Treatment Discontinuation in Adult HIV-Infected Patients on First-Line Antiretroviral Therapy in Nigeria.

BACKGROUND: Retention in care and treatment services is critical to health outcomes of individuals diagnosed and living with HIV. We evaluated the incidence of and risk factors for treatment discontinuation (TD) in a large adult HIV population on ART in Nigeria. METHOD: A retrospective cohort study of adult HIV patients initiated on first-line ART between 2004 and 2011 at the Jos University Teaching Hospital (JUTH) in Nigeria. Follow up information of participants was retrieved from various sources (patient visit database, pharmacy data and patients charts) up to the end of 2012. The primary study endpoint was TD, defined as discontinuation of ART for any reason, including death or loss to follow-up (lack of pharmacy pick-up for periods≥12 months). The Incidence and hazard for TD were estimated by Kaplan-Meier and Cox proportional regression analysis, respectively. RESULT: Overall, 3,362 (28%) patients discontinued treatment during 49,436 person-years (py) of follow-up (incidence rate (IR) 6.8 TD per 100 py). The hazard of treatment discontinuation decreased with increasing age (adjusted hazard ratio (aHR 0.99; 95% CI 0.98-0.99). Other independent risk factors for treatment discontinuation were: being unmarried (aHR 1.24; 95% CI: 1.12-1.38), having primary or secondary level of education as compared to tertiary level education (aHR 1.24; 95% CI: 1.12-1.40) and average percent adherence to drug refill visits<95% (adjusted hazard ratio (aHR) 2.13; 95% CI: 1.9-2.40). Compared to tenofovir, greater hazard of TD was noted in patients initiated on ART containing didanosine (aHR) 1.73; 95% CI: 1.03-2.91), but lower in those initiated on zidovudine containing regimen (aHR 0.77; 95% CI: 0.69-0.86). CONCLUSION: Long-term treatment discontinuation rate in this study was comparable to estimates in resource-rich countries. Younger patients, as well as patients with lower educational levels and those with poor adherence had significant hazards for treatment discontinuation and should be the target of interventions to reduce treatment discontinuation and improve retention, especially within the first year of ART.

Acceptance and stigmatization of PLWA in Nigeria.

There is now an acknowledged burden of AIDS and the HIV in Nigeria. In treatment centres, AIDS-related disorders account for up to 40% of admissions, while many communities have recorded regular losses within the last five years. In December 1999, the federal government announced that 2.9 million people (or 5.4% of the Nigerian population) were already infected by HIV. An important aspect of HIV/AIDS programmes is the care of persons living with AIDS (PLWA), both in curative centres and in communities. Based on operations research of a STD/AIDS Management Project, this paper examines acceptance of PLWA in communities in Southern Benue State, an area of high prevalence. From interviews with PLWA, their family members and others in the communities, it was found that the level of stigmatization is high and acceptance of PLWA is low. These reactions stem mainly from the fear of contracting 'the disease that has no cure', believed to be transmittable through any form of physical contact. Based on beliefs, which are further reinforced by the local terms for AIDS, some suggested that PLWA be eliminated before they infect others. These findings suggest that the challenges of AIDS control programmes include coming to terms with the epidemic and fostering more acceptance for PLWA and, above all, changing the current perception of HIV/AIDS from a personal to public health problem. The challenges are daunting but urgent, particularly because Nigeria's HIV/AIDS epidemic is reaching an explosion phase and more care will be provided at home.