Predictors of Interruptions in Antiretroviral Therapy among People Living with HIV in Nigeria: A Retrospective Cohort Study Using the Nigeria National Data Repository

This study aimed to identify predictors of time to first interruption in treatment (IIT) and predictors of ever being interrupted in ART treatment among PLHIV in Nigeria using a national longitudinal dataset that covers all PEPFAR-funded implementing partners to inform national strategies to prevent IIT. This retrospective cohort study used data from Nigeria’s National Data Repository (NDR). The NDR is a de-identified longitudinal database of over 1.9 million PLHIV who received ART in Nigeria beginning in 2004 and is owned by the Federal Ministry of Health (FMoH). The NDR contains patient-level demographics, clinic visits, laboratory, and ART prescription and refill data uploaded at least monthly. The data extracted for this study were obtained from electronic medical record systems of 2,226 public facilities offering HIV care in the country. In this study, we investigated the predictors of treatment interruption using data from the national HIV treatment program. We identified sets of predictors of first interruption in treatment using the logistic regression and these to be consistent in predicting time to first interruption including sex, non NRTI drug in ART regimen, recorded HIV viral load, recorded CD4 cell count, WHO clinical staging, functional status, last measured weight, highest education attained, occupation, marital status, year enrolled in care, pre and post surge, pre and post-COVID and residing in a state capital, Lagos, FCT (urban) versus other locations (rural). Age grouping was the only variable that was predictive only for time to first interruption but not for having a first interruption. To reduce the risk of IIT it is important to target interventions preemptively. We have highlighted the need for tailored interventions that address the unique needs of PLHIV in Nigeria. Targeted interventions focusing on those with a combination of risk factors could include education, counseling, supportive services, and monitoring and outreach. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The author(s) received no specific funding for this work. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The data was obtained on the 1st of November 2021 following a University of Maryland Baltimore (UMB) institutional review board (IRB) determination that the research is nonhuman subject research. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data cannot be shared publicly because it is the property of the Nigerian Federal MInistry of Health. Data are available from the Nigerian Federal Ministry of Health (contact via email) for researchers who meet the criteria for access to confidential data.