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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Treatment outcomes in a decentralized antiretroviral therapy program: A comparison of two levels of care in north central Nigeria
AIDS Research and Treatment, Volume 2014, Article 560623, Year 2014
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Description
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 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. © 2014 Prosper Okonkwo et al.
Authors & Co-Authors
Okonkwo, Prosper I.
Nigeria, Abuja
Apin Public Health Initiatives Ltd./gte
Sagay, Atiene Solomon
Nigeria, Jos
University of Jos
Aladi Agaba, Patricia A.
Nigeria, Jos
University of Jos
Yohanna, Stephen
Nigeria, Jos
University of Jos
Agbaji, Oche Ochai O.
Nigeria, Jos
University of Jos
Imade, Godwin Eremwan
Nigeria, Jos
University of Jos
Banigbe, Bolanle Feyisayo
Nigeria, Abuja
Apin Public Health Initiatives Ltd./gte
Adeola, Juliet
Nigeria, Abuja
Apin Public Health Initiatives Ltd./gte
Oyebode, Tinuade Abimbola
Nigeria, Abuja
Apin Public Health Initiatives Ltd./gte
Nigeria, Jos
University of Jos
Idoko, John Alechenu
Nigeria, Jos
University of Jos
Nigeria, Abuja
National Agency for the Control of Aids
Kanki, Phyllis Jean
United States, Boston
Harvard T.h. Chan School of Public Health
Statistics
Citations: 11
Authors: 11
Affiliations: 4
Identifiers
Doi:
10.1155/2014/560623
e-ISSN:
20901259
Research Areas
Health System And Policy
Infectious Diseases
Study Locations
Nigeria