Exploratory Analysis of Time from HIV Diagnosis to ART Start, Factors and effect on survival A longitudinal follow up study at seven teaching hospitals in Ethiopia

Abstract

Background: the HIV care in Ethiopia has reached 79% coverage.The timeliness of the care provided at the different levels in thecourse of the disease starting from knowing HIV positive status toART initiation is not well known. This study intends to explore thetiming of the care seeking, the care provision and associatedfactors.Methods: This is a longitudinal follow-up study at seven universityhospitals. Patients enrolled in HIV care from September 2005 toDecember 2013 and aged ≥14 years were studied. Different times inthe cascade of HIV care were examined including the durationfrom date HIV diagnosed to enrollment in HIV care, duration fromenrollment to eligibility for ART and time from eligibility toinitiation of ART. Ordinal logistic regression was used toinvestigate their determinants while the effect of these periods onsurvival of patients was determined using cox-proportional hazardsregression.Results: 4159 clients were studied. Time to enrollment after HIVtest decreased from 39 days in 2005 to 1 day after 2008. It tooklonger if baseline CD4 was higher, and eligibility for ART wasassessed late. Young adults, lower baseline CD4, HIVdiagnosis<2008, late enrollment, and early eligibility assessmentwere associated with early ART initiation. Male gender, advanceddisease stage and lower baseline CD4 were consistent risk factorsfor mortality.Conclusion and recommendation: Time to enrollment and durationof ART eligibility assessment as well as ART initiation time aftereligibility is improving. Further study is required to identify whymortality is slightly increasing after 2010.