One-Stop Shop: A Community-Based ART Clinic Model to Improve HIV Prevention and Treatment Cascade for Key Populations in Nigeria

Background: Key populations (KPs) and their sex partners account for as much as 51% of new infections in Nigeria. Due to stigma, Antiretroviral Therapy (ART) among KPs have been a challenge. To achieve population-level impact in mixed HIV epidemics in Africa, high coverage of integrated HIV prevention and treatment strategies that will improve access to ART among KPs is needed. This strengthens good linkage along the HIV cascade, ultimately resulting in improved treatment uptake among the KPs. This paper presents the results of a community-based ART clinic model designed to improve HIV Prevention, Treatment and Care for KPs in Nigeria.

Methods: A series pilot community-based ART clinics otherwise known as One-Stop Shops (OSSs) were set up. These provided integrated services for HIV Testing and Counseling (HTC), STI treatment, clinical referrals and ART to KPs across eight prioritized states of Nigeria's thirty-six states. The eight states are Akwa Ibom, Rivers, Cross Rivers, Benue, Nasarawa, Kaduna, Lagos and the FCT respectively. This cross-sectional study randomly examined 3 months data collected from April-June 2015 outside the OSSs, and compared with data collected between October and December 2015 in OSSs.

Results: Overall 17,395 KPs received HTC (61% FSW, 17% MSM and 22% PWID). Compared to services outside the OSSs that reached 3,626 (21%) KPs with HTC, uptake of HTC in the OSSs accounted for 79%, p=0.01. Overall mean age of the KPs was 28.60 ± 15.63 years. Among 601 HIV positive KPs identified (189 outside the OSSs and 412 in OSSs), linkage to ART treatment was 4% outside the OSSs and 25% in OSSs, p< 0.001. STI treatment among 2,029 KPs was 76% in OSSs compared to 24% outside the OSSs. The OSS model accounted for 92% of CD4+ T-cell count uptake. Overall HIV seroprevalence was 3.5%. HIV positivity yield was higher among MSM (5.0%) compared to FSW (3.4%) and PWID (2.1%).

Conclusion: The OSS model effectively increases uptake of prevention, treatment as well as prevention-treatment linkage in a more conducive settings that protect the privacy of KPs. The OSS is a tailored and integrated community-based ART clinical services model and is recommended for scale up.