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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

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dc.contributor.author Yohanna, Stephen
dc.date.accessioned 2024-10-03T03:07:13Z
dc.date.available 2024-10-03T03:07:13Z
dc.date.issued 2014-03
dc.identifier.issn 2141-2359
dc.identifier.uri http://localhost:8080/xmlui/handle/123456789/2915
dc.description.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 en_US
dc.language.iso en_US en_US
dc.publisher Journal of AIDS and HIV Research en_US
dc.relation.ispartofseries 6;3
dc.subject 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 en_US
dc.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 en_US
dc.type Article en_US


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