Background: Lesotho adopted the test-and-treat approach for HIV treatment in June 2016, which increased antiretroviral treatment (ART) clinic volume. We evaluated community-based vs. facility-based differentiated models of multimonth dispensing of ART among stable HIV-infected adults in Lesotho. Methods: Thirty facilities were randomized to 3 arms, facility 3-monthly ART (3MF) (control), community ART groups (3MC), and 6-monthly community distribution points (6MCD). We estimated risk differences (RDs) between arms using population-averaged generalized estimating equations, controlling for baseline imbalances and specifying for clustering. The primary outcome was retention in ART care by intention-to-treat and virologic suppression as a secondary outcome (ClinicalTrials.gov: NCT03438370). Results: A total of 5,336 participants were enrolled, with 1898, 1558, and 1880 in 3MF, 3MC, and 6MCD, respectively. Retention in ART care was not different across arms and achieved the prespecified noninferiority limit (−3.25%) between 3MC vs. 3MF (control); 6MCD vs. 3MF; and 6MCD vs. 3MC, adjusted RD = −0.1% [95% confidence interval (CI): −1.6% to 1.5%], adjusted RD = −1.3% (95% CI: −3.0% to 0.5%), and adjusted RD = −1.2% (95% CI: −2.9% to 0.5%), respectively. After 12 months, 98.6% (n = 1503), 98.1% (n = 1126), and 98.3% (n = 1285) were virally load (VL) suppressed in 3MF, 3MC, and 6MCD, respectively. There were no differences in VL between 3MC vs. control and 6MCD vs. control, risk ratio (RR) = 1.00 (95% CI: 0.98 to 1.01) and RR = 1.00 (95% CI: 0.98 to 1.01), respectively. Conclusions: There were no differences in retention and VL suppression for stable HIV-infected participants receiving multimonth dispensing of ART within community-based differentiated models when compared with the facility-based standard-of-care model.

Background Patient interruption of antiretroviral therapy (ART) continues to limit HIV programs’ progress toward epidemic control. Multiple factors have been associated with client interruption in treatment (IIT)— including age, gender, CD4 count, and education level. In this paper, we explore the factors associated with IIT in people living with HIV (PLHIV) in United States Agency for International Development (USAID)-supported facilities under the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) program in Nigeria. Methods We conducted cross-sectional analyses on data obtained from Nigeria’s National Data Repository (NDR), representing a summarized record of 573 630 ART clients that received care at 484 PEPFAR/USAID-supported facilities in 16 states from 2000–2020. IIT was defined as no clinical contact for 28 days or more after the last expected clinical contact. Univariate and multivariate logistic regression models were computed to explore the factors associated with IIT. The variables included in the analysis were sex, age group, zone, facility level, regimen line, multi-month dispensing (MMD), and viral load category. Results Of the 573 630 clients analysed in this study, 32% have been recorded as having interrupted treatment. Of the clients investigated, 66% were female (32% had interrupted treatment), 39% were aged 25–34 at their last ART pick-up date (with 32% of them interrupted treatment), 59% received care at secondary level facilities (37% interrupted treatment) and 38% were last receiving between three- to five-month MMD (with 10% of these interrupted treatment). Those less likely to interrupt ART were males (aOR = 0.91), clients on six-month MMD (aOR = 0.01), adults on 2nd line regimen (aOR = 0.09), and paediatrics on salvage regimen (aOR = 0.02). Clients most likely to interrupt ART were located in the South West Zone (aOR = 1.99), received treatment at a tertiary level (aOR = 12.34) or secondary level facilities (aOR = 4.01), and had no viral load (VL) on record (aOR =10.02). Age group was not significantly associated with IIT. Conclusions Sex, zone, facility level, regimen line, MMD, and VL were significantly associated with IIT. MMD of three months and longer (especially six months) had better retention on ART than those on shorter MMD. Not having a VL on record was associated with a considerable risk of IIT.

Growing evidence shows that a significant number of patients with COVID-19 experience persistent symptoms, also known as long COVID-19. We sought to identify persistent symptoms of COVID-19 in frontline workers at Right to Care South Africa, who are past the acute phase of illness, using a cross-sectional survey. We analysed data from 207 eligible COVID-19 positive frontline workers who participated in a two-month post-COVID-19 online self-administered survey. The survey response rate was 30%; of the 62 respondents with a median age of 33.5 years (IQR= 30–44 years), 47 (76%) were females. The majority (n = 55; 88.7%) self-isolated and 7 (11.3%) were admitted to hospital at the time of diagnosis. The most common comorbid condition reported was hypertension, particularly among workers aged 45–55 years. The most reported persistent symptoms were characterised by fatigue, anxiety, difficulty sleeping, chest pain, muscle pain, and brain fog. Long COVID-19 is a serious phenomenon, of which much is still unknown, including its causes, how common it is especially in non-hospitalised healthcare workers, and how to treat it. Given the rise in COVID-19 cases, the prevalence of long COVID-19 is likely to be substantial; thus, the need for rehabilitation programs targeted at each persistent COVID-19 symptom is critical.

Background Human immunodeficiency virus (HIV) is untransmissible when the viral load (VL) is undetectable, underscoring the importance of achieving VL suppression for HIV epidemic control. It is estimated that 78% of people living with HIV (PLHIV) on antiretroviral therapy (ART) in Nigeria are virally suppressed. The need to improve VL suppression rates raises questions about the factors associated with an unsuppressed VL, which this study explored using a large cross-sectional database of clients who received ART over a period of 20 years. Methods Data from 517,012 clients with a documented VL were analyzed using univariate and adjusted multivariate logistic regression. The independent variables investigated were sex, age group, facility type, time on ART until last VL test, multi-month dispensing (MMD), and geopolitical zone. To verify model improvement by variable, we performed backward elimination for the logistic regression model. Results Sixty-six percent of the study population were females. The largest age groups were 35–44 and 25–34, accounting for 32% and 31%, respectively. The greatest adjusted odds for an unsuppressed VL were associated with shorter duration MMD prescriptions of 1–2 months (adjusted odds ratio [AOR]=14.05) and 3 months (AOR=3.13). Males had 8% greater odds (AOR=1.08) of being unsuppressed. The age groups below the 45–59 age group (AOR=0.84) had higher odds of having an unsuppressed VL, with the highest odds in the 0–14 age group (AOR=1.87). Clients enrolled at tertiary and secondary level facilities had the greatest odds of having an unsuppressed VL. A shorter time on ART until the last VL (1–3 years [AOR=1.14]) was associated with a higher risk of an unsuppressed VL. Clients in the North-Central (AOR=1.83) and North-East (AOR=1.49) zones had the greatest odds of viral non-suppression. Conclusions Enabling the provision of 3+ months of MMD to PLHIV and targeting younger age groups, tertiary and secondary health facilities, small and medium facilities, and the North-Central and North-East zones for interventions could lead to improvements in VL suppression in Nigeria. The independent factors associated with an unsuppressed VL can guide improvements in ART program development and VL suppression of PLHIV in Nigeria.

ObjectivesIdentify factors (demographic and clinical) associated with a non-suppressed viral load (VL) of people living with HIV (PLHIV) on antiretroviral therapy (ART) in Nigeria.DesignCross-sectional study.SettingSixteen US Agency for International Development supported states in Nigeria.Participants585 632 PLHIV on ART.Primary outcome measuresVL non-suppression (defined as having a VL of at least 1000 HIV RNA copies per mL of plasma). χ2testing and multivariable modified Poisson regression with robust variance estimates were conducted on routinely collected ART programme data.ResultsSixty-six per cent of the study population were females. The largest age groups were 25–34 and 35–44, accounting for 32.1% and 31.1%, respectively. Males had a 9% greater likelihood (adjusted prevalence ratio, APR=1.09) of being non-suppressed. The age groups below 60+ (APR=0.67) had a higher likelihood of a non-suppressed VL, with the highest in the 0–14 age group (APR=2.38). Clients enrolled at tertiary and secondary level facilities had the greatest likelihood of a non-suppressed VL. Clients who started ART between 2010 and 2015 had the greatest likelihood of viral non-suppression (APR=6.19). A shorter time on ART (<1 year (APR=3.92)) was associated with a higher likelihood of a non-suppressed VL. Clients receiving care at private facilities had a lower likelihood of viral non-suppression in the adjusted model. Clients in the Edo (APR=2.66) and Niger (APR=2.54) states had the greatest likelihood of viral non-suppression.ConclusionsTargeting males, clients of younger age, those on treatment for less than 3 years, clients at tertiary and secondary health facilities, small and medium facilities, and clients in the Edo, Niger and Borno states for interventions could lead to improvements in VL suppression in Nigeria. The independent factors associated with a non-suppressed VL can guide improvements in ART programme development and VL suppression of PLHIV on ART in Nigeria.