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Potential risk factors identified in various studies include clients’ educational level, the lack of a telephone, and risky sexual behaviour. There are several factors associated with clients interrupting treatment, such as their age, gender, CD4 count, and geographical location. In this study we have adhered to the IIT concept as defined by PEPFAR. In that regard, the PEPFAR definition of IIT supports more timely identification of clients interrupting treatment. IIT is comparable to the loss to follow up (LTFU) concept as defined by WHO – with the distinction that LTFU is defined as no clinical contact for at least 90 days after the last expected clinical visit. Ĭlient interruption in treatment was defined by PEPFAR in 2020 as no clinical contact for at least 28 days after the last clinical appointment or expected clinic visit. Continuation of treatment is important because clients must achieve a suppressed viral load (VL), better client health outcomes, and epidemic control. There are currently an estimated 754 566 PLHIV in the 16 states supported by USAID under the PEPFAR program in Nigeria, with an estimated 467 567 PLHIV (62%) receiving ART. The most recent estimate of ART coverage in Nigeria was 65% in 2019, which is significantly below the coverage proportions targeted by UNAIDS and PEPFAR. In 2016, Nigeria started rolling out the “test and treat” policy. Significant efforts have been deployed worldwide to make ART widely accessible to PLHIV following the “treat all” policy recommended by the World Health Organization (WHO) in 2016. More ambitious targets have also been set for 2030 to reach PEPFAR’s 95-95-95 goals for the care and treatment cascade. The UNAIDS 90-90-90 strategy aimed to have 90% of PLHIV know their status, and 90% of those to be retained on antiretroviral therapy (ART) (90% coverage) such that 90% of those are virally suppressed by 2020. The incidence rate decreased from 0.74 to 0.52 per 1 000 population from 2010 to 2019, ending with 100 000 new infections. The prevalence of HIV/AIDS in Nigeria is estimated at 1.4% of the population, with 1.8 million people living with HIV (PLHIV). Globally there are an estimated 38 million PLHIV in 2019, with 2.9 million of those in the Western and Central African region. Not having a VL on record was associated with a considerable risk of IIT. MMD of three months and longer (especially six months) had better retention on ART than those on shorter MMD. Sex, zone, facility level, regimen line, MMD, and VL were significantly associated with IIT. Age group was not significantly associated with IIT. Clients most likely to interrupt ART were located in the South West Zone (aOR = 1.99), received treatment at a tertiary level (aOR = 12.34) or secondary level facilities (aOR = 4.01), and had no viral load (VL) on record (aOR =10.02). Those less likely to interrupt ART were males (aOR = 0.91), clients on six-month MMD (aOR = 0.01), adults on 2 nd line regimen (aOR = 0.09), and paediatrics on salvage regimen (aOR = 0.02). Of the clients investigated, 66% were female (32% had interrupted treatment), 39% were aged 25–34 at their last ART pick-up date (with 32% of them interrupted treatment), 59% received care at secondary level facilities (37% interrupted treatment) and 38% were last receiving between three- to five-month MMD (with 10% of these interrupted treatment). Of the 573 630 clients analysed in this study, 32% have been recorded as having interrupted treatment. The variables included in the analysis were sex, age group, zone, facility level, regimen line, multi-month dispensing (MMD), and viral load category.
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Univariate and multivariate logistic regression models were computed to explore the factors associated with IIT. IIT was defined as no clinical contact for 28 days or more after the last expected clinical contact. We conducted cross-sectional analyses on data obtained from Nigeria’s National Data Repository (NDR), representing a summarized record of 573 630 ART clients that received care at 484 PEPFAR/USAID-supported facilities in 16 states from 2000–2020. President’s Emergency Plan for AIDS Relief (PEPFAR) program in Nigeria. In this paper, we explore the factors associated with IIT in people living with HIV (PLHIV) in United States Agency for International Development (USAID)-supported facilities under the U.S. Multiple factors have been associated with client interruption in treatment (IIT)- including age, gender, CD4 count, and education level.
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Patient interruption of antiretroviral therapy (ART) continues to limit HIV programs’ progress toward epidemic control.