The Burden of Pneumocystis Pneumonia Infection among HIV Patients in Ethiopia: A Systematic Review

Abstract

Pneumocystis pneumonia (PCP) is a leading cause of death among patients with AIDS worldwide, but its burden is difficult to estimate in low- and middle-income countries, including Ethiopia. This systematic review aimed to estimate the pooled prevalence of PCP in Ethiopia, the second most densely populated African country. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were used to review published and unpublished studies conducted in Ethiopia. Studies that reported on the prevalence of PCP among HIV-infected patients were searched systematically. Variations between the studies were assessed by using forest plot and I-squared heterogeneity tests. Subgroup and sensitivity analyses were carried out when I2 > 50. The pooled estimate prevalence with 95% CI was computed using a random-effects model of analysis. Thirteen articles, comprising studies of 4847 individuals living with HIV, were included for analysis. The pooled prevalence of PCP was 5.65% (95% CI [3.74–7.56]) with high heterogeneity (I2 = 93.6%, p < 0.01). To identify the source of heterogeneity, subgroup analyses were conducted by study design, geographical region, diagnosis methods, and year of publication. PCP prevalence differed significantly when biological diagnostic methods were used (32.25%), in studies published before 2010 (32.51%), in cross-sectional studies (8.08%), and in Addis Ababa (14.05%). PCP prevalence differences of 3.25%, 3.07%, 3.23%, and 2.29% were recorded in studies based on clinical records, published since 2017, follow-up studies, and north-west Ethiopian studies, respectively. The prevalence of PCP is probably underestimated, as the reports were mainly based on clinical records. An expansion of biological diagnostic methods could make it possible to estimate the exact burden of PCP in Ethiopia.

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“…Our study included study participants who were on DTG-based as well as on EFV-based regimens which have better tolerability to enhance ART adherence and subsequent VLS than only the EFV-based regimens. However, the finding is higher than the studies conducted in eastern Ethiopia, South Africa, and Uganda [22,27,28,46]. The difference might be due to differences in study design, study subject, and operational definition for elevated viral load.…”

“…The study also showed that 29.0% versus 28.8% of women enrolled in PMTCT care newly, and 5.6% versus 7.8% of women started ART during the delivery or breastfeeding period among women in the DTG-based and in the EFV-based regimens arm respectively. The median (IQR) maternal ART duration on PMTCT care was 22 (19)(20)(21)(22)(23)(24) months for the DTG-based regimens arm and 22 (19)(20)(21)(22)(23)(24)(25) months for the EFV-based regimens arm (Table 3).…”

“…As per the United Nations Program on HIV/AIDS (UNAIDS) global targets, Ethiopia has planned to achieve the third 95% target (95% of people receiving ART have achieved an undetectable VL) since 2020 [19,20]. Except for five African countries, other developing countries including Ethiopia did not achieve the third 95% target among women [11,[21][22][23][24][25][26][27][28][29][30][31][32]. Besides, previous studies focused on VLS among women other than DTG-based regimens and the safety and efficacy of DTG-based versus EFV-based regimens among people living with HIV.…”