Journal Article

Outcomes of Nigeria's HIV/AIDS Treatment Program for Patients Initiated on Antiretroviral Treatment between 2004-2012

Debem, Henry, Auld, Andrew F., Swaminathan, Mahesh, Odafe, Solomon, Ngige, Evelyn, Asadu, Chukwuemeka, Dalhatu, Ibrahim, Dokubo, Kainne, Onotu, Dennis, Ellerbrock, Tedd V., Agolory, Simon, Abatta, Emmanuel, Shiraishi, Ray W., Abiri, Oseni

2016

Overview

The Nigerian Antiretroviral therapy (ART) program started in 2004 and now ranks among the largest in Africa. However, nationally representative data on outcomes have not been reported. We evaluated retrospective cohort data from a nationally representative sample of adults aged ≥15 years who initiated ART during 2004 to 2012. Data were abstracted from 3,496 patient records at 35 sites selected using probability-proportional-to-size (PPS) sampling. Analyses were weighted and controlled for the complex survey design. The main outcome measures were mortality, loss to follow-up (LTFU), and retention (the proportion alive and on ART). Potential predictors of attrition were assessed using competing risk regression models. At ART initiation, 66.4 percent (%) were females, median age was 33 years, median weight 56 kg, median CD4 count 161 cells/mm3, and 47.1% had stage III/IV disease. The percentage of patients retained at 12, 24, 36 and 48 months was 81.2%, 74.4%, 67.2%, and 61.7%, respectively. Over 10,088 person-years of ART, mortality, LTFU, and overall attrition (mortality, LTFU, and treatment stop) rates were 1.1 (95% confidence interval (CI): 0.7-1.8), 12.3 (95%CI: 8.9-17.0), and 13.9 (95% CI: 10.4-18.5) per 100 person-years (py) respectively. Highest attrition rates of 55.4/100py were witnessed in the first 3 months on ART. Predictors of LTFU included: lower-than-secondary level education (reference: Tertiary), care in North-East and South-South regions (reference: North-Central), presence of moderate/severe anemia, symptomatic functional status, and baseline weight <45kg. Predictor of mortality was WHO stage higher than stage I. Male sex, severe anemia, and care in a small clinic were associated with both mortality and LTFU. Moderate/Advanced HIV disease was predictive of attrition; earlier ART initiation could improve program outcomes. Retention interventions targeting men and those with lower levels of education are needed. Further research to understand geographic and clinic size variations with outcome is warranted.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Acquired immune deficiency syndrome / Adolescent / Adult / Adults / AIDS / Ambulatory Care Facilities - statistics & numerical data / Anemia / Anti-HIV Agents - therapeutic use / Antiretroviral agents / Antiretroviral drugs / Antiretroviral therapy / Antiretroviral Therapy, Highly Active / Biology and Life Sciences / CD4 antigen / CD4 Lymphocyte Count / CD4-Positive T-Lymphocytes - drug effects / CD4-Positive T-Lymphocytes - immunology / CD4-Positive T-Lymphocytes - virology / Computer and Information Sciences / Confidence intervals / Drug therapy / Education / Female / Females / Highly active antiretroviral therapy / HIV / HIV Infections - drug therapy / HIV Infections - epidemiology / HIV Infections - immunology / HIV Infections - mortality / Human immunodeficiency virus / Humans / Lentivirus / Lost to Follow-Up / Male / Medical records / Medicine and Health Sciences / Middle Aged / Mortality / Nigeria - epidemiology / Patient outcomes / Patients / People and Places / Prospective payment systems (Medical care) / Rankings / Regression analysis / Regression models / Retention / Retrospective Studies / Retroviridae / Sexually transmitted diseases / Social Class / Statistical analysis / STD / Surveys / Survival Analysis / Treatment Outcome