Symbolic image representing HIV treatment access in Ethiopia.

Equal Access, Equal Outcomes? Unpacking HIV Treatment Success in Ethiopia

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Avery Sinclair in Health & Wellness December 2025 • 4 min read.

"A new study reveals that primary healthcare centers can deliver antiretroviral therapy just as effectively as hospitals, challenging long-held beliefs."


For years, hospitals have been seen as the gold standard for HIV treatment, particularly in resource-limited settings. The perception has been that their advanced facilities and specialist doctors lead to better outcomes for patients on antiretroviral therapy (ART). But what if that wasn't the whole story?

A groundbreaking study conducted in the Oromia region of Ethiopia is challenging these long-held assumptions. Researchers compared the survival rates and treatment outcomes of adult patients starting ART at primary healthcare centers versus those at hospitals. The findings could reshape how HIV care is delivered, not only in Ethiopia but in similar countries worldwide.

This article dives into the details of this retrospective cohort study, exploring its methodology, key findings, and the implications for the future of HIV treatment accessibility and effectiveness. Get ready to rethink where quality HIV care can be delivered.

Primary Care vs. Hospitals: Leveling the Playing Field in HIV Treatment

Symbolic image representing HIV treatment access in Ethiopia.

The Ethiopian study, a retrospective cohort analysis, examined data from 1,895 adult patients newly starting ART between October 2010 and January 2014. The patients were treated in either primary health care centers or hospitals within the Oromia region. Researchers meticulously tracked their progress, focusing on key outcomes like survival rates (time to death) and instances of patients being lost to follow-up (LTFU).

The results were surprising. After analyzing the data, the researchers found:

  • Comparable Survival: The median survival probability was statistically similar between the two groups, meaning patients at primary care centers fared just as well as those in hospitals (P-value = 0.11).
  • No Increased Risk: Receiving treatment at a primary health care center did not increase the risk of adverse outcomes (death or LTFU).
  • Key Predictors: Regardless of the treatment facility, factors like advanced HIV disease stage at the start of treatment, poor functional status (e.g., being bedridden), and low adherence to ART drugs were the strongest predictors of negative outcomes.
These findings highlight that when standardized treatment protocols are followed, and patients receive adequate support, primary healthcare centers can be a safe and effective alternative to hospitals for ART delivery. It suggests that decentralizing HIV services doesn't necessarily compromise the quality of care.

Implications and the Path Forward

The Ethiopian study carries significant implications for HIV treatment strategies, particularly in resource-limited settings. Decentralizing ART services to primary healthcare centers can ease the burden on overcrowded hospitals, bringing treatment closer to patients and potentially improving access, especially in rural areas.

However, it's crucial to acknowledge that simply shifting services isn't enough. The study also underscores the importance of:

<ul><li><b>Early Diagnosis and Treatment:</b> Getting patients into care and on ART as early as possible remains paramount.</li><li><b>Adherence Support:</b> Robust support systems are needed to ensure patients adhere to their medication regimens.</li><li><b>Addressing Underlying Factors:</b> Socioeconomic factors and other health conditions that can impact treatment outcomes need to be addressed holistically.</li></ul><br>By focusing on these key areas, countries can leverage the potential of primary healthcare centers to expand access to effective HIV treatment, ultimately improving the health and well-being of their populations.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1186/s12913-016-1818-3, Alternate LINK

Title: Comparison Of Survival In Adult Antiretroviral Treatment Naïve Patients Treated In Primary Health Care Centers Versus Those Treated In Hospitals: Retrospective Cohort Study; Oromia Region, Ethiopia

Subject: Health Policy

Journal: BMC Health Services Research

Publisher: Springer Science and Business Media LLC

Authors: Abebe Megerso, Sileshi Garoma

Published: 2016-10-18

Everything You Need To Know

1

What was the main goal of the study?

The study compared the success of antiretroviral therapy (ART) delivery in primary healthcare centers and hospitals. The findings revealed that primary healthcare centers achieved comparable survival rates and treatment outcomes as hospitals for adult patients starting ART, challenging the assumption that hospitals are always superior for HIV treatment.

2

How did the researchers conduct the study?

The study's methodology involved a retrospective cohort analysis of 1,895 adult patients initiating antiretroviral therapy (ART) between October 2010 and January 2014. Researchers examined patient data from primary health care centers and hospitals in the Oromia region of Ethiopia, focusing on survival rates and instances of patients being lost to follow-up (LTFU) to compare outcomes.

3

Why is this study important?

The significance lies in the potential to reshape HIV care delivery, particularly in resource-limited settings. Decentralizing antiretroviral therapy (ART) services to primary healthcare centers can alleviate the strain on hospitals, improve patient access, especially in rural areas, and potentially reduce costs, all while maintaining comparable treatment outcomes, as demonstrated by the comparable survival rates found in the study.

4

What were the key findings of the study?

The study found that the survival rates and treatment outcomes for patients receiving antiretroviral therapy (ART) were statistically similar whether they received care at primary healthcare centers or hospitals. Factors such as the stage of HIV disease at the start of treatment, functional status, and adherence to ART drugs were strong predictors of outcomes, regardless of the treatment setting.

5

What are the implications of these findings?

The implications of the study include the potential to decentralize antiretroviral therapy (ART) services. The study's results suggest that primary healthcare centers can effectively deliver ART, which can improve access to treatment, especially in areas where hospitals may be difficult to reach. This could also reduce the burden on hospitals, making HIV treatment more accessible and potentially improving patient outcomes across the board.

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