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

Performance of the Antiretroviral Treatment Program in Ethiopia, 2005-2015: strengths and weaknesses toward ending AIDS.
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Assefa Y, Gilks CF, Lynen L, Williams O, Hill PS, Tolera T, Malvia A, Van Damme W,


Assefa Y, Gilks CF, Lynen L, Williams O, Hill PS, Tolera T, Malvia A, Van Damme W, (click to view)

Assefa Y, Gilks CF, Lynen L, Williams O, Hill PS, Tolera T, Malvia A, Van Damme W,

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International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases 2017 05 1960() 70-76 pii 10.1016/j.ijid.2017.05.012

Abstract
BACKGROUND
Ethiopia is one of the countries which has scaled up antiretroviral treatment (ART) over the past decade. This study reviews the performance of the ART program in Ethiopia during the past decade, and identifies successes and weaknesses toward ending AIDS in the country.

METHODS
A review and synthesis of data was conducted using multiple data sources: reports from all health facilities in Ethiopia to the Federal Ministry of Health, HIV/AIDS estimates and projections, and retrospective cohort and cross-sectional studies conducted between 2005/6 and 2014/15.

FINDINGS
The ART program has been successful over several critical areas: (1) ART coverage improved from 4% to 54%; (2) the median CD4 count/mm(3) at the time of ART initiation increased from 125 in 2005/6 to 231 in 2012/13; (3) retention in care after 12 months on ART has increased from 82% to 92%. In spite of these successes, important challenges also remain: (1) ART coverage is not equitable: among regions (5.6%-93%), between children (25%) and adults (60%), and between female (54%) and male patients (69%); (2) retention in care is variable among regions (83%-94%); and, (3) the shift to second-line ART is slow and low (0·58%).

INTERPRETATION
The findings suggest that the ART program should sustain the successes and reflect on the shortcomings toward the goal of ending AIDS. It is important to capitalize on and calibrate the interventions and approaches utilized to scale up ART in the past. Analysis of the treatment cascade, in order to pinpoint the gaps and identify appropriate solutions, is commendable in this regard.

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