Introduction Ethiopia launched an Appointment Spacing Model in 2017, which involved a six-month clinical visit and medication refill cycle. This study aimed to assess the uptake of the Appointment Spacing Model of care and associated factors among stable adult HIV clients on ART in Ethiopia. Methods A cross-sectional study was conducted from October 3 to November 30, 2020 among 415 stable adult ART clients. EpiData version 4.2 was used for data entry and SPSS version 25 was used for cleaning and analysis. A multivariable logistic regression model was fitted to identify associated factors, with CI at 95% with AOR being reported to show the strength of association. Results The uptake of the appointment spacing model was 50.1%. Residence [AOR: 2.33 (95% CI: 1.27, 4.26)], monthly income [AOR: 2.65 (95% CI: 1.13, 6.24)], social support [AOR: 2.21 (95% CI: 1.03, 4.71)], duration on ART [AOR: 2.41 (95% CI: 1.48, 3.92)], baseline regimen change [AOR: 2.20 (95% CI: 1.02, 4.78)], viral load [AOR: 2.80 (95% CI: 1.06, 7.35)], and alcohol abstinence [AOR: 2.02 (95% CI: 1.21, 3.37)] were statistically significant. Conclusions The uptake of the ASM was low. Behavioral change communication, engaging income-generating activities, and facility-level service providers’ training may improve the uptake.

Background HIV treatment failure is a devastating public health challenge worldwide. Low rates and delays in switching are associated with increased death and second-line failure. But the time to switch and predictors are not well studied in Ethiopia. Therefore, this study assessed the time to switch to second-line ART and its predictors among HIV-infected adults with virological failure in Northwest Ethiopia. Methods An institution-based retrospective follow-up study was conducted from Oct 1/2016 to Feb 28/2020 in Northwest Ethiopia. Secondary data were extracted through a predefined extraction tool from 427 HIV-infected adults, which were selected by systematic random sampling. Kaplan–Meier with log rank test was done to identify the survival time and compare survival time among different categorical independent variables. The Cox proportional hazard model was fitted and variables having a p-value of less than 0.05 with a 95% confidence level were identified as a predictor of time to switch to second-line ART and interpreted accordingly. Results A total of 288 (67.45%) HIV-infected adults were switched to second-line ART with a median time of 162 days (IQR: 35,682). The risk of switching is higher among HIV infected adults with viral RNA of 60,000 copies/mL or more at failure (AHR=1.80, 95% CI: 1.31–2.48), ≥8 years duration on first-line ART (AHR: 2.31, 95% CI: 1.62, 3.29) and enhanced adherence counseling of 4 to 6 sessions (AHR: 1.28, 95% CI: 1.01, 1.63), and lower with 4 or more missed appointments (AHR: 0.49, 95% CI; 0.28, 0.84) and no history of 1st line regimen change (AHR: 0.53: 95% CI: 0.41,0.69). Conclusion The median time to switch to second-line ART following 1st line virological failure is about 162 days, higher than other related studies. But switching was higher in patients with high viral RNA copies, missed appointments, longer duration on first-line ART, and the number of enhanced adherence counseling. So, intervention strategies that aid patients to have timely switch without due delays as soon as virologic failure should be prioritized.