Multilevel modelling and multiple group analysis of disparities in continuity of care and viral suppression among adolescents and youths living with HIV in Nigeria

Abstract

IntroductionSubstantial disparities in care outcomes exist between different subgroups of adolescents and youths living with HIV (AYLHIV). Understanding variation in individual and health facility characteristics could be key to identifying targets for interventions to reduce these disparities. We modelled variation in AYLHIV retention in care and viral suppression, and quantified the extent to which individual and facility characteristics account for observed variations.MethodsWe included 1170 young adolescents (10–14 years), 3206 older adolescents (15–19 years) and 9151 young adults (20–24 years) who were initiated on antiretroviral therapy (ART) between January 2015 and December 2017 across 124 healthcare facilities in Nigeria. For each age group, we used multilevel modelling to partition observed variation of main outcomes (retention in care and viral suppression at 12 months after ART initiation) by individual (level one) and health facility (level two) characteristics. We used multiple group analysis to compare the effects of individual and facility characteristics across age groups.ResultsFacility characteristics explained most of the observed variance in retention in care in all the age groups, with smaller contributions from individual-level characteristics (14%–22.22% vs 0%–3.84%). For viral suppression, facility characteristics accounted for a higher proportion of variance in young adolescents (15.79%), but not in older adolescents (0%) and young adults (3.45%). Males were more likely to not be retained in care (adjusted OR (aOR)=1.28; p<0.001 young adults) and less likely to achieve viral suppression (aOR=0.69; p<0.05 older adolescent). Increasing facility-level viral load testing reduced the likelihood of non-retention in care, while baseline regimen TDF/3TC/EFV or NVP increased the likelihood of viral suppression.ConclusionsDifferences in characteristics of healthcare facilities accounted for observed disparities in retention in care and, to a lesser extent, disparities in viral suppression. An optimal combination of individual and health services approaches is, therefore, necessary to reduce disparities in the health and well-being of AYLHIV.

Factors associated with viral suppression among adults living with HIV on antiretroviral therapy in Nigeria: Analysis of a population‐based survey, 2018

“…The proportion of VLS from this survey is similar to the findings from other studies involving routinely collected data from HIV care and treatment centers in Nigeria [17–19]. Although there is variation in defining VLS, duration on treatment, and inclusion criteria, the range of VLS falls within what was found in the current survey.…”

“…In this 2018 nationally representative population-based survey in Nigeria, 98.7% of PLWH who knew their status had detectable ARVs in their blood and 80.9% of those on ART were virally suppressed. Although viral suppression on ART was below targets that have been set to help The proportion of VLS from this survey is similar to the findings from other studies involving routinely collected data from HIV care and treatment centers in Nigeria [17][18][19]. Although there is variation in defining VLS, duration on treatment, and inclusion criteria, the range of VLS falls within what was found in the current survey.…”

Perfil da coorte de pessoas em tratamento da infecção por HIV no SUS, Brasil, 2015–2018

“…The linkage between individual and service databases makes it possible, for the first time in the country, to establish a dialogue with international studies of a similar design 8 , 33 . It is therefore expected that the Qualiaids Brazil Cohort will contribute to the construction of evidence in the area, based on analyses that integrate the different levels involved in determining the results of the HIV treatment of people monitored in the SUS services.…”

“…O relacionamento entre bases de dados individuais e dos serviços possibilita, pela primeira vez no país, o diálogo com estudos internacionais de desenho semelhante 8 , 33 . Espera-se, assim, que a Coorte Qualiaids Brasil contribua para a construção de evidências na área, a partir de análises que integrem os diferentes níveis envolvidos na determinação de resultados do tratamento do HIV de pessoas acompanhadas nos serviços do SUS.…”

Understanding why and how youth-friendly health services improve viral load suppression among adolescents and young people living with HIV in Nigeria: realist evaluation with qualitative comparative analysis

“…We purposively selected 10 health facilities in Benue State, Nigeria, from the APIN-supported secondary and tertiary facilities network. The selection was based on our previous studies evaluating facility service conditions and YPLHIV treatment outcomes across the state 29 30. To ensure diversity in outcomes, we grouped the facilities into three performance clusters: cluster A (low performing) with less than 75% coverage of HIV VL suppression among enrolled YPLHIV, cluster B (medium performing) with 75%–89% coverage and cluster C (high performing) with 90% or more coverage.…”