Performance of community-based ART programmes for key populations in Nigeria and sub-Saharan Africa

Key populations (female sex workers, men who have sex with men, transgender people, and persons who inject drugs) are disproportionately affected by HIV/AIDS and are at increased risk of contracting HIV compared to the general population. They are underserved and have limited access to quality HIV prevention, care and treatment services. To optimise access to quality HIV services among key populations (KP) and improve treatment outcomes (such as retention-in-care, medication adherence, and viral suppression), the World Health Organization recommended community-based approaches to HIV service delivery for KP. However, to inform the successful roll out and scale-up of community-based ART service delivery models for KP (KP-CBART), there is need to study the long-term outcomes and to explain the dynamics between the contextual factors and mechanisms that influence the outcomes for successful implementation. The overall aim of this PhD research work is to evaluate the performance of KP-CBARTmodels for key populations in sub-Saharan Africa and Benue State Nigeria. Findings from this evaluation will provide answers to the following questions: “what works?”, “how and why does it work?”, “for whom”, and “in what circumstances (context)” ?”.
This PhD research project has two parts. The first part is a scoping review of the effect of community-base ART service delivery models along the cascade of HIV care on treatment outcomes in sub-Saharan Africa. The second part is the outcome evaluation of KP-CBART service delivery in Benue State Nigeria using a realist impact evaluation approach. This study will be conducted in phases relying on both quantitative and qualitative research methods (mixed method design). Multiple case studies of KP-CBART will be evaluated and findings from each of the case studies will produce a programme theory that can be compared and redefined as a middle range theory.
Findings from my studies will inform future adaptation of KP-CBART models to meet health needs of KP for optimal impact. As such this PhD project will provide evidence-based information on community-based antiretroviral service delivery to increase access of KP to quality HIV services and to improve their treatment outcomes, thus contribute to achieving the UNAIDS target of HIV epidemic control by 2030.

Trefwoorden:B780-tropische-geneeskunde