Tuberculosis preventive treatment uptake among people living with HIV during COVID-19 period in Addis Ababa, Ethiopia: a retrospective data review.

BACKGROUND: Screening for tuberculosis (TB) and providing TB preventive treatment (TPT) along with antiretroviral therapy is key components of human immune deficiency virus (HIV) care. The uptake of TPT during the coronavirus disease 2019 (COVID-19) period has not been adequately assessed in Addis Ababa City Administration. This study aimed at assessing TPT uptake status among People living with HIV (PLHIV) newly initiated on antiretroviral therapy during the COVID-19 period at all public hospitals of Addis Ababa City Administration, Ethiopia. METHODS: A retrospective data review was conducted from April-July 2022. Routine District Health Information System 2 database was reviewed for the period from April 2020-March 2022. Proportion and mean with standard deviation were computed. Logistic regression analysis was conducted to assess factors associated with TPT completion. A p-value of < 0.05 was considered statistically significant. RESULTS: A total of 1,069 PLHIV, aged 18 years and above were newly initiated on antiretroviral therapy, and of these 1,059 (99.1%) underwent screening for TB symptoms. Nine hundred twelve (86.1%) were negative for TB symptoms. Overall, 78.8% (719) of cases who were negative for TB symptoms were initiated on TPT, and of these 70.5% and 22.8% were completed and discontinued TPT, respectively. Of 719 cases who were initiated on TPT, 334 (46.5%) and 385 (53.5%) were initiated on isoniazid plus rifapentine weekly for three months and Isoniazid preventive therapy daily for six months, respectively. PLHIV who were initiated on isoniazid plus rifapentine weekly for three months were more likely to complete TPT (adjusted odds ratio [AOR],1.68; 95% confidence interval [CI], 1.01, 2.79) compared to those who were initiated on Isoniazid preventive therapy daily for six months. CONCLUSION: While the proportion of PLHIV screened for TB was high, TPT uptake was low and far below the national target of achieving 90% TPT coverage. Overall a considerable proportion of cases discontinued TPT in this study. Further strengthening of the programmatic management of latent TB infection among PLHIV is needed. Therefore, efforts should be made by the Addis Ababa City Administration Health Bureau authorities and program managers to strengthen the initiation and completion of TPT among PLHIV in public hospitals.

Surgical Capacity in Public and Private Health Facilities After a Five-Year Strategic Plan Implementation in Ethiopia: A Cross Sectional Study.

Background: Surgical capacity is critical for ensuring optimum access to safe, affordable, and timely emergency and essential surgical care (EESC) in low- and middle-income countries (LMICs) like Ethiopia. A five-year strategic plan has been implemented during 2016-2020 in Ethiopia to improve surgical capacity. Objectives: This study aims to evaluate the impact of the five-year strategy in surgical capacity in the country. Methods: A cross sectional survey was conducted in 172 health care facilities in Ethiopia from December 30, 2020, to June 10, 2021. Descriptive statistical analysis was done using STATA statistical software Version 15. Findings: A total of 2,312 surgical workforces were available and, the surgical workforce to population ratio ranged from 1.13:100,000 for public specialized hospitals to 10.8:100,000 for health centre operation room (OR) blocks. Surgical bed to population ratio was 0.03:1000 population, and the average numbers of OR tables per facility were 34. Nearly 25% and 10% of OR tables were not functional in public primary hospitals and private hospitals, respectively. The average surgical volume to population ratio was 189:100,000. Conclusions: Following the implementation of surgical care strategy, the surgical workforce density has increased. However, the study revealed that there is still a huge unmet gap in surgical capacity. The improvement in surgical volume is very low compared to the increment in the surgical workforce density. In addition to the investment being made to build surgical capacity, emphasis needs to be put on surgical system design and strengthening surgical system efficiency.

Access to surgical care in Ethiopia: a cross-sectional retrospective data review.

BACKGROUND: Access to emergency and essential surgical care is still unmet and accessibility is disproportionately inequitable in Ethiopia and other low-and middle-income countries. The aim of this study was to assess surgical care access in terms of capability, capacity, and timeliness of care in different levels of health care in Ethiopia. METHODS: A cross-sectional study with retrospective data review was conducted in 172 health facilities from December 30, 2020 to June 10, 2021. Descriptive statistics such as median with interquartile range and proportion were computed using STATA Version 15 statistical software. RESULTS: Within a 90-day interval of the study period, 69,717 major and minor surgeries, and 33,052 bellwether procedures were performed, and major surgeries accounted for 58% of the surgeries. About 1.6%, 23.56%, 25.34%, and 32.2% of both major and minor, and 3.1%, 12.8%, 27.6%, and 45.3% of bellwether procedures were performed in health center OR blocks, primary, general, and specialized hospitals, respectively. Private hospitals performed 17.33% of major and minor and 11.2% of bellwether procedures for the period. The average pre-admission waiting time for surgical patients in primary, general, and specialized hospitals was 9.68, 37.6, and 35.9 days, respectively, whereas, in private hospitals, the average pre-admission waiting time was 1.42 days. On average, surgical patients traveled 5 Hrs, 11 Hrs, 28.4 Hrs, and 21.3 Hrs to access surgical services in primary, general, specialized, and private hospitals, respectively. The surgical workforce to the population served ratio was 7.5, 1.15, and 1.31/100.000 population in primary, specialized and general hospitals, respectively. CONCLUSION: Most surgical procedures were performed in specialized hospitals, indicating that there is a burden in these health facilities. The pre-admission waiting time for surgical patients was long in higher-level public hospitals. Surgical patients traveled a long distance to access surgical service in higher level hospitals. The ratio of surgical workforce per 100,000 population served was low in all levels of public health facilities in general, and in higher level hospitals in particular. Efforts should therefore be made to strengthen all levels of the health system and improve surgical care access in terms of capacity, capability, and timeliness in the country.

Assessment of maternal and child health care services performance in the context of COVID-19 pandemic in Addis Ababa, Ethiopia: evidence from routine service data.

BACKGROUND: In many settings, health care service provision has been modified to managing COVID-19 cases, and this has been affecting the provision of maternal and child health services. The aim of this study was to assess trends in selected maternal and child health services performance in the context of COVID-19 pandemic. METHODS: A cross-sectional data review was conducted in Addis Ababa, Ethiopia from April to May 2021. Routine health management information system database was reviewed from Addis Ababa Health Bureau for the period from July 2019 to March 2021 across all quarters. Proportion and mean with standard deviation were computed. T-test was used to assess statistically significant differences in services mean performance. RESULTS: Postnatal care  visit, new contraceptives accepters, safe abortion care and number of under-5 years old children treated for pneumonia significantly decreased by 9.3% (p-value 0.04), 20.3% (p-value 0.004), 23.7% (p-value 0.01) and 77.2% (p-value < 0.001), respectively during the first 8 months of the COVID-19 pandemic compared to the previous 8 months' average performance. The trends in Antenatal care first visit, new contraceptive accepters, pentavalent-3 vaccination and under-five children treated for pneumonia began to decline in January to  March 2020, a quarter when the COVID-19 pandemic began; with accelerated declines in April to June 2020 following national lockdown. The trends for the stated services began to increase during July-September 2020, the last quarter of national lockdown. Contraceptive accepters and pentavalent-1 vaccination continued to decline and showed no recovery until January-March 2021 when this study was completed. CONCLUSIONS: Most of the maternal and child health services performance declined following the onset of COVID-19 pandemic and national lockdown, and most of the services began recovering during July-September 2020, the last quarter of national lockdown. However, new and repeat contraceptive accepters and pentavalent-1 recipients continue to decline and show no recovery during end of the study period. Implementing COVID-19 prevention measures and assuring the community about the safety of service delivery is imperative to ensure continuity of the maternal and child health services. Regular monitoring and evaluation of services performance is required to identify slowly recovering services and respond to potentially volatile changes during the COVID-19 pandemic.

Burden and genotype distribution of high-risk Human Papillomavirus infection and cervical cytology abnormalities at selected obstetrics and gynecology clinics of Addis Ababa, Ethiopia.

BACKGROUND: Human papillomavirus is recognized as a major cause of cervical cancer. It is estimated that annually, 7,095 women are diagnosed with cervical cancer and 4,732 die from the disease in Ethiopia. Understanding that the screening practice is very poor and the coverage is very limited, this disease burden is one of the major public health agendas in Ethiopia. This study aimed to assess the burden and genotype distribution of high-risk human papillomavirus (HR HPV) infection and cervical cytology abnormalities at selected obstetrics and gynecology clinics of Addis Ababa, Ethiopia. METHODS: An institutional-based cross-sectional study design was employed from June to October 2015. Cervical samples were collected from 366 participants based on inclusion criteria. HR HPV DNA was analyzed using an Abbott Real-Time PCR system, and cervical cytology screening was performed using the conventional Pap-smear technique. Data were entered in to Epi-data version 13 and analyzed using STATA version 11. RESULTS: The overall HR HPV burden and abnormal cytology were 13.7 and 13.1%, respectively. The majority of HR HPV types were other than types 16 and 18. Of the total abnormal cytology results, 81.3% were low-grade squamous intraepithelial lesions (LSILs), and 12.5 and 6.3% were atypical squamous cells of undetermined significance (ASCUS) and high-grade squamous intraepithelial lesions (HSILs), respectively. Residence, occupation, and HIV serostatus were significantly associated with HR HPV infection. Among the variables, age, age at first marriage, and education were the only ones associated with cervical cytology abnormalities. The overall agreement between the real-time PCR and Pap cytology screening methods was 78.96% (Kappa value of 0.12, 95% CI (0.00-0.243), P = 0.01). CONCLUSIONS: Non-16/18 HR HPV genotypes represented the largest proportion of HR HPV infections in this study. Women without cervical cytology abnormalities had the highest frequency of HR HPV infection. A large-scale community-based cohort study shall be designed and implemented to further identifying the persistent genotype and assessing the changes in cervical epithelial cell lines.