# The Effect of Conflict on Medical Services for People Living With Advanced HIV Disease and Cryptococcal Meningitis in Ethiopia's Tigray Region: A Qualitative Study of Healthcare Providers

## TL;DR

This study examines how conflict in Ethiopia's Tigray region disrupted HIV and cryptococcal meningitis care, causing drug shortages and emotional distress among healthcare providers.

## Contribution

The study provides new insights into the impact of conflict on HIV and CM healthcare delivery and provider well-being in Tigray.

## Key findings

- Conflict disrupted HIV and CM services, causing drug shortages and treatment interruptions.
- Healthcare providers experienced significant emotional and moral distress during the conflict.
- Essential medications and diagnostic tools for CM were largely unavailable during all conflict phases.

## Abstract

Armed conflict in Tigray, Ethiopia, disrupted healthcare, and heightened risks for people with advanced HIV disease (AHD) including serious infections like cryptococcal meningitis (CM). This study described healthcare providers' experiences before, during, and after the conflict, focusing on vulnerabilities in HIV and CM services, infrastructure, and supply availability.

This qualitative study was conducted at Ayder Comprehensive Specialized Hospital in Tigray, Ethiopia. Healthcare professionals were purposively sampled across outpatient and inpatient settings. Semistructured interviews explored care delivery, resource challenges, and professional experiences across preconflict, conflict, and postconflict phases. Transcripts underwent inductive thematic analysis, with iterative coding and team consensus to identify key themes reflecting participants' experiences.

Interviews with 13 healthcare professionals highlighted 4 main findings: (1) the conflict disrupted HIV and CM services, causing drug shortages, treatment interruptions, and preventable suffering; (2) providers faced significant emotional and moral distress while delivering care in conflict settings; (3) essential medications, diagnostic tools, and standardized supplies for CM care were largely unavailable at all phases of conflict; and (4) gaps in training and limited adherence to CM guidelines hindered effective patient management.

This study described frontline providers' experiences of HIV and CM care before, during, and after the northern Ethiopian conflict. Findings revealed disrupted services, severe shortages of essential medications and diagnostics, provider moral distress, and limited adherence to CM guidelines. Highlighting the urgent need to rebuild healthcare infrastructure, secure uninterrupted HIV and CM treatment, strengthen evidence-based training, and provide sustained psychosocial and professional support for healthcare providers.

This qualitative study in Tigray, Ethiopia, explores healthcare providers' experiences delivering advanced HIV and cryptococcal meningitis care before, during, and after conflict, revealing disrupted services, drug shortages, and emotional distress, highlighting urgent needs for resilient systems, uninterrupted care, and provider support.