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Background: Human immunodeficiency virus self-testing (HIVST) is universally accepted as an HIV testing option to achieve the United Nations Agency for International Development first 95 goal by 2030. HIV testing coverage through voluntary counseling and testing and provider initiated testing and counseling is low among female sex workers (FSWs). However, there is no evidence on the level of HIVST among FSWs in the study area. Objective: To assess the uptake of HIVST and associated factors among FSWs at non-governmental facilities in Debre Markos and Bahir Dar towns, Northwest Ethiopia, 2022. Methods: An institution-based cross-sectional study design was employed. A total of 423 study participants were selected by systematic random sampling technique. The data were collected using a structured and pre-tested questionnaire; entered into EpiData version 3.1 and exported to SPSS version 25 for analysis. An adjusted odds ratio (AOR) with a 95% confidence interval (CI) was estimated to assess the strength of association between independent variables and dependent variable. Bivariable logistic regression was done for each variable and those with a P-value of < 0.25% were selected for multivariable analysis. Finally, P-value < 0.05% was declared statistically significant. Results: The magnitude of HIVST uptake among FSWs was 59.3%. Time since engagement of sex work > 5 years [AOR 2.16 (95% CI: 1.158-4.013)], age of first sexual debut >19 years [AOR 3.23 (95% CI: 2.045-5.093)], previous urban residence [AOR 3.99 (95% CI: 2.58-6.18)], good knowledge towards HIVST [AOR 1.78 (95% CI: 1.066-2.964)], education status being college and above [AOR 5.6 (95% CI: 3.12-9.30)] were significantly associated factors. Conclusion: HIVST uptake among FSWs was 59.3% which is lower than expected at national level. Educational status, age at first sexual debut, knowledge towards HIVST, and time since engagement in sex work were significantly associated with HIVST uptake.
RESUMO
Background: HIV treatment failure is a devastating public health challenge worldwide. Low rates and delays in switching are associated with increased death and second-line failure. But the time to switch and predictors are not well studied in Ethiopia. Therefore, this study assessed the time to switch to second-line ART and its predictors among HIV-infected adults with virological failure in Northwest Ethiopia. Methods: An institution-based retrospective follow-up study was conducted from Oct 1/2016 to Feb 28/2020 in Northwest Ethiopia. Secondary data were extracted through a predefined extraction tool from 427 HIV-infected adults, which were selected by systematic random sampling. Kaplan-Meier with log rank test was done to identify the survival time and compare survival time among different categorical independent variables. The Cox proportional hazard model was fitted and variables having a p-value of less than 0.05 with a 95% confidence level were identified as a predictor of time to switch to second-line ART and interpreted accordingly. Results: A total of 288 (67.45%) HIV-infected adults were switched to second-line ART with a median time of 162 days (IQR: 35,682). The risk of switching is higher among HIV infected adults with viral RNA of 60,000 copies/mL or more at failure (AHR=1.80, 95% CI: 1.31-2.48), ≥8 years duration on first-line ART (AHR: 2.31, 95% CI: 1.62, 3.29) and enhanced adherence counseling of 4 to 6 sessions (AHR: 1.28, 95% CI: 1.01, 1.63), and lower with 4 or more missed appointments (AHR: 0.49, 95% CI; 0.28, 0.84) and no history of 1st line regimen change (AHR: 0.53: 95% CI: 0.41,0.69). Conclusion: The median time to switch to second-line ART following 1st line virological failure is about 162 days, higher than other related studies. But switching was higher in patients with high viral RNA copies, missed appointments, longer duration on first-line ART, and the number of enhanced adherence counseling. So, intervention strategies that aid patients to have timely switch without due delays as soon as virologic failure should be prioritized.
RESUMO
BACKGROUND: There is paucity of evidence on the magnitude of HIV patients' retention and attrition in Ethiopia. Hence, the aim of this study was to determine the pooled magnitude of HIV patient clinical retention and attrition and to identify factors associated with retention and attrition in Ethiopia. METHODS: Systematic review and meta-analysis were done among studies conducted in Ethiopia using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Both published and unpublished studies conducted from January 1, 2005 to June 6th, 2019 were included. Major databases and search engines such as Google Scholar, PUBMED, African Journals Online (AJOL) and unpublished sources were searched to retrieve relevant articles. Data were assessed for quality, heterogeneity and publication bias. Analysis was conducted using STATA version 14 software. RESULT: From a total of 45 studies 546,250 study participants were included in this review. The pooled magnitude of retention in care among HIV patients was 70.65% (95% CI, 68.19, 73.11). The overall magnitude of loss to follow up 15.17% (95% CI, 11.86, 18.47), transfer out 11.17% (95% CI, 7.12, 15.21) and death rate were 6.75% (95% CI, 6.22, 7.27). Major determinants of attrition were being unmarried patient (OR 1.52, 95% CI: 1.15-2.01), non-disclosed HIV status (OR 6.36, 95% CI: 3.58-11.29), poor drug adherence (OR 6.60, 95% CI: 1.41-30.97), poor functional status (OR 2.11, 95% CI: 1.33-3.34), being underweight (OR 2.21, 95% CI: 1.45-3.39) and advanced clinical stage (OR 1.85, 95% CI: 1.36-2.51). Whereas absence of opportunistic infections (OR 0.52, 95% CI: 0.30-0.9), normal hemoglobin status (OR 0.29, 95% CI: 0.20-0.42) and non-substance use (OR 95% CI: 0.41, 0.17-0.98) were facilitators of HIV patient retention in clinical care. CONCLUSION: The level of retention to the care among HIV patients was low in Ethiopia. Socio-economic, clinical, nutritional and behavioral, intervention is necessary to achieve adequate patient retention in clinical care.
