Determinants of First-line Antiretroviral Treatment Failure Among Patients on Antiretroviral Therapy in Public Hospitals Jimma, Southwest Ethiopia a Case-Control Study
Amrachu Bekele Asfaw,
Aderajew Nigusie,
Tamrat Shaweno,
Esayas Kebede Gudina,
Masrie Getnet,
Demuma Amdisa,
Tefera Belachew Lemma,
Lelisa Sena Dadi
Issue:
Volume 4, Issue 2, June 2019
Pages:
13-24
Received:
16 March 2019
Accepted:
14 October 2019
Published:
23 October 2019
Abstract: Highly Active Antiretroviral Therapy (HAART) has substantially declined morbidity and mortality related to Human immunodeficiency virus/Acquired immunodeficiency syndrome (HIV/AIDS). Despite this fact, first-line ART failure has emerged as a growing concern. However, factors associated with first-line ART failure are not well empathized and studied. Hence, we aimed to identify the determinants of first-line ART failure among patients attending ART in Public Hospitals Jimma, Southwest Ethiopia. A case-control study was conducted in March 2018 on a sample of 384 (288 controls and 96 cases) adult people living with HIV/AIDS (PLWHA). Cases were HIV patients aged 15 years or older who were on first-line ART regimens with documented therapeutic failure. Controls were HIV patients aged 15 years or older who were on first-line ART regimen but without evidence of therapeutic failure. Data were extracted from electronic databases and supplemented by data collected through interviewer-administered questionnaires. Bivariate and multivariate logistic regression analyses were used. Adjusted odds ratios and 95% confidence intervals were used to report independently associated factors at P-value<0.05. In this study, higher odds of first-line ART failure was experienced among urban residents (AOR:2.2; 95%CI: 1.1, 3.6), smokers (AOR:5.9; 95%CI:3.2, 10.8), Khat users (AOR:2.2; 95%CI:1.3,3.7), poor treatment adherents (AOR:2.2; 95%CI: 1.1,4.5), tuberculosis coinfection (AOR:3.9; 95%CI:2.2, 6.8), prior exposure to ART (AOR:3.8; 95%CI:1.7, 8.1), zidovudine based regimen (AOR:4.8; 95%CI: 2.5,9.0) and longer duration on ART more than 73 months (AOR:1.9; 95%CI:1.2, 3.3). This study evidenced that being an urban resident, TB co-infection, poor medication adherence, and zidovudine-based regiment were positively and independently associated with first-line ART failure. Thus, the focus should be given assessment and management of medication compliance for urban residents and longer duration ART users. Assessment and management of substance use disorders are highly recommended besides ARV medication refills. Attention should be given enhanced adherence counseling and peer support to improve adherence. Early screening and management of tuberculosis infection should be strengthened. It is advisable to initiate ART with the recommended TDF-based first-line ART regimens instead of AZT-based.
Abstract: Highly Active Antiretroviral Therapy (HAART) has substantially declined morbidity and mortality related to Human immunodeficiency virus/Acquired immunodeficiency syndrome (HIV/AIDS). Despite this fact, first-line ART failure has emerged as a growing concern. However, factors associated with first-line ART failure are not well empathized and studied...
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Evaluating the Efficacy of Vertebral Axial Decompression Therapy in Treatment of Patients with Chronic Lower Back Pain: A Systematic Review
James McKivigan,
Brittany Krisak,
Brittni Vogel,
Ashley Harrington,
Van Nguyen
Issue:
Volume 4, Issue 2, June 2019
Pages:
25-34
Received:
22 July 2019
Accepted:
29 September 2019
Published:
25 October 2019
Abstract: The primary objective of the study was to explore the effectiveness of Vertebral Axial Decompression (VAX-D) in treating patients with chronic low back pain (CLBP) as a safe and competent therapeutic method. Also, to determine the quality of life in alleviating chronic lumbar pain using mechanical Lumbar traction force applied to the lumbar spine. A systematic review and meta-analysis involving detailed literature survey on Vertebral Axial Decompression (VAX-D) therapy for patients with chronic low back pain were conducted in three databases namely MEDLINE, EMBASE and Cochrane Library from (January 1994 to February 2019). Studies supporting the outcomes with qualitative statistical analysis on chronic low back pain and Lumbar traction were retrieved. We retrieved sixteen randomized controlled trials (RCTs) for systematic review, and 6 studies were found to be eligible for inclusion in meta-analysis with a sample size of 486 patients receiving Lumbar traction. Among them, one study was found to be high quality that detailed the positive relationship between reduction of pain intensity after VAX-D therapy. However, most of the studies are unsuccessful in demonstrating an improvement towards the patient's mobility or quality of life. There is no reliable indication of the efficacy of VAX-D therapy for chronic low back pain patients. Studies on VAX-D had methodological errors and inadequate data for profound statistical analysis. Further, there was no evidence to show the dosage requirement, patient position, and settings on the VAX-D table that led to observed outcomes. Any prospect of research focusing on LBP morbidity should enable to distinguish between symptom duration and pattern with accurate standard methods. Therefore, more studies validating the effective treatment strategies in the management of patients with chronic low back pain are warranted.
Abstract: The primary objective of the study was to explore the effectiveness of Vertebral Axial Decompression (VAX-D) in treating patients with chronic low back pain (CLBP) as a safe and competent therapeutic method. Also, to determine the quality of life in alleviating chronic lumbar pain using mechanical Lumbar traction force applied to the lumbar spine. ...
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