EXPLORING FACTORS INFLUENCING NUTRITIONAL SUPPLEMENTATION WITH MORINGA OLEIFERA AMONG ADULT HIV PATIENTS ON DOLUTEGRAVIR BASED TREATMENT AT UNIVERSITY TEACHING HOSPITAL IN LUSAKA DISTRICT, ZAMBIA

Nosia Mhango Mwila, Amit Kumar Singh, Isaac Fwemba, Aubrey C. Kalungia

Abstract


HIV remains a major public health problem globally having claimed 40.4 million lives since the start of the epidemic. HIV alters nutrition by inducing an increase in energy expenditure and nutrient requirements, driven by both the immune response and the direct effects of viral replication. Nutrition deficiencies can compromise the effectiveness of antiretroviral therapy making individuals with HIV more susceptible to opportunistic infections. Sub-Saharan Africa has the highest HIV prevalence and is home to some of the most nutritionally unsecured countries in the world. Advancements in HIV treatment have been made but several deaths are still attributed to nutritional deficiencies. In the quest for improved treatment outcomes, dolutegravir-based regimens have gained prominence due to superior efficacy and tolerability compared to efavirenz-based regimens. Zambia rolled out dolutegravir-based as the preferred first-line regimen in 2018. However, the utilization of Moringa oleifera among HIV patients on antiretroviral therapy is unknown. Therefore the study aimed to explore the knowledge, perception, attitude, cultural belief and utilization of Moringa oleifera nutrition supplements among adult HIV patients on dolutegravir-based treatment. The study used interviews to obtain data among adult patients aged 18 and above. Participants were selected using homogeneous purposive sampling until saturation of the ideas was reached. Data was analyzed through thematic analysis. Moringa utilization addressed nutritional deficiencies imperative to enhance the effectiveness of HIV treatment and improve the quality of life for individuals living with HIV. Conclusion and recommendation, the ministry of Health to consider strengthening policy that may promote the use of Moringa among patients on ART apart from cultural practices. Nutritional and health information is not enough to promote Moringa consumption and familiarity, but incorporating it into local foods with a high satiating power.

 

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Keywords


antiretroviral therapy, dolutegravir, Human Immunodeficiency Virus, Moringa oleifera, nutrition

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Alba, G., Dakhaoui, H., Santa-Maria, C., Palomares, F., Cejudo-Guillen, M., Geniz, I., Sobrino, F., Paz, S. M., & Lopez-Enriquez, S. (2023). Nutraceuticals as potential therapeutic modulators in immunometabolism. Nutrients, 15(3), 1–23.

Amlogu, A. M., Tewfik, S., Wambebe, C., & Tewfik, I. (2016). A comparative study: Long and short term effect of a nutrition sensitive approach to delay the progression of HIV to AIDS among people living with HIV (PLWH) in Nigeria. International Journal of Food, Nutrition and Public Health, 6 (December 2012), 79–90.

Aprioku, J. S., Robinson, O., Obianime, A. W., & Tamuno, I. (2022). Moringa supplementation improves immunological indices and hematological abnormalities in seropositive patients receiving HAARTs. African Health Sciences, 22(2), 1–11. https://doi.org/10.4314/ahs.v22i2.2

Biswas, D., Nandy, S., Mukherjee, A., Pandey, D. K., & Dey, A. (2020). Moringa oleifera Lam. and derived phytochemicals as promising antiviral agents: A review. South African Journal of Botany, 129, 272–282. https://doi.org/10.1016/j.sajb.2019.07.049

Dorward, J., & Hamers, R. L. (2019). Dolutegravir in sub-Saharan Africa: Context is crucial. The Lancet HIV, 6(2), e72–e73. https://doi.org/10.1016/S2352-3018(18)30331-X

Dorward, J., Lessells, R., Drain, P. K., Oliveira, T. D., Pillay, Y., Karim, S. S. A., & Garrett, N. (2019). Dolutegravir for first-line antiretroviral therapy in low-income and middle-income countries: Uncertainties and opportunities for implementation and research. The Lancet HIV, 5(7), 1–11. https://doi.org/10.1016/S2352-3018(18)30093-6

Ewetola, E. A., Oyeyiola, Y. B., Owoade, F. M., & Farotimi, M. F. (2019). Influence of soil texture and compost on the early growth and nutrient uptake of Moringa oleifera Lam. Journal of Plant Sciences, 2019(2), 26–33.

Fadoyin, A. S., Oyewole, S. O., Ayanrinde, F. A., Baba, G. A., & Erhabor, T. A. (2014). Socio-economic factors influencing adoption of Moringa oleifera water purification by farmers in Kaduna State, Nigeria. International Letters of Natural Sciences, 20, 85–90. https://doi.org/10.18052/www.scipress.com/ilns.20.85

Famuyide, F. L. A., & Adio, O. O. A. F. (2014). Households' perception, awareness and willingness to pay for Moringa oleifera Lam powder in Oyo State. Journal of Agricultural Science, 2(June), 94–103.

Fuseini, H., Gyan, B. A., Kyei, G. B., Heimburger, D. C., & Koethe, J. R. (2022). Undernutrition and HIV infection in sub-Saharan Africa: Health outcomes and therapeutic interventions. Current HIV/AIDS Reports, 18(2), 87–97. https://doi.org/10.1007/s11904-021-00541-6

Gambo, A., Gqaleni, N., & Babalola, T. K. (2022). Dietary diversity and impact of Moringa oleifera Lam. leaves supplemented – Diet on the nutritional status and CD4 cell counts of patients receiving antiretroviral therapy in Nigeria: A double-blind randomized trial. Heliyon, 8(May), e09524. https://doi.org/10.1016/j.heliyon.2022.e09524

Gambo, A., Moodley, I., Babashani, M., & Babalola, T. K. (2021). Impact of Moringa oleifera leaves supplementation on quality of life of people living with HIV: A double-blind randomized controlled trial. Quality of Life Research. https://doi.org/10.1007/s11136-021-02842-0

Gambo, A., Moodley, I., Babashani, M., Babalola, T. K., & Gqaleni, N. (2021). A double-blind, randomized controlled trial to examine the effect of Moringa oleifera leaf powder supplementation on the immune status and anthropometric parameters of adult HIV patients on antiretroviral therapy in a resource-limited setting. PLOS ONE, 16(12). https://doi.org/10.1371/journal.pone.0261935

Ganapathy, S., Harichandrakumar, K., Tamilarasu, K., Penumadu, P., & Nair, N. S. (2023). An auxiliary approach to prediction of binary outcome with Bayesian network model: Exploration with data for recurrence of breast cancer. Journal of Clinical and Diagnostic Research, 17(3), 13–17. https://doi.org/10.7860/jcdr/2023/59472.17598

Gandji, K., & Assogbadjo, A. E. (2018). Factors determining the use and cultivation of Moringa oleifera in the Republic of Benin. Economic Botany, 72(3), 332–345. https://doi.org/10.1007/s12231-018-9424-4

Heidkamp, R. A., Piwoz, E., Gillespie, S., Keats, E. C., Alimonte, M. R. D., Menon, P., Das, J. K., Flory, A., Clift, J. W., Ruel, M. T., Vosti, S., Akuoku, J. K., & Bhutta, Z. A. (2022). Nutraceuticals: Regulatory process across the world. The World Journal of Biological Psychiatry, 23(January), 1–23. https://doi.org/10.1136/bmj.k2252

Jiang, J., Xu, X., Guo, W., Su, J., Huang, J., Liang, B., Chen, H., Zang, N., Kanters, S., Vitoria, M., Zoratti, M., Doherty, M., Penazzato, M., Rangaraj, A., Ford, N., Thorlund, K., Anis, P. A. H., Karim, M. E., Mofenson, L., ... Bansback, N. (2016). Dolutegravir (DTG, S/GSK1349572) combined with other ARTs is superior to RAL- or EFV-based regimens for treatment of HIV-1 infection: A meta-analysis of randomized controlled trials. EClinicalMedicine, 28, 1–10. https://doi.org/10.1186/s12981-016-0115-x

Jia, X. C., Xia, Z. H., Shi, N., Wang, Y. P., Luo, Z. X., Yang, Y. L., & Shi, X. Z. (2020). The factors associated with natural disease progression from HIV to AIDS in the absence of ART, a propensity score matching analysis. Epidemiology and Infection, 148, e87. https://doi.org/10.1017/S0950268820000540

Keats, E. C., Neufeld, L. M., Garrett, G. S., Mbuya, M. N. N., & Bhutta, Z. A. (2019). Improved micronutrient status and health outcomes in low- and middle-income countries following large-scale fortification: Evidence from a systematic review and meta-analysis. The American Journal of Clinical Nutrition, 109(6), 1696–1708.

Kekana, T. W., Marume, U., Muya, C. M., & Nherera-Chokuda, F. V. (2021). Moringa oleifera leaf meal as a feed supplement for dairy calves. South African Journal of Animal Science, 51(5), 550–559. https://doi.org/10.4314/sajas.v51i5.1

Lecher, S., Ellenberger, D., Kim, A. A., Fonjungo, P. N., Agolory, S., Borget, M. Y., Broyles, L., Carmona, S., Chipungu, G., De Cock, K. M., Deyde, V., Downer, M., Gupta, S., Kaplan, J. E., Kiyaga, C., Knight, N., MacLeod, W., Makumbi, B., Muttai, H., ... Nkengasong, J. (2015). Scale-up of HIV viral load monitoring — Seven sub-Saharan African countries. MMWR. Morbidity and Mortality Weekly Report, 64(46), 1287–1290. https://doi.org/10.15585/mmwr.mm6446a3

Mabapa, M. P., Ayisi, K. K., Mariga, I. K., Mohlabi, R. C., & Chuene, R. S. (2017). Production and utilization of Moringa by farmers in Limpopo Province, South Africa. International Journal of Agricultural Research, 12(4), 160–171. https://doi.org/10.3923/ijar.2017.160.171

Mahomoodally, M. F., Ragoo, L., Sreekeesoon, P. D., & Khedoo, Z. M. (2013). The potential of complementary and alternative medicines in the management of HIV infection and related complications. Spatula DD, 3(4), 127–140. https://doi.org/10.5455/spatula.20131025123323

Maryam, M., & Manzoor, A. (2023). Exploring the commercial versatility of Moringa oleifera: A valuable resource for diverse industries. Journal of Plant Sciences, 1(1), 1–9.

Mashamaite, C. V., Pieterse, P. J., Mothapo, P. N., & Phiri, E. E. (2021). Moringa oleifera in South Africa: A review on its production, growing conditions and consumption as a food source. South African Journal of Science, 117(11/12), 8689.

Matsena Zingoni, Z., Chirwa, T. F., Todd, J., & Musenge, E. (2019). HIV disease progression among antiretroviral therapy patients in Zimbabwe: A multistate Markov model. Frontiers in Public Health, 7(November), 1–15. https://doi.org/10.3389/fpubh.2019.00326

Meireles, M. V., Pascom, A. R. P., Duarte, E. C., & McFarland, W. (2019). Comparative effectiveness of first-line antiretroviral therapy: Results from a large real-world cohort after the implementation of dolutegravir. AIDS, 33(10), 1663–1668. https://doi.org/10.1097/QAD.0000000000002254

Melinscak, F. (2019). Tutorial: Bayesian statistics (part 1). arXiv preprint arXiv:1905.02516.

Michela, B., Gianni, P., A, F. S., Benedetta, R., Martina, R., Erica, C., Simona, B., Alberto, B., Alessandro, L., Laura, I., Valentina, F., Giovanna, P., Chiara, P., Carlotta, B., Roberto, C., Serena, C., Patrizia, D. M., & Emanuele, C. (2018). Nutritional characterisation of Zambian Moringa oleifera: Acceptability and safety of short-term daily supplementation in a group of malnourished girls. International Journal of Food Sciences and Nutrition, 69(8), 952–963. https://doi.org/10.1080/09637486.2018.1475550

Minutolo, A., Potestà, M., Roglia, V., Cirilli, M., Iacovelli, F., Cerva, C., Fokam, J., Desideri, A., Andreoni, M., Grelli, S., Colizzi, V., Muleo, R., & Montesano, C. (2021). Plant microRNAs from Moringa oleifera regulate immune response and HIV infection. Frontiers in Pharmacology, 11, 1–14. https://doi.org/10.3389/fphar.2020.620038

Monera, T. G., & Maponga, C. C. (2012). Prevalence and patterns of Moringa oleifera use among HIV positive patients in Zimbabwe: A cross-sectional survey. Journal of Public Health in Africa, 3(1), 22–24. https://doi.org/10.4081/jphia.2012.e6

Mulugeta, G., & Fekadu, A. (2014). Industrial and agricultural potentials of Moringa. Journal of Natural Sciences Research, 4(14), 57–63.

Murtadlo, A. A. A., Wahyuningsih, S., Turista, D. D. R., Wiguna, A., Wijayanti, A., Rachmawati, Y., Dibha, A. F., Hasan, T., Wijaya, R. M., Hafidzhah, M. A., Utami, S. L., Listiyani, P., Hikam, A. M., Chandra, N., Tamam, M. B., & Ullah, M. E. (2022). Screening of reverse transcriptase inhibitor from Moringa oleifera bioactive compound through in silico study against HIV-1. SAINSTEK International Journal on Applied Science, Advanced Technology and Informatics, 1(02), 46–53. https://doi.org/10.24036/sainstek/vol1-iss02/9

Musheke, M., Bond, V., & Merten, S. (2013). Self-care practices and experiences of people living with HIV not receiving antiretroviral therapy in an urban community of Lusaka, Zambia: Implications for HIV treatment programmes. AIDS Research and Therapy, 10(1), 1–13. https://doi.org/10.1186/1742-6405-10-12

Nandra, R., Parry, M., Forsberg, J., & Grimer, R. (2017). Can a Bayesian belief network be used to estimate 1-year survival in patients with bone sarcomas? Clinical Orthopaedics and Related Research, 475(6), 1681–1689. https://doi.org/10.1007/s11999-017-5346-1

National Institutes of Health. (2014). Plasma HIV-1 RNA (Viral Load) and CD4 count monitoring. AIDS Info, 1–14.

Njonge, F. K., Judith, N. N., Kikuvi, G. M., & Tolo, F. M. (2019). Determinants of Moringa oleifera utilization among HIV positive patients attending comprehensive care clinic at Migori County Referral Hospital, Kenya. Journal of Health Medicine and Nursing, 4(6), 1–16.

Nkirote, J. N. (2021). Antiviral activity of Moringa oleifera extracts among people living with HIV and AIDS attending comprehensive care clinic at Migori County Referral Hospital, Kenya [Master's thesis]. Jomo Kenyatta University of Agriculture and Technology.

Nworu, C. S., Okoye, E. L., Ezeifeka, G. O., & Esimone, C. O. (2013). Extracts of Moringa oleifera Lam. showing inhibitory activity against early steps in the infectivity of HIV-1 lentiviral particles in a viral vector-based screening. African Journal of Biotechnology, 12(30), 4866–4873. https://doi.org/10.5897/ajb2013.12343

O'Donnell, K., & Igoe, D. (2022). World AIDS Day: Update on epidemiology of HIV in Ireland, November 2022. Health Protection Surveillance Centre.

Oh, J. H., Craft, J., Al-lozi, R., Vaidya, M., Meng, Y., & Joseph, O. (2015). Bayesian network inference for supporting clinical decisions in radiation oncology. Physics in Medicine & Biology, 60(6), 1635–1651. https://doi.org/10.1088/0031-9155/56/6/008

Oke, D. O., Orumwense, L. A., Olugbire, O. O., Oloba, O. G., Awofadeju, J. O. H., & Akanbi, S. F. (2020). Factors influencing the dis-adoption of Moringa oleifera among farming households in Oyo State, Nigeria. Journal of Applied Sciences and Environmental Management, 24(4), 673–679. https://doi.org/10.4314/jasem.v24i4.20

Oyepata, J. S., & Tosin, J. (2021). Effect of clinical study of Moringa oleifera on body mass index, low density lipoprotein and triglyceride level in patients on tenofovir/lamivudine/efavirenz combination therapy. Journal of Advances in Medicine and Medical Research, 6(1), 14–27.

Park, E., Chang, H. J., & Nam, H. S. (2018). A Bayesian network model for predicting post-stroke outcomes with available risk factors. Frontiers in Neurology, 9(SEP), 1–11. https://doi.org/10.3389/fneur.2018.00699

Pham, M. D., Nguyen, H. V., Anderson, D., Crowe, S., & Luchters, S. (2022). Viral load monitoring for people living with HIV in the era of test and treat: Progress made and challenges ahead – a systematic review. BMC Public Health, 22(1), 1–23. https://doi.org/10.1186/s12889-022-13504-2

Phillips, A. N., Bansi-matharu, L., Venter, F., Havlir, D., Pozniak, A., Kuritzkes, D. R., Wensing, A., Lundgren, J. D., Pillay, D., Mellors, J., Cambiano, V., Jahn, A., Apollo, T., Mugurungi, O., Ripin, D., Silva, J. Da, Raizes, E., Ford, N., Siberry, G. K., ... Foundation, M. G. (2020). Updated assessment of risks and benefits of dolutegravir versus efavirenz in new antiretroviral treatment initiators in sub-Saharan Africa: Modelling to inform treatment guidelines. The Lancet HIV, 7(3), e193–e200. https://doi.org/10.1016/S2352-3018(19)30400-X

Pilotos, J., Ibrahim, K. A., Mowa, C. N., & Opata, M. M. (2020). Moringa oleifera treatment increases Tbet expression in CD4+ T cells and remediates immune defects of malnutrition in Plasmodium chabaudi-infected mice. Malaria Journal, 19(1), 1–16. https://doi.org/10.1186/s12936-020-3129-8

Praygod, G., Friis, H., & Filteau, S. (2018). Nutritional support to reduce mortality in patients with HIV? The Lancet HIV, 5(5), e202–e204. https://doi.org/10.1016/S2352-3018(18)30047-X

Praygod, G., Kasonka, L., Woodd, S., Rehman, A. M., Chisenga, M., Siame, J., Koethe, J. R., Changalucha, J., Michael, D., Kidola, J., Manno, D., Larke, N., Yilma, D., Heimburger, D. C., Friis, H., & Kelly, P. (2015). Effects on mortality of a nutritional intervention for malnourished HIV-infected adults referred for antiretroviral therapy: A randomised controlled trial. BMC Medicine, 13(1), 1–13. https://doi.org/10.1186/s12916-014-0253-8

Puga, J. L., Krzywinski, M., & Altman, N. (2015). Points of significance: Bayesian networks. Nature Methods, 12(9), 799–800. https://doi.org/10.1038/nmeth.3550

Qadir, R., Anwar, F., Bashir, K., Tahir, M. H., & Ibrahim, M. (2022). Variation in nutritional and antioxidant attributes of Moringa oleifera L. leaves at different maturity stages. Frontiers in Energy Research, 10, 1–7. https://doi.org/10.3389/fenrg.2022.888355

Repaka, A. N., Ravikanti, S. D., & Franklin, R. G. (2019). Design and implementing heart disease prediction using naives Bayesian. In Proceedings of the International Conference on Trends in Electronics and Informatics (ICOEI 2019) (pp. 292–297). IEEE. https://doi.org/10.1109/icoei.2019.8862604

Roberts, T., Cohn, J., Bonner, K., & Hargreaves, S. (2016). Scale-up of routine viral load testing in resource-poor settings: Current and future implementation challenges. Clinical Infectious Diseases, 62(8), 1043–1048. https://doi.org/10.1093/cid/ciw001

Ross, J. M., Ying, R., Celum, C. L., Baeten, J. M., Thomas, K. K., Murnane, P. M., van Rooyen, H., Hughes, J. P., & Barnabas, R. V. (2018). Modeling HIV disease progression and transmission at population-level: The potential impact of modifying disease progression in HIV treatment programs. Epidemics, 23, 34–41. https://doi.org/10.1016/j.epidem.2017.12.001

Rutherford, G. W., & Horvath, H. (2016). Dolutegravir plus two nucleoside reverse transcriptase inhibitors versus efavirenz plus two nucleoside reverse transcriptase inhibitors as initial antiretroviral therapy for people with HIV: A systematic review. PLOS ONE, 11(10), e0162775. https://doi.org/10.1371/journal.pone.0162775

Sauce, D., Larsen, M., Fastenackels, S., Pauchard, M., Ait-Mohand, H., Schneider, L., Guihot, A., Boufassa, F., Zaunders, J., Iguertsira, M., Bailey, M., Gorochov, G., Duvivier, C., Carcelain, G., Kelleher, A. D., Simon, A., Meyer, L., Costagliola, D., Deeks, S. G., ... Appay, V. (2011). HIV disease progression despite suppression of viral replication is associated with exhaustion of lymphopoiesis. Blood, 117(19), 5142–5151. https://doi.org/10.1182/blood-2011-01-331306

Seifu, E., & Teketay, D. (2020). Introduction and expansion of Moringa oleifera Lam. in Botswana: Current status and potential for commercialization. South African Journal of Botany, 129, 471–479.

Shifera, N., Yosef, T., Matiyas, R., Kassie, A., Assefa, A., & Molla, A. (2022). Undernutrition and associated risk factors among adult HIV/AIDS patients attending antiretroviral therapy at public hospitals of Bench Sheko Zone, Southwest Ethiopia. SAGE Open Medicine, 10, 1–10. https://doi.org/10.1177/23259582221079154

Sihag, G., Delcroix, V., Grislin-Le Strugeon, E., Piechowiak, S., Gaxatte, C., & Puisieux, F. (2021). Evaluation of risk factors for fall in elderly using Bayesian networks: A case study. Computer Methods and Programs in Biomedicine Update, 1, 100035. https://doi.org/10.1016/j.cmpbup.2021.100035

Stap, L. Van Der, Haaften, M. F. Van, Marrewijk, E. F. Van, Heij, A. H. De, Jansen, P. L., Burgers, J. M. N., Sieswerda, M. S., Los, R. K., Reyners, A. K. L., & Linden, Y. M. Van Der. (2022). The feasibility of a Bayesian network model to assess the probability of simultaneous symptoms in patients with advanced cancer. Scientific Reports, 12(1), 1–11. https://doi.org/10.1038/s41598-022-26342-4

Stevens, C. O., Ugese, F. D., & Baiyeri, K. P. (2015). Utilization potentials of Moringa oleifera in Nigeria: A preliminary assessment. International Letters of Natural Sciences, 40, 30–37. https://doi.org/10.18052/www.scipress.com/ilns.40.30

Tosin, J. O., Wolfe, O. A., Iyeopu, S. M., Simeon, J. O., & Lubo, M. T. (2019). Clinical study on the effect of Moringa oleifera on serum level of glucose and triglyceride in subjects taken tenofovir, lamivudine and efavirenz combination regimen. European Scientific Journal, 15(21), 280–293. https://doi.org/10.19044/esj.2019.v15n21p280

Tshingani, K., Donnen, P., Mukumbi, H., Duez, P., & Dramaix-wilmet, M. (2017). Impact of Moringa oleifera lam. leaf powder supplementation versus nutritional counseling on the body mass index and immune response of HIV patients on antiretroviral therapy: A single-blind randomized control trial. BMC Complementary and Alternative Medicine, 17(1), 1–13. https://doi.org/10.1186/s12906-017-1920-z

Um, S., & Adhikari, S. (2022). Considerations in Bayesian agent-based modeling for the analysis of COVID-19 data. Frontiers in Public Health, 10, 1–26.

United Nations. (2020). Sustainable Development Goals: Guidelines for the Use of the SDG Logo including the Color Wheel, and 17 Icons. United Nations Department of Global Communications, 1–68.

UNAIDS. (2021). Global HIV statistics. Fact Sheet 2021, 1–3.

UNAIDS. (2022). The sustainable development goals report. United Nations.

Velasco, C. R., & Canada, M. C. B. (2022). Determinants of farmers' willingness to cultivate Moringa oleifera: The case of Dipaculao, Aurora, Philippines. Asian Journal of Agriculture and Rural Development, 12(4), 279–286. https://doi.org/10.55493/5005.V12I4.4671

Villarreal, M., Anyonge, C. H., Swallow, B., & Kwesiga, F. (2006). The challenge of HIV/AIDS: Where does agroforestry fit in? In World Agroforestry into the Future (pp. 181-192). World Agroforestry Centre.

Vitoria, M., Hill, A., Ford, N., Doherty, M., Clayden, P., Venter, F., Ripin, D., Flexner, C., & Domanico, P. L. (2018). The transition to dolutegravir and other new antiretrovirals in low-income and middle-income countries: What are the issues? AIDS, 32(12), 1551–1561. https://doi.org/10.1097/QAD.0000000000001845

Wardana, M. S., Jufri, M., & Mun'im, A. (2022). Physicochemical properties and nutrition of Moringa oleifera Lam. leaf extract: A preliminary study on preparation phytosomes as herbal supplement for children. International Journal of Applied Pharmaceutics, 14(1), 281–287. https://doi.org/10.22159/ijap.2022v14i1.43477

World Health Organization. (2018). Dolutegravir (DTG) and the fixed dose combination (FDC) of tenofovir/lamivudine/dolutegravir (TLD) briefing note. World Health Organization, 1–10.

World Health Organization. (2019). Update of recommendations on first- and second-line antiretroviral regimens. World Health Organization.

World Health Organization. (2023). Epidemiological fact sheet HIV statistics, globally and by WHO region, 2023. World Health Organization.

World Health Organization. (2022). Update on the transition to dolutegravir-based antiretroviral therapy: Report of a WHO meeting, 29–30 March 2022. World Health Organization.

ZAMPHIA. (2016). Zambia Population-Based HIV Impact Assessment. Journal of the International AIDS Society, 20(S7), 1–4.

ZAMPHIA. (2021). Zambia Population-Based HIV Impact Assessment 2021. ICAP at Columbia University.

Zandonà, A., Francescon, M., Bronfeld, M., Calvo, A., Chiò, A., & di Camillo, B. (2017). A dynamic Bayesian network model for simulation of disease progression in amyotrophic lateral sclerosis patients. PeerJ, 5(Suppl 4), 1–11. https://doi.org/10.7287/peerj.preprints.3262v1

ZCGTP. (2020). Zambia Guidelines for Treatment and Prevention of HIV Infection. Zambia Ministry of Health.

Zhou, L., Shi, W., Assanangkornchai, S., Vichitkunakorn, P., & Tang, J. (2022). Application of Bayesian networks to identify factors influencing acceptability of HIV pre-exposure prophylaxis in Guilin, China. Scientific Reports, 12(1), 1–12. https://doi.org/10.1038/s41598-022-24965-1




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