Treatment Outcomes in a Decentralized Antiretroviral Therapy Program: A Comparison of Two Levels of Care in North Central Nigeria
Sagay, Atiene S.
Agaba, Patricia A.
Agbaji, Oche O.
Imade, Godwin E.
Oyebode, Tinuade A.
Idoko, John A.
MetadataShow full item record
CitationOkonkwo, P., A. S. Sagay, P. A. Agaba, S. Yohanna, O. O. Agbaji, G. E. Imade, B. Banigbe, et al. 2014. “Treatment Outcomes in a Decentralized Antiretroviral Therapy Program: A Comparison of Two Levels of Care in North Central Nigeria.” AIDS Research and Treatment 2014 (1): 560623. doi:10.1155/2014/560623. http://dx.doi.org/10.1155/2014/560623.
AbstractBackground. Decentralization of antiretroviral therapy (ART) services is a key strategy to achieving universal access to treatment for people living with HIV/AIDS. Our objective was to assess clinical and laboratory outcomes within a decentralized program in Nigeria. Methods. Using a tiered hub-and-spoke model to decentralize services, a tertiary hospital scaled down services to 13 secondary-level hospitals using national and program guidelines. We obtained sociodemographic, clinical, and immunovirologic data on previously antiretroviral drug naïve patients aged ≥15 years that received HAART for at least 6 months and compared treatment outcomes between the prime and satellite sites. Results. Out of 7,747 patients, 3729 (48.1%) were enrolled at the satellites while on HAART, prime site patients achieved better immune reconstitution based on CD4+ cell counts at 12 (P < 0.001) and 24 weeks (P < 0.001) with similar responses at 48 weeks (P = 0.11) and higher rates of viral suppression (<400 c/mL) at 12 (P < 0.001) and 48 weeks (P = 0.03), but similar responses at 24 weeks (P = 0.21). Mortality was 2.3% versus 5.0% (P < 0.001) at prime and satellite sites, while transfer rate was 8.7% versus 5.5% (P = 0.001) at prime and satellites. Conclusion. ART decentralization is feasible in resource-limited settings, but efforts have to be intensified to maintain good quality of care.
Citable link to this pagehttp://nrs.harvard.edu/urn-3:HUL.InstRepos:12717415
- SPH Scholarly Articles