PG-11 Characteristics of a nationwide cohort of Nigerian adolescents living with HIV on ART
Authors: Fadare Olawale , Badejo Fei , Ogunsola Olabanjo , Nta Iboro , Ilozumba Jude , Busari Olusegun , Sam-Agudu Nadia , Ezeanolue Echezona 
Published: April 2019

Background:
At an estimated 240,000, Nigeria has the second highest number of adolescents living with HIV (ALHIV) globally. Treatment outcomes for ALHIV have been poorer than for adults and younger children living with HIV. In order to improve outcomes for this population, comprehensive profile information is needed for programming innovations and differentiated care. We collated patient-level data from a large cohort of Nigerian ALHIV on ART to facilitate high-level decision-making for better outcomes.

Methods:
Between April and September 2017, data from all sites supported by 6 of the largest member organizations of the Nigeria Implementation Science Alliance were collected from the relevant State Health agencies. These 6 PEPFAR-implementing partners (IPs) supported healthcare facilities across all 6 of Nigeria's geopolitical zones.
Data from 10 to 19 year old ALHIV enrolled in care and on ART during the review period were targeted. Data collected were extracted from IP-verified de-identified programmatic databases that included socio-demographic and clinical treatment information. Data from each partner were merged into a single Microsoft Excel database and descriptive analysis conducted using STATA 13.

Results:
A total of 22,551 unique ALHIV entries were identified, from 29 of Nigeria's 37 states and the Federal Capital Territory. The highest proportion of ALHIV (34.1%) came from the North-Central Zone, and the lowest proportion (9.3%) from the South-West. ALHIV in this cohort comprised 13,473 (59.7%) females, and were spread at 30.5%, 33.5% and 36.0% across early (10–13 years), mid (14–16 years) and late (17–19 years) adolescence, respectively. The greatest proportion of females (77.5%) was in the 19 year age group, with the lowest proportion (∼50%) across the 10–14 year age group.
After excluding 4% missing data, approximately 91% of adolescents in the cohort were documented as being currently on first line NNRTI-based adult or pediatric combination ART. The remaining 5% of ALHIV were on PI-based second-line regimens. Facility-based ART refills for the majority (59.4%) of this cohort were on a two-monthly cycle; 29.7% on a one-monthly cycle and 10.2% on a three-monthly schedule.
There were significant data gaps, with little to no information available on source of HIV infection and point of service entry into care, marital or sexual activity status, HIV disclosure status, or viral suppression.

Conclusions:
This ALHIV cohort represents nearly 10% of the estimated 240,000 ALHIV in Nigeria, and offers an opportunity to understand and program for impactful differentiated ALHIV care in the country. Questions remain on the relative absence of older adolescent males in care, regimen adjustments and switching based on weight and viral load data, and the best schedule and approach for delivering ART to this challenging population. Missing and non-prioritized data is an issue, specifically that needed to provide adherence support and comprehensive sexual and reproductive health services, including PMTCT and partner notification. Data collection for relevant indicators need to be incorporated into routine programming for improved service delivery. Longitudinal monitoring for this cohort can potentially yield valuable data to improve treatment outcomes.