Expansion of HIV-1 screening and anti-retroviral treatment programs in a resource-poor setting: results from a faith-based organization in Jos, Plateau State, Nigeria.

BACKGROUND Until recently, availability of anti-retroviral therapy (ART) in Nigeria has been limited to government and university based programs. Through the United States' President's Emergency Plan For AIDS Relief (PEPFAR), additional funding has become available for the treatment of HIV-positive patients. OBJECTIVE To report the expansion of HIV-1 screening, enrollment in an ART program, and treatment outcomes over twelve months among HIV-positive patients at a nonprofit, non-governmental faith-based clinic providing free and holistic care in Jos City, Plateau State, Nigeria. DESIGN This was a retrospective analysis of HIV-1 screening and ART received by patients at Faith Alive Foundation Hospital (FAFH). From January through December 2005, voluntary counseling and testing (VCT) was freely available to all patients who requested it. Also beginning in December 2004, HIV-1 infected patients were enrolled in an expanded HIV/AIDS program at FAFH, where patients in clinical stages 3 or 4 based on World Health Organization (WHO) clinical classification, or had a CD4(+) cell count of less than 200/ml, were initiated on a simplified highly active ART (HAART) regimen through PEPFAR funding. Data from the first six quarters of the FAFH-PEPFAR ART program are presented here. Additionally, analysis of 645 patients who have received ART for one year, including changes in CD4(+) cell count from baseline is shown. RESULTS In 2005, a total of 7672 persons received VCT and 3869 (50.4%) HIV-1 positive results were found. From October 2004 to March 2006, the total number of patients enrolled in the FAFH HIV/AIDS program rose from 1330 to 5946 people. Over the same period, the number of patients who received ART increased from 302 to 1667. A majority of patients received an oral ART regimen consisting of generic nevirapine, lamivudine, and stavudine. The number of patients initiated on ART each quarter ranged from 57-578, and the number of deaths of patients on ART was between 12 and 21 people per quarter. Analysis of 645 patients initiated on ART during the first quarter of the FAFH-PEPFAR ART program revealed that the median CD4(+) cell count at baseline was 106/ml and the median increase was 173/ml (median time of follow-up, 7.0 months). CONCLUSIONS Comprehensive HIV/AIDS care has been significantly expanded at FAFH, a free and holistic medical center in Jos, Nigeria. Cumulative data from the first year of this PEPFAR-funded ART program indicated that promising outcomes are achievable through delivery of care at this faith-based medical center.