Equity in HIV/AIDS services requires optimization of mainstreaming sectors in Ethiopia.

BACKGROUND: Mainstreaming HIV and AIDS across sectors is crucial to close the disparities in service provision and coverage. However, evidence has shown that certain social groups are left behind in receiving HIV/AIDS services. The objective of this study was twofold: to understand the reasons behind the existing inequities and to explore challenges of equity in HIV/AIDS services in the Amhara region of Ethiopia. METHODS: Twenty-two adults (aged 26-57 years) from eighteen sectors that are mainstreaming HIV and AIDS were purposefully selected until the point of saturation and participated in a semi-structured in-depth interview conducted between January 20 and February 17, 2023. Interviewees were asked to describe their mainstreaming experiences in equitable HIV/AIDS services, reflect on the challenges and barriers that impede equitable service provision, or explain the reasons behind the existence of inequity in HIV/AIDS services. The interviews were audio recorded, transcribed, translated, and iteratively analysed, with early analysis informing subsequent interviews. An inductive-reflexive thematic analysis was conducted, whereby themes and subthemes were identified, and the relationships between subthemes and patterns were critically reviewed. RESULTS: The challenges to equitable HIV/AIDS service provision were grouped into eight thematic areas: (1) changing contexts that shifts public and government attention to emerging diseases, war and political instability, and poverty; (2) leadership-related, such as the lack of supervision and monitoring, not politicising HIV/AIDS (not providing political attention to HIV/AIDS) and weak intersectoral collaboration; (3) financial constraints due to a random budgeting and contract interruption with non-governmental organisations (NGOs); (4) lack of resources due to scarcity and unfair distribution; (5) inadequate skilled personnel due to inadequate numbers and lack of continuous professional and career development; (6) lack of equity-related evidence-based tools and guidelines; (7) inadequate understanding of equity due to lack of training and misunderstanding, and lack of access to equity-oriented tools and guidelines; and (8) cultural norms, values, and perceptions. CONCLUSIONS: This study identified critical challenges faced in the equitable HIV/AIDS services provision. To achieve equity in HIV/AIDS services, mainstreaming sectors need to invest in mechanisms to sustain services in emergency situations; identify effective leaders to maintain collaboration, monitoring, and evaluation; institutionalise responsive budgeting and establish alternative funds to maintain non-governmental organisations initiatives; provide continuous up-to-date training and create a common evidence-sharing platform; implement proper recruitment, education, and professional development of HIV/AIDS focal persons; and promote and practice culturally safe care. It is, therefore, essential to optimise sectors that are mainstreaming HIV/AIDS and incorporate equity considerations in their strategic plans and working guidelines.

Awareness and care seeking for long COVID symptoms among Coronavirus disease survivors in Bahir Dar City, Northwest Ethiopia: phenomenological study.

BACKGROUND: Corona Virus Disease (COVID-19) has long-term sequels that persisted for months to years and manifested with a spectrum of signs and symptoms. Presentations of long COVID-19 symptoms are heterogeneous, vary from person to person, and can reach up to over 200 symptoms. Limited studies are conducted on the awareness of long COVID-19. So, this study aimed to explore the awareness about and care seeking for long COVID-19 symptoms among COVID survivors in Bahir Dar City in 2022. METHODS: A qualitative study with a phenomenological design was used. Participants of the study were individuals who survived five months or longer after they tested positive for COVID-19 in Bahir Dar city. Individuals were selected purposively. An in-depth interview guide was prepared and used to collect the data. Open Cod 4.03 software was used for coding and synthesizing. Thematic analysis was used to analyze the transcripts. RESULTS: The themes emerged from the data were awareness, experience of symptoms and their effects, and care practices of long COVID-19. Although only one participant mentioned the common symptoms of long COVID-19 the survivors experienced general, respiratory, cardiac, digestive, neurological, and other symptoms. These symptoms include rash, fatigue fever, cough, palpitations, shortness of breath, chest pain, and abdominal pain, loss of concentration, loss of smell, sleep disorder, depression, joint and muscle pain. These symptoms brought various physical and psychosocial effects. The majority of the respondents described that long COVID-19 symptoms will go off by themselves. To alleviate the problems some of the participants had taken different measures including medical care, homemade remedies, spiritual solutions, and lifestyle modification. CONCLUSIONS: The result of this study revealed that participants have a significant deficit of awareness about the common symptoms, risk groups, and communicability of Long COVID. However, they experienced the majority of the common symptoms of Long COVID. To alleviate the problems, they had taken different measures including medical care, homemade remedies, spiritual solutions, and lifestyle modification.

The role of health facility and individual level characteristics on medication adherence among PLHIV on second-line antiretroviral therapy in Northeast Ethiopia: use of multi-level model.

BACKGROUND: Medication adherence plays a pivotal role in achieving the desired treatment outcomes. The proportion of HIV patients on second-line antiretroviral therapy is becoming a growing public health concern. However, to date, little attention has been given to second-line antiretroviral medication adherence. Moreover, the association between health facility characteristics and medication adherence has yet not been tested. Thus, this research was conducted to determine the magnitude of medication adherence and examine the role of facility-level determinants among HIV patients on second-line ART. METHODS: A cross-sectional study was conducted on 714 HIV patients on second-line therapy who were selected via systematic random sampling in twenty public health facilities. Medication adherence was measured using the six-item Simplified Medication Adherence Questionnaire (SMAQ) tool. Data were collected in a personal interview as well as document reviews. A multi-level binary logistic regression was used to uncover individual and facility-level determinants. The effect size was presented using an adjusted odds ratio (AOR), and statistical significance was declared at a P value less than 0.05. RESULTS: The magnitude of optimal medication adherence among HIV patients on second-line antiretroviral therapy was 69.5% (65.9-72.7%). Medication adherence was positively associated with the use of adherence reminder methods [AOR = 3.37, (95% CI 2.03-5.62)], having social support [AOR = 1.11, (95% CI 1.02-1.23)], and not having clinical depression [AOR = 3.19, (95% CI 1.93-5.27). The number of adherence counselors [AOR = 1.20, (95% CI 1.04-1.40)], teamwork for enhanced adherence support [AOR = 1.82, (95% CI 1.01-3.42)], and caseloads at ART clinics were all significantly correlated with ARV medication adherence at the facility level. CONCLUSIONS: A large proportion of HIV patients on second-line antiretroviral therapy had adherence problems. Both facility-level and individual-level were linked with patient medication adherence. Thus, based on the identified factors, individual and system-level interventions should be targeted.

Impact of COVID-19 on population health and economic wellbeing in Ethiopia: A national pilot survey.

Introduction: The COVD-19 pandemic has resulted in unprecedented global health and economic crisis, particularly in countries struggling with poverty. We conducted a national survey to understand the economic and health impacts of COVID-19 in Ethiopia. Methods: A pilot, population-based, cross-sectional survey was conducted among adults randomly selected from the Ethio Telecom list of mobile phone numbers. Participants underwent a comprehensive phone interview about the impact of COVID-19 on their economic well-being and the health-related risks associated with COVID-19. Results: Of 4,180 calls attempted, 1194 were answered, of which a successful interview was made with 614 participants. COVID-19 affected the family income of 343 [55.9%] participants, 56 [9.1%] lost their job, 105 [17.1%] perceived high stress in their household, and 7 [1.14%] reported death in their family in the past month. The odds of having a decreased income due to COVID-19 were 2.4 times higher among self-employed [adjusted odds ratio (AOR) 2.4, 95% CI (1.58-3.77)] and 2.8 times higher among unemployed [AOR 2.8, 95% CI (1.35-5.85)] participants. Two-hundred twenty-one [36%] participants had comorbidity in their household with hypertension, 72 [11.7%], diabetes,50 [8.1%], asthma, 48 [7.8%], and other chronic diseases, 51 [8.4%]. Forty-six [7.5%] participants had COVID-like symptoms in the previous month, where cough, headache, and fatigue were the most common. Conclusion: COVID-19 posed serious economic pressure on households. Self-employed and unemployed were the most affected. Continuous surveillance is needed to actively monitor the impact of COVID-19 in the community and safeguard the economic and health well-being of individuals and households.

Major depressive disorder and its association with adherence to antiretroviral therapy and quality of life: cross-sectional survey of people living with HIV/AIDS in Northwest Ethiopia.

BACKGROUND: Major depression is believed to affect treatment adherence and overall quality of life (QoL) of people living with HIV/AIDS (PLWHA). Comorbid major depression contributes to a two-fold higher risk of mortality among PLWHA. Understanding the relationships of major depression, adherence to antiretroviral therapy (ART) and QoL is important to identify areas for intervention. The aim of this study is to examine relationship of major depressive disorder (MDD) and adherence to ART with QoL, and to investigate socio-demographic and clinical factors associated with MDD, adherence and QoL among PLWHA in Northwest Ethiopia. METHOD: A cross-sectional study was conducted in the ART clinic of Felege-Hiwot referral hospital in Northwest Ethiopia from July to October 2019. Adult PLWHA were selected using a systematic random sampling technique. Data were collected using interview administered questionnaires and chart reviews. Mini International Neuropsychiatric Interview and WHOQOL-HIV-BREF-Eth instruments were used to measure MDD and QoL respectively. Adherence to ART was assessed using pill count data from patients' adherence monitoring chart. Univariate and multivariate Poisson regressions were used to assess associations of socio-demographic and clinical factors with MDD and adherence to ART. A multivariate linear regression was used to examine the associations of both MDD and adherence with overall QoL. RESULT: Of the total of 393 invited participants, 391 (99.5%) completed the interviews. MDD was negatively associated with overall QoL: participants with MDD had a lower QoL score of 0.17 points compared to those with no MDD. MDD was associated with reduced adherence to ART when functional disability was controlled (RR = 1.43; 95%CI = 1.05, 1.96; p = 0.025). However, there was no statistical association between adherence to ART and overall QoL. Functional disability was associated with both MDD (RR = 5.07; 95%CI = 3.27,7.86; p < 0.001) and overall QoL (ß = 0.29; 95%CI = 0.21,0.36; p < 0.001). CONCLUSION: The relationship between MDD and QoL indicates the need for feasible, acceptable and evidence-based mental health interventions to reduce depression and improve overall QoL of PLWHA. We recommend future studies investigate causal relationships of MDD, adherence to ART and QoL of PLWHA to better understand priority areas for intervention.

Depression and associated factors among prisoners in Bahir Dar Prison, Ethiopia.

BACKGROUND: Globally there is a rapid increase in prison population, and one out of nine inmates suffers from mental disorders like depression. In Ethiopia, although a mental health strategy is in place, little attention is given to prisoners and studies which focus on depression among prisoners are still scarce. The aim of this study was to assess the prevalence of depression and factors associated with it among prisoners. METHOD: Across-sectional study was conducted from October 5 to 28, 2016 in Bahir Dar city. Simple random sampling technique was used to select 402 prisoners. Depression was measured using Patient Health Questionnaire, nine item version (PHQ-9) at a cut point of five. Data on socio-demographic characteristics, behavioral factors, perceived general health, and prison situation variables were collected using structured questionnaire. The data were collected by trained interviewers. SPSS version 20 was used to analyze the data. Binary logistic regression was used to identify predictors of depression. RESULT: The prevalence of depression was 45.5% (95%CI: 40.5-50.5%). In the final model, having children [Adjusted Odds Ratio (AOR) = 2.48; 95%CI: 1.60-3.83], health satisfaction rated as moderate [AOR = 3.20; 95%CI: 1.12-9.00] or dissatisfied [AOR = 1.63; 95%CI: 1.02-2.62] compared to satisfied, being sentenced for more than 5 years [AOR = 2.31; 95%CI: 1.01-5.25] or 1-5 years [AOR = 3.04; 95%CI: 1.2-7.71] were positively associated with depression. CONCLUSION: High prevalence of depression was found among prisoners. Those with poor general health, long years of imprisonment, and concerns of children were the most vulnerable. Strengthening mental health services of prisons is critically required.

Facility delivery and postnatal care services use among mothers who attended four or more antenatal care visits in Ethiopia: further analysis of the 2016 demographic and health survey.

BACKGROUND: Antenatal care provides the best opportunity to promote maternal and child health services use. But many Ethiopian mothers deliver at home and fail to attend postnatal care. Therefore, this study was done to identify factors associated with health facility delivery among mothers who attended four or more antenatal care visits. The study was also intended to identify factors associated with postnatal care service use among mothers who delivered at home after four or more antenatal care visits. METHODS: This study used the 2016 Ethiopian Demographic and Health Survey data. Two thousand four hundred fifteen women who attended four or more antenatal care visits were included to identify factors associated with health facility delivery after four or more antenatal care visits. Among them, 1055 mothers delivered at home. These women were included to identify factors associated with postnatal care service use. Stata 15.1 was used to analyze the data. Multivariable logistic regression model was fitted to identify associations between the outcome and predictor variables. RESULTS: Among women who had four or more antenatal care visits, 56% delivered at health facility. Mothers with secondary or higher level of education (AOR = 2.9; 95% CI = 1.6-5.3), urban residents (AOR = 3.4; 95% CI = 1.9-6.1), women with highest wealth quintile (AOR = 2.7; 95% CI = 1.5-4.8), and working women (AOR = 1.6; 95% CI = 1.2-2.3) had higher odds of delivering at health facilities. High birth order (AOR = 0.5; 95% CI = 0.3-0.7) was negatively associated with a lower likelihood of health facility delivery. Among women who delivered at home, only 8% received postnatal care within 42 days after delivery. Only the content of care received during antenatal care visits (AOR = 1.40; 95% CI = 1.1-1.8) was significantly associated with postnatal care attendance. CONCLUSION: Women with lower socio-economic status had lower odds of giving birth at health facility even after attending antenatal care. The more antenatal care components a mother received, the higher her probability of delivering at health facility. Similarly, postnatal care attendance was higher among women who had received more antenatal care components.

Untreated depression and tuberculosis treatment outcomes, quality of life and disability, Ethiopia.

OBJECTIVE: To investigate the association between comorbid depression and tuberculosis treatment outcomes, quality of life and disability in Ethiopia. METHODS: The study involved 648 consecutive adults treated for tuberculosis at 14 primary health-care facilities. All were assessed at treatment initiation (i.e. baseline) and after 2 and 6 months. We defined probable depression as a score of 10 or above on the nine-item Patient Health Questionnaire. Data on treatment default, failure and success and on death were obtained from tuberculosis registers. Quality of life was assessed using a visual analogue scale and we calculated disability scores using the World Health Organization's Disability Assessment Scale. Using multivariate Poisson regression analysis, we estimated the association between probable depression at baseline and treatment outcomes and death. RESULTS: Untreated depression at baseline was independently associated with tuberculosis treatment default (adjusted risk ratio, aRR: 9.09; 95% confidence interval, CI: 6.72 to 12.30), death (aRR: 2.99; 95% CI: 1.54 to 5.78), greater disability (ß: 0.83; 95% CI: 0.67 to 0.99) and poorer quality of life (ß: -0.07; 95% CI: -0.07 to -0.06) at 6 months. Participants with probable depression had a lower mean quality-of-life score than those without (5.0 versus 6.0, respectively; P < 0.001) and a higher median disability score (22.0 versus 14.0, respectively; P < 0.001) at 6 months. CONCLUSION: Untreated depression in people with tuberculosis was associated with worse treatment outcomes, poorer quality of life and greater disability. Health workers should be given the support needed to provide depression care for people with tuberculosis.

Burden and presentation of depression among newly diagnosed individuals with TB in primary care settings in Ethiopia.

BACKGROUND: Understanding co-morbidity of depression and tuberculosis (TB) has been limited by challenges in measurement of depression due to overlapping symptoms, use of small hospital samples and uncontrolled analysis. This study was conducted to better understand the burden and presentation of depression, and associated factors in people with TB in primary care settings in Ethiopia. METHODS: We conducted a cross-sectional survey among 657 people newly diagnosed with TB. Symptoms of depression were measured using the Patient Health Questionnaire (PHQ-9). TB symptoms and other factors were captured using standardised questionnaires. The factor structure of PHQ-9 was examined. Multivariable analysis was carried out to estimate prevalence ratios. RESULTS: The prevalence of probable depression was 54.0%. The PHQ-9 had one factor structure (alpha = 0.81). Little interest or pleasure in doing things (73.0%) was the commonest depressive symptom. Older age (Adjusted Prevalence ratio (APR) = 1.19; 95%CI = 1.06, 1.33), female sex (APR = 1.23; 95%CI = 1.18, 1.27), night sweating (APR = 1.25; 95%CI = 1.16, 1.35), pain (APR = 1.69; 95%CI = 1.24, 2.29), being underweight (APR = 1.10; 95%CI = 1.07, 1.13), duration of illness (APR = 1.35; 95%CI = 1.22, 1.50), level of education (APR = 0.93; 95%CI = 0.90, 0.95), and social support (APR = 0.89; 95%CI = 0.85, 0.93) were independently associated with probable depression. CONCLUSIONS: Depression appears highly prevalent in people with TB and PHQ-9 seems to be a useful instrument to detect depression in the context of TB. The frequency of depressive symptoms would suggest that the occurrence of the symptoms in people with TB is in the usual manifestation of the disorder. Prospective studies are needed to understand the longitudinal relationship between TB and depression.

Utilization of HIV testing services among pregnant mothers in low income primary care settings in northern Ethiopia: a cross sectional study.

BACKGROUND: HIV testing of women in child bearing age is an entry point for preventing mother-to-child transmission of HIV (MTCT). This study aims to identify the proportion of women tested for HIV and to determine factors associated with utilization of HIV testing services among pregnant mothers in primary care settings in northern Ethiopia. METHODS: A cross sectional study was conducted in 416 pregnant women from four primary care centers between October 2, 2012 and May 31, 2013 in East Gojjam, Ethiopia. RESULTS: The proportion of mothers who tested for HIV was 277(67%). Among mothers who were not tested for HIV, lack of HIV risk perception (n = 68, 49%) was a major self-reported barrier for HIV testing. A multivariable logistic regression analysis showed that those pregnant women who had comprehensive knowledge about MTCT had an Adjusted Odd Ratio (AOR) of 3.73 (95% CI: 1.56, 8.94), having comprehensive knowledge on prevention of mother to child transmission (PMTCT) of HIV an AOR of 2.56 (95% CI: 1.26, 5.19), and a favorable attitude towards persons living with HIV an AOR of 2.42 (95%CI, 1.20, 4.86) were more likely to be tested for HIV. CONCLUSION: One third of pregnant women had never been tested for HIV until the time of the study. Efforts should be made to improve mother's knowledge about MTCT and PMTCT to increase uptake of HIV testing. Enhancing mother's HIV risk perception to scale up HIV testing in resource limited setting is highly recommended.

Maternal associated factors of low birth weight: a hospital based cross-sectional mixed study in Tigray, Northern Ethiopia.

BACKGROUND: Birth weight is an important determinant of child survival and development. So far, the prevalence and traditional maternal feeding practice correlates of low birth weight have not been explored well in Ethiopia. Therefore, the purpose of this study was to determine the prevalence and associated factors of low birth weight among mothers who delivered at governmental hospitals, Northern, Ethiopia. METHODS: A cross-sectional mixed study design was carried out in 3 zonal hospitals among 308 mothers and their respective live born baby consecutively using interviewer administered piloted questionnaire and 3 focus group discussions were conducted for the qualitative part. The mothers were interviewed and assessed within 6 hours of delivery; all babies were weighed on standard beam balance from Aug 2 to Sep 12. Data were entered, cleaned and analyzed using SPSS version 16.0. Bivariate and multivariate logistic regression was employed to identify the predictors at p < 0.05. For the qualitative study design, following iterative hearing of the discussions verbatim interpretation was done & categorized in to themes and finally triangulated with the quantitative results. RESULTS: The prevalence of low birth weight was found to be 14.6% (95 % CI = 12.56-16.61) and the mean and standard deviations of the birth weights were 3094.9 ± 587.6 grams. Low birth weight was associated with rural place of residence (AOR = 4.34 (95 % CI = 1.99-9.48)), preterm birth/gestational age less than 37 weeks (AOR = 18.5 (95 % CI = 4.94-69.4)), presence of any chronic medical illness (AOR = 5.3 (95 % CI = 1.12-25.45) and maternal weight <50 kg (AOR = 2.26 (95 % CI = 1.06-4.80)). It was found that tradition of selection and preference of nutritionally poor food items during pregnancy was deep-rooted in the community. CONCLUSION: The prevalence of low birth weight was found to be high and it was associated with rural place of residence, gestational age <37 wks, presence of any chronic medical illness & maternal weight <50 kg. Emphasis should be given to nutritional counseling and disease specific ANC provision by skilled health professionals; Discussions with the community and religious leaders are mandatory aspect on the tradition of feeding of pregnant mothers to tackle the problem. This study also calls for community based further studies.

Lived Experiences of Hospitalized Patients With Coronavirus Disease at Tibebe Ghion Comprehensive Specialized Hospital, Bahir Dar, North West Ethiopia, A Phenomenological Study.

BACKGROUND: Hospitalized patients with coronavirus disease experienced different challenges at treatment centers; however, there is no evidence in Ethiopia on patients' experiences at COVID-19 treatment centers. Therefore, the aim of this study was to explore the lived experiences of hospitalized patients with coronavirus disease at Tibebe Ghion Comprehensive Specialized Hospital, Bahir Dar, Ethiopia, in 2021. METHODS: A qualitative phenomenological study design with a heterogeneous purposive sampling technique was used. Fifteen hospitalized patients participated from March 15 to April 1, 2021. The information was gathered through an in-depth interview technique with an audio recorder. Thematic analysis was used to analyze the data using Atlas Ti version 7.09 software. RESULT: Hospitalized patients with the coronavirus disease had a variety of experiences with various phenomena. Lived experiences were identified with 2 major themes: the psychoemotional theme has 2 subthemes (psychological and emotional experience), and the context-related experience has 5 subthemes (socioeconomic, patient-health care provider, health facility-related, exposure prevention, and governmental-related factors). CONCLUSION: The study identified 2 major themes: 7 subthemes and 10 categories. Study participants faced different challenges, mainly hopelessness, anxiety, a lack of caregiver, isolation, a shortage of medications, poor communication between the patient and health care provider, and a lack of health insurance. Therefore, we recommend giving psychological support, improving communication between patients and health care professionals, and ensuring health insurance.

Correction: Universality of universal health coverage: A scoping review.

[This corrects the article DOI: 10.1371/journal.pone.0269507.].

Alcohol use and alcohol use disorders in sub-Saharan Africa: A systematic review and meta-analysis.

BACKGROUND AND AIMS: Population-level alcohol use data are available from high-income countries, but limited research has been conducted in sub-Saharan Africa. This systematic review and meta-analysis aimed to summarize population-level alcohol use in sub-Saharan Africa. METHOD: Databases searched included PubMed, EMBASE, PsycINFO and AJOL, without language restrictions. Searches were also conducted in the Global Health Data Exchange (GHDx) and Google Scholar. Search terms encompassed 'substance' or 'substance-related disorders' and 'prevalence' and 'sub-Saharan Africa'. We included general population studies on alcohol use (including any use, high-risk alcohol use and alcohol use disorders) from 2018 onwards. Prevalence data for alcohol use among sub-Saharan African adolescents (10-17) and adults (18+) were extracted. Analyses included life-time and past 12- and 6-month alcohol use. RESULTS: We included 141 papers. Among adolescents, the life-time prevalence of alcohol use was 23.3% [95% confidence interval (CI) = 11.3-37.1%], 36.2% (CI = 18.4-56.1%) in the past year and 11.3% (CI = 4.5-20.4%) in the past 6 months. Among adolescents, 12-month prevalence of alcohol use disorder and alcohol dependence were 7.7% (CI = 0.0-27.8%) and 4.1% (CI = 1.4-7.9%), respectively. Among adults, the life-time prevalence of alcohol use was 34.9% (CI = 17.7-54.1%), 27.1% (CI = 5.0-56.4%) in the past year and 32.2% (CI = 19.8-46.0%) in the past 6 months. Among adults, the 12-month prevalence of alcohol use disorder and alcohol dependence were 9.5% (CI = 0.0-30.4%) and 4.3% (CI = 0.8-9.8%), respectively. The highest weighted life-time prevalence of alcohol use, 86.4%, was reported in Tanzania among adults. The highest weighted past 6-month prevalence of alcohol use, 80.6%, was found in Zambia among adolescents. CONCLUSION: Alcohol use patterns vary across countries and subregions within sub-Saharan Africa, and comprehensive population-level data on alcohol use remain scarce in numerous sub-Saharan African countries. The prevalence of alcohol use disorder is common among adolescents in sub-Saharan Africa.

Effect of integrating traditional care with modern healthcare to improve tuberculosis control programs in Ethiopia: a protocol for a cluster-randomized controlled trial.

BACKGROUND: Tuberculosis (TB) remains a major cause of morbidity and mortality in the world, despite being a preventable and curable disease. The World Health Organization (WHO) End-TB Strategy, aligned with the Sustainable Development Goals (SDGs), sets a target of reducing the TB mortality rate by 95%, TB incidence rate by 90%, and catastrophic costs due to TB by 2035, compared with a 2015 level. To achieve these ambitious targets, several interventions have been implemented in the last few years, resulting in major progress toward reducing the burden of TB. However, over one-third of the global TB cases remained undetected and never received treatment. Most of those undetected cases were found in low- and middle-income countries such as Ethiopia. Though several interventions were implemented to increase TB case detection and mitigate catastrophic costs associated with TB, sustaining these interventions in resource-constrained settings remains challenging. Consequently, an alternative method is needed to increase TB case detection while decreasing diagnosis delays and catastrophic costs. Therefore, this study aimed to integrate traditional TB care into modern TB care to improve TB control programs, including early TB case detection, and reduce catastrophic costs in high TB burden settings such as Ethiopia. METHODS: A cluster randomized controlled trial will be conducted in northwest Ethiopia to determine the effectiveness of integrating traditional care with modern TB care. The intervention will be conducted in randomly selected districts in the South Gondar Zone. The control group will be an equal number of districts with usual care. The intervention comprised three key components, which include referral linkage from traditional to modern health care; training of health professionals and traditional care providers in three different rounds to increase their knowledge, attitude, and skills toward the referral systems; and TB screening at traditional health care sites. The primary outcomes of interest will be an increase in case detection rate, and the secondary outcomes of interest will be decreased diagnosis delays and catastrophic costs for TB patients. Data will be collected in both the intervention and control groups on the main outcome of interest and a wide range of independent variables. Generalized linear mixed models will be used to compare the outcome of interest between the trial arms, with adjustment for baseline differences. DISCUSSION: This cluster-randomized controlled trial study will assess the effectiveness of a strategy that integrates traditional healthcare into the modern healthcare system for the control and prevention of TB in northwest Ethiopia, where nearly 90% of the population seeks care from traditional care systems. This trial will provide information on the effectiveness of traditional and modern healthcare integration to improve TB case detection, early diagnosis, and treatment, as well as reduce the catastrophic costs of TB. TRIAL REGISTRATION: ClinicalTrials.gov NCT05236452. Registered on July 22, 2022.

Lived experience of people on anti-retro viral therapy in the context of covid-19: A phenomenological study.

INTRODUCTION: People living with human immune virus (HIV) are confronting multiple psychosocial and economic issues influenced by the illness. People on anti-retro viral drugs (ART) were at risk for discontinuation of medications during corona viral disease-2019 (COVID-19) pandemic. COVID-19 outbreak made people living with HIV (PLWH) to experience critical challenges and barriers to optimal care. The experience of people living with HIV such as stigma and discrimination, economic problem, psychosocial problem before the emergency of COVID-19 were studied but there is lack of understanding on the lived experience of people living with HIV in the context of COVID-19 in Ethiopia particularly in Tach Gayint. This study aimed to explore the lived experience of people on ART in context of COVID-19 in Tach Gayint district. METHODS AND MATERIALS: Phenomenological study design conducted with 16 study participants from March 12-April 12/2021. Data were collected using in-depth interview using interview guide and digital recorder. The investigator took note in addition to digital record. Interviews were transcribed word for word and translated conceptually. Analysis followed Reading of transcriptions, develop and apply coding, displaying data, data reduction and interpretation. Atlas.ti-7 software used to facilitate analysis. The quality of data was assured by the principles of credibility, dependability, conformability and transferability. RESULT: The study explored psychological experience, change in social interaction, and economic experience and ART drug interruption as the main themes including other sub-themes. Most participants perceived the severity of COVID-19 on them. Lack of participation in social activities due to fear of contracting and the participants experienced dying and loss of income. This extreme fear pushed some participants to interrupt their daily ART intake especially during lock down period. Personal, familial and community context contributed for these distressing experiences. CONCLUSION AND RECOMMENDATION: This study reported participants' psychosocial, economic experiences including ART drug interruptions. The government should design policies and interventions to alleviate their personal, household and community problems, which were the caused for the mentioned hostile experiences.

Socioeconomic inequality and contributors in accepting attitudes toward people living with HIV among adults in Ethiopia from 2005 to 2016: a population-based cross-sectional study.

INTRODUCTION: The public's accepting attitude toward people living with HIV is crucial in reducing HIV-related stigma and discrimination, increasing people's access to HIV service. This study examines the inequalities in accepting attitudes toward people living with HIV in Ethiopia from 2005 to 2016. METHODS: This cross-sectional study was based on the 2005, 2011 and 2016 Ethiopian Demographic Health Surveys. A total of 17 075, 28 478 and 25 542 adults were included in the 2005, 2011 and 2016 surveys, respectively. Socioeconomic inequality was investigated using the concentration curve and Erreygers' concentration index (ECI), which is scaled from -1 (pro-poor) to +1 (pro-rich). The ECI was decomposed to identify the contributors to socioeconomic inequality using generalised linear regression with the logit link function. RESULTS: Accepting attitude toward people living with HIV was 17.9% (95% CI: 16.6%, 19.3%) in 2005, which increased to 33.5% (95% CI: 31.8%, 35.3%) in 2011 and 39.6% (95% CI: 37.6%, 41.9%) in 2016. ECI was 0.342 (p<0.001), 0.436 (p<0.001) and 0.388 (p<0.001), respectively, for 2005, 2011 and 2016. The trend line illustrates socioeconomic inequality seems diverging over time, with an increasing ECI of 0.005 every year (r=0.53; p=0.642; slope=0.005). CONCLUSIONS: The current study found that there was pro-rich inequality from 2005 to 2016. People with higher socioeconomic status had a better attitude toward people living with HIV. Comprehensive knowledge about HIV/AIDS, education status, residence, and access to electronic and paper-based media, as well as HIV testing, contribute to a better accepting attitude toward people living with HIV. It is of utmost importance for the country to enhance accepting attitude toward people living with HIV to reduce stigma and discrimination. This requires whole-system response according to the primary healthcare approach toward ending the epidemic of HIV/AIDS in the country.

Acceptability of integrating traditional tuberculosis care with modern healthcare services in the Amhara Regional State of Northwest Ethiopia: A qualitative study.

Many people with tuberculosis (TB) rely solely on traditional healthcare services. Integrating traditional healthcare with modern healthcare services can increase access, quality, continuity, consumer satisfaction, and efficiency. However, successful integration of traditional healthcare with modern healthcare services requires stakeholder acceptance. Therefore, this study aimed to explore the acceptability of integrating traditional care with modern TB care in the South Gondar zone, the Amhara Regional State, northwest Ethiopia. Data were collected from patients with TB, traditional healers, religious leaders, healthcare providers, and TB program personnel. Data were collected using in-depth interviews and focus group discussions from January to May 2022. A total of 44 participants were included in the study. The context and perspectives of integration were thematized into the following five major themes: 1) referral linkage, 2) collaboration in awareness creation in the community, 3) collaboration in monitoring and evaluation of integration, 4) maintaining continuity of care and support, and 5) knowledge and skill transfer. Integrating traditional and modern TB care was acceptable to both modern and traditional healthcare providers as well as TB service users. This may be an effective strategy for improving the TB case detection rate by decreasing diagnosis delay, treatment initiation, and catastrophic costs.

Adherence to Lifestyle Modification Practices and Its Associated Factors Among Hypertensive Patients in Bahir Dar City Hospitals, North West Ethiopia.

Background: Globally, hypertension affects 1.4 billion adults, accounting for 31% of the world population. The prevention and control of hypertension is not addressed only by pharmacological management. Even though the prevalence of uncontrolled hypertension and its complications is increasing every day, Adherence to lifestyle modification practice among diagnosed hypertensive individuals is low for a number of reasons. The study aims to assess adherence to lifestyle modification practices and associated factors among hypertensive patients at Bahir Dar city hospitals, in North West Ethiopia. Methods: An institutional-based cross-sectional study design was conducted at Bahir Dar city from October 30 to November 30, 2022. A stratified sampling technique was used. For the data quality pre-test was done, the questionnaire was checked for completion, the assumption of binary logistic regression (VIF 1.8 and no outlier), and model fit using the Hosmer and Lemeshow's test was checked. Binary logistic and multivariate logistic regression were used to find significant variables after the data were entered into EpiInfo and analyzed using SPSS version 23. Results: The overall adherence to lifestyle modification practices was about 32.4%. From the independent factors, above secondary educational status (AOR = 0.201 95% CI (0.081-0.499)), good knowledge (AOR = 3.323 95% CI (1.79-6.168)), good self-efficacy (AOR = 3.553 95% CI (1.91-6.613)), good social support (AOR = 8.339 95% CI (4.251-16.357)), and good patient-physician relationship (AOR = 2.424 95% CI (1.309-4.490)) were statistically significant predictors of adherence to lifestyle modification practices. Conclusion: Only one-third of the participants had adhered to the recommended lifestyle modifications. Educational status, knowledge, self-efficacy, social support, and patient-physician relationships were significant factors. Healthcare organizations should develop programs to raise hypertension patients' awareness and degree of self-efficacy that aid in adherence to advised lifestyle changes.

Socioeconomic inequality in knowledge about HIV/AIDS over time in Ethiopia: A population-based study.

Socioeconomic inequality in comprehensive knowledge about HIV/AIDS can hinder progress towards ending the epidemic threat of this disease. To address the knowledge gap, it is essential to investigate inequality in HIV/AIDS services. This study aimed to investigate socioeconomic inequality, identify contributors, and analyze the trends in inequality in comprehensive knowledge about HIV/AIDS among adults in Ethiopia. A cross-sectional study was conducted using 2005, 2011, and 2016 population-based health survey data. The sample size was 18,818 in 2005, 29,264 in 2011, and 27,261 in 2016. Socioeconomic inequality in comprehensive knowledge about HIV/AIDS was quantified by using a concentration curve and index. Subsequently, the decomposition of the concentration index was conducted using generalised linear regression with a logit link function to quantify covariates' contribution to wealth-based inequality. The Erreygers' concentration index was 0.251, 0.239, and 0.201 in 2005, 2011, and 2016, respectively. Watching television (24.2%), household wealth rank (21.4%), ever having been tested for HIV (15.3%), and education status (14.3%) took the significant share of socioeconomic inequality. The percentage contribution of watching television increased from 4.3% in 2005 to 24.2% in 2016. The household wealth rank contribution increased from 14.6% in 2005 to 21.38% in 2016. Education status contribution decreased from 16.2% to 14.3%. The percentage contribution of listening to the radio decreased from 16.9% in 2005 to -2.4% in 2016. The percentage contribution of residence decreased from 7.8% in 2005 to -0.5% in 2016. This study shows comprehensive knowledge about HIV/AIDS was concentrated among individuals with a higher socioeconomic status. Socioeconomic-related inequality in comprehensive knowledge about HIV/AIDS is woven deeply in Ethiopia, though this disparity has been decreased minimally. A combination of individual and public health approaches entangled in a societal system are crucial remedies for the general population and disadvantaged groups. This requires comprehensive interventions according to the primary health care approach.