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Background: The use of structural equation modelling and latent variables remains unusual in epidemiology despite its potential usefulness and assessment of casual relations. Measuring direct and indirect effect of latent variables helps for proper intervention and for the ART program to be effective. The main objective of current investigation was to assess casual relations, direct and indirect effect of latent covariates on CD4 cell count change for HIV positive adults under HAART. Methods: Based on the repeated measures of CD4 cell count change data obtained in ART section at Felege Hiwot Teaching and Specialized hospital, AMOS software was employed parameter estimation. The data was conducted on 792 randomly selected HIV positive adults. The data was collected by the health staff for sake of delivering medication adherence. Results: CD4 cell count change was directly and indirectly affected by the latent variables. The powers of effects of observed variables with and without latent variables were a little bit different from each other. Hence, the power effect of observed variables with latent variables was lower as compared to without latent variables. The direct effect of latent variables on the response variable was a little bit greater than indirect effect. Conclusion: The power of effects of observed variables were stronger than their effects with latent variables. Hence, the latent variables had significant contributions for progress of CD4 cell count change. Health related education about the direct and indirect effect of latent variables should be given for patients under HAART.

Background Due to the substantial increase in the number of glaucoma cases within the next several decades, glaucoma is a significant public health issue. The main objective of this study was to investigate determinants for the variation of intraocular pressure and time to blindness of glaucoma patients under treatment at Felege Hiwot Referral Hospital, Bahir Dar, Ethiopia. Materials and Method A retrospective cohort study design was conducted on 328 randomly selected glaucoma patients in ophthalmology clinic at the hospital under the follow-up period from January 2014 up to December 2018. A linear mixed effects model for intraocular data, a semi-parametric survival model for the time-to-blindness data and joint modeling of the two responses were used for data analysis. Result The comparison of joint and separate models revealed that joint model was more adequate and efficient inferences because of its smaller standard errors in parameter estimations. This was also approved using AIC, BIC and based on a significant likelihood ratio test as well. The estimated association parameter (α) in the joint model was 0.0160 and statistically significant (p - value = 0.0349). This indicated that there was strong evidence for positive association between the effects of intraocular pressure and the risk of blindness. The result indicated that the higher value of intraocular pressure was associated with the higher risk of blindness. As age increased by one year, the average IOP of the patients was also increased by 0.0726 mmHg (p-value

Background: The rate of prevalence of HIV among adults has been increasing in Sub-Sahara African countries over the last decade. Currently, an estimated number of 722, 248 people are living with HIV, 23, 000 people are newly infected with HIV and 11,000 people are died because of AIDS related illness. The objective of this study was to identify the most significant variables associated with the variation of CD4 cell count and body mass index (BMI) of HIV positive adults who initiated HAART at Felege Hiwot Teaching and Specialized Hospital, North-West Ethiopia. This study also aimed to compared the precision of parameter estimates conducted by separate and joint models.Methods: To analyze the long-term CD4 cells count and body mass index of HIV infected adults, a cohort longitudinal study of 792 HIV-infected patients was performed. A joint model was employed to identify the variables associated with the variation of CD4 cell count and body mass index of adults receiving treatment at Felege Hiwot Teaching and specialized Hospital. A random of 792 samples was taken among patients using individual charts in the hospital.Results: Among the main effects, Socio-demographic variables (Level of education, level of disclosure of the disease to persons living together and Marital status ), individuals factors(age, weight and gender), economic factors (ownership of cell phone, level of income), clinical factors (baseline CD4 cell count) retention (food and medication adherence, follow-up time/visit) significantly affected the variables of interests. Similarly, the interaction effects of follow-up times/visits * cell phone ownership, follow-up times/visits * gender, age * gender of patients significantly affected both response variables in current investigation.Conclusion: Socio-demographic, individual and Clinical variables had significant effect on CD4 cell count and BMI in HAART medication program. Follow-up time/visit in the HAART program had also direct and significant effect on the variables of interest. Older HIV patients should be targeted by appropriate public health actions, such as opportunistic screening and easier access to healthcare service. The patients should be advised to disclose the disease to get support from communities around them.

Background : Currently, around 36.7 million people in the world are living with HIV. Among these, 52% are living in sub-Saharan African. Antiretroviral therapy (ART) has played an important role in improving the prognosis and quality of life of HIV/AIDS patients, and in reducing the rate of disease progression and death. Several previous researches on factors affecting HAART adherence competence had controversies. As far as the author’s knowledge concerned, no research had been conducted on longitudinal HAART adherence competence in the study area. The main objective of this study was to identify Socio-demographic and Clinical factors associated with HAART adherence competence in successive visits among adult HIV patients after commencement of HAART. Methods : A retrospective cohort study on 792 HAART attendants was conducted to analyze the current study for HIV positive adults who had a minimum of two clinical visits. Secondary data were employed to examine Socio-demographic, economic, individual and clinical factors affecting the variable of interest overtime among HAART users. The Structural Equation modeling (SEM) was applied to identify predictors of HAART adherence competence over time. Results : In this longitudinal study, factors affecting long-term HAART adherence competence in successive visits had been identified. Socio-demographic factors (like Marital status, level of disclosure of the disease, residence area, education, economic factors (owner ship of cell phone, household income), individual factors (age, sex, weight) and clinical factors (CD4 cell count, WHO stages), directly associated with retention of HAART medication care. On the other hand, HAART medication care was significantly and independently associated with the longitudinal HAART adherence competence. Conclusion : The HAART adherence competence in successive visits increased with the number of follow-up visits, but the rate of increase was different for different groups such as male & female, urban & rural, and disclosing & hiding the disease to family members. An integrated health related education should be given for poor adherent patients like rural residents, males, patients living without partners, patients with no cell phone and aged patients.