Accelerating HIV epidemic control in Benue state, Nigeria, 2019–2021: the APIN program experience

Abstract

Introduction: As at 2019, Nigeria was ranked the fourth highest HIV burden in the world. There is varied geographical HIV prevalence in Nigeria. The progress made is inequitable across geographical locations and sub-populations (18). Benue state has the second highest HIV prevalence in Nigeria. In 2018, about 35,623 people living with HIV (PLHIV) were yet to commence antiretroviral treatment (ART) in the state, accounting for an estimated ART coverage gap of 11% out of the combined gap of 320,921 in the country. To close this gap, the Benue ART surge (BAS) was implemented. The aim of this study was to describe the BAS strategic approaches and demonstrate progress in expanding ART access for PLHIV in Benue State, Nigeria. Methods: BAS was implemented in 252 health facilities from May 2019 to September 2021. Data were collected and reported using an Excel-based dashboard and electronic medical records. The trend of HIV case identification, ART initiation, viral load suppression rate, and rate of interruption in treatment during the BAS period was then described and analyzed. Results: Out of 893,462 clients reached, 6.7% ( n = 60,297) were diagnosed with HIV and 99.8% ( n = 60,236) were initiated on ART. HIV case identification per month increased by 467% from 650 at baseline to a peak of 3685 in August 2020, and then declined by 35% to 2380 in September 2021. All new HIV-infected patients (100%) were linked to ART. Viral load testing coverage and viral load suppression rate increased from 30% (43,185/126,004) and 84% ( n = 36,165/43,185) at baseline to 95% ( n = 193,890/204,095) and 96% (185,785/193,890), respectively. Conclusion: Implementation of the BAS improved access to comprehensive HIV services in Benue State. The increase in HIV case identification and ART initiation significantly reduced the HIV treatment gap in the state. To fast track the attainment of UNAIDS 95-95-95 goals, lessons learnt from the BAS should be adapted and scaled up in the national HIV program in Nigeria.

A Retrospective Medical Record Review on the Outcome of Enhanced Adherence Counseling among Unsuppressed HIV Clients in Benue State, Nigeria

“…[15] This achievement can be attributed to various strategies implemented in the state by APIN to promote treatment continuity. These strategies included ensuring that ART treatment and services are freely available to everyone in the state with a focus on treatment readiness and employing a multidisciplinary approach to treatment retention [22]. Case management was introduced to ensure close follow-up within the first 3 months of ART initiation, a crucial period for long-term treatment adherence [22].…”

“…These strategies included ensuring that ART treatment and services are freely available to everyone in the state with a focus on treatment readiness and employing a multidisciplinary approach to treatment retention [22]. Case management was introduced to ensure close follow-up within the first 3 months of ART initiation, a crucial period for long-term treatment adherence [22]. Additionally, preemptive measures were taken to reduce missed clinic appointments, such as patient education, and structured appointment systems such as family-centered care when multiple members of a family are infected with HIV.…”

Predictors of Interruptions in Antiretroviral Therapy among People Living with HIV in Nigeria: A Retrospective Cohort Study Using the Nigeria National Data Repository

“…While each approach is valid, each measures a different outcome. These differences may account for narrow and contradictory findings related to factors driving IIT and limit the generalizability of these studies to other regions[11], [17], [18].…”

“…While each approach is valid, each measures a different outcome. These differences may account for narrow and contradictory findings related to factors driving IIT and limit the generalizability of these studies to other regions [11], [17], [18]. This study aimed to identify predictors of the time to first IIT and predictors of ever being interrupted in ART treatment among PLHIV in Nigeria using a national longitudinal dataset that covers all PEPFAR-funded implementing partners to inform national strategies to prevent IIT.…”

INTEREST 2022: new perspectives in HIV treatment, pathogenesis and prevention in Africa

“…By leveraging on strong stakeholder engagement, the APIN health programme has implemented a state-wide surge campaign that dramatically increased uptake of viral load testing and suppression in Nigeria as reported in this issue. 15 Similarly, Nwanja and colleagues also report how working with traditional birth attendants and other informal health care providers increased the rate of HIV testing and detection in Nigeria. 16 Similar work has recently been reported in Uganda where uptake of HIV testing increased by 77% when offered by traditional healers.…”