BackgroundViral load monitoring is used as an important biomarker for diagnosing treatment failure in patients with HIV infection/AIDS. Ethiopia has started targeted viral load monitoring. However, factors leading to virological failure are not well understood and studied. Thus, the aim of this study was to identify the determinants of virological failure among HIV-infected patients on highly active antiretroviral therapy at the University of Gondar Referral Hospital, Northwest Ethiopia.MethodsA case–control study was conducted from May to June 2015. Cases were subjects who had already experienced virological failure; controls were those without virological failure. Data were extracted from 153 cases and 153 controls through chart review. A multivariate logistic regression analysis was carried out to identify factors associated with virological failure, and variables with a p-value <0.05 were considered statistically significant.ResultsIn this study, higher odds of virological failure was observed among patients aged <35 years (adjusted odds ratio [AOR] =2.52, 95% CI: 1.33, 4.77), who had had CD4+ count <200 cells/mm3 (AOR=9.03, 95% CI: 4.40, 18.50), showed poor adherence to antiretroviral therapy (ART) (AOR=15.80, 95% CI: 6.90, 36.50), and had taken ART for longer durations of 25–47 months (AOR=3.00, 95% CI: 1.10, 8.40) and ≥48 months (AOR=6.70, 95% CI: 2.70, 16.60).ConclusionThis study showed that patients aged <35 years and with recent low CD4 count, poor adherence to treatment, and longer exposure to ART were positively and significantly associated with virological treatment failure. Therefore, evidence-based intervention should be implemented to improve adherence to ART, which in turn helps to boost immunity (CD4) and suppresses viral replication and load. Moreover, attention should be given to younger patients who have had ART for longer periods.

BackgroundAccording to a report on the worldwide trends in blood pressure from 1975 to 2015, mean blood pressure is increasing in low and middle income countries while it is either decreasing or stabilizing in high income countries. Few studies have been published on the prevalence of hypertension in Ethiopia demonstrating an increased trend; however, these studies had small sample size and were limited to participants older than 35 years; which left the burden among adolescents and young adults unaddressed. The aim of this study was to assess prevalence of hypertension (HTN) and associated factors in Gondar city.MethodA population based cross-sectional study was conducted among 3227 individuals in Gondar city. A multistage cluster random sampling was used. The Kish method from World Health Organization (WHO) STEPS instrument of random sampling method was used for selecting one individual older than or equal to 18 years from each household. WHO and International Diabetic Association (IDA) criterion was used to classify HTN.ResultThe overall prevalence of HTN was 27. 4% [95% CI: (25. 8–28.9)]. The prevalence for participants in the age group of ≥35 years was 36. 1%. It consistently increased from 9.5% in the age group of 18–25 years to 46.3% in the age group of ≥65 years (P-value < 0. 001). Only 47% of the participants had ever had any kind of blood pressure measurement. Being elderly (AOR = 5. 56; 95% CI: 3. 71–8. 35), obese (AOR =2. 62; 95%CI: 1. 70–4. 03), widowed (AOR = 1. 87; 95%CI: 1. 27–2. 75), separated (AOR = 1. 87; 95%CI: 1. 27–2. 75), daily alcohol user (AOR = 1. 51; 95%CI: 1. 02–2. 23), male gender (AOR = 1. 42; 95%CI: 1. 18–1. 72) and born in urban area (AOR = 1. 31; 95%CI: 1. 10–1. 56) were found to be independently associated with HTN.ConclusionThere is a high prevalence of hypertension in Gondar city and is showing increasing trend compared to previous reports. Interventions to raise awareness and to improve both capacity and accessibility of facilities for screening hypertension are highly recommended.

Background At the end of 2018, South Africa updated its all-oral regimen, to include bedaquiline (BDQ) and two months of linezolid (LZD) for all patients initiating the shorter 9 to 12 months regimen for rifampicin-resistant tuberculosis (RR-TB). We assessed a group of patients in rural KwaZulu-Natal for safety and effectiveness of this treatment regimen under programmatic conditions. Methods We conducted a retrospective cohort analysis on RR-TB patients treated with a standardized all-oral short regimen between July 1, 2018 and April 30, 2019 in three facilities in King Cetshwayo District. An electronic register (EDR Web) and facility-based clinical charts were used to collect variables which were entered into an Epi-Info database. Results Our cohort included 117 patients; 68.4%(95%CI:59.3-76.3) were HIV positive. The median time to culture conversion was 56 days(95%CI:50-57). Treatment success was achieved in 75.2%(95%CI:66.5-82.3) of patients. Mortality within the cohort was 12.8%(95%CI:7.8-20.3). Anaemia was the most frequent severe adverse event. The median time to develop severe anaemia was 7.1 weeks(IQR 4.0-12.9) after treatment initiation. LZD was interrupted in 25.2%(95%CI:17.8-34.5) of participants. Conclusions An all-oral shorter regimen, including BDQ and LZD as core drugs for the treatment of RR-TB, shows good outcomes, in a high HIV burden rural setting. Adverse events (AEs) are common, especially for LZD, but could be managed in the program setting. Support is needed when introducing new regimens to upskill staff in the monitoring, management and reporting of AEs.

Introduction. The primary goal of antiretroviral therapy (ART) is to reduce the viral load in HIV-infected patients to promote quality of life, as well as to reduce HIV-related morbidity and mortality. A high rate of virologic failure was reported in Waghimra Zone, Northwest Ethiopia, in viral load assessment conducted among HIV-infected patients on ART in the Amhara region. However, there is limited evidence on the determinants of virological failure in the study area. This study aimed to identify the determinants of virological failure among HIV-infected patients on antiretroviral therapy in Waghimra zone, Northern Ethiopia, 2019. Methods. An institutional-based unmatched case-control study was conducted from May 21 to June 30, 2019. Cases were people living with HIV (PLHIV) on ART who had already experienced virological failure; controls were those without virological failure. Data were extracted from 92 cases and 184 controls through chart review using a pretested and structured checklist. The data were entered using Epi Info version 7 and exported to SPSS version 20 for analysis. A multivariate logistic regression analysis was carried out to identify factors associated with virological failure, and variables with a P value <0.05 were considered statistically significant. Results. This study revealed that poor adherence to ART (adjusted odds ratio (AOR) = 4.24, 95% confidence interval (CI): 2.17, 8.31), taking ART for longer than five years (AOR = 3.11, 95% CI: 1.17, 8.25), having drug toxicity (AOR = 3.34, 95% CI: 1.54, 7.23), age of PLHIV ≥ 35 years (AOR = 2.45, 95% CI: 1.29,4.64), and recent CD4 count <200 cells/mm³ (AOR = 3.06, 95% CI: 1.52, 6.13) were factors associated with virologic failure. Conclusion and Recommendation. This study showed that poor adherence to treatment, longer duration on ART, experiencing drug toxicity, older age, and recent CD4 <200 cell/mm³ are factors that increase the risk of virologic failure.

BackgroundAntimicrobial stewardship programs are nonexistent in most resource limited settings like Ethiopia. This has resulted in inappropriate use of antibiotics and widespread development of antibiotic resistance. Targeted initiatives surrounding antimicrobial use are needed to tackle this global health threat. Therefore, a program was established to generate data on antibiotic consumption, resistance, and facilitate appropriate use of antibiotics at an academic hospital in northwestern Ethiopia.MethodsA committee was developed with a multidisciplinary team of clinicians, microbiologist, pharmacists and nurses. A baseline assessment of antibiotic use in the hospital was conducted through review of patient prescriptions and antibiotic inventory changes over time. To understand patterns, listed indication for use was recorded. Clinical audits, provider feedback mechanisms, and a quarterly antibiogram were also developed.ResultsAmong 384 records of patients with infectious diseases, 250 adult and 134 pediatric cases were identified. Community acquired pneumonia (CAP) was the most common reason for use of antibiotics, accounting for 33.6% of adults and 22.2% of pediatric cases. Cephalosporins and penicillins were used in adults with CAP in 48.8% and 51.2% of cases, respectively, with or without macrolides or tetracycline. For severe CAP (30 cases), WHO or IDSA guideline concordance was identified as follows: appropriate antibiotic selection in 23 (76.6%), appropriate treatment duration in 15 (50.0%), and timely switch to oral therapy in 20 (66.7%) of the cases. The quarterly antibiogram included 516 bacterial isolates over one year. The most common organisms were Staphylococcus aureus and Escherichia coli, accounting for 34.7% and 16.8% isolates, respectively. The challenges faced in establishing the program were lack of electronic medical records for tracking antibiotic use and inconsistent supply of microbiologic reagents for microbial surveillance.ConclusionAn effective antimicrobial stewardship program can be established in a resource limited setting with a committed team. Data generated by the program will be used to guide appropriate use of antibiotics and design interventions.Disclosures All authors: No reported disclosures.