Investigating psychological distress and peer influence in the longitudinal path linking food insecurity to adolescent substance use: a nationwide low-income cohort study.

Food insecurity (FI), defined as the limited or uncertain availability of nutritionally adequate and safe foods, remains a major life concern among many poor subpopulations. Few investigations have been made into the mechanism underlying its impact on adolescent substance use. This study aimed to examine the longitudinal relationship between FI and cigarette and alcohol use among economically disadvantaged adolescents and then explore the role of psychological distress and peer substance use in the aforementioned association. Data of 1,243 adolescents (Mage = 13.3 years; 645 males) were obtained from a nationwide cohort study on Taiwanese adolescents from low-income families. Multiple hierarchical regression analyses based on generalized linear mixed-effects models with binomial distribution found that FI was consistently associated with cigarette smoking (ß = 0.458, p < 0.001) but not alcohol drinking (ß = 0.142, p = 0.143) when both psychological distress and peer substance use were adjusted. In the moderated mediation analysis based on bootstrap methods, we observed that psychological distress mediated the association between food insecurity and alcohol drinking (ß = 0.036, 95% CI = 0.015-0.063) but not cigarette smoking (ß = 0.018, 95% CI =-0.001-0.037). Furthermore, the indirect effects varied by peer drinking status (index of moderated mediation = 0.04, 95% CI 0.015-0.072). Clinical and public health attention should be given to evaluating food-insecure adolescents' psychological well-being and peer influence when counseling their substance use issues.

Work-related stress among nurses in the COVID-19 pandemic: What are the contributing factors?

OBJECTIVE: To analyze the contributing factors of work-related stress among nurses in the COVID-19 pandemic. METHODS: A cross-sectional study was conducted with 101 nurse practitioners from two hospitals in West Java, Indonesia. We distributed an online questionnaire to evaluate work-related stress and the data were analyzed using ordinal logistic regression. RESULTS: More than half of the nurses experienced moderate work-related stress. The study revealed that nurses aged over 35 years old had a lower likelihood of experiencing work-related stress (AOR: 0.173; 95%CI: 0.038-0.782). Married nurses had a higher likelihood (AOR: 7.156; 95% CI: 1.456-35.163). Additionally, nurses with low and moderate workloads had a lower likelihood (AOR: 0.003; 95%CI: 0.000-0.051) and (AOR: 0.025; 95%CI: 0.005-0.116), respectively. CONCLUSION: The consideration of age, marital status, and workload is essential in effectively addressing work-related stress among nurse practitioners.

Health Care Needs Among People Living with HIV: The Implication of Continuum of Care.

Background: Human immunodeficiency virus remains a major public health problem in Indonesia. People living with HIV (PLWH) have various health problems as result from disease progression that impacts their health care needs. This study aims to explore health care needs and to test the factors associated with health care needs among people living with HIV. Methods: A cross-sectional descriptive study design was undertaken with 243 respondents completing a self-reported HIV-Health Care Need Questionnaire. Participants were recruited using the purposive sampling technique from six HIV clinics in West Java, Indonesia. The data were analyzed using descriptive and multiple logistic regression statistical techniques. Results: The majority of the subjects were diagnosed within less than 5 years and have been receiving antiretroviral therapy. Nursing care was indicated as the most needed, offered, and received care. Emergency financial assistance, legal services, insurance premiums, and nutritional intervention were perceived as gaps between needed and received. Characteristics such as age, educational background, having HIV manager, and income were significantly correlated to nutritional care (p< 0.05). Nutritional care was increased by 3.96% if PLWH having HIV manager (CI: 1.17-13.38, p< 0.05). Conclusion: Addressing the gap between health care needs and health offered was important to ensure that care was received appropriately. Continuing assessment of health care needs can provide direction to deliver appropriate care and ensure a comprehensive continuum of care for PLWH.

Work-related stress among nurses in the COVID-19 pandemic: What are the contributing factors? / Estresse laboral entre enfermeiros na pandemia de COVID-19: Quais são os fatores contribuintes? / Estrés laboral entre enfermeros en la pandemia de COVID-19: ¿Cuáles son los factores contribuyentes?

ABSTRACT Objective: To analyze the contributing factors of work-related stress among nurses in the COVID-19 pandemic. Methods: A cross-sectional study was conducted with 101 nurse practitioners from two hospitals in West Java, Indonesia. We distributed an online questionnaire to evaluate work-related stress and the data were analyzed using ordinal logistic regression. Results: More than half of the nurses experienced moderate work-related stress. The study revealed that nurses aged over 35 years old had a lower likelihood of experiencing work-related stress (AOR: 0.173; 95%CI: 0.038-0.782). Married nurses had a higher likelihood (AOR: 7.156; 95% CI: 1.456-35.163). Additionally, nurses with low and moderate workloads had a lower likelihood (AOR: 0.003; 95%CI: 0.000-0.051) and (AOR: 0.025; 95%CI: 0.005-0.116), respectively. Conclusion: The consideration of age, marital status, and workload is essential in effectively addressing work-related stress among nurse practitioners.

RESUMO Objetivo: Analisar os fatores contribuintes do estresse laboral entre enfermeiros na pandemia de COVID-19. Método: Estudo transversal conduzido com 101 enfermeiros de dois hospitais em Java Ocidental, Indonésia. Um questionário online foi distribuído para avaliar o estresse laboral e os dados foram analisados por meio de regressão logística ordinal. Resultados: Mais da metade dos enfermeiros relatou estresse laboral moderado. O estudo revelou que enfermeiros com mais de 35 anos tinham menor probabilidade de vivenciar estresse laboral (AOR: 0,173; IC95%: 0,038-0,782) e enfermeiros casados tinham maior probabilidade (AOR: 7,156; IC95%: 1,456-35,163). Enfermeiros com cargas de trabalho baixas e moderadas tinham menor probabilidade, (AOR: 0,003; IC95%: 0,000-0,051) e (AOR: 0,025; IC95%: 0,005-0,116), respectivamente. Conclusão: É essencial considerar a idade, estado civil e carga de trabalho para uma abordagem eficaz do estresse laboral entre enfermeiros.

RESUMEN Objetivo: Analizar los factores contribuyentes del estrés laboral entre enfermeros en la pandemia de COVID-19. Métodos: Estudio transversal realizado con 101 enfermeros de dos hospitales de Java Occidental, Indonesia. Se distribuyó un cuestionario en línea para evaluar el estrés laboral y los datos se analizaron mediante regresión logística ordinal. Resultados: Más de la mitad de los enfermeros experimentaron un estrés laboral moderado. El estudio reveló que los enfermeros mayores de 35 años tenían una menor probabilidad de experimentar estrés laboral (AOR: 0.173; IC95%: 0.038-0.782) y los enfermeros casados tenían una mayor probabilidad (AOR: 7.156; IC95%: 1.456-35.163). Los enfermeros con cargas de trabajo bajas y moderadas tenían una probabilidad menor, (AOR: 0.003; IC95%: 0.000-0.051) y (AOR: 0.025; IC95%: 0.005-0.116), respectivamente. Conclusión: Es fundamental considerar la edad, el estado civil y la carga de trabajo para un abordaje eficaz del estrés laboral entre los enfermeros.

Problematic Use of Internet Among Indonesia University Students: Psychometric Evaluation of Bergen Social Media Addiction Scale and Internet Gaming Disorder Scale-Short Form.

OBJECTIVE: Social media addiction and internet gaming disorder may cause mental health problems among a minority of university students. The Bergen Social Media Addiction Scale (BSMAS) and the 9-item Internet Gaming Disorder Scale-Short Form (IGDS9-SF) are commonly used worldwide. However, they have not been translated or validated into Indonesian. The present study aimed to translate and validate the BSMAS and IGDS9-SF in an Indonesian context among young adults. METHODS: A multi-center, web-based cross-sectional study was conducted among 458 university students (74% female; mean age 22.5 years) in Indonesia from June to December 2021. The BSMAS and IGDS9-SF were translated into Indonesian. Internal consistency (using Cronbach's α and McDonald's ω) and factor structure (using confirmatory factor analysis) of the two instruments were examined. Concurrent validity of BSMAS and IGDS9-SF was examined using their correlations with two external concepts: nomophobia and psychological distress. RESULTS: Internal consistency of the Indonesian BSMAS and IGDS9-SF were both acceptable (Cronbach's α=0.80 and 0.90; McDonald's ω=0.86 and 0.92). Both instruments were unidimensional with good factor loadings (0.54-0.78 for BSMAS; 0.63-0.79 for IGDS9-SF). Moreover, BSMAS and IGDS9-SF had stronger associations with nomophobia (r=0.58 and 0.12; p<0.001) than with psychological distress (r=0.43 and 0.15; p<0.001). CONCLUSION: The Indonesian versions of the BSMAS and IGDS9-SF had good psychometric properties in terms of linguistic validity, unidimensionality, and reliability. The findings indicate the tools are appropriate for assessing the risk of social media addiction and internet gaming disorder among university students in Indonesia.

Determinants of Adolescent Reproductive Health in West Java Indonesia: A Cross-Sectional Study.

The problem of adolescent reproductive health (ARH) in Indonesia is worrying, especially regarding the Triad Adolescent Reproductive Health (Triad ARH) behavior. Many factors influence ARH behavior. This cross-sectional study explores the association factors between demographic factors, knowledge, and attitudes toward ARH behavior. Six hundred and sixty-eight junior high school and senior high school students were randomly selected from five public schools in Bandung Regency, West Java, Indonesia. The questionnaire used in this study consisted of four parts, namely: (1) demographic data of respondents; (2) knowledge including 20 questions used multiple choice questions; (3) attitude with 12 questions measured using the Likert scale; and (4) behaviors with seven questions measured using Likert scale. Results showed that gender (p = 0.006), age (p = 0.031), and level of education (p = 0.006) were associated with behavior toward ARH behavior, but knowledge (p = 0.582), religion (p = 0.628), ethnic (p = 0.276), and attitude (p = 0.094) were not associated with ARH behavior. Multivariate analysis showed that only gender (p < 0.010) significantly contributed to ARH behavior. Multivariate analysis showed that gender (OR: 2.168, 95% (CI: 1.204-3.904)) significantly contributed to ARH behavior. Based on the results, it can be concluded that the gender factor influences adolescent reproductive health behavior. This study provides further evidence that to promote positive ARH behavior's among youth in West Java, Indonesia, gender should be put in place and be sustainable, using the media and the Internet and involving the collaboration of parents, teachers, and peers to improve adolescent reproductive health.

Reliability and validity study of the Indonesian Smartphone Application-Based Addiction Scale (SABAS) among college students.

Background/Objective: Smartphone addiction, smartphone dependence, and compulsive smartphone use all describe similar phenomena that can cause problems in everyday daily life in many countries worldwide. Most scholars agree that it is the applications on smartphones that individuals have problems with rather than the smartphone itself. For this reason, smartphone application-based addiction is an issue of concern and one instrument has been specifically developed to assess this risk, namely, the Smartphone Application-Based Addiction Scale (SABAS). Although the SABAS has been translated into a number of languages, it has not been translated or validated into Indonesian. Methods: The SABAS was translated into Bahasa Indonesian utilizing a cross-cultural method to ensure its linguistic validity. The linguistic validity of the Indonesian SABAS was ensured using international standard translation guidelines. Moreover, reliability and validity testing of the translated Indonesian SABAS were carried out using Cronbach's α, McDonald's ω, confirmatory factor analysis (CFA), and correlations with psychometric scales assessing psychological distress and nomophobia. Results: Using a sample of 458 participants (mean age = 22.46 years), reliability tests showed that the Indonesian SABAS was acceptable (Cronbach α = 0.74; McDonald's ω = 0.79). Construct validity of the Indonesian SABAS was supported by satisfactory CFA fit indices; concurrent validity supported by good correlations with psychological distress (r = 0.50) and nomophobia (r = 0.61). Conclusions: The Indonesian version of SABAS is valid and reliable to be used for assessing the risk of smartphone application-based addiction in college students.

Internet-Related Instruments (Bergen Social Media Addiction Scale, Smartphone Application-Based Addiction Scale, Internet Gaming Disorder Scale-Short Form, and Nomophobia Questionnaire) and Their Associations with Distress among Malaysian University Students.

The present study evaluated the psychometric properties of four instruments related to internet use, namely the Bergen Social Media Addiction Scale (BSMAS), Smartphone Application-Based Addiction Scale (SABAS), (nine-item) Internet Gaming Disorder Scale Short Form (IGDS9-SF), and Nomophobia Questionnaire (NMPQ) as well as their associations with psychological distress among Malaysian university students. A total of 380 Malaysian university students (71.6% females, mean age 24.0 years) were recruited through convenience sampling and completed an online survey including questions concerning socio-demographic background, social media addiction, smartphone addiction, internet gaming disorder, and nomophobia. Confirmatory factor analysis and Rasch analysis were applied to evaluate the psychometric properties of the instruments and Cronbach's alpha value and McDonald's omega value were used to confirm the internal consistency reliability of the instruments. The unidimensional structure was confirmed for the BSMAS, SABAS, and IGDS9-SF while the four-factor structure was confirmed for NMPQ. All instruments showed good internal consistency reliability. Promising validity and reliability were confirmed for BSMAS, SABAS, IGDS9-SF, and NMPQ. Therefore, they are useful to assess different types of problematic internet use among university students in Malaysia. Furthermore, a significant association was observed between internet use and psychological distress. The present study is the first to investigate the validity and reliability of BSMAS, SABAS, IGDS9-SF, and NMPQ among Malaysian university students using rigorous psychometric testing methods (i.e., Rasch analysis).

The Motors of COVID-19 Vaccination Acceptance Scale (MoVac-COVID19S): Measurement Invariant Evidence for Its Nine-Item Version in Taiwan, Indonesia, and Malaysia.

Background: As the number of COVID-19 cases grows worldwide, one solution to the global pandemic is vaccination. Unfortunately, the hesitancy of receiving vaccines is still high, particularly among younger age groups (eg, students). Because the hesitancy of receiving vaccines is an important issue, instruments have been developed to assess vaccine hesitancy. Moreover, the use of these instruments among specific groups such as students is of critical importance. Aim: The present study examined the psychometric properties of the nine-item MoVac-COVID19S (also known as the DrVac-COVID19S) including its measurement invariance among university students in three different countries (ie, Taiwan, Indonesia, and Malaysia). Methods: A multi-country, web-based cross-sectional survey study was conducted among 1809 university students, recruited from the three countries from May to September 2021. The nine-item scale was translated into Traditional Chinese, Bahasa Indonesian, and Malay. Results: The results of the confirmatory factor analysis indicated that the one-factor structure of the MoVac-COVID19S was fully supported among Indonesian and Malay participants (comparative fit index [CFI] = 0.991 and 0.998; Tucker-Lewis index [TLI] = 0.997 and 0.987; root mean sqaure error of approximation [RMSEA] = 0.040 and 0.071; and standardized root mean square residual [SRMR] = 0.014 and 0.039). Moreover, the four-factor structure was supported among Indonesian, Malay, and Taiwanese participants (CFI = 0.998, 0.998, and 0.985; TLI = 0.997, 0.996, and 0.973; RMSEA = 0.044, 0.038, and 0.091; and SRMR = 0.013, 0.018, and 0.049). Conclusion: The MoVac-COVID19S has good construct validity among university students from three different countries (ie, Taiwan, Indonesia, and Malaysia). The four-factor structure of the MoVac-COVID19S was supported. Therefore, health-care providers may want to assess the four underlying constructs to better understand why a university student accepts or declines COVID-19 vaccine uptake in the three countries. Using the findings, government policymakers and health-care authorities can design appropriate programs to help decrease vaccine hesitancy.

Prevalence and determinants of diarrhea among under-five children in five Southeast Asian countries: Evidence from the demographic health survey.

PURPOSE: To describe the prevalence and the correlation between individual, environmental and household, health behavior, and source of information factors with diarrhea among under-five children in five Southeast Asian countries based on the National Health Survey. DESIGN AND METHODS: Cross-sectional design conducted in five countries in Southeast Asia. Datasets from Demographic and Health Surveys and Multiple Indicator Cluster Surveys in five countries were analyzed. RESULTS: A total of 12,447 children under 5 years of age from five countries in Southeast Asia (Indonesia 1807, Cambodia 2650, Myanmar 1717, the Philippines 3669, and Timor-Leste 2614) were included in this study. Binary logistic regression was performed to analyze the data. A total of 12,447 under-five children were included in the study. Overall, in five Southeast Asian countries, the prevalence of diarrhea is known from 8.39% in the Philippines to 18.21% in Indonesia. Several factors related to diarrhea are individual; environmental and household; health behavior such as stool disposal, breastfeeding mothers, and children's food history; and source of information factors. CONCLUSION: The findings of this study indicate that diarrhea is a serious public health problem in the Southeast Asian region that must be addressed using preventive and curative approaches. PRACTICE IMPLICATION: The results indicate the need for cross-collaboration among nurses, medical doctor, and sanitarian is needed to tackle the childhood diarrhea and minimize the severity based on those determinants.

Triple-P e-Parenting to Improve Awareness of Psychiatric Nurses on Preventing Cyberbullying in Adolescents.

The impact of cyberbullying includes mental health problems and an increased risk of suicide. Psychiatric nurses play an important role in reducing the impact of cyberbullying on students. Nurses, educators, and counselors also play a role to prevent cyberbullying by improving awareness. The purpose of this study is to explore the awareness and involvement of mental nurses and their motivation and confidence in preventing cyberbullying. The research method used in this study was a quasi-experimental pre-post tests study. The sample in this study included 192 respondents. Data analysis used a t-test (pair t-test). This study shows that seminars about cyberbullying and Triple-P e-Parenting are effective in increasing nurses' awareness regarding the incidence of cyberbullying in adolescents (p < 0.001). The aspects that influence the increase in awareness of mental nurses are attitude (p < 0.001) and parenting (p < 0.001). Awareness of nurses as parents related to cyberbullying is important to prevent cyberbullying in adolescents. Seminars about cyberbullying, the role of parents, and how to prevent cyberbullying are effective in preventing cyberbullying in adolescents by paying attention to the experiences of parents who have children affected by cyberbullying.

COVID-19-Related Variables and Its Association with Anxiety and Suicidal Ideation: Differences Between International and Local University Students in Taiwan.

PURPOSE: The present study examined the differences between international and local university students in Taiwan regarding COVID-19-related variables, anxiety, and suicidal ideation. PARTICIPANTS AND METHODS: An online cross-sectional survey (sent via an online link in an email) was carried out comprising university students (n=529). The students were assessed on measures (including validated psychometric instruments) of perceived susceptibility to COVID-19, perceived sufficiency of resources, sources of COVID-19 information, perceived satisfaction with support, anxiety and suicidal ideation. RESULTS: Local students had higher susceptibility to COVID-19 (p<0.001) but decreased sufficiency with resources (p<0.001) and anxiety (p<0.001) compared with international students. Staying with family members, satisfaction with support, and information seeking were the factors that predicted anxiety among international students (all p-values<0.05), while information seeking predicted local students' anxiety (p<0.001). Furthermore, staying with family members, susceptibility to COVID-19, and sufficiency with resources were the factors that predicted suicidal ideation among international students (all p-values<0.05), while being a male and satisfaction with support predicted suicidal ideation among local students (all p-values<0.05). CONCLUSION: International students displayed different COVID-19-related challenges compared with local students. More specifically, international students as compared with local students had lower susceptibility to COVID-19 and higher anxiety. Therefore, healthcare providers should pay more attention to international students' psychological health and awareness regarding impacts of COVID-19 on health.

People with HIV infection had lower bone mineral density and increased fracture risk: a meta-analysis.

A meta-analysis to investigate the difference in fracture risk between individuals with and without HIV infection was performed. People living with HIV had lower bone mineral density (BMD) and greater risks of overall fractures and fragility fractures. Reducing fragility and maintaining skeletal strength for PLWH are urgently needed for this population. PURPOSE: The introduction of effective antiretroviral therapy increased the life expectancy of people living with HIV (PLWH). This population now faces problems related to aging such as decreased bone mineral density (BMD) and increased fracture risk. Some antiretroviral therapies may also negatively impact bone health. We performed a meta-analysis to investigate the difference in the fracture risk between individuals with and without HIV infection. METHODS: We compared BMD, risk of fragility fracture, and risk of all fracture between the two groups. This study included 35 articles with 106,994 PLWH and 228,794,335 controls. RESULTS: PLWH had lower lumbar spine and hip BMD than controls. PLWH had a higher prevalence of all fracture events (4.08% versus 0.44%) and fragility fractures (2.66% versus 2.19%). The relative risks of all and fragility fractures of PLWH were 1.91 (95% confidence interval (CI), 1.46-2.49; p < 0.001) and 1.68 (95% CI: 1.40-2.01; p < 0.001). PLWH also had more vertebral fractures (1.26% versus 0.37%; RR, 1.97; 95% CI: 1.22-3.2; p < 0.05), hip fractures (1.38% versus 0.81%; RR, 1.88; 95% CI: 0.99-3.57; p = 0.05), and wrist fractures (1.38% versus 1.29%; RR, 1.67; 95% CI: 1.13-2.45; p < 0.05) than healthy controls. The pooled incidence of fractures was 1.72 per 100 person-years in PLWH and 1.29 in healthy controls. CONCLUSION: PLWH had lower BMD and greater risks of all fractures and fragility fractures. Reducing fragility and maintaining skeletal strength for PLWH are urgently needed for this population.

Anxiety and Suicidal Thoughts During the COVID-19 Pandemic: Cross-Country Comparative Study Among Indonesian, Taiwanese, and Thai University Students.

BACKGROUND: The COVID-19 pandemic has negatively affected the mental health of university students. OBJECTIVE: This study examined the psychological responses toward COVID-19 among university students from 3 countries-Indonesia, Taiwan, and Thailand. METHODS: We used a web-based, cross-sectional survey to recruit 1985 university students from 5 public universities (2 in Indonesia, 1 in Thailand, and 1 in Taiwan) via popular social media platforms such as Facebook, LINE, WhatsApp, and broadcast. All students (n=938 in Indonesia, n=734 in Thailand, and n=313 in Taiwan) answered questions concerning their anxiety, suicidal thoughts (or sadness), confidence in pandemic control, risk perception of susceptibility to infection, perceived support, resources for fighting infection, and sources of information in the context of the COVID-19 pandemic. RESULTS: Among the 3 student groups, Thai students had the highest levels of anxiety but the lowest levels of confidence in pandemic control and available resources for fighting COVID-19. Factors associated with higher anxiety differed across countries. Less perceived satisfactory support was associated with more suicidal thoughts among Indonesian students. On the other hand, Taiwanese students were more negatively affected by information gathered from the internet and from medical staff than were Indonesian or Thai students. CONCLUSIONS: Our findings suggest that health care providers in Thailand may need to pay special attention to Thai university students given that high levels of anxiety were observed in this study population. In addition, health care providers should establish a good support system for university students, as the results of this study indicate a negative association between support and suicidal thoughts.

HCV co-infection among people living with HIV Is associated with Higher fracture risk.

INTRODUCTION: The purpose of this study was to predict the 10-year risk of fracture among people living with HIV (PLWH) using FRAX™, and to determine the risk factors related to a high probability of fractures. METHODOLOGY: This study consisted of 288 subjects aged 40 years and above. The ten-year probability of major osteoporotic fractures (MOF) and hip fractures was assessed using the FRAX™ algorithm with bone mineral density (BMD) data. A logistic regression was used to determine risk factors related to a high probability of major osteoporotic fracture and hip fracture. RESULTS: The median 10-year probability of fracture was 3.7% (IQR 2.2-6.2) for MOF and 0.8% (IQR 0.3-2.5) for hip fractures. In addition to old age, previous fracture history, and low T-scores, HCV co-infection was associated with a higher risk of hip fractures in PLWH (AOR: 4.3, 95% CI: 1.29-14.33). Old age and low T-scores were also associated with a high probability of MOF. CONCLUSIONS: HCV co-infection among PLWH is associated with a higher risk of hip fracture. Sustained efforts in terms of pharmacologic and non-pharmacologic interventions in PLWH are necessary to prevent osteoporotic fractures, especially in those with HCV co-infections.

Bone fracture among people living with HIV: A systematic review and meta-regression of prevalence, incidence, and risk factors.

INTRODUCTION: People living with HIV (PLWH) had a higher prevalence and incidence rate of bone fracture compared to general population. Although several studies have explored this phenomenon, the prevalence and incidence rate of fracture were varied. OBJECTIVE: The aim of the study is to determine and analyze the pooled prevalence, incidence rate of fracture and fracture risk factors among people living with HIV (PLWH). METHODS: PubMed, Cochrane Library, CINAHL with full Text, and Medline databases for studies published up to August 2019 were searched. Studies reporting the prevalence or incidence of fracture among PLWH were included. Study quality was assessed using the Joanna Briggs Institute (JBI) appraisal tool. A meta-analysis with random-effects model was performed to determine pooled estimates of prevalence and incidence rates of fracture. A meta-regression was performed to determine the source of heterogeneity. RESULTS: The pooled estimated prevalence of fracture among PLWH was 6.6% (95% CI: 3.8-11.1) with pooled odds ratio of 1.9 (95%CI: 1.1-3.2) compared to the general population. The pooled estimates of fracture incidence were 11.3 per 1000 person-years (95% CI: 7.9-14.5) with incidence rate ratio (IRR) of 1.5 (95% CI: 1.3-1.8) compared to the general population. Risk factors for fracture incidence were older age (aHR 1.4, 95% CI: 1.3-1.6), smoking (aHR 1.3, 95% CI: 1.1-1.5), HIV/HCV co-infection (aHR 1.6, 95% CI: 1.3-1.9), and osteoporosis (aHR 3.3, 95% CI: 2.2-5.1). CONCLUSIONS: Our finding highlights a higher risk of fracture among PLWH compared to the general population. Osteoporosis, smoking and HIV/HCV coinfection as the significant modifiable risk factors should be prioritized by the HIV health providers when care for PLWH.