Factors Associated With An Interruption in Treatment of People Living With HIV in USAID-Supported States in Nigeria: A Retrospective Study From 2000‒2020

Abstract

Background: Patient interruption of antiretroviral therapy (ART) continues to limit HIV programs’ progress toward epidemic control. Multiple factors have been associated with program interruptions in treatment (IIT)—also referred to by the World Health Organization as loss to follow-up (LTFU)―including age, gender, CD4 count, and education level. Program implementers can prevent future IIT by understanding which clients are more likely to interrupt treatment. In this paper, we explore the factors associated with treatment interruptions in people living with HIV (PLHIV) in United States Agency for International Development (USAID)-supported facilities under the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) program in Nigeria. Methods: A retrospective secondary cross-sectional analysis on data obtained from Nigeria’s National Data Repository (NDR), representing a summarized record of 573 630 ART clients that received care at 484 PEPFAR/USAID-supported facilities in 16 states from 2000‒2020 were used in this analysis. Interruption in treatment was recorded as no clinical contact for 28 days after the last scheduled appointment or expected clinical contact. Both univariate and multivariate logistic regression models were computed to explore the factors associated with IIT. The variables included in the analysis were sex, age group, zone, facility type, regimen line, multi-month dispensing (MMD), and viral load category.Results: Of the 573 630 clients analysed in this study, 32% in the cohort have been recorded as having interrupted treatment. Of the clients investigated, 66% were female (32% had interruption in treatment), 39% were aged 25‒34 at their last ART pick-up date (with 32% of them interrupted treatment), 62% received care at a hospital (38% interrupted treatment) and 38% were last receiving between three- to five-month MMD (with 10% of these interrupted treatments). Those less likely to interrupt ART were males (aOR = 0.93), clients on six-month MMD (aOR = 0.04), adults on 2nd line regimen (aOR = 0.14), and paediatrics on 1st line regimen (aOR = 0.09). Clients most likely to interrupt ART were located in the South West Zone (aOR = 1.91), received treatment at a hospital (aOR = 3.39) or medical center (aOR = 5.15), and had no viral load (VL) on record (aOR =8.92). Age group was not significantly associated with IIT.Conclusions: Sex, zone, facility type, regimen line, MMD, and VL were significantly associated with IIT. MMD of three months and longer (especially six months) had better retention on ART than those on shorter MMD. Not having a VL on record was associated with a considerable risk of IIT.

Predictors of the observed high prevalence of loss to follow-up in ART-experienced adult PLHIV: A retrospective longitudinal cohort study in the Tanga Region, Tanzania

“…Our study found that adults in second-line ART regimens had a higher risk of LTFU than those in the rstline. Our nding is similar to the studies conducted in Nigeria [19][20] and Uganda [24], which reported a high risk of LTFU in treatment among patients on a second-line regimen. However, the nding is inconsistent with a study [31,36] that found patients on 1st line regimens too have an increased risk of LTFU.…”

“…The prevalence of LTFU in adults PLHIV in the current study was similar to the ndings of studies conducted in Nigeria and Gabon, where the cumulative rate of LTFU at 13-and 10-years review in Nigeria was 30.6% and 32% [19,20], while in Gabon in a two years review was 34.1% [21]. The study ndings are in contrast to the 13.45% LTFU in a retrospective study in Northwest Ethiopia [22], 3% LTFU in a study in French [23], 12.75% LTFU in a retrospective study in Kampala-Uganda [24], 12.8% LTFU in a cohort study in South Africa [25], while a study done in Guinea and Kenya reported a prevalence of 57.61% and 54% LTFU from a seven years follow-up study [26,27].…”