Outcomes of Nigeria's HIV/AIDS Treatment Program for Patients Initiated on Antiretroviral Treatment between 2004-2012

Details

• Alternative Title:
  PLoS One
• Personal Author:
  Dalhatu, Ibrahim ; Onotu, Dennis ; Odafe, Solomon ; Abiri, Oseni ; Debem, Henry ; Agolory, Simon ; Shiraishi, Ray W. ; Auld, Andrew F. ; Swaminathan, Mahesh ; Dokubo, Kainne ; Ngige, Evelyn ; Asadu, Chukwuemeka ; Abatta, Emmanuel ; Ellerbrock, Tedd V.
• Description:
  Background
  
  The Nigerian Antiretroviral therapy (ART) program started in 2004 and now ranks among the largest in Africa. However, nationally representative data on outcomes have not been reported.
  
  Methods
  
  We evaluated retrospective cohort data from a nationally representative sample of adults aged ≥15 years who initiated ART during 2004 to 2012. Data were abstracted from 3,496 patient records at 35 sites selected using probability-proportional-to-size (PPS) sampling. Analyses were weighted and controlled for the complex survey design. The main outcome measures were mortality, loss to follow-up (LTFU), and retention (the proportion alive and on ART). Potential predictors of attrition were assessed using competing risk regression models.
  
  Results
  
  At ART initiation, 66.4 percent (%) were females, median age was 33 years, median weight 56 kg, median CD4 count 161 cells/mm3, and 47.1% had stage III/IV disease. The percentage of patients retained at 12, 24, 36 and 48 months was 81.2%, 74.4%, 67.2%, and 61.7%, respectively. Over 10,088 person-years of ART, mortality, LTFU, and overall attrition (mortality, LTFU, and treatment stop) rates were 1.1 (95% confidence interval (CI): 0.7–1.8), 12.3 (95%CI: 8.9–17.0), and 13.9 (95% CI: 10.4–18.5) per 100 person-years (py) respectively. Highest attrition rates of 55.4/100py were witnessed in the first 3 months on ART. Predictors of LTFU included: lower-than-secondary level education (reference: Tertiary), care in North-East and South-South regions (reference: North-Central), presence of moderate/severe anemia, symptomatic functional status, and baseline weight <45kg. Predictor of mortality was WHO stage higher than stage I. Male sex, severe anemia, and care in a small clinic were associated with both mortality and LTFU.
  
  Conclusion
  
  Moderate/Advanced HIV disease was predictive of attrition; earlier ART initiation could improve program outcomes. Retention interventions targeting men and those with lower levels of education are needed. Further research to understand geographic and clinic size variations with outcome is warranted.
  
  
• Subjects:
  Adolescent Adult Ambulatory Care Facilities Anti-HIV Agents Antiretroviral Therapy, Highly Active CD4 Lymphocyte Count CD4-Positive T-Lymphocytes Female HIV Infections Humans Lost To Follow-Up Male Middle Aged Retrospective Studies Social Class Survival Analysis Treatment Outcome

  More +
• Source:
  PLoS One. 11(11).
• Pubmed ID:
  27829033
• Pubmed Central ID:
  PMC5102414
• Document Type:
  Journal Article
• Place as Subject:
  Nigeria
• Volume:
  11
• Issue:
  11
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:768b24f13717006b93766163bbd343a169a114c1e0e74e8733f004dd874d9a2b
• Download URL:
  https://stacks.cdc.gov/view/cdc/43055/cdc_43055_DS1.pdf
• File Type:
  [PDF - 2.15 MB ]