Outcomes of Antiretroviral Treatment: A Comparison between Hospitals and Health Centers in Ethiopia

Objective Ethiopia has a high prevalence of HIV infection. The objective of this study was to compare the outcomes of ART between hospital and health center levels. Methods Medical records of 1,709 ART patients followed for 24 months at two hospitals and three health centers in the Oromia region of Ethiopia were reviewed. Noted outcomes of ART were: currently alive and on treatment; lost to follow up; transferred out; and died. Results Of 1,709 HIV-positive patients started on ART between September 2006 and February 2007, 1,044 (61%) remained alive and were on treatment after 24-month follow up. 835 (57%) of ART patients at hospitals and 209 (83%) at health centers were retained in the program. Of those who were alive and receiving ART, 79% of patients at health centers and 72% at hospitals were clinically or immunologically improving. Also, 331 (23%) patients at hospitals were lost to follow up as compared to 24 (10%) of patients at health centers [RR at 95% CI: .358 (.231-.555)].While 11% was the mortality rate at hospitals, 5% of patients at health centers also died [RR at 95% CI: .360 (.192-.673)]. Conclusion ART at health centers was associated with more favorable outcomes than at hospitals. Evidently, continuous community conversations on care and treatment, expansion of ART to more health centers, peer education and counseling, and training of health extension workers on adherence counseling could further boost retention in the ART program.