Long-term retention and predictors of attrition for key populations receiving antiretroviral treatment through community-based ART in Benue State Nigeria: A retrospective cohort study

Autor: Sara Van Belle, Caroline Masquillier, Jay Osi Samuel, Olujuwon Ibiloye, Olubunmi Amoo, Tom Decroo, Temiwoluwa Omole, Prosper Okonkwo, Plang Jwanle, Ekere Jaachi, Josefien van Olmen, Lutgarde Lynen, Ahmed Isah
Rok vydání: 2021
Předmět:
Male
RNA viruses
HIV Infections
Logistic regression
Pathology and Laboratory Medicine
Men who have sex with men
Geographical Locations
Sexual and Gender Minorities
Immunodeficiency Viruses
Risk Factors
Medicine and Health Sciences
Attrition
Public and Occupational Health
Virus Testing
Multidisciplinary
Hazard ratio
HIV diagnosis and management
Middle Aged
Viral Load
Vaccination and Immunization
Outreach
Anti-Retroviral Agents
Medical Microbiology
Viral Pathogens
Viruses
Medicine
Infectious diseases
Female
Pathogens
Viral load
Research Article
Adult
Medical conditions
Science
Immunology
Nigeria
Antiretroviral Therapy
Men WHO Have Sex with Men
Viral diseases
Microbiology
Medication Adherence
Antiviral Therapy
Diagnostic Medicine
Virology
Retroviruses
medicine
Humans
Microbial Pathogens
Retrospective Studies
Sex Workers
Proportional hazards model
business.industry
Lentivirus
Organisms
Biology and Life Sciences
HIV
Retrospective cohort study
medicine.disease
CD4 Lymphocyte Count
People and Places
Africa
HIV-1
Population Groupings
Human medicine
Preventive Medicine
business
Viral Transmission and Infection
Demography
Sexuality Groupings
Zdroj: PLoS ONE
PLoS ONE, Vol 16, Iss 11, p e0260557 (2021)
ISSN: 1932-6203
Popis: Background Key populations (KP) are disproportionately infected with HIV and experience barriers to HIV care. KP include men who have sex with men (MSM), female sex workers (FSW), persons who inject drugs (PWID) and transgender people (TG). We implemented three different approaches to the delivery of community-based antiretroviral therapy for KP (KP-CBART) in Benue State Nigeria, including One Stop Shop clinics (OSS), community drop-in-centres (DIC), and outreach venues. OSS are community-based health facilities serving KP only. DIC are small facilities led by lay healthcare providers and supported by an outreach team. Outreach venues are places in the community served by the outreach team. We studied long-term attrition of KP and virological non-suppression. Method This is a retrospective cohort study of KP living with HIV (KPLHIV) starting ART between 2016 and 2019 in 3 0SS, 2 DIC and 8 outreach venues. Attrition included lost to follow-up (LTFU) and death. A viral load >1000 copies/mL showed viral non-suppression. Survival analysis was used to assess retention on ART. Cox regression and Firth logistic regression were used to assess risk factors for attrition and virological non-suppression respectively. Result Of 3495 KPLHIV initiated on ART in KP-CBART, 51.8% (n = 1812) were enrolled in OSS, 28.1% (n = 982) in DIC, and 20.1% (n = 701) through outreach venues. The majority of participants were FSW—54.2% (n = 1896), while 29.8% (n = 1040), 15.8% (n = 551) and 0.2% (n = 8) were MSM, PWID, and TG respectively. The overall retention in the programme was 63.5%, 55.4%, 51.2%, and 46.7% at 1 year, 2 years, 3 years, and 4 years on ART. Of 1650 with attrition, 2.5% (n = 41) died and others were LTFU. Once adjusted for other factors (age, sex, place of residence, year of ART enrollment, WHO clinical stage, type of KP group, and KP-CBART approach), KP-CBART approach did not predict attrition. MSM were at a higher risk of attrition (vs FSW; adjusted hazard ratio (aHR) 1.27; 95%CI: 1.14–1.42). Of 3495 patients, 48.4% (n = 1691) had a viral load test. Of those, 97.8% (n = 1654) were virally suppressed. Conclusion Although long-term retention in care is low, the virological suppression was optimal for KP on ART and retained in community-based ART care. However, viral load testing coverage was sub-optimal. Future research should explore the perspectives of clients on reasons for LTFU and how to adapt approach to CBART to meet individual client needs.
Databáze: OpenAIRE
Externí odkaz:
Nepřihlášeným uživatelům se plný text nezobrazuje