Browsing by Author "Zyambo, Cosmas"

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    Alcohol consumption and tobacco smoking associated with decreased antiretroviral therapy adherence among people living with HIV in Zambia: Evidence from a 2023 national NCDs/ HIV survey.
    (2026) Zyambo, Cosmas; Somwe, Paul; Musukuma, Mwiche; Mandyata, Chomba; Bwembya, Phoebe; Phiri, Henry; Chavula, Malizgani; Halwindi, Hikabasa; Zulu, Joseph; Mutale, Wilbroad
    BACKGROUND: In order to achieve the 95-95-95 goals and obtain optimal benefits from ART, PLWH must adhere to prescribed medication. AIM: Investigate factors associated with ART adherence in a clinical setting in Zambia. METHODS: National cross-sectional study involving 193 clinics across all 10 provinces of Zambia. The primary outcomes assessed were ART adherence status, associated behavioral factors, and clinical characteristics. Logistic regression analysis was conducted to evaluate associations between these factors and ART adherence. Both unadjusted odds ratios (UOR) and adjusted odds ratios (AOR) were calculated, with adjustments made for relevant covariates, and all estimates reported with 95% confidence intervals. RESULTS: Of the 5,204 PLWH, 7.1% were non-adherent to ART (9.7% males vs 5.9% females). Of those who were non adherent, 60% and 22% consumed alcohol and smoked tobacco respectively. In adjusted analysis, age; 45-59 (AOR: 0.5, 95% CI:0.32-0.79), 60+ (AOR: 0.26, 95% CI: 0.12-0.59) and education; Primary (AOR: 0.6, 95% CI: 0.4-0.9), secondary (AOR: 0.57, 95% CI: 0.4-0.82), college/university (AOR: 0.5, 95% CI: 0.29-0.89) were associated with decreased odds of being non-adherence to ART. In contrast, being male (AOR: 1.45, 95% CI:1.07-1.98), being in informal employment (AOR:1.65, 95% CI:1.15-2.36), having average yearly income; > $160 (AOR: 1.55, 95% CI: 1.16-2.06), Alcohol consumption; healthy consumption (AOR: 2.72, 95% CI: 1.9-3.89), unhealthy consumption (AOR: 2.76, 95% CI: 1.8-4.22), indeterminant consumption (AOR: 3.03, 95% CI: 2.04-4.5) and tobacco smoking (AOR: 95% CI: 2.03 1.42-2.9) were associated with increased odds of being non-adherence to ART. CONCLUSIONS: ART non-adherence among PLWH in Zambia is 7.1%, with higher rates in males. Substance use especially alcohol and tobacco are common among the non-adherent. The associations between alcohol consumption, tobacco smoking, and ART adherence highlight the potential value of targeted support strategies. These results can inform future longitudinal research and contribute to the development of evidence-based interventions.
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    Prevalence and predictors of virological failure in pediatric patients on HAART in sub-Saharan Africa: a systematic review and meta-analysis.
    (2023) Machila, Nchimunya; Libonda, Liyali ; Habineza, Paul; Velu, Rachel M.; Kamboyi, Harvey K.; Ndhlovu, Jacob; Wamunyima, Inonge; Sinadambwe, Monahani M.; Mudenda, Steward; Zyambo, Cosmas; Bumbangi, Flavien N.
    Antiretroviral treatment failure has emerged as a challenge in the management of pediatric human immunodeficiency virus (HIV) patients, especially in resource-limited countries despite accessibility to Highly Active Antiretroviral Therapy (HAART). A systematic review and meta-analysis was conducted to synthesize virological failure (VF) prevalence and ascertain its predictors in children in sub-Saharan Africa. An electronic database search strategy was conducted from January to September 2021 on PubMed, EMBASE, SCOPUS, HINARI, and CINAHL. Further, manual searching was conducted on non-indexed journals. Utilizing the JASP© version 0.17.2 (2023) statistical software, a meta-analysis of pooled prevalence of VF was estimated using the standardized mean differences. Further, selection models were used to assess the risk of bias and heterogeneity. The pooled odds ratios were estimated for the respective studies reporting on predictors of VF. The overall pooled estimate of the prevalence of VF in sub-Saharan Africa among the sampled population was 29% (95% CI: 27.0-32.0; p<0.001). Predictors of VF were drug resistance (OR: 1.68; 95% CI: 0.88-2.49; p < 0.001), poor adherence (OR: 5.35; 95% CI: 5.26-5.45; p < 0.001), nevirapine (NVP)-based regimen (OR: 5.11; 95% CI: 4.66-5.56; p < 0.001), non-usage of cotrimoxazole prophylaxis (OR: 4.30; 95% CI: 4.13-4.47; p < 0.001), higher viral load at the initiation of antiretroviral therapy (ART) (OR: 244.32; 95% CI: 244.2-244.47; p <0.001), exposure to the prevention of mother to child transmission (PMTCT) (OR: 8.02; 95%CI: 7.58-8.46; p < 0.001), increased age/older age (OR: 3.37; 95% CI: 2.70-4.04; p < 0.001), advanced World Health Organization (WHO) stage (OR: 6.57; 95% CI: 6.17-6.98; p < 0.001), not having both parents as primary caregivers (OR: 3.01; 95% CI: 2.50-3.53; p < 0.001), and tuberclosis (TB) treatment (OR: 4.22; 95% CI: 3.68-4.76; p <0.001). The mean VF prevalence documented is at variance with studies in other developing countries outside the sub-Saharan region. The high prevalence of HIV cases contrasting with the limited expertise in the management of pediatric ART patients could explain this variance.