Globally, approximately 38 million people were living with the human immunodeficiency virus (HIV) in 2019. Of these, 36.2 million were adults, and 1.8 million were children (<15 years old). Most people living with HIV are from low-and middle-income countries: 20.7 million people (54%) in eastern and southern Africa. The number of people who died of AIDS has declined over the years due to improving access to Antiretroviral therapy (ART).
ART is the daily use of a combination of medicine called "HIV regimen" to stop the virus from multiplying and can suppress it to undetectable levels in the blood. The initial standard treatment for people newly diagnosed with HIV generally includes three antiretroviral drugs from at least two different HIV drug classes.
HIV treatment access is key to the global effort to end acquired immunodeficiency syndrome (AIDS) as a public health threat. By the end of 2019, 25.4 million people with HIV (67%) were accessing ART globally. The Joint United Nations Programme on HIV/AIDS (UNAID) planned that 90% of all people who know their status should be on ART. However, 12.6 million people did not access the treatment. According to the 2018 estimate, 613,000 Ethiopians were living with HIV. However, only 436,000 individuals have received the treatment.
Ethiopia is a low-income country experiencing a high number of patients with HIV/AIDS. In response to HIV/AIDS, Ethiopia introduced the ART program to save lives, restore mental and physical functions, and improve the quality of life of people living with HIV/AIDS. The first adult treatment guideline was issued in 2003 and revised in 2005, 2007, 2014, and 2018. A pediatric treatment guideline was also developed and consolidated with the adult guidelines in 2007.
The availability of HIV-related preventive care and treatment services is essential to reduce the burden of the disease. The treatment is aimed at early case detection through testing services, care, support, adherence surveillance, and monitoring. However, many resource-limited countries face challenges in availing of services.
A well-functioning ART center needs a separate area for advisory services with appropriate privacy rooms. In India, the assessment of ART centers showed less than half of the facilities (48%) had ideal counseling areas and education and communication materials. The study on the availability of HIV testing, care, and treatment in Ghana revealed viral load and early infant diagnosis, and laboratory testing services were reported at 5.8% and 13.4%, respectively. Shortage of test kits, drugs, and job training were the challenges of various facilities. The study conducted in South Africa showed that the service quality of ART clinic counselors often fails to address HIV prevention. The healthcare provider performed TB symptom screening for only 41.1% of visitors.
A study from the 2014 Service Provision Assessment (SPA) survey revealed the capacity of health facilities for HIV/AIDS care was poor. For instance, out of the 873 health facilities, 32.6%, 53.7%, and 74.5% of health facilities providing ART, prevention of mother-to-child transmission (PMTCT), and HIV counseling and testing (HCT) service, respectively. The overall capacity scores were 45% for health centers and 77.1% for hospitals. Nearly one-third and a quarter of the health centers provided HCT and ART services using national guidelines.
Antiretroviral drugs, baseline CD4 count or viral load, and tuberculosis (TB) screening were available in less than 50% of the health centers. Other studies also revealed that inputs for services such as drugs were not available adequately. Moreover, studies on client satisfaction with ART service ranged from 55.2% to 89.6%. Different factors affect client satisfaction, such as income, age, marital status, educational status, distance, occupation, availability of drugs, patient-client interaction, and communication.
The process evaluation conducted on pediatric ART service in Addis Ababa revealed the overall compliance of healthcare providers to the national guideline of ART service was 81.6%. The evaluation of HIV/ AIDS quality care in Bahir Dar Felege Hiwot referral hospital showed that among patients eligible for ART per the national guidelines, only 205 (76.8%) took ART. In comparison, 34 (12.7%) never started ART, and the remaining 28 (10.5%) failed to continue treatment after initiation.
Previous studies only focused on client satisfaction or the availability of materials. A comprehensive and systematic assessment of different program dimensions is essential to make evidence-based decisions for program improvement.
Pediatric antiretroviral treatment failure and viral load are high despite the existing treatment. Therefore, the evaluation of the implementation of pediatric ART services is crucial. As to the authors' knowledge, there is no evaluation conducted in Ethiopia about pediatrics' ART implementation status in the health center (HC) setup. Therefore, this evaluation is designed to assess the availability of resources required to provide pediatric ART services effectively, assess the compliance of HCPs with the national guideline in delivering pediatric ART services and determine the level of caregiver satisfaction with ART services provided and identify factors associated with the satisfaction of caregivers/mothers. Moreover, the evaluation results could be used for pediatric ART service improvement and to make evidence-based decision-making. The evaluation's finding is significant to the public, government, and stakeholders.