Abstract:
BACKGROUND : Patient interruption of antiretroviral therapy (ART) continues to limit HIV programs’ progress toward
epidemic control. Multiple factors have been associated with client interruption in treatment (IIT)— including age,
gender, CD4 count, and education level. 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. President’s
Emergency Plan for AIDS Relief (PEPFAR) program in Nigeria.
METHODS : 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. IIT was defined as no clinical contact for 28 days or more after the last expected clinical
contact. Univariate and multivariate logistic regression models were computed to explore the factors associated with
IIT. The variables included in the analysis were sex, age group, zone, facility level, regimen line, multi-month dispensing
(MMD), and viral load category.
RESULTS : Of the 573 630 clients analysed in this study, 32% have been recorded as having interrupted treatment. 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). Those less likely to interrupt ART were males (aOR = 0.91), clients on six-month MMD (aOR = 0.01), adults
on 2nd
line regimen (aOR = 0.09), and paediatrics on salvage regimen (aOR = 0.02). 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). Age group was not significantly associated
with IIT.
CONCLUSIONS : Sex, zone, facility level, regimen line, MMD, and VL were significantly associated with IIT. MMD of three
months and longer (especially six months) had better retention on ART than those on shorter MMD. Not having a VL
on record was associated with a considerable risk of IIT.
