Predictors of hospitalization among children on ART in Ethiopia: A cohort study

Abstract

Background: Substantial progress has been made in the management of pediatric HIV infection in Ethiopia with the implementation of mother-to-child-prevention programs. Since the introduction of HAART in 2005, mortality among HIV-infected children has reduced while the rate of hospitalization was expected to rise. The purpose of this study, therefore, was to assess predictors of hospitalization in children on ART in seven university referral hospitals in Ethiopia. Methods: A prospective cohort study design was employed on children age 0-18 years as part of a multisite observational study. ART-experienced eligible and ART-naïve children with HIV/AIDS were enrolled into the Advanced Clinical Monitoring (ACM) till December 31, 2012 were included. From the database, information on hospitalization and other independent variables were extracted. Analysis was done using both SPSS for Windows version 16.0 and STATA. Descriptive analyses and modeling was done using logistic regression. Results: Of the 405 children on ART (174 experienced, 231 naive), 86 (20.7%) were hospitalized for various reasons; two children were excluded since they were hospitalized for unrelated conditions (appendicitis and burn). Fifty one (60.7%) of the eighty four admitted children were hospitalized in the first six months of ART initiation. Of the independent variables, only the presence of opportunistic infections and duration on ART were significantly associated with hospitalization both on bi-variable and multivariable analyses (P-value <0.05). As the duration on ART increased by one month, the risk of hospitalization decreased by 5.4%, which is statistically significant (P < 0.001). Whereas the incidence (number) of OI's increased by one, the risk of being hospitalized increased by 35.2% (P = 0.002). Of the individual opportunistic infections, pneumonia was found to be the only predictor of hospitalization (P-value = 0.002). Conclusion: This study showed that nearly two-third of the hospitalization was within 6 months of initiation of ART; and presence of OI and duration on ART were the only predictors of hospitalization.

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

“…In Ethiopia, the threat of HIV treatment failure is becoming a continuing discussion. This might be due to poor HIV care services, delayed to recognize treatment failure, [34], late initiation of HAART [33], high burden of opportunistic infections [35], lack of appropriate nutritional support [36], ART-associated adverse reaction, [37] and frequent psychological problem [38,39]. Besides, the absence of frequent therapeutic drug monitors and/ or resistance testing while the patient is still on the suspect or failing regimen.…”

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

“…In Ethiopia threat of HIV treatment failure is becoming appointed discussion. This might be due to implementation of poor HIV care, delaying on recognition of symptom of treatment failure, (35), late initiation of HAART (36), high burden of opportunistic infections (37), lack of well nutritional support (38), ART associated adverse reaction, (39) and frequent psychological problem (40,41) are recorded in Ethiopia. Besides, absence of frequent therapeutic drug monitors and/ or resistance testing while the patient is still on the suspect or failing regimen.…”

Incidence of common opportunistic infections among HIV-infected children on ART at Debre Markos referral hospital, Northwest Ethiopia: a retrospective cohort study

“…OIs are the leading causes of morbidity and mortality among HIV-infected children contributing to 94.1% of HIV-related deaths [10][11][12][13]. Unless OIs are treated as early as possible, they markedly affecting the treatment outcomes of PLHIV leading to poor quality of life, hastening disease progression, increasing medical costs, potentiating the risk of treatment failure, and impairing patient's response to antiretroviral therapy (ART) drugs [14,15].…”