Prevalence and predictors of persistent low-level HIV viraemia: a retrospective cohort study among people receiving dolutegravir-based antiretroviral therapy in Southern Nigeria.

Background: Persistent low-level viraemia (PLLV) is a risk factor for virologic failure among people receiving antiretroviral therapy (ART). Objectives: We assessed the prevalence and predictors of PLLV among individuals receiving Dolutegravir-based ART in southern Nigeria. Design: This retrospective cohort study used routine program data from electronic medical records of persons receiving Dolutegravir-based first-line ART in 154 PEPFAR/USAID-supported health facilities in Akwa Ibom and Cross Rivers states, Nigeria. Methods: Clients on first-line Dolutegravir-based ART ⩾6 months, who had a viral load result in the 12 months preceding October 2021 (baseline), and a second viral load result by September 2022 were included. Persons with low-level viraemia (LLV) (viral load 51-999 copies/ml) received additional adherence support. The outcome analysed was PLLV (two consecutive LLV results). Indices were summarized using descriptive statistics, and predictors of PLLV were determined using multivariate logistic regression. Results: In total, 141,208 persons on ART were included, of which 63.3% (n = 89,944) were females. The median age was 36 [29-44] years, median ART duration was 19 [11-42] months. At the end of the study, 10.5% (14,759/141,208) had initial LLV, 90.1% (13,304/14,759) of which attained undetectable viral load (⩽50 copies/ml), and 1.1% (163/14,759) transitioned to virologic failure (⩾1000 copies/ml) by the end of the study. PLLV prevalence was 0.9% (1292/141,208). Increasing ART duration [adjusted odds ratio (aOR) = 1.0; 95% confidence interval (CI): 1.005-1.008; p < 0.001] and viral suppression (<1000 copies/ml) before initial LLV (aOR = 1.7; 95% CI: 1.50-2.00; p < 0.001) were positively associated with PLLV, while receipt of tuberculosis preventive therapy reduced the likelihood of PLLV (aOR = 0.3; 95% CI: 0.10-0.94; p = 0.039). Conclusion: PLLV was uncommon among individuals receiving dolutegravir-based ART and was associated with longer ART duration, prior viral suppression, and non-receipt of tuberculosis preventive therapy. This strengthens recommendations for continuous adherence support and comprehensive health services with ART, to prevent treatment failure.

How Hypertension Rates and HIV Treatment Outcomes Compare between Older Females and Males Enrolled in an HIV Treatment Program in Southern Nigeria: A Retrospective Analysis.

Studies show that treatment outcomes may vary among persons living with HIV. To fast-track the attainment of epidemic control across gender and age groups, the Accelerating Control of the HIV Epidemic (ACE-5) Project implemented in Akwa Ibom and Cross Rivers States, Nigeria, examined the hypertension rates and treatment outcomes of older adults living with HIV. The demographic and treatment characteristics of males and females ≥ 50 years living with HIV, who initiated antiretroviral therapy (ART) as of September 2021, were abstracted from medical records across 154 health facilities and community sites in Akwa Ibom and Cross River states, Nigeria. We compared these characteristics by sex using the chi-square test. The log-rank test was used to compare differences in their retention (i.e., being on treatment) and viral suppression (VS) rates [<1000 copies/Ml] in September 2022. Of the 16,420 older adults living with HIV (10.8% of the treatment cohort) at the time of the study, 53.8%, and 99.5% were on a first-line ART regimen. Among the 3585 with baseline CD4 documented (21.8% of the cohort), the median [IQR] CD4 count was 496 [286-699] cells/mm3, with more males having lower baseline CD4 than females [13.4% of males vs. 10.2% of females, p-value = 0.004]. In total, 59.9% received treatment at out-of-facility locations, with more males receiving treatment in this setting than females [65.7% vs. 54.8% p-value < 0.001]. Of those in whom blood pressure was assessed (65.9% of the treatment cohort), 9.6% were hypertensive, with males being less likely to be hypertensive [8.0% vs. 11.1% p-value < 0.001] than females. Overall, retention as of September 2022 was 96.4%, while VS was 99.0% and did not differ significantly by sex [retention: p = 0.901; VS: p = 0.056]. VS was slightly but not significantly higher among females than males (98.8% versus 99.2%; Aor = 0.79, 95%CI = 0.58-1.10, p = 0.17). Although older males and females living with HIV had similar treatment outcomes, hypertension screening was suboptimal and could impact long-term morbidity and mortality. Our study emphasizes the need to integrate noncommunicable disease screening and the management of hypertension in the care of older persons living with HIV.

Scale-up of antiretroviral treatment access among people living with HIV in Rivers State, Nigeria, 2019--2020.

OBJECTIVE: The aim of this study was to describe and evaluate the impact of the programme intervention of the Rivers State Antiretroviral Treatment (ART) Surge, a collaboration between the US President's Emergency Plan for AIDS Relief (PEPFAR) and the State Ministry of Health, to increase HIV case-finding and ART access in Rivers State, the state with the largest ART gap among people living with HIV (PWH) in Nigeria. DESIGN: During April 2019-September 2020, the intervention included six specific strategies: using local government area-level ART gap analysis to guide case-finding; expanding targeted community testing; tailoring comprehensive key population HIV services; engaging HIV treatment programme stakeholders; synchronizing team efforts; and using near real-time data for programme action. METHODS: Weekly reported facility and community data on tests conducted, PWH diagnosed, and PWH initiated on ART were aggregated. The total number of PWH maintained on ART was reported quarterly. RESULTS: During May 2019-September 2020, the weekly number of newly diagnosed PWH initiated on ART supported by PEPFAR in Rivers State increased from 82 to 1723. During October 2019-September 2020, the monthly number of people screened for HIV testing eligibility in the community increased from 44 000 to 360 000. During April 2019-September 2020, the total number of PWH on ART supported by PEPFAR statewide increased by 3.8 times, from 26 041 to 99 733. CONCLUSION: The strategies applied by HIV program stakeholders contributed to scale-up of PWH identification and ART linkage within the Rivers State ART Surge. Continued gains through time indicate the importance of the application of a quality improvement approach to maintain programme flexibility and effectiveness.

Effect of community treatment initiative on antiretroviral therapy uptake among linkage-resistant people living with HIV in Northern Nigeria.

BACKGROUND: Community Treatment Initiative (CTI) was developed in northern Nigeria as an intervention to link a cohort of people living with HIV (PLHIV) who refused antiretroviral treatment through a conventional linkage method to care and treatment. The CTI attempted to take treatment to PLHIV in the community. METHODS: This was a non-control interventional study that evaluated the proportion of linkage-resistant PLHIV linked to treatment through the CTI in nine geographical areas. Data were collected between October and December 2015. Linkage-resistant PLHIV were identified and linked to treatment using the CTI. Data were analyzed using Excel and IBM SPSS version 20.0. The simple proportion was used to estimate the linkage-resistant PLHIV who were eventually linked and retained in care and who ultimately achieved virological suppression (viral load <1000 copies/ml). The Chi-square test was used and the level of significance set at a p-value of <0.05. RESULTS: An estimated 541 (20%) PLHIV (239 (44.2%) male, 302 (55.8%) female) seen from October to December 2015 refused linkage to treatment. This was statistically significant at a p-value of <0.0001. Three hundred and seventy-seven (69.7%) of the PLHIV who refused linkage to treatment eventually accepted treatment using an alternative community treatment method; this was significant (p<0.0001). The 6-month retention rate for PLHIV who accepted the alternative treatment method was 88.1% (n=332); this was significant (p<0.0001). Seventy-eight percent of those retained in care attained virological suppression. CONCLUSIONS: The CTI improved linkage to care and treatment for a cohort of linkage-resistant PLHIV. Focus on this cohort of linkage-resistant positive clients is required to achieve HIV epidemic control.

Effect of clients Strategic Index Case Testing on community-based detection of HIV infections (STRICT study).

BACKGROUND: Strategic Index Case Testing (STRICT), a form of partner notification service, was initiated to track, identify and notify sexual partners of people living with HIV (Index clients) with the sole aim of testing them to determine their HIV status and linking clients who are positive to Anti-Retroviral Therapy (ART). This research analyzed the HIV sero-prevalence among sexual partners of HIV positive clients using STRICT and determines the role of STRICT in HIV epidemic control. METHODS: This is a non-control Interventional study that determined the impact of Strategic Index Case Testing (STRICT) on detecting previously undiagnosed HIV infections among sexual partners of positive index clients. This study was conducted in seven Local Government Areas (LGAs) of Karu, Nasarawa, Lafia, Doma, AMAC, Bwari, and Ushongo. These LGAs were selected for HIV epidemic control due to projected high prevalence of HIV from previous program level data. HTS was offered to sexual partners of index PLHIV from facility and community within the LGAs. Index clients were PLHIV diagnosed from outreaches, hot spots set up in strategic places and Provider Initiated Testing and Counseling (PITC) in comprehensive and primary health care facilities. Newly diagnosed PLHIV and those already enrolled and commenced on ART from October 2015 to July 2016 were identified from source registers. These index clients were counseled on how to notify their sexual partners about their HIV status and on bringing them for HIV Testing and Counseling (HTS). Those unable to do so after a given period of time were assisted by health workers in informing their various sexual partners based on the confidential agreement and informed consent signed by the Index clients. FINDINGS: A total of 1277 index cases were counseled and interviewed with 879 index clients agreeing to disclosure, giving a disclosure rate of 68.3%. We identified 888 sexual partners from the interviews and traced 870 (97.9%) sexual contacts. A total of 741 (85.2%) of 870 sexual contacts traced were tested for HIV, out of which 378 (51%) tested positive using an HIV rapid test kit, and this was statistically significant at P Value=0.0254. A total of 348 (92.1%) out of 378 HIV positive sexual partners were immediately commenced on ART using the recommended UNAIDS Test and Treat approach to HIV epidemic control. INTERPRETATION: STRICT identifies the need for reaching out to sexual partners of index clients and providing them with HIV Testing Services (HTS) as they belong to a high risk priority population and also linking them to care and treatment. This group of people must be reached with HTS strategies in order to end the HIV epidemic as evidenced by high sero-prevalence of 51% among them.