Determinants of virological failure among HIV clients on second-line antiretroviral treatment at Felege-hiwot and University of Gondar comprehensive specialized hospitals in the Amhara Region, Northwest Ethiopia: A case-control study.

BACKGROUND: Second-line HIV treatment failure has become increasing worldwide, mainly in sub-Sahara Africa including Ethiopia. Even though the problem becomes increasing, inadequate information was available about its magnitude and associated factors in the current study area. OBJECTIVE: To assess the factors of second-line Anti-Retroviral Treatment virological failure among second-line ART users. METHOD AND MATERIALS: Institutional-based unmatched case-control study design was conducted from September to December 2021 at Felege Hiowt and University of Gondar Comprehensive Specialized Hospitals; Amhara region, Northwest Ethiopia. A total of 216 patients (60 cases and 156 controls) were recruited by a simple random sampling technique with a 1:3 cases-to-controls ratio. Patients who had two viral load results >1000 copies/ml within a 3-month interval after taking ART drugs for at least 6 months were cases and those who had ≤1,000 copies/ mL were controls. The sample size was calculated by using Epi-Info version 7.2.4. Structured questionnaires were used to gather the required information. SPSS version 26 was used to summarize the findings. In bivariate logistic regression model, Variables with two-tailed P-value ≤ 0.25 at 95% confidence interval were transferred into multivariate binary logistic regression model and P value at ≤ 0.05 was set as statistically significant. RESULTS: Out of 216 patients recruited, 212 have participated with a response rate of 98.2%. From these participants, 117(55.2%) were males and 187(88.2%) were urban dwellers. Among the total respondents, 208(98.1%) had age > 24 years, 200(94.3) were at HIV clinical stage I, 72(34%) had poor ART adherence and 112(52.8) did not disclose their HIV status. Likewise, most of the patients 147(69.37) didn't use condoms. The associated factors were not disclosing HIV status (AOR = 3.4, 95% CI: 1.52-7.79), medium adherence (AOR = 3.7, 95% CI = 1.3-10.7), poor adherence level (AOR = 5.27, 95% CI: 2.2-12.5), not using condoms (AOR = 4.47, 95% CI: 1.63-12.2) and Viral load (>150 copies/ml) when switched to second-line ART (AOR = 3.56, 95% CI: 1.5-8). CONCLUSION AND RECOMMENDATIONS: Non-disclosure, poor or medium adherence, not using condoms and high Viral load (>150 copes/ml) when switched to second-line ART were the main factors for second-line Anti-Retroviral Treatment virological failure. Disclosure about HIV status, using condoms and improving treatment adherence level are crucial to reduce second-line virological failure.

Utilization of the Integrated Management of Newborn and Childhood Illness (IMNCI) protocol and associated factors among health care workers in health centers of South Gondar Zone, Northwest Ethiopia: an institution-based mixed study.

Introduction: Globally, 11 million children have died before reaching their fifth birthday. The introduction of the Integrated Management of Newborn and Childhood Illness (IMNCI) protocol reduces the morbidity and mortality rates among children under the age of 5. However, the share of neonatal mortality is increasing. As a result, the United Nations has established sustainable development goals to reduce national neonatal death rates through the utilization of the Integrated Management of Newborn and Childhood Illness protocol as the main tool for 12 per 1,000 live births by 2030. However, the death rate from preventable causes has increased owing to the low utilization of the protocol. Objective: The objective of this research is to assess the utilization of the IMNCI protocol and associated factors among healthcare workers (HCW) in health centers at the South Gondar Zone, Northwest Ethiopia, in 2022. Methods: The institution-based mixed study design was conducted from November to December 2022 at the South Gondar Zone, Amhara. A total of 422 HCW were selected using a computer-generated random-number generator. Data were cleaned and entered into EpiData 3.1 software and analyzed using SPSS version 25.0. Binary logistic regression was used to identify candidates for multivariable logistic analysis with p-value < 0.2, and for multivariable analysis, p-value < 0.05, with a 95% confidence interval, was considered significant. Thematic analysis was used for the qualitative data. Results: In total, 417 respondents were included in the final analysis. The overall response rate was 98.8%, and the mean age was 30.01 years. The results showed that the proportion of IMNCI utilization was 63.1%. The odds of the utilization of IMNCI protocol among HCW who took training were 3.13 times higher than those among HCW who did not take training [adjusted odds ratio (AOR) = 3.13, 95% CI: 1.594, 6.147]. The lack of drugs reduces the utilization of the IMNCI protocol by 75.7% compared with the use of drugs (AOR = 0.243, CI: 95%:0.128, 0.464). HCW who always referred to the chart booklet during case management were 3.34 times more likely to utilize the IMNCI protocol (AOR = 3.34, 95% CI: 1.99, 5.60) compared with those who did not refer to the chart booklet. Conclusions and recommendations: The utilization of the IMNCI protocol was low. A shortage of medical consumables and equipment attitude and training were identified as factors that affected the utilization of the protocol. Therefore, the availability of necessary logistics and training for employees with regular supportive supervision and monitoring should be conducted with the integration of sectors at the district and zone levels.

Public School Adolescents Had Increased Odds of Being Willing to Uptake HPV Vaccinations Owing to Sociodemographic and Healthcare Access Features in Bahir Dar City, Ethiopia.

Background: Cervical cancer is one of the most prevalent and fatal malignancies in women worldwide. Despite the fact that vaccination is an effective method in reducing cervical cancer, its uptake varies between public and private school adolescents and remains a challenge in low- and middle-income countries, including Ethiopia. Empirical evidence on how much variation there is among public and private school adolescent in their willingness to uptake human papillomavirus (HPV) vaccination is also limited. Thus, the aim of this study was to compare levels of willingness to uptake HPV vaccination among public and private school female adolescents and associated factors in Bahir Dar City, Ethiopia. Methods: A comparative cross-sectional study was conducted on 844 adolescents aged 10 to 19 in primary schools in Bahir Dar, Ethiopia. Multistage sampling was used. A self-administered, structured, and pretested questionnaire was used to collect data. The determinants of willingness to accept HPV vaccination were identified using logistic regression, and exploratory factor analyses were performed to determine load and mean. The level of statistical significance was determined using a P - value of 0.05. Results: The overall proportion of willing to uptake HPV vaccination was 50.6% (95% CI: 47.4-54), whereas in public and private primary schools, the magnitude was 61% (95% CI: 56.3-65.4%) and 40.2% (95% CI: 35.6-44.9), respectively. In terms of willingness to uptake HPV vaccination, the odds were likely to be significantly higher among those whose mothers had a postsecondary education (AOR = 2.0, 95% CI: 1.29-3.05), a high cue to action (AOR = 1.92, 95% CI: 1.20-3.05), and high self-efficacy (AOR = 2.34, 95% CI: 1.58-3.48). High perceived barriers likely decreased the willingness to uptake HPV vaccination (AOR = 0.49, 95% CI: 0.34-0.70). Conclusion: Adolescent girls in public primary schools were more likely to uptake HPV vaccination than those in private provided that income status and socioeconomic factors became less important. Willingness to uptake HPV vaccination was found to be low as compared to the WHO target for Ethiopian context and was influenced by maternal education status, perceived barriers, cues to action, and self-efficacy. As a result, greater emphasis should be placed on implementing a school-based and maternal educational program on cervical cancer prevention and control focusing on the behavioral contexts.

Perceived risk factors of HIV infection and ART adherence at Zewditu Memorial hospital, Addis Ababa, Ethiopia: A survey of people living with HIV/ AIDS experiences

Introduction: Despite several interventions, HIV/AIDS continued global leading cause of morbidity and mortality, particularly in developing countries including Ethiopia. Aim: This study was aimed at assessing the risks of HIV infection and conditions after ART initiation among people living with HIV/AIDS at Zewditu Hospital, Addis Ababa, Ethiopia. Methods: An ethnographic study was conducted using an in-depth interview through semi structured questionnaire and tape recorder. Using tape recorder, careful probing, verbatim transcription, interviewing up to saturation point and considering disparity are activities to keep data trustworthiness. Data were read carefully and grouped in to themes; risky behaviors, diagnosis and reactions, conditions after ART initiation, and future plan for thematic analysis. Results: Seven people living with HIV/AIDS (three male and four female) were participated. The mean age of respondents was 39.29 ± 6.34 SD. There were three orthodox followers, three divorced, two in marriage and two college graduated. All had serious risky behaviors to HIV infection: four had multiple sexual partners, three were very poor, two with substance abuse, two had blood contact history, and one had unprotected sex with different men. All accepted their diagnosis result, but only four started ART soon. All participants stopped having children or pregnancy since knowing their status and only four disclosed status. All respondents showed health improvement, and four respondents have desire to have marriage and children. Conclusions: Interviewed people were with different serious risky behaviors that will lead them HIV infection. ART service helped them improve their health, weight gain and have future plan on marriage, having children and education. Coordinated community level education, strong counseling, accessing uninterrupted HIV testing and ART services, open partner/family discussion, early HIV diagnosis and treatment, avoiding substance abuse, improving income of people with HIV/AIDS and safe sex practice are crucial to prevent HIV infection and improve ART adherence