Prevalence, patterns and predictors of opportunistic infections in adults infected with human immunodeficiency virus at Bule Hora University Teaching Hospital, South Eastern Ethiopia: A retrospective cross-sectional study

Prevalence, patterns and predictors of opportunistic infections in adults infected with human immunodeficiency virus at Bule Hora University Teaching Hospital, South Eastern Ethiopia: A retrospective cross-sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Prevalence, patterns and predictors of opportunistic infections in adults infected with human immunodeficiency virus at Bule Hora University Teaching Hospital, South Eastern Ethiopia: A retrospective cross-sectional study Lencho Bati, Birhanu Dajene, Woyesa Elema, Henok Buno This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7454052/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction Patients with human immunodeficiency virus face high rates of morbidity and mortality due to opportunistic infections. No prior research has assessed the prevalence, patterns and predictors of opportunistic infections in patients living with human immunodeficiency virus in the West Guji zone, specifically at Bule Hora University Teaching Hospital. Therefore, this study aimed to assess the prevalence, patterns and predictors of opportunistic infections among human immune deficiency positive adults receiving antiretroviral therapy. Methodology Facility based retrospective cross sectional study was conducted from November 1–30, 2024. Data was collected using checklist which was adopted from Ethiopian federal ministry of health guideline and patient follow up registry book. During data analysis, bivariate and multivariate logistic regression was used to identify independent risk factors for the presence of opportunistic infections. Result Of 379 assessed patients, 47.2% (95%CI 42.1–52.4) experienced opportunistic infections. The prevalent opportunistic infections were pulmonary tuberculosis (37.4%, n = 117), bacterial pneumonia (25.9%, n = 81), and chronic diarrhea (12.8%, n = 40). Lack of isoniazid preventive therapy initiation ( p < 0.001, AOR 2.451, 95%CI 1.417–4.241), lack of cotrimoxazole preventive therapy initiation ( p = 0.009, AOR 2.076, 95%CI 1.196–3.603), poor adherence to treatment ( p < 0.001, AOR 9.067, 95% CI 4.927–16.686) and fair adherence ( p < 0.001, AOR 5.326, 95%CI 2.711–10.465) were significant risk factors of opportunistic infections. Conclusion and Recommendation Prevalence of common opportunistic infections were high in this study. Healthcare workers should work on timely antiretroviral therapy initiation, early prophylaxis initiation and improving patient adherence to antiretroviral therapy. Antiretroviral therapy Opportunistic Infection pattern prevalence Ethiopia Figures Figure 1 Figure 2 Contributions to the Literature This study offers representative data on the extent, patterns and related factors of opportunistic infections among adult patients with human immunodeficiency virus as there is limited evidence at study site It thoroughly highlights potential areas for enhancement in the management of opportunistic infections among patients with human immunodeficiency virus who are receiving follow-up care. It also offers evidence to improve adherence to antiretroviral therapy and prevention of opportunistic infections in health facility. Introduction Human Immunodeficiency Virus (HIV) is a virus that targets the body's immune system, which is responsible for fighting infections, and leads to acquired immunodeficiency syndrome (AIDS). By weakening the immune system, it makes individuals infected with the virus more vulnerable to various infections known as opportunistic infections (OIs) [ 1 ]. OI is a disease such as tuberculosis, pneumonia, candidiasis, herpes zoster, genital, gastrointestinal and Central nervous system infections caused by a microbial agent in the presence of a weaken host immune system. These OIs are a major cause of illness and death among those with HIV/AIDS [ 2 – 5 ]. HIV infection and OIs influence each other reciprocally. HIV weakens the immune system, increasing susceptibility to OIs. Conversely, OIs can raise HIV viral load, accelerating disease progression, increasing transmission risk, and negatively impacting treatment outcomes and cost-effectiveness [ 6 – 8 ]. Highly active antiretroviral therapy (HAART) significantly reduces OIs, but the risk and severity of OIs remain elevated in individuals with advanced HIV, high viral loads (≥ 1000 copies/ml), poor HAART adherence, inadequate prophylaxis (e.g., isoniazid, cotrimoxazole), malnutrition, severe immunosuppression, immobility, and low CD4 counts (< 200 cells/mm3) [ 9 – 11 ]. An OIs accounts for 90% of global AIDS-related deaths (an estimated 36 million fatalities) since the epidemic began. OIs are also responsible for over 20%-50% of AIDS-related hospital admissions worldwide [ 12 ]. Globally in 2023 only, AIDS-related illnesses caused an estimated 630,000 deaths and OIs accounting for about 585,000 of these fatalities [ 13 ]. In addition, the 2023 United nation AIDS report identifies sub-Saharan Africa, including Ethiopia, as the region most heavily affected by HIV/AIDS and its associated OIs [ 14 – 16 ]. Global HIV development assistance totaled $ 170.79 billion to treat AIDS and OIs between 2000 and 2019 [ 11 ]. Despite efforts to integrate OIs diagnosis, prevention and treatment into HIV care in Ethiopia, studies from various hospitals in a country reveal a persistent high prevalence of OIs among people living with HIV (PLWHIV) receiving HAART medications [ 9 , 17 – 19 ]. Lack of updated data on OIs prevalence, patterns and predictors at Bule Hora University Teaching Hospital (BHUTH) in South Eastern Ethiopia motivated this study, which aimed to assess the magnitude of OIs, patterns and identify their predictors among patients receiving HAART. Materials and Methods Study area and period The study was conducted at the ART clinic of BHUTH in West Guji zone, South Eastern Ethiopia from November 1–30, 2024. The hospital is situated 474 kilometers southeast of Addis Ababa, the capital city, in a town with a population of 141,579 (78,030 males and 63,549 females) [ 20 ]. BHUTH offers a wide range of medical care services, including antiretroviral therapy clinic. The hospital serves as a referral center for health centers and nearby hospitals. Research Design A facility based retrospective cross sectional study was used. Study Population All charts of adult HIV/AIDS patients receiving HAART at the BHUTH, ART clinic between September 2023 and September 2024. Inclusion criteria All charts of adult 18 and above years of age and who were on HAART were enrolled in the study Exclusion criteria This study excluded charts of patients transferred to other facilities, those who did not return for follow-up within six months, and those with incomplete medical records. Dependent variable magnitude of OIs pattern of OIs Independent variables Demographic characteristics Age, sex, marital status, functional status, educational status and residence Clinical characteristics WHO stage, HAART choice, types of OIs, adherence, BMI Sample size determination and sampling technique The sample size was calculated using the single population proportion formula where the value of magnitude of OIs among PLWHIV is 43.97% in Ethiopia [ 9 ] and a 95% confidence interval (CI) with a corresponding coefficient of reliability of 1.96, and a 5% margin of error. The final calculated sample size was 379. Medical records of 385 patients diagnosed with HIV/AIDS from September 2023 to September 2024 were reviewed at the ART clinic. Among these, 2 patients had incomplete data (with the outcome variable unrecorded), 4 patients were transferred to other facilities and were therefore excluded from the study. Consequently, the study included 379 patients who were followed up from September 1, 2023, to September 1, 2024. Since all patients meeting the inclusion criteria were included, no sampling techniques were employed. Data Collection procedure A pretest of the checklist was conducted on 5% of patient medical records from the Bula Hora health center's ART clinic follow-up. This ensured data checklist reliability and consistency, allowing for necessary corrections before full implementation. Data was collected by 3 ART pharmacists after 2 days training was given using a checklist which was adopted from Ethiopian federal ministry of health (FMOH) guideline and individual patient card for monitoring HIV/AIDS patients on follow up. The checklist includes patient information details, such as socio-demographic characteristics, functional status, and clinical characteristics like type of OIs, treatment of OIs, prophylaxis usage, WHO clinical staging and body mass index. Data analysis procedures The data was coded and checked for completeness and entered into SPSS for windows version 25.0 statistical software. Before analysis, the data were arranged, edited, and cleaned by running simple frequencies and cross-tabulations. In order to manage confounding variables, variables that were shown statistically significant with the magnitude of OIs at p < 0.5 under bivariable logistic regression analysis were reexamined using multivariable logistic regression analysis, and those variables with p 95% that is the percentage of missed dose is < 2 doses of 30 doses or < 3 dose of 60 dose) as documented by ART health personnel [ 21 ]. Fair Adherence if PLWHIV adherent 85–94% that is the percentage of missed dose are 3–5 doses of 30 doses or 3–9 dose of 60 dose) as documented by ART health personnel [ 21 ]. Opportunistic infection: Poor Adherence if a missed dose rate in PLWHIV less than 85% (e.g., > 6 doses out of 30, or > 9 doses out of 60), as documented by ART healthcare providers [ 21 ]. Results Demographic Characteristics of the patients The study reviewed 379 patient charts from September 2023 to December 2024. The sociodemographic data showed majority, 206(54.4%) of the patients were women. Most patients, 133(35.1%) were aged 28–37, followed by 104(27.4%) patients who were found between 38–47 age group. Two hundred thirty eight (62.8%) patients were married, while 68(17.9%) were single. A significant portion of patients, 176(46.4%) were illiterate and 220(58%) patients were resided in rural areas as summarized in Table 1 below. Table 1 Socio demographic characteristics of HIV patients in ART clinic at BHUTH, South East Ethiopia from September 2023 to September 2024 Characteristics Category Frequency Percentage Age 18–27 90 23.8 28–37 133 35.1 38–47 104 27.4 > 48 52 13.7 Sex Male 173 45.6 Female 206 54.4 Marital status Single 68 17.9 Married 238 62.8 Divorced 42 11.1 Widowed 31 8.2 Level of education Illiterate 176 46.4 Primary 112 29.6 Secondary Diploma or higher 48 43 12.7 11.3 Residency Urban 159 42 Rural 220 58 Clinical Characteristics The clinical characteristic of patient at ART clinic showed that, most patients, 179(47.2%) were categorized in WHO stage I, followed by 129(34%) patients who were categorized in stage III. Few patients, 21(5.5%) were found in stage IV. Two hundred eight eight (76%) patients were taken cotrimoxazole prophylaxis (CPT), while 280(73.9%) patients did not receive isoniazid preventive therapy (IPT). The majority of the patients, 368(97.1%) were on first-line HAART, with only 11(2.9%) who were on second-line treatment. Regarding adherence, 240(63.3%) showed good adherence to ART, while 86(22.7%) had poor adherence as summarized in Table 2 . Table 2 Clinical Characteristics of HIV patients in ART clinic at BHUTH, South East Ethiopia from September 2023 to September 2024 Characteristics Category Frequency Percentage WHO stage Stage I 179 47.2 Stage II 50 13.2 Stage III 129 34.0 Stage IV 21 5.5 CPT Yes 288 76 No 91 24 IPT Yes 99 26.1 No 280 73.9 HAART Choice 1st line 368 97.1 2nd line 11 2.9 Adherence Good 240 63.3 Fair 53 14 Poor 86 22.7 Body Mass Index 25 24 6.3 Functional status Ambulatory 316 83.4 Bed ridden 63 16.6 WHO: World Health Organization, CPT: Cotrimoxazole prophylaxis therapy, IPT: Isoniazid preventative therapy Prevalence of OIs among HIV patients on follow up Of 379 participants, 179(47.2%) had opportunistic infections (OIs) with (95%CI 42.1–52.4), while 200(52.8%) did not had OIs as shown in Fig. 1 . Patterns of opportunistic Infections Overall, a total of 313 infection episodes occurred among the study participants (n = 379). Among these OIs, the most common opportunistic infections were pulmonary tuberculosis 117(37.4%), followed by 81(25.9%) patients with bacterial pneumonia, and 40(12.8%) patients with chronic diarrhea of all opportunistic infection summarized in Fig. 2 . Factors associated with magnitude of opportunistic infections We used logistic regression analysis to determine the association of selected variables with the magnitude of OIs among PLWHIV included in the study. Variables statistically significant at p < 0.05 under bivariate logistic regression analysis were rechecked under multivariable logistic regression. Accordingly, lack of initiation of IPT( p value = 0.001, AOR = 2.451(95%CI:1.417–4.241)), lack of initiation of CPT( p value = 0.009, AOR = 2.076 (95%CI:1.196–3.603)), Fair adherence ( p value = < 0.001, AOR: 5.326(95%CI:2.711–10.465)) and poor adherence ( p value = < 0.001, AOR: 9.067(95%CI:4.927–16.686)) were strong predictors of OIs (Table 3 ). Table 3 Bivariate and multivariate logistic regression analysis of factors associated with the magnitude of OIs among HIV patients in ART clinic at BHUTH, South East Ethiopia from September 2023 to September 2024 Characteristics OI present COR (95%CI) p value AOR (95%CI) p value Yes No Age 18–27 41(10.8%) 49(12.9%) 1 1 28–37 66(17.4%) 67(17.7%) 1.177(0.689–2.013) 0.551 38–47 51(13.5%) 53(14%) 1.150(0.653–2.025) 0.628 > 48 21(5.5%) 31(8.2%) 0.810(0.405–1.617) 0.550 Sex Male 76(20%) 97(25.6%) 1 1 1 Female 103(27.2%) 103(27.2%) 1.276(0.851–1.915) 0.239 1.191(0.734–1.933) 0.478 Marital status Single 32(8.4%) 36(9.5%) 1 1 1 Married 104(27.4%) 134(35.4%) 0.873(0.508–1.449) 0.623 0.640(0.344–1.189) 0.158 Divorced 25(6.5%) 17(4.5%) 1.654(0.759–3.604) 0.205 1.629(0.672–3.947) 0.280 Widowed 18(4.7%) 13(3.4%) 1.558(0.661–3.673) 0.311 1.380(0.517–3.681) 0.520 Educational level Illiterate 89(23.5%) 87(23%) 0.976(0.501–1.903) 0.944 Primary 45(11.9%) 67(17.7%) 0.641(0.316-1.300) 0.218 Secondary 23(6.1%) 25(6.6%) 0.878(0.385–2.001) 0.757 Diploma or higher 22(5.8%) 21(5.5%) 1 1 1 Residence Urban 74(19.5%) 85(22.4%) 1 1 Rural 105(27.7%) 115(30.3%) 1.049(0.697–1.578) 0.819 IPT Yes 34(9%) 65(17.2%) 1 1 1 No 145(38.2%) 135(35.6%) 0.487(0.302–0.784) 0.003 2.451(1.417–4.241) 0.001 CPT Yes 127(33.5%) 161(42.5%) 1 1 No 52(13.7%) 39(10.3%) 0.592(0.368–0.952) 0.031 2.076(1.196–3.603) 0.009 Adherence Good 76(20%) 164(43.3%) 1 1 Fair 35(9.2%) 18(4.7%) 4.196(2.234–7.880) < 0.001 5.326(2.711–10.465) < 0.001 Poor 68(17.9%) 18(4.7%) 8.152(4.535–14.635) < 0.001 9.067(4.927–16.686) < 0.001 AOR: adjusted odd ratio, COR: crude odd ratio, CPT: cotrimoxazole preventative therapy, IPT: isoniazid preventative therapy, OI: opportunistic infection Discussion This retrospective cross-sectional study was aimed to assess the prevalence, patterns and predictors of OIs among HIV-positive patients taking HAART in BHUTH at ART clinic over one year by assessing patient charts. In our study, we found that an overall prevalence of OIs were 47.2% (95%CI 42.1–52.4). The result was comparable with 47.6% of the magnitude of OIs seen in Taiwan [ 22 ], 48% of OIs documented at Hiwot Fana Specialized University Hospital, Eastern Ethiopia [ 23 ] and 51.9% recorded in Cameroon [ 24 ]. However, the burden of OIs continues more challenging patients in our study compared to study done in Rwanda (9.2%)[ 25 ], Nigeria (22.4%)[ 26 ], Mogadishu Somalia (37.1%)[ 27 ], Sidama in southern Ethiopia (39.6%)[ 28 ], Debre Markos referral hospital (42.8%)[ 29 ], 6.0% in north east Ethiopia [ 18 ], 32.2% magnitude of Dessie hospital [ 30 ] and 43.97% of meta-analysis in Ethiopia [ 9 ]. The high prevalence rate in our study could be attributed to the sociodemographic characteristics such as residence, nutritional status, poor awareness of the population about the HIV infection, delay on the time of diagnosis and HAART initiation, lack of prophylaxis initiation and poor adherence to the treatment. Among the OIs, the most frequent seen in the patients were PTB which was 37.4%. This was consistent with study done in Kenya (35%)[ 31 ] and Dessie (37.7%)[ 30 ]. Our result was higher than the study done in Rwanda [ 25 ], Sidama [ 28 ], Hiwot Fana Specialized University Hospital [ 23 ]. However, the result was lower than the study done in Uganda [ 32 ], Gabon [ 10 ], Mekelle [ 33 ] and Salale [ 34 ]. The difference may be related with types of study method used across the studies, sample size considered, sociodemographic characteristics such as residence, time of initiation of HAART, time of initiation of IPT and cotrimoxazole prophylaxis, adherence to medication and follow up status. Furthermore, our finding was similar to the WHO report which indicated TB is the most opportunistic infection seen in HIV/AIDS patients in the world and particularly Ethiopia is among the 30 high HIV-TB burden countries. This affecting the strategy aims to end the TB epidemic by reducing TB related deaths by 95% and by cutting incident TB cases by 90% between 2015 and 2035 [ 35 ]. Second highly occurred OI were pneumonia (25.9%) followed by chronic diarrhea (12.8%) respectively. The magnitude of pneumonia seen in our study was higher than the study done in Rwanda which had the magnitude of 15.6% [ 25 ], 21.5% result of study done in Sidama [ 28 ], 2% of eastern Ethiopia [ 23 ], 14.9% of study done in Dessie [ 30 ] and 9.6% of study done in Mekelle [ 33 ]. This discrepancy may be attributed with the difference in study design and sample size used among the compared studies. In addition, in our study, the number of patients who did not started prophylaxis were high compared with other studies which was one of the contributing reasons of difference. In this study, compared to those patients initiated IPT, lack of initiation of IPT in HIV/AIDS patients without active PTB responsible to increase the risk of opportunistic infection 2.451 times with the CI (1.417–4.241). This was comparable with the study done in Uganda [ 36 ], Zimbabwe [ 37 ], Salale [ 34 ] and eastern Ethiopia [ 23 ]. According to the WHO guidelines Systematic identification of Latent TB infection in people living with HIV/AIDS should be performed using “Clinical symptom-based TB screening” and IPT should be initiated in those who are unlikely to have active TB irrespective of CD4 count and ART status [ 38 , 39 ]. If this was not done as per the guidelines, the magnitude of OIs like PTB was very high in a patient on HAART. This is due to the on time initiation of IPT improve weakened cellular immunity to fight infections [ 14 ] as our study indicated PTB was the most common OIs seen in the patients who did not start IPT at time of initiation of HAART. This study also showed lack of initiation of cotrimoxazole prophylaxis on time of HAART initiation increase the risk of OIs 2.076 times with the CI (1.196–3.603). This study was agree with study done in eastern Ethiopia [ 23 ]. Additionally, our findings align with randomized controlled trials conducted in sub-Saharan Africa, which demonstrated that timely initiation of cotrimoxazole decreases mortality, and hospitalization among individuals living with HIV by lowering the risk of opportunistic infections, irrespective of their CD4 counts and tuberculosis status [ 40 ]. Furthermore, Fair adherence to HAART increases the risk of OIs 5.326 times, CI (2.711–10.465) and poor adherence to HAART increases the occurrence of OIs 9.067 times with the CI (4.927–16.686) compared to those patients who had good adherence. This agrees with study done in Uganda [ 32 ], Sidama [ 28 ], Dessie [ 30 ], pooled meta-analysis in Ethiopia [ 41 ] and Mekelle [ 33 ]. WHO guidelines confirm that poor adherence to antiretroviral therapy (ART) in adults with HIV significantly increases the risk of OIs. This is because poor adherence reduces ARV effectiveness, accelerates viral replication, and suppresses the immune system, thereby fostering an environment conducive to OI development [ 21 , 42 ]. Conclusion and Recommendation According to this study, there were the most common opportunistic infections like tuberculosis, bacterial pneumonia and chronic diarrhea which were increase severity of the virus among patient on HAART. Lack of isoniazid preventive therapy initiation, lack of cotrimoxazole preventive therapy initiation, poor adherence to treatment and fair adherence were significant risk factors for development of such OIs. Healthcare workers should prioritize early HIV testing, ART enrollment, timely HAART initiation, early prophylaxis initiation, and work on practices which improved patient adherence. Early initiation of HAART through active case-finding programs will reduce the burden of OIs in HIV-infected individuals. Furthermore, LTBI should be treated preventatively in identified patients to avert active TB disease and occurrence of OIs. Improved TB infection control in the study settings, along with effective management of both HIV and TB, will need to reduce morbidity and mortality among infected individuals. Furthermore, we recommend prospective studies for identifications of factors with OIs to develop targeted interventions. Limitation of the study This study was cross-sectional study design which limits its ability to establish causality and the reported odds ratios do not indicate a strong association. Abbreviations ART Antiretroviral Treatment BHUTH Bule Hora University Teaching hospital BMI: Body Mass Index CD4: Cell Differentiation FMOH: Federal Ministry of health HAART: Highly Active Antiretroviral Therapy HIV/AIDS: Human Immunodeficiency virus/acquired immunodeficiency syndrome IPT: Isoniazid Preventative Therapy LTBI: Latent tuberculosis infection OIs: Opportunistic infections PTB: Pulmonary Tuberculosis TB: Tuberculosis WHO: World Health Organization Declarations Ethical approval The study was conducted after ethical approval with reference number IOH/pharm/318/67 was received from the Research and Ethics Review Committee of department of pharmacy in institute of health of bule hora university (Abduba Wario; email: [email protected] , Henok Buno; email: [email protected] and Woyesa Elema; email: [email protected] ). The letter of cooperation was submitted to the hospital's chief executive officer and the head of the ART clinic, alongside a verbal explanation of the study's purpose. Consent to participate Informed consents were obtained from all patients whose medical charts were reviewed. All data gathered were kept confidential; individual patient names and any other identifiers that could reveal patient identities were excluded from the data collection, using only unique ART patient numbers instead. Additionally, the collected data were used exclusively for research purposes. The study adhered to the principles outlined in the Helsinki Declaration. Availability of data and material This manuscript includes all necessary data sets supporting its conclusions. Competing interest the authors declare that they have no competing interest consent for publication not applicable Funding This research work did not have any funding Author Contributions LB. 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Evidence that poor HAART adherence has a great impact on HIV/AIDS treatment failure more than severity of illness and opportunity of infection in Ethiopia: Systematic review and meta-analysis, biorxiv , p. 440743, 2018. Foka FET, Mufhandu HT. Current ARTs, virologic failure, and implications for AIDS management: a systematic review, Viruses , vol. 15, no. 8, p. 1732, 2023. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7454052","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":534677707,"identity":"3851d270-c970-48b4-a9b3-974ba7185b2f","order_by":0,"name":"Lencho Bati","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA3UlEQVRIiWNgGAWjYDACCTB5gIGBmfkAiCtDvBYeZrYEEJeHBC0MPAYgFmEt5tLNzz7dqLkjb8/O8/nVjRoLHgb2w0c34NNiOeeY8eycY88Me5h5t1nnHAM6jCct7QY+LQY3EoyZc9gOM4K0GOewAbVI8JgR0JL+mTnn32H7HmaeZ8Y5/4jSkmPMnNt2OBGohflxbhsRWixn5BQz5/Y9S+45zGYGZEjwsBHyi7lE+mbmnG93bNv7Dz/+nPOtTo6f/fAx/A5DYrOB44gNn3J0LcwfCKkeBaNgFIyCkQkAsu9FhClN4oIAAAAASUVORK5CYII=","orcid":"","institution":"Bule Hora university","correspondingAuthor":true,"prefix":"","firstName":"Lencho","middleName":"","lastName":"Bati","suffix":""},{"id":534677708,"identity":"370e0734-69da-4aff-b58a-a92cf1a268dd","order_by":1,"name":"Birhanu Dajene","email":"","orcid":"","institution":"Bule Hora university Teaching 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1","display":"","copyAsset":false,"role":"figure","size":99980,"visible":true,"origin":"","legend":"\u003cp\u003eprevalence of OI in HIV infected adult in ART clinic at BHUTH, South East Ethiopia, from September 2023 to September 2024\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7454052/v1/d648882a2edb228fefcd6e5d.png"},{"id":94622435,"identity":"914e22d6-7f05-47e9-8975-0adf7ddc258d","added_by":"auto","created_at":"2025-10-29 04:18:19","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":82199,"visible":true,"origin":"","legend":"\u003cp\u003ePatterns of OIs in HIV infected adult in ART clinic at BHUTH, Southern Ethiopia, from September 2023 to September 2024\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7454052/v1/7692fb6e35db0eb907e43b81.png"},{"id":99679668,"identity":"37d82eea-c0c0-49d5-854f-557ac0da1fd7","added_by":"auto","created_at":"2026-01-07 08:40:57","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1219256,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7454052/v1/8df6ba76-1cc2-4f71-a608-48b6c8ba5839.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prevalence, patterns and predictors of opportunistic infections in adults infected with human immunodeficiency virus at Bule Hora University Teaching Hospital, South Eastern Ethiopia: A retrospective cross-sectional study","fulltext":[{"header":"Contributions to the Literature","content":"\u003cul\u003e\n \u003cli\u003eThis study offers representative data on the extent, patterns and related factors of opportunistic infections among adult patients with human immunodeficiency virus as there is limited evidence at study site\u003c/li\u003e\n \u003cli\u003eIt thoroughly highlights potential areas for enhancement in the management of opportunistic infections among patients with human immunodeficiency virus who are receiving follow-up care.\u003c/li\u003e\n \u003cli\u003eIt also offers evidence to improve adherence to antiretroviral therapy and prevention of opportunistic infections in health facility.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Introduction","content":"\u003cp\u003eHuman Immunodeficiency Virus (HIV) is a virus that targets the body's immune system, which is responsible for fighting infections, and leads to acquired immunodeficiency syndrome (AIDS). By weakening the immune system, it makes individuals infected with the virus more vulnerable to various infections known as opportunistic infections (OIs) [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. OI is a disease such as tuberculosis, pneumonia, candidiasis, herpes zoster, genital, gastrointestinal and Central nervous system infections caused by a microbial agent in the presence of a weaken host immune system. These OIs are a major cause of illness and death among those with HIV/AIDS [\u003cspan additionalcitationids=\"CR3 CR4\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eHIV infection and OIs influence each other reciprocally. HIV weakens the immune system, increasing susceptibility to OIs. Conversely, OIs can raise HIV viral load, accelerating disease progression, increasing transmission risk, and negatively impacting treatment outcomes and cost-effectiveness [\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eHighly active antiretroviral therapy (HAART) significantly reduces OIs, but the risk and severity of OIs remain elevated in individuals with advanced HIV, high viral loads (\u0026ge;\u0026thinsp;1000 copies/ml), poor HAART adherence, inadequate prophylaxis (e.g., isoniazid, cotrimoxazole), malnutrition, severe immunosuppression, immobility, and low CD4 counts (\u0026lt;\u0026thinsp;200 cells/mm3) [\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAn OIs accounts for 90% of global AIDS-related deaths (an estimated 36\u0026nbsp;million fatalities) since the epidemic began. OIs are also responsible for over 20%-50% of AIDS-related hospital admissions worldwide [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Globally in 2023 only, AIDS-related illnesses caused an estimated 630,000 deaths and OIs accounting for about 585,000 of these fatalities [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. In addition, the 2023 United nation AIDS report identifies sub-Saharan Africa, including Ethiopia, as the region most heavily affected by HIV/AIDS and its associated OIs [\u003cspan additionalcitationids=\"CR15\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Global HIV development assistance totaled \u003cspan\u003e$\u003c/span\u003e170.79\u0026nbsp;billion to treat AIDS and OIs between 2000 and 2019 [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eDespite efforts to integrate OIs diagnosis, prevention and treatment into HIV care in Ethiopia, studies from various hospitals in a country reveal a persistent high prevalence of OIs among people living with HIV (PLWHIV) receiving HAART medications [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan additionalcitationids=\"CR18\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Lack of updated data on OIs prevalence, patterns and predictors at Bule Hora University Teaching Hospital (BHUTH) in South Eastern Ethiopia motivated this study, which aimed to assess the magnitude of OIs, patterns and identify their predictors among patients receiving HAART.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy area and period\u003c/h2\u003e\u003cp\u003eThe study was conducted at the ART clinic of BHUTH in West Guji zone, South Eastern Ethiopia from November 1\u0026ndash;30, 2024. The hospital is situated 474 kilometers southeast of Addis Ababa, the capital city, in a town with a population of 141,579 (78,030 males and 63,549 females) [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. BHUTH offers a wide range of medical care services, including antiretroviral therapy clinic. The hospital serves as a referral center for health centers and nearby hospitals.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eResearch Design\u003c/h3\u003e\n\u003cp\u003eA facility based retrospective cross sectional study was used.\u003c/p\u003e\n\u003ch3\u003eStudy Population\u003c/h3\u003e\n\u003cp\u003eAll charts of adult HIV/AIDS patients receiving HAART at the BHUTH, ART clinic between September 2023 and September 2024.\u003c/p\u003e\n\u003ch3\u003eInclusion criteria\u003c/h3\u003e\n\u003cp\u003eAll charts of adult 18 and above years of age and who were on HAART were enrolled in the study\u003c/p\u003e\n\u003ch3\u003eExclusion criteria\u003c/h3\u003e\n\u003cp\u003eThis study excluded charts of patients transferred to other facilities, those who did not return for follow-up within six months, and those with incomplete medical records.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eDependent variable\u003c/h2\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003emagnitude of OIs\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003epattern of OIs\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eIndependent variables\u003c/h3\u003e\n\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eDemographic characteristics\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eAge, sex, marital status, functional status, educational status and residence\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eClinical characteristics\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eWHO stage, HAART choice, types of OIs, adherence, BMI\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\n\u003ch3\u003eSample size determination and sampling technique\u003c/h3\u003e\n\u003cp\u003eThe sample size was calculated using the single population proportion formula where the value of magnitude of OIs among PLWHIV is 43.97% in Ethiopia [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] and a 95% confidence interval (CI) with a corresponding coefficient of reliability of 1.96, and a 5% margin of error. The final calculated sample size was 379. Medical records of 385 patients diagnosed with HIV/AIDS from September 2023 to September 2024 were reviewed at the ART clinic. Among these, 2 patients had incomplete data (with the outcome variable unrecorded), 4 patients were transferred to other facilities and were therefore excluded from the study. Consequently, the study included 379 patients who were followed up from September 1, 2023, to September 1, 2024. Since all patients meeting the inclusion criteria were included, no sampling techniques were employed.\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eData Collection procedure\u003c/h2\u003e\u003cp\u003eA pretest of the checklist was conducted on 5% of patient medical records from the Bula Hora health center's ART clinic follow-up. This ensured data checklist reliability and consistency, allowing for necessary corrections before full implementation. Data was collected by 3 ART pharmacists after 2 days training was given using a checklist which was adopted from Ethiopian federal ministry of health (FMOH) guideline and individual patient card for monitoring HIV/AIDS patients on follow up. The checklist includes patient information details, such as socio-demographic characteristics, functional status, and clinical characteristics like type of OIs, treatment of OIs, prophylaxis usage, WHO clinical staging and body mass index.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eData analysis procedures\u003c/h2\u003e\u003cp\u003eThe data was coded and checked for completeness and entered into SPSS for windows version 25.0 statistical software. Before analysis, the data were arranged, edited, and cleaned by running\u003c/p\u003e\u003cp\u003esimple frequencies and cross-tabulations. In order to manage confounding variables, variables that were shown statistically significant with the magnitude of OIs at \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.5 under bivariable logistic regression analysis were reexamined using multivariable logistic regression analysis, and those variables with \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 were deemed to be factors truly affects the magnitude of OIs.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eOperational definition\u003c/h2\u003e\u003cp\u003e\u003cstrong\u003eGood Adherence\u003c/strong\u003e\u003cp\u003eif PLWHIV adherent\u0026thinsp;\u0026gt;\u0026thinsp;95% that is the percentage of missed dose is \u0026lt;\u0026thinsp;2 doses of 30 doses or \u0026lt;\u0026thinsp;3 dose of 60 dose) as documented by ART health personnel [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eFair Adherence\u003c/strong\u003e\u003cp\u003eif PLWHIV adherent 85\u0026ndash;94% that is the percentage of missed dose are 3\u0026ndash;5 doses of 30 doses or 3\u0026ndash;9 dose of 60 dose) as documented by ART health personnel [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e\u003c/p\u003e\u003cp\u003eOpportunistic infection:\u003c/p\u003e\u003cp\u003e\u003cstrong\u003ePoor Adherence\u003c/strong\u003e\u003cp\u003eif a missed dose rate in PLWHIV less than 85% (e.g., \u0026gt;\u0026thinsp;6 doses out of 30, or \u0026gt;\u0026thinsp;9 doses out of 60), as documented by ART healthcare providers [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eDemographic Characteristics of the patients\u003c/h2\u003e\u003cp\u003eThe study reviewed 379 patient charts from September 2023 to December 2024. The sociodemographic data showed majority, 206(54.4%) of the patients were women. Most patients, 133(35.1%) were aged 28\u0026ndash;37, followed by 104(27.4%) patients who were found between 38\u0026ndash;47 age group. Two hundred thirty eight (62.8%) patients were married, while 68(17.9%) were single. A significant portion of patients, 176(46.4%) were illiterate and 220(58%) patients were resided in rural areas as summarized in Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e below.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSocio demographic characteristics of HIV patients in ART clinic at BHUTH, South East Ethiopia from September 2023 to September 2024\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristics\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFrequency\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePercentage\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18\u0026ndash;27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e23.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28\u0026ndash;37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e133\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e35.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e38\u0026ndash;47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e104\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e27.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e173\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e45.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e206\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e54.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarital status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSingle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e17.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e238\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e62.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDivorced\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWidowed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLevel of education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIlliterate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e176\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e46.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePrimary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e112\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e29.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSecondary\u003c/p\u003e\u003cp\u003eDiploma or higher\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e48\u003c/p\u003e\u003cp\u003e43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12.7\u003c/p\u003e\u003cp\u003e11.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eResidency\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUrban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e159\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e42\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRural\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e220\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e58\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eClinical Characteristics\u003c/h2\u003e\u003cp\u003eThe clinical characteristic of patient at ART clinic showed that, most patients, 179(47.2%) were categorized in WHO stage I, followed by 129(34%) patients who were categorized in stage III. Few patients, 21(5.5%) were found in stage IV. Two hundred eight eight (76%) patients were taken cotrimoxazole prophylaxis (CPT), while 280(73.9%) patients did not receive isoniazid preventive therapy (IPT). The majority of the patients, 368(97.1%) were on first-line HAART, with only 11(2.9%) who were on second-line treatment. Regarding adherence, 240(63.3%) showed good adherence to ART, while 86(22.7%) had poor adherence as summarized in Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eClinical Characteristics of HIV patients in ART clinic at BHUTH, South East Ethiopia from September 2023 to September 2024\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristics\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eFrequency\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e\u003cp\u003ePercentage\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWHO stage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eStage I\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e179\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e\u003cp\u003e47.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eStage II\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e\u003cp\u003e13.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eStage III\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e129\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e\u003cp\u003e34.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eStage IV\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e\u003cp\u003e5.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCPT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e288\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e\u003cp\u003e76\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIPT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e\u003cp\u003e26.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e280\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e\u003cp\u003e73.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHAART Choice\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e1st line\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e368\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e\u003cp\u003e97.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e2nd line\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e\u003cp\u003e2.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAdherence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eGood\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e240\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e\u003cp\u003e63.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eFair\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003ePoor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e\u003cp\u003e22.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBody Mass Index\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;18.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e\u003cp\u003e25.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e18.5\u0026ndash;24.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e259\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e\u003cp\u003e68.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e6.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eFunctional status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eAmbulatory\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e316\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e83.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eBed ridden\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e16.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003eWHO: World Health Organization, CPT: Cotrimoxazole prophylaxis therapy, IPT: Isoniazid preventative therapy\u003c/h2\u003e\u003cdiv id=\"Sec18\" class=\"Section3\"\u003e\u003ch2\u003ePrevalence of OIs among HIV patients on follow up\u003c/h2\u003e\u003cp\u003eOf 379 participants, 179(47.2%) had opportunistic infections (OIs) with (95%CI 42.1\u0026ndash;52.4), while 200(52.8%) did not had OIs as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003ePatterns of opportunistic Infections\u003c/h2\u003e\u003cp\u003eOverall, a total of 313 infection episodes occurred among the study participants (n\u0026thinsp;=\u0026thinsp;379). Among these OIs, the most common opportunistic infections were pulmonary tuberculosis 117(37.4%), followed by 81(25.9%) patients with bacterial pneumonia, and 40(12.8%) patients with chronic diarrhea of all opportunistic infection summarized in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\u003ch2\u003eFactors associated with magnitude of opportunistic infections\u003c/h2\u003e\u003cp\u003eWe used logistic regression analysis to determine the association of selected variables with the magnitude of OIs among PLWHIV included in the study. Variables statistically significant at \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 under bivariate logistic regression analysis were rechecked under multivariable logistic regression. Accordingly, lack of initiation of IPT(\u003cem\u003ep\u003c/em\u003e value\u0026thinsp;=\u0026thinsp;0.001, AOR\u0026thinsp;=\u0026thinsp;2.451(95%CI:1.417\u0026ndash;4.241)), lack of initiation of CPT(\u003cem\u003ep\u003c/em\u003e value\u0026thinsp;=\u0026thinsp;0.009, AOR\u0026thinsp;=\u0026thinsp;2.076 (95%CI:1.196\u0026ndash;3.603)), Fair adherence (\u003cem\u003ep\u003c/em\u003e value\u0026thinsp;=\u0026thinsp;\u0026lt;\u0026thinsp;0.001, AOR: 5.326(95%CI:2.711\u0026ndash;10.465)) and poor adherence (\u003cem\u003ep\u003c/em\u003e value\u0026thinsp;=\u0026thinsp;\u0026lt;\u0026thinsp;0.001, AOR: 9.067(95%CI:4.927\u0026ndash;16.686)) were strong predictors of OIs (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBivariate and multivariate logistic regression analysis of factors associated with the magnitude of OIs among HIV patients in ART clinic at BHUTH, South East Ethiopia from September 2023 to September 2024\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eCharacteristics\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eOI present\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eCOR (95%CI)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eAOR (95%CI)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18\u0026ndash;27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e41(10.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e49(12.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28\u0026ndash;37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e66(17.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e67(17.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.177(0.689\u0026ndash;2.013)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.551\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e38\u0026ndash;47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e51(13.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e53(14%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.150(0.653\u0026ndash;2.025)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.628\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21(5.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e31(8.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.810(0.405\u0026ndash;1.617)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.550\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eSex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e76(20%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e97(25.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e103(27.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e103(27.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.276(0.851\u0026ndash;1.915)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e0.239\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.191(0.734\u0026ndash;1.933)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.478\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eMarital status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSingle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e32(8.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e36(9.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e104(27.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e134(35.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.873(0.508\u0026ndash;1.449)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.623\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.640(0.344\u0026ndash;1.189)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.158\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDivorced\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25(6.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e17(4.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.654(0.759\u0026ndash;3.604)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e0.205\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.629(0.672\u0026ndash;3.947)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.280\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWidowed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18(4.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13(3.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.558(0.661\u0026ndash;3.673)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e0.311\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.380(0.517\u0026ndash;3.681)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.520\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eEducational level\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIlliterate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e89(23.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e87(23%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.976(0.501\u0026ndash;1.903)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.944\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePrimary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e45(11.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e67(17.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.641(0.316-1.300)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.218\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSecondary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23(6.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e25(6.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.878(0.385\u0026ndash;2.001)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.757\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDiploma or higher\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22(5.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21(5.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eResidence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUrban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e74(19.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e85(22.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRural\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e105(27.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e115(30.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.049(0.697\u0026ndash;1.578)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.819\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eIPT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e34(9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e65(17.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e145(38.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e135(35.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.487(0.302\u0026ndash;0.784)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e0.003\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2.451(1.417\u0026ndash;4.241)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eCPT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e127(33.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e161(42.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e52(13.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e39(10.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.592(0.368\u0026ndash;0.952)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e0.031\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2.076(1.196\u0026ndash;3.603)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e0.009\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eAdherence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGood\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e76(20%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e164(43.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFair\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e35(9.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e18(4.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.196(2.234\u0026ndash;7.880)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e5.326(2.711\u0026ndash;10.465)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePoor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e68(17.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e18(4.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e8.152(4.535\u0026ndash;14.635)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e9.067(4.927\u0026ndash;16.686)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003cem\u003eAOR: adjusted odd ratio, COR: crude odd ratio, CPT: cotrimoxazole preventative therapy, IPT: isoniazid preventative therapy, OI: opportunistic infection\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis retrospective cross-sectional study was aimed to assess the prevalence, patterns and predictors of OIs among HIV-positive patients taking HAART in BHUTH at ART clinic over one year by assessing patient charts.\u003c/p\u003e\u003cp\u003eIn our study, we found that an overall prevalence of OIs were 47.2% (95%CI 42.1\u0026ndash;52.4). The result was comparable with 47.6% of the magnitude of OIs seen in Taiwan [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], 48% of OIs documented at Hiwot Fana Specialized University Hospital, Eastern Ethiopia [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] and 51.9% recorded in Cameroon [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. However, the burden of OIs continues more challenging patients in our study compared to study done in Rwanda (9.2%)[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], Nigeria (22.4%)[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], Mogadishu Somalia (37.1%)[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], Sidama in southern Ethiopia (39.6%)[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e], Debre Markos referral hospital (42.8%)[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], 6.0% in north east Ethiopia [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], 32.2% magnitude of Dessie hospital [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] and 43.97% of meta-analysis in Ethiopia [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. The high prevalence rate in our study could be attributed to the sociodemographic characteristics such as residence, nutritional status, poor awareness of the population about the HIV infection, delay on the time of diagnosis and HAART initiation, lack of prophylaxis initiation and poor adherence to the treatment.\u003c/p\u003e\u003cp\u003eAmong the OIs, the most frequent seen in the patients were PTB which was 37.4%. This was consistent with study done in Kenya (35%)[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e] and Dessie (37.7%)[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Our result was higher than the study done in Rwanda [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], Sidama [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e], Hiwot Fana Specialized University Hospital [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. However, the result was lower than the study done in Uganda [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e], Gabon [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], Mekelle [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e] and Salale [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. The difference may be related with types of study method used across the studies, sample size considered, sociodemographic characteristics such as residence, time of initiation of HAART, time of initiation of IPT and cotrimoxazole prophylaxis, adherence to medication and follow up status. Furthermore, our finding was similar to the WHO report which indicated TB is the most opportunistic infection seen in HIV/AIDS patients in the world and particularly Ethiopia is among the 30 high HIV-TB burden countries. This affecting the strategy aims to end the TB epidemic by reducing TB related deaths by 95% and by cutting incident TB cases by 90% between 2015 and 2035 [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eSecond highly occurred OI were pneumonia (25.9%) followed by chronic diarrhea (12.8%) respectively. The magnitude of pneumonia seen in our study was higher than the study done in Rwanda which had the magnitude of 15.6% [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], 21.5% result of study done in Sidama [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e], 2% of eastern Ethiopia [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], 14.9% of study done in Dessie [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] and 9.6% of study done in Mekelle [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. This discrepancy may be attributed with the difference in study design and sample size used among the compared studies. In addition, in our study, the number of patients who did not started prophylaxis were high compared with other studies which was one of the contributing reasons of difference.\u003c/p\u003e\u003cp\u003eIn this study, compared to those patients initiated IPT, lack of initiation of IPT in HIV/AIDS patients without active PTB responsible to increase the risk of opportunistic infection 2.451 times with the CI (1.417\u0026ndash;4.241). This was comparable with the study done in Uganda [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e], Zimbabwe [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e], Salale [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e] and eastern Ethiopia [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. According to the WHO guidelines Systematic identification of Latent TB infection in people living with HIV/AIDS should be performed using \u0026ldquo;Clinical symptom-based TB screening\u0026rdquo; and IPT should be initiated in those who are unlikely to have active TB irrespective of CD4 count and ART status [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. If this was not done as per the guidelines, the magnitude of OIs like PTB was very high in a patient on HAART. This is due to the on time initiation of IPT improve weakened cellular immunity to fight infections [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] as our study indicated PTB was the most common OIs seen in the patients who did not start IPT at time of initiation of HAART.\u003c/p\u003e\u003cp\u003eThis study also showed lack of initiation of cotrimoxazole prophylaxis on time of HAART initiation increase the risk of OIs 2.076 times with the CI (1.196\u0026ndash;3.603). This study was agree with study done in eastern Ethiopia [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Additionally, our findings align with randomized controlled trials conducted in sub-Saharan Africa, which demonstrated that timely initiation of cotrimoxazole decreases mortality, and hospitalization among individuals living with HIV by lowering the risk of opportunistic infections, irrespective of their CD4 counts and tuberculosis status [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eFurthermore, Fair adherence to HAART increases the risk of OIs 5.326 times, CI (2.711\u0026ndash;10.465) and poor adherence to HAART increases the occurrence of OIs 9.067 times with the CI (4.927\u0026ndash;16.686) compared to those patients who had good adherence. This agrees with study done in Uganda [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e], Sidama [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e], Dessie [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e], pooled meta-analysis in Ethiopia [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e] and Mekelle [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. WHO guidelines confirm that poor adherence to antiretroviral therapy (ART) in adults with HIV significantly increases the risk of OIs. This is because poor adherence reduces ARV effectiveness, accelerates viral replication, and suppresses the immune system, thereby fostering an environment conducive to OI development [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e].\u003c/p\u003e"},{"header":"Conclusion and Recommendation","content":"\u003cp\u003eAccording to this study, there were the most common opportunistic infections like tuberculosis, bacterial pneumonia and chronic diarrhea which were increase severity of the virus among patient on HAART. Lack of isoniazid preventive therapy initiation, lack of cotrimoxazole preventive therapy initiation, poor adherence to treatment and fair adherence were significant risk factors for development of such OIs. Healthcare workers should prioritize early HIV testing, ART enrollment, timely HAART initiation, early prophylaxis initiation, and work on practices which improved patient adherence. Early initiation of HAART through active case-finding programs will reduce the burden of OIs in HIV-infected individuals. Furthermore, LTBI should be treated preventatively in identified patients to avert active TB disease and occurrence of OIs. Improved TB infection control in the study settings, along with effective management of both HIV and TB, will need to reduce morbidity and mortality among infected individuals. Furthermore, we recommend prospective studies for identifications of factors with OIs to develop targeted interventions.\u003c/p\u003e\u003c/p\u003e\u003cdiv id=\"Sec22\" class=\"Section2\"\u003e\u003ch2\u003eLimitation of the study\u003c/h2\u003e\u003cp\u003eThis study was cross-sectional study design which limits its ability to establish causality and the reported odds ratios do not indicate a strong association.\u003c/p\u003e\u003c/div\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eART Antiretroviral Treatment\u003c/p\u003e\u003cp\u003eBHUTH Bule Hora University Teaching hospital\u003c/p\u003e\u003cp\u003eBMI: Body Mass Index\u003c/p\u003e\u003cp\u003eCD4: Cell Differentiation\u003c/p\u003e\u003cp\u003eFMOH: Federal Ministry of health\u003c/p\u003e\u003cp\u003eHAART: Highly Active Antiretroviral Therapy\u003c/p\u003e\u003cp\u003eHIV/AIDS: Human Immunodeficiency virus/acquired immunodeficiency syndrome\u003c/p\u003e\u003cp\u003eIPT: Isoniazid Preventative Therapy\u003c/p\u003e\u003cp\u003eLTBI: Latent tuberculosis infection\u003c/p\u003e\u003cp\u003eOIs: Opportunistic infections\u003c/p\u003e\u003cp\u003ePTB: Pulmonary Tuberculosis\u003c/p\u003e\u003cp\u003eTB: Tuberculosis\u003c/p\u003e\u003cp\u003eWHO: World Health Organization\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted after ethical approval with reference number IOH/pharm/318/67 was received from the Research and Ethics Review Committee of department of pharmacy in institute of health of bule hora university (Abduba Wario; email: [email protected], Henok Buno; email: [email protected] and Woyesa Elema; email: [email protected]). The letter of cooperation was submitted to the hospital\u0026apos;s chief executive officer and the head of the ART clinic, alongside a verbal explanation of the study\u0026apos;s purpose.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consents were obtained from all patients whose medical charts were reviewed. All data gathered were kept confidential; individual patient names and any other identifiers that could reveal patient identities were excluded from the data collection, using only unique ART patient numbers instead. Additionally, the collected data were used exclusively for research purposes. The study adhered to the principles outlined in the Helsinki Declaration.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis manuscript includes all necessary data sets supporting its conclusions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ethe authors declare that they have no competing interest\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003econsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003enot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research work did not have any funding\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLB. (author) contributed substantially to this work, from proposal preparation, data entry to data analysis, interpretation and participated in the manuscript preparation. BD participate in data entry and analysis. WE evaluate the manuscript and HB prepare tables and evaluate the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe gratefully acknowledge Bule Hora University teaching hospital ART clinic for their permission to collect the participant data.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003ePrabhu S, van Wagoner N. Human immunodeficiency virus infection and acquired immunodeficiency syndrome (HIV/AIDS): an overview. Sexually transmissible Oral Dis, pp. 51\u0026ndash;71, 2023.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShaw J, Matin N. 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PLoS ONE. 2019;14(10):e0223076.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFund G. Best practices on TB case finding and treatment: reflections and lessons from West and Central Africa and beyond, \u003cem\u003eWorld Health Organization, Geneva, Switzerland\u003c/em\u003e, 2018.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGriffiths C, Barne M, Saxena P, Yaphe J. Challenges of tuberculosis management in high and low prevalence countries in a mobile world. Prim Care Respiratory J. 2014;23(1):106\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSuthar AB, Granich R, Mermin J, Van Rie A. Effect of cotrimoxazole on mortality in HIV-infected adults on antiretroviral therapy: a systematic review and meta-analysis. Bull World Health Organ. 2012;90:128\u0026ndash;38.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEndalamaw A, Mekonen M, Geremew D, Ambaw F, Tesera H, Habtewold TD. Evidence that poor HAART adherence has a great impact on HIV/AIDS treatment failure more than severity of illness and opportunity of infection in Ethiopia: Systematic review and meta-analysis, \u003cem\u003ebiorxiv\u003c/em\u003e, p. 440743, 2018.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFoka FET, Mufhandu HT. Current ARTs, virologic failure, and implications for AIDS management: a systematic review, \u003cem\u003eViruses\u003c/em\u003e, vol. 15, no. 8, p. 1732, 2023.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Antiretroviral therapy, Opportunistic Infection, pattern, prevalence, Ethiopia","lastPublishedDoi":"10.21203/rs.3.rs-7454052/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7454052/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatients with human immunodeficiency virus face high rates of morbidity and mortality due to opportunistic infections. No prior research has assessed the prevalence, patterns and predictors of opportunistic infections in patients living with human immunodeficiency virus in the West Guji zone, specifically at Bule Hora University Teaching Hospital. Therefore, this study aimed to assess the prevalence, patterns and predictors of opportunistic infections among human immune deficiency positive adults receiving antiretroviral therapy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethodology\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFacility based retrospective cross sectional study was conducted from November 1–30, 2024. Data was collected using checklist which was adopted from Ethiopian federal ministry of health guideline and patient follow up registry book. During data analysis, bivariate and multivariate logistic regression was used to identify independent risk factors for the presence of opportunistic infections.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResult\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOf 379 assessed patients, 47.2% (95%CI 42.1–52.4) experienced opportunistic infections. The prevalent opportunistic infections were pulmonary tuberculosis (37.4%, n = 117), bacterial pneumonia (25.9%, n = 81), and chronic diarrhea (12.8%, n = 40). Lack of isoniazid preventive therapy initiation (\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001, AOR 2.451, 95%CI 1.417–4.241), lack of cotrimoxazole preventive therapy initiation (\u003cem\u003ep\u003c/em\u003e = 0.009, AOR 2.076, 95%CI 1.196–3.603), poor adherence to treatment (\u003cem\u003ep \u0026lt;\u003c/em\u003e 0.001, AOR 9.067, 95% CI 4.927–16.686) and fair adherence (\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001, AOR 5.326, 95%CI 2.711–10.465) were significant risk factors of opportunistic infections.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion and Recommendation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePrevalence of common opportunistic infections were high in this study. Healthcare workers should work on timely antiretroviral therapy initiation, early prophylaxis initiation and improving patient adherence to antiretroviral therapy.\u003c/p\u003e","manuscriptTitle":"Prevalence, patterns and predictors of opportunistic infections in adults infected with human immunodeficiency virus at Bule Hora University Teaching Hospital, South Eastern Ethiopia: A retrospective cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-29 04:05:46","doi":"10.21203/rs.3.rs-7454052/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"299541d1-1ee7-4510-ae0c-24c477486a07","owner":[],"postedDate":"October 29th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-07T08:40:23+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-29 04:05:46","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7454052","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7454052","identity":"rs-7454052","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}