Implementing an integrated community based health systems strengthening approach to improve HIV survival in Northern Togo

ABSTRACT

To disseminate lessons learned from the implementation experience of a public-private sector partnership, we describe a comprehensive HIV/AIDS program including 5-year survival outcomes for individuals who initiated antiretroviral therapy (ART) treatment in Togo from 2010 to 2015. A retrospective case study analysis was conducted from a cohort of patients receiving ART at an HIV/AIDS care clinic in Kara Region, Togo. Kaplan-Meier curves with Log rank tests were used to compare estimated survival curves by demographic and clinical characteristics. Associations were described between survival probability and age, gender, World Health Organization (WHO) disease stage, and timing of ART initiation. Cox proportional hazard model was used to determine predictors of mortality. After approximately five-years since ART initiation (1780 days), there were 114 deaths, with a survival probability of 75.3% (95% CI: 70.3–80.6%). Participants with advanced WHO disease stage were more likely at risk of death relative to patients categorized as WHO Stage 1, with Stage 4 approximately 9 times more likely (aHR 9.22, 95% CI 4.29–19.84). Our study suggests that delivering comprehensive HIV care through a private-public partnership may serve as a model to expand and improve HIV/AIDS care as well as high quality primary care.

KEYWORDS:

• Health systems strengthening
• HIV/AIDS
• community health workers
• Togo

Acknowledgements

We acknowledge and thank the team who conducted data collection and verification. We are grateful to the members of this partnership for their collaboration, dedication, and continued efforts to improve access to quality care in Togo. Lastly, we are grateful for the patients and their families who allowed us to share their experiences.

Disclosure statement

No potential conflict of interest was reported by the authors.

ORCID

Kevin P. Fiori http://orcid.org/0000-0003-1370-7366