HIV care continuum outcomes in Ethiopia: Surrogates for UNAIDS 90–90–90 targets for ending HIV/AIDS

Abstract Introduction How the UNAIDS 90-90-90 targets for ending HIV/AIDS by 2030 progressing have not yet been assessed in many countries including Ethiopia. We assessed HIV care continuum outcomes as a complex surrogate markers for the 90-90-90 targets. Methods Data were collected from 12 years anti-retroviral therapy (ART) records. For UNAIDS diagnosis target, early HIV diagnosis was considered as a surrogate marker. For treatment target, number of people on ART, number of people who discontinued from ART or transferred out, and number of people who had fair or poor adherence were used as surrogates. For viral suppression target, number of people with treatment success (combination of immunological and clinical) was used as a surrogate marker. Results 8172 patients were enrolled for HIV cares in the period between 2003–2015. For the diagnosis target, 34.5% patients knew their status early (43%-children, 33%-adults). For the treatment target, 65% patients received ART, 1154 (21.9%) patients discontinued from ART, 1015 (19.3%) patients on ART transferred out to other sites, 916 (17%) of patients on ART had fair or good adherence. For the virological suppression target, 80.7, 80.3% and 65.8% of patients had immunological, clinical and treatment success displaying an estimated 66% of patients achieved the target. Conclusion The finding reflects that an estimated 35% of patients knew their status timely, 65% of diagnosed patients received treatment and 66% of patients on ART achieved viral suppression. This is very far from the UNAIDS 90-90-90 targets underscoring the need for rigorous innovative methods such as unmanned aerial systems (or drones) for transporting laboratory specimens, immediate or same day ART initiation, community distribution of ART, runaway packs during conflict, and use of GenXpert for HIV viral load testing would significantly help to hit the target. Question: How resource constraint countries attain the 90-90-90 targets?