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Differentiated service delivery models among PLHIV in Akwa Ibom and Cross River States, Nigeria during the COVID-19 pandemic: descriptive analysis of programmatic data.
| Content Provider | Europe PMC |
|---|---|
| Author | Sanwo, Olusola Persaud, Navindra E. Nwaokoro, Pius Idemudia, Augustine Akpan, Uduak Toyo, Otoyo Imohi, Philip Badru, Titilope Obiora‐Okafo, Chika Uzochukwu, Chimamaka Excellence Aliu, Oluwapelumi Olatunbosun, Kolawole Pandey, Satish Raj Khamofu, Hadiza Chiegil, Robert James, Ezekiel Iyortim, Isa Oqua, Dorothy Bateganya, Moses |
| Abstract | IntroductionThe rapid increase in the number of people living with HIV (PLHIV) on antiretroviral therapy (ART) in Akwa Ibom and Cross River states in Nigeria led to overcrowding at clinics. Patients were devolved to receive ART refills through five differentiated service delivery (DSD) models: fast‐track (FT), adolescent refill clubs (ARCs), community pharmacy ART refill programs (CPARPs), community ART refill clubs (CARCs) and community ART refill groups (CARGs) designed to meet the needs of different groups of PLHIV. In the context of COVID‐19‐related travel restrictions, out‐of‐facility models offered critical mechanisms for continuity of treatment. We compared retention and viral suppression among those devolved to DSD with those who continued standard care at facilities.MethodsA retrospective cohort study was conducted among patients devolved to DSD from January 2018 to December 2020. Bivariate analyses were conducted to assess differences in retention and viral suppression by socio‐demographic characteristics. Kaplan–Meier assessed retention at 3, 6, 9 and 12 months. Differences in proportions were compared using the chi‐square test; a p‐value of <0.05 was considered significant.ResultsA total of 40,800 PLHIV from 84 facilities received ART through the five models: CARC (53%), FT (19.1%), ARC (12.1%), CPARP (10.4%) and CARG (5.4%). Retention rates at 6 months exceeded 96% for all models compared to 94% among those continuing standard care. Among those using DSD, retention rate at 12 months was higher among adults than children (97.8% vs. 96.7%, p = 0.04). No significant sex differences in retention rates were found among those enrolled in DSD. Viral suppression rates among PLHIV served through DSD were significantly higher among adults than children (95.4% vs. 89.2%; p <0.01). Among adults, 95.4% enrolled in DSD were virally suppressed compared to 91.8% of those in standard care (p <0.01). For children, 89.2% enrolled in DSD were virally suppressed compared to 83.2% in standard care (p <0.01).ConclusionsPLHIV receiving ART through DSD models had retention but higher viral suppression rates compared to those receiving standard care. Expanding DSD during COVID‐19 has helped ensure uninterrupted access to ART in Nigeria. Further scale‐up is warranted to decongest facilities and improve clinical outcomes. |
| Page Count | 9 |
| Journal | Journal of the International AIDS Society |
| Volume Number | 24 Suppl 6 |
| PubMed Central reference number | PMC8554211 |
| Issue Number | Suppl 6 |
| PubMed reference number | 34713591 |
| e-ISSN | 17582652 |
| DOI | 10.1002/jia2.25820 |
| Language | English |
| Publisher | John Wiley and Sons Inc. |
| Publisher Date | 2021-10-01 |
| Publisher Place | Hoboken |
| Access Restriction | Open |
| Rights License | This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. © 2021 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society. |
| Subject Keyword | differentiated service delivery people living with HIV treatment retention viral suppression COVID‐19 Nigeria |
| Content Type | Text |
| Resource Type | Article |
| Subject | Infectious Diseases Public Health, Environmental and Occupational Health |
