Abstract:

Introduction: WHO clinical staging and or CD4 were used as eligibility criteria for initiation and monitoring of patients on ART in Sub-Saharan African. With health facility-based ART services, most patients in Sub-Saharan African were initiated on ART at late WHO clinical staging. Data are lacking on the clinical staging at the initiation of community-based ART services in Nigeria. This study describes WHO clinical staging among key populations initiated on community-based ART services using WHO test and treat guideline in Nigeria.

Methodology: This is a baseline data analysis of a longitudinal study of all KPs who initiated community-based ART services in 7 states in Nigeria. Time 1 data abstracted from facility records includes age and sex, marital, educational, and employment status and WHO clinical staging at initiation.

Results: Eighty-two percent of participants were initiated at early WHO clinical staging (1& 2). Among KPs, 85% of FSW were initiated at the early stage, followed by MSM (75%) and then PWID (66%). More PWID (34%) were initiated at the late stage (3&4) followed by MSM (25%) and FSW (15%). Factors positively associated with early initiation include: being a female, sex partners living together, unemployment and low educational status.

Conclusion: Community based ART services using test and treat guideline will improve early initiation of KPs on ART services. However, further study to identify reasons for late ART initiation among KPs is required to support programme effort to achieve the UNAIDS 90-90-90 goals.

Keywords: HIV/AIDS, key populations, community-based antiretroviral therapy, WHO clinical staging, test and treat.

References:

[1].AIDS Info (2017); Guidelines for the use of antiretroviral therapy in adults and adolescents living with HIV. Available at https://aidsinfo.nih.gov/guidelines/html/1/adult-and-adolescent-arv/10/initiation-of-antiretroviral-therapy

[2].Alison L. Drake, a,* Suzanne K. Wilson, b John Kinuthia, c Alison C. Roxby, d Daniel Matemo, e (2015); Healthcare-seeking behavior of HIV-infected mothers and male partners in Nairobi, Kenya. Glob Public Health. 2015 Dec; 10(10): 1215–1226. doi: 10.1080/17441692.2014.1003573

[3].Andrea L Wirtz,1,2 Dunker Kamba,3 Vincent Jumbe,4,5 Gift Trapence,3 Rehana Gubin,6 (2014); A qualitative assessment of health-seeking practices among and provision practices for men who have sex with men in Malawi. BMC Int Health Hum Rights. 2014; 14: 20, doi: 10.1186/1472-698X-14-20

[4].Anita Morrison, Lawrence Elliot, Laurence Gruer (2006); Injecting related harm and treatment seeking behavior among injecting drug users. https://doi.org/10.1111/j.1360-0443.1997.tb02853.

[5].Avert (2016); HIV/AIDS in Nigeria; Available at https://www.AVERT.org/Professionals/HIV-around-world/Sub-Saharan-Africa/Nigeria

[6].Avert (2017); People Who Inject Drugs, HIV, and AIDS. Available at https://www.avert.org/professionals/hiv-social-issues/key-affected-populations/people-inject-drugs

[7].Averts (2018); HIV and AIDS in Nigeria. Available at https://www.avert.org/professionals/hiv-around-world/sub-saharan-africa/nigeria

[8].Baveewo S, Ssali F, Karamagi C, Kalyango JN, Hahn JA, Ekoru K, et al. (2011) Validation of World Health Organisation HIV/AIDS Clinical Staging in Predicting Initiation of Antiretroviral Therapy and Clinical Predictors of Low CD4 Cell Count in Uganda. PLoS ONE 6(5): e19089. https://doi.org/10.1371/journal.pone.0019089

[9].Bhekisisa (2017); Africa: Why Does HIV Kill More Men than Women? Available at http://allafrica.com/stories/201708150097.html

[10]. Chigomezgo Munthali, Miriam Taegtmeyer, Paul G Garner, David G Lalloo (2014) Diagnostic accuracy of the WHO clinical staging system for defining eligibility for ART in sub-Saharan Africa: a systematic review and meta-analysis. Journal of International AIDS Society 2014, 17:18932 Http://dx.doi.org/10.7448/IAS.17.1.18932

[11]. Delayed HIV diagnosis and initiation of antiretroviral therapy: inequalities by educational level, COHERE in EuroCoord. AIDS 2014, 28:2297–2306. DOI:10.1097/QAD.0000000000000410

[12]. Denis Nash, Olga Tymejczyk, Tsigereda Gadisa, Sarah Gorrell Kulkarni, Susie Hoffman, et al (2016) Factors associated with initiation of antiretroviral therapy in the advanced stages of HIV infection in six Ethiopian HIV clinics, 2012 to 2013; Journal of International AIDS Society. https://doi.org/10.7448/IAS.19.1.20637

[13]. Elias K, Tobias F, Rinke de Wit, Ermias H. Mulu G. Tsehaynesh M. et al (1999) Evaluation of the World Health Organization staging system for HIV infection and disease in Ethiopia: association between clinical stages and laboratory markers. DOI: 10.1097/00002030-199902250-00011

[14]. Federal ministry of health, Nigeria (2014); Integrated biological and behavioral surveillance survey (IBBSS) 2014. Available at https://www.google.com.ng/search?q=11.+Federal+ministry+of+health%2C+Nigeria+(2014)%3B+Integrated+biological+and+behavioural+surveillance+survey&oq=11.+Federal+ministry+of+health%2C+Nigeria+(2014)%3B+Integrated+biological+and+behavioural+surveillance+survey&aqs=chrome..69i57.1253j0j7&sourceid=chrome&ie=UTF-8

[15]. Federal Ministry of Health, Nigeria (2014); Integrated national guidelines for HIV prevention, treatment and care 2014. Available at https://childrenandaids.org/sites/default/files/2017-05/Nigeria-Integrated-National-Guildlines-For-HIV-Prevention-treatment-and-care-2014.pdf

[16]. Federal ministry of health, Nigeria (2014); National HIV seroprevalence sentinel survey among pregnant women attending an antenatal clinic in Nigeria. Available at

https://www.google.com.ng/search?q=12.+Federal+ministry+of+health%2C+Nigeria+(2014)%3B+National+HIV+seroprevalence+sentinel+survey+among+pregnant+women+attending+antenatal+clinic+in+Nigeria&oq=12.+Federal+ministry+of+health%2C+Nigeria+(2014)%3B+National+HIV+seroprevalence+sentinel+survey+among+pregnant+women+attending+antenatal+clinic+in+Nigeria&aqs=chrome..69i57.1456j0j7&sourceid=chrome&ie=UTF-8

[17]. Federal Ministry of Health, Nigeria (2016); National guidelines for HIV prevention, treatment and care 2016. Available at http://apps.who.int/medicinedocs/documents/s23252en/s23252en.pdf

[18]. Federal ministry of health, Nigeria (2016); National guidelines for HIV prevention treatment and care 2016. Available at http://apps.who.int/medicinedocs/documents/s23252en/s23252en.pdf

[19]. Ford, Nathan, b; Migone, Chantal; Calmy, Alexandra; Kerschberger, Bernhard; Kanters, Steve (2018); Benefits and risks of rapid initiation of antiretroviral therapy. JAIDS: Volume 32 - Issue 1 - p 17–23. doi: 10.1097/QAD.0000000000001671

[20]. HIV.gov (2016); the Global HIV/AIDS Epidemic. Available at https://www.hiv.gov/hiv-basics/overview/data-and-trends/global-statistics

[21]. Hoots BE1, Finlayson TJ, Broz D, Paz-Bailey G; NHBS Study Group (2017); Antiretroviral Therapy Use Among HIV-Infected People Who Inject Drugs-20 Cities, United States, 2009-2015. J Acquir Immune Defic Syndr. 2017 Jul 1;75 Suppl 3: S392-S396. doi: 10.1097/QAI.0000000000001416

[22]. http://www.paho.org/hq/index.php?option=com_docman&task=doc_view&gid=23834&Itemid=270

[23]. http://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2017/december/20171201_blind spot

[24]. Ian R Grubb,1 Sarah W Beckham,§,2 Michel Kazatchkine,3 Ruth M Thomas,4 Eliot R Albers,5 (2017); Maximizing the benefits of antiretroviral therapy for key affected populations. J Int AIDS Soc. 2014; 17(1): 19320. doi: 10.7448/IAS.17.1.19320

[25]. ILO (2013); The impact of employment on HIV treatment adherence. Available at http://www.workingpositive.net/pdf/treatment-adherence.pdf

[26]. Jean B Nachega, an Olalekan A Uthman,b Karl Peltzer, c Lindsey A Richardson, d Edward J Mills, e (2015); Association between antiretroviral therapy adherence an employment status; systemic review and meta-analysis. Bull World Health Organ. 2015 Jan 1; 93(1): 29–41.doi: 10.2471/BLT.14.138149

[27]. Jennifer L. Weinberg and Carrie L. Kovarik, MD (2010); The WHO Clinical Staging System for HIV/AIDS, American Medical Association Journal Ethics, Volume 12, Number 3: 202-206.

[28]. Laurie Barclay (2015); Women More Likely Than Men to Receive HIV Treatment

[29]. Maria L, Frances U, Susie H, Batya E, Srah GK, et al (2013); The Problem of Late ART initiation in Sub-Saharan Africa: A Transient Aspect of Scale-up or a Long-term Phenomenon? J Health Care Poor Underserved; 24(1): 359–383. doi: 10.1353/hpu.2013.0014

[30]. Medscape public health. Available at https://www.medscape.com/viewarticle/855079

[31]. Mills EJ, Beyrer C, Birungi J, Dybul MR (2012) Engaging Men in Prevention and Care for HIV/AIDS in Africa. PLoS Med 9(2): e1001167. https://doi.org/10.1371/journal.pmed.1001167

[32]. PAHO; Towards a Caribbean Consensus. Improving Access to Key Populations to Comprehensive HIV Health Services available at http://www.paho.org/hq/index.php?option=com_docman&task=doc_view&gid=23834&Itemid=270&lang=en

[33]. Pan American Health Organization (2011); Improving Access of Key Populations to Comprehensive HIV Health Services: Towards a Caribbean Consensus, Washington, D.C.: PAHO, © 2011

[34]. Paz Sobrino-Vegas, Johana Rodriguez, Juan Berenguer, Ann Maria Caro-Murillo (2012). An educational gradient in HIV diagnosis delay, mortality, antiretroviral treatment initiation and response in a country with universal health access. Antiretroviral Therapy 2012; 17:1-8. (doi: 10.3851/IMP1939)

[35]. Rose Wilcher (2017); Call for paper: Optimizing the impact of key population programming across HIV cascade. Available at https://researchforevidence.fhi360.org/call-for-papers-optimizing-the-impact-of-key-population-programming-across-the-hiv-cascade

[36]. Schneider G1, Juday T, Wentworth C 3rd, Lanes S, Hebden T, Seekins D.(2013); Impact of healthcare payer type on HIV stage of illness at the time of initiation of antiretroviral therapy in the USA AIDS Care. 2013;25(11):1470-6. doi: 10.1080/09540121.2013.774316.

[37]. Shroufi A, Gunguwo H, Dixon M, Nyathi M, Ndebele W, Saint-Sauveur JF, (2013); HIV-infected adolescents in southern Africa can achieve good treatment outcomes: results from a retrospective cohort study. AIDS. 2013 Jul 31;27(12):1971-8. DOI: 10.1097/QAD.0b013e32836149ea

[38]. Siegfried N1, Uthman OA, Rutherford GW. (2017); Optimal time for initiation of antiretroviral therapy in asymptomatic, HIV-infected, treatment-naive adults. Cochrane Database Syst Rev. 2010 Mar 17;(3): CD008272. doi: 10.1002/14651858.CD008272.pub2, https://www.ncbi.nlm.nih.gov/pubmed/20238364

[39]. UNAIDS (2014); 90-90-90: An ambitious treatment target to help end the AIDS epidemic. Available at http://www.unaids.org/sites/default/files/media_asset/90-90-90_en_0.pdf

[40]. UNAIDS Ottawa/Geneva (2017); On World AIDS Day, UNAIDS warns that men are less likely to access HIV treatment and more likely to die of AIDS-related illnesses. Available at

[41]. Vogt, Florian MD, MSc; Rehman, Andrea M. PhD; Kranzer, Katharina PhD; Nyathi, Mary MD; Van Griensven (2017); Relationship Between Time to Initiation of Antiretroviral Therapy and Treatment Outcomes: A Cohort Analysis of ART Eligible Adolescents in Zimbabwe. JAIDS Journal of Acquired Immune Deficiency Syndromes: April 1st, 2017 - Volume 74 - Issue 4 - p 390–398. doi: 10.1097/QAI.0000000000001274

[42]. WHO (2008); HIV/AIDS Care and Treatment for People Who Inject Drugs in Asia and the Pacific: An Essential Practice Guide. Available at http://apps.who.int/medicinedocs/en/d/Js19812en/

[43]. WHO (2014); Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations. Available at http://apps.who.int/iris/bitstream/10665/128048/1/9789241507431_eng.pdf?ua=1&ua=1

[44]. WHO (2015); Guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV. Available at http://apps.who.int/iris/bitstream/handle/10665/186275/9789241509565_eng.pdf?sequence=1

[45]. WHO (2016); Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection; recommendation for a public health approach 2nd edition. Available at http://apps.who.int/iris/bitstream/10665/208825/1/9789241549684_eng.pdf?ua=1

[46]. WHO 2005: Treat 3 million by 2005, interim WHO clinical staging of HIV/AIDS and HIV/AIDS case definition for surveillance African region. http://www.who.int/hiv/pub/guidelines/clinicalstaging.pdf?ua=1