Clinical Epidemiology and Health Systems Determinants of HIV/AIDS Care Outcomes in Port Harcourt Local Government Area, Rivers State, Nigeria
Nduye Christie Tobin Briggs
Department of Community Medicine, Faculty of Clinical Sciences, Rivers State University, Port Harcourt, Nigeria.
Ifeoma Christiana Nwadiuto *
Department of Community Medicine, Faculty of Clinical Sciences, Rivers State University, Port Harcourt, Nigeria.
*Author to whom correspondence should be addressed.
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.
Keywords: HIV/AIDS, viral suppression, clinical epidemiology, health systems determinants, differentiated service delivery, antiretroviral therapy adherence, depression, HIV-related stigma, health information systems.