I² statistic, while publication bias was evaluated using funnel plots and Egger’s test. Out of 1,245 studies identified, 24 met the inclusion criteria, comprising a total of 24,637 participants. The pooled incidence rate of LTFU among adults on ART was 8 per 100 person-years (95% CI: 7–10), and the pooled median time to LTFU was 27.77 months (95% CI: 19.22–36.32). Moreover, variation in study sample size (R² = 34.10%) contributed substantially to the high level of heterogeneity among the included studies. Predictors of LTFU included not receiving isoniazid prophylaxis (HR = 1.39, 95% CI: 1.30–1.49), fair or poor ART adherence (HR = 1.56, 95% CI: 1.49–1.64), WHO clinical stages III–IV (HR = 1.29, 95% CI: 1.21–1.38), undisclosed HIV status (HR = 1.34, 95% CI: 1.24–1.45), CD4 count < 200 cells/mm³ (HR = 1.28, 95% CI: 1.19–1.33), BMI < 18.5 kg/m² (HR = 1.34, 95% CI: 1.27–1.43), and age 15–24 years (HR = 1.31, 95% CI: 1.22–1.41). The median time to LTFU among adults on ART in Ethiopia was close to the national target, suggesting the need to enhance retention strategies. Targeted interventions should focus on young adults, undernourished patients, and those with poor adherence. Strengthening adherence support and preventive care, including isoniazid prophylaxis, is essential to improve ART retention outcomes.

ObjectiveTo estimate the pooled attrition rate among HIV-infected children receiving antiretroviral therapy (ART) and identify predictors of attrition in Ethiopia.DesignSystematic review and meta-analysis.Data sourcesPubMed, HINARI, Web of Science, African Journals Online and Google Scholar were searched up to 20 February 2025.Eligibility criteriaCohort studies conducted in Ethiopia that reported attrition from ART and its predictors among children, published as full-length articles in English, were included.Data extraction and synthesisThree independent reviewers extracted data and assessed study quality using the Joanna Briggs Institute checklist for cohort studies. Heterogeneity was assessed using the I² statistic. Publication bias was evaluated with funnel plots and Egger’s test. A random-effects model was applied to estimate the pooled attrition rate.ResultsAmong 1093 studies identified, 14 met the inclusion criteria and were included in the analysis. The pooled attrition rate among HIV-infected children receiving ART was 6.04 per 100 person-years of observation (95% CI 4.90 to 7.44). Anaemia (HR=3.39; 95% CI 2.40 to 4.78), suboptimal ART adherence (HR=2.33; 95% CI 1.39 to 3.89) and underweight status (HR=3.43; 95% CI 2.04 to 5.78) were significantly associated with higher attrition.ConclusionsThe pooled attrition rate among HIV-infected children receiving ART in Ethiopia is relatively low. Nevertheless, enhanced counselling on ART adherence is crucial to further reduce attrition, and special attention should be given to children with anaemia or underweight status.PROSPERO registration numberCRD420251015059.

Recently, dolutegravir (DTG) has been associated with weight gain, dyslipidemia, and hyperglycemia, which in turn raise(s) the risk of hypertension. However, little is known about the burden of hypertension among people living with HIV (PLHIV) taking DTG-based therapy in Ethiopia. This study aimed to assess the prevalence and factors associated with hypertension among PLHIV taking DTG-based therapy. We conducted a cross-sectional study on 415 selected PLHIV aged 18 years or older who had been on DTG-based therapy for at least six months at the antiretroviral therapy (ART) clinic of Dessie Comprehensive Specialized Hospital from February 5 to April 5, 2023. Participants with a diagnosis of hypertension before DTG-based ART initiation, pregnant women, and patients who were seriously ill and unable to respond were excluded from the study. Data on sociodemographic, behavioral, and clinical characteristics were collected using a structured questionnaire and patient chart review. Blood pressure, anthropometric, and biochemical measurements were done. Hypertension was defined as systolic and/or diastolic blood pressure ≥ 140 mmHg and 90 mmHg, respectively. A multivariable logistic regression was carried out to determine factors associated with hypertension. Variables with a p-value < 0.05 were considered statistically significant. The prevalence of hypertension was 15.2% (95% CI: 11.9–19). Sex (AOR = 3.01, 95% CI: 1.56–5.79, p = 0.001), duration of taking DTG-based therapy (AOR = 3.61, 95% CI: 1.72–7.59, p = 0.001), family history of hypertension (AOR = 3.51, 95% CI: 1.54–8.04, p = 0.003), body mass index (BMI) (AOR = 1.92, 95% CI: 1.02–3.64, p = 0.044), and fasting blood glucose level (FBG) (AOR = 2.33, 95% CI: 1.01–5.39, p = 0.047) were significantly associated with hypertension among PLHIV on DTG-based ART in Ethiopia. Hypertension is not uncommon in PLHIV taking DTG-based therapy. Sex, duration of taking DTG-based therapy, family history of hypertension, BMI, and FBG levels were significant correlates of hypertension among PLHIV taking DTG-based therapy. These findings highlight the need for routine hypertension screening and lifestyle interventions for PLHIV on DTG-based therapy, particularly among males, those with prolonged use of DTG-based therapy, a family history of hypertension, elevated BMI, or increased FBG.

Aim: This study aimed to assess the prevalence of hypertension and diabetes and the factors associated with these conditions in adult patients living with human immunodeficiency virus (HIV). It also aimed to assess their self-management skills for these chronic conditions, as effective self-management is critical to improving health outcomes and enhancing quality of life for individuals managing multiple health challenges. Methods: A cross-sectional, facility-based study was conducted in May and June 2022. We randomly selected 520 adult people living with HIV attending antiretroviral therapy clinics in three hospitals in Southern Ethiopia. Nine trained nurses collected data using a pre-tested structured questionnaire, and SPSS version 20 was employed for analysis. A logistic regression model was utilized to identify factors associated with chronic comorbidities in HIV. Results: The mean age of participants was 38.7 ± 9.01 years, with diabetes and hypertension prevalence at 1.5% [95% CI: (0.70, 3.00)] and 9% [95% CI: (7.10, 12.30)], respectively. Chronic comorbidities such as hypertension and diabetes were significantly associated with age 35–54 years [adjusted odds ratio (AOR) = 3.54, 95% CI: (1.46, 8.74)], 55 years and older [AOR = 7.66, 95% CI: (2.29, 25.50)], and overweight or obesity [AOR = 2.82, 95% CI: (1.00, 7.93)]. The overall HIV self-management score was 42 ± 3.92 out of 60, with the lowest mean score (1.69 ± 0.92) in the social support domain. Conclusions: The prevalence of diabetes and hypertension was relatively low in our study. In Ethiopia, self-management skills appear low, and the limited understanding of self-management concepts raises questions about the validity of the self-management scale, potentially leading to inaccurate skill assessments.

In many low- and middle-income countries, including Ethiopia, dolutegravir (DTG)-based regimens are the preferred first-line regimens for people living with HIV (PLWH). However, there are concerns about hyperglycemia and, in certain circumstances, diabetes mellitus in individuals who have switched to DTG. To assess the prevalence and factors associated with hyperglycemia among PLWH on DTG-based antiretroviral therapy (ART). An institutional-based cross-sectional study. The study was carried out from December 1, 2021 to February 30, 2022, and included 423 participants who were recruited via a simple random sampling technique. We enrolled PLWH aged 18 years or older who had been on DTG-based ART for more than 6 months. Data were collected by using an interviewer-administered structured questionnaire, medical card review, physical measurement, and biochemical measurements. Hyperglycemia was defined as a fasting blood glucose level ⩾110 mg/dl. Multivariable logistic regression was used to identify factors associated with hyperglycemia, using SPSS version 26.0 software. Variables with a p-value of <0.05 were considered statistically significant. The prevalence of hyperglycemia among PLWH receiving DTG-based ART was 12.1% (95% CI: 9.2-15.1). Age (AOR = 1.04, 95% confidence interval (CI): 1-1.08, p = 0.036), BMI (AOR = 1.09, 95% CI: 1.01-1.17, p = 0.022), and triglyceride level (AOR = 2.44, 95% CI: 1.28-4.64, p = 0.006) were significant predictors of hyperglycemia among PLWH on DTG-based ART. Overall, our study revealed a high prevalence of hyperglycemia (12.1%) among PLWH receiving DTG-based ART. Age, BMI, and triglyceride levels were significant predictors of hyperglycemia. These findings underscore the importance of monitoring blood glucose levels in PLWH receiving DTG-based ART, with a special emphasis on patients with advanced age, increased BMI, and increased triglyceride levels.

The global prevalence of poor anticoagulation control with warfarin therapy is high. Similarly, the quality of anticoagulation control with warfarin therapy in Ethiopia has been reported to be poor, with a notable paucity of data, especially in the western part of the country. This study aimed to evaluate the anticoagulation quality, and associated factors among adult outpatients on warfarin therapy at Wallaga University Referral Hospital and Nekemte Comprehensive Specialized Hospital, Nekemte town, Western Ethiopia. A retrospective study was conducted at public hospitals in Nekemte town from June 1 to 31 July 2023. Data were collected by reviewing patients' medical charts using a systematic random sampling technique. Time in the therapeutic range was determined using the Rosendaal method. The collected data were entered into EpiData version 4.6.0 and then exported to SPSS version 27.0 for analysis. Bivariable and multivariable logistic regression analyses were performed to identify significant associations. In the multivariable analysis, statistical significance was declared at a p-value of less than 0.05. A total of 402 patient medical charts with warfarin indications were reviewed. The mean age of the study participants was 38.9 ± 17.9years, and 271 (67.4%) were female. Good warfarin anticoagulation quality was observed in 36 (9%) of the patients. Aspirin use (AOR = 2.685; CI: 0.872-10.277; p-value = 0.002) and congestive heart failure (AOR = 4.392; CI: 1.028-18.768; p-value = 0.046) were identified as independent predictors of poor anticoagulation quality. Aspirin use and congestive heart failure were independent predictors of poor anticoagulation quality with warfarin therapy.

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...

Introduction: Diabetes mellitus (DM) is an important chronic comorbid condition that occurs in people living with the human immunodeficiency virus (HIV). It is associated with increased morbidity and mortality. Many cases of comorbidities with diabetes mellitus have been reported, particularly in areas of the world where the prevalence of HIV is high. The rate of diabetes hospitalizations among HIV-infected individuals increased from 3.9 to 8.4 per 100 hospitalizations. Although the cost of HIV care has increased, the burden of DM among people living with HIV has economic consequences. Objectives: This study aimed to assess the incidence of DM among HIV patients receiving ART in the Asella Referral and Teaching Hospital, Oromia Regional State, Ethiopia. Methods: Ten years retrospective follow-up study was conducted among 268 HIV patients receiving ART at Asella Referral and Teaching Hospital. HIV patients receiving ART between January 01/2013 and Dec 31/2022 were enrolled in this study. A systematic sampling technique was used to select patients’ medical charts. Data were extracted from the patients’ medical chart records from March 21 to March 23, 2023, using a data extraction format. Data were entered into Epi Data version 4.6.0.0, and exported to STATA version 14.2 for statistical analysis. Results: A total of 268 medical charts of HIV patients receiving ART were included in the final analysis, which provided a response rate of 98.52%. The mean age of participants was 38.17 years. Among 268 HIV patients followed for 10 years, 142 (52.99%) were female, 33(49.63%) were aged between 30-40 years. Approximately 154 (57.46%) of them were urban residents. The incidence density rate (IDR) of DM in the cohort of HIV patients receiving ART during 1291.33 person-year observation was 6.20 per 1000 [95% CI: 3.10, 12.39] person-years. The cumulative incidence proportion of DM among HIV patients receiving ART was 2.99% [95% CI: 1.49, 5.88] within the 10 years follow-up period. Conclusion: The incidence of DM among HIV patients receiving ART was relatively high. It is important to emphasize HIV patients receiving ART for early screening of DM among these patients.

PurposeThis study aimed to assess the burden of metabolic syndrome among people living with HIV (PLWH) on dolutegravir (DTG)- and efavirenz (EFV)-based regimens.MethodsA hospital-based comparative cross-sectional study design was implemented from May 5, 2022, to August 5, 2022.ResultsThe overall prevalence of metabolic syndrome was 18.6% (32/172) for all regimens, with 25.6% (22/86) for the DTG- and 11.6% (10/86) for the EFV-based regimens (P = .019). Body mass index ≥ 25 kg/m2 (adjusted odds ratio [AOR] = 3.04; 95% confidence interval [CI]: 1.13-8.14), CD4 count ≥ 500 cells/mm3 (AOR = 3.01; 95% CI: 1.09-8.28), insufficient physical activity (AOR = 2.60; 95% CI: 1.00-6.72), and DTG-based regimen (AOR = .86; 95% CI: 1.14-7.20) were associated with metabolic syndrome.ConclusionThe prevalence of metabolic syndrome was significantly higher among PLWH on DTG-based regimens. This signifies that DTG-treated patients should be advised on lifestyle adjustments to prevent the development of metabolic syndrome.

The most common and severe cause of morbidity and mortality among HIV- positive children is opportunistic infections (OIs). All HIV-infected children are at risk of developing a variety of OIs. Healthcare workers, programmers, and other stakeholders are in doubt about using the onset and predictors of OIs among schoolchildren on antiretroviral therapy (ART) due to the presence of conflicting results found in the primary studies. Hence, this study was conducted to provide a single figure of onset and specific predictors of OIs by overcoming the existing heterogeneity in Ethiopia. The included studies were searched from different national and international databases systematically. The included studies were cohort in design and published in English between 2015 and 2022. The data were extracted using a validated Microsoft Excel tool after the quality of the included studies was assured. The extracted data were exported to Stata Version 17.0 for further management and analysis. The presence of heterogeneity across studies was checked using the Chi-square test and quantified using the I 2 test. Various methods, including forest plots, publication bias assessment, sensitivity tests, subgroup analysis, and meta-regression, were employed to determine the source of heterogeneity, but none were successful. The overall onset of OIs was estimated by pooling the incidence of primary studies using a random-effects meta-analysis model. The predictors were identified using meta-regression and the presence of significant association was declared using a p-value of 0.05 with 95% CI. The strength of association was reported using an adjusted hazard ratio with 95% CI. Eleven studies were included in this systematic review and meta-analysis. The onset of OIs among schoolchildren on ART in Ethiopia was 5.58 (95% CI: 4.50, 6.67) per 100 children-years of OI-free observations. Those children who had no parents had a 1.41 (95% CI: 1.10, 1.80) times higher chance of getting OIs when compared with those children having one or both parents. Children who had poor ART adherence had a 2.96 (95% CI: 1.66, 5.29) times higher chance of experiencing OIs than children who had good ART adherence. Finally, the chance of experiencing OIs among rural children was 2.15 (95% CI: 1.63, 2.83) times higher than their counterparts in Ethiopia. Three in every 33 schoolchildren on ART developed OIs in Ethiopia. Predictors of OIs included schoolchildren without parents, those with poor adherence to ART, and rural residents. This suggests that social support, medication adherence, and access to healthcare services may play important roles in preventing and controlling OIs among schoolchildren living with HIV in rural areas.

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...

Despite effectiveness of antiretroviral therapy in reducing mortality of opportunistic infections among HIV infected children, however tuberculosis (TB) remains a significant cause for morbidity and attributed for one in every three deaths. HIV-infected children face disproportionate death risk during co-infection of TB due to their young age and miniatures immunity makes them more vulnerable. In Ethiopia, there is lack of aggregated data TB and HIV mortality in HIV infected children. We conducted an extensive systematic review of literature using Preferred Reporting of Systematic Review and Meta-Analysis (PRISMA) guideline. Five electronic databases were used mainly Scopus, PubMed, Medline, Web of Science, and Google scholar for articles searching. The pooled proportion of TB was estimated using a weighted inverse variance random-effects meta-regression using STATA version-17. Heterogeneity of the articles was evaluated using Cochran's Q test and I2 statistic. Subgroup analysis, sensitivity test, and Egger's regression were conducted for publication bias. This met-analysis is registered in Prospero-CRD42024502038. In the final met-analysis report, 13 out of 1221 articles were included and presented. During screening of 6668 HIV-infected children for active TB occurrence, 834 cases were reported after ART was initiated. The pooled proportion of active TB among HIV infected children was found 12.07% (95% CI: 10.71-13.41). In subgroup analysis, the Oromia region had 15.6% (95%CI: 10.2-20.6) TB burden, followed by southern Ethiopia 12.8% (95%CI: 10.03-15.67). During meta-regression, missed isoniazid Preventive therapy (IPT) (OR: 2.28), missed contrimoxazole preventive therapy (OR: 4.26), WHO stage III&IV (OR: 2.27), and level of Hgb ≤ 10gm/dl (OR = 3.11.7) were predictors for active TB. The systematic review found a higher proportion of active TB in HIV-infected children in Ethiopia compared to estimated rates in end TB strategy. To prevent premature death during co-infection, implement effective TB screening and cases tracing strategies in each follow up is needed.

BackgroundHuman Immunodeficiency Virus (HIV) continues to be the major cause of childhood deaths, particularly in the sub-Saharan African region. In Ethiopia, though several primary studies have been conducted on the incidence of HIV-related child mortality, the pooled incidence density mortality rate among HIV-positive children is unknown. Therefore, this systematic review and meta-analysis aimed to estimate the pooled incidence density mortality rate among HIV-positive children and identify its associated factors in Ethiopia.MethodsWe browsed PubMed, HINARI, Science Direct, Google Scholar, African Journals Online, and cross-references using different search terms to identify articles. Quality appraisal was done using the Joanna Briggs Institute checklist. Meta-package was used to estimate the pooled incidence of mortality and hazard ratio (HR) of predictors. Heterogeneity was tested using the I-square statistics. Publication bias was tested using a funnel plot visual inspection and Egger’s test. Data was presented using forest plots and tables. The random effect model was used to compute the pooled estimate.ResultsThe overall pooled incidence density mortality rate among HIV-positive children was 2.52 (95% CI: 1.82, 3.47) per 100 child years. Advanced HIV disease (hazard ratio (HR): 3.45, 95% CI (Confidence Interval): 2.64, 4.51), tuberculosis co-infection (HR: 3.19, 95% CI: 2.08, 4.88), stunting (3.22, 95% CI: 2.46, 4.22), underweight (HR: 2.71, 95% CI: 1.72, 4.26), wasting (HR: 4.14, 95% CI: 2.27, 7.58), didn’t receive Isoniazid preventive therapy (HR: 3.33, 95% CI: 2.22, 4.99), anemia (HR: 3.03, 95% CI: 2.52, 3.64), fair or poor antiretroviral therapy adherence (HR: 4.14, 95% CI: 3.28, 5.28) and didn’t receive cotrimoxazole preventive therapy (HR: 3.82, 95% CI: 2.49, 5.86) were factors associated with a higher hazard of HIV related child mortality.ConclusionsThe overall pooled incidence density mortality rate among HIV-positive children was high in Ethiopia as compared to the national strategy target. Therefore, counseling on antiretroviral therapy adherence should be strengthened. Regular monitoring of hemoglobin levels and assessment of nutritional status should be done for all children living with HIV. Moreover, healthcare professionals should follow the national HIV treatment guidelines and provide cotrimoxazole preventive therapy and Isoniazid preventive therapy up on the guidelines for children living with HIV.RegistrationRegistered in PROSPERO with ID: CRD42023486902.

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.

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.

At the end of 2022, globally, only 46% of children (aged 0-14 years) on ART had suppressed viral loads. Viral load suppression is crucial to reduce HIV-related deaths. To suppress the viral load at the expected level, children must be retained in ART treatment. Nevertheless, lost to follow-up from ART treatment continues to be a global challenge, particularly, in developing countries. Previously, primary studies were conducted in Ethiopia to assess the incidence of lost to follow-up among HIV-positive children on ART treatment. However, variations have been seen among the studies. Therefore, this systematic review and meta-analysis aimed to estimate the pooled incidence of lost to follow-up among HIV-positive children on ART and identify its associated factors in Ethiopia. We searched PubMed, HINARI, Science Direct, Google Scholar, and African Journals Online to obtain articles published up to November 20, 2023. Critical appraisal was done using the Joanna Briggs Institute checklist. Heterogeneity was identified using I-square statistics. Funnel plot and Egger's tests were used to identify publication bias. Data was presented using forest plots and tables. Random and fixed-effect models were used to compute the pooled estimate. Twenty-four studies were included in the final analysis. The pooled incidence of lost to follow-up among HIV-positive children on ART was 2.79 (95% CI: 1.99, 3.91) per 100-child-year observations. Advanced HIV disease (HR: 2.20, 95% CI: 1.71, 2.73), having opportunistic infection (HR: 2.59, 95% CI: 1.39; 4.78), fair or poor ART treatment adherence (HR: 2.92, 95% CI: 1.31; 6.54) and children aged between 1-5 years (HR: 2.1,95% CI: 1.44; 2.95) were factors associated with lost to follow up among HIV positive children on ART. The overall pooled incidence of lost to follow-up among HIV-positive children on ART is low in Ethiopia. Therefore, counseling on ART drug adherence should be strengthened. Moreover, emphasis has to be given to children with advanced HIV stage and opportunistic infection to reduce the rate of lost to follow up among HIV-positive children on ART. Registered in PROSPERO with ID: CRD42024501071.

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).

BackgroundDespite antiretroviral treatment (ART), the human immunodeficiency virus (HIV) continues to pose a considerable health burden in resource-poor countries. This systematic review and meta-analysis aimed to determine the pooled incidence density of mortality and identify potential predictors among HIV-infected children receiving ART, from studies conducted in various parts of Ethiopia.MethodsA comprehensive database search was made in Excerpta Medica, PubMed, Web of Science, African Journals Online, Google Scholar, and Scopus. We reported results following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020. Excel Spreadsheet and STATA Version 14 software were used for data abstraction and meta-analysis, respectively. Statistical heterogeneity among studies was assessed using I2 statistics. Meta-regression and subgroup analysis were performed to further explore the sources of statistical heterogeneity. Moreover, publication bias and a leave-out-one sensitivity analysis were performed.ResultsTwenty-two articles involving 8,731 participants met inclusion criteria and were included. The pooled incidence density of mortality was 3.08 (95% confidence interval (CI), 2.52 to 3.64) per 100 child years. Predictors of mortality were living in rural areas (hazard ratio (HR), 2.18 [95% CI, 1.20 to 3.98]), poor adherence to ART (HR, 2.85 [ 95% CI, 1.39 to 5.88]), failure to initiate co-trimoxazole preventive therapy (HR, 2.16 [95% CI, 1.52 to 3.07]), anemia (HR, 2.28 [95% CI, 1.51 to 3.45]), opportunistic infections (HR, 1.52 [ 95% CI, 1.15 to 2.00]), underweight (HR, 1.74 [95% CI, 1.26 to 2.41]), wasting (HR, 2.54 [95% CI, 1.56 to 4.16]), stunting (HR, 2.02 [95% CI, 1.63 to 2.51]), World Health Organization classified HIV clinical stages III and IV (HR, 1.71 [95% CI, 1.42 to 2.05]), and Nevirapine-based regimens (HR, 3.91 [95% CI, 3.09 to 4.95]).ConclusionsThis study found that the overall mortality rate among HIV-infected children after ART initiation was high. Therefore, high-level commitment and involvement of responsible caregivers, healthcare providers, social workers, and program managers are of paramount importance to identify these risk factors and thus enhance the survival of HIV-infected children receiving ART.

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.