Background Expanded access to antiretroviral therapy (ART) leads to improved HIV/AIDS treatment outcomes in Nigeria, however, increasing rates of loss to follow-up among those on ART is threatening optimal standard achievement. Therefore, this retrospective cross-sectional study is aimed at identifying correlates and predictors of loss to follow-up in patients commencing ART in a large HIV program in Nigeria. Methods Records of all patients from 432 US CDC Presidents Emergency Plan for AIDS Relief (PEPFAR) supported facilities across 10 States and FCT who started ART from 2004 to 2017 were used for this study. Bivariate and multivariate analysis of the demographic and clinical parameters of all patients was conducted using STATA version 14 to determine correlates and predictors of loss to follow-up. Results Within the review period, 245,257 patients were ever enrolled on anti-retroviral therapy. 150,191 (61.2%) remained on treatment, 10,960 (4.5%) were transferred out to other facilities, 6926 (2.8%) died, 2139 (0.9%) self-terminated treatment and 75,041 (30.6%) had a loss to follow-up event captured. Males (OR: 1.16), Non-pregnant female (OR: 4.55), Patients on ≥ 3-monthly ARV refills (OR: 1.32), Patients with un-suppressed viral loads on ART (OR: 4.52), patients on adult 2nd line regimen (OR: 1.23) or pediatric on 1st line regimen (OR: 1.70) were significantly more likely to be lost to follow-up. Conclusion Despite increasing access to anti-retroviral therapy, loss to follow-up is still a challenge in the HIV program in Nigeria. Differentiated care approaches that will focus on males, non-pregnant females and paediatrics is encouraged. Reducing months of Anti-retroviral drug refill to less than 3 months is advocated for increased patient adherence.

Background People living with HIV (PLHIV) constantly need to address social issues such as the cost of accessing care, stigma, and lack of social support which impacts on their level of adherence to clinic visits or antiretroviral treatment leading to adverse health outcomes. This study examined the social barriers in accessing care by clients who returned to care after transient loss to follow-up. Methods This study was a cross-sectional survey of PLHIV from 99 US CDC PEPFAR-supported HIV clinics located in 10 of Nigeria’s 36 states and Federal Capital Territory, who were momentarily lost to follow-up but returned to care after tracking. Demographic and social factors at bivariate and multivariate level were analyzed to determine the predictors of difficulty in accessing HIV clinics. Results Of the 7483 clients tracked, 1386 (18.5%) were confirmed to be in care, 2846 (38.2%) were lost to follow-up (LTFU), 562 (7.5%) returned to care, 843 (11.2%) discontinued care, 827 (11.1%) transferred out to other facilities for care, 514 (6.8%) had died while 505 (6.7%) could not be reached by phone or located at their addresses. 438 out of the 562 (78%) returnee PLHIV gave consent and participated in the study. 216 out of the 438 (50%) clients who returned to care were transiently lost to follow-up because they had difficulty accessing their HIV clinic. Also, 126/438 (29%) of returnee PLHIV were previously lost to follow-up. Difficult access to a HIV clinic was significantly influenced by prior LTFU (OR 2.5 [95% CI 1.3–4.8], p = 0.008), history of being stigmatized (OR 2.1 [95% CI 1.1–3.8], p = 0.02), lack of social or financial support (OR 2.8 [95% CI 1.3–6.0], p = 0.01) and perceived in-adequate healthcare workers support (OR 3.8 [95% CI 1.2–11.2], p = 0.02). Age (p = 0.218) and gender (p = 0.771) were not significant determinants of difficult access to an HIV clinic. Conclusion Stigma, lack of support and prior loss to follow-up event are essential factors affecting retention in care. Social constructs such as home-based visits, community-based care services, transportation subsidies, and robust strong social systems should be built into HIV service delivery models to improve retention in care of people on HIV treatment. The authors advocate for further studies on how differentiated care models impact on retention of patients in care.

BackgroundExpanded access to antiretroviral therapy (ART) has improved HIV outcomes in Nigeria. However, increasing rates of patients lost to follow-up (LTFU) is threatening the achievement of the UNAIDS treatment targets to treat 90% of HIV-diagnosed patients and attain 90% viral suppression amongst those on treatment. Therefore, this retrospective cross-sectional study is aimed at identifying correlates and predictors of loss to follow-up in ART-commenced patients in a large HIV programme in Nigeria.MethodsRecords of all patients who started ART from 2004 to 2017 of 432 PEPFAR-supported facilities across 10 states in Nigeria were used for this study. Univariate, bivariate and multivariate analysis using frequencies, percentages, chi-square and logistic regression was conducted using STATA version 14 to determine occurrence, correlates and predictors of LTFU.ResultsAmong all 2 45 257 ever-enrolled-on-ART patients within the review period, 1 50 191 patients (61.2%) remained on treatment while 75 041 (30.6%) were LTFU. Patients were significantly more likely to be LTFU when non-pregnant female (OR: 4.55,p<0.001); on ≥3 monthly ARV refills (OR: 1.32, p<0.001); with unsuppressed viral loads on ART (OR: 4.52, p<0.001); adult on second-line regimen (OR: 1.23 p<0.001); paediatric on first-line regimen (OR: 1.70, p<0.001); 10–14 years (OR: 2.99, p<0.001); and ≥65 years (OR: 1622.84, p<0.001).ConclusionDespite increasing access to ART, LTFU is still a challenge in the HIV programme in Nigeria with gender, type of regimen, age, unsuppressed viral load, duration of ARV refill, and duration of ART amongst others as significant predictors of LTFU. Differentiated care is advocated to prevent LTFU and improve retention of people living with HIV on treatment while further research to unravel the gender and social dimensions of LTFU is encouraged.