Bayisa Lami, Keno Tesfaye Shibiru, Ayana Gurmessa Enkosa, Abera Tesfaye, Akuma Adugna Olani
School of Nursing and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Oromiya, Ethiopia.
Department of Pediatrics and Child Health, School of Medicine, Institute of Health Sciences, Wollega University, Nekemte, Oromiya, Ethiopia.
J Int Assoc Provid AIDS Care. 2025 Jan-Dec;24:23259582241307467. doi: 10.1177/23259582241307467.
Decentralized human immunodeficiency virus (HIV) is a model adopted to improve access to antiretroviral therapy (ART) within communities and mitigate the burden of HIV treatment and care on health care facility. In Ethiopia, these services help HIV clients fully benefit from ART as they are able to access ART within their catchment areas. However, HIV clients still travel out of their catchment areas to commence the ART. Thus, this study aimed to assess the magnitude of out-of-catchment area ART initiation and its associated factors among people living with HIV (PLWHIV) in Western Ethiopia. This cross-sectional study was conducted among 423 PLWHIV from November 25 to December 30, 2025, at Nekemte Comprehensive Specialized Hospital. A systematic sampling method was used to recruit the study participants. Epi Data 3.1 and STATA 14.0 were used for data entry and analysis, respectively. Logistic regression analysis was computed to identify factors associated with out-of-catchment ART initiation among PLWHIV. Variables with a value <.25 from the bivariable analysis were entered into the multivariable analysis. Adjusted odds ratio (AOR) with 95% confidence interval (CI) and value <.05 were used to determine a significant association. A total of 423 PLHIV were included in the study. The mean age of study participants was 33.43 ± 9.79 years. One-fifth (22%) of the participants-initiated ART out of their catchment area with 95% (CI: 18.28-26.20). Participants who did not disclose their HIV (AOR = 4.39, 95% CI = 2.45-7.87), tested through voluntary counseling and testing (AOR = 3.99, 95% CI = 2.21-7.19), knowledgeable about HIV/AIDS (AOR = 2.15, 95% CI = 1.18-3.93), using traditional healing (AOR = 1.91, 95% CI = 1.03-3.55), being female (AOR = 2.42, 95% CI = 1.36-4.32), and perceived stigma (AOR = 3.41, 95% CI = 1.88-6.18) were significantly associated with out-of-catchment ART initiation. A substantial number of PLWHIV initiated ART outside their designated catchment areas. To address this, it is crucial to enhance HIV serostatus disclosure, combat discrimination associated with HIV/AIDS, and promote decentralized HIV care and ART services.
分散式人类免疫缺陷病毒（HIV）模式是为了改善社区内抗逆转录病毒疗法（ART）的可及性，并减轻医疗机构在HIV治疗和护理方面的负担而采用的。在埃塞俄比亚，这些服务有助于HIV感染者充分受益于ART，因为他们能够在自己的服务区域内获得ART。然而，HIV感染者仍会前往其服务区域之外的地方开始接受ART。因此，本研究旨在评估埃塞俄比亚西部HIV感染者（PLWHIV）中超出服务区域开始接受ART的比例及其相关因素。这项横断面研究于2025年11月25日至12月30日在 Nekemte综合专科医院对423名PLWHIV进行。采用系统抽样方法招募研究参与者。分别使用Epi Data 3.1和STATA 14.0进行数据录入和分析。进行逻辑回归分析以确定PLWHIV中与超出服务区域开始接受ART相关的因素。双变量分析中P值<0.25的变量被纳入多变量分析。使用调整后的优势比（AOR）、95%置信区间（CI）和P值<0.05来确定显著关联。共有423名PLHIV纳入研究。研究参与者的平均年龄为33.43±9.79岁。五分之一（22%）的参与者在其服务区域之外开始接受ART，95%置信区间为（CI：18.28 - 26.20）。未披露其HIV感染状况的参与者（AOR = 4.39，95% CI = 2.45 - 7.87）、通过自愿咨询和检测进行检测的参与者（AOR = 3.99，95% CI = 2.21 - 7.19）、了解HIV/AIDS的参与者（AOR = 2.15，95% CI = 1.18 - 3.93）、使用传统疗法的参与者（AOR = 1.91，95% CI = 1.03 - 3.55）、女性参与者（AOR = 2.42，95% CI = 1.36 - 4.32）以及感知到耻辱感的参与者（AOR = 3.41，95% CI = 1.88 - 6.18）与超出服务区域开始接受ART显著相关。大量PLWHIV在其指定的服务区域之外开始接受ART。为解决这一问题，加强HIV血清学状态披露、消除与HIV/AIDS相关的歧视以及推广分散式HIV护理和ART服务至关重要。
