Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Oct;24 Suppl 6(Suppl 6):e25820.
doi: 10.1002/jia2.25820.

Differentiated service delivery models among PLHIV in Akwa Ibom and Cross River States, Nigeria during the COVID-19 pandemic: descriptive analysis of programmatic data

Olusola Sanwo  1 , Navindra E Persaud  2 , Pius Nwaokoro  1 , Augustine Idemudia  3 , Uduak Akpan  3 , Otoyo Toyo  3 , Philip Imohi  3 , Titilope Badru  1 , Chika Obiora-Okafo  1 , Chimamaka Excellence Uzochukwu  3 , Oluwapelumi Aliu  3 , Kolawole Olatunbosun  1 , Satish Raj Pandey  1 , Hadiza Khamofu  1 , Robert Chiegil  2 , Ezekiel James  4 , Isa Iyortim  4 , Dorothy Oqua  5 , Moses Bateganya  2
Affiliations

Differentiated service delivery models among PLHIV in Akwa Ibom and Cross River States, Nigeria during the COVID-19 pandemic: descriptive analysis of programmatic data

Olusola Sanwo et al. J Int AIDS Soc. 2021 Oct.

Abstract

Introduction: The 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.

Methods: A 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.

Results: A 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).

Conclusions: PLHIV 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.

Keywords: COVID-19; Nigeria; differentiated service delivery; people living with HIV; treatment retention; viral suppression.

PubMed Disclaimer

Conflict of interest statement

The authors report no competing interests.

Figures

Figure 1
Figure 1
Twelve‐month retention among patients on differentiated service delivery. ART, antiretroviral therapy.
See this image and copyright information in PMC

References

    1. Joint United Nations Programme on HIV/AIDS (UNAIDS) . UNAIDS fact sheet (World AIDS Day 2020)—latest global and regional statistics on the status of the AIDS epidemic [Internet]. Geneva: UNAIDS; 2020.
    1. World Health Organization (WHO) . Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach. 2nd ed. Geneva: WHO; 2016. - PubMed
    1. Buzaalirwa LE, Maharaj TER, Kgaka NOM, Thulare HIL, Perez J, Amor PI. Strategies to address clinic waiting time and retention in care: lessons from a large ART centre in South Africa. Presented at: 17th International Conference on AIDS and STIs in Africa. Cape Town, South Africa; 2013.
    1. Emery S, Neuhaus JA, Phillips AN, Babiker A, Cohen CJ, Gatell JM, et al. Strategies for management of antiretroviral therapy (SMART) study group: major clinical outcomes in antiretroviral therapy (ART)‐naive participants and in those not receiving ART at baseline in the SMART study. J Infect Dis. 2008;197:1133–44. - PubMed
    1. Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al. Prevention of HIV‐1 infection with early antiretroviral therapy. N Engl J Med. 2011;365:493–505. - PMC - PubMed

Publication types

Substances