Implementation Evaluation of Enhanced Adherence Counselling for High Viral Load Management at Jimma Medical Center, Oromia, Ethiopia

Abstract

Background: Despite substantial global effort made, HIV remained to be a leading cause of morbidity and mortality. Poor adherence to ART is identified as the most common reason for high viral load copies/ml of blood and subsequent treatment failure. WHO recommended enhanced adherence counselling as it is possible to prevent 70% of treatment failure with enhanced adherence counselling before shifting to another drug regimen since october 2016. Objective: The Aim of this evaluation study was to assess the implementation status of EAC in Jimma Medical Center by assessing Availability, Compliance and Satisfaction dimensions with pre-determined judgment parameter weighted values by stakeholders and factors that affect re-suppression rate of clients with high viral load from June 10-May 10 2023. Methods: Evaluation of the implementation status of Enhanced Adherence Counselling program in Jimma medical center,in Oromia region,Ethiopia was done by addressing Availability, Compliance and Satisfaction dimensions. Regression analysis was for re suppression rate. Service provision, HCWs interaction with clients and HCWs compliance were the themes used in the qualitative data analysis.The design of the evaluation was single case study design.Total of 174 clients and 8 HCWs were involved in the study.The techniques used were client exit interview, document review observation and in-depth interview by employing structured questionnaires, observational check-list, and semi-structured interview guide for in-depth interview.The tools prepared were pre-tested; the sample units were selected by population census technique for quantitative data and purposive sampling technique for all qualitative data. Data collectors were two nurses and one supervisor (intern physician) for quantitative data and orientation was given for data collectors and supervisorhow to fill kobo toolbox. Document review, observation and HCWs in-depth interview were done by the principal investigator.The study period was from May 10-June 10, 2023. Quantitative data was analysed using SPSS statistical packages version 23 and the qualitative data by thematic analysis manually.The evaluation standards were considered. Results:The overall availability, compliance and satisfaction scores were 84.51%, 88.23% and 86.04% by judgment parameter analysis respectively. The overall implementation status of the program was 86%. The overall retention rate was 89.1%. Statistically significant associations (p-value<0.05) were observed between the retention rate and marital status, client duration of stay on ART and client satisfaction level. ART patients who were married were 97.5% less likely to retain in their initial regimen (AOR= 0.03 95%CI: 0.003, 0.217). A 1.3% less likely retention was observed with decreased ART duration by 0.13 months (AOR= 0.98 95%CI: 0.987, 1.00). Patients with high satisfaction level were more than seven (7) times more likely to retain their first regimen (AOR= 7.14: 95%CI: 1.56, 32.70). Conclusion: Overall, most respondents were retained in their initial regimen 155(89.1%). Recommendation: Factors like marital status, duration of stay on ART and client satisfaction level should be taken into consideration to maintain the clients’ retention rate.