The public health approach to antiretroviral treatment (ART) service scale-up in Ethiopia: the first two years of free ART, 2005-2007.

BACKGROUND

The World Health Organization has proposed a public health approach to antiretroviral therapy (ART) to promote scaling up access to treatment in developing countries. Ethiopia has been implementing this approach for ART provision since 2005.

OBJECTIVE

To describe the Ethiopian experience in the scale-up of ART services using the public health approach.

METHODS AND PATIENTS

This is a retrospective study of patients who were started on ART since 2005. We used data from the monthly HIV Care and ART Update reports of the Ethiopian AIDS Resource Center, analyzing the trend of ART service provision and site expansion from the second quarter of 2005 to the second quarter of 2007. Data were analyzed for 1) patients enrolled for chronic HIV/AIDS care, 2) patients started on ART and 3) facilities providing ART.

RESULTS

The number of ART sites increased from 3 in early 2005 to 265 in early June 2007. During that time, the number of ART patients increased from 8,276 to 92,450 and of patients receiving chronic HIV/AIDS care from 13,773 to 156,729. The proportion of females and children on ART and of patients residing outside of Addis Ababa also sharply increased.

CONCLUSION

The sharp increase in the number of sites providing ART service and patients started on ART is mainly due to the simplification and standardization of ART delivery models and employing nurses for ART provision. The public health approach is an innovative strategy to scale up ART service provision to poor and rural communities where it hasn't been possible to provide the service based on the traditional delivery model.