Gaps in the HIV Care Continuum: Late Presentation, Disengagement From Care and Lack of Viral Suppression in People With HIV in Ethiopia

Objectives People living with HIV (PLHIV) with ongoing viremia have the potential for onward transmission. Identifying such individuals throughout the care continuum is therefore important for reducing HIV incidence. This study aimed to characterize persons at gaps at different stages of the HIV care continuum in Central Ethiopia. Methods PLHIV ≥ 15 years were recruited between 2022 and 2024. We considered late presentation to care, recent history of disengagement from care, and unsuppressed viral load (VL) during antiretroviral therapy (ART) as representing gaps in the care continuum. Characteristics of newly enrolled participants were compared regarding late presentation to care (CD4 < 350 cells/mm 3 and/or WHO Stage III/IV). ART recipients were compared with regard to VL category (> 1000 vs. ≤ 1000 copies/mL), and individuals with recent history of disengagement were compared to virologically suppressed ART recipients. Multivariable logistic regression analysis was used for these comparisons. Results Among 2148 participants (median age 37 years), 882 (41.1%) were men. Late presentation to care occurred in 485/975 newly enrolled participants (49.8%). Male sex was associated with late presentation (adjusted odds ratio [aOR], 2.24; 95% confidence interval [95% CI], 1.70–2.96), as well as with disengagement (aOR, 3.28; 95% CI, 2.32–4.63) and unsuppressed VL during ART (aOR, 1.82; 95% CI, 1.22–2.70). Conclusions Men were overrepresented in gaps at different stages of the HIV care continuum in this Ethiopian setting, highlighting the need for targeted interventions among men.