Scaling up antiretroviral treatment and improving patient retention in care: lessons from Ethiopia, 2005-2013.

BACKGROUND: Antiretroviral treatment (ART) was provided to more than nine million people by the end of 2012. Although ART programs in resource-limited settings have expanded treatment, inadequate retention in care has been a challenge. Ethiopia has been scaling up ART and improving retention (defined as continuous engagement of patients in care) in care. We aimed to analyze the ART program in Ethiopia. METHODS: A mix of quantitative and qualitative methods was used. Routine ART program data was used to study ART scale up and patient retention in care. In-depth interviews and focus group discussions were conducted with program managers. RESULTS: The number of people receiving ART in Ethiopia increased from less than 9,000 in 2005 to more than 439, 000 in 2013. Initially, the public health approach, health system strengthening, community mobilization and provision of care and support services allowed scaling up of ART services. While ART was being scaled up, retention was recognized to be insufficient. To improve retention, a second wave of interventions, related to programmatic, structural, socio-cultural, and patient information systems, have been implemented. Retention rate increased from 77% in 2004/5 to 92% in 2012/13. CONCLUSION: Ethiopia has been able to scale up ART and improve retention in care in spite of its limited resources. This has been possible due to interventions by the ART program, supported by health systems strengthening, community-based organizations and the communities themselves. ART programs in resource-limited settings need to put in place similar measures to scale up ART and retain patients in care.

Towards achieving the fast-track targets and ending the epidemic of HIV/AIDS in Ethiopia: Successes and challenges.

BACKGROUND: Ethiopia has adopted the global plan to end the epidemic of HIV/AIDS. The aim of this study was to assess the progress made towards achieving this plan. METHODS: A review and analysis of national population-based surveys, surveillance, and routine programme data was executed. The data analysis was conducted using Excel 2016 and Stata 14 (StataCorp LP, College Station, TX, USA). RESULTS: Between 2011 and 2016, the number of HIV-related deaths dropped by 58%, while that of new HIV infections dropped by only 6%. Discriminatory attitudes declined significantly from 77.9% (95% confidence interval (CI) 77.3-78.4%) in 2011 to 41.5% (95% CI 40.6-42.4%) in 2016. Around 79% of adult people living with HIV (PLHIV) were aware of their HIV status; 90% of PLHIV who were aware of their HIV status were taking antiretroviral treatment (ART) and 88% of adult PLHIV on ART had viral suppression in 2016. The proportion of people aged 15-49 years who had ever been tested for HIV and had received results increased from 39.8% (95% CI 39.2-40.4%) in 2011 to 44.8% (95% CI 44.2-45.4%) in 2016. This proportion was very low among children below age 15 years at only 6.2% (95% CI 5.9-6.5%). Among regions, HIV testing coverage varied from 13% to 72%. Female sex workers had lower coverage for HIV testing (31%) and ART (70%) than the national average in the adult population. International funding for HIV dropped from more than US$ 1.3 billion in 2010-2012 to less than US$ 800 million in 2016-2018. CONCLUSIONS: Ethiopia is on track to achieve the targets for HIV testing, ART, viral suppression, and AIDS-related deaths, but not for reductions in new HIV infections, discriminatory attitudes, and equity. Ending the epidemic of HIV/AIDS requires a combined response, including prevention and treatment, tailored to key populations and locations, as well as increased funding.

HIV and tuberculosis coinfection in the southern region of Ethiopia: a prospective epidemiological study.

HIV has played a key role in TB, modifying its incidence and clinical presentation. This study describes the prevalence of HIV among TB patients attending health facilities in the southern region of Ethiopia. The HIV prevalence was 18% for female and 21% for male TB patients. 15% and 30%, respectively, of the rural and urban patients with TB were HIV positive (p<0.05). 19% (51/261) smear-positive PTB, 26% (36/137) smear-negative PTB and 11% (10/94) of the extrapulmonary TB patients were HIV positive. The proportion of patients with extra-PTB varied from 11% to 38% across the centres and was highest in the zones with the lowest HIV prevalence. In the light of limited diagnostic facilities, clinicians often make a clinical diagnosis of TB without laboratory confirmation. The increase in the number of TB cases could be due to HIV. However, the number of health facilities offering TB treatment in the area also increased (from 53 to 236) during the same period and the increase in TB is likely to be the result of a combination of factors, including improved detection and HIV. It is important to consider this multi-factorial phenomenon when interpreting the increase of TB in a geographical area.