Assefa Yibeltal, Gilks Charles F, Lynen Lutgarde, Williams Owain, Hill Peter S, Tolera Taye, Malvia Alankar, Van Damme Wim
The University of Queensland, School of Public Health, Brisbane, Australia; Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
The University of Queensland, School of Public Health, Brisbane, Australia.
Int J Infect Dis. 2017 Jul;60:70-76. doi: 10.1016/j.ijid.2017.05.012. Epub 2017 May 19.
Ethiopia is one of the countries which has scaled up antiretroviral treatment (ART) over the past decade. This study reviews the performance of the ART program in Ethiopia during the past decade, and identifies successes and weaknesses toward ending AIDS in the country.
A review and synthesis of data was conducted using multiple data sources: reports from all health facilities in Ethiopia to the Federal Ministry of Health, HIV/AIDS estimates and projections, and retrospective cohort and cross-sectional studies conducted between 2005/6 and 2014/15.
The ART program has been successful over several critical areas: (1) ART coverage improved from 4% to 54%; (2) the median CD4 count/mm at the time of ART initiation increased from 125 in 2005/6 to 231 in 2012/13; (3) retention in care after 12 months on ART has increased from 82% to 92%. In spite of these successes, important challenges also remain: (1) ART coverage is not equitable: among regions (5.6%-93%), between children (25%) and adults (60%), and between female (54%) and male patients (69%); (2) retention in care is variable among regions (83%-94%); and, (3) the shift to second-line ART is slow and low (0·58%).
The findings suggest that the ART program should sustain the successes and reflect on the shortcomings toward the goal of ending AIDS. It is important to capitalize on and calibrate the interventions and approaches utilized to scale up ART in the past. Analysis of the treatment cascade, in order to pinpoint the gaps and identify appropriate solutions, is commendable in this regard.
埃塞俄比亚是过去十年中扩大抗逆转录病毒治疗（ART）规模的国家之一。本研究回顾了埃塞俄比亚过去十年中ART项目的实施情况，并确定该国在终结艾滋病方面的成功与不足。
使用多种数据源进行数据回顾与综合分析：埃塞俄比亚所有卫生设施向联邦卫生部提交的报告、艾滋病毒/艾滋病估计数和预测，以及2005/6年至2014/15年期间进行的回顾性队列研究和横断面研究。
ART项目在几个关键领域取得了成功：（1）ART覆盖率从4%提高到54%；（2）开始接受ART时的CD4细胞计数中位数/mm从2005/6年的125增加到2012/13年的231；（3）接受ART治疗12个月后的治疗留存率从82%提高到92%。尽管取得了这些成功，但仍存在重要挑战：（1）ART覆盖率不均衡：在各地区之间（5.6%-93%）、儿童（25%）和成人（60%）之间以及女性患者（54%）和男性患者（69%）之间；（2）各地区的治疗留存率各不相同（83%-94%）；（3）向二线ART的转换缓慢且比例较低（0.58%）。
研究结果表明，ART项目应保持成功并反思不足之处，以实现终结艾滋病的目标。利用并校准过去扩大ART规模时所采用的干预措施和方法很重要。在这方面，分析治疗流程以找出差距并确定适当解决方案值得称赞。
