Implications of adopting new WHO guidelines for ART initiation in Ethiopia

Purpose: In 2010, WHO issued new guidelines for initiating ART for patients with a CD4 cell count ≤350 instead of ≤200. The implications for Ethiopia were examined by estimating the increase in patient load this policy change would create. Data and methods: CD4 test data were reviewed from all 9,842 pre-ART and ART patients (age range 6-88 years) at 19 high patient load health centers in Addis Ababa and the regions of Amhara, Oromia, SNNPR and Tigray between April and May 2010. At the 12 most accessible health centers, over 7,000 patient records were independently reviewed one month later to assess data validity. All health centers received support from the USAID/PEPFAR funded HIV/AIDS Care and Support Program, Ethiopia's main partner in making HIV services universally accessible. Results: Increasing the CD4 starting point for initiation of ART to 350 will increase the patient load on ART at HCs in Ethiopia by 23%. Data verification showed less than 5% error on all CD4 counts. Implications: As Ethiopia is rapidly expanding comprehensive HIV services to health centers, thereby offloading patients from hospitals and making services available to many more HIV+ people in the country, a 23% increase in patients needing ART has significant cost and logistics implications that need to be carefully planned for before adopting the new WHO guidelines in resource poor settings like Ethiopia.