Impacts of a Pilot of Community Antiretroviral Group Initiative on HIV‑Positive Patients in a Tertiary Health Facility in Abuja, North Central Nigeria

Abstract

Background: Decentralization, as seen in community antiretroviral group (CAG), has resulted in a significant decline in deaths from AIDS‑related causes with projected further benefits in middle‑ and low‑income countries, such as Nigeria. After 2 years of CAG implementation in our facility, this study is designed to assess its impacts on the pilot‑cohort of patients, (individual and group), and the hospital facility.

Materials and Methods: Pooled data from the CAG register of the pilot cohort of 84 clients, was used for the study. Review of data at entry and 2 years after was done. A questionnaire was used to obtain additional qualitative data. This was administered to all the eighty‑four pilot patients and 31 caregivers.

Results: There were eight locations, with 84, clients, 62 females and 22 males. The mean/standard deviation of age was 39.38 ± 9.68 years. There were significant increases in weight (kg), (from 65.94 ± 11.012 to 70.69 ± 11.465, P < 0.001), body mass index (kg/m2), (from 24.77 ± 3.879 to 26.79 ± 4.282 P < 0.001), packed cell volume (%) from (31.19 ± 5.014 to 35.64 ± 5.131, P < 0.001), CD4 (cells/mm³), (from 394.36 ± 193.094 to 563.87 ± 220.137 P < 0.001). The viral load suppression was sustained, reducing even further, from 85.06 ± 182.329 to 31.10 ± 46.648 copies/ml, P < 0.001. Retention in care and outcomes were better.

Conclusions: From this pilot, the CAG model has shown promise in reducing attrition, improving quality of care, and other direct and indirect  benefits, including; cardiovascular, nutritional, and socioeconomic. This has justified the scale‑up of this laudable model that will further improve the quality of care given to the patients and the overall quality profile of the facility and system.

Keywords: Abuja, antiretroviral‑care, decentralization, pilot