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    EVALUATING THE PROCESS OF ADULT ANTIRETROVIRAL THERAPY SERVICE DELIVERY IN AYDER COMPREHENSIVE SPECIALIZED HOSPITAL, MEKELLE, TIGRAY, ETHIOPIA
    (Mekelle University, 2024-10-20) Hailay Teklu Kidanu
    Background: Antiretroviral therapy (ART) is vital for the prevention of morbidity and mortality in HIV-positive patients. It also helps prevent new infections, improves quality of life and increases productivity. ART is initiated in all adults, pregnant and lactating women, and adolescents with HIV, regardless of World Health Organization clinical stage or CD4 T lymphocyte count. This evaluation aimed to evaluate the delivery of ART services at Ayder Comprehensive Specialized Hospital. Objective: To evaluate the process of adult ART service delivery in Ayder Comprehensive Specialized Hospital, Mekelle, Tigray, Ethiopia, 2024. Method: A case study design with formative evaluation approach was used, employing both qualitative and quantitative methods. The evaluation focused on the availability of essential resources, healthcare providers compliance to standard guidelines, and service accommodation dimensions. Quantitative data were collected from August 18-September 16/2024 by reviewing a sample of 142 ART clients’ clinical records and documents using structured format and entered and analyzed using SPSS 27.0. Sample size for charts review was calculated using a single population proportion formula and corrected for finite population. Qualitative data were obtained using evaluator administered unstructured questionnaire, five key informants and ten clients were interviewed, and the data were analyzed thematically. Results: Among ART clients who used the ART service in ACSH, 95.6% were adults. The overall rate of ART service for adults was 80.5% and was judged to be “good”. Resource availability was 76.5%, healthcare provider compliance to standard guidelines to enable sound ART service was 81.9%, and service accommodation was 82.6%. The level of provider compliance in assessing patients for ARV drugs adherence was 99.3% and judged as “very good”. In addition, the result of viral load test below 1000 copies/ml was 90.8%, corresponding to suppressed or low viremia, and was rated as “Very Good”. The most recent CD4 cell count result above 350 cells/µLwas 64.8%, with a mean CD4 cell count of 496 cells/µL (SD 282.692). Provision of co-trimoxazole prophylaxis was 83.8%, which is “good”, and monitoring of clients' body weight was 99.3%, and this was judged as “very good” according to predetermined evaluation criteria. However, TPT provision was only 20.4%, which is “poor and in need of urgent improvement”. The overallXIII acceptance of the service by users was rated at 80%. Only 71.1% of ART patients adhered to prescribed follow-up plans. Conclusion and Recommendations: The majority of resources recommended in the national ART implementation guideline were available in the clinic. However, it became apparent that there are limitations to the sustainability of ART medications, laboratory tests, and nutritional supplements. In addition, interruptions in the function of the CD4 cell count, and lack of the essential OI preventive drugs were demonstrated. It was also found that there were insufficient rooms to provide follow-up service, raising concerns about user privacy. Both the technical compliance of the providers and the acceptance of the service by ART users were rated as "good.". The clinic's ART service is rated 80.5% in terms of overall operational quality. This condition requires special attention in order for the institution to offer consistent service provision to all clients. As a result, particular suggestions were given in view of the findings.