HIV Treatment Outcomes among MSM in Southwest Nigeria: Comparison Study of KP-friendly Centers and One Stop Shop (original) (raw)

2019, NISA 2019 Conference

Background: Nigeria with an HIV prevalence of 1.4% has a mixed epidemic, a general epidemic affecting the general population and concentrated epidemic affecting key and vulnerable populations.. In Nigeria, FSW, MSM and PWID, who constitute an estimated 1% of the adult Nigerian population, contribute nearly 23% of new HIV infections. About 20% of infections may be attributed to female sex workers, their clients and client partners alone, of which three-fourths may be attributable to brothel-based FSWs. People who inject drugs (PWID), MSM and their partners respectively contribute about 9% and 10% of the annual new infections. These KPs and their partners together, who constitute an estimated 3.4% of the adult population, contribute as much as 40% of new infections (1). Drivers of HIV epidemic among the KP include stigma, discrimination, limited KP-friendly services, and other structural barriers like unfavorable legal environment for MSM in Nigeria through the introduction of the Same Sex Prohibition Act. Also the HIV prevention, treatment, and care continuum remains inaccessible for many KP (Baral et al., 2009, Schwartz, 2015). As a result, progress toward ensuring universal access to HIV services for KP, and achieving HIV epidemic control, has been sub-optimal in many SSA countries (WHO, 2016). In a bid to improve access to HIV services among MSM, staffs in selected public and private hospitals were trained to provide key population friendly services and drop-in centres known as OSS were set up to provide comprehensive HIV services under one roof. Objective: To evaluate differences in rates of HIV infection, ART initiation, viral suppression and retention among MSM referred to OSS and KP friendly centers. Methods: This was a retrospective analysis of the programmatic data of an HIV intervention projects among the MSM populations in Oyo and Lagos states, Nigeria, between October 2018 and June 2019.The project in Oyo state was centered around OSS while Lagos engaged KP friendly public health centers Findings: HIV Treatment Cascade S/N Cascade Levels One Stop Shop(OSS) KP friendly centers P value 1 HIV Testing 3,248 2,707 2 HIV Positive 204 (6.3%) 260(9.6%) 3 ART Linkage 185(90.7%) 250(96.2%) 4 Viral Load Suppression 19/20 (95%) 20/50(40%) 5 Retention 177(95.7%) 229 (91.6%) Discussion: At the OSS, a total of3, 248 MSM were tested for HIV infection and 204 confirmed HIV infected, giving a positivity rate of 6.3% while on the KP friendly centers project a total of 2,707 were screened for HIV and 260 were confirmed HIV positive giving an infection rate of 9.6%.The difference in number tested for HIV was as a result of the difference in the program targets given to the two states. The HIV infection rate among MSM in Lagos state where the KP friendly centers was engaged can thus be said to be higher than the infection rate among MSM in Oyo state where the OSS center used. ART Linkage and initiation of ART among the positive MSM was higher at 96% with the KP friendly centers compared with the 91% ART initiation rate at the OSS. Viral suppression rate of 95% among MSM enrolled at the OSS was higher than the 40% suppression rate among the infected MSM in care at the KP friendly centers in Lagos. About 96% and 92% of those on ART were still active in care at the OSS and the KP friendly centers respectively 6 months after enrolment. Conclusions: HIV prevalence among MSM who patronised KP friendly hospitals in Lagos is higher than those who accessed care at the OSS in Oyo state. Linkage to ART for initiation was also higher among MSM referred to KP friendly centers compared to those referred to OSS. However, viral suppression and retention in care at 6months were higher among MSM receiving care at OSS. Recommendations Therefore a project that combine the benefits of the two modes of interventions will be most ideal for the MSM community.