Towards achieving the fast-track targets and ending the epidemic of HIV/AIDS in Ethiopia: successes and challenges

Background: Ethiopia has adopted the global plan to end the epidemic of HIV/AIDS. We aimed to assess the progress toward achieving this plan.

Methods: A review and analysis of national population-based surveys, surveillances and routine program data was executed. Data analysis was conducted using Excel 2016 and Stata 14: Data Analysis and Statistical Software, StataCorp LP, College Station, Texas, USA.

Findings: Between 2011 and 2016, the number of HIV-related deaths dropped by 58% while that of new HIV infections dropped by only 6%. Discriminatory attitudes declined significantly from 77.9% (95%CI 77.3,78.4) in 2011 to 41.5% (95%CI 40.6,42.4) in 2016. Around 79% of adult people living with HIV (PLHIV) were aware of their HIV status; 90% of PLHIV who were aware of their HIV status were taking antiretroviral treatment (ART); and, 88% of adult PLHIV on ART had viral suppression in 2016. The proportion of people age 15-49 years ever tested for HIV and received results increased from 39.8% (95%CI 39.2,40.4) in 2011 to 44.8% (95%CI 44.2,45.4) in 2016. This proportion was very low among children below age 15 years: only 6.2% (95%CI 5.9,6.5). Among regions, HIV testing coverage varied from 13% to 72%. Female sex workers had lower coverage for HIV testing (31%) and ART (70%) than the national average in adult population. International funding for HIV dropped from more than 1.3 billion in 2010-12 to less than 800 million in 2016-18.

Conclusion: Ethiopia is on track to achieve the targets for HIV testing, ART, viral suppression and AIDS-related deaths, but not for reductions in new HIV infections, discriminatory attitudes and equity. Ending the epidemic of HIV/AIDS requires a combined response, including prevention and treatment, tailored to key populations and locations, and increased funding.