title: Enrolment trends in a comprehensive HIV programme in rural north-central Nigeria: improved care indices, but declining quality of clinical data over time.
abstract: BACKGROUND
  Vanderbilt University affiliate Friends in Global Health was funded in 2008 to support comprehensive HIV/AIDS services in north-central Nigeria. We summarise programme characteristics and trends in enrolment and quality of data collection in this rural, resource-limited environment.
  
  
  METHODS
  We used routinely collected programme data in supported sites from June 1 2009 to September 30, 2013.Baseline characteristics were defined as those collected closest to a 90-day window period before and after enrolment. Summary characteristics were compared by site and enrolment year.
  
  
  RESULTS
  We enrolled 3,960 HIV-infected patients into care (68% women), median age of 32 years [interquartile range (IQR): 27-40]. Most clients were married (79%) and unemployed (60%). At enrolment, median CD4+ cell count was 230 cells/μL (IQR: 114-390) and haemoglobin was 10.7 g/dL (IQR: 9.3-11.9). Advanced clinical disease [World Health Organization (WHO) clinical stage III/IV] at enrolment was documented in 29% of clients. Cumulative enrolment increased from 377 patients in 2009 to 3,960 patients by 2013.With each successive year, more clients were enrolled at earlier stages of disease; in 2009, 37% of patients were identified as WHO clinical stage I, while in 2013, 55% of patients were so classified. While documentation of clinical staging remained stable, the completeness of CD4+ cell count and haemoglobin data declined with time.
  
  
  CONCLUSIONS
  Expanded testing in a comprehensive HIV programme in rural Nigeria brought persons to care at earlier stages of illness. Yet, as clinical services expanded, data collection quality declined. The paradox of successful scaling up HIV services but deteriorating quality of data underscores the importance of data management training and quality improvement efforts.
authors.forename: Muktar H
authors.initials: MH
authors.lastname: Aliyu
authors.forename: Meridith
authors.initials: M
authors.lastname: Blevins
authors.forename: Folasade
authors.initials: F
authors.lastname: Arinze
authors.forename: Karen M
authors.initials: KM
authors.lastname: Megazzini
authors.forename: Scottie
authors.initials: S
authors.lastname: Bussell
authors.forename: Julie
authors.initials: J
authors.lastname: Dunlap
authors.forename: Chisom
authors.initials: C
authors.lastname: Odoh
authors.forename: Usman I
authors.initials: UI
authors.lastname: Gebi
authors.forename: Mukhtar Y
authors.initials: MY
authors.lastname: Muhammad
authors.forename: Bryan E
authors.initials: BE
authors.lastname: Shepherd
authors.forename: Carolyn M
authors.initials: CM
authors.lastname: Audet
authors.forename: Sten H
authors.initials: SH
authors.lastname: Vermund
authors.forename: C William
authors.initials: CW
authors.lastname: Wester
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality; D006302:Health Services Research; D006801:Humans; D008297:Male; D009549:Nigeria / Q000453:epidemiology; D015397:Program Evaluation; D012424:Rural Population / Q000706:statistics & numerical data; D016019:Survival Analysis; D013997:Time Factors
chemical_list: D019380:Anti-HIV Agents
keywords: HIV/AIDS,; PEPFAR,; data quality,; enrolment,; rural Nigeria; trends,
references.citation: J Acquir Immune Defic Syndr. 2014 Feb 1;65(2):e41-9
references.pmid: 23727981
references.citation: AIDS. 2014 Mar;28 Suppl 2:S151-60
references.pmid: 24849475
references.citation: BMC Infect Dis. 2013;13:522
references.pmid: 24192332
references.citation: Clin Infect Dis. 2014 Feb;58(3):432-41
references.pmid: 24198226
references.citation: MMWR Morb Mortal Wkly Rep. 2013 Nov 29;62(47):945-52
references.pmid: 24280913
references.citation: Contemp Clin Trials. 2013 Sep;36(1):187-97
references.pmid: 23816493
references.citation: AIDS. 2010 Sep 10;24(14):2263-70
references.pmid: 20683318
references.citation: Am J Clin Pathol. 2009 Jun;131(6):875-86
references.pmid: 19461097
references.citation: S Afr Med J. 2006 Apr;96(4):315-20
references.pmid: 16670804
references.citation: N Engl J Med. 2013 Jan 17;368(3):218-30
references.pmid: 23323898
references.citation: PLoS Med. 2012;9(9):e1001304
references.pmid: 22973181
references.citation: J Acquir Immune Defic Syndr. 2012 Mar 1;59(3):e35-42
references.pmid: 22156912
references.citation: Int J STD AIDS. 2011 Nov;22(11):621-7
references.pmid: 22096045
references.citation: Lancet. 2011 Oct 29;378(9802):1572-9
references.pmid: 21951656
references.citation: J Int AIDS Soc. 2011;14:46
references.pmid: 21955541
references.citation: Int J STD AIDS. 2014 Apr;25(5):355-9
references.pmid: 24104694