The Outcome of HIV Patients on ART during the War and Siege in a Tertiary Hospital, Northern Ethiopia, a Cross-Sectional Study

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Abstract Introduction: HIV remains a serious global health pandemic, especially in developing countries where conflicts and political instabilities have persisted for decades. Although Tigray once had one of Ethiopia's best health systems, it has now completely collapsed due to the devastating two-year war and siege. Not only the lack of food but also the lack of medication has led to a loss of life and increased complications. Therefore, the aim of this study was to assess the outcomes of people living with HIV infection in Tigray. Method: Health facility-based independent repeated cross-sectional study designs were used to assess the outcome of HIV/AIDS patients during the war and siege in Ayder Comprehensive Specialized Hospital from October 2022 to November 2022. Descriptive statistics and logistic regression were applied. The results are presented with tables and figures. Results: A total of 440 participants were enrolled in prewar and during the war and siege periods with equal distribution to each. The mean ages were 39 and 41.2 years before and during the war. In this study, 63 (28.6%) in prewar, and 120 (54.5%) during the war and siege period had poor outcome status (p=0.000). Following the eruption of the war, 68.8% of ART drugs were not available for more than 12 months, and only 10.6% (23/218) and 30.7% (67/218) of the participants took IPT and CPT, respectively. During the crisis, services such as CD4 and viral load determinations were significantly affected (p=000); there were also frequent ART switches and an increased number of missed appointments (p=000). In prewar, severe malnutrition AOR 3.98 (95% CI-1.04-15.22), viral load determination AOR 0.07 (95% CI-0.03-0.18), and viral load >1000 copies AOR 6.68 (95% CI-2.91-15.32) were found to be associated factors with HIV outcome. During the crisis, AOR 2.56 (95% CI-1.14-5.74), CD4 count above 200 cells/ml AOR 0.27 (95% CI-0.08-0.97), patients on CPT 0.43 (95% CI-0.22-0.85), and frequent ART switches AOR 0.12 (95% CI-0.05-0.28) were the independent factors identified. Conclusion: The war and siege have led to significantly poor outcome status of HIV patients and disruption of services in HIV care.

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