Treatment Outcomes in a Decentralized Antiretroviral Therapy Program: A Comparison of Two Levels of Care in North Central Nigeria

Abstract

Background. Decentralization of antiretroviral therapy (ART) services is a key strategy to achieving universal access to treatment for people living with HIV/AIDS. Our objective was to assess clinical and laboratory outcomes within a decentralized program in Nigeria. Methods. Using a tiered hub-and-spoke model to decentralize services, a tertiary hospital scaled down services to 13 secondary-level hospitals using national and program guidelines. We obtained sociodemographic, clinical, and immunovirologic data on previously antiretroviral drug naïve patients aged ≥15 years that received HAART for at least 6 months and compared treatment outcomes between the prime and satellite sites. Results. Out of 7,747 patients, 3729 (48.1%) were enrolled at the satellites while on HAART, prime site patients achieved better immune reconstitution based on CD4+ cell counts at 12 (P < 0.001) and 24 weeks (P < 0.001) with similar responses at 48 weeks (P = 0.11) and higher rates of viral suppression (<400 c/mL) at 12 (P < 0.001) and 48 weeks (P = 0.03), but similar responses at 24 weeks (P = 0.21). Mortality was 2.3% versus 5.0% (P < 0.001) at prime and satellite sites, while transfer rate was 8.7% versus 5.5% (P = 0.001) at prime and satellites. Conclusion. ART decentralization is feasible in resource-limited settings, but efforts have to be intensified to maintain good quality of care.

Adolescence and the risk of ART non-adherence during a geographically focused public health intervention: an analysis of clinic records from Nigeria

“…Our findings speak to the growing literature on benefits of health care decentralization that shifts HIV-related services to primary-level facilities (Cobos Muñoz et al, 2017). The very large differences in risk of ART non-adherence by facility level further suggest the effectiveness of a more targeted approach to decentralization (Okonkwo et al, 2014).…”

Retention in Differentiated Care: Multiple Measures Analysis for a Decentralized HIV Care and Treatment Program in North Central Nigeria

“…A “hub-and-spoke” model of decentralization was used in which the JUTH-HIV specialty clinic (“hub”) was linked to 13 community hospitals in surrounding semi-urban and rural areas (“spokes”). Community hospitals were empowered to initiate and maintain patients on ART close to their residences [ 21 ]. Community hospital clinics were linked to 47 primary health care clinics (PHCs) providing HIV education, prevention and referral services.…”

Mortality among people living with HIV on antiretroviral treatment in Bali, Indonesia: incidence and predictors

“…A variety of socio-demographic and clinical characteristics have been found to be associated with mortality among PLWH taking ART but differ across settings. 6–22 There is a paucity of data allowing an examination of factors associated with mortality among PLWH in Indonesia. Understanding which factors are important in the Indonesian setting is critical to allow for more targeted and effective interventions among high-risk populations 9,23 and to monitor the effectiveness of ART programmes being implemented.…”