The HIV epidemic and prevention response in Tigrai, Ethiopia: a synthesis at sub-national level.

Gebreab Barnabas,Hiwot Haile Selassie,Elisabetta Pegurri,Samuel Zemariam,Warren Naamara

doi:10.1186/1471-2458-14-628

Gebreab Barnabas, Hiwot Haile Selassie + Show 3 more

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https://doi.org/10.1186/1471-2458-14-628

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Abstract

BackgroundThis study, the first of its kind carried out at sub-national level in Ethiopia, was conducted in order to understand the dynamics of HIV transmission at regional and district level in Tigrai, Ethiopia; and to assess the adequacy of the HIV prevention response.MethodsRoutine data from health centres, data from available published and grey literature and studies, and primary qualitative information were triangulated to draw an updated picture of the HIV epidemic, HIV response and resource allocation in Tigrai.ResultsHIV prevalence in Tigrai was 1.8% in 2011 (EDHS). ANC data show that there has been a continuous decline in the prevalence of HIV in both urban and rural areas (urban: 14.9% in 2001 to 5.0% in 2009; rural: 5.2% in 2001 to 1.3% in 2009, ANC surveillance data). Variability in prevalence by zone and by district was observed. Possible reasons for higher prevalence include the presence of mobile seasonal workers, highly urbanized centres, a high concentration of economic activity and connecting roads and large commercial farms. Sex workers, seasonal farm workers and HIV negative partners in discordant couples were identified as being at higher risk. There is no evidence that programme planning is done on the basis of geographical variations in HIV prevalence and there are gaps in programmes and services for certain high risk population groups.ConclusionConsiderable efforts have been invested in the HIV prevention response in Tigrai however, these efforts do not fully respond to the actual needs. For a more effective and targeted HIV prevention response, studies and data syntheses need to be carried out at sub-national level in order to accurately identify local specificities and plan accordingly. Resources should be targeted towards areas where transmission is linked to sex work, mobility and the mobile labour workforce.

Highlights

This study, the first of its kind carried out at sub-national level in Ethiopia, was conducted in order to understand the dynamics of Human acquired immunodeficiency syndrome (HIV) transmission at regional and district level in Tigrai, Ethiopia; and to assess the adequacy of the HIV prevention response
A synthesis of HIV epidemiological data carried out in 2008 reported that the HIV epidemic in Ethiopia was heterogeneous with marked regional differences (Figure 1) and concluded that HIV programmes should not be led by national level statistics but instead targeted at districts or communities with higher prevalence; thereby requiring that research and data use is conducted at district level [8]
We further reviewed the Bibliography on HIV/Acquired immunodeficiency syndrome (AIDS) in Ethiopia [11] and references lists of identified studies ii) unpublished documents were collated from the Federal HIV Prevention and Control Office (FHAPCO) and the Tigrai Health Bureau, from Non-governmental organisation (NGO) working on HIV/AIDS in Tigrai and Masters level dissertations prepared by Addis Ababa University students on HIV/AIDS in Tigrai; iii) special effort was made to look for any information on high risk population groups such as sex workers, youth related behavioural studies, seasonal workers, alluvial gold miners, uniformed services, refugees, prisoners, long distance truck drivers, university students, discordant couples, street children, orphans and vulnerable children, men having sex with men and injecting drug users

Summary

Introduction

This study, the first of its kind carried out at sub-national level in Ethiopia, was conducted in order to understand the dynamics of HIV transmission at regional and district level in Tigrai, Ethiopia; and to assess the adequacy of the HIV prevention response. The rationale is to better understand the heterogeneity of the HIV epidemic and to determine the degree of alignment between HIV prevention resource allocation and where and how transmission is occurring [1]. A synthesis of HIV epidemiological data carried out in 2008 reported that the HIV epidemic in Ethiopia was heterogeneous with marked regional differences (Figure 1) and concluded that HIV programmes should not be led by national level statistics but instead targeted at districts or communities with higher prevalence; thereby requiring that research and data use is conducted at district level [8]. The Indian subcontinent offered a recent example of the benefit of utilizing data from different sources at a more granular or local level for planning and tailoring the HIV response [10]

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Conclusion