Chronic protein-energy malnutrition and associated factors among HIV-positive adults who were on anti-retroviral therapy in Addis Ababa, Ethiopia: an institution-based crosssectional study

Robesan Gebisa Darega ¹ Eshetu Mesfin Tadesse ² Girma Beressa ³ Telila Mesfin Tadesse ^4,5*

• ¹ Department of Public Health, Sheger City Health Office, Addis Ababa, Addis Ababa, Ethiopia
• ² Department of Public Health, ICAP, Addis Ababa, Addis Ababa, Ethiopia
• ³ Department of Public Health, Madda Walabu University, Goba General Teaching Hospital, Goba, Ethiopia
• ⁴ School of Health Science, Madda Walabu University, Bale Robe, Ethiopia
• ⁵ School of Medicine, Madda Walabu University, Goba General Teaching Hospital, Goba, Ethiopia

Background: Malnutrition hastens the progression of human immunodeficiency virus (HIV) and worsens its impact by weakening the immune system, increasing susceptibility to opportunistic infections, and reducing the effectiveness of treatment. Human immunodeficiency virus infection, in turn, causes or aggravates malnutrition through reduced food intake, increased energy needs, or poor nutrient absorption. Malnutrition and HIV infection increase the risk of mortality in adults.Objectives: This study aims to assess the prevalence of chronic protein-energy malnutrition (PEM) and identify associated factors among HIV-positive adults on antiretroviral therapy (ART) in Addis Ababa, Ethiopia.Methods: An institutional-based cross-sectional study using a systematic random sampling technique was conducted from December 15, 2019, to January 30, 2020, involving 1354 HIVpositive adults on ART. Data were entered into EPI-Data version 3.1 and transferred to Statistical Package for Social Science (SPSS) version 20 for analysis. Explanatory variables with a P-value of < 0.2 in bivariable logistic regression were included in the multivariable logistic regression model. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) were used to examine the strength of associations. A P-value < 0.05 was considered statistically significant.Results: A total of 1286 patients participated in the study, yielding a response rate of 94.98%.The prevalence of chronic PEM was 12.6% (95% CI: 10.8-14.5%). Among the participants, 83.4% had adequate dietary diversity, and 52.2% experienced food insecurity. Multivariable logistic regression revealed that clients with primary education (AOR=2.542; 95% CI: 1.265-5.111), tertiary education (AOR=4.036; 95% CI: 1.624-10.031), and eating difficulty (AOR=2.231; 95% CI: 1.315-3.785) were more likely to be chronically protein-energy malnourished.The prevalence of chronic PEM in this study was lower than previous findings.Adult patients on ART with primary education, tertiary education, and eating difficulty were at higher risk for chronic PEM. These findings highlight the need for targeted nutritional interventions and support for HIV-positive adults on ART, particularly those with identified risk factors.