HIV/AIDS: Research and Palliative Care (Nov 2023)
Effect of Multi-Month Dispensing on Viral Suppression for Newly Enrolled Adolescents and Adults in Northern Nigeria
Abstract
Bazghina-Werq Semo,1,* Nnenna A Ezeokafor,2,3,* Babatunde Oyawola,3 Cyrus Mugo4 1Global Health Division, Chemonics International, Washington, DC, USA; 2Maryland Global Initiative Cooperation, University of Maryland, Abuja, Nigeria; 3Global Health Division, Chemonics International, Abuja, Nigeria; 4Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya*These authors contributed equally to this workCorrespondence: Bazghina-Werq Semo, Global Health Division, Chemonics International, 1275 New Jersey Avenue, Washington, DC, 20003, USA, Email [email protected]: We evaluated the effect of multi-month dispensing (MMD) on viral suppression among newly enrolled adolescents and adults with HIV in 11 northern Nigerian states.Patients and Methods: We conducted a retrospective analysis of longitudinal data from 75 health facilities. We abstracted electronic medical records for patients ≥ 10 years, initiated on ART April 1, 2019 – June 30, 2021, and with a 6- or 12-month viral load (VL) result. We categorized participants in the MMD group to see if they received antiretroviral treatment (ART) for ≥ 84 days at any visit within 6 months of ART initiation. We consider cut-offs for viral suppression at 50 copies/mL. The period when the VL was performed was classified as pre-COVID-19 (before April 1, 2020) or during the COVID-19 pandemic. We estimated relative risks (RR) by comparing the unsuppressed proportion of those on MMD to those not on MMD, adjusted for age, gender, and COVID-19 period.Results: Overall, 19,859 participant records were abstracted. Median age was 33 years, 64% were female, 91% were started on a dolutegravir (DTG)-based regimen, and 65% were on MMD. Overall, 15,259 (77%) participants were followed for ≥ 6 months, 4136 (27%) had a VL at 6 months and 3640 (24%) had a VL at 12 months after ART initiation. A slightly higher proportion of patients on MMD had undetectable VL levels at 6 months (65% vs 58%) and 12 months (66% vs 62%). In the adjusted analysis, we found no significant differences in undetectable VL at 6 months and 12 months between newly enrolled patients on MMD and those not on MMD. Those on Protease inhibitor-based regimen had 54% lower likelihood of undetectable VL compared to those on DTG-based regimen.Conclusion: MMD does not result in poorer viral suppression among newly enrolled patients.Keywords: HIV, differentiated service delivery, PLHIV, Nigeria
