HIV Care continuum Outcomes: Can Ethiopia Meet the UNAIDS 90-90-90 Targets?

Abstract

Background: Ethiopia has pledged to the UNAIDS 90-90-90 framework. However, the achievements of these UNAIDS targets are not assessed in Southwest Ethiopia. Using HIV care and treatment outcomes as surrogate markers, we assessed all targets.

Methods: Complex surrogate makers were used to assess the HIV care continuum outcomes using antiretroviral therapy data in Jimma University Teaching Hospital. Early HIV diagnosis was a surrogate marker to measure the first 90. Numbers of people on HIV treatment and who have good adherence were used to measure the second 90. To measure the third 90, we used immunological success that was measured using numbers of CD4 counts, clinical success using WHO clinical stages and treatment success using immunological and clinical successes.

Results: In total, 8172 patients were enrolled for HIV care from June 2003 to March 2015. For the diagnosis target, the prevalence of early HIV diagnosis among patients on ART was 35% (43% among children and 33.3% among adults). For the treatment target, 5299(65%) received ART of which 1154(22%) patients lost to follow-up or defaulted from ART treatment, and 1015(19%) patients on treatment transferred out to other sites. In addition, 17% had fair or good adherence. Finally, 81% had immunological success, 80% had clinical success and 66% treatment success.

Conclusions: The study revealed that Southwest Ethiopia achieved 35%, 65% and 66% of the first, second and third UNAIDS targets, a very far performance from achieving the target. These highlight further rigorous interventions to improve outcome of HIV continuum of care.

Keywords: Ethiopia; HIV care continuum; Jimma; UNAIDS 90-90-90; discontinuation; early HIV diagnosis; immunologic failure.

Figure 1

Southwest Ethiopia cascade of the UNAIDS 90-90-90 Targets, 2016

Figure 2

Trends in the percentage distribution of late presentation for HIV care among HIV infected people on ART, Southwest Ethiopia, 2004–2014 NB. The thin black in the graph shows the predicted equation for the trend of late presentation for HIV care displayed in the graph using thick blue line.

Figure 3

Trends in the percentage distribution of discontinuation from ART among HIV infected people on ART, Southwest Ethiopia, 2004–2014 NB. The thin black in the graph shows the predicted equation for the trend of discontinuation from ART displayed in the graph using thick blue line.