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Multicenter Study
. 2017 Feb;27(Suppl 1):17-28.
doi: 10.4314/ejhs.v27i1.3s.

Exploratory Analysis of Time from HIV Diagnosis to ART Start, Factors and effect on survival: A longitudinal follow up study at seven teaching hospitals in Ethiopia

Alula M Teklu  1 , Kesetebirhan Delele  2 , Mulu Abraha  3 , Bekele Belayhun  4 , Esayas Kebede Gudina  5 , Abiy Nega  1
Affiliations
Multicenter Study

Exploratory Analysis of Time from HIV Diagnosis to ART Start, Factors and effect on survival: A longitudinal follow up study at seven teaching hospitals in Ethiopia

Alula M Teklu et al. Ethiop J Health Sci. 2017 Feb.

Abstract

Background: The HIV care in Ethiopia has reached 79% coverage. The timeliness of the care provided at the different levels in the course of the disease starting from knowing HIV positive status to ART initiation is not well known. This study intends to explore the timing of the care seeking, the care provision and associated factors.

Methods: This is a longitudinal follow-up study at seven university hospitals. Patients enrolled in HIV care from September 2005 to December 2013 and aged ≥14 years were studied. Different times in the cascade of HIV care were examined including the duration from date HIV diagnosed to enrollment in HIV care, duration from enrollment to eligibility for ART and time from eligibility to initiation of ART. Ordinal logistic regression was used to investigate their determinants while the effect of these periods on survival of patients was determined using cox-proportional hazards regression.

Results: 4159 clients were studied. Time to enrollment after HIV test decreased from 39 days in 2005 to 1 day after 2008. It took longer if baseline CD4 was higher, and eligibility for ART was assessed late. Young adults, lower baseline CD4, HIV diagnosis<2008, late enrollment, and early eligibility assessment were associated with early ART initiation. Male gender, advanced disease stage and lower baseline CD4 were consistent risk factors for mortality.

Conclusion and recommendation: Time to enrollment and duration of ART eligibility assessment as well as ART initiation time after eligibility is improving. Further study is required to identify why mortality is slightly increasing after 2010.

Keywords: Ethiopia; HIV; HIV testing; antiretroviral therapy; eligibility; enrollment; mortality.

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Figures

Figure 1
Figure 1
Different time periods in the cascade of ART provision from time HIV status is known to enrollment (T-1), to eligibility (T-2), to ART initiation (T-3), and finally to survival.
Figure 2
Figure 2
Trend of duration of time from knowing HIV status to enrollment in chronic HIV care, T-1
Figure 3
Figure 3
Trends of time from enrollment to eligibility - T-2
Figure 4
Figure 4
Trends in time from eligibility for ART to initiation of treatment-T-3
Figure 5
Figure 5
Kaplan Meier Survival Estimates on Time to Death by HIV Diagnosis Year
See this image and copyright information in PMC

References

    1. Federal Ministry of Health, author. AIDS in Ethiopia. 5th ed. 2004.
    1. Federal Ministry of Health, author. AIDS in Ethiopia. 6th ed. 2005.
    1. Ethiopian Public Health Institute, author. HIV Related Estimates and Projections for Ethiopia-2015. 2015
    1. Federal HIV/AIDS Prevention and Control Office, author. Country progress report on the HIV response, 2014. 2014
    1. World Health Organisation, author. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach. Geneva, Switzerland: 2013. - PubMed

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