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Background <p>Although the beginning of antiretroviral therapy shortly after HIV infection results in better outcomes compared to waiting until symptoms appear, globally, there is a research gap in this area. Specifically, in Ethiopia, where the burden of the disease is high, little is known about the timing of the initiation, and previous studies assessed the area either qualitatively or quantitatively only. Therefore, this study aimed to assess the factors that affect the timely initiation of ART by employing a mix of both qualitative and quantitative methods in the North Shewa Zone of the Amhara region in Ethiopia.</p> Methods <p>A concurrent mixed method was used to gather information about antiretroviral therapy initiators in health facilities under the North Shewa zonal health department from February to April 2024. A total of 596 patients were selected using a multistage random sampling method for the quantitative study, while 28 participants were selected for the qualitative study using purposive sampling. The quantitative data were collected using structured data collection forms, and interview guides supported by an audio recorder were used for qualitative data. The quantitative part was uploaded to the Kobo toolbox for collection. Bivariable and multivariable logistic regression analyses were used to determine the relationships between the independent and dependent variables. The quantitative data were analyzed using Stata version 16.0 software, while the qualitative data were analyzed thematically by OpenCode version 4.03 software. The P-value of less than 0.05 was declared statistically significant. The qualitative data were analyzed thematically.</p> Result <p>The prevalence of delayed ART initiation was 22% (95% CI, 18.99–25.67%). Individuals who had ambulatory functional status (AOR 2.65, 95% CI 1.18–5.97), clients who took prophylaxis for opportunistic infection (AOR 5.77, 95% CI 2.16–15.41), prior opportunistic infection (AOR 3.93, 95% CI 1.89–8.16) and disclosure status (AOR 0.46, 95% CI 0.26–0.82) were significantly associated with delay ART initiation. Moreover, the qualitative findings revealed clinical, client, and provider/facility-related challenges.</p> Conclusion <p>The study highlights a high prevalence of delayed antiretroviral therapy initiation compared to the WHO test and treat target, with factors result disclosure status, functional status, baseline OI prophylaxis, and OI development. Therefore, client counseling should focus on disclosure, ensuring HIV-positive linkage to ART, and provision of OI prophylaxis and treatment as per the updated guidelines.</p> Clinical trial <p>Not applicable.</p>

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Delay antiretroviral therapy initiation and factors affecting it among patients on antiretroviral treatment at North Shewa zone public health facilities, Amhara region, Ethiopia, 2024: a mixed method approach

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  • 发表日期：

    2026年1月28日

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  • Melaku Walie Mersha,
  • Zenebe Abebe Gebreegziabher,
  • Awraris Hailu Bilchut

摘要

Background

Although the beginning of antiretroviral therapy shortly after HIV infection results in better outcomes compared to waiting until symptoms appear, globally, there is a research gap in this area. Specifically, in Ethiopia, where the burden of the disease is high, little is known about the timing of the initiation, and previous studies assessed the area either qualitatively or quantitatively only. Therefore, this study aimed to assess the factors that affect the timely initiation of ART by employing a mix of both qualitative and quantitative methods in the North Shewa Zone of the Amhara region in Ethiopia.

Methods

A concurrent mixed method was used to gather information about antiretroviral therapy initiators in health facilities under the North Shewa zonal health department from February to April 2024. A total of 596 patients were selected using a multistage random sampling method for the quantitative study, while 28 participants were selected for the qualitative study using purposive sampling. The quantitative data were collected using structured data collection forms, and interview guides supported by an audio recorder were used for qualitative data. The quantitative part was uploaded to the Kobo toolbox for collection. Bivariable and multivariable logistic regression analyses were used to determine the relationships between the independent and dependent variables. The quantitative data were analyzed using Stata version 16.0 software, while the qualitative data were analyzed thematically by OpenCode version 4.03 software. The P-value of less than 0.05 was declared statistically significant. The qualitative data were analyzed thematically.

Result

The prevalence of delayed ART initiation was 22% (95% CI, 18.99–25.67%). Individuals who had ambulatory functional status (AOR 2.65, 95% CI 1.18–5.97), clients who took prophylaxis for opportunistic infection (AOR 5.77, 95% CI 2.16–15.41), prior opportunistic infection (AOR 3.93, 95% CI 1.89–8.16) and disclosure status (AOR 0.46, 95% CI 0.26–0.82) were significantly associated with delay ART initiation. Moreover, the qualitative findings revealed clinical, client, and provider/facility-related challenges.

Conclusion

The study highlights a high prevalence of delayed antiretroviral therapy initiation compared to the WHO test and treat target, with factors result disclosure status, functional status, baseline OI prophylaxis, and OI development. Therefore, client counseling should focus on disclosure, ensuring HIV-positive linkage to ART, and provision of OI prophylaxis and treatment as per the updated guidelines.

Clinical trial

Not applicable.