HIV treatment scale-up: a critical step to controlling HIV epidemic in a resource-limited country

Abstract

Objectives: The study was conducted to determine the trend in HIV treatment coverage among people living with HIV and to evaluate effectiveness of the national antiretroviral treatment (ART) programme in reducing new infections in a mixed HIV epidemic nation, Nigeria.

Study design: Ecological cross-sectional study.

Methods: The study utilized national HIV programme service data and National HIV/AIDS and Reproductive Health Survey (NARHS) data for 36 states and Federal Capital Territory from 2012 to 2015 in Nigeria. Chi-squared test for trend was conducted to determine differences in ART coverage across the years. We correlated 2015 ART coverage with HIV prevalence Annual Rate of Reduction (ARR) between 2012 and 2015. A linear regression model was fitted to predict the HIV prevalence ARR in relation to ART coverage and adjusted for the effect of socio-behavioral interventions (coverage of condom-use among male).

Results: Nigeria has recorded steady progress with HIV treatment coverage with an annual rate of progress of 18.25%, P < 0.001; however, huge gaps still exist. Females and adults had higher odds of receiving ART. HIV prevalence annual reduction rate was higher for states that had higher ART coverage (r = 0.4; P = 0.02). Our analysis indicated that a 10% increase in ART coverage was associated with a 4% increase in the annual rate of reduction for HIV prevalence (adjusted β = 0.4; 95% confidence interval: 0.1-0.8; P = 0.01).

Conclusions: Regardless of the low ART coverage, our analysis supports the evidence base to inform accelerated access to HIV treatment for population Nigeria and other similar resource-limited settings to make ending HIV by 2030 a reality.

Keywords: Antiretroviral treatment; HIV; HIV elimination; Nigeria.