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BACKGROUND: Understanding the patterns of HIV/AIDS epidemics is crucial to tracking and monitoring the progress of prevention and control efforts in countries. We provide a comprehensive assessment of the levels and trends of HIV/AIDS incidence, prevalence, mortality, and coverage of antiretroviral therapy (ART) for 1980-2017 and forecast these estimates to 2030 for 195 countries and territories.METHODS: We determined a modelling strategy for each country on the basis of the availability and quality of data. For countries and territories with data from population-based seroprevalence surveys or antenatal care clinics, we estimated prevalence and incidence using an open-source version of the Estimation and Projection Package-a natural history model originally developed by the UNAIDS Reference Group on Estimates, Modelling, and Projections. For countries with cause-specific vital registration data, we corrected data for garbage coding (ie, deaths coded to an intermediate, immediate, or poorly defined cause) and HIV misclassification. We developed a process of cohort incidence bias adjustment to use information on survival and deaths recorded in vital registration to back-calculate HIV incidence. For countries without any representative data on HIV, we produced incidence estimates by pulling information from observed bias in the geographical region. We used a re-coded version of the Spectrum model (a cohort component model that uses rates of disease progression and HIV mortality on and off ART) to produce age-sex-specific incidence, prevalence, and mortality, and treatment coverage results for all countries, and forecast these measures to 2030 using Spectrum with inputs that were extended on the basis of past trends in treatment scale-up and new infections.FINDINGS: Global HIV mortality peaked in 2006 with 1·95 million deaths (95% uncertainty interval 1·87-2·04) and has since decreased to 0·95 million deaths (0·91-1·01) in 2017. New cases of HIV globally peaked in 1999 (3·16 million, 2·79-3·67) and since then have gradually decreased to 1·94 million (1·63-2·29) in 2017. These trends, along with ART scale-up, have globally resulted in increased prevalence, with 36·8 million (34·8-39·2) people living with HIV in 2017. Prevalence of HIV was highest in southern sub-Saharan Africa in 2017, and countries in the region had ART coverage ranging from 65·7% in Lesotho to 85·7% in eSwatini. Our forecasts showed that 54 countries will meet the UNAIDS target of 81% ART coverage by 2020 and 12 countries are on track to meet 90% ART coverage by 2030. Forecasted results estimate that few countries will meet the UNAIDS 2020 and 2030 mortality and incidence targets.INTERPRETATION: Despite progress in reducing HIV-related mortality over the past decade, slow decreases in incidence, combined with the current context of stagnated funding for related interventions, mean that many countries are not on track to reach the 2020 and 2030 global targets for reduction in incidence and mortality. With a growing population of people living with HIV, it will continue to be a major threat to public health for years to come. The pace of progress needs to be hastened by continuing to expand access to ART and increasing investments in proven HIV prevention initiatives that can be scaled up to have population-level impact.FUNDING: Bill & Melinda Gates Foundation, National Institute of Mental Health of the US National Institutes of Health (NIH), and the National Institute on Aging of the NIH.

Introduction.In regional state of the study area, HIV (Human Immunodeficiency Virus) prevalence is 2.2% and opportunistic infections (OIs) occurred in 88.9% of pre-ART (Antiretroviral Therapy) people living with HIV/AIDS (PLWHA). Even though OIs are prevalent in the study area, duration of staying free from acquiring rehappening opportunistic infections and its determinant factors are not studied.Method. The study was conducted in randomly selected 341 adult Pre-ART PLWHA who are included in chronic HIV care. OI free duration was estimated using the actuarial life table and Kaplan Meier survival. Cox proportional-hazard model was used to calculate hazard rate.Result. OIs were rediagnosed in three quarters (75.37%) participants. In each week the probability of getting new recurrence OI was about 15.04 per 1000 person weeks. The median duration of not acquiring OI recurrence was 54 weeks. After adjustment, variables associated with recurrence were employment status, marital status, exposure for prophylaxis and adherence to it, CD4 count, and hemoglobin value.Conclusion. Giving prophylaxis and counseling to adhere it, rise in CD4 and hemoglobin level, and enhancing job opportunities should be given for PLWHA who are on chronic HIV care while continuing the care.

Background: Evidence shows that earlier access to Anti-retroviral Therapy helps to increase survival of children by delaying the progression to AIDS. However its long-term effect on mortality has remained unanswered in Ethiopia especially in the study area. Objective: To assess incidence and predictors of mortality among Children on Anti-retroviral Therapy in Public Health Facilities of Arba-Minch Town, Gamo Gofa zone, Southern, Ethiopia. Methods: Institution based retrospective cohort study was employed among 421 HIV-positive children enrolled on anti-retroviral therapy from January 1st 2009 to December 30th 2016. The data on relevant variables was collected from patients` medical cards and electronic database by trained data collectors. Data was entered and cleaned by Epi Info version 7 and analyzed by STATA version 11. Life table was used to estimate the cumulative survival of children and Kaplan Meier survival curve together with log rank test was used to compare survival between different categories of covariates. Cox proportional-hazard regression model was used to identify independent predictors of mortality. Result: Overall, 15.4% of children (n=65) died over a follow-up period of 21,175 person-months of observation. The mortality rate of this cohort was 3.07 deaths per 1000 person-months. The cumulative probability of survival after 96th month of treatment was 73.9% (95% CI=63.2-81.9). During the multivariate analysis of baseline variables, we observed that the delayed and regressed developmental milestone (AHR=4.42, 95% CI=1.99-9.75), (AHR=6, 95% CI=2.68-13.45), opportunistic infection at baseline (AHR=1.93, 95% CI=1.03-3.64), tuberculosis co-infection at base line (AHR=2.28, 95% CI=1.23-4.22), low hemoglobin level (AHR=3.32, 95% CI=1.83-6.04), absolute CD4 below threshold (AHR=2.08, 95% CI=1.15-3.77), fair and poor adherence to ART were (AHR=2.17, 95% CI=1.12-4.79), (AHR=2.05, 95% CI=1.02-4.13), isoniazid preventive therapy (AHR=0.38, 95% CI=0.22-0.68) and Co-trimoxazole preventive therapy (AHR=0.26, 95% CI=0.15-0.46) were independent predictors of mortality. Conclusions: Mortality was high especially during the first sixth months following anti-retroviral therapy initiation. Therefore, higher priority should be given to HIV-infected children with tuberculosis co-infection further intervention like isoniazid preventive therapy and co-trimoxazole preventive therapy as well close follow should be given to all children after start of anti-retroviral therapy.

Introduction: Globally approximately one million children die every year from severe acute malnutrition. It is reported that severe acute malnutrition(SAM) is the commonest reason for paediatric hospital admission in many poor countries; 25 to 30% of children with severe malnutrition die during hospital admissions. Objective: To assess the success rate of OTP in treatment of children with SAM and identify its determinants at Kamba district, South West Ethiopia. Method: Institution based retrospective longitudinal study was carried out on children who were treated on the OTP. A total sample of 711 was selected from 4 health centers and 12 satellite health posts. A structured and pretested data abstraction form were prepared and used for data collection. The data were cleaned, coded and entered into Epi-INFO, analyzed by SPSS. The results were estimated using Kaplan-Meier survival curves, log-rank test and Cox-regression. Result: The recovery rate was 67.7% and the median recovery time was 7.14 weeks (IQR 5.28-8.14). Children treated at a health centers have 1.36 times higher recovery rate than children treated at health post (AHR = 1.495, 95% CI = 1.188, 1.881). Controlling for other factors; the probability of a child to recover from SAM under OTP is 1.25 times higher among children aged greater than two years old than those children aged less than or equal to two years old (AHR = 1.255, 95% CI = 1.012, 1.556). Conclusion and Recommendation: The recovery rate was lower than the international standard. Type of health facility providing the OTP services and age of the child had significant association (at 0.05 P-value) with survival time among children who recovered from SAM under OTP. Special focus should be given to young children and decentralization of OTP service from health centers to health posts should be carried out with great caution.

Introduction: As many evidences showed, commencing sex at younger age was risk for acquiring HIV (Human Immunodeficiency Virus) and other sexually transmitted infections (STIs) and of experiencing unplanned Pregnancy due to practicing of it without plan/ not using protective materials. In North East Ethiopia, of half (51.3%) of youths initiated sex at median age of 17 years, 39.1% of them were practicing without plan, three quarter (73.1%) were not discussing about contraception and half of them were having more than one sexual partner. In northwest Ethiopian students, the prevalence of HIV infection, and other STIs was 1.1%, and 10.7% respectively and a quarter (24.3%) of students was experiencing pregnancy that was ended with abortion (89%). In parallel, about half of students in similar area was commencing sex at mean age of about 17 years and about half (47.2%) students were having more than one sexual partner though less than half (45.2%) of them were using condom during sexual practice. In the presence of earlier sexual onset and its consequences, there is no prior local evidence. Therefore the current study is aimed to calculate time of sexual debut and to determine its associated factors. Methodology: The study was conducted among 326 systematically selected day time regular Debre Markos preparatory (grade 11-12th) students. Data was collected by pretested Amharic (local language) version self-administered questionnaire. A coded questionnaire was entered by EpiData version 3.1 and analyzed by SPSS version 20. Time of sexual onset was estimated using the actuarial life table and Kaplan Meier survival. Log rank test was used to compare age of sexual debut across categories of categorical variable. Cox proportional-hazard model was used to calculate hazard rate and to determine independent predictors of outcome. Result: Above one third (37.7%) participants were commencing sex. The median time of sexual initiation was 16 years. Of those beginning sex, about 40.7% were not using condom during sex. In multivariate Cox proportional hazard model, predictors that are risk for younger age sexual onset were being female, rural resident, smoker, alcohol drinker, and watching pornography movies. Thus organizations working on school youths should further work to enhance age of sexual onset by giving especial attention for risk groups.

Background: Highly Active Antiretroviral Therapy improves time to death and recurrence of any opportunistic infections in peoples living with HIV. But little is known about its effect on time to increase WHO clinical stage. Thus, this study was aimed at assessing time to increase WHO clinical stage and associated factors. Method: Retrospective cohort study was used and the required sample size was 464. Study participants were selected randomly from the list of adult people living with HIV attending the public health facilities for ART. Univariate analysis was used to describe patients’ baseline and follow up characteristics. Kaplan-Meier survival and log rank test were used to estimate survival and compare survival curves respectively. Cox proportional-hazard regression model was used to calculate hazard rate and to determine independent predictors of time to increase WHO clinical stage. Result: A total of 464 patients (232 in each cohort) contribute for 898.12 person years of follow up. The overall incidence rate of increased WHO clinical stage was 16.6 per 100 person years of follow up and the incidence of increased WHO clinical stage was 38.5 per 100 person year and 3.8 per 100 person year of follow up in ART and HAART cohorts respectively. Being on Highly Active Antiretroviral Therapy and taking prophylaxis at baseline were the identified predictors’ that prevent increment of WHO clinical stage. In contrary being widowed and single marital status, substance use, rural residence and being in age category 45 years and above were independent predictors for increment of WHO clinical stage. Conclusion: Increment of WHO clinical stage was higher in pre ART cohorts. Special consideration should be given for those who are widowed, substance users and aged 45 years and above.

Background: Non-adherence to antiretroviral therapy is a major challenge to Acquired Immunodeficiency Syndrome (AIDS) care. For Antiretroviral Therapy (ART) to be effective, high level of adherence is required. In spite of this, there is no information on determinant none-adherence to antiretroviral therapy in the study area; therefore this study was conducted to identify predictors of none-adherence to antiretroviral therapy among People Living with HIV/AIDS (PLWHA) in Arba Minch General Hospital. Methods: Unmatched case-control study design was employed on 115 case and 347 controls. Non-adherence to ART is considered as case and adherence to ART is taken as control. Data was collected by using a structured pre-tested questionnaire and by using data abstraction format from ART registration chart. Binary logistic regression analysis was calculated to assess the presence and degree of association between dependent and independent variables; finally multivariate analysis was conducted to identify independent factors for none adherence. Result: From interviewed respondent majority of respondent 304(65.8%) were females and the rest 158(34.2%) were males. From all respondent 209(45%) were in age group 30-39 years. Factors like rural residence 6.30(3.01-13.15), PLWHA who has no family and community support 1.92(1.05-3.51), mobile phone adjusted odds ratio (AOR) 1.20(1.15-3.44)), alcohol drinker 5.88(2.86-12.09), malnutrition 2.83(1.18-6.77) and who consume low dietary diversity 7.18(3.43-15.04) and CD4 Count