Prevalence of and Risk Factors for Trachoma in Southern Nations, Nationalities, and Peoples' Region, Ethiopia: Results of 40 Population-Based Prevalence Surveys Carried Out with the Global Trachoma Mapping Project.

PURPOSE: We sought to estimate the prevalence of trachoma at sufficiently fine resolution to allow elimination interventions to begin, where required, in the Southern Nations, Nationalities, and Peoples' Region (SNNPR) of Ethiopia. METHODS: We carried out cross-sectional population-based surveys in 14 rural zones. A 2-stage cluster randomized sampling technique was used. A total of 40 evaluation units (EUs) covering 110 districts ("woredas") were surveyed from February 2013 to May 2014 as part of the Global Trachoma Mapping Project (GTMP), using the standardized GTMP training package and methodology. RESULTS: A total of 30,187 households were visited in 1047 kebeles (clusters). A total of 131,926 people were enumerated, with 121,397 (92.0%) consenting to examination. Of these, 65,903 (54.3%) were female. In 38 EUs (108 woredas), TF prevalence was above the 10% threshold at which the World Health Organization recommends mass drug administration with azithromycin annually for at least 3 years. The region-level age- and sex-adjusted trichiasis prevalence was 1.5%, with the highest prevalence of 6.1% found in Cheha woreda in Gurage zone. The region-level age-adjusted TF prevalence was 25.9%. The highest TF prevalence found was 48.5% in Amaro and Burji woredas. In children aged 1-9 years, TF was associated with being a younger child, living at an altitude 15°C, and the use of open defecation by household members. CONCLUSION: Active trachoma and trichiasis are significant public health problems in SNNPR, requiring full implementation of the SAFE strategy (surgery, antibiotics, facial cleanliness, and environmental improvement)

Beneficial Effect of Isoniazid Preventive Therapy and Antiretroviral Therapy on the Incidence of Tuberculosis in People Living with HIV in Ethiopia

<div><p>Background</p><p>IPT with or without concomitant administration of ART is a proven intervention to prevent tuberculosis among PLHIV. However, there are few data on the routine implementation of this intervention and its effectiveness in settings with limited resources.</p><p>Objectives</p><p>To measure the level of uptake and effectiveness of IPT in reducing tuberculosis incidence in a cohort of PLHIV enrolled into HIV care between 2007 and 2010 in five hospitals in southern Ethiopia.</p><p>Methods</p><p>A retrospective cohort analysis of electronic patient database was done. The independent effects of no intervention, “IPT-only,” “IPT-before-ART,” “IPT-and-ART started simultaneously,” “ART-only,” and “IPT-after-ART” on TB incidence were measured. Cox-proportional hazards regression was used to assess association of treatment categories with TB incidence.</p><p>Results</p><p>Of 7,097 patients, 867 were excluded because they were transferred-in; a further 823 (12%) were excluded from the study because they were either identified to have TB through screening (292 patients) or were on TB treatment (531). Among the remaining 5,407 patients observed, IPT had been initiated for 39% of eligible patients. Children, male sex, advanced disease, and those in Pre-ART were less likely to be initiated on IPT. The overall TB incidence was 2.6 per 100 person-years. As compared to those with no intervention, use of “IPT-only” (aHR = 0.36, 95% CI = 0.19–0.66) and “ART-only” (aHR = 0.32, 95% CI = 0.24–0.43) were associated with significant reduction in TB incidence rate. Combining ART and IPT had a more profound effect. Starting IPT-before-ART (aHR = 0.18, 95% CI = 0.08–0.42) or simultaneously with ART (aHR = 0.20, 95% CI = 0.10–0.42) provided further reduction of TB at ∼80%.</p><p>Conclusions</p><p>IPT was found to be effective in reducing TB incidence, independently and with concomitant ART, under programme conditions in resource-limited settings. The level of IPT provision and effectiveness in reducing TB was encouraging in the study setting. Scaling up and strengthening IPT service in addition to ART can have beneficial effect in reducing TB burden among PLHIV in settings with high TB/HIV burden.</p></div

Cohort profile of study population, SNNP region, Ethiopia, September 2007 to August 2010.

<p>Of 7,097 patients enrolled in chronic HIV care, 5,407 were eligible for analysis contributing a total of 11,290 PY of follow-up. These were further classified into six treatment categories based on the combination of treatment received, IPT and/or ART, as well as the timing of IPT initiation with respect to ART. There were 295 incident TB cases diagnosed in the study period. IPT-Isoniazid Preventive Therapy; ART-antiretroviral therapy; TB-Tuberculosis; HIV-Human Immunodeficiency virus; PY-person year. * ‘No IPT NO ART’ group is equivalent to no intervention group.</p

Incidence rate of TB among HIV infected patients in Chronic HIV care in SNNP region, Ethiopia, September 2007 to August 2010.

<p>*Controlled for sex, WHO stage, baseline CD4, and Cotrimoxazole status; HR-Hazard Ratio; CI- Confidence Interval; IPT-Isoniazid Preventive Therapy; ART-antiretroviral therapy; CPT-Cotrimoxazole Preventive Therapy; WHO-World Health Organization; HIV-Human Immunodeficiency virus.</p

Characteristics of HIV infected patients in chronic HIV care in SNNP region, Ethiopia, September 2007 to August 2010.

<p><b>*</b>among those who initiated IPT (n = 2131); IPT-Isoniazid Preventive Therapy; ART-antiretroviral therapy; CPT-Cotrimoxazole Preventive Therapy; WHO-World Health Organization; HIV-Human Immunodeficiency virus.</p

Characteristics of HIV infected patients in Chronic HIV care who took IPT in SNNP region, Ethiopia, September 2007 to August 2010.

<p>IPT-Isoniazid Preventive Therapy; ART-antiretroviral therapy; CPT-Cotrimoxazole Preventive Therapy; WHO-World Health Organization; HIV-Human Immunodeficiency virus.</p

Sensitivity analysis for effectiveness of IPT with or without ART using Cox proportional hazards model among patients on ART assuming those who were lost to follow-up and dead developed TB in SNNP region, Ethiopia, September 2007 to August 2010.

<p>*Controlled for sex, WHO stage, cotrimoxazole use, and baseline CD4; HR-Hazard Ratio; CI- Confidence Interval; IPT-Isoniazid Preventive Therapy; ART-antiretroviral therapy; WHO-World Health Organization; HIV-Human Immunodeficiency virus.</p