Abstract:
Key populations (KP) are disproportionately infected with HIV and experience barriers to
HIV care. KP include men who have sex with men (MSM), female sex workers (FSW), persons
who inject drugs (PWID) and transgender people (TG). We implemented three different
approaches to the delivery of community-based antiretroviral therapy for KP (KPCBART)
in Benue State Nigeria, including One Stop Shop clinics (OSS), community dropin-
centres (DIC), and outreach venues. OSS are community-based health facilities serving
KP only. DIC are small facilities led by lay healthcare providers and supported by an outreach
team. Outreach venues are places in the community served by the outreach team.
We studied long-term attrition of KP and virological non-suppression.
Method
This is a retrospective cohort study of KP living with HIV (KPLHIV) starting ART between
2016 and 2019 in 3 0SS, 2 DIC and 8 outreach venues. Attrition included lost to follow-up
(LTFU) and death. A viral load >1000 copies/mL showed viral non-suppression. Survival
analysis was used to assess retention on ART. Cox regression and Firth logistic regression
were used to assess risk factors for attrition and virological non-suppression respectively.
Result
Of 3495 KPLHIV initiated on ART in KP-CBART, 51.8% (n = 1812) were enrolled in OSS,
28.1% (n = 982) in DIC, and 20.1% (n = 701) through outreach venues. The majority of participants
were FSW—54.2% (n = 1896), while 29.8% (n = 1040), 15.8% (n = 551) and 0.2%
(n = 8) were MSM, PWID, and TG respectively. The overall retention in the program was63.5%, 55.4%, 51.2%, and 46.7% at 1 year, 2 years, 3 years, and 4 years on ART. Of 1650
with attrition, 2.5% (n = 41) died and others were LTFU. Once adjusted for other factors
(age, sex, place of residence, year of ART enrollment, WHO clinical stage, type of KP
group, and KP-CBART approach), KP-CBART approach did not predict attrition. MSM were
at a higher risk of attrition (vs FSW; adjusted hazard ratio (aHR) 1.27; 95%CI: 1.14–1.42).
Of 3495 patients, 48.4% (n = 1691) had a viral load test. Of those, 97.8% (n = 1654) were
virally suppressed.
Conclusion
Although long-term retention in care is low, the virological suppression was optimal for KP
on ART and retained in community-based ART care. However, viral load testing coverage
was sub-optimal. Future research should explore the perspectives of clients on reasons for
LTFU and how to adapt approach to CBART to meet individual client needs.
