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. 2023 Aug 22;18(8):e0284847.
doi: 10.1371/journal.pone.0284847. eCollection 2023.

Effect of Test and Treat on clinical outcomes in Nigeria: A national retrospective study

Marie-Claude C Lavoie  1   2   3 , Akipu Ehoche  3 , Natalia Blanco  2   3 , Ibrahim Ahmed El-Imam  4 , Ademola Oladipo  5 , Ibrahim Dalhatu  5 , Solomon Odafe  5 , Sylvia Adebajo  4 , Alexia H Ng  5 , Laura Rapoport  2   3 , Jonathan G Lawton  2   3 , Christopher Obanubi  5 , Denis Onotu  5 , Sadhna Patel  5 , Akudo Ikpeazu  6 , Greg Ashefor  7 , Bashorun Adebobola  6 , Mary Adetinuke Boyd  5 , Gambo Aliyu  7 , Kristen A Stafford  1   2   3
Affiliations

Effect of Test and Treat on clinical outcomes in Nigeria: A national retrospective study

Marie-Claude C Lavoie et al. PLoS One. .

Abstract

Background: In Nigeria, results from the pilot of the Test and Treat strategy showed higher loss to follow up (LTFU) among people living with HIV compared to before its implementation. The aim of this evaluation was to assess the effects of antiretroviral therapy (ART) initiation within 14 days on LTFU at 12 months and viral suppression.

Methods: We conducted a retrospective cohort study using routinely collected de-identified patient-level data hosted on the Nigeria National Data Repository from 1,007 facilities. The study population included people living with HIV age ≥15. We used multivariable Cox proportional frailty hazard models to assess time to LTFU comparing ART initiation strategy and multivariable log-binomial regression for viral suppression.

Results: Overall, 26,937 (38.13%) were LTFU at 12 months. Among individuals initiated within 14 days, 38.4% were LTFU by 12 months compared to 35.4% for individuals initiated >14 days (p<0.001). In the adjusted analysis, individuals who were initiated ≤14 days after HIV diagnosis had a higher hazard of being LTFU (aHR 1.15, 95% CI 1.10-1.20) than individuals initiated after 14 days of HIV diagnosis. Among individuals with viral load results, 86.2% were virally suppressed. The adjusted risk ratio for viral suppression among individuals who were initiated ≤14 days compared to >14 days was not statistically significant.

Conclusion: LTFU was higher among individuals who were initiated within 14 days compared to greater than 14 days after HIV diagnosis. There was no difference for viral suppression. The provision of early tailored interventions to support newly diagnosed people living may contribute to reducing LTFU.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow diagram of individuals included in the analysis.
Fig 2
Fig 2. Kaplan-Meir survival curves showing time lost to follow-up by ART initiation (≤14 days vs >14 days).
Log-rank test, p<0.001.
See this image and copyright information in PMC

References

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