Background. Decentralization of antiretroviral therapy (ART) services is a key strategy to achieving universal access to treatment\nfor people living with HIV/AIDS. Our objective was to assess clinical and laboratory outcomes within a decentralized program\nin Nigeria. Methods. Using a tiered hub-and-spoke model to decentralize services, a tertiary hospital scaled down services to 13\nsecondary-level hospitals using national and program guidelines. We obtained sociodemographic, clinical, and immunovirologic\ndata on previously antiretroviral drug na�¨?ve patients aged ?15 years that received HAART for at least 6 months and compared\ntreatment outcomes between the prime and satellite sites. Results. Out of 7,747 patients, 3729 (48.1%) were enrolled at the satellites\nwhile on HAART, prime site patients achieved better immune reconstitution based on CD4+ cell counts at 12 (P < 0.001) and 24\nweeks (P < 0.001) with similar responses at 48 weeks (P = 0.11) and higher rates of viral suppression (<400 c/mL) at 12 (P < 0.001)\nand 48 weeks (P = 0.03), but similar responses at 24 weeks (P = 0.21). Mortality was 2.3% versus 5.0% (P < 0.001) at prime and\nsatellite sites, while transfer rate was 8.7% versus 5.5% (P = 0.001) at prime and satellites. Conclusion. ART decentralization is\nfeasible in resource-limited settings, but efforts have to be intensified to maintain good quality of care.
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