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    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

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    Author
    Jahun, Ibrahim
    Said, 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
    Show allShow less

    Date
    2021-09-20
    Journal
    PLoS ONE
    Publisher
    Public Library of Science
    Type
    Article
    
    Metadata
    Show full item record
    See at
    https://doi.org/10.1371/journal.pone.0257476
    Abstract
    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
    AIDS
    Acquired Immunodeficiency Syndrome
    Nigeria
    HIV Infections
    Telemedicine
    Technology
    Surveys and Questionnaires
    Documentation
    HIV Testing
    Identifier to cite or link to this item
    http://hdl.handle.net/10713/16702
    ae974a485f413a2113503eed53cd6c53
    10.1371/journal.pone.0257476
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