Implementation and Impact of the Advanced HIV Disease Package of Care in Ekiti State, Nigeria: A Retrospective Cohort Study

Abstract

Background: Advanced HIV Disease remains a major driver of HIV-related morbidity and mortality in low- and middle-income countries, including Nigeria. Evidence on the real-world impact of the WHO-recommended AHD package of care in Nigeria is limited. This study examined its effect on diagnostics, treatment, and outcomes in Ekiti State. Methods: We conducted a retrospective cohort study across 15 ART sites using the National Medical Records System data. Patients aged ≥5 years who newly enrolled in HIV care between December 2019 and November 2021(before the implementation of the WHO AHD package of care) and December 2021 and May 2023(implementation period) were included. Data were analyzed using STATA version 16.1. Results: 892 patients were included in the study with a median age of 35 years (IQR: 28 - 44), and the majority were females (59.3%). Many of the patients were from the key population typology. The study showed an increase in the uptake of CD4 from 83.7% to 99.3%. It also showed an increase in the diagnosis of tuberculosis using TB LAM, although the level of service uptake was generally low. Diagnostic services for cryptococcal meningitis were also seen to be very poor. Clinical outcomes at six months showed a significant difference (p <0.01) in the mortality outcome. Conclusion: The AHD package improved CD4 testing coverage and reduced mortality, demonstrating its potential to strengthen HIV care in Nigeria. Persistent gaps in Tuberculosis Lipoarabinomannan Assay and cryptococcal antigen testing highlight the need for stronger diagnostic capacity and full adoption of the package. These findings provide early evidence to guide scale-up and optimization of AHD care in similar settings.