Descriptive Analysis of Interruption in HIV Treatment Using LAMIS Data for USAID-Supported Health Facilities in Kano State, Nigeria

Critical to sustaining these accomplishments is developing and implementing client-centered care models to support people living with HIV (PLHIV) in continuing to engage in treatment and achieving viral suppression. Understanding facility and client data trends related to engagement in treatment is essential for tracking progress toward universal retention and improving facility programs to retain PLHIV on treatment. A study on antiretroviral treatment (ART) in lower-income countries found that loss to follow-up (LTFU) after one year was greater than 40% in some programs. In Nigeria, studies have reported interruption in treatment rates ranging from 28% to 31%. Understanding which PLHIV are likely to experience interruption in treatment is essential for assessing program impact and tailoring HIV programming to bring those clients back into treatment with care models that are accessible and meet their needs. The National Data Repository (NDR) provides an opportunity to conduct LTFU analysis across the HIV cohort in Nigeria. The NDR is a database designed to hold all national HIV care and treatment client-level data. U.S. Agency for International Development (USAID) implementing partners upload data to the NDR via the Lafiya Management Information System (LAMIS). The data parameters uploaded into the NDR include ART clinic/hospital number, facility name, state, ART start date, client's date of birth, last clinic date, regimen given, and number of days of antiretrovirals (ARVs). The objectives of this analysis are to perform a descriptive analysis of the LAMIS data within the NDR to highlight any potential relationships between a client's current 28-day status and other client variables. Additionally, the analysis aims to describe the relationship of a subset of variables on interruption in treatment at USAID-supported PEPFAR facilities, including age, sex, and time on ART. Furthermore, the analysis seeks to identify and profile sites within Kano State with disproportionately low continuity of treatment. The data source for this analysis is retrospective cohort data from 484 USAID-supported PEPFAR facilities across 16 Nigerian states that initiated ART. The Data.FI team completed a descriptive analysis of the demographic and clinical parameters of all clients using the R software to explore relationships associated with clients experiencing interruption of treatment in four USAID priority states. The data cleaning process involved compiling 616,762 LAMIS client records from all USAID-supported states, partners, and facilities into a single database for analysis. The distribution of client records by current ART status shows that 44.6% of clients are active, 24.5% have stopped treatment, 14.3% have been transferred out, and 16.6% are deceased. The client ART start date distribution, by gender, reveals that 53.4% of clients are male and 46.6% are female. The client distribution by current ART status, by state, indicates that Kano State has the highest number of clients experiencing interruption in treatment. The Kano State current ART status distribution, by Local Government Area (LGA), shows that 34.6% of clients are active, 26.4% have stopped treatment, 17.3% have been transferred out, and 21.7% are deceased. The proportional distribution of Kano State current ART status, by LGA, indicates that the highest rates of interruption in treatment are found in the Kano Municipal and Gwale LGAs. The client distribution, by age group and sex, reveals that the majority of clients are between the ages of 25 and 44, with a higher proportion of males in this age group. The high-risk populations, by age group, gender, and LGA, show that the highest rates of interruption in treatment are found among clients aged 25-34, with a higher proportion of males in this age group. The high-risk age groups, by time on ART and months of ARV refills, indicate that clients who have been on ART for less than 12 months are more likely to experience interruption in treatment. The top priority facilities with clients experiencing interruption in treatment in Kano State are identified as those with the highest rates of interruption in treatment, with the Kano Municipal and Gwale LGAs having the highest rates. The geographic distribution of facilities with high rates of clients experiencing interruption in treatment shows that the Kano Municipal and Gwale LGAs have the highest rates of interruption in treatment.