title: Treatment outcomes in a decentralized antiretroviral therapy program: a comparison of two levels of care in north central Nigeria.
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 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.
authors.affiliation: AIDS Prevention Initiative Nigeria, Abuja, Nigeria.
authors.forename: Prosper
authors.initials: P
authors.lastname: Okonkwo
authors.affiliation: Department of Obstetrics & Gynaecology, University of Jos/Jos University Teaching Hospital, Jos 930001, Nigeria ; AIDS Prevention Initiative Nigeria, Jos University Teaching Hospital, Jos 930001, Nigeria.
authors.forename: Atiene S
authors.initials: AS
authors.lastname: Sagay
authors.affiliation: AIDS Prevention Initiative Nigeria, Jos University Teaching Hospital, Jos 930001, Nigeria ; Department of Family Medicine, University of Jos/Jos University Teaching Hospital, Jos 930001, Nigeria.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Agaba
authors.affiliation: AIDS Prevention Initiative Nigeria, Jos University Teaching Hospital, Jos 930001, Nigeria.
authors.forename: Stephen
authors.initials: S
authors.lastname: Yohanna
authors.affiliation: AIDS Prevention Initiative Nigeria, Jos University Teaching Hospital, Jos 930001, Nigeria ; Department of Medicine, University of Jos/Jos University Teaching Hospital, Jos 930001, Nigeria.
authors.forename: Oche O
authors.initials: OO
authors.lastname: Agbaji
authors.affiliation: Department of Obstetrics & Gynaecology, University of Jos/Jos University Teaching Hospital, Jos 930001, Nigeria ; AIDS Prevention Initiative Nigeria, Jos University Teaching Hospital, Jos 930001, Nigeria.
authors.forename: Godwin E
authors.initials: GE
authors.lastname: Imade
authors.affiliation: AIDS Prevention Initiative Nigeria, Abuja, Nigeria.
authors.forename: Bolanle
authors.initials: B
authors.lastname: Banigbe
authors.affiliation: AIDS Prevention Initiative Nigeria, Abuja, Nigeria.
authors.forename: Juliet
authors.initials: J
authors.lastname: Adeola
authors.affiliation: AIDS Prevention Initiative Nigeria, Abuja, Nigeria ; Department of Obstetrics & Gynaecology, University of Jos/Jos University Teaching Hospital, Jos 930001, Nigeria.
authors.forename: Tinuade A
authors.initials: TA
authors.lastname: Oyebode
authors.affiliation: AIDS Prevention Initiative Nigeria, Jos University Teaching Hospital, Jos 930001, Nigeria ; National Agency for the Control of AIDS, Abuja, Nigeria.
authors.forename: John A
authors.initials: JA
authors.lastname: Idoko
authors.affiliation: Infectious Diseases & Immunology, Harvard School of Public Health, Boston, MA, USA.
authors.forename: Phyllis J
authors.initials: PJ
authors.lastname: Kanki