Analysis of HIV Treatment Cascade Among Key Affected Population in Lagos, Nigeria.

Background: Key populations are defined groups who, due to specific higher-risk behaviour, are at increased risk of HIV infection irrespective of the epidemic type or local context. Also, they often have legal and social issues related to their behaviour that increase their vulnerability to HIV. In Nigeria, Key population (KP) groups account for a significant portion of new HIV infections. Directly, FSW, MSM and PWID, who constitute an estimated 1% of the adult Nigerian population, contribute nearly 23% of new HIV infections. About 20% of infections may be attributed to female sex workers, their clients and client partners alone, of which three-fourths may be attributable to brothel-based FSWs. People who inject drugs (PWID), MSM and their partners respectively contribute about 9% and 10% of the annual new infections. These KPs and their partners together, who constitute an estimated 3.4% of the adult population, contribute as much as 40% of new infections

Methods: This was a retrospective analysis of the programmatic data of an HIV intervention projects among the three key populations in 15 local government areas (LGA) in Lagos, Nigeria, between October 2018 and June 2019.

Findings:  Among the MSM, HIV positivity rate was 9.6 %      (2.9% to 15.2%), about 96% were linked and initiated on antiretroviral drugs (ARV). Six months   ART retention rate was 95%. For the FSW, the  HIV infection rate was  of 5% (1.4% -12.9%) and   a linkage and ART initiation  rate was  96.5% while  the  six month ART retention rate was 92% . Among the   male PWID the HIV positivity rate was 1.4%. (0.4%- 17.3%) while the female PWID   HIV positivity rate was 8.14%, which was 8 times the average positivity rate among the male PWID. Linkage and ART initiation rate was 100% among HIV positive PWID but only 50% were still active in care 6months after initiation (ART retention rate).    

Conclusions: Having attained   over 90% ARV initiation and retention rates among MSM, FSW and PWID on the project, achieving the 3rd UNAIDS target of 90% viral suppression in the groups is very much possible with appropriate programming. Also engaging social support service such as the use of peers as case managers is associated with excellent   6 month retention outcome.