Sociodemographic Characteristics
A total of 58 adult HIV patient medical charts were assessed with their repeated follow up for about 322 observations. The mean age (SD) was 37 (10) years with a minimum of 19 years and a maximum of 61 years old. Around 30 (51.7%) of them were female and, 24(41.4%) of them were also married. Regarding educational status and residence 25 (43%) and 39 (67.2%) were primary school level and urban dwellers, respectively. More than half 33(56.9%) of them does not disclose their HIV status to their families and relatives (Table 1).
Table 1
Sociodemographic Characteristics of Adult Newly ART initiated Clients in Dessie City, July 2020(n = 58, Tª=6 and number of Observations 322).
Variable | Category | Number of Follow up in months |
0 | 3 | 6 | 9 | 12 | 15 |
Sex | Male | 28(48.28%) | 28(48.28%) | 28(48.28%) | 26(51.0%) | 26(51.0%) | 22(46.8%) |
Female | 30(51.72%) | 30(51.72%) | 30(51.72%) | 25(49.0%) | 25(49.0%) | 25(53.2%) |
Marital Status | Single | 11(18.97%) | 11(18.97%) | 11(18.97%) | 9(17.6%) | 9(17.6%) | 8(17.0%) |
Married | 24(41.38%) | 2441.38%) | 2441.38%) | 22(43.1%) | 22(43.1%) | 20(42.6%) |
Divorced | 16(27.59%) | 16(27.59%) | 16(27.59%) | 14(27.5%) | 14(27.5%) | 14(29.8%) |
Widowed | 7(12.07%) | 7(12.07%) | 7(12.07%) | 6(11.8%) | 6(11.8%) | 6(10.6%) |
Educational Status | No Education | 19(32.76%) | 19(32.76%) | 19(32.76%) | 16(31.4%) | 16(31.4%) | 13(27.7%) |
Primary | 25(43.10%) | 25(43.10%) | 25(43.10%) | 24(47.0%) | 24(47.0%) | 24(51.0%) |
Secondary and above | 14(24.14%) | 14(24.14%) | 14(24.14%) | 11(21.6%) | 11(21.6%) | 9(21.3%) |
Residence | Urban | 39(67.24%) | 38(65.52) | 39(67.28) | 35(68.6%) | 35(68.6%) | 32(68.1%) |
Rural | 19(32.76%) | 20(34.48) | 19(32.72) | 16(31.4%) | 16(31.4%) | 15(31.9%) |
Disclosing HIV status | Yes | 25(43.1%) | 25(43.1%) | 26(44.8%) | 20(39.2%) | 22(43.1%) | 21(44.7%) |
No | 33(56.9%) | 33(56.9%) | 32(55.2) | 31(60.8%) | 29(56.9%) | 26(55.3%) |
Marital status | Single | 11(19%) | 11(19%) | 11(19%) | 9(17.6%) | 9(17.6%) | 8(17%) |
Married | 24(41.4%) | 24(41.4%) | 24(41.4%) | 22(43.1%) | 22(43.1%) | 20(42.6%) |
Divorced | 16(27.6%) | 16(27.6%) | 16(27.6%) | 14(27.5%) | 14(27.5%) | 14(29.8%) |
Widowed | 7(12%) | 7(12%) | 7(12%) | 6(11.8%) | 6(11.8%) | 5(10.6%) |
• ªT is the number of observations |
Clinical Profiles
The clinical profile of clients under antiretroviral drugs varies with time from baseline to month fifteen. The working functional status of ART clients at baseline or at times antiretroviral initiation was 46(79.3%) and then increases to 46(98%) at fifteen months from the time initiation. The WHO stage of diseases also favors the same condition, which is 39(67.2%) stage one at baseline and 46(98%) in the month fifteen. Most of the clients, 36(62%) were experienced an opportunistic infection at baseline and decline over to 4(8.5%) to the end of the follow-up of this study. Most of clients 48(82.8%) were taking isoniazid as tuberculosis preventive therapy and only a few 3(5.2%) had TB disease at baseline. In this study, Antiretroviral drug adherence also varies across time the maximum of good adherence 46(90.2%) was attained at nine-month and the minimum good Antiretroviral drug adherence 39(76.5%) was at 12 months. Under regimen type half of clients 30(51.7%) were initiated with DTG based regimen and almost all of them 44(93.6%) were taking it at the end of the follow-up (Table 2).
Table 2
Clinical Profile of Newly ART Initiated clients in Dessie City, July 2020(n = 58, Tª=6 and number of Observations 322).
Variable | Category | Number of follow up months |
0 | 3 | 6 | 9 | 12 | 15 |
Functional Status | Working | 46(79.3%) | 54(93.1%) | 54(93.1%) | 51(100%) | 51(100%) | 46(98%) |
Ambulatory and Bedridden | 12(20.7%) | 4(6.9%) | 4(6.9%) | 0(0%) | 0(0%) | 1(2%) |
WHO Stage | Stage I | 39(67.2%) | 39(67.2%) | 39(67.2%) | 51(100%) | 51(100%) | 46(98%) |
Stage II | 6(10.4%) | 6(10.4%) | 6(10.4%) | 0(0%) | 0(0%) | 0(0%) |
Stage III | 10(17.2%) | 10(17.2%) | 10(17.2%) | 0(0%) | 0(0%) | 1(2%) |
Stage IV | 3(5.2%) | 3(5.2%) | 3(5.2%) | 0(0%) | 0(0%) | 0(0%) |
OI | Yes | 36(62%) | 9(15.5%) | 7(12%) | 1(2%) | 5(9.8%) | 4(8.5%) |
| No | 22(38%) | 49(84.5%) | 51(88%) | 50(98%) | 46(90.2%) | 43(91.5%) |
TB | Yes | 3(5.2%) | 3(5.2%) | 3(5.2%) | 0(0%) | 0(0%) | 0(0%) |
| No | 55(94.8) | 55(94.8) | 55(94.8) | 51(100%) | 51(100%) | 47(100%) |
Adherence | Good | | 48(82.8%) | 46(79.3%) | 46(90.2%) | 39(76.5%) | 41(87.2%) |
Fair | | 9(15.5%) | 7(12%) | 4(7.84%) | 8(15.7%) | 4(8.5%) |
Poor | | 1(1.7%) | 5(8.7%) | 1(2%) | 4(7.8%) | 2(4.3%) |
Regimen category | DTG based | 30(51.7%) | 32(55.2%) | 34(57.9%) | 39(76.5%) | 39(86.3%) | 44(93.6%) |
NVP/EFV | 28(48.3%) | 26(44.8%) | 24(42.1%) | 12(23.5%) | 12(13.7%) | 3(6.4%) |
Taking Other Medication | Yes | 38(65.5%) | 10(17.2%) | 8(12.3%) | 2(3.9%) | 3(5.9%) | 3(6.4%) |
No | 20(34.5%) | 48(82.8%) | 50(87.7%) | 49(96.1%) | 48(94.1%) | 44(93.6%) |
Modern Family Planning | Yes | 35(60.3%) | 36(62.1%) | 37(63.8%) | 37(72.5%) | 37(72.5%) | 37(70.2%) |
No | 23(39.7%) | 22(37.9%) | 21(36.2%) | 14(27.5%) | 14(27.5%) | 14(29.8%) |
Taking INH Currently | Currently on INH | 48(82.8%) | 53(91.4%) | 53(91.4%) | 3(5.9%) | 0(0%) | 0(0%) |
Not on INH | 10(17.2%) | 5(8.6%) | 5(8.6%) | 48(94.1%) | 51(100%) | 47(100%) |
Taking CPT currently | Yes | 46(79.3%) | 42(72.4%) | 42(72.4%) | 35(68.6%) | 34(66.7%) | 35(74.5%) |
No | 12(20.7%) | 16(27.6%) | 16(27.6%) | 16(31.4%) | 17(33.3%) | 12(25.5%) |
• ªT is the number of observations |
Summary Measures for Covariates
The mean weight (SD) vary across time 51.3(8.3) kg at baseline to 55.8(8.4) kg at the end of 15 month on ART and the overall mean (SD) was 54.6(7.86) kg. The mean (SD) body mass index at baseline was 19.4(3.3) kg and then raise overtime to 21.3(3.25) kg at the end of this follow-up study (Table 3).
Table 3
Summary measures for Covariates in Newly ART initiated in Dessie City, July 2020(n = 58, Tª=6 and number of Observations 322).
Covariates | Summary measures | Number of follow up months | Total |
0 | 3 | 6 | 9 | 12 | 15 |
Weight | Mean | 51.3 | 53.8 | 54.1 | 56.4 | 56.9 | 55.8 | 54.58 |
Standard Deviation | 8.3 | 7.6 | 7.45 | 6.8 | 7.42 | 8.4 | 7.86 |
Minimum | 33 | 33.2 | 33 | 45 | 42 | 32 | 32 |
Maximum | 72 | 77 | 75 | 80 | 80 | 80 | 80 |
BMI | Mean | 19.4 | 20.3 | 20.5 | 21.08 | 21.35 | 21.3 | 20.63 |
Standard Deviation | 3.3 | 2.98 | 3.0 | 2.7 | 3.06 | 3.25 | 3.12 |
Minimum | 14 | 14 | 14 | 16.8 | 17 | 16 | 14 |
Maximum | 30.3 | 30.4 | 31.5 | 29 | 29 | 29 | 31.5 |
• ª T is the number of observations |
Profile Plotting of Weight against Months on ART
The weights of ART clients were varying across sex, which is more varies at baseline among females, and also the variation continues over time. Unlike female, the variation in male at baseline lesser and also the variation in male slightly decrease over time (Fig. 1).
Figure 1 Individual Profile of Newly ART initiated ART Clients in Dessie City, July 2020.
The mean weight change shows a quadratic nature (Fig. 2), and there is a difference between males and females. The mean weight among females is lower than male (Fig. 3).
Figure 2 The mean Weight Chane in Dessie City, July 2020.
Figure 3 The mean weight in Male and Female in Dessie City, July 2020
The Weight Changes across Months on ART.
The Repeated measure of ANOVA with a Wilk’s Lamda statistics shows that there is a significant difference in the weight change of adult ART clients with a P-Value < 0.001. The variations were detected by wild statistics of Bonferroni methods and the result shows a significant difference every six months apart and more rather than within three months interval.
Adult ART clients gain weight 4.92 kg (C95%: 3.03–6.82) within one year after the initiation of ART clients. The mean weight changes after initiation of ART over 15 months of follow up is decreased to 3.28 kg. This study address change of weights after initiation of adult ART clients and its covariate predictors. The analysis shows that no opportunistic infection, the interaction between months on ART and absence of opportunistic infection, and WHO stage were statistically significant (Table 4).
Table 4
Predictors of weight change among newly initiated ART clients in Dessie, July, 2020. (n = 58, ªT = 6 and number of Observations 322).
Weight | Coef. | Std. Err. | P > value | [95% Conf. Interval] |
Age | 0.09 | 0.08 | 0.261 | -0.07 | 0.26 |
Sex | | | | | |
Male | 2.15 | 1.74 | 0.218 | -1.27 | 5.56 |
Disclosing HIV status | | | | | |
No | 0.76 | 1.31 | 0.562 | -1.81 | 3.33 |
Residence | | | | | |
Rural | -1.68 | 1.65 | 0.309 | -4.93 | 1.56 |
Opportunistic infection | | | | | |
No | 1.85 | 0.6 | 0.002* | 0.66 | 3.03 |
Interaction between months on ART and functional status | -0.156 | 0.38 | 0.680 | -0.9 | 0.59 |
Tuberculosis | | | | | |
No | -3.12 | 2.09 | 0.135 | -7.21 | 0.97 |
Months on ART interact with WHO stage | 0.33 | 0.34 | 0.320 | -0.32 | 0.99 |
Months on ART interact with OI | 0.09 | 0.02 | 0.000* | 0.05 | 0.13 |
Functional status | | | | | |
Ambulatory and Bedridden | -2.6 | 1.76 | 0.138 | -6.04 | 0.84 |
Months on ART interact with regimen change | -0.08 | 0.08 | 0.303 | -0.23 | 0.07 |
Taking Cotrimoxazole Preventive Therapy | | | | | |
Currently on not CPT | 0.16 | 0.2 | 0.421 | -0.23 | 0.56 |
WHO stage | | | | | |
Advanced Stageα | -3.52 | 1.62 | 0.030* | -6.71 | -0.34 |
Educational status | | | | | |
Have formal Education | 2.26 | 1.75 | 0.196 | -5.69 | 1.17 |
Marital Status | | | | | |
Currently married | -2.27 | 1.76 | 0.198 | -5.72 | 1.18 |
• *statistically significant ªT is the number of observations αWHO stage III and IV |
The interaction term of months on ART with the absence of opportunistic infection increases 0.09 kg of weight over time as a month on ART increases in adult ART clients. Adult ART clients with absence of opportunistic infection over a period of time in a month on ART increase their weight by 1.85 kg within the time span of their follow up. Adult ART clients, who were experienced advanced WHO stage disease over a period of their follow up time a month on ART, were decrease their weight by 3.5 kg in their follow-up time (Table 4).