Challenges in Achieving the UNAIDS 95-95-95 Targets: Evaluation of the Antiretroviral Therapy Program among Adult HIV/AIDS Patients at Woldia General Hospital, Northeast Ethiopia

Seada Seid^1*Mezgebu Yitayal²Lake Yazachew Amogne²Abdurahman Arega³Ali Yimer^1,4*

• ¹Department of Public Health, College of Health Sciences, Woldia University, Woldia, Ethiopia
• ²Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Amhara Region, Ethiopia
• ³College of Business and Economics, Department of Management, Woldia University, Ethiopia, Woldia, Ethiopia
• ⁴Woldia University, Woldiya, Ethiopia

Background: In Ethiopia and other low-income countries antiretroviral therapy program(ART) faces various several challenges, including poor medication adherence, a higher incidence of adverse effects, drug resistance, and persistent issues of discrimination and stigma. This study aimed to evaluate the implementation process of the antiretroviral therapy (ART) program among adult HIV/AIDS patients at Woldia General Hospital in Northeast Ethiopia.Between June 1 and June 30, 2020, a mixed-method case study was conducted. A total of 384 patient charts were reviewed, and 402 individuals living with HIV/AIDS were surveyed. Additionally, six key informant interviews were conducted, and 30 observations of healthcare professionals were recorded.The quantitative data were entered into Epidata version 4.6 and subsequently transferred to STATA version 14 for analysis. Bivariable analysis was performed to identify variables with p-values less than 0.2 as potential candidates for multivariable logistic regression, with statistical significance set at p<0.05. The qualitative data underwent transcription, translation into English, coding, thematic analysis, and manual interpretation. The overall implementation status of the program was assessed based on predefined evaluation criteria.Results; According to national guidelines, 74.8% of the program was implemented consistently. Patient satisfaction was reported at 77%, healthcare personnel adherence to guidelines at 66%, and resource availability at 88.4%. Key challenges included shortages of test kits, Plumpy'Nut, and medications for opportunistic infections, as well as inadequate data management and issues with patient file handling.Additionally, a significant concern was that many laboratory tests were conducted outside the country's established guidelines. Factors associated with patient satisfaction included the ability to disclose their condition (AOR = 3.25; 95% CI: 1.46, 7.26) and a waiting time of less than 30 minutes (AOR = 3.88; 95% CI: 1.26, 11.97).The program was executed at a relatively high standard. However, patient satisfaction did not meet the national target of 85%, and adherence to national guidelines was minimal. Essential supplies such as HIV test kits, Plumpy'Nut, viral load tests, and medications for opportunistic infections were not consistently available. Additionally, most laboratory tests were not conducted in accordance with the guidelines. Factors influencing satisfaction included the ability to disclose health status and waiting times of under thirty minutes.