Clinical Epidemiology and Health Systems Determinants of HIV/AIDS Care Outcomes in Port Harcourt Local Government Area, Rivers State, Nigeria

Abstract

Background: Clinical epidemiology and health systems determinants shape HIV care outcomes, yet comparative data on facility types from urban South-South Nigeria remain limited. This study characterised both dimensions for HIV/AIDS care in Port Harcourt Local Government Area (PHALGA), Rivers State, Nigeria. Methods: A convergent parallel mixed-methods study was conducted across eight facilities (a public tertiary facility, model primary health centres, and private facilities). Quantitative data were obtained from a cross‑sectional survey of 542 people living with HIV (PLHIV) using validated tools (MMAS‑8, PHQ‑9, Stigma Index). The primary outcome was viral suppression (<1,000 copies/mL). Multivariable logistic regression identified independent clinical and health system predictors. Qualitative data from 12 key informant interviews (4 clinicians, 5 adherence counsellors, and 3 pharmacists across 6 facilities) were analysed using framework analysis. Results: The mean age of participants was 35.2 years (SD 10.4; median 34, IQR 27–42), and 62.4% (n=338) were female. The overall viral suppression rate was 68.3%. The independent predictors of viral suppression included older age (AOR 1.21 per 10 years, p=0.04), female sex (AOR 1.78, p=0.008), high adherence (AOR 2.94, p<0.001), treatment buddy support (AOR 1.72, p=0.01), and differentiated service delivery (DSD) enrolment (AOR 1.96, p=0.003), while depression (AOR 0.51, p=0.003), stigma (AOR 0.63, p=0.02), and private facility attendance (AOR 0.62, p=0.045) were associated with reduced odds of suppression. Service availability was limited: only 25% of facilities offered mental health screening, 37.5% reported antiretroviral therapy (ART) stockouts, and no private facility transmitted data to the state electronic medical record (EMR) (data extractability: 67.1% private versus 100% public tertiary). Qualitative findings converged on uneven DSD fidelity, absent mental health integration, and weak private-sector surveillance. Conclusion: Viral suppression in PHALGA falls below the 95‑95‑95 target, with meaningful disparities by facility type. Strengthening DSD supply chains to address the 37.5% stockout rate, integrating routine PHQ‑9 screening for depression, and mandating private-sector EMR reporting to close surveillance gaps are essential interventions to improve suppression from 68.3% towards the 95% target.