Predictors of adherence to antiretroviral therapy among HIV-infected persons: a prospective study in Southwest Ethiopia

BACKGROUND: The devastating impact of AIDS in the world especially in sub-Saharan Africa has led to an unprecedented global effort to ensure access to antiretroviral (ARV) drugs. Given that medication-taking behavior can immensely affect an individual's response; ART adherence is now widely recognized as an 'Achilles heel' for the successful outcome. The present study was undertaken to investigate the rate and predictors of adherence to antiretroviral therapy among HIV-infected persons in southwest Ethiopia. METHODS: The study was conducted in the antiretroviral therapy unit of Jimma University Specialized Hospital. A prospective study was undertaken on a total of 400 HIV infected person. Data were collected using a pre-tested interviewer-administered structured questionnaire at first month (M0) and third month (M3) follow up visits. RESULTS: A total of 400 and 383 patients at baseline (M0) and at follow up visit (M3) respectively were interviewed. Self-reported dose adherence in the study area was 94.3%. The rate considering the combined indicator (dose, time and food) was 75.7%. Within a three month follow up period, dose adherence decreased by 2% and overall adherence rate decreased by more than 3%. Adherence was common in those patients who have a social support (OR, 1.82, 95%CI, 1.04, 3.21). Patients who were not depressed were two times more likely to be adherent than those who were depressed (OR, 2.13, 95%CI, 1.18, 3.81). However, at the follow up visit, social support (OR, 2.42, 95%CI, 1.29, 4.55) and the use of memory aids (OR, 3.29, 95%CI, 1.44, 7.51) were found to be independent predictors of adherence. The principal reasons reported for skipping doses in this study were simply forgetting, feeling sick or ill, being busy and running out of medication in more than 75% of the cases. CONCLUSION: The self reported adherence rate was high in the study area. The study showed that adherence is a dynamic process which changes overtime and cannot reliably be predicted by a few patient characteristics that are assumed to vary with time. Adherence is a process, not a single event, and adherence support should be integrated into regular clinical follow up

Simulation/optimization modeling for water resources management

Many important advances have been made in the development of mathematical models for conjunctive water management and reservoir management. However, the conjunctive use models that have detailed stream/aquifer system interactions have not considered reservoir management rules. Conversely, reservoir management models have not simulated stream/aquifer interactions in detail. There is a need for enhanced linking of reservoir and stream/aquifer systems in conjunctive water management models. This paper presents a simulation/optimization model that integrates linear reservoir decision rules, detailed simulations of stream/aquifer system flows, conjunctive use of surface and ground water, and delivery via branching canals to water users. The linear decision rule is an example of a rule that has been widely discussed in reservoir operation literature and is simple to program. State variables, including aquifer hydraulic head, streamflow, and surface water/aquifer interflow, are represented through discretized convolution integrals and influence coefficients. Reservoir storage and branching canal flows and interflows are represented using embedded continuity equations. Results of model application to a hypothetical study area under several scenarios indicate that the more detail used to represent the physical system, the better the conjunctive management. The most detailed representation provides 13% more water than the least detailed system

Not Available

Not AvailablePeste des petits ruminants (PPR) is an acute and highly contagious viral disease of sheep and goats. Indian veterinary research Institute has developed a very efficacious vaccine using lineage IV virus of PPR being used under field condition. Infectivity assay and identity test of the vaccine virus are two important tests to be carried out routinely for quality assurance of PPR vaccine. We developed a monoclonal antibody based cell-ELISA for simultaneous titration and identity test of vaccine virus using 4G6 anti-nucleocapsid monoclonal antibody. Cell-ELISA developed correlated well (r=0.96) with the conventional titration technique using cytopathic effect of virus as indicator. Cell ELISA has a relative sensitivity and specificity of more than 97% compared to infectivity titration. Findings indicated that, cell-ELISA can be successfully used for infectivity and identity test of virus in vaccine samples.Not Availabl

Utilizing native lignin as redox-active material in conductive wood for electronic and energy storage applications

Nanostructured wood veneer with added electroactive functionality combines structural and functional properties into eco-friendly, low-cost nanocomposites for electronics and energy technologies. Here, we report novel conducting polymer-impregnated wood veneer electrodes where the native lignin is preserved, but functionalized for redox activity and used as an active component. The resulting electrodes display a well-preserved structure, redox activity, and high conductivity. Wood samples were sodium sulfite-treated under neutral conditions at 165 degrees C, followed by the tailored distribution of PEDOT:PSS, not previously used for this purpose. The mild sulfite process introduces sulfonic acid groups inside the nanostructured cell wall, facilitating electrostatic interaction on a molecular level between the residual lignin and PEDOT. The electrodes exhibit a conductivity of up to 203 S m(-1) and a specific pseudo-capacitance of up to 38 mF cm(-2), with a capacitive contribution from PEDOT:PSS and a faradaic component originating from lignin. We also demonstrate an asymmetric wood pseudo-capacitor reaching a specific capacitance of 22.9 mF cm(-2) at 1.2 mA cm(-2) current density. This new wood composite design and preparation scheme will support the development of wood-based materials for use in electronics and energy storage.Funding Agencies|Wallenberg Wood Science Center (Knut and Alice Wallenberg Foundation); Karl-Erik Onnesjo Foundation; Treesearch, a collaboration platform for Swedish forest industrial research</p

Vitamin D deficiency among smear positive pulmonary tuberculosis patients and their tuberculosis negative household contacts in Northwest Ethiopia: a case–control study

Abstract Background Vitamin D is a fat-soluble vitamin that increases the immunity against tuberculosis (TB), decreases the re-activation of latent TB and reduces the severity of active TB disease. Epidemiological studies on the prevalence of vitamin D deficiency, and its association with TB showed inconsistent results in different countries. This study was aimed to determine the prevalence of vitamin D deficiency and its association with TB in Northwest Ethiopia. Methods A case–control study was conducted among smear positive pulmonary tuberculosis patients and their household contacts without symptoms suggestive of TB. Study participants were recruited at 11 TB diagnostic health facilities in North and South Gondar zones of Amhara region between May 2013 and April 2015. The spot-morning-spot sputum samples and 5 ml blood sample were collected prior to commencing TB treatment for the diagnosis of TB and serum vitamin D assay, respectively. The diagnosis of TB was performed using smear microscopy and GeneXpert. Serum vitamin D level was analyzed using VIDAS 25 OH Vitamin D Total testing kits (Biomerieux, Marcy I’Etoile, France) on mini VIDAS automated immunoassay platform. Vitamin D status was interpreted as deficient (100 ng/ml). Results Of the total study participants, 134 (46.2%) were vitamin D deficient, and only 56 (19.3%) had sufficient vitamin D level. A total of 59 (61.5%) TB patients and 75 (38.7%) non TB controls were vitamin D deficient. Results of multivariate logistic regression analyses showed a significantly higher vitamin D deficiency among tuberculosis cases (p < 0.001), females (p = 0.002), and urban residents (p < 0.001) than their respective comparison groups. Moreover, age groups of 35–44 (p = 0.001), 45–54 (p = 0.003) and ≥55 (p = 0.001) years had significantly higher vitamin D deficiency compared with age group <15 years. Conclusions Vitamin D deficiency is highly prevalent among TB patients and non TB controls in Ethiopia where there is year round abundant sunshine. Study participants with tuberculosis, females, older age groups, and urban residents had significantly higher prevalence of vitamin D deficiency. These findings warrant further studies to investigate the role of vitamin D supplementation in the prevention and treatment of tuberculosis in high TB burden countries like Ethiopia

Decentralization of Acid Fast Bacilli (AFB) External Quality Assurance Using Blind Rechecking for Sputum Smear Microscopy in Ethiopia.

INTRODUCTION:Ethiopia achieved a rapid expansion of TB microscopic centers for acid fast bacilli (AFB). However, external quality assurance (EQA) services were, until recently, limited to few regional and sub-regional laboratories. In this paper, we describe the decentralization experience and the result of EQA using random blinded rechecking. MATERIALS AND METHODS:The routine EQA quarterly report was compiled and analyzed. A positive result by the microscopic center while the EQA center reported negative result is categorized as false positive (FP). A negative result by the microscopic center while the EQA center reported positive is considered false negative (FN). The reading of EQA centers was considered a gold standard to compute the sensitivity, specificity, positive predictive (PPV) and negative predictive values (NPV) of the readings of microscopic centers. RESULTS:We decentralized sputum smear AFB EQA from 4 Regional Laboratories (RRLs) to 82 EQA centers and enrolled 956 health facilities in EQA schemes. Enrollment of HFs in EQA was gradual because it required training and mentoring laboratory professionals, institutionalizing internal QA measures, equipping all HFs to perform diagnosis, and establishing more EQA centers. From 2012 to 2014 (Phase I), the FP rate declined from 0.6% to 0.2% and FN fell from as high as 7.6% to 1.6% in supported health facilities (HFs). In HFs that joined in Phase II, FN rates ranged from 5.6 to 7.3%. The proportion of HFs without errors has increased from 77.9% to 90.5% in Phase I HFs and from 82.9% to 86.9% in Phase II HFs. Overall sensitivity and specificity were 95.0% and 99.7%, respectively. PPV and NPV were 93.3% and 99.7%, respectively. CONCLUSION:Decentralizing blinded rechecking of sputum smear microscopy is feasible in low-income settings. While a comprehensive laboratory improvement strategy enhanced the quality of microscopy, laboratory professionals' capacity in slide reading and smear quality requires continued support