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Title: Background. 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 na¨ıve 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)and24 weeks (𝑃� < 0.001)withsimilarresponsesat48weeks(𝑃� = 0.11) and higher rates of viral suppression (<400c/mL)at12(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)atprimeand satellite sites, while transfer rate was 8.7% versus 5.5% (𝑃� = 0.001)atprimeandsatellites.Conclusion. ART decentralization is feasible in resource-limited settings, but efforts have to be intensified to maintain good quality of care
Authors: Yohanna, Stephen
Keywords: Background. 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 na¨ıve 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)and24 weeks (𝑃 < 0.001)withsimilarresponsesat48weeks(𝑃 = 0.11) and higher rates of viral suppression (<400c/mL)at12(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)atprimeand satellite sites, while transfer rate was 8.7% versus 5.5% (𝑃 = 0.001)atprimeandsatellites.Conclusion. ART decentralization is feasible in resource-limited settings, but efforts have to be intensified to maintain good quality of care
Issue Date: Mar-2014
Publisher: Journal of AIDS and HIV Research
Series/Report no.: 6;3
Abstract: Background. 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 na¨ıve 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)and24 weeks (𝑃 < 0.001)withsimilarresponsesat48weeks(𝑃 = 0.11) and higher rates of viral suppression (<400c/mL)at12(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)atprimeand satellite sites, while transfer rate was 8.7% versus 5.5% (𝑃 = 0.001)atprimeandsatellites.Conclusion. ART decentralization is feasible in resource-limited settings, but efforts have to be intensified to maintain good quality of care
URI: http://localhost:8080/xmlui/handle/123456789/2915
ISSN: 2141-2359
Appears in Collections:Research Articles

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