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Determinants of Adherence to Antiretroviral Therapy among HIV-Infected Patients in Africa
Ayalu A. Reda,Sibhatu Biadgilign
AIDS Research and Treatment , 2012, DOI: 10.1155/2012/574656
Abstract: Background. There are only a few comprehensive studies of adherence to ART and its challenges in Africa. This paper aims to assess the evidence on the challenges and prospects of ART adherence in sub-Saharan Africa. Methods. The authors reviewed original and review articles involving HIV-positive individuals that measured adherence to ART and its predictors in the past decade. Findings. Against expectations, sub-Saharan Africa patients have similar or higher adherence levels compared to those of developed countries. The challenges to ART adherence include factors related to patients and their families, socioeconomic factors, medication, and healthcare systems. Conclusion. Despite good adherence and program-related findings, antiretroviral treatment is challenged by a range of hierarchical and interrelated factors. There is substantial room for improvement of ART programs in sub-Sahara African countries. 1. Introduction Acquired immune deficiency syndrome (AIDS) is one of the most destructive epidemics the world has ever witnessed. Presently an estimated 33.4 million people are living with HIV worldwide, nearly two-thirds of these live in sub-Saharan Africa [1]. Antiretroviral therapy (ART) has shown to delay progression to AIDS, resulting in a greater and more sustained virologic and immunologic response [2] and improve survival [3]. In sub-Saharan Africa, there has been a dramatic increase in the number of HIV/AIDS patients on antiretroviral treatment from just 100,000 persons in 2003 to 3.9 million in 2009 involving close to 40% of those in need of the treatment [4]. Two sub-Saharan Africa countries, Botswana and Rwanda, have achieved universal access target (treatment coverage of 80% or more of patients in need) at the end of 2009 [4], while countries such as Ethiopia, Zambia, Namibia, and Senegal are moving closer to the same target having covered 50–80% of patients in need of treatment [4]. According to recent studies, ART regimens require 70–90% adherence in order to be effective [5]. However, sustaining adherence to antiretroviral therapy (ART) over the long term requires accurate and consistent monitoring, and this is a particular challenge for countries in sub-Saharan Africa [5]. It is further challenged by various social and clinical obstacles [5] where inadequate suppression of viral replication by ART are resulting due to poor adherence to therapy, low potency of the antiretroviral regimens, viral resistance to antiretroviral medications, and pharmacokinetic interactions [6] causing inadequate drug delivery [5, 7]. The transmissibility of
Predictors of mortality among HIV infected patients taking antiretroviral treatment in Ethiopia: a retrospective cohort study
Sibhatu Biadgilign, Ayalu A Reda, Tesfaye Digafe
AIDS Research and Therapy , 2012, DOI: 10.1186/1742-6405-9-15
Abstract: A retrospective cohort study was conducted among HIV infected patients on ART in eastern Ethiopia. Cox regression and Kaplan-Meier analyses were performed to investigate factors that influence time to death and survival over time.A total of 1540 study participants were included in the study. From the registered patients in the cohort, the outcome of patients as active, deceased, lost to follow up and transfer out was 1005 (67.2%), 86 (5.9%), 210 (14.0%) and 192 (12.8%) respectively. The overall mortality rate provides an incidence density of 2.03 deaths per 100 person years (95% CI 1.64 - 2.50). Out of a total of 86 deaths over 60？month period; 63 (73.3%) died during the first 12？months, 10 (11.6%) during the second year, and 10 (11.6%) in the third year of follow up. In multivariate analysis, the independent predictors for mortality were loss of more 10% weight loss, bedridden functional status at baseline, ≤ 200 CD4 cell count/ml, and advanced WHO stage patients.A lower level of mortality was detected among the cohort of patients on antiretroviral treatment in eastern Ethiopia. Previous history of weight loss, bedridden functional status at baseline, low CD4 cell count and advanced WHO status patients had a higher risk of death. Early initiation of ART, provision of nutritional support and strengthening of the food by prescription initiative, and counseling of patients for early presentation to treatment is recommended.
Prevalence and Determinants of Khat (Catha edulis) Chewing among High School Students in Eastern Ethiopia: A Cross-Sectional Study
Ayalu A. Reda, Asmamaw Moges, Sibhatu Biadgilign, Berhanu Y. Wondmagegn
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0033946
Abstract: Background Use of psychoactive drugs such as khat leaves (Catha edulis) alter moods and emotional state and lead to adverse effects on the health and social life of users. Ethiopia is a major producer and exporter of khat in east Africa and the majority of the khat comes from the eastern part of the country, however, no studies have been conducted to investigate the habit in this area. This study was conducted to assess the prevalence and predictors of khat chewing among high school students in Harar, eastern Ethiopia. Methodology The study was conducted among 1,890 secondary school students in Harar town in April 2010. A structured self-administered questionnaire was used for data collection. Descriptive statistics and logistic regression were performed to examine the prevalence and predictors of khat chewing. Result The overall prevalence of khat chewing among the sample was 24.2% (95% CI 22.2%–26.2%). About 28.5% of females and 71.5% of males had chewed khat. Older age (OR 1.31; 95% CI 1.16–1.49), male gender (OR 2.10; 95% CI 1.50–2.93), Muslim religion (OR 1.88; 95% CI 1.17–3.04), having friends who chewed khat (OR 7.93; 95% CI 5.40–11.64), and availability of someone with a similar habit in the family (OR 1.50; 95% CI 1.07–2.11) were found to be independent predictors of chewing. Conclusion A significant proportion of students chew khat. The use of khat is significantly associated with age, gender, Muslim religion, peer influence and habit of family and other relatives among students. Measures such as educational campaigns need to be instituted to create awareness among school adolescents and their parents in order to reduce the prevalence of the habit and its adverse social and health consequences.
Determinants of cigarette smoking among school adolescents in eastern Ethiopia: a cross-sectional study
Ayalu A Reda, Asmamaw Moges, Berhanu Yazew, Sibhatu Biadgilign
Harm Reduction Journal , 2012, DOI: 10.1186/1477-7517-9-39
Abstract: To assess the prevalence of cigarette use and its determinant factors among high school students in eastern Ethiopia.A cross-sectional study was conducted using structured self-administered questionnaires among 1,721 school adolescents in Harar town, eastern Ethiopia. Univariate and multivariate logistic regression analyses were performed to examine associations.The analysis revealed that prevalence of ever cigarette smoking was 12.2% (95% CI 10.8% - 13.9%). Reasons mentioned for smoking cigarettes were for enjoyment (113, 52.8%), for trial (92, 42.9%), and for other reasons (9, 4.3%). The main predictors of cigarette smoking were sex (OR 4.32; 95% CI 2.59-7.22), age (OR 1.20; 95% CI 1.05-1.38) and having friends who smoke (OR 8.14; 95% CI 5.19-12.70). Living with people who smoke cigarettes was not significantly associated with smoking among adolescents (OR 1.25; 95% CI 0.81-1.92).This study concluded that high proportion of school adolescents in Harar town smoked cigarettes. Sex, age and peer influence were identified as important determinants of smoking. There is a need for early cost-effective interventions and education campaigns that target secondary school students.Smoking is currently considered one of the greatest problems in public health worldwide, and it is one of the most preventable causes of death. Globally, the use and sale of substances such as alcohol and tobacco is causing substantial levels of health problems [1]. The World Health Organization (WHO) attributes more than 4 million deaths a year to tobacco and this figure is expected to increase to 10 million deaths a year by 2020. Moreover, it is now a growing public health challenge in the developing world [2]. According to WHO estimates, approximately 47% of men and 12% of women smoke cigarettes worldwide in 2010 [3]. Citing the death of 5 million individuals worldwide every year due to smoking-related diseases, the WHO states that smoking should be considered a pandemic [3]. In the United State
Health workers' attitudes toward sexual and reproductive health services for unmarried adolescents in Ethiopia
Tilahun Mesfin,Mengistie Bezatu,Egata Gudina,Reda Ayalu A
Reproductive Health , 2012, DOI: 10.1186/1742-4755-9-19
Abstract: Background Adolescents in developing countries face a range of sexual and reproductive health problems. Lack of health care service for reproductive health or difficulty in accessing them are among them. In this study we aimed to examine health care workers' attitudes toward sexual and reproductive health services to unmarried adolescents in Ethiopia. Methods We conducted a descriptive cross-sectional survey among 423 health care service providers working in eastern Ethiopia in 2010. A pre-tested structured questionnaire was used to collect data. Descriptive statistics, chi-square tests and logistic regression were performed to drive proportions and associations. Results The majority of health workers had positive attitudes. However, nearly one third (30%) of health care workers had negative attitudes toward providing RH services to unmarried adolescents. Close to half (46.5%) of the respondents had unfavorable responses toward providing family planning to unmarried adolescents. About 13% of health workers agreed to setting up penal rules and regulations against adolescents that practice pre-marital sexual intercourse. The multivariate analysis indicated that being married (OR 2.15; 95% CI 1.44 - 3.06), lower education level (OR 1.45; 95% CI 1.04 - 1.99), being a health extension worker (OR 2.49; 95% CI 1.43 - 4.35), lack of training on reproductive health services (OR 5.27; 95% CI 1.51 - 5.89) to be significantly associated with negative attitudes toward provision of sexual and reproductive services to adolescents. Conclusions The majority of the health workers had generally positive attitudes toward sexual and reproductive health to adolescents. However, a minority has displayed negatives attitudes. Such negative attitudes will be barriers to service utilization by adolescents and hampers the efforts to reduce sexually transmitted infections and unwanted pregnancies among unmarried adolescents. We therefore call for a targeted effort toward alleviating negative attitudes toward adolescent-friendly reproductive health service and re-enforcing the positive ones.
Standard Precautions: Occupational Exposure and Behavior of Health Care Workers in Ethiopia
Ayalu A. Reda,Shiferaw Fisseha,Bezatu Mengistie,Jean-Michel Vandeweerd
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0014420
Abstract: Occupational exposure to blood and body fluids is a serious concern for health care workers, and presents a major risk for the transmission of infections such as HIV and hepatitis viruses. The objective of this study was to investigate occupational exposures and behavior of health care workers (HCWs) in eastern Ethiopia.
Predictors of Change in CD4 Lymphocyte Count and Weight among HIV Infected Patients on Anti-Retroviral Treatment in Ethiopia: A Retrospective Longitudinal Study
Ayalu A. Reda, Sibhatu Biadgilign, Amare Deribew, Betemariam Gebre, Kebede Deribe
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0058595
Abstract: Background Antiretroviral treatment (ART) has been introduced in Ethiopia a decade ago and continues to be scaled up. However, there is dearth of literature on the impact of ART on changes in CD4 lymphocyte count and weight among patients on treatment. Objective To determine the predictors of change in CD4 lymphocyte count and weight among HIV/AIDS infected patients taking antiretroviral treatment in eastern Ethiopia. Methods A retrospective cohort study was conducted among HIV/AIDS patients taking ART from 2005 to 2010. A sample of 1540 HIV infected adult patients who started antiretroviral therapy in hospitals located in eastern Ethiopia were included in the study. The primary outcomes of interest were changes in CD4 count and weight. Descriptive statistics and multivariable regression analyses were performed to examine the outcomes among the cohort. Results Both the median CD4 lymphocyte counts and weight showed improvements in the follow up periods. The multivariate analysis shows that the duration of ART was an important predictor of improvements in CD4 lymphocyte count (beta 7.91; 95% CI 7.48–8.34; p 0.000) and weight (beta 0.15; 95% CI 0.13–0.18; p 0.000). Advanced WHO clinical stage, lower baseline CD4 cell count, and baseline hemoglobin levels were factors associated with decline in weight. Actively working patients had higher CD4 lymphocyte count and weight compared to those that were ambulatory (p<0.05). Conclusion We detected a substantial increment in weight and CD4 lymphocyte count among the patients who were taking ART in eastern Ethiopia. Patients who are of older age, with low initial CD4 lymphocyte count, late stage of the WHO clinical stages and lower hemoglobin level may need special attention. The reasons for the improved findings on CD4 count and weight throughout the five years of follow up merit further investigation.
Reliability and Validity of the Ethiopian Version of the Hospital Anxiety and Depression Scale (HADS) in HIV Infected Patients
Ayalu Aklilu Reda
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0016049
Abstract: The hospital anxiety and depression scale (HADS) is a widely used instrument for evaluating psychological distress from anxiety and depression. HADS has not yet been validated in Ethiopia. The aim of this study was to evaluate the reliability and validity of the Amharic (Ethiopian language) version of HADs among HIV infected patients.
The effect of household heads training about the use of treated bed nets on the burden of malaria and anaemia in under-five children: a cluster randomized trial in Ethiopia
Amare Deribew, Zewdie Birhanu, Lelisa Sena, Tariku Dejene, Ayalu A Reda, Morankar Sudhakar, Fessehaye Alemseged, Fasil Tessema, Ahmed Zeynudin, Sibhatu Biadgilign, Kebede Deribe
Malaria Journal , 2012, DOI: 10.1186/1475-2875-11-8
Abstract: A cluster randomized trial was done in 22 (11 intervention and 11 control) villages in south-west Ethiopia. The intervention consisted of tailored training of household heads about the proper use of LLITN and community network system. The burden of malaria and anaemia in under-five children was determined through mass blood investigation at baseline, six and 12 months of the project period. Cases of malaria and anaemia were treated based on the national protocol. The burden of malaria and anaemia between the intervention and control villages was compared using the complex logistic regression model by taking into account the clustering effect. Eight Focus group discussions were conducted to complement the quantitative findings.A total of 2,105 household heads received the intervention and the prevalence of malaria and anaemia was assessed among 2410, 2037 and 2612 under-five children at baseline, six and 12 months of the project period respectively. During the high transmission/epidemic season, children in the intervention arm were less likely to have malaria as compared to children in the control arm (OR = 0.42; 95%CI: 0.32, 0.57). Symptomatic malaria also steadily declined in the intervention villages compared to the control villages in the follow up periods. Children in the intervention arm were less likely to be anaemic compared to those in the control arm both at the high (OR = 0.84; 95%CI: 0.71, 0.99)) and low (OR = 0.73; 95%CI: 0.60, 0.89) transmission seasons.Training of household heads on the utilization of LLITN significantly reduces the burden of malaria in under-five children. The Ministry of Health of Ethiopia in collaboration with other partners should design similar strategies in high-risk areas to control malaria in Ethiopia.Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12610000035022Long-lasting insecticide-treated bed nets (LLITN) are proven to reduce malaria-related morbidity and mortality in under-five children [1-5]. However,
The effect of household heads training on long-lasting insecticide-treated bed nets utilization: a cluster randomized controlled trial in Ethiopia
Amare Deribew, Zewdie Birhanu, Lelisa Sena, Tariku Dejene, Ayalu A Reda, Morankar Sudhakar, Fessehaye Alemseged, Fasil Tessema, Ahmed Zeynudin, Sibhatu Biadgilign, Kebede Deribe
Malaria Journal , 2012, DOI: 10.1186/1475-2875-11-99
Abstract: The study included 22 (11 intervention and 11 control) villages in southwest Ethiopia. The intervention consisted of tailored training of household heads about the proper use of LLITN and community network system. All households in each group received free LLITN. Data were collected at baseline, six and 12 months of the follow up periods. Utilization of LLITN in the control and intervention villages was compared at baseline and follow up periods.A total of 21,673; 14,735 and 13,758 individuals were included at baseline, sixth and twelfth months of the project period. At the baseline survey, 47.9% of individuals in the intervention villages and 68.4% in the control villages reported that they had utilized LLITN the night before the survey. At the six month, 81.0% of individuals in the intervention villages and 79.3% in the control villages had utilized LLITN. The utilization of LLITN in all age groups in the intervention villages was increased by 17.7 percentage point (95% CI 9.7-25.6) at sixth month and by 31.0 percentage point (95% CI 16.9-45.1) at the twelfth month. Among under-five children, the LLITN utilization increased by 31.6 percentage point (95% CI 17.3-45.8) at the sixth month and 38.4 percentage point (95% CI 12.1-64.7) at the twelfth months of the project period.Household level skill-based training has demonstrated a marked positive effect in the utilization of LLITN. The effect of the intervention steadily increased overtime. Therefore, distribution of LLITN should be accompanied by a skill-based training of household heads to improve its utilization.Australian New Zealand Clinical Trials Registry (ACTR number: ACTRN12610000035022).Long-lasting insecticide-treated bed nets (LLITN) have demonstrated a significant impact in the reduction of malaria-related childhood morbidity and mortality [1-5]. However, the utilization of LLITN is greatly affected by behavioral factors in countries south of the Sahara. Previous studies had given much emphasis on the co
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