Trends in HIV-1 pretreatment drug resistance and HIV-1 variant dynamics among antiretroviral therapy-naive Ethiopians from 2003 to 2018: a pooled sequence analysis.

BACKGROUND: Ethiopia is among the highly HIV-affected countries, with reported 12,000 and 12,000 AIDS-related deaths and incidents as per reports from 2021. Although the country has made a promising progress in antiretroviral therapy, recent studies have indicated that pretreatment drug resistance (PDR) is alarmingly increasing, which has become a challenge for the effectiveness of HIV treatment. Epidemiologic data on PDR is necessary to help establish ART regimens with good efficacy. Thus, this systematic review aimed to determine the trend analysis of PDR among ART-naïve individuals along with HIV variant dynamics in Ethiopia. METHOD: HIV-1 pol sequences from studies conducted between 2003 and 2018 among ART-naïve Ethiopian individuals were retrieved from GenBank and analyzed for the presence of PDR mutations (PDRM) along with the analysis of HIV-1 variant dynamics. The Calibrated Population Resistance (CPR) tool Version 8.1 and the REGA HIV-1 Subtyping Tool Version 3 were used to determine the PDRM and HIV-1 genetic diversity, respectively. RESULT: We identified nine studies and analyzed 1070 retrieved HIV-1 pol sequences in this systematic review. The pooled prevalence of PDR was 4.8% (51/1070), including 1.4% (15/1070), 2.8% (30/1070), and 0.8% (9/1070) for nucleoside reverse transcriptase inhibitor (NRTI), non-NRTI (NNRTI), and protease inhibitor (PI) resistance, respectively. NRTI and NNRTI concurrent PDRM were observed among 0.2% (2/799) of the analyzed sequences. The overall PDR prevalence has been increasing over the years. Though the prevalence of the NNRTI, NRTI, and PI PDR also increased over the years, the NNRTI increment was more pronounced than the others, reaching 7.84% in 2018 from 2.19% in 2003. The majority (97%; 1038/1070) of the genetic diversity was HIV-1 subtype C virus, followed by subtype C' (2%; 20/1038) and other subtypes (1%; 10/1038). CONCLUSIONS: According to this systematic review, the overall pooled prevalence of PDR is low. Despite the low prevalence, there has been an increasing trend of PDR over the years, which implies the need for routine surveillance of PDRMs along with preventive measures. Hence, this supports the recently endorsed transition of ART regimens from NNRTI to integrase strand transfer inhibitor-based regimens recommended by the WHO. In addition, this finding underscores the need for routine baseline genotypic drug resistance testing for all newly diagnosed HIV-infected patients before initiating treatment to halt the upward trend of PDR.

Rape survivors' experience in Tigray: a qualitative study.

INTRODUCTION: As consequences of war, women and girls are the most likely segment of society to be impacted by violence. War also affects the critical facilities and makes the situation worse as victims cannot get the vital basic services. According to media and unpublished reports, Tigrayan women have been victimized by gang rape and sexual violence. Furthermore, there is substantive evidence of intentional destruction and vandalization of health facilities due to the one-year-old-armed conflict. This study aimed to explore experiences of rape survivors in areas hit by armed conflict in the Tigray region of Ethiopia. METHODS: In this qualitative study, a phenomenological study design was employed among Tigrayan sexual assault survivors in a war-ravaged of Tigray. Survivors were selected purposively and included in the study for an in-depth interview. An interview guide was used to collect the data. Audio records from the in-depth interviews in Tigrigna were transcribed verbatim and then translated into English for analysis. Atlas-ti 7 software was used to code the interview transcripts of the qualitative data, and categorizations and thematizing of the codes were done. Direct quotes were used to describe categories or themes. RESULTS: Ten women who were survivors of sexual violence and rape related to the war in Tigray participated in the interview. The age of the women ranged between 16 and 30 years with a mean age of 21.7. Among the participants, five were teenagers, six were single and/or economically dependent on their family or husband, and two did not attend any school and were not able to read and write. This study has generated five major thematic areas: (1) infliction of long-lasting trauma on children (2) effects of the rape (3) means of escaping from rape and killings (4) home remedies as means of life saving in war affected areas, and (5) beyond rape. CONCLUSIONS: Rape in war-stricken Tigray has been widespread which includes teenagers and it caused immense psychological and physical damage to the survivors and their families. Damage of critical facilities such as the absence of safe houses for survivors and health services was an added complexity to the victims of rape. Hence, a coordinated effort by the government of Tigray and international partners is required to heal, support and rehabilitate the victims and rebuild the damaged health institutions and reequip the health facilities.