Adherence to Highly Active Antiretroviral Therapy and Its Association with HIV Disclosure status among People Living with HIV/AIDS in Ethiopia: A systematic review and Meta-Analysis.

Background:Adherence to Highly Active Antiretroviral Therapy (HAART) medication is the pressing public health problem worldwide. Non-adherence to HAART leads to treatment failure, immunologic failure, and virological failure. Despite different interventions made; still, HAART medication adherence among adult people living with HIV/AIDS (PLWHA) is inconsistent across studies and the effect of HIV disclosure status was not well studied. Therefore this study determines the pooled prevalence of HAART adherence and its relationship with HIV disclosure status among Adult PLWHA.MethodsWe searched 3247 both published and unpublished original articles from January 2016 to November 2019 in Ethiopia using different search engines. Data were extracted using Microsoft excel. New Castle Ottawa Scale quality assessment tool was used. STATA software version 11 was used for analysis. A random-effects meta-analysis was performed. Cochran Q statistics and I2 were used to estimate heterogeneity. Eggers and Begg’s test was used to assess the publication bias.ResultsA total of 15 studies for systematic review and four studies for Meta-analysis were used. The pooled prevalence of HAART medication adherence is found to be 81.19% (80.132, 82.248). In the subgroup analysis, the pooled prevalence of HAART adherence was 79.82% (73.19, 86.45) in the Oromia region, 82.51% ( 73.14, 91.87) in the Amhara region, and 72.7% (63.78, 81.61) in the SNNPR. HIV disclosure improves HAART adherence by nearly three times compared to non-HIV disclosed HAART users (AOR=2.99, 95%CI: 1.88, 4.77).ConclusionsThe pooled prevalence of HAART adherence among adult PLWHA was found to be low. Having HIV disclosure improved HAART medication adherence.

HIV/AIDS treatment failure and associated factors in Ethiopia: Meta-analysis

Background: The national burden of HIV treatment failure and associated factors in Ethiopian context is required to provide evidence towards a renewed ambitious future goal.Methods: We accessed Ethiopian Universities’ online repository library, Google Scholar, PubMed, Web of Science, and Scopus to get the research articles. We run I-squared statistics to see heterogeneity. Publication bias was checked by using Egger’s regression test. The pooled prevalence was estimated using DerSimonian-Laird random-effects model. We employed the sensitivity analysis to see the presence of outlier result in the included studies. Results: The overall HIV treatment failure was 15.9% (95% CI: 11.6%-20.1%). Using immunological, virological, and clinical definition, HIV treatment failure was 10.2% (6.9%-13.6%), (5.6% (95% CI: 2.9%-8.3%), and (6.3% (4.6%-8.0%)), respectively. The pooled effects of WHO clinical stage III/IV (AOR=1.9; 95% CI: 1.3-2.6), presence of opportunistic infections (AOR=1.8; 95% CI: 1.2-2.4), and poor HAART adherence (AOR= 8.1; 95% CI: 4.3-11.8) on HIV treatment failure were estimated. Conclusions : HIV treatment failure in Ethiopia found to be high. HIV intervention programs need to address the specified contributing factors of HIV treatment failure. Behavioral intervention to prevent treatment interruption is required to sustain HIV treatment adherence. Protocol Registration : It has been registered in the PROSPERO database with a registration number of CRD42018100254.

Socio-Demographic, Economic and Clinical predictors of HAART Adherence Competence for HIV Positive adults at Felege Hiwot Teaching and Specialized Hospital, North West Ethiopia

Background : Currently, around 36.7 million people in the world are living with HIV. Among these, 52% are living in sub-Saharan African. Antiretroviral therapy (ART) has played an important role in improving the prognosis and quality of life of HIV/AIDS patients, and in reducing the rate of disease progression and death. Several previous researches on factors affecting HAART adherence competence had controversies. As far as the author’s knowledge concerned, no research had been conducted on longitudinal HAART adherence competence in the study area. The main objective of this study was to identify Socio-demographic and Clinical factors associated with HAART adherence competence in successive visits among adult HIV patients after commencement of HAART. Methods : A retrospective cohort study on 792 HAART attendants was conducted to analyze the current study for HIV positive adults who had a minimum of two clinical visits. Secondary data were employed to examine Socio-demographic, economic, individual and clinical factors affecting the variable of interest overtime among HAART users. The Structural Equation modeling (SEM) was applied to identify predictors of HAART adherence competence over time. Results : In this longitudinal study, factors affecting long-term HAART adherence competence in successive visits had been identified. Socio-demographic factors (like Marital status, level of disclosure of the disease, residence area, education, economic factors (owner ship of cell phone, household income), individual factors (age, sex, weight) and clinical factors (CD4 cell count, WHO stages), directly associated with retention of HAART medication care. On the other hand, HAART medication care was significantly and independently associated with the longitudinal HAART adherence competence. Conclusion : The HAART adherence competence in successive visits increased with the number of follow-up visits, but the rate of increase was different for different groups such as male & female, urban & rural, and disclosing & hiding the disease to family members. An integrated health related education should be given for poor adherent patients like rural residents, males, patients living without partners, patients with no cell phone and aged patients.

Still poor HAART adherence has great impact on HIV/AIDS treatment failure in Ethiopia

ABSTRACTBackgroundThe pooled burden of HIV treatment failure and its associated factors in Ethiopian context is required to provide evidence towards renewed ambitious future goal.MethodsEthiopian Universities’ (University of Gondar and Addis Ababa University) online repository library, Google scholar, PubMed, Web of Science, and Scopus were used to get the research articles. I-squared statistics was used to see heterogeneity. Publication bias was checked by Egger’s regression test. The DerSimonian-Laird random effects model was employed to estimate the overall prevalence. Subgroup analysis based on geographical location of the study, study population by age, treatment failure type, and study design was conducted to see variation in outcomes. The sensitivity analysis was also employed to see whether the outlier result found in the included studies.ResultsOverall HIV treatment failure found to be 15.9% (95% CI: 11.6%-20.1%). Using immunological definition, HIV treatment failure was 10.2% (6.9%-13.6%); using virological definition of treatment failure (5.6% (95% CI: 2.9%-8.3%) and clinical definition of treatment failure (6.3% (4.6%-8.0%)) were also determined. The pooled effects of WHO clinical stage III/IV (AOR=1.9; 95% CI: 1.3-2.6), presence of opportunistic infections (AOR=1.8; 95% CI: 1.2-2.4), and poor HAART adherence (AOR= 8.1; 95% CI: 4.3-11.8) on HIV treatment failure are estimated.ConclusionsHIV treatment failure in Ethiopia found to be high. HIV intervention programs need to address the specified contributing factors of HIV treatment failure. Behavioral intervention to prevent treatment interruption is required to sustain HIV treatment adherence.Protocol RegistrationIt has been registered in the PROSPERO database (CRD42018100254).

Cervical cancer screening practices, knowledge of screening and risk, and highly active antiretroviral therapy adherence among women living with human immunodeficiency virus in Lima, Peru

Cervical cancer (CC) is the leading cause of cancer death among Peruvian women. Awareness shown by women living with HIV (WLHIV) of their increased risk and Papanicoloau (Pap) smear frequency is understudied, particularly in Peru. We assessed the uptake of guidelines-based CC screening practices and its associations with two predictors, knowledge of CC screening and risk and highly active antiretroviral therapy (HAART) adherence, among WLHIV. Collected by self-administered questionnaires from 2014 to 2016, we analyzed the data of 71 WLHIV. Most WLHIV (77.5%, n = 55/71) were overdue to CC screening by not having a Pap smear within the prior 12 months. WLHIV who had on-time Pap smears had a higher median composite ‘knowledge’ score of 3.0 ([interquartile range] 1.5–4) compared to 2.0 (IQR 1–3) for overdue WLHIV. On-time and overdue WLHIV had the same median composite ‘HAART adherence’ score of 3.0 (IQR 2–4). Bivariate analysis found no association between knowledge nor adherence with on-time Pap smears. Although on-time WLHIV were more knowledgeable about CC screening and risk, overall CC screening uptake was poor. Larger studies of this population are needed to assess the educational, social, and structural barriers contributing to this low prevalence of screening.

Depression Among HIV-Infected Patients–A Reality that Must Not be Forgotten

IntroductionHIV-infection is a very stigmatized, chronic disease with increased rates of psychiatric disorders, being major depression the most common.ObjectiveTo review the recent research related to depression in HIV-infected patients.MethodsLiterature review based on PubMed/Medline, using the keywords “HIV” and “depression”.ResultsHIV-infected patients have a chance 2-7 times higher of developing major depression, around the time of diagnosis or during the course of their illness. However, only fewer than 50% of the cases are recognized clinically. Several factors contribute to its under-recognition and under-treatment, such as the overlap between the neurovegetative symptoms of depression, the somatic symptoms of HIV disease, and the effects of comorbid diseases; the mistaken belief that depressive symptoms are expected in this group; the neuropsychiatric side effects associated with some antiretrovirals. Besides, major depression presents important diagnostic challenges due to biological, psychological, and social components associated with the infection. The authors will analyze the clinical presentation.Depression has been associated with a negative impact on quality of life, poorer HAART adherence, faster HIV disease progression and increased mortality risk. Importantly, however, appropriate psychiatric intervention can do it over. In fact, studies suggest that patients receiving SSRI treatments for depression have rates of adherence and CD4+ T-cell counts similar to non-depressed patients receiving HAART.ConclusionsThe high prevalence of major depression in HIV-positive individuals and its serious consequences if untreated, increase even further the importance of its effective identification and subsequent treatment in this group of patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.