IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 18, Issue 1 Ver. 1 (January. 2019), PP 05-08 www.iosrjournals.org DOI: 10.9790/0853-1801010508 ww.iosrjournals.org 5 | Page Grading the Level of Adherence to the Care and Treatment of Providers and Clients on Antiretroviral Therapy Program in Dessie Referral Hospital, South Wollo, Ethiopia Fasil Walelign Fentaye 1 , Prem Kumar 2 . 1 Asst. Professor of Public Health, College of Medicine & Health Sciences, Wollo University 2 Asst. Professor, College of Medicine & Health Sciences, Wollo University Corresponding Author: Dr. Prem Kumar Abstract: Background: Antiretroviral therapy (ART) is one of the interventions implemented to reduce morbidity and mortality due to HIV/AIDS. The evaluation of implementation process and its fidelity can give insight in to the “black-box” of the program and give on time information for improvement of the program. Objectives of the evaluation: The general objective of the study was to evaluate the quality and level of Adherence to the care and treatment among clients receiving of Antiretroviral Therapy Dessie Referral Hospital, Ethiopia, 2016. Methods: The evaluation was conducted in Dessie Referral Hospital, Dessie. Adherence, quality of delivery, facilitating strategies, participant responsiveness, recruitment and context are the components of process evaluation measured. Case study design was employed and qualitative and quantitative methods were utilized. Results: The faithfulness of the implementation of the program was found to be 61.30%. As the selected indicators of adherence showed, 54 .62% of the clients were given services in accordance with the national guideline. On average, only 46.46% of the clients on chronic care were receiving services for clinical or immunological assessment and 70.70% of the services related to prevention and management of common opportunistic infections were found adherent to the guidelines. Only 58.47% of the clients were initiated for antiretroviral therapy as needed by the guideline. Only 23.91% of the clients were given for Adherence assessment, counseling, and support. Conclusion and Recommendation: The adherence to implementation of the program was found low regardless to the high effort being delivered to the program by partners. It needs implementation urgent improvement packages by all relevant stakeholders. Keywords: Grading, Quality, Level of Adherence, Antiretroviral Therapy --------------------------------------------------------------------------------------------------------------------------------------- Date of Submission: 23-12-2018 Date of acceptance: 07-01-2019 --------------------------------------------------------------------------------------------------------------------------------------- I. Introduction Even if there were repeated reports of the now called “AIDS-related” illnesses before, July 1982 saw the first reports of AIDS among hemophiliacs and injection drug users (IDUs) in USA. In January 1983, Communicable Diseases Control (CDC) reported the first case of heterosexual transmission in USA [1]. HIV/AIDS is a major public health concern and cause of death in Africa. Joint United Nations Programme on HIV/AIDS (UNAIDS) has predicted outcomes for the region to the year 2025. These range from a plateau and eventual decline in deaths beginning around 2012 to a catastrophic continual growth in the death rate with potentially 90 million cases of infection [2]. In Ethiopia, the first HIV infections were detected from stored sera 1984 and the first two hospitalized AIDS patients were reported to Federal Ministry of Health (FMoH) in 1986 [3]. By the first sero-survey conducted in 1984-85 among military recruited individuals showed a prevalence of 0.07 percent. Since then, HIV/AIDS has become a major public health concern in the country, leading the Government of Ethiopia to declare a public health emergency in 2002 [4]. In order to make the universal access targets, expansion of the service and early diagnosis and initiation of ART is recommended by WHO in 2010. If these recommendations were to apply in Ethiopia, the number of PLHIV in need of ART increases by half. This makes the target much inaccessible than before. In addition to these, challenges for ART program are identified to be adherence, side effects, viral drug resistance, stigma and discrimination, cost of medications and treatment, and vulnerable groups [5]. A major concern of the Ethiopian national ART Program is how to sustain a lifelong supply of free ARV for all those on treatment. Since the ART program is supported by donors such as the Global Fund for HIV/AIDS, Tuberculosis and Malaria and the US government’s Ethiopian AIDS Emergency Plan, a complete dependence on donors’ commitment is unadvisable. In addition to these concerns, the available resources should be effectively and efficiently utilized to bring about the expected outcomes of the program. This necessitates assessment of the program components and activities in the context in which they are working. [6]. II. Objectives  To assess the socio-demographics of clients who are receiving ART centre, Dessie.  Evaluate whether the program components are delivered to the ART clients as designed in the national guidelines at Dessie Referral Hospital.  Determine the adherence level of the ART clients for care and treatment at Dessie Referral Hospital.