Background: Pre-ART, defined as all services provided between the timeframe of a patient testing positive to HIV till the first dose of antiretroviral, can be a crucial period in patient retention and attrition. Therefore, this study aims to examine practices around facility level Pre-ART throughout Ethiopia based on discussions with clinicians and facility staff and to determine potential considerations for country specific Pre-ART guidelines and future public health practice in other resource constrained countries.
Methods: Framework Analysis was applied to secondary data derived from key informant interviews with facility level clinicians and staff in Ethiopia regarding themes around Pre-ART. We identified significant data surrounding the practices and processes currently taking place at a sample of six sites. An exploratory understanding of the challenges and best practices surrounding Pre-ART was highlighted and themes to be taken under consideration by a Pre-ART guideline-working group in Ethiopia were noted.
Results: Study sites indicated various service provisions and practices around Pre-ART care along the testing to treatment cascade. Patient tracking, Cotrimoxazole prescription, access to CD4 machines, and data management practices varied by facility. Similar practices around linkages from testing to treatment were noted across facilities.
Conclusion: Combining the local resource reservoir with a national guideline plan allow for the ideal meshing of top down and bottom up implementation and will minimize the pitfalls of system wide rollout of Pre-ART guidelines. The ultimate goals behind any Pre-ART program should be to provide a measure of care and support which patient’s value. The benefits then derived from this valuation result in the key public health outcomes, namely in terms of patient retention, early initiation onto ART, and continued monitoring of patient progress across the testing to treatment cascade. Meeting these goals and objectives hinges on a collaborative effort and one that bridges the divide of policy makers and practitioners
