The gender distribution showing a higher number of females accessing care (60.7%) conforms with the global epidemiology distribution, where women are the most affected by the virus [9]. The adult age group between 25 to 34 years shows higher prevalence, which aligns with many regions around the world. However, it is noteworthy that, during the sampled period, children (< 14 years) and elderly patients (> 55 years) were poorly represented for care, which is in line with a study reported in North and East Africa [12, 13]. There is a significant difference in access to care by the KP between the two DSD models, with CCSAPs having a larger percentage of patients (77.8%) compared to OSS (22.2%). The preference for CCSAPs might be attributed to their easy access, proximity to hotspot communities, and comprehensive approach to patient care, which likely attracts more patients seeking universal care [14, 15]. In addition, the CCSAPs are equipped and supported by the program with the necessary training, close monitoring and evaluation, and tools for quality services. Within the CCSAPs model, the KPs were represented well, and the PWIDs and Sexual Partners of FSW and MSM accessed the care most, demonstrating the success of the targeted KP intervention program.
An incredible finding was the program combined the DSD model's high viral load suppression rate (99.4%). This is a noteworthy programmatic achievement, showing the effectiveness of first-line antiretroviral drug therapy and the quality of adherence counselling in controlling viral replication and decreasing the risk of transmission. This outcome is in line with what was previously reported in sub-Saharan Africa and Asia [16, 17, 18]. The high viral suppression rate reveals the overall quality of HIV care provided by the employed DSD models. Notwithstanding, for the overall high viral suppression rate, there are interesting differences to note between the two models. A slightly higher viral load suppression rate was recorded at CCSAPs (99.6%) compared to OSS (99.0%). This difference, although small, might possess clinical implications which require additional investigation. It is important to study the contributing factors, including the best practices employed leading to higher viral suppression rates in CCSAPs, which could be potentially replicated in other settings.
There are also disparities in patient retention to care and outcomes among the service models. The CCSAPs had a greater proportion of patients actively in care (76.9%) compared to OSS (21.8%), representing better retention in the comprehensive care model. This is good for program sustainability, However, higher mortality cases were reported in CCSAPs, which raises concerns about the quality of care delivery and access to care as well as provides and merits more exploration. The reasons behind the interruptions in care and transfers out of CCSAPs should also be studied to identify potential barriers to continuous treatment.
No indication of a statistically significant difference between the two DSD models concerning viral load suppression rates. However, the study found a statistically significant difference in the dissemination of current ART between the models. This outcome portrays differences in treatment approaches and management between the two service models, which might have effects on the treatment outcomes. It is essential to explore these variations further and understand their clinical importance to optimize HIV care among the two models to patient outcomes.
This study is among the few that studied differential healthcare models among Key Populations in Nigeria, which employed a large sample size of real-world data of the HIV KP program. To our knowledge, it is among the few studies that compare important components of DSD models and clinical and sociodemographic characteristics of KPs. Some of the limitations of this study relate to the study design. The study is a retrospective data review that could have an impact on data accuracy. Similarly, there might be selection bias for accessing care by KPs, which can influence the generalizability of findings. The study did not access all factors that could contribute to access and quality of HIV care by KPs. Thus, careful thought of these strengths and limitations is crucial when interpreting and applying the study discoveries to clinical practice programs or policy decisions.