1. Arsi university
college of health science
department of public health
Research Presentation on prevalence and its associated
factor of substance use among RVI patient in Asella hospital
December,2016
2. Assessment of the prevalence and its associated factors of
substance use among RVI patient who have ART follow up in
Asella hospital
Investigator
1.Mengesha Akale(CII)
2.Mesay Mechal(CII) Advisor:
3.Mesfin Ketema(CII) Mr.Getu Teshome(MPH)
4.Mitiku Dabi(CII) Mr.Mesfin Tafa(MPH)
5.Misgana Haile(CII) Examiner:
Abebe Ferede(MPH)
presented by: Mengesha Akale(CII)
4. Introduction
• AIDS caused by HIV is a major health problem in many parts of the
world, and is considered as a pandemic disease (EDHS. 2011 )
• The virus infecting almost 60 million people worldwide, killing 25
million of them. In USA between 55,000 and 60,000 people become
newly infected with HIV every year (CDC 2010).
• 5 million people were newly infected with HIV of which 3.4 million
infections were in Africa. More than 80% of the women worldwide
and 87% of children infected with HIV/AIDS are in sub Saharan
Africa(WHO,2001).
5. • Ethiopia is one of the Sub-Saharan African countries where there
is high rate of HIV/AIDS infection next to South Africa and
Nigeria( WHO, 2006).
• Estimated 753,100 people are living with HIV in Ethiopia with a
declining national HIV prevalence in 2011 1.5% and 1.1% in 2015
;urban are more affected than rural areas (WHO 2015) .
6. Problem of statement
• Use of substances such as alcohol, khat and tobacco has become one
of the rising major public health and socio-economic problems
worldwide (Volkow ND,2005).
• Substance abuse is a primary vector for the spread of HIV through
engagement in high-risk behaviors, either when intoxicated or
engage in prostitution in order to obtain drugs.
• People who use substance are more likely than the general
population to contract HIV. Similarly, people with HIV are more likely
to abuse substance at some time during their lives(CDC,2010)
7. • PLWHA are nearly twice more likely to use alcohol than people in the
general population. Moreover, up to 50 percent of adults with HIV
infection have a history of alcohol problems (Samet,2004).
• Alcohol, hasten viral growth, induce immune suppression,renders
drugs ineffective b/se fails to adhere to treatment, interaction with
ART (KendaliJ.2010).
8. • Khat use has been suggested to be a risk factor for unprotected sex
and HIV transmission due to increased risk of multiple sexual partners
and reduced condom use (Ayenew,2012).
• High prevalence of smoking among PLWHA is well-documented in
developed countries, ranging from 40% to 74% ( 2 to 3-fold higher
than that in the general population (Tesoriero JM,2010).
9. Significance of study
• The substance use in RVI patient need special attention due to its
deleterious effect on disease progression.
• It decrease immunity, non adherence to drugs, ↓effectivity of drugs
and expose individual to engage in risky sexual intercorse↑
transmission
• Despite this extensive impact of substance use in RVI patient, there is
little research done in our country.
• Hence, this study may put many important result in understanding the
magnitude of substance use and determinant factor among RVI
patient in Asella hospital.
10. Objective of the study
General objective:
to assess prevalence of substance use and its associated factor
among RVI patient who have ART follow up in ATRH.
Specific objectives:
To assess the prevalence of substance abuse among RVI patients at
Asella hospital.
To determine associated factor with substance use among RVI
patients at Asella hospital.
11. Methodology
Study area
The study was conducted in ATRH which was established in 1958.
It gives both in-patient and out-patient services for 3 million
population.
ART clinic was started since 1998 and currently give service for 3427
HIV patient of which 60 are on pre ART initiation.
Study design and period
Institutional based cross-sectional study design was used and carried
out from June to August, 2016.
12. Source of population
All RVI patient who have ART follow up in Asella hospital.
Study population
Those ART patients who was randomly selected from the sampling
frame of ART patients of the study area .
13. Sample Size determination
• was calculated by using single population proportion for cross sectional
survey and taking the proportion based on previous research result for
alcohol, smoking and chat prevalence among PLWHA.
n= z2p (1-p) using CI=95%,degree of precision 5%.
d2
• The prevalence of alcohol drinker among PLWHA in Vietnam was 55%.
Thus, taking p 55% and adding 10% non-response rate a total sample size
became 418.
14. • The prevalence of cigarette smoking among HIV patient was 15% in
South Africa. This make sample size of 216 together with 10% non-
response rate.
• In Jimma specialized hospital about 23% of HIV patient were chat
chewers. Thus, total sample size became 299 by taking p value of 23%
and adding 10% non-response rate.
• Finally, the sample size taken from alcohol prevalence (418) was used
to include more participant.
15. Sampling technique
• Systematic random sampling technique was applied to select
individuals.
• First k value was determined from total population (3427) and sample
size (418).
• Then, sample was taken every k value (8) from sampling frame
16. • Dependent variables:
Substance use
• Independent variables
Socio-demographic characteristics, family use of substance, friend
substance use
17. Data collection methods
• Data was collected by semi structured self-administered
questionnaire .
• The questionnaires were adopted and modified from WHO-
substance use survey.
• It consists of socio-demographic variables, substance use and health
status related questions.
• For some specific question secondary data (card of the patient) was
used.
• Participation was on voluntary basis and confidentiality was
maintained
18. Data quality assurance
• Data were collected from those who were interested to participate in
the study.
• The purpose of the study was well explained and their was adequate
supervision during data collection that encourage the participant to
respond the truth.
• Before and during data processing, the information were checked
again for completeness and internal consistency.
19. Data analysis
• The data was coded, cleaned and entered in to computer using Epi-
info 3.5.3 and then transferred to SPSS version 21 software programs
for further analysis.
• Descriptive stastics was used o describe the study population.
• Bivariate and multivariate analysis were employed to identify factors
associated with the outcome variable.
20. Ethical considerations:
Ethical clearance was secured from Research and Ethics
Committee of college of Health Sciences
Participation was voluntary and information obtained at each
course of study were kept confidentially.
Dissemination of results:
conclusion and recommendations was made. Then, copies of the
research paper was submitted to AU-SOH Public Health department.
21. Result
Socio-demographic characteristics:
A total of 418 participants were included in the study with 100%
response rate. Majority of the respondents were between 36-
45years (37.1%).
More than half of study participants were female which was 229
(54.8%). Ethnically Oromo (65.3%) and Amhara (32.1%) account the
majority of the participant.
Regarding the religion most of them were Orthodox 260(62.2%)
followed by Muslim 94(22.5%).
See table 1
22. Magnitude substance use
• 115 of the participant consume substance at least once in their life,
which account for substance prevalence in this study of 27.5%.
• The prevalence of Alcohol 13.6%.
• Those who consumed all alcohol, cigarettes and khat and those who
consume only khat account 2.2%.
• The prevalence of substance use currently in the last 30 days among
PLWHA were 3.8%.
• See table 2
23. Factors to initiate substance use
• The most common attributed factor that initiated them to start
substance use were to get personal pleasure (29.6%), to be sociable
(28.7%) and peer influence (27%).
• 45.7 % of them had friends who consume substance where as 24.4 %
of them had family member who uses substance.
See table 3
24. Consequence of substance consumption
• The majority of substance consumer were engaged in risky sexual
behavior (39.2%) and those who suffer from economic crisis account
for 31.3%.
• Majority of substance users didn’t use condom during sexual
intercourse (67.8%).
• Reason not to use condom:
intoxication with substance(46.2%)
lack of knowledge(26.2%)
not accessible (19.2) and no extramarital r/s(5.1%)
See table 4
25. Clinical background of participant
• 89.7% of respondent were clinical stage I RVI patient.
• The current CD4 count of the majority of participant lies between
351-500 which account about 32.5%.
• Of the total respondents, 411(98.3%) were currently on ART
medication.
• 70 individual(17%) of the respondent were not adherent to the drugs.
See table 5
26. Bivariate and multivariate analysis
• Socio-demographic variable, friend use of substance, family use of
substance and WHO stage of HIV were considered in the bivariate
analysis.
• In bivariate analysis; sex, educational level. Marital status, occupation,
friend and family use of substance had p value<0.05.
• These variables were taken and analyzed together using multivariate
logistic regression model.
27. • After controlling for the effects of potentially confounding factors
using multivariate logistic regression model sex, family substance
use and friend substance use were found to be statistically
significant predictors of substance use.
• Being male (AOR: 14.1(5.84, 33.87), friends use of substance(AOR:
0.11(0.06,0.22) and family use of substance(AOR: 2.66(1.15,6.13)
were strongly associated with substance use.
See table 6
28. Discussion
• In this study the overall prevalence of substance use at least once in
life among the respondents was 27.5% .This is significantly higher
than a study done in Myanma (7.9%).
• The prevalence of former and current alcoholic drinker is 13.6% and
2.6% respectively. This is lower than similar study done in Vietnam
(55%) and Brown University (48%) .
29. • The prevalence of former and current smokers were 0.7 % and 1.2%.
• The life time prevalence of Khat chewing was 2.2% which is lower
than study in Jimma University (23.0%) and in Gore town in Oromia
region (61%) .
Former smoker Current smoker
South Africa 21.7% 15%
Vietnam 9.5% 36.1%
Uruguay 20.3% 42.4%
30. • concomitant use of alcohol& Khat, alcohol & cigarettes were higher
than smoking or khat chewing alone.
• This is consistent with study in Gore town,in oromia region(Alcohol &
khat user were 67%).
• about 40% of PLWHA were using more than one types of substance in
Mayanma .
• Smoker were 6 times more likely to be drinker in Brazil.
31. • The prevalence of substance use in this study was higher in male that
is about 53.4 % of male participant. This is consistent with study
finding in Jimma, Zambia and Vietnam.
• about 67.8 % of those who consume substance were engaged in risky
sexual activities or didn’t use condom after substance use.
• This is consistent with similar study done in Myanma and Brown
University .
32. Strength and limitation of study
Strength:
• The questionnaires were adopted and modified from WHO substance use
survey questionnaire and after extensive review of relevant literatures.
• The collected data were cleaned, coded and entered in to Epi-Info version
3.5.3 software and transferred and analyzed using SPSS computer software
package version 21.
• 100% response rate
Limitation
Limited study done in Ethiopia to compare our result with the national l
The participant may be subjected to recall bias and under reporting of
substance use.
33. Conclusion and recommendation
• This study revealed that the life time prevalence of substance use
among RVI patients was 27.2%.
• Male sex and family use of substance was strongly associated with
substance use.
Recommendation
• Detail awareness creation about the influence of substance use on
HIV by health professionals have invaluable benefit.
• Arsi university inparticular public health department need to further
investigate this research by including more variable.
34. Refereces
1.EDHS. 2011.
2. CDC 2010.
3.WHO 2001,2006,2015
4. Volkow ND, Li TK: Drugs and alcohol: Treating and preventing abuse,
addiction and their medical consequences.2005; 108: 3-17.
5.Samet; detecting alcohol problems in HIV-infected patients:2004;
20(2):151–155.
6.Kendall J. Integrating HIV/AIDS and Alcohol Research Vol. 33, No. 3, 2010).
7.Ayenew F: Alcohol and khat use as risk factors for HIV infection . Trop Doct.
2012; 42(2):99–100.)
35. Aknowledgement
• First of all we would like thank our heavenly God for his generous
support and endless love.
• Next, We would like to give a warm hearted word of appreciation and
thanks to public health department of Arsi University .
• Our deepest gratitude also goes to our advisors Mr. Mesfin Tafa
(MPH) and Mr. Getu Teshome(MPH) for their invaluable advice, close
follow up, unreserved guidance and comments in preparing this
research.
