Safety and Effectiveness of an All-Oral, Bedaquiline-Based, Shorter Treatment Regimen for Rifampicin-Resistant Tuberculosis in High Human Immunodeficiency Virus (HIV) Burden Rural South Africa: A Retrospective Cohort Analysis.

BACKGROUND: At the end of 2018, South Africa updated its all-oral regimen, to include bedaquiline (BDQ) and 2 months of linezolid (LZD) for all patients initiating the shorter 9-12 months regimen for rifampicin-resistant tuberculosis (RR-TB). We assessed a group of patients in rural KwaZulu-Natal for safety and effectiveness of this treatment regimen under programmatic conditions. METHODS: We conducted a retrospective cohort analysis on RR-TB patients treated with a standardized all-oral short regimen between 1 July 2018 and 30 April 2019 in 3 facilities in King Cetshwayo District. An electronic register (EDR web) and facility-based clinical charts were used to collect variables, which were entered into an Epi-Info database. RESULTS: Our cohort included 117 patients; 68.4% (95% confidence interval [CI]: 59.3-76.3) tested positive for human immunodeficiency virus (HIV). The median time to culture conversion was 56 days (95% CI: 50-57). Treatment success was achieved in 75.2% (95% CI: 66.5-82.3) of patients. Mortality within the cohort was 12.8% (95% CI: 7.8-20.3). Anemia was the most frequent severe adverse event (AE). The median time to develop severe anemia was 7.1 weeks (interquartile range [IQR] 4.0-12.9) after treatment initiation. LZD was interrupted in 25.2% (95% CI: 17.8-34.5) of participants. CONCLUSIONS: An all-oral shorter regimen, including BDQ and LZD as core drugs for the treatment of RR-TB, shows good outcomes, in a high HIV burden rural setting. AEs are common, especially for LZD, but could be managed in the program setting. Support is needed when introducing new regimens to train staff in the monitoring, management, and reporting of AEs.

High burden of hypertension across the age groups among residents of Gondar city in Ethiopia: a population based cross sectional study.

BACKGROUND: According to a report on the worldwide trends in blood pressure from 1975 to 2015, mean blood pressure is increasing in low and middle income countries while it is either decreasing or stabilizing in high income countries. Few studies have been published on the prevalence of hypertension in Ethiopia demonstrating an increased trend; however, these studies had small sample size and were limited to participants older than 35 years; which left the burden among adolescents and young adults unaddressed. The aim of this study was to assess prevalence of hypertension (HTN) and associated factors in Gondar city. METHOD: A population based cross-sectional study was conducted among 3227 individuals in Gondar city. A multistage cluster random sampling was used. The Kish method from World Health Organization (WHO) STEPS instrument of random sampling method was used for selecting one individual older than or equal to 18 years from each household. WHO and International Diabetic Association (IDA) criterion was used to classify HTN. RESULT: The overall prevalence of HTN was 27. 4% [95% CI: (25. 8-28.9)]. The prevalence for participants in the age group of ≥35 years was 36. 1%. It consistently increased from 9.5% in the age group of 18-25 years to 46.3% in the age group of ≥65 years (P-value < 0. 001). Only 47% of the participants had ever had any kind of blood pressure measurement. Being elderly (AOR = 5. 56; 95% CI: 3. 71-8. 35), obese (AOR =2. 62; 95%CI: 1. 70-4. 03), widowed (AOR = 1. 87; 95%CI: 1. 27-2. 75), separated (AOR = 1. 87; 95%CI: 1. 27-2. 75), daily alcohol user (AOR = 1. 51; 95%CI: 1. 02-2. 23), male gender (AOR = 1. 42; 95%CI: 1. 18-1. 72) and born in urban area (AOR = 1. 31; 95%CI: 1. 10-1. 56) were found to be independently associated with HTN. CONCLUSION: There is a high prevalence of hypertension in Gondar city and is showing increasing trend compared to previous reports. Interventions to raise awareness and to improve both capacity and accessibility of facilities for screening hypertension are highly recommended.

Determinants of virological failure among patients on highly active antiretroviral therapy in University of Gondar Referral Hospital, Northwest Ethiopia: a case-control study.

BACKGROUND: Viral load monitoring is used as an important biomarker for diagnosing treatment failure in patients with HIV infection/AIDS. Ethiopia has started targeted viral load monitoring. However, factors leading to virological failure are not well understood and studied. Thus, the aim of this study was to identify the determinants of virological failure among HIV-infected patients on highly active antiretroviral therapy at the University of Gondar Referral Hospital, Northwest Ethiopia. METHODS: A case-control study was conducted from May to June 2015. Cases were subjects who had already experienced virological failure; controls were those without virological failure. Data were extracted from 153 cases and 153 controls through chart review. A multivariate logistic regression analysis was carried out to identify factors associated with virological failure, and variables with a p-value <0.05 were considered statistically significant. RESULTS: In this study, higher odds of virological failure was observed among patients aged <35 years (adjusted odds ratio [AOR] =2.52, 95% CI: 1.33, 4.77), who had had CD4+ count <200 cells/mm3 (AOR=9.03, 95% CI: 4.40, 18.50), showed poor adherence to antiretroviral therapy (ART) (AOR=15.80, 95% CI: 6.90, 36.50), and had taken ART for longer durations of 25-47 months (AOR=3.00, 95% CI: 1.10, 8.40) and ≥48 months (AOR=6.70, 95% CI: 2.70, 16.60). CONCLUSION: This study showed that patients aged <35 years and with recent low CD4 count, poor adherence to treatment, and longer exposure to ART were positively and significantly associated with virological treatment failure. Therefore, evidence-based intervention should be implemented to improve adherence to ART, which in turn helps to boost immunity (CD4) and suppresses viral replication and load. Moreover, attention should be given to younger patients who have had ART for longer periods.