1. 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
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Ibrahim Jahun, Ishaq Said, Ibrahim El-Imam, Akipu Ehoche, Ibrahim Dalhatu, Aminu Yakubu, Stacie Greby, Megan Bronson, Kristin Brown, Moyosola Bamidele, Andrew T Boyd, Pamela Bachanas, Emilio Dirlikov, Chinedu Agbakwuru, Andrew Abutu, Michelle Williams-Sherlock, Denis Onotu, Solomon Odafe, Daniel B Williams, Orji Bassey, Obinna Ogbanufe, Chibuzor Onyenuobi, Ayo Adeola, Chidozie Meribe, Timothy Efuntoye, Omodele J Fagbamigbe, Ayodele Fagbemi, Uzoma Ene, Tingir Nguhemen, Ifunanya Mgbakor, Matthias Alagi, Olugbenga Asaolu, Ademola Oladipo, Joy Amafah, Charles Nzelu, Patrick Dakum, Charles Mensah, Ahmad Aliyu, Prosper Okonkwo, Bolanle Oyeledun, John Oko, Akudo Ikpeazu, Aliyu Gambo, Manhattan Charurat, Tedd Ellerbrock, Sani Aliyu, and Mahesh Swaminathan
- Subjects
Medicine ,Science - Abstract
BackgroundIneffective 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.MethodsThe 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.ResultsOf 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.ConclusionsActive 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.
- Published
- 2021
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