HIV Treatment and Care Services in Yemen: Implications Of Internal Country Conflicts

Abstract

Introduction: Yemen has been experiencing an internal conflict since 2011 influencing the HIV treatment program. Objective: This study aims to assess the implications of internal country conflicts on HIV-treatment program performance for policy formulation, programme planning and national resource mobilization. Methodology: Secondary data analysis and mixed methods of quantitative and qualitative were used. Data analysis was conducted through SPSS. The sample size was 84 for quantitative and 35 for qualitative. Results: Mean age of PLHIV was 40.5 (±10.6 SD) years and 64.3% were males, 42.9% married, and 9.5% had HIV-positive children. 84.5% of PLHIV have more than one symptom at the first visit and most of them presented late with clinical stages 3 and 4. HIV/TB co-infection represents 9.5% for pulmonary TB and 2.4 for extrapulmonary TB. Access to ART during the conflict significantly depended on the residence of PLHIV (p < 0.0005) and (95% confidence interval (CI): 2.48 to 1.22) and on the availability of the clinic (p < 0.0005) with (95% CI: 1.007 to 1.953). 41.7% of PLHIV were LTFU, 25.7% gave conflict as the main reason, 66.6% of PLHIV experienced a change in ART regimen per lifetime, and 70.9% of them gave ARV stockout as the main reason. Most PLHIV had difficulty accessing services during conflict. Most PLHIV (13/20) were not comfortable with the quality of service. All HCPs mentioned that the HIV-treatment program is funded only by the Global Fund and experienced shortages of ARVs before and during the conflict. Conclusion: It is important to have national policies and resources for HIV-treatment programs so one can ensure the sustainability of services.