An Overview of Disease and Health Research Vol. 12

Background: Despite significant progress toward achieving the Joint United Nations Programme on HIV/AIDS 95–95–95 targets, retention in pediatric HIV care remains a major challenge in Nigeria, particularly in underserved and hard-to-reach communities. Children living with HIV (CLHIV) often experience delayed diagnosis, poor linkage to treatment, treatment interruptions, caregiver-related barriers, stigma, and inadequate psychosocial support, all of which contribute to poor treatment outcomes. In Taraba State, gaps in pediatric HIV case finding, retention in care, and viral suppression continue to threaten efforts toward epidemic control.

Aim: This study assessed the effectiveness of a one-year community-based intervention aimed at improving HIV case identification, linkage to treatment, retention in care, and viral suppression among children living with HIV, adolescents and young people, caregivers, and the general population in selected communities in Taraba State, Nigeria.

Methods: A comprehensive community-based HIV intervention was implemented across three Local Government Areas (LGAs)—Karim Lamido, Sardauna, and Ussa—to address persistent gaps across the HIV treatment cascade. The intervention adopted targeted risk screening, index case testing, home-based HIV testing services, community outreach campaigns, and promotion of HIV self-testing to improve HIV case detection while reducing stigma and improving access in underserved populations.

Individuals diagnosed with HIV were promptly linked to treatment and supported through differentiated service delivery approaches designed to improve long-term retention. These included community pharmacy-based antiretroviral therapy (ART) refill systems, community ART support groups, nurse-led community clinics, treatment navigation services, active follow-up mechanisms, and integrated mental health and psychosocial support services. Capacity strengthening was conducted for multidisciplinary healthcare workers, case managers, community volunteers, and persons with lived HIV experience to enhance stigma-free, family-centred, and patient-centred service delivery. Programmatic data collected over a one-year implementation period were analysed across the HIV care continuum, including HIV testing and diagnosis (first 95), linkage to treatment (second 95), retention in care, and viral suppression (third 95).

Results: A total of 8,990 children, adolescents, caregivers, and members of the general population were tested for HIV across the three LGAs, with nearly equal representation of males (49.5%) and females (50.5%). Overall, 233 individuals tested HIV-positive, yielding an overall positivity rate of 2.6%, with females accounting for 69.5% of all positive cases.

Children aged 0–14 years represented the largest testing cohort (n=2,675) but recorded the lowest positivity rate (0.8%), highlighting persistent challenges in pediatric case identification. Higher positivity rates were observed among caregivers (4.7%) and the general population (4.5%), reinforcing the importance of family-centred testing approaches for identifying pediatric HIV risks.

Among the 233 individuals who tested positive, 168 were newly identified and referred for treatment, while 65 were previously known HIV-positive clients already receiving ART. Of those referred, 163 were successfully linked and enrolled in HIV treatment services, representing a linkage rate of 97%.

Among individuals enrolled on treatment, 143 remained actively engaged in care during the implementation period, resulting in an overall retention rate of 88%. Pediatric retention outcomes improved significantly through caregiver engagement and decentralised treatment delivery models. Retention rates varied across LGAs, with Karim Lamido recording the highest retention rate (95%), followed by Ussa (81%) and Sardauna (73%).

Among clients receiving ART, 91 had valid viral load test results, of whom 88 achieved viral suppression, resulting in a viral suppression rate of 97%. This demonstrates strong treatment adherence outcomes among retained clients.

Conclusion: The intervention demonstrated that community-driven, family-centred HIV programming can effectively address retention gaps in pediatric HIV care while improving broader treatment outcomes among adolescents, caregivers, and community members. High linkage rates, improved retention outcomes, and excellent viral suppression highlight the effectiveness of combining community-based case finding, differentiated service delivery models, and integrated psychosocial support in resource-limited settings. Scaling up similar interventions across high-burden communities in Nigeria could significantly strengthen pediatric HIV retention outcomes and accelerate national progress toward achieving sustainable HIV epidemic control.