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Introduction and background: The rapid expansion of antiretroviral treatment (ART) is one of the most remarkable achievements in public health history. ART was provided to eight million people by the end of 20 II, which is a 20-fold increase since 2003. In 2011, a majority (54%) of people eligible for ART in low- and middle-income countries were receiving the treatment. This has been possible due to the support from different global health initiatives and organizations, including PEPFAR, the Global Fund to fight AIDS, TB and Malaria, UNAIDS and WHO, in addition to national leadership and commitment. In spite of the success in scaling up ART in resource-limited settings, retaining patients in care is a critical gap in ART programs. Ensuring good retention in care thus remains one of the key challenges for ART programs while the treatment is still scaled up further. ART programs in resource-limited settings have been implementing a variety of interventions to improve retention in recent years. Ethiopia is one of a number of resource-limited countries which have been scaling up ART over the last seven years. By mid-2012, over 830 health facilities were providing ART services nationwide. The number of patients who had been ever started on ART increased from 900 at the beginning of2005 to more than 379,000 by mid-2012. In spite of these achievements in scaling up ART in the country, losses to follow-up and early mortality of patients on ART remain major gaps, with only 72% cumulative retention in care. In line with other sub-Saharan African countries, Ethiopia has been implementing different ART delivery models to scale up ART and improve retention in care. The use of these different ART delivery models, however, was based on little or no evidence on their feasibility, acceptability and effectiveness. Therefore, this PhD study was conducted to identify approaches for scaling up ART and develop a framework for improving retention in care in Ethiopia.
Methodology: A variety of study designs, including a review and analysis of routine program data, a retrospective cohort study, a systematic review of literature, and qualitative methods (including in-depth interviews and focus group discussions (FGDs) were used to achieve the objectives of the thesis.................................................................
Dissertation available at ACIPH Library |
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