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Individual and Network Factors Associated With HIV Care Continuum Outcomes Among Nigerian MSM Accessing Health Care Services

Ramadhani, Habib O., MD, PhD*; Ndembi, Nicaise, PhD*,†; Nowak, Rebecca G., PhD*; Ononaku, Uchenna, NCE; Gwamna, Jerry, MD; Orazulike, Ifeanyi, BSc§; Adebajo, Sylvia, MD, PhD; Crowell, Trevor A., MD, PhD¶,#; Liu, Hongjie, PhD**; Baral, Stefan D., MD, MPH††; Ake, Julie, MD, MSc#; Charurat, Man E., PhD* For the TRUST/RV368 Study Group

JAIDS Journal of Acquired Immune Deficiency Syndromes: September 1, 2018 - Volume 79 - Issue 1 - p e7–e16
doi: 10.1097/QAI.0000000000001756
Clinical Science
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Background and Setting: Because data on the determinants of the HIV care continuum from key populations such as men who have sex with men (MSM) in resource-limited settings are limited, the study aimed to characterize HIV care continuum outcomes and assess individual and network barriers to progression through the HIV care continuum among MSM in Abuja and Lagos, Nigeria.

Methods: TRUST/RV368 study used respondent-driven sampling to accrue MSM into community-based clinics in Nigeria. Participants received HIV testing at enrollment. HIV-infected participants were offered antiretroviral therapy (ART) with HIV RNA testing every 3 months (Abuja) or 6 months (Lagos). Multiple logistic regression models were used to calculate adjusted odds ratios for factors associated with each point in the HIV care continuum, including HIV testing, ART initiation, and 6-month viral suppression.

Results: A total of 1506 MSM were recruited, 1178 (78.2%) tested for HIV and 369 (31.3%) were HIV positive newly diagnosed. Of these, 188 (50.1%) initiated ART, 136 (72.3%) completed 6 months, and 96 (70.6%) were virally suppressed. Larger network size and stronger social network support were each positively associated with HIV testing uptake. Factors associated with ART initiation were higher education and stronger social network support. Having stronger social network support was associated with increased odds of viral suppression at 6 months.

Conclusions: Social determinants of health potentiated increased HIV care continuum outcomes. Integration of HIV prevention, HIV counseling and testing services, and universal coverage of ART into a community-based clinic is critical in achieving better HIV care continuum outcomes.

*Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD;

Institute of Human Virology Nigeria, Abuja, Federal Capital Territory, Nigeria;

U.S. Centers for Disease Control and Prevention, Abuja, Federal Capital Territory, Nigeria;

§International Center for Advocacy and Rights to Health, Abuja, Federal Capital Territory, Nigeria;

Population Council, Abuja, Federal Capital Territory, Nigeria;

Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD;

#U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD;

**University of Maryland School of Public Health, College Park, MD; and

††Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD.

Correspondence to: Habib O. Ramadhani, MD, PhD, Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, 725 W Lombard Street, Baltimore 21201 (e-mail: Homari@ihv.umaryland.edu).

Supported by a cooperative agreement between the Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., and the U.S. Department of Defense [W81XWH-11-2-0174]; the National Institutes of Health [R01 MH099001 and R01 AI120913]; Fogarty AITRP [D43TW01041]; and the President's Emergency Plan for AIDS Relief through a cooperative agreement between the Department of Health and Human Services/Centers for Disease Control and Prevention, Global AIDS Program, and the Institute for Human Virology-Nigeria [U2G IPS000651].

The authors have no funding or conflicts of interest to disclose

The views expressed are those of the authors and should not be construed to represent the positions of the U.S. Army, the Department of Defense, or the Department of Health and Human Services. The investigators have adhered to the policies for protection of human subjects as prescribed in AR-70.

Received February 14, 2018

Accepted April 24, 2018

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