Abstract
BackgroundEthiopia Population-based HIV Impact Assessment findings showed that in Addis Ababa, only 65.2% of people living with HIV (PLHIV) know their status. We present the enhanced HIV/AIDS data management and systematic monitoring experience in Addis Ababa City Administration Health Bureau (AACAHB).MethodsAACAHB established a command-post with leadership and technical team members from the health bureau, 10 sub-city health offices, and non-governmental stakeholders. The command-post improved governance, standardized HIV program implementation, and established accountability mechanism. A web-based database was established at each health facility, sub-city, and AACAHB level. Performance was scored (green, ≥75%; yellow, 50–74%; red, < 50%). The command-post reviewed performance on weekly basis. A mentorship team provided a weekly site-level support at underperforming public and private health facilities. At facility level, quality of data on recording tools such as registers, and individual medical records were maintained through continued review, feedback mechanisms and regular consistency check of data. Percentage and 95% confidence interval were computed to compare the improvement in program performance over time.ResultsAfter 6 months of intervention period, the monthly New HIV case finding in 47 health facilities increased from 422 to 734 (1.7 times) and treatment initiation increased from 302 to 616 (2 times). After 6 months, the aggregate scoring for HIV testing at city level improved from yellow to green, HIV case finding improved from red to green, and treatment initiation improved from red to yellow. An increasing trend was noted in HIV positive case finding with statistically significant improvement from 43.4% [95% Confidence Interval: 40.23–46.59%] in May 2019 to 74.9% [95% Confidence Interval: 72.03–77.6%] in September 2019. Similarly, significant improvement was recorded for new HIV treatment from 30.9% [95% Confidence Interval: 28.01–33.94%] in May 2019 to 62.5% [95% Confidence Interval: 59.38–65.6%] in September 2019.ConclusionsRegular data driven HIV program review was institutionalized at city, sub-city and health facility levels which further improved HIV program monitoring and performance. The performance of HIV case finding and treatment initiation improved significantly via using intensified monitoring, data driven performance review, targeted site-level support based on the gap, and standardized approaches.
Highlights
Ethiopia Population-based Human immunodeficiency virus (HIV) Impact Assessment findings showed that in Addis Ababa, only 65.2% of people living with HIV (PLHIV) know their status
Regular data driven HIV program review was institutionalized at city, sub-city and health facility levels which further improved HIV program monitoring and performance
In 2018, Ethiopia Population-based HIV Impact Assessment (EPHIA) findings showed that in Addis Ababa, HIV prevalence is 3.1% among adults aged 15–49 years and that only 65.2% of PLHIV are aware of their status, resulting in an estimated detection gap of 26,764 PLHIV to reach the first of the 90–90-90 targets established by the Joint United Nations Program on HIV/ AIDS (UNAIDS): 90% of PLHIV know their status; of these, 90% are receiving antiretroviral therapy (ART); and of these, 90% have viral load (VL) suppression [6]
Summary
Ethiopia Population-based HIV Impact Assessment findings showed that in Addis Ababa, only 65.2% of people living with HIV (PLHIV) know their status. Spatial distribution of HIV cases in the three Ethiopian Demographic and Health Surveys (2005, 2011, and 2016) showed that Addis Ababa city and the surrounding areas continue to have the highest prevalence of HIV in Ethiopia [5]. In 2018, Ethiopia Population-based HIV Impact Assessment (EPHIA) findings showed that in Addis Ababa, HIV prevalence is 3.1% among adults aged 15–49 years and that only 65.2% of PLHIV are aware of their status, resulting in an estimated detection gap of 26,764 PLHIV to reach the first of the 90–90-90 targets established by the Joint United Nations Program on HIV/ AIDS (UNAIDS): 90% of PLHIV know their status; of these, 90% are receiving antiretroviral therapy (ART); and of these, 90% have viral load (VL) suppression [6]. In Addis Ababa, EPHIA showed that only 63.3% of those who know their HIV-positive status were receiving ART, and the VL suppression rate was low (58.2%) [7]
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