Performance of the Antiretroviral Treatment Program in Ethiopia, 2005-2015: strengths and weaknesses toward ending AIDS

Assefa, Yibeltal; Gilks, Charles F.; Lynen, Lutgarde; Williams, Owain David; Hill, Peter S; Tolera, Taye; Malvia, Alankar; Damme, Wim Van

doi:10.1016/j.ijid.2017.05.012

Cited by 37 publications

(31 citation statements)

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“…[16][17][18][19] In addition to this, all available studies estimated treatment failure only by clinical and CD4 criteria. 18,20 For this reason, the ART failure rate is expected to be underestimated in our country. Thus, unless we perform best to increase the durability and effectiveness of first-line regimens, we may end up with null or limited options to increase the survival of HIV-infected children and to control the epidemic plus short of hitting the UNAIDS 2020 targets.…”

Section: Introductionmentioning

confidence: 99%

<p>Incidence and Predictors of Treatment Failure Among Children Receiving First-Line Antiretroviral Treatment in General Hospitals of Two Zones, Tigray, Ethiopia, 2019</p>

Sibhat

Kassa

Gebrehiwot

2020

PHMT

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Background: Despite many efforts undertaken to control the human immunodeficiency virus epidemic, it remains to be the major global public health challenge. With expanding access to pediatric antiretroviral therapy, children are more likely to experience treatment failure. All previous studies conducted in Ethiopia estimated treatment failure using only clinical and CD4 criteria. Thus, the ART failure rate is expected to be underestimated in our country. Objectives of the Study: To assess the incidence and predictors of treatment failure among children receiving first-line ART in general hospitals of Mekelle and Southern Zones of Tigray region, Ethiopia, 2019. Methods: Retrospective follow up study was employed. The sample size was estimated based on a Log rank test using Stata V-13 and all 404 charts were taken for review. Data were collected by extraction tool; entered using Epi-data manager; cleaned and analyzed by Stata V-14. Data were described using the Kaplan-Meier curve, Log rank test, life table, and crude hazard ratios and analyzed using adjusted hazard ratios and p-value by Cox proportional hazard regression. Any variable at P <0.05 in the bi-variable analysis was taken to multi-variate analysis and significance was declared at P≤ 0.05. Data were presented using tables, charts, and texts. Results: The incidence rate of ART failure was 8.68 (95% CI 7.1 to 10.6) per 1000 person-month observations with a total of 11,061.5 person-month observations. Children who had tuberculosis at baseline [AHR=2.27; 95% CI 1.12-4.57], advanced recent WHO stage [AHR=5.21; 95% CI 2.75-9.88] and sub-optimal ART adherence [AHR=2.84, 95% CI 1.71-4.72] were at higher hazard for first-line treatment failure. Besides this having a long duration of ART follow up [AHR=0.85; 95% CI 0.82-0.87] was found to be protective against treatment failure. Conclusion and Recommendation: The incidence of first-line ART failure was grown as a major public health concern. Treatment failure was predicted by the duration of follow up, advanced recent WHO stage, sub-optimal adherence, as well as the presence of tuberculosis at baseline. Hence, it is better to give priority for strengthening the focused evaluation of the WHO clinical stage and tuberculosis co-infection at baseline with continuous adherence monitoring.

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Section: Introductionmentioning

confidence: 99%

<p>Incidence and Predictors of Treatment Failure Among Children Receiving First-Line Antiretroviral Treatment in General Hospitals of Two Zones, Tigray, Ethiopia, 2019</p>

Sibhat

Kassa

Gebrehiwot

2020

PHMT

View full text Add to dashboard Cite

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“…Countries have been implementing certain interventions that have enabled them to narrow the inequity gap. In Ethiopia, for instance, the framework of primary healthcare, in general, and the public health approach to ART delivery, in particular, includes community engagement and participation, task shifting, decentralization, free provision of HIV services, health systems strengthening [19,38,39]. The drop in inequity in ART coverage, mainly among the major regions and regions with huge burden of HIV, can be explained by the improved health systems capacity and the approach that the country has been utilizing to increase primary healthcare (PHC) services [36,37].…”

Section: Scaling Up Of Antiretroviral Treatment: Coveragementioning

confidence: 99%

Leaving no one behind: lessons from implementation of policies for universal HIV treatment to universal health coverage

Assefa

Hill

Damme

et al. 2020

Preprint

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Background: The third Sustainable Development Goal (SDG-3) aims to ensure healthy lives and promote well-being for all at all ages. SDG-3 has a specific target on universal health coverage (UHC), which emphasizes the importance of all people and communities having access to quality health services without risking financial hardship. The objective of this study is to review progress towards UHC using antiretroviral treatment (ART) as a case study. Methods: We used a mixed-methods design including qualitative and quantitative approaches. We reviewed and synthesised the evidence on the evolution of the WHO HIV treatment guidelines between 2002 and 2019. We calculated ART coverage over time by gender, age group, and location. We also estimated ART coverage differences and ratios. Findings: ART guidelines have evolved from “treating the sickest” to “treating all”. ART coverage increased globally from under 7% in 2005 to 62% in 2018. There have been successes in increasing ART coverage in all populations and locations. However, progress varies by population and location in many regions. There is inequity in ART coverage: women (68%) versus men (55%), and adults (62%) versus children (54%). This inequity has widened over time, and with expanded ART eligibility criteria. On the other hand, data from at least one high-burden country (Ethiopia) shows that inequity among regions has narrowed over time due to the improvements in the primary health care systems and implementation of the public health approach in the country. Conclusion: ART coverage has increased at global, regional and national levels to all population groups. However, the gains have not been equitable among locations and populations. Policies towards universality may widen the inequity in resource-limited settings unless countries take precautions and “put the last first”. We argue that primary health care and public health approaches, with multi-sectoral actions and community engagement, are vital to minimize inequity, achieve UHC and leave no one behind.

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“…These countries have implemented certain interventions that enabled them to narrow the inequity gap. In Ethiopia, the framework of primary healthcare, in general, and public health approach to ART delivery, in particular, includes community engagement and participation, task shifting, decentralization, free provision of HIV services, health systems strengthening [17,36,37]. The drop in inequity in ART coverage, mainly among the major regions and regions with huge burden of HIV, can be explained by the improved health systems capacity and the approach that the country has been utilizing to increase primary healthcare (PHC) services [34,35].…”

Section: Scaling Up Of Antiretroviral Treatment: Coveragementioning

confidence: 99%

Leaving no one behind: lessons from implementation of policies for universal HIV treatment to universal health coverage

Assefa

Hill

Damme

et al. 2019

Preprint

Self Cite

View full text Add to dashboard Cite

Background The third Sustainable Development Goal (SDG-3) aims to ensure healthy lives and promote well-being for all at all ages. SDG-3 has a specific target on universal health coverage (UHC), which emphasizes the importance of all people and communities having access to quality health services without risking financial hardship. The objective of this study is to review progress towards UHC using antiretroviral treatment (ART) as a case study.Methods We used a mixed-methods design including qualitative and quantitative approaches. We reviewed and synthesised the evidence on the evolution of the WHO HIV treatment guidelines between 2002 and 2019. We calculated ART coverage over time by gender, age group, and location. We also estimated ART coverage differences and ratios.Findings ART guidelines have evolved from “treating the sickest” to “treating all”. ART coverage increased globally from under 7% in 2005 to 62% in 2018. There have been successes in increasing ART coverage in all populations and locations. However, progress varies by population and location in many regions. There is inequity in ART coverage: women (68%) versus men (55%), and adults (62%) versus children (54%). This inequity has widened over time, and with expanded ART eligibility criteria. On the other hand, data from at least one high-burden country (Ethiopia) shows that inequity among regions has narrowed over time due to the improvements in the primary health care systems and implementation of the public health approach in the country.Conclusion ART coverage has increased at global, regional and national levels to all population groups. However, the gains have not been equitable among locations and populations. Policies towards universality may widen the inequity in resource-limited settings. We argue that primary health care and public health approaches, with multi-sectoral actions, are vital to minimize inequity and achieve UHC.

show abstract

Performance of the Antiretroviral Treatment Program in Ethiopia, 2005-2015: strengths and weaknesses toward ending AIDS

Cited by 37 publications

References 10 publications

<p>Incidence and Predictors of Treatment Failure Among Children Receiving First-Line Antiretroviral Treatment in General Hospitals of Two Zones, Tigray, Ethiopia, 2019</p>

<p>Incidence and Predictors of Treatment Failure Among Children Receiving First-Line Antiretroviral Treatment in General Hospitals of Two Zones, Tigray, Ethiopia, 2019</p>

Leaving no one behind: lessons from implementation of policies for universal HIV treatment to universal health coverage

Leaving no one behind: lessons from implementation of policies for universal HIV treatment to universal health coverage

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