Abstract

Background information: Survival of people living with HIV/AIDS (PLWHA) has increased
since the emergency of High Active Antiretroviral Therapy (HAART) in 1996. HIV cascades
have been constructed so that the final outcome is one that will have a positive effect on reducing
HIV incidence, morbidity and mortality by suppressing the viral load and thereby increased
the CD4 cell counts. The study was aimed to determine the Longitudinal Cascade and Survival
analysis of people living with HIV/AIDS in tertiary health institutions in Enugu state.
Methodology: This was a descriptive cross-sectional study design. The study population
consisted of those diagnosed for HIV/AIDS at tertiary health institutions in Enugu State. The
total numbers of clients enrolled were 793 and 249 clients were loss to follow up, majority was
males. Those initiated on ART were 544. Clients of age <15 years were excluded and they were 31
clients. Finally, 500 clients were selected, males were 138 and female were 362 by simple random
sampling techniques. Data was collected from HIV / AIDS patients ART record cards, registers
and institutions data units for those initiated on ART in 2014 using a designed proforma. Those
clients aged 15 years and above were retrospectively studied between 2014 and 2018 and some
of them that survived after five years (60 months) on ART were interviewed by applying simple
random sampling technique. Cohort inclusion begins at initiation on ART with follow-up clinical
information collected year by year for five years. IBM SPSS statistics version 24.0 was used.
Chi square test was used to assess association between categorical variables and the level of
statistical significance of the proportions was determined by a P-value less than 0.05. Manual
content analysis was used for the interview and probability of dying and surviving analysis.
Results: The majority of the baseline CD4 cell count results presented by clients before
initiated on ART were within 100-199 cell/mm3 106 (23.1%). This was followed by those
within 200-299 cell/mm3 105 (22.9%). The least baseline results were those within the group
≤ 50 cell/mm3, 33 (7.17%). In all, 460 people presented their CD4 cell count baseline results
before placed on ART. CD4 cell count results at 60 month indicate that those clients of CD4
cell count results group ≥ 500, 160 (51.1%) were highest, followed by group within 400-
499, 300-399 and 200-299 which while 92 (29.4%), 45 (14.4%) and 16 (5.1%) respectively.
Conclusion: Based on the study, HIV prevalence in Nigeria now appears to have assumed a
downward trend following the availability of ART and a relative stability from 2012 to 2018, yet
a sustained and more effective intervention is still needed to avert increase incidence by mostat–
risk subpopulations in the Enugu State.