BackgroundReducing attrition in paediatric HIV-positive patients using combined antiretroviral therapy (cART) programmes in sub-Saharan Africa is a challenge. This study explored the rates and predictors of attrition in children started on cART in Asmara, Eritrea.MethodsThis was a retrospective cohort study using data from all paediatric patients on cART between 2005 and 2020, conducted at the Orotta National Referral and Teaching Hospital. Kaplan-Meier estimates of the likelihood of attrition and multivariate Cox proportional hazards models were used to assess the factors associated with attrition. All p values were two sided and p<0.05 was considered statistically significant.ResultsThe study enrolled 710 participants with 374 boys (52.7%) and 336 girls (47.3%). After 5364 person-years’ (PY) follow-up, attrition occurred in 172 (24.2%) patients: 65 (9.2%) died and 107 (15.1%) were lost to follow-up (LTFU). The crude incidence rate of attrition was 3.2 events/100 PY, mortality rate was 2.7/100 PY and LTFU was 1.2/100 PY. The independent predictors of attrition included male sex (adjusted HR (AHR)=1.6, 95% CI: 1 to 2.4), residence outside Zoba Maekel (AHR=1.5, 95% CI: 1 to 2.3), later enrolment years (2010–2015: AHR=3.2, 95% CI: 1.9 to 5.3; >2015: AHR=6.1, 95% CI: 3 to 12.2), WHO body mass index-for-age z-score <−2 (AHR=1.4, 95% CI: 0.9 to 2.1), advanced HIV disease (WHO III or IV) at enrolment (AHR=2.2, 95% CI: 1.2 to 3.9), and initiation of zidovudine+lamivudine or other cART backbones (unadjusted HR (UHR)=2, 95% CI: 1.2 to 3.2). In contrast, a reduced likelihood of attrition was observed in children with a record of cART changes (UHR=0.2, 95% CI: 0.15 to 0.4).ConclusionA low incidence of attrition was observed in this study. However, the high mortality rate in the first 24 months of treatment and late presentation are concerning. Therefore, data-driven interventions for improving programme quality and outcomes should be prioritised.

Background: The periodically emerging new and old infectious microorganisms greatly magnify the global burden of infectious diseases. The majority of emerging infectious events are caused by bacteria, which can be associated with the evolution of drug-resistant strains and the overwhelming of the natural host defenses. Medicinal plants play an important role in the treatment of various infectious diseases. The objective of this study is to evaluate the in vitro antimicrobial activities of crude extracts of aqueous and solvents from two Eritrean traditional medicinal plants (Silene macrosolen and Solanum incanum). Methodology: Roots and leaves of Solanum incanum and stems and roots of Silene macrosolen were collected and extracted using standard methods. The extracted ingredients were then subjected to standard bacterial strains (Escherichia. coli ATCC-25923, Staphylococcus. aureus ATCC-25922, and Pseudomonas. aeruginosa ATCC-27853) to determine their antibacterial activity by measuring their zone of inhibition. Phytochemical analysis of the crude extract to see the presence of phytochemical compounds in the extract of selected plants. Results: The highest inhibition zone was observed for methanol extracted S. macrosolen stem and chloroform extracted S. incanum root against S. aureus in 400 mg / ml with 23mm and 24.5mm respectively. Methanol and cold aqueous extracted stem of S. macrosolen also showed the highest inhibition of 26mm and 23mm diameter, against P. aeruginosa and E. coli respectively. The MIC and MBC of the cold aqueous extract of S. macrosolen stem were found at 25 mg / ml and 50mg/ml respectively, against both E. coli and P. aeruginosa, while the MIC of the chloroform-extracted root of S. incanum was found at 50mg/ml, however, the MBC could not be found in the concentration tested against S. aureus. Conclusion: Based on the finding of this study S. aureus was found to be more susceptible to the plant extracts than E. coli and P. aeruginosa, and the methanolic and cold aqueous extracts of the S. macrosolen stem revealed the highest antibacterial activity.

Background Information on treatment failure (TF) in People living with HIV in a data-poor setting is necessary to counter the epidemic of TF with first-line combined antiretroviral therapies (cART) in sub-Saharan Africa (SSA). In this study, we examined the risk factors associated with TF in Asmara, Eritrea from 2001 to 2020. Methods A multicenter, retrospective 1:2 matched (by age and gender) case–control study was conducted in four major hospitals in Asmara, Eritrea on adults aged ≥ 18 years who were on treatment for at least 6 months. Cases were patients who fulfills at least one of the WHO therapy failure criterion during the study period. Controls were randomly selected patients on first-line treatment and plasma viral load < 1000 copies/ml in their latest follow-up measurement. Multivariable logistic regression analysis was conducted to identify risk factors for TF. All P-values were 2-sided and the level of significance was set at P < 0.05 for all analyses. Results Of the 1068 participants (356 cases; 712 controls), 585 (54.7%) were females. The median age at treatment initiation was 46 years [interquartile range (IQR): 39–51]. Median time to combined antiretroviral therapy (cART) failure was 37 months (IQR = 24–47). In the multivariate analysis, factors associated with increased likelihood of TF included initial nucleoside reverse transcriptase inhibitors (NRTI) backbone (Zidovudine + Lamivudine (AZT + 3TC): adjusted odds ratio (aOR) = 2.70, 95% Confidence interval (CI): 1.65–4.41, P-value < 0.001), (Abacavir + lamivudine (ABC + 3TC): aOR = 4.73, 95%CI: 1.18–18.92, P-value = 0.028], and (Stavudine + Lamivudine (D4T + 3TC): aOR = 5.00; 95% CI: 3.03–8.20, P-value < 0.001) in comparison to Emtricitabine and Tenofovir diproxil fumarate (FTC + TDF). Additional associations included prior exposure to cART (aOR = 2.28, 95%CI: 1.35–3.86; P- value = 0.002), record of sub-optimal drug adherence (aOR = 3.08, 95%CI: 2.22–4.28; P < 0.001), ambulatory/bedridden at presentation (aOR = 1.61, 95%CI: 1.12–4.28; P-value = 0.010), presence of comorbidities (aOR = 2.37; 95%CI: 1.36–4.10, P-value = 0.002), duration of cART (< 5 years: aOR: 5.90; 95% CI: 3.95–8.73, P-value < 0.001), and use of SMX-TMP prophylaxis (aOR = 2.00, 95%CI, 1.44–2.78, P-value < 0.001). Conclusion Our findings underscore the importance of optimizing cART adherence, diversification of cART regimens, and interventions directed at enhancing early HIV diagnosis, prompt initiations of treatment, and improved patient-focused monitoring of treatment response.

Introduction Treatment failure (TF) in HIV infected children is a major concern in resource-constrained settings in Sub-Saharan Africa (SSA). This study investigated the prevalence, incidence, and factors associated with first-line cART failure using the virologic (plasma viral load), immunologic and clinical criteria among HIV-infected children. Methods A retrospective cohort study of children (<18 years of age on treatment for a period of > 6 months) enrolled in the pediatric HIV/AIDs treatment program at Orotta National Pediatric Referral Hospital from January 2005 to December 2020 was conducted. Data were summarized using percentages, medians (± interquartile range (IQR)), or mean ± standard deviation (SD). Where appropriate, Pearson Chi-Squire (χ2) tests or Fishers exacts test, Kaplan–Meier (KM) estimates, and unadjusted and adjusted Cox-proportional hazard regression models were employed. Results Out of 724 children with at least 24 weeks’ follow-up 279 experienced therapy failure (TF) making prevalence of 38.5% (95% CI 35–42.2) over a median follow-up of 72 months (IQR, 49–112 months), with a crude incidence of failure of 6.5 events per 100- person-years (95% CI 5.8–7.3). In the adjusted Cox proportional hazards model, independent factors of TF were suboptimal adherence (Adjusted Hazard Ratio (aHR) = 2.9, 95% CI 2.2–3.9, p < 0.001), cART backbone other than Zidovudine and Lamivudine (aHR = 1.6, 95% CI 1.1–2.2, p = 0.01), severe immunosuppression (aHR = 1.5, 95% CI 1–2.4, p = 0.04), wasting or weight for height z-score < -2 (aHR = 1.5, 95% CI 1.1–2.1, p = 0.02), late cART initiation calendar years (aHR = 1.15, 95% CI 1.1–1.3, p < 0.001), and older age at cART initiation (aHR = 1.01, 95% CI 1–1.02, p < 0.001). Conclusions Seven in one hundred children on first-line cART are likely to develop TF every year. To address this problem, access to viral load tests, adherence support, integration nutritional care into the clinic, and research on factors associated with suboptimal adherence should be prioritized.