Optimizing community linkage to care and antiretroviral therapy Initiation: Lessons from the Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS) and their adaptation in Nigeria ART Surge
Author
Jahun, IbrahimSaid, Ishaq
El-Imam, Ibrahim
Ehoche, Akipu
Dalhatu, Ibrahim
Yakubu, Aminu
Greby, Stacie
Bronson, Megan
Brown, Kristin
Bamidele, Moyosola
Boyd, Andrew T
Bachanas, Pamela
Dirlikov, Emilio
Agbakwuru, Chinedu
Abutu, Andrew
Williams-Sherlock, Michelle
Onotu, Denis
Odafe, Solomon
Williams, Daniel B
Bassey, Orji
Ogbanufe, Obinna
Onyenuobi, Chibuzor
Adeola, Ayo
Meribe, Chidozie
Efuntoye, Timothy
Fagbamigbe, Omodele J
Fagbemi, Ayodele
Ene, Uzoma
Nguhemen, Tingir
Mgbakor, Ifunanya
Alagi, Matthias
Asaolu, Olugbenga
Oladipo, Ademola
Amafah, Joy
Nzelu, Charles
Dakum, Patrick
Mensah, Charles
Aliyu, Ahmad
Okonkwo, Prosper
Oyeledun, Bolanle
Oko, John
Ikpeazu, Akudo
Gambo, Aliyu
Charurat, Manhattan
Ellerbrock, Tedd
Aliyu, Sani
Swaminathan, Mahesh
Date
2021-09-20Journal
PLoS ONEPublisher
Public Library of ScienceType
Article
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Background: Ineffective linkage to care (LTC) is a known challenge for community HIV testing. To overcome this challenge, a robust linkage to care strategy was adopted by the 2018 Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS). The NAIIS linkage to care strategy was further adapted to improve Nigeria's programmatic efforts to achieve the 1st 90 as part of the Nigeria Antiretroviral Therapy (ART) Surge initiative, which also included targeted community testing. In this paper we provide an overview of the NAIIS LTC strategy and describe the impact of this strategy on both the NAIIS and the Surge initiatives. Methods: The NAIIS collaborated with community-based organizations (CBOs) and deployed mobile health (mHealth) technology with real-time dashboards to manage and optimize community LTC for people living with HIV (PLHIV) diagnosed during the survey. In NAIIS, CBOs' role was to facilitate linkage of identified PLHIV in community to facility of their choice. For the ART Surge, we modified the NAIIS LTC strategy by empowering both CBOs and mobile community teams as responsible for not only active LTC but also for community testing, ART initiation, and retention in care. Results: Of the 2,739 PLHIV 15 years and above identified in NAIIS, 1,975 (72.1%) were either unaware of their HIV-positive status (N = 1890) or were aware of their HIV-positive status but not receiving treatment (N = 85). Of these, 1,342 (67.9%) were linked to care, of which 952 (70.9%) were initiated on ART. Among 1,890 newly diagnosed PLHIV, 1,278 (67.6%) were linked to care, 33.7% self-linked and 66.3% were linked by CBOs. Among 85 known PLHIV not on treatment, 64 (75.3%) were linked; 32.8% self-linked and 67.2% were linked by a CBO. In the ART Surge, LTC and treatment initiation rates were 98% and 100%, respectively. Three-month retention for monthly treatment initiation cohorts improved from 76% to 90% over 6 months. Conclusions: Active LTC strategies by local CBOs and mobile community teams improved LTC and ART initiation in the ART Surge initiative. The use of mHealth technology resulted in timely and accurate documentation of results in NAIIS. By deploying mHealth in addition to active LTC, CBOs and mobile community teams could effectively scale up ART with real-time documentation of client-level outcomes.Keyword
AIDSAcquired Immunodeficiency Syndrome
Nigeria
HIV Infections
Telemedicine
Technology
Surveys and Questionnaires
Documentation
HIV Testing
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http://hdl.handle.net/10713/16702ae974a485f413a2113503eed53cd6c53
10.1371/journal.pone.0257476
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