Title

Lessons Learned from the introduction of advanced HIV disease package of care in Nigeria

Presenter

Boma Levy-Braide

Authors

B. Levy-Braide¹, N. Otubu¹, O. Abudiore¹, W. Eigege¹, O. Sowale¹, A. Inyang¹, I. Amamilo², D. Rathakrishnan², A. Moore², J. Conroy², C. Amole², F. Lufadeju¹, O. Wiwa¹, C. Adesigbin³, P. Nwaokenneya³, U. Atu³, M.-I. Patiko³, A. Ikpeazu³, R. Oladele⁴, O. Agbaji⁵, S. Akanmu⁶

Institutions

¹Clinton Health Access Initiative, HIV Access Program, Abuja, Nigeria, ²Clinton Health Access Initiative, HIV Access Program, Boston, United States, ³National AIDS and STI Control Program, Federal Ministry of Health, Abuna, Nigeria, ⁴Medical Mycology Association of Nigeria, Lagos, Nigeria, ⁵Jos University Teaching Hospital, Jos, Nigeria, Jos, Nigeria, ⁶Lagos University Teaching Hospital, Lagos, Nigeria, Lagos, Nigeria

BACKGROUND: In Nigeria, 32% of PLHIV who received CD4 tests in 2018 had Advanced HIV Disease (AHD), this population had the highest mortality. Despite this, a package of care for AHD (AHD PoC) was not clearly defined in-country. This abstract outlines the process and lessons learned from introducing the AHD PoC in Nigeria.
DESCRIPTION: The Nigeria MOH constituted a working group in 2019 to develop and oversee implementation of the AHD PoC in-country. The first phase of implementation involved 28 facilities across 4 high-burden states that account for 31% of national HIV burden (Lagos, Akwa-Ibom, Rivers, Anambra). In 2020, National guidelines, training materials, and reporting tools were reviewed to include the AHD PoC. Healthcare-worker (HCW) capacity was built to implement AHD PoC. Commodities were distributed and facility implementation commenced in February 2021. Newly identified PLHIV were screened for AHD. Those with AHD were screened for Tuberculosis and Cryptococcal-Meningitis (CM), followed by rapid ART initiation and intensive adherence support.
LESSONS LEARNED: By September 2022, 13,795 new PLHIV were identified; 85.4% (11,781) received CD4 tests, of which 46.6% (5,487) had CD4 <200cell/mm³. Of the 5,487 AHD clients, 77.9% (4,277) were screened for TB using TB LF-LAM, 34.1% (1,458) were positive, of which 67.8% (989) started TB treatment. The screening coverage for blood cryptococcal antigen (CrAg) using CrAg LFA was 83.4% (4,576), 2.3% (106) were positive. Only 35.8% (38) of blood CrAg-positive clients received a CSF CrAg test, 23.7% (9) were CSF positive, of which 66.7% (6) started CM treatment. Poor access to adjunct commodities contributed to observed gaps in TB LF-LAM and CSF CrAg testing.

Programming for CrAg and TB LF-LAM tests should consider adjunct commodities vital to close gaps observed across the cascade, particularly lumbar-puncture packs for CSF CrAg and urine cups for TB LF-LAM. Considering HCW capacity gaps for lumbar puncture (LP) at some facilities, a hub-and-spoke model will be ideal for scale-up, and LP referral mechanisms should be strengthened.
CONCLUSIONS: Implementing the AHD PoC increased TB and CM case-finding among PLHIV, and could potentially reduce mortality associated with AHD.

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