scholarly journals Efficacy of metronidazole to prevent active pulmonary tuberculosis in people living with HIV/AIDS on highly active anti-retroviral therapy: a prospective cohort study

2020 ◽  
Vol 8 (11) ◽  
pp. 3826
Author(s):  
Ketut Suryana
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Alcohol Consumption ◽  
Pulmonary Tuberculosis ◽  
Prospective Cohort ◽  
People Living With Hiv ◽  
Active Pulmonary Tuberculosis ◽  
Highly Active ◽  
Associated Risk Factors ◽  
Living With Hiv

Background: People living with HIV/AIDS (PLWHA) were more susceptible of Active Pulmonary Tuberculosis (APT) than non-PLWHA. Whether Metronidazole Preventive Therapy (MPT) may prevent APT, remain unclear. The objective of the study was to investigate efficacy of MPT and other associated risk factors of APT among PLWHA on Highly Active Anti Retroviral Therapy (HAART).Methods: A prospective cohort study included 182 PLWHA on HAART and asymptomatic tuberculosis (TB), 62 received MPT (first group) and 120 PLWHA did not receive MPT (second group). APT were diagnosed among the first group (4 participants) and the second group (26 participants). Monthly visit to replenish pills and to confirm APT. Efficacy of MPT to prevent APT, socio-demography and laboratory, were analyzed using Chi-square with significancy p<0.05.Results: Of 112 participants (62.20%) were males, 70 (37.80%) females, mean age (year) 37.31±9.83. Four (2.20%) of participants (first group) and 26 (14.47%) (second group) were confirmed APT (p=0.003). In bivariate analysis, sex (p=0.020), alcohol consumption (p=0.000); smoking (p=0.000), CD4 cell counts (<70 cell/µl) (p=0.001), previous history of TB (p=0.000) were the significant factors associated with APT. Participants who received MPT had a significantly lower risk of APT than participants who did not receive MPT (p=0.003). Other factors; weight, Hb, WBC, neutrophil, lymphocyte, Neutrophil Lymphocyte Ratio (NLR) were not significantly associated with APT.Conclusions: We found, a significant protective effect of MPT, prevent APT. Other significant associated risk factors of APT were sex (male), smoking, alcohol consumption, previous TB history, lower CD4 counts.

scholarly journals Immunological and virological discordance among people living with HIV on highly active antiretroviral therapy in Tigray, Northern Ethiopia

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Genet Gebrehiwet Hailu ◽  
Araya Gebreyesus Wasihun
Keyword(s):  
Risk Factors ◽  
Treatment Adherence ◽  
Highly Active Antiretroviral Therapy ◽  
Cd4 Count ◽  
People Living With Hiv ◽  
Northern Ethiopia ◽  
Highly Active ◽  
Associated Risk Factors ◽  
Study Participants ◽  
Living With Hiv

Abstract Background People living with human immunodeficiency virus (HIV) with immuno-virological discordant responses are at an increased risk to develop acquired immunodeficiency syndrome (AIDS) and severe non AIDS events which are risk factors for death. This study was aimed to assess prevalence of immuno- virological discordant responses and associated risk factors among highly active antiretroviral therapy (HAART) users in Tigray, Northern Ethiopia. Methods A cross sectional study was conducted from September to December 30, 2016 on 260 people living with HIV who started first line HAART from January 2008 to March 2016 at Mekelle hospital and Ayder comprehensive specialized hospital. Baseline and follow-up clinical data and CD4+ result were collected from patient charts. Besides, socio-demographic data and blood samples for CD4 + count and viral load measurement were collected during data collection period. Fisher’s exact test, bivariate and multivariate logistic regressions were used for data analysis. P-value < 0.05 with 95% CI was considered as statistically significant. Result Among the 260 study participants, 8.80% (95% Confidence Interval (CI) =8.77–8.84%) and 2.70% (95% CI = 2.68–2.72%) had virological and immunological discordant responses, respectively with an overall immuno-virological discordance response of 11.50% (95% CI = 11.46–11.54%). The median age of the study participants at HAART initiation was 35 (IQR: 28–44 years). More than half (58.1%) of the study participants were females. Age at or below 35 years old at HAART initiation (AOR ((95% CI) = 4.25(1.48–12.23), p = 0.007)), male gender ((Adjusted Odds Ratio (AOR) (95% CI) =1.71(1.13–1.10), p = 0.029)), type of regimen given ((AOR(95% CI) = 0.30 (0.10–0.88), p = 0.028)) and good treatment adherence ((AOR (95% CI) = 0.12 (0.030–0.0.48), p = 0.003)) were associated risk factors for virological discordant response. Likewise, immunological discordant response was associated with tuberculosis co-infections (p = 0.016), hepatitis B virus co-infections (p = 0.05) and low CD4+ count (≤100 cells/μl) at baseline (p = 0.026). Conclusions Over all, immuno-virological discordance response was 11.5% in the study area. Males, low baseline CD4+ count, poor/fair treatment adherence, and TB and HBV co-infections were significantly associated with higher immuno-virological discordance. We recommend that decision of patient treatment outcome, regimen change and patient management response should be done using trends of both viral load and CD4+ count concurrently.

scholarly journals Multilevel of Factors Affected Optimal Adherence to Antiretroviral Therapy and Viral Suppression Amongst HIV-infected Prisoners in South Ethiopia: A Prospective Cohort Study

2021 ◽  
Author(s):  
Terefe Gone Fuge ◽  
George Tsourtos ◽  
Emma R Miller
Keyword(s):  
Cohort Study ◽  
Antiretroviral Therapy ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Viral Suppression ◽  
People Living With Hiv ◽  
South Ethiopia ◽  
Pharmacy Refill ◽  
Living With Hiv ◽  
Optimal Adherence

Abstract ObjectivesMaintaining optimal adherence and viral suppression in people living with HIV (PLWHA) is essential to ensure both preventative and therapeutic benefits of antiretroviral therapy (ART). Prisoners bear a particularly high burden of HIV infection and are highly likely to transmit to others during and after incarceration. However, the level of treatment adherence and viral suppression in incarcerated populations in low-income countries is unknown. This study aimed to determine the prevalence of non-adherence and viral failure, and contributing factors amongst prisoners in South Ethiopia. MethodsA prospective cohort study was conducted between June 1, 2019 and May 31, 2020 to compare the level of adherence and viral suppression between incarcerated and non-incarcerated PLWHA. The study involved 74 inmates living with HIV (ILWHA) and 296 non-incarcerated PLWHA. Background information (including sociodemographic, socioeconomic, psychosocial, behavioural, and incarceration related characteristics) was collected using a structured questionnaire. Adherence was determined based on the participants’ self-report and pharmacy refill records. Plasma viral load measurements undertaken within the study period were prospectively extracted to determine viral suppression. Univariate and multivariate regression models were used to analyse data. ResultsWhile prisoners had a significantly higher pharmacy refill adherence compared to non-incarcerated PLWHA (89% vs 75%), they had a slightly lower dose adherence (81% vs 83%). The prevalence of viral failure (VF) was also slightly higher (6%) in ILWHA compared to non-incarcerated PLWHA (4.4%). The overall dose non-adherence (NA) was significantly associated with missing ART appointments, level of satisfaction with ART services, patient’s ability to comply with a specified medication schedule and types of methods used to monitor the schedule. In ILWHA specifically, accessing ART services from a hospital compared to a health centre, an inability to always attend clinic appointments, experience of depression and a lack of social support predicted NA. VF was significantly higher in males, people of age 31to 35 years and in those who experienced social stigma, regardless of their incarceration status. ConclusionsThis study revealed that HIV-infected prisoners in South Ethiopia were more likely to be non-adherent to ART doses and to develop viral failure compared to their non-incarcerated counterparts. A multitude of factors were found to be responsible for this requiring multilevel intervention strategies focusing on the specific needs of prisoners.

scholarly journals Incidence of home delivery among women living with HIV in Lira, Northern Uganda: a prospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Agnes Napyo Kasede ◽  
Thorkild Tylleskär ◽  
David Mukunya ◽  
Josephine Tumuhamye ◽  
Grace Ndeezi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Home Delivery ◽  
Northern Uganda ◽  
Adjusted Risk ◽  
Women Living With Hiv ◽  
Living With Hiv ◽  
At Home

Abstract Background Home delivery has been associated with mother-to-child transmission of HIV and remains high among HIV-infected women. Predictors for home delivery in the context of HIV have not been fully studied and understood in Northern Uganda. We therefore aimed to find out the incidence and risk factors for home delivery among women living with HIV in Lira, Northern Uganda. Methods This prospective cohort study was conducted between August 2018 and January 2020 in Lira district, Northern Uganda. A total of 505 HIV infected women receiving antenatal care at Lira regional referral hospital were enrolled consecutively and followed up at delivery. We used a structured questionnaire to obtain data on exposures which included: socio-demographic, reproductive-related and HIV-related characteristics. Data was analysed using Stata version 14.0 (StataCorp, College Station, Texas, U.S.A.). We estimated adjusted risk ratios using Poisson regression models to ascertain risk factors for the outcome of interest which was home delivery (which is delivering an infant outside a health facility setting under the supervision of a non-health worker). Results The incidence of home delivery among women living with HIV was 6.9% (95%CI: 4.9–9.5%). Single women were more likely to deliver at home (adjusted risk ratio = 4.27, 95%CI: 1.66–11). Women whose labour started in the night (night time onset of labour ARR = 0.39, 95%CI: 0.18–0.86) and those that were adherent to their ART (ARR = 0.33, 95%CI: 0.13–0.86) were less likely to deliver at home. Conclusion Home delivery remains high among women living with HIV especially those that do not have a partner. We recommend intensified counselling on birth planning and preparedness in the context of HIV and PMTCT especially for women who are: separated, divorced, widowed or never married and those that are not adherent to their ART.

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