Garumma Tolu Feyissa

Stigma and discrimination against people living with HIV by healthcare providers, Southwest Ethiopia

BackgroundStigma and discrimination against people living with human immunodeficiency virus (HIV) are obstacles in the way of effective responses to HIV. Understanding the extent of stigma / discrimination and the underlying causes is necessary for developing strategies to reduce them. This study was conducted to explore stigma and discrimination against PLHIV amongst healthcare providers in Jimma zone, Southwest Ethiopia.MethodsA cross-sectional study, employing quantitative and qualitative methods, was conducted in 18 healthcare institutions of Jimma zone, during March 14 to April 14, 2011. A total of 255 healthcare providers responded to questionnaires asking about sociodemographic characteristics, HIV knowledge, perceived institutional support and HIV-related stigma and discrimination. Factor analysis was employed to create measurement scales for stigma and factor scores were used in one way analysis of variance (ANOVA), T-tests, Pearson’s correlation and multiple linear regression analyses. Qualitative data collected using key-informant interviews and Focus Group Discussions (FGDs) were employed to triangulate with the findings from the quantitative survey.ResultsMean stigma scores (as the percentages of maximum scale scores) were: 66.4 for the extra precaution scale, 52.3 for the fear of work-related HIV transmission, 49.4 for the lack of feelings of safety, 39.0 for the value-driven stigma, 37.4 for unethical treatment of PLHIV, 34.4 for discomfort around PLHIV and 31.1 for unofficial disclosure. Testing and disclosing test results without consent, designating HIV clients and unnecessary referral to other healthcare institutions and refusal to treat clients were identified. Having in-depth HIV knowledge, the perception of institutional support, attending training on stigma and discrimination, educational level of degree or higher, high HIV case loads, the presence of ART service in the healthcare facility and claiming to be non-religious were negative predictors of stigma and discrimination as measured by the seven latent factors.ConclusionsHigher levels of stigma and discrimination against PLHIV were associated with lack of in-depth knowledge on HIV and orientation about policies against stigma and discrimination. Hence, we recommend health managers to ensure institutional support through availing of clear policies and guidelines and the provision of appropriate training on the management of HIV/AIDS.

Alcohol use disorders and associated factors among people living with HIV who are attending services in south west Ethiopia

BackgroundAlcohol use disorders (AUDs) in persons living with human immunodeficiency virus (PLHIV) in high-income countries have been associated with poor adherence to antiretroviral medications and worse HIV-related outcomes. Little is known about AUDs among people attending HIV services in sub-Saharan Africa.MethodsAcross-sectional study was carried out among PLHIV who attended HIV services at Jimma University Specialized Hospital in September 2012. The World Health Organization’s Alcohol Use Disorders Identification Tool (AUDIT) was used to measure probable hazardous, harmful and dependent use of alcohol (‘alcohol use disorders’). Associations between AUDs and other variables were explored using logistic regression analysis. All variables associated with AUDs with a p value <0.25 were included in the final multivariable model.ResultsThe overall prevalence of AUDs was 32.6%, with hazardous use, harmful use and alcohol dependence accounting for 24.7%, 2.8% and 5.1% of the total, respectively. There was no significant difference in the prevalence of AUDs in persons receiving antiretroviral treatment compared to those who were antiretroviral therapy naïve (32.6% vs. 38.6%). AUDs were identified in 26.0% and 44.1% of females and males, respectively. Male gender, smoking cigarettes and psychological distress were positively associated independently with AUDs.ConclusionThe high prevalence of AUDs detected in our facility-based survey of PLHIV in Ethiopia highlights the need to integrate delivery of effective and feasible interventions for AUDs into HIV care.

Validation of an HIV-related stigma scale among health care providers in a resource-poor Ethiopian setting

Background Stigma and discrimination (SAD) against people living with human immunodeficiency virus (HIV) are barriers affecting effective responses to HIV. Understanding the causes and extent of SAD requires the use of a psychometrically reliable and valid scale. The objective of this study was to validate an HIV-related stigma scale among health care providers in a resource-poor setting. Methods A cross-sectional validation study was conducted in 18 health care institutions in southwest Ethiopia, from March 14, 2011 to April 14, 2011. A total of 255 health care providers responded to questionnaires asking about sociodemographic characteristics, HIV knowledge, perceived institutional support (PIS) and HIV-related SAD. Exploratory factor analysis (EFA) with principal component extraction and varimax with Kaiser normalization rotation were employed to develop scales for SAD. Eigenvalues greater than 1 were used as a criterion of extraction. Items with item-factor loadings less than 0.4 and items loading onto more than one factor were dropped. The convergent validity of the scales was tested by assessing the association with HIV knowledge, PIS, training on topics related to SAD, educational status, HIV case load, presence of an antiretroviral therapy (ART) service in the health care facility, and perceived religiosity. Results Seven factors emerged from the four dimensions of SAD during the EFA. The factor loadings of the items ranged from 0.58 to 0.93. Cronbach’s alphas of the scales ranged from 0.80 to 0.95. An in-depth knowledge of HIV, perceptions of institutional support, attendance of training on topics related to SAD, degree or higher education levels, high HIV case loads, the availability of ART in the health care facility and claiming oneself as nonreligious were all negatively associated with SAD as measured by the seven newly identified latent factors. Conclusion The findings in this study demonstrate that the HIV-related stigma scale is valid and reliable when used in resource-poor settings. Considering the local situation, health care managers and researchers may use this scale to measure and characterize HIV-related SAD among health care providers. Tailoring for local regions may require further development of the tool.

Household dietary diversity and Animal Source Food consumption in Ethiopia: evidence from the 2011 Welfare Monitoring Survey

BackgroundIt is imperative to track dietary quality and progress in nutritional outcomes in a population to develop timely interventions. Dietary diversity is a commonly used proxy to assess dietary quality in low-income countries. This study identified predictors of household dietary diversity in Ethiopia and pattern of consumption of animal source food (ASF) among households.MethodsSecondary data were analyzed from the 2011 Ethiopian Welfare Monitoring Survey (WMS). This survey used a structured questionnaire to collect socio-demographic and economic data. Dietary data were collected using a dietary diversity questionnaire measuring dietary diversity over the past 1 week. A Household Dietary Diversity Score (HDDS) was constructed according to the Food and Agricultural Organization (FAO) guidelines. Consumption of ASFs is described by its distribution among the regions and by HDDS. Multiple logistic regression analysis was fitted to identify independent predictors for HDDS.ResultsA total of 27,995 households were included in the analyses. A little over half of the study households (52.2%) had more than four household members, and 75% of households were male headed. The mean HHDS was five food groups. Cereals were the most commonly (96%) consumed food groups. Fish, egg and fruits, on the other hand, were the least consumed food groups. ASFs were consumed in greater proportion among households with higher HDDS. Being part of the higher and middle socio economic strata (P < 0.001), literacy (P < 0.01), urban residence (P < 0.01), male headed household (P < 0.01), larger family size (P <0.01) and owning livestock (P < 0.01) were positively associated with higher HDDS.ConclusionsConsidering these findings, nutrition sensitive interventions which address the problem through economic and educational empowerment and modern technologies supporting agricultural practices need to be designed to increase both local production and increased consumption.

Khat use in people living with HIV: a facility-based cross-sectional survey from South West Ethiopia

BackgroundKhat is an evergreen plant with leaves containing the amphetamine-like compounds cathinone and cathine. Many people in the Horn of Africa use khat on a regular basis. Adverse health and social consequences of khat use have been described but little is known about the use of khat in people living with Human Immunodeficiency Virus (PLHIV) in Ethiopia. This study aimed to assess the prevalence of khat use and factors associated with khat use among PLHIV who are in contact with HIV services in a hospital in south-west Ethiopia.MethodsA cross-sectional study was conducted among 389 PLHIV who attended HIV services at Jimma University Specialized Hospital in September 2012. A structured questionnaire, translated into the local languages, was used to ask about the frequency of khat use and potential risk factors and consequences of khat use in this patient group. Logistic regression analysis was used for bivariate and multivariable analysis.ResultsThe overall prevalence of current khat use among people living with HIV was 23.0%. The prevalence was 18.3% in females and 33.6% in males. Christians were less likely to use khat when compared to Muslims (adjusted Odds Ratio (aOR) 0.26, 95% CI = 0.13, 0.55). There was a positive association between khat use and mental distress (aOR 1.84, 95% CI = 1.01, 3.36), smoking cigarettes (aOR 21.21, 95% CI = 7.19, 62.51), alcohol use disorders (aOR 2.16, 95% CI = 1.10, 4.21), CD4 count ≤200 cells/mm3 (aOR 3.46, 95% CI = 1.60, 7.50) and missing at least one dose of antiretroviral medication in the preceding month (ART) (aOR 4.2, 95% CI = 1.80, 5.75).ConclusionIn this study there was a high prevalence of khat use among people living with HIV which was associated with poorer adherence to ART. There is a need to adapt and evaluate feasible and acceptable interventions to reduce khat use in people living with HIV.

The effectiveness of home-based HIV counseling and testing on reducing stigma and risky sexual behavior among adults and adolescents: A systematic review and meta-analyses

Background Human immunodeficiency virus (HIV) counselling and testing (HCT) is a critical and essential gateway to HIV prevention, treatment, care and support services. Though some primary studies indicate that home‐based HCT is more effective than facility based HCT to reduce stigma and risky sexual behavior, to the best of the authors knowledge, no systematic review has tried to establish consistency in the findings across populations. Objectives The objective of this review was to determine the effectiveness of home‐based HIV counselling and testing (HBHCT) in reducing HIV‐related stigma and risky sexual behavior among adults and adolescents. Inclusion criteria Types of participants All adults and adolescents aged 13 years or above Type of intervention This review considered any studies that evaluated home‐based HIV counseling and testing (HBHCT) as an intervention. Types of studies This review considered quantitative (experimental and observational) studies. Types of outcomes This review considered studies that included the following outcome measures: stigma, violence, sexual behavior and clinical outcomes Search strategy The search strategy aimed to find both published and unpublished studies reported in English Language from 2001 to 2014 in MEDLINE, Web of Science, EMBASE, Scopus and CINAHL. The search for unpublished studies included: WHO International Clinical Trials Registry Platform, Clinicaltrials.gov, Mednar, Google Scholar, AIDSinfo and ProQuest Dissertations and Theses Database (PQDT). Methodological quality Papers selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute (JBI). Data extraction Data were extracted from papers included in the review using the standardized data extraction tool from the Joanna Briggs Institute Qualitative Assessment and Review Instrument. Data synthesis Quantitative data were pooled using the meta‐analysis software provided by JBI. Effect sizes were calculated using fixed effects model. Where the findings could not be pooled using meta‐analyses, results were presented in a narrative form. Results Nine studies were included in this review, five of them reporting on stigma and related outcomes, three of them on sexual behavior and four of them on clinical outcomes. Meta‐analysis indicated that the risk of observing any stigmatizing behavior in the community was 16% (RR=0.84, 95% CI 0.79 to 0.89] lower among the participants exposed to home‐based HCT when compared to the risk among those participants not exposed to home‐based HCT. The risk of experiencing any stigmatizing behavior by HIV positive patients was 37% (RR 0.63, 95% CI 0.45 to 0.88) lower among the intervention population compared to the risk among the control population. The risk of intimate partner violence was 34% (RR 0.66, 95% CI 0.49 to 0.89) lower among participants exposed to home‐based HCT when compared to the risk among participants in the control arm. Compared to the control arm, the risk of reporting more than one sexual partner was 58% (RR 0.42, 95% CI 0.31 to 0.58) lower among participants exposed to home‐based HCT. The risk of having any casual sexual partner in the past three months was 51% (RR 0.49, 95% CI 0.40 to 0.59) lower among the population exposed to home‐based HCT when compared to the risk among those participants not exposed to home‐based HCT. The risk of having ever been forced for sex among participants exposed to home‐based HCT was 20% (RR 0.8, 0.56 to 1.14) lower when compared to the risk among the control arm; however this result was not statistically significant and the wide confidence interval indicates that the risk estimate was imprecise. Conclusions Home‐based HCT is protective against intimate partner violence, stigmatizing behavior, having multiple sexual partners, and having casual sexual partners. Implications for practice The low quality of studies included makes it difficult to formulate clear recommendations regarding the effectiveness of home‐based HCT on the above outcomes as compared to other models of HCT. However, the current findings may help in designing HIV prevention programs, especially in high prevalence settings and where stigma is higher and there is limited access or barriers to utilizing facility‐based services. Implications for research Randomized controlled trials that assess the effectiveness of home‐based HCT on stigma, sexual behavior, viral load and viral suppression are needed.

Factors Associated with Khat Chewing among High School Students in JimmaTown Southwest Ethiopia

Background: Khat is a large green shrub grown in Eastern to Southern Africa and extends to Arabian Peninsula. Khat has its own impact on mental and physical health of the chewers. Studies revealed that khat chewing was associated with frequent absenteeism from class and poor academic performance among students. Although khat has harmful consequences, little is known about factors associated with khat chewing among high school students in Ethiopia. Methods: A cross-sectional study design was conducted on 296 high school students in Jimma city using a structured questionnaire. Khat and risky sexual behavior were assessed using the questionnaire. A structured self-reported questionnaire (SRQ-20) which was developed by the World Health Organization (WHO) was used to assess mental distress. The questionnaire was translated into local language was used to assess khat chewing pattern. Logistic regression analysis was used to determine associations between independent variables and khat chewing. Variables with p-value of less than 0.05 in multivariate logistic regression were declared to have statistically significant association with the outcome variable. Result: The life time prevalence of khat chewing among Jimma city high school students was nearly 16%. The current prevalence of khat chewing among these students was 14.2%. Out of this, 71.4% and 28.6% of them were male and females respectively. Out of the students who had mental distress, 22.2% of them were khat chewers. Being in an age group between 19-23 years ((AOR 4.42, 95% CI=1.25, 15.67), being male (AOR 3.76, 95% CI=1.57, 9.02), having suicidal ideation (AOR 3.65, 95% CI=1.3-10.20) and having ever had a sexual contact (AOR, 13.42, 95% CI=2.76-65.16) were positively associated with khat chewing. Conclusion: In this study there was high prevalence of khat chewing which was associated with risky sexual behavior and suicidal ideation that needs necessary action to tackle the problems.

Prevalence of depression and its associated factors among primary caregivers of patients with severe mental illness in southwest, Ethiopia

BackgroundDepression is a serious mental illness that affects patients’ treatment outcome and caregiver’s day to day life. The prevalence of depression among caregivers of patients with severe mental illness is greater than the general population. Little is known about depression among primary caregivers of patients with severe mental illness in Ethiopia. This study is aimed at assessing prevalence of depression and associated factors among primary caregivers of patients with mental illness.MethodsA cross-sectional study was conducted among primary caregivers of patients with severe mental illness in Jimma University Teaching Hospital. Patient health questionnaire (PHQ-9) was used to assess depression. A multidimensional scale of perceived social support (MSPSS) was used to assess perceived social support; Cut down, Annoyed, Guilty, Eye opener (CAGE) scale was used to assess alcohol use disorder. After conducting descriptive analyses, logistic regression analysis was finally used for bivariate and multivariable analysis.ResultThe overall prevalence of depression among primary caregivers of patients with mental illness was 12 (19%). Out of those caregivers with depressions, 11.3, 3.5 and 4.2% had moderate, moderately severe and severe types of depression respectively. The prevalence of depression among female primary caregivers was 25% (n = 40). Being single (aOR 2.62, 95% CI = 1.07, 6.41), giving care more than six hours per day (aOR 3.75, 95% CI = 1.51, 9.33) and caring for a patient who had more than once episodes of suicidal attempts (aOR 1.48, 95% CI = 1.07, 3.42) were positively associated with depression among caregivers of patients with mental illness.ConclusionWe found that the prevalence of depression among primary caregivers was high. Depression among caregivers was associated with giving care more than six hours per day and caring for a patient who had two or more episodes of suicidal attempts. The prevalence of depression among female caregivers was higher than that of the male caregivers. Therefore, special focus should be given to primary caregivers spending long hours for providing care, those with low perceived social support; caregivers of patients with suicidal ideation and female caregivers.

Discontinuation from Antiretroviral Therapy: A Continuing Challenge among Adults in HIV Care in Ethiopia: A Systematic Review and Meta-Analysis.

Background Discontinuation of antiretroviral therapy (ART) reduces the immunological benefit of treatment and increases complications related to human immune-deficiency virus (HIV). However, the risk factors for ART discontinuation are poorly understood in developing countries particularly in Ethiopia. This review aimed to assess the best available evidence regarding risk factors for ART discontinuation in Ethiopia. Methods Quantitative studies conducted in Ethiopia between 2002 and 2015 that evaluated factors associated with ART discontinuation were sought across six major databases. Only English language articles were included. This review considered studies that included the following outcome: ART treatment discontinuation, i.e. ‘lost to follow up’, ‘defaulting’ and ‘stopping medication’. Meta- analysis was performed with Mantel Haenszel method using Revman-5 software. Summary statistics were expressed as pooled odds ratio with 95% confidence intervals at a p-value of <0.05. Results Nine (9) studies met the criteria of the search. Five (5) were retrospective studies, 3 were case control studies, and 1 was a prospective cohort study. The total sample size in the included studies was 62,156. Being rural dweller (OR = 2.1, 95%CI: 1.5–2.7, I2 = 60%), being illiterate (OR = 1.5, 95%CI: 1.1–2.1), being not married (OR = 1.4, 95%CI: 1.1–1.8), being alcohol drinker (OR = 2.9, 95%CI: 1.9–4.4, I2 = 39%), being tobacco smoker (OR = 2.6, 95%CI: 1.6–4.3, I2 = 74%), having mental illness (OR = 2.7, 95%CI: 1.6–4.6, I2 = 0%) and being bed ridden functional status (OR = 2.3, 95%CI: 1.5–3.4, I2 = 37%) were risk factors for ART discontinuation. Whereas, having HIV positive partner (OR = 0.4, 95%CI: 0.3–0.6, I2 = 69%) and being co-infected with Tb/HIV (OR = 0.6, 95%CI: 0.4–0.9, I2 = 0%) were protective factors. Conclusion Demographic, behavioral and clinical factors influenced ART treatment discontinuation. Hence, we recommend strengthening decentralization of HIV care services in remote areas, strengthening of ART task shifting, application of seek-test-treat-succeed model, and integration of smoking cession strategies and mental health care into the routine HIV care program.

Factors associated with discontinuation of anti-retroviral therapy among adults living with HIV/AIDS in Ethiopia: a systematic review protocol

REVIEW QUESTION/OBJECTIVE The aim of this review is to assess the best available evidence regarding risk factors for discontinuation from anti-retroviral therapy in Ethiopia. Specifically, the review will be assessing the association between discontinuation from anti-retroviral therapy and the following: Socio-demographic and economic factors Behavioral factors Clinical factors Institutional factors INCLUSION CRITERIA Types of participants This review will consider studies reporting on HIV-positive participants aged 15 years and older who have commenced anti-retroviral therapy. Patients who have been transferred out will be excluded. Patients should have at least one follow-up time. If studies include both adult and pediatrics, and are not stratified by age (pediatrics and adults) during analysis, they will be excluded. Besides, if the studies focus on attrition (mortality or discontinuation) and are not stratified by mortality and discontinuation during analysis, the study will also be excluded. Types of exposure This review will consider studies that have examined risk factors for anti-retroviral therapy treatment discontinuation. These include socio-demographic and economic risk factors such as age, sex, income and being dependent on food supplies; behavioral risk factors such as mental status, presence of bereavement, the partner’s HIV status and fear stigma; clinical factors such as isoniazid prophylaxis provision, presence of side effects, baseline CD4 counts and regimen substitution; and institutional risk factors such as distance from the facility and waiting times. Types of outcomes This review will consider studies that include the following outcomes: anti-retroviral therapy treatment discontinuation, i.e. lost to follow up, drop out or defaulting and stopping TRUNCATED AT 250 WORDS