WHO Clinical Staging at Initiation of Community-based ART Services among Key Populations in Nigeria

Abstract

Introduction: WHO clinical staging and or CD4 were used as eligibility criteria for initiation and monitoring of patients on ART in Sub-Saharan African. With health facility-based ART services, most patients in Sub-Saharan African were initiated on ART at late WHO clinical staging. Data are lacking on the clinical staging at the initiation of community-based ART services in Nigeria. This study describes WHO clinical staging among key populations initiated on community-based ART services using WHO test and treat guideline in Nigeria. Methodology: This is a baseline data analysis of a longitudinal study of all KPs who initiated community-based ART services in 7 states in Nigeria. Time 1 data abstracted from facility records includes age and sex, marital, educational, and employment status and WHO clinical staging at initiation. Results: Eighty-two percent of participants were initiated at early WHO clinical staging (1& 2). Among KPs, 85% of FSW were initiated at the early stage, followed by MSM (75%) and then PWID (66%). More PWID (34%) were initiated at the late stage (3&4) followed by MSM (25%) and FSW (15%). Factors positively associated with early initiation include: being a female, sex partners living together, unemployment and low educational status. Conclusion: Community based ART services using test and treat guideline will improve early initiation of KPs on ART services. However, further study to identify reasons for late ART initiation among KPs is required to support programme effort to achieve the UNAIDS 90-90-90 goals.