PROCESS EVALUATION OF ART PROGRAM AMONG ADULT HIV/AIDS PATIENTS AT WOLDIA GENERAL HOSPITAL, NORTH EAST, ETHIOPIA

Abstract

Abstract Background: Ethiopia introduced ART program in 2003 in selected health facilities following the issuance of the National Antiretroviral Drugs Supply and Use Policy in 2002.ART was instrumental to mitigate the burden of HIV pandemic in Ethiopia and other resource limited settings. ART program is one of the comprehensive programs designed for improving Quality of Life of People Living with HIV and reducing morbidity, mortality, and overall health care cost. Although significant progress has been made towards ending AIDS as a public health threat, many gaps in service access and quality remain. Additionally implementing ART program has challenges like poor drug adherence, higher prevalence of side effects, drug resistance, stigma and discrimination. Even though implementing the program has these challenges as much as my review, there are limited evaluations done in Ethiopia about the implementation status of adult ART program. Evaluation objective: The objective of this evaluation was to evaluate the ART service implementation status provided by health care workers in Woldia General Hospital, North East, Ethiopia, 2020. Methods: A case study design with mixed method approach was used to evaluate the process of ART program. A sample of 402 HIV/AIDS patients who were on follow up in ART clinic were interviewed using systematic random sampling technique using interviewer administered structured questionnaire. Additionally 384 patient charts were selected using simple random sampling technique and a total of thirty observations of health care workers were conducted to assess the implementation status of ART program and six key informants interview (administrative staffs and team leaders) were interviewed purposefully using semistructured questionnaire.

The quantitative data was entered in to Epi data version 4.6 and exported to STATA version

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for analysis. Qualitative data were transcribed and translated to English and coded and thematized and analyzed manually. The overall implementation status of the program was determined based on pre- set judgment criteria. Degree of association between satisfaction and independent variables were assessed using bivariable analysis and those having p-value less than 0.2 were taken as a candidate for multivariable logistic regression analysis to identify variables having p< 0.05 were taken as factors associated with satisfaction. The qualitative data was analyzed based on pre-defined and emerged themes. Results; The overall program implementation according to the national guideline found to be 74.8%.Resources recommended by the national guide line with availability of 88.4%, adherence of health care workers towards the guide line was 66% and level of patient

satisfaction towards the service was 77%.There was a problem of availability of test kits, Opportunistic infection treatment drugs, plumpinut, and viral load test. There was also a problem of proper handling of patient charts, data incompleteness and most laboratory tests were not done according to the national guide line. Additionally refreshment training for health care providers was not given. Being able to disclose (AOR=3.25; 95% CI; 1.46, 7.26) and waiting time <30 minutes (AOR=3.88; 95%CI; 1.26, 11.97) were factors associated with satisfaction. Conclusion: The overall level of program implementation was very good. However, patient satisfaction (lower than the national target of 85%) and compliance with the national guide line was low. There is a need to improvement in the overall program implementation according to the judgment criteria. Opportunistic infection treatment drugs, plumpinut, viral load test and HIV test kits were not available. Most laboratory tests were not done as per the guide line. Being able to disclose and waiting time for <30 minutes were factors associated with satisfaction. Therefore, the hospital shall to provide unavailable resources, and the health care providers shall perform according to the national guide line, proper handling of patient charts and record the services properly provided to clients in their chars for better program implementation. Moreover, patients shall be advised to disclose their sero-status and the hospital shall device strategies to shorten the waiting time to improve patient satisfaction. Key words: Evaluation, process, ART program, Ethiopia.