Same-day antiretroviral therapy initiation and its association with viral suppression and retention in HIV care in Ethiopia

Abstract

Same-day antiretroviral therapy (ART) initiation has emerged as a promising strategy to enhance treatment outcomes by reducing the time between HIV diagnosis and the commencement of ART. However, the impact of same-day ART initiation on viral suppression and patient retention in HIV care in Ethiopia has not been thoroughly evaluated. The purpose of this study was to evaluate same-day ART initiation regarding viral suppression and retention in HIV care at selected healthcare facilities in Ethiopia This research aims to fill the existing knowledge gap by examining the status of same-day ART initiation and its impact on viral suppression and retention in HIV care in Ethiopia. Furthermore, based on the findings and results of the study, the researcher intended to develop strategies for same-day ART initiation, tracing HIV patients lost to follow-up, and viral suppression monitoring mechanisms. The setting was two specific health care facilities in Adama and Bishoftu towns in the East Shewa zone of Ethiopia. A three-phased exploratory sequential mixed methods design was adopted by integrating qualitative and quantitative methodologies in a sequential process. Phase 1 was qualitative and its target population were patients started on same-day ART from the 1st of October 2017 until the 30th of October 2019, physicians, nurses, case managers, and adherence supporters working in the ART clinics of two selected healthcare facilities. Sampling was non-probability purposive. The sample comprised of 30 participants and was further determined by data saturation. The semi-structured interview guides and a cell phone were used as data collection instruments. Phase 1 was employed to explore details on the benefits and challenges associated with same-day ART initiation. The insights gleaned from this phase were subsequently utilised to refine the data collection tools for Phase 2. Phase 2 was quantitative, and data was collected from patients’ clinical records in the smart care database of the selected healthcare facilities' ART clinic by means of a checklist. Simple random sampling was used. The sample consisted of 332 clinical records. Phase 3 focused on strategies development, which was validated by health experts. In Phase 1, data was analysed thematically, and verbatim transcriptions were conducted by using Tesch’s eight-step analytic approach. The quantitative data in Phase 2 were analysed using the Statistical Package for the Social Sciences (SPSS), Version 28. The findings identified the benefits of same-day ART initiation, the challenges, current approaches, and future strategies to be implemented for quality service provision and meeting global targets in HIV care and treatment programmes. Twenty-one themes emerged from the analysis of the data from Phase 1. The quantitative results showed that the retention rate in HIV care and treatment was 59%. Viral suppression rates at 6, 12, and 24 months were 93%, 95%, and 86%, respectively, indicating progress towards the global target of 95% by 2030. In Phase 3, a modified Delphi Technique was used. The strategies produced three thematic areas and sixteen strategic key areas. After validation, the strategies were modified, and a total of fifteen strategies were adopted as the final outcomes. This study contributed to enhancing the understanding of same-day ART initiation, highlighting its benefits, challenges, and implications for HIV care in Ethiopia. The recommendations were aimed at emphasising a multifaceted and patient-centric approach to optimising the implementation of same-day ART initiation for sustained improvements in HIV care outcomes in pursuance of the 2030 global targets. The researcher intends to share the recommendations for future research with the Ministry of Health, regional health bureaus, town/zonal health departments, healthcare facility heads, healthcare providers, patients, and the communities in Ethiopia