Improving Patient Continuity in Treatment in Borno

Borno, located in northeast Nigeria, has an estimated population of 5,860,200 and an HIV prevalence of 1.7 percent, with approximately 41,032 adults and children living with HIV and 17,348 receiving life-long antiretroviral therapy (ART). Patient continuity of treatment (COT) is a key indicator of successful HIV management, as it ensures that individuals living with HIV (PLHIV) maintain routine engagement with their medications after commencing ART. According to the UNAIDS global HIV goals, achieving epidemic control requires that all PLHIV are identified, linked immediately to treatment, and maintain COT with viral suppression. In Borno State, the COT benchmark is set at 98 percent. An analysis conducted in November 2022 revealed that Borno State did not meet the 98 percent COT target among PLHIV. A further analysis identified four facilities in Borno that were below the target, and improvements were focused on these facilities. The facilities included the University of Maiduguri Teaching Hospital, Umaru Shehu Ultra Modern Hospital, Muhammed Shuwa Memorial Hospital, and Maiduguri State Specialist Hospital. The root causes of patients' interruption in treatment (IIT) in fragile, conflicted, and violent (FCV) settings were identified as security issues, poor tracking and accountability of PLHIV on treatment by case managers, poor documentation on HIV treatment registers and electronic medical record (EMR) system, patients' challenges in reaching clinics, and patients' lack of knowledge about when they are due for medication. To address these issues, corrective actions were implemented, including bridging gaps in patient tracking, addressing documentation gaps, and collaborating with stakeholders to ensure safe travel for patients in FCV settings. The impact of these corrective actions is evident in the HIV Continuity of Treatment Trend graph, which shows a significant improvement in COT rates over time. The graph indicates that the COT rates for the four facilities in Borno State have increased, with some facilities achieving COT rates above 98 percent. The data suggests that the implemented corrective actions have been effective in improving patient continuity in treatment in Borno State, Nigeria. The Data for Implementation (Data.FI) project, which is a five-year cooperative agreement funded by the U.S. President's Emergency Plan for AIDS Relief through the U.S. Agency for International Development, has been instrumental in supporting the implementation of these corrective actions. The project is implemented by Palladium, in partnership with JSI Research & Training Institute (JSI), Johns Hopkins University (JHU) Department of Epidemiology, Right to Care (RTC), Cooper/Smith, DT Global, Jembi Health Systems, and Macro-Eyes, and supported by expert local resource partners.