---
title: "Prevalence and risk factors for intestinal parasites in HIV patients on ART in North Shoa, Ethiopia"
id: "plos-one-0-prevalence-of-intestinal-parasites-and-associated-factors-among-hiv-patients"
canonical_url: "https://medichelpline.com/clinical-feed/plos-one-0-prevalence-of-intestinal-parasites-and-associated-factors-among-hiv-patients"
content_type: "clinical_feed_article"
specialty: "Infectious Disease"
source_name: "PLOS ONE (Medicine)"
source_url: "https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357660"
published_at: "2026-09-01T14:00:00.000Z"
evidence_level: "Journal Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Prevalence and risk factors for intestinal parasites in HIV patients on ART in North Shoa, Ethiopia
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/plos-one-0-prevalence-of-intestinal-parasites-and-associated-factors-among-hiv-patients
- **Specialty:** [Infectious Disease](https://medichelpline.com/clinical-feed/infectious-disease.md)
- **Primary Source:** PLOS ONE (Medicine)
- **Source URL:** [Original Journal Publication](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357660)
- **Published At:** 2026-09-01T14:00:00.000Z
- **Evidence Rating:** Journal Feed
## Executive GIST (TL;DR)
- This cross-sectional study assessed **intestinal parasites** among HIV-positive adults receiving antiretroviral therapy (ART) at four public hospitals in North Shoa Zone, Oromia, Ethiopia, between February and May 2024. The final sample included 493 participants selected by systematic random sampling. - Stool examination used three microscopy-based methods: **direct wet mount**, formol-ether concentration, and modified Ziehl–Neelsen staining; preserved specimens were also used for concentration techniques. - The overall prevalence of intestinal parasitic infection was 28% (95% CI: 24.1–31.8). Participant mean age was 43.26 years (SD ±12.38); 61.1% lived in rural areas. - Multivariable analysis identified three independent associations with intestinal parasitic infection: rural residence (AOR 14.38; 95% CI: 5.52–37.47; P = 0.001), CD4 count <200 cells/µL (AOR 7.08; 95% CI: 2.33–21.59; P = 0.001), and use of an unprotected water source (AOR 12.90; 95% CI: 3.01–55.36; P = 0.001). - The authors conclude intestinal parasites are common among HIV patients in the study area and recommend routine stool examination for patients with low **CD4** counts and improved access to safe drinking water, especially in rural settings. - Limitations noted include reliance on microscopy methods available during the study and the cross-sectional design; the authors recommend longitudinal studies with broader assessment of associated factors. - Data supporting the study are publicly available in a Zenodo repository; the study reported no specific funding and no competing interests declared.
## Clinical Analysis & Structured Key Points
[ Skip to main content ](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357660#main-content) Advertisement * [plos.org](https://plos.org/) * [Create account](https://community.plos.org/registration/new) * [Sign in](https://journals.plos.org/user/secure/login?page=%2Fplosone%2Farticle%3Fid%3D10.1371%2Fjournal.pone.0357660) * * About * Browse * Publish * [](https://journals.plos.org/plosone/ "PLOS One") * Search [advanced search](https://journals.plos.org/plosone/search) * [Browse Topics](https://journals.plos.org/plosone/subjectAreaBrowse) Browse Subject Areas ? Click through the PLOS taxonomy to find articles in your field. For more information about PLOS Subject Areas, click [here](https://github.com/PLOS/plos-thesaurus/blob/master/README.md "Link opens in new window"). [](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357660) [](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357660) * 0 [Save](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0357660#savedHeader) [Total Mendeley and Citeulike bookmarks.](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0357660#savedHeader) * 0 [Citation](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0357660#citedHeader) [Paper's citation count computed by Dimensions.](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0357660#citedHeader) * 33 [View](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0357660#viewedHeader) [PLOS views and downloads.](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0357660#viewedHeader) * 0 [Share](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0357660#discussedHeader) [Sum of Facebook, Twitter, Reddit and Wikipedia activity.](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0357660#discussedHeader) Open Access Peer-reviewed Research Article # Prevalence of intestinal parasites and associated factors among HIV patients receiving antiretroviral therapy at public hospitals in North Shoa Zone, Oromia, Ethiopia: Cross-sectional study * Belay Merkeb Zewude , Roles Conceptualization, Formal analysis, Methodology, Writing – original draft * E-mail: belaymerkeb19@gmail.com Affiliation Department of Medical Laboratory Sciences, College of Medical and Health Sciences, Salale University, Fitche, Ethiopia [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0002-2169-0173 ](https://orcid.org/0000-0002-2169-0173 "ORCID Registry") ⨯ * Wuletaw Tadesse Mekonnin, Roles Conceptualization, Supervision, Writing – review & editing Affiliation Department of Medical Laboratory Sciences, College of Medical and Health Sciences, Salale University, Fitche, Ethiopia ⨯ * Desta Amensisa Tola, Roles Data curation, Methodology, Supervision Affiliation Department of Medical Laboratory Sciences, College of Medical and Health Sciences, Salale University, Fitche, Ethiopia ⨯ * Negesse Bokona Rufe Roles Data curation, Writing – review & editing Affiliation Department of Medical Laboratory Sciences, College of Medical and Health Sciences, Salale University, Fitche, Ethiopia ⨯ # Prevalence of intestinal parasites and associated factors among HIV patients receiving antiretroviral therapy at public hospitals in North Shoa Zone, Oromia, Ethiopia: Cross-sectional study * Belay Merkeb Zewude, * Wuletaw Tadesse Mekonnin, * Desta Amensisa Tola, * Negesse Bokona Rufe ![PLOS](https://journals.plos.org/resource/img/logo-plos-full-color.svg) x * Published: September 1, 2026 * * [Article](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357660) * [Authors](https://journals.plos.org/plosone/article/authors?id=10.1371/journal.pone.0357660) * [Metrics](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0357660) * [Comments](https://journals.plos.org/plosone/article/comments?id=10.1371/journal.pone.0357660) * [Media Coverage](http://plos.altmetric.com/details/doi/10.1371/journal.pone.0357660) * [Abstract](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357660#abstract0) * [Background](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357660#sec005) * [Materials and methods](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357660#sec006) * [Result](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357660#sec019) * [Discussion](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357660#sec023) * [Conclusion and recommendation](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357660#sec025) * [Acknowledgments](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357660#ack) * [References](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357660#references) * [Reader Comments](https://journals.plos.org/plosone/article/comments?id=10.1371/journal.pone.0357660) * [Figures](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357660) ![Accessible Data Icon](https://journals.plos.org/resource/img/accessible_data.svg)Accessible Data [ See the data ![Link Icon](https://journals.plos.org/resource/img/data_link_icon.svg) ](https://doi.org/10.5281/zenodo.20323699) This article includes the Accessible Data icon, an experimental feature to encourage data sharing and reuse. [Find out how research articles qualify for this feature.](https://theplosblog.plos.org/2023/07/accessible-data/) ## Abstract ### Background Intestinal parasite infections have a significant impact on HIV patients and are a serious global public health concern. In Ethiopia, the frequency of intestinal parasites among HIV patients is significant. The prevalence of intestinal parasites and associated factors among HIV-positive patients in the study area is unknown. Therefore, this study aims to determine the prevalence of intestinal parasites and associated factors among HIV positive patients receiving antiretroviral therapy (ART) at North Shoa public hospitals using direct wet mount, formol-ether concentration and modified Ziehl-Neelsen staining techniques. ### Methods A cross-sectional study was conducted among HIV patients receiving ART at public hospitals in the North Shoa Zone, Oromia Region, Ethiopia, from February 2024 to May 2024. A total of 493 participants were included using systematic random sampling methods. Socio-demographic data and other associated factors were collected using a structured questionnaire. Stool specimens were collected in a clean container and examined for intestinal parasites. Data were analyzed using SPSS version 27. Bivariate and multivariable logistic regression analyses were performed to identify factors associated with intestinal parasitic infections. ### Results In this study, 61.1% of participants resided in rural areas, with a mean age of 43.26 years (SD = ±12.38). The overall prevalence of intestinal parasitic infection among HIV patients in this study was 28% (95% CI: 24.1–31.8). Rural residence (AOR: 14.38; 95% CI: 5.52–37.47, P = 0.001), CD4 count ). All data have been anonymized. **Funding:** The author(s) received no specific funding for this work. **Competing interests:** The authors have declared that no competing interests exist. ## Background In developing countries, intestinal helminths and protozoan parasitic infections are among the most common, with a significant morbidity and mortality rate [[1](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357660#pone.0357660.ref001)]. The severity of intestinal parasite infections depends on several factors, including the immunological status of the individuals [[2](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357660#pone.0357660.ref002)]. Human immunodeficiency virus (HIV) depletes CD4 cells, weakening a person’s immunity and thereby predisposing them to opportunistic infections [[3](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357660#pone.0357660.ref003)]. Co-infections with other infectious agents, such as intestinal parasites, are particularly concerning because HIV infection remains a global public health concern. The development of moderate to severe infections, which are often asymptomatic or mild in an immunocompetent host, is facilitated by the immunodeficiency linked to this virus [[4](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357660#pone.0357660.ref004)]. Studies have suggested that _C. parvum_ , _I.belli_ , and _Blastocystis hominis_ are common opportunistic parasites associated with AIDS illness [[5](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357660#pone.0357660.ref005)]. Moreover, additional studies indicated that intestinal parasites were more prevalent in individuals with HIV than in those without HIV [[6](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357660#pone.0357660.ref006)–[8](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357660#pone.0357660.ref008)]. Immunosuppression (CD4 < 200 cells/µL) is more common in patients with intestinal parasitic infections than in patients without intestinal parasites [[9](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357660#pone.0357660.ref009)]. According to the UNAIDS report, globally, 39 million people were living with HIV/AIDS in 2022 while 630,000 had died from AIDS-related illness. Eastern and southern Africa accounted for around 53.6% of the total cases [[10](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357660#pone.0357660.ref010)]. Intestinal parasite infection is quite common in sub-Saharan Africa, where most HIV/AIDS patients reside [[11](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357660#pone.0357660.ref011)]. A systematic review of a study conducted among HIV-positive patients reported a pooled prevalence of 39.15% of intestinal parasites [[12](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357660#pone.0357660.ref012)]. This proportion is higher than the prevalence among the total population, which is 25.01% [[13](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357660#pone.0357660.ref013)]. According to research findings, each person with HIV should be suspected of having an opportunistic intestinal parasite infection [[14](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357660#pone.0357660.ref014)]. The diagnosis of parasitic infections relies on several laboratory methods. Microscopy is the primary tool for the detection of intestinal parasites. Intestinal parasites can be detected by a direct wet mount of stool specimens. However, when parasites are rarely found in direct wet mounts, concentration techniques are recommended to increase the likelihood of detection [[15](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357660#pone.0357660.ref015),[16](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357660#pone.0357660.ref016)]. Due to inappropriate waste disposal, intestinal parasites are thought to be more prevalent among HIV-positive individuals in Ethiopia [[17](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357660#pone.0357660.ref017)]. Despite these findings, most medical facilities lack sensitive diagnostic techniques to identify low levels of parasitic infection. Furthermore, the majority of healthcare facilities lack access to certain diagnostic techniques for particular intestinal parasites, particularly for some opportunistic intestinal parasites. The only technique for detecting intestinal parasites in North Shoa public hospital laboratories is the direct wet mount, which understates the true prevalence. Patients are not routinely tested for these pathogens at monitoring centers. Furthermore, there is a paucity of information regarding the prevalence of intestinal parasites and associated factors among HIV-positive patients in the study area. Thus, the objective of this study is to determine the prevalence of intestinal parasites and associated factors among HIV-positive patients receiving antiretroviral therapy (ART) at North Shoa public hospitals. ## Materials and methods ### Study design, period, and area A hospital-based cross-sectional study was conducted in North Shoa Zone public hospitals, Oromia regional state, Ethiopia, from February 2024 to May 2024. There are 1,639,587 people living in 14 districts in this zone; 820,595 of them are men and 818,992 are women. According to the information obtained from the North Shoa Zone health bureau, there are 7 public hospitals, 63 health centers, and 267 health posts in the zone, which provide different health care services for the population. For this study, four hospitals (Salale University Comprehensive Specialized Hospital, Kuyu General Hospital, Chanco General Hospital, and Mukaturi Hospital) were selected using simple random sampling via a lottery system. ### Population The source population for this study was all HIV patients receiving ART at public hospitals in the North Shoa Zone. The study population included all HIV patients receiving ART at the selected public hospitals in the North Shoa Zone during the study period. ### Eligibility criteria All HIV patients receiving ART at selected public hospitals in the North Shoa Zone were included in the study, except for individuals who had taken anti-parasitic medications within the previous two weeks and who were severely ill at the time of data collection. ### Study variables Dependent variable of the study was Intestinal parasitic infection status. The independent variables includes marital status, sex, educational status, age, address, source of drinking water, a habit of eating uncooked vegetables, a habit of hand washing existence of toilet, CD4 count, and WHO disease stage. ### Sample size calculation and sampling methods The sample size was calculated using the sample size determination formula for a single population proportion. The sample size calculation considered a 73.3% proportion from the study conducted in Nekemte Specialized Hospital [[7](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357660#pone.0357660.ref007)], along with a 95% confidence interval, a 5% margin of error, a design effect of 1.5, and an additional 10% to account for non-response. This led to a final sample size of 493 individuals. To choose representative individuals, a multi-stage sampling procedure was used. First, a lottery was used to choose four hospitals at random: Salale University Comprehensive Specialized Hospital, Kuyu General Hospital, Chanco General Hospital, and Mukaturi Hospital. Each hospital received a proportionate share of the sample: 257 individuals were assigned to Salale University Comprehensive Specialized Hospital, 175 to Kuyu General Hospital, 35 to Chanco General Hospital, and 26 to Mukaturi Hospital. Lastly, systematic random sampling was used to choose eligible patients from each hospital. ### Measurement and data collection #### Data collection procedure. Socio-demographic characteristics, clinical presentation, treatment history, and other variables of the study participants were collected using a structured questionnaire after written informed consent/assent was obtained. Data collectors were hired, instructed, and trained to collect data using the pre-structured questionnaire. Stool specimens were collected (4 g of formed stool and 10 mL of diarrheic stool) into wide-open-necked, carefully labeled, dry, leak-proof, and grease-free transparent stool containers by the participants. The participants were instructed on how to collect stool specimens at the point of care. #### Laboratory analysis. **Direct wet mount method:** Stool specimens were collected at the hospital laboratory and then tested for intestinal parasites using the direct wet mount method with normal saline (0.85% NaCl). To further enhance the detection of intestinal protozoan cysts, Lugol’s iodine staining was performed. The remaining stool specimens were preserved in 10% formalin for further analysis. **Formol-ether concentration technique procedures:** The formol–ether concentration technique was performed for each sample. Approximately 1 gm of stool specimens were emulsified in 7 mL of 10% formol water contained in a screw-cap tube using an applicator stick. The emulsified samples were sieved, after which 3 mL of diethyl ether was added and the mixture was shaken vigorously and centrifuged at 2000 revolutions per minute for 3 minutes. After centrifugation, the sediment was transferred onto a slide, covered with a cover glass, and examined microscopically using 10× and 40 × objective lenses [[18](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0357660#pone.0357660.ref018)]. **Modified Ziehl–Neelsen method procedures:** A smear was prepared, air-dried, and fixed with methanol for 2–3 minutes. It was then stained with carbo
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