TITLE:
HIV Treatment Cascade Assessment of a Community-Based Test and Start Model for Key Populations in Lagos State Nigeria: Where Are the Gaps?
AUTHORS:
Jean Njab, Sylvia Adebajo, George Eluwa, Elizabeth Shoyemi, Progress Osakwe, Charles Eke, Daniel Offie
KEYWORDS:
HIV, Cascade, Assessment
JOURNAL NAME:
World Journal of AIDS,
Vol.8 No.3,
September
21,
2018
ABSTRACT: Background: Community-based
test and start (TAS) models have shown the potential to improve clinical
outcomes for key populations because early access to treatment will have
population level impact by reducing transmission through the promotion and
provision of hassle-free quality HIV testing, on the spot ART initiation and
unrestricted access to culturally competent health professionals. We assessed the effectiveness
of a pioneer community-based test and start (TAS) model for key populations in
Lagos along UNAIDS 90/90/90 cascade. Methods: Men who
have sex with men (MSM), female sex workers (FSW), and persons who inject drugs
(PWID), >14 years of age were recruited through peer-referral for HIV
testing services (HTS) at a community-based KP-friendly clinic in Lagos between
June 2015 and September 2016. The clinic provides comprehensive HIV services,
including HIV treatment. Those who test positive are enrolled and provided with
TAS services. Using routine service data, we deployed descriptive cross
tabulations at p Results: In total, 8812 KPs comprising MSM (51.6%),
FSW (32.7%) and PWID (15.7%) were tested during this period. About one-half (46.4%)
were young KP (15 - 25 years). The majority (76.1%) were male, single (86.1%),
almost all (99%) had at least primary school level education, and about
one-quarter (25.1%) were employed. Among MSM, 506 (11.1%) tested positive, 276
(54.5%) were initiated on ART, of whom 155 conducted viral load testing and 88
(56.7%) had achieved viral suppression ( Client satisfaction index
was 96.1%. Conclusion: The current
community-based model showed excellent capacity to achieve the first 90 goal
among target KP communities. However, linkage to care and treatment, adherence,
and retention remain major challenges in achieving the second and third nineties
at the community level.