Solina Center for International Development and Research (SCIDaR), 8, Libreville Street, Wuse 2, Abuja, Nigeria.
Healthy Sunrise Foundation, Las Vegas, USA.
AIDS Res Ther. 2022 Feb 22;19(1):11. doi: 10.1186/s12981-022-00438-3.
In Nigeria, private for-profit health facilities present an opportunity to achieve the UNAIDS 95-95-95 HIV targets because of their reach and patronage. However, little is known about determinants of outcomes in these facilities. This study describes patient outcomes and the patient and health facility characteristics associated with these outcomes in adults receiving HIV treatment in private facilities in the Federal Capital Territory (FCT), Benue and Nasarawa states in north-central Nigeria.
A retrospective longitudinal analysis of program data collected between 2013 and 2019 was done. Patient attributes and outcomes were compared across the two states and FCT. Incidence rates were determined for all cause exit, mortality and loss to follow up (LTFU). Cox proportional hazard models were used to identify associations between patient and facility attributes and these outcomes. Bivariate and multivariate logistic regression models were used to determine the factors associated with viral suppression among the study participants.
Of the 22,010 study subjects, 42.7%, 22.2% and 35.1%, respectively, were in Benue, FCT and Nasarawa. Almost a third (31.8%) had received antiretroviral treatment (ART) for less than a year at censoring. Incidence rates for all-cause exit, mortality and loss to follow up (LTFU) were 17.2 (95% CI 16.8, 17.5), 2.1 (95% CI 2.0, 2.2), and 11.2 (95% CI 10.8, 11.8) per 100 person years respectively. Males had higher risks of death (HR = 1.47, 95% CI 1.25-1.73), and LTFU (HR = 1.08, 95% CI 1.00-1.16). Age at ART start showed a dose-response association with both mortality and LTFU. Care at model facilities (OR = 2.16, p < 0.001), Zidovudine (AZT)-based regimens (OR = 2.00, p < 0.001), and lowest quartile baseline CD4 + count (OR = 2.40, p < 0.001) were associated with regimen switch. 75.6% of subjects were viral suppressed. Male gender (OR = 0.84, p = 0.025); AZT-based regimen (OR = 0.72, p < 0.001), age in the bottom quartile (OR = 0.71, p = 0.002) were associated with virally suppression.
Private for-profit facilities are a major provider of HIV and other health services in Nigeria. With appropriate technical support and engagement, they can help accelerate efforts to achieve epidemic control of HIV in Nigeria, and contribute to achievement of UNAIDS 95-95-95 target by 2030.
在尼日利亚，私立盈利性医疗机构因其覆盖面广和客源多，为实现艾滋病规划署 95-95-95 艾滋病毒目标提供了机会。然而，人们对这些医疗机构的结果决定因素知之甚少。本研究描述了在尼日利亚中北部联邦首都区（FCT）、贝努埃州和纳萨拉瓦州接受艾滋病毒治疗的成年人的患者结局以及与这些结局相关的患者和卫生机构特征。
对 2013 年至 2019 年期间收集的项目数据进行了回顾性纵向分析。比较了两个州和 FCT 之间的患者属性和结果。确定了所有原因退出、死亡率和失访（LTFU）的发生率。使用 Cox 比例风险模型确定患者和医疗机构属性与这些结果之间的关联。使用二变量和多变量逻辑回归模型确定与研究参与者病毒抑制相关的因素。
在 22010 名研究对象中，分别有 42.7%、22.2%和 35.1%来自贝努埃州、FCT 和纳萨拉瓦州。近三分之一（31.8%）在截止时接受抗逆转录病毒治疗（ART）不到一年。所有原因退出、死亡率和失访（LTFU）的发生率分别为 17.2（95%CI 16.8,17.5）、2.1（95%CI 2.0,2.2）和 11.2（95%CI 10.8,11.8）/100 人年。男性死亡风险（HR=1.47,95%CI 1.25-1.73）和 LTFU（HR=1.08,95%CI 1.00-1.16）的风险更高。开始 ART 时的年龄与死亡率和 LTFU 呈剂量反应关系。在模型设施中接受护理（OR=2.16，p<0.001）、齐多夫定（AZT）为基础的方案（OR=2.00，p<0.001）和最低四分位基线 CD4+计数（OR=2.40，p<0.001）与方案转换有关。75.6%的受试者病毒得到抑制。男性（OR=0.84，p=0.025）；基于 AZT 的方案（OR=0.72，p<0.001），年龄在最低四分位（OR=0.71，p=0.002）与病毒抑制有关。
私立盈利性医疗机构是尼日利亚艾滋病毒和其他卫生服务的主要提供者。通过适当的技术支持和参与，它们可以帮助加速尼日利亚艾滋病毒流行控制的努力，并有助于实现 2030 年艾滋病规划署 95-95-95 目标。
