Quality assurance for point-of-care testing: Ethiopia’s experience

In 2015, there were an estimated 729 517 people living with HIV in Ethiopia, including 95 094 children (aged 0–14 years), according to the 2015 Estimation and Projection Package/Spectrum modelling. HIV prevalence at the national level is 4.2% among urban populations and 0.6% rural populations; by gender, HIV prevalence is 1.52% among women and 1.0% among men.1 The HIV epidemic in Ethiopia is primarily associated with proximity to major transport corridors and concentrated in urban areas, where prevalence is 5.2% in cities with a population above 50 000 people compared with 2.8% in smaller cities and 0.6% in rural areas.2 Considerable progress has been made over the last decade in scaling up access to testing worldwide. The Federal Ministry of Health of Ethiopia adapted and started implementation of programmes to achieve the ambitious UNAIDS 90-90-90 goal, whereby 90% of HIV-positive people are diagnosed by 2020, 90% of HIV-positive patients are on antiretroviral therapy, and 90% of HIV-positive patients achieve viral suppression.3,4 However, the biggest challenges to achieving the 90-90-90 goals in Ethiopia are the first two goals. Currently, 40% of infected people are unaware of their HIV status, with 12.1% of those identified as HIV-positive being neither in care nor on antiretroviral therapy. There is also very limited information available on viral suppression. Therefore, closing these gaps would require some innovative approaches to find HIV-positive people unaware of their HIV status and link them to care and treatment, using both laboratory services and point-of-care (POC) testing ...