Improving the UNAIDS 90-90-90 Treatment Targets: Solutions Suggested from a Qualitative Study of HIV Patients, Community Advocates, Health Workers and Program Managers in Jimma, Southwest Ethiopia

Abstract

Ethiopia's performance toward the UNAIDS 90-90-90 targets is low. The present study explored interventions to improve delayed HIV care presentation (first 90), poor retention (second 90) and clinical and immunological failure (third 90). We employed a qualitative approach using in-depth interviews with 10 HIV patients, nine health workers, 11 community advocates and five HIV program managers. Ethical approvals were obtained from Australia and Ethiopia. The following were suggested solutions to improve HIV care and treatment to meet the three 90s: (i) strengthening existing programs including collaboration with religious leaders; (ii) implementing new programs such as self-HIV testing, house-to-house HIV testing, community antiretroviral therapy (ART) distribution and teach-test-treat-link strategy; (iii) decentralizing and integrating services such as ART in health post and in private clinics, and integrating HIV care services with mental illness and other non-communicable diseases; and (iv) filling gaps in legislation in issues related with HIV status disclosure and traditional healing practices. In conclusion, the study suggested important solutions for improving delayed HIV care presentation, attrition, and clinical and immunological failure. A program such as the teach-test-treat-link strategy was found to be a cross-cutting intervention to enhance the three 90s. We recommend further nationwide research before implementing the interventions.

Keywords: Ethiopia; HIV care continuum; UNAIDS 90-90-90 targets; antiretroviral therapy; delayed HIV diagnosis; discontinuation; immunologic failure; interventions; qualitative.

Figure 1

HIV care framework for assessing negative outcomes of HIV care and treatment, Southwest Ethiopia, 2018 (Adapted based on Kranzer et al., 2012) [8]. The box with the grey arrow shows the steps on the pathway of HIV care: HIV testing and diagnosis, ART linkage, lifelong ART retention and virological suppression. The dotted lines, circles or rectangles in red outside the grey arrow show negative outcomes in the pathway of HIV care: late presentation for HIV care, ART discontinuation, immunological, clinical or virological failure, and mortality.