HIV drug resistance early warning indicators in Ethiopia: Variability at regional and health facility levels and trend over time

•There is a sharp decline in on-time antiretroviral drug pickup practice among people taking antiretroviral therapy in Ethiopia, across the consecutive six round HIV drug resistance early warning indicators (EWI) surveys (2008–2015). Moreover, drug supply continuity is declining over time in the same rounds of the survey period.•HFs dispensing practice was consistently excellent across all six rounds of HIV drug resistance EWIs surveys. Moreover, patient retention in care is improving over time.•EWIs vary by HFs and administrative regions in Ethiopia. The aim of this study was to assess status of early warning indicators (EWIs) for HIV drug resistance in Ethiopia. A retrospective cohort study was conducted among 90 health facilities (HFs) in 2015. Data were abstracted for ‘on time pill pickup’ (EWI-I), ‘Retention in care’ (EWI-II), ‘drug supply continuity’(EWI-III) and ‘dispensing practices’ (EWI-IV). Data analysis was conducted using WHO Excel tool and SPSS V20. EWI-IV was excellent across all of the six rounds of EWI surveys conducted between 2008 and 2015. There were improvements in EWI-II over time from 55.6% to 81%. However, EWI-I and EWI-III declined from 86.7% to 31% and 100% to 41%, respectively. During 2015, half of the HFs in Gambella, Amhara and Southern Nation, Nationalities and people regional (SNNPR) states achieved excellent performance for EWI-I. Similarly, all HFs in Afar, Amhara, Dire Dawa, Harari and Tigray regions achieved excellent performance for EWI-II. There were also differences by level of HFs for EWI-III; 62% of hospitals and 28% of health centers were out of stock of one or more ARV drugs by 2015. Excellent performance of EWI-IV and improvement of EWI-II over time shall be maintained. The program shall further work to ensure medication adherence and supply continuity.