Uptake of community-based differentiated antiretroviral therapy service delivery and associated factors among people living with HIV in Ethiopia: a multicenter cross-sectional study.

Background: Achieving the 95-95-95 targets require an efficient and innovative person-centered approach, specifically community-based differentiated service delivery (DSD), to improve access to human immunodeficiency virus (HIV) services and reduce burdens on the health system. Therefore, this study aimed to assess the uptake of community-based DSD models and associated factors among people living with HIV (PLHIV). Methods: A multicenter cross-sectional study was conducted among PLHIV in public health facilities in South Ethiopia. Data were collected and entered into EpiData version 3.1 before being exported to Stata version 14 for further analysis. In the bivariable logistic regression analysis, variables with a p-value of ≤0.25 were included in the multivariable logistic regression analysis. A p-value of <0.05 was used to identify statistically significant factors. Results: Among 381 stable PLHIV, 55.91% were women. The median age (interquartile range) was 40 years (27-53). The uptake of community-based DSD models was 19.16%. Residence and disclosure were the two independent factors significantly associated with the uptake of community-based DSD models. Conclusion: One out of five stable PLHIV on antiretroviral therapy uptake the community-based DSD models. Improvement in uptake is needed in Ethiopia's resource-limited healthcare system to better achieve the 95-95-95 targets.

Diabetic microvascular complications and associated factors in patients with type 2 diabetes in Southern Ethiopia.

Background: Microvascular complications are long-term complications that affect small blood vessels, usually developed in diabetes, and are primary causes of end-stage renal disease, several painful neuropathies, and blindness. Thus, this study aimed to determine diabetic microvascular complications and factors associated with them among patients with type 2 diabetes. Methods: An institution-based cross-sectional study was conducted among 378 type 2 diabetes patients. The presence of at least one diabetic microvascular complications diagnosed by physicians and found on the record was considered to have microvascular complications. The data was collected by reviewing the medical records of T2DM patients who were on follow-up from January 1, 2012, to December 31, 2021. The collected data was entered into EpiData version 3.1 and analyzed by Stata version 14. Bivariate and multivariable logistic regression were used to identify statistically significant risk factors for diabetic microvascular complications at p-value < 0.05. Results: Patients with type 2 diabetes mellitus had a prevalence of diabetic microvascular complications of 26.5% (95% CI: 22.0%, 30.9%). Diabetic neuropathy was the highest (13.2%), followed by diabetic nephropathy (12.4%), and diabetic retinopathy (6.4%). Increasing age, poor glycemic control, hypertension comorbidity, anemia, positive proteinuria, a longer duration of type 2 diabetes mellitus, and hypercholesterolemia were significantly associated factors with diabetic microvascular complications. Conclusion: Diabetic microvascular complications were highly prevalent. Therefore, the study suggests that interventional strategies should be taken for poor glycemic control, hypertension comorbidity, anemia, positive proteinuria, and hypercholesterolemia to control the development of diabetic microvascular complications in patients with type 2 diabetes.

Incidence and Predictors of Diabetic Nephropathy among Type 2 Diabetes Mellitus Patients, Southern Ethiopia.

Background: Diabetic nephropathy is the most common cause of end-stage renal disease, and it brings high morbidity and mortality. Globally, the predominant rise in type II diabetes prevalence significantly increases the incidence of diabetic nephropathy. Therefore, timely diagnosis and prompt management of diabetic nephropathy and early identification of predictors are essential. Thus, this study aimed to determine the incidence and predictors of diabetic nephropathy among type II diabetes mellitus patients. Methods: A retrospective follow-up study was conducted among 532 type II diabetes patients who enrolled at Hawassa University Comprehensive Specialized Hospital from January 1, 2012, to December 31, 2021. A simple random sampling technique was used to select the study participants. The extracted data were entered into EpiData version 3.1 and analyzed by Stata version 14. A bivariate and multivariable Cox proportional hazard regression analysis was fitted to identify predictors of diabetic nephropathy. The Cox proportional hazards assumption was checked using the Schoenfeld residual test, and the goodness of fit of the model was checked using the Cox-Snell residual test. An adjusted hazard ratio with a 95% confidence interval and P values were used to identify statistically significant predictors. Results: The overall incidence rate of diabetic nephropathy was 2.71 cases (95% CI: 2.12, 3.47) per 1,000 person-months of observation. Age (AHR = 1.027; 95% CI = 1.005, 1.049), fasting blood sugar (AHR = 1.010; 95% CI = 1.007, 1.013), and systolic blood pressure (AHR = 1.050; 95% CI = 1.031,1.069) were significant positive predictors of diabetic nephropathy, whereas the duration of diabetes longer than five years (AHR = 0.20; 95% CI = 0.09, 0.44) was a protective predictor for the development of diabetic nephropathy. Conclusion: The incidence rate of diabetic nephropathy was high. Age, fasting blood sugar, systolic blood pressure, and duration of diabetes were found to be independent predictors of diabetic nephropathy. To overcome this public health problem, prompt and effective strategies should be designed based on identified predictors to prevent the development of diabetic nephropathy.