BACKGROUND Ineffective linkage to care (LTC) is a known challenge for community HIV testing. To overcome this challenge, a robust linkage to care strategy was adopted by the 2018 Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS). The NAIIS linkage to care strategy was further adapted to improve Nigeria's programmatic efforts to achieve the 1st 90 as part of the Nigeria Antiretroviral Therapy (ART) Surge initiative, which also included targeted community testing. In this paper we provide an overview of the NAIIS LTC strategy and describe the impact of this strategy on both the NAIIS and the Surge initiatives. METHODS The NAIIS collaborated with community-based organizations (CBOs) and deployed mobile health (mHealth) technology with real-time dashboards to manage and optimize community LTC for people living with HIV (PLHIV) diagnosed during the survey. In NAIIS, CBOs' role was to facilitate linkage of identified PLHIV in community to facility of their choice. For the ART Surge, we modified the NAIIS LTC strategy by empowering both CBOs and mobile community teams as responsible for not only active LTC but also for community testing, ART initiation, and retention in care. RESULTS Of the 2,739 PLHIV 15 years and above identified in NAIIS, 1,975 (72.1%) were either unaware of their HIV-positive status (N = 1890) or were aware of their HIV-positive status but not receiving treatment (N = 85). Of these, 1,342 (67.9%) were linked to care, of which 952 (70.9%) were initiated on ART. Among 1,890 newly diagnosed PLHIV, 1,278 (67.6%) were linked to care, 33.7% self-linked and 66.3% were linked by CBOs. Among 85 known PLHIV not on treatment, 64 (75.3%) were linked; 32.8% self-linked and 67.2% were linked by a CBO. In the ART Surge, LTC and treatment initiation rates were 98% and 100%, respectively. Three-month retention for monthly treatment initiation cohorts improved from 76% to 90% over 6 months. CONCLUSIONS Active LTC strategies by local CBOs and mobile community teams improved LTC and ART initiation in the ART Surge initiative. The use of mHealth technology resulted in timely and accurate documentation of results in NAIIS. By deploying mHealth in addition to active LTC, CBOs and mobile community teams could effectively scale up ART with real-time documentation of client-level outcomes.

中文翻译：

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优化社区与护理和抗逆转录病毒治疗的联系启动：尼日利亚艾滋病毒/艾滋病指标和影响调查 (NAIIS) 的经验教训及其在尼日利亚 ART Surge 中的适应。

背景技术 无效的护理联系 (LTC) 是社区 HIV 检测面临的一个已知挑战。为了克服这一挑战，2018 年尼日利亚艾滋病毒/艾滋病指标和影响调查 (NAIIS) 采用了与护理战略的强有力联系。NAIIS 与护理战略的联系得到了进一步调整，以改善尼日利亚实现第一个 90 的计划工作，作为尼日利亚抗逆转录病毒治疗 (ART) 激增计划的一部分，其中还包括有针对性的社区测试。在本文中，我们概述了 NAIIS LTC 策略，并描述了该策略对 NAIIS 和 Surge 计划的影响。方法 NAIIS 与社区组织 (CBO) 合作，部署带有实时仪表板的移动医疗 (mHealth) 技术，以管理和优化调查期间诊断出的艾滋病毒感染者 (PLHIV) 的社区长期护理服务。在 NAIIS 中，社区组织的作用是促进社区中已识别的艾滋病毒携带者与他们选择的设施的联系。对于 ART Surge，我们修改了 NAIIS LTC 策略，授权 CBO 和移动社区团队不仅负责活跃的 LTC，还负责社区测试、ART 启动和护理保留。结果 在 NAIIS 中发现的 2,739 名 15 岁及以上艾滋病毒感染者中，1,975 名 (72.1%) 不知道自己的 HIV 阳性状况 (N = 1890) 或知道自己的 HIV 阳性状况但未接受治疗 (N = 85) 。其中，1,342 例 (67.9%) 与护理相关，其中 952 例 (70.9%) 开始接受 ART。在 1,890 名新诊断的艾滋病毒感染者中，1,278 名（67.6%）与护理相关，33.7% 与自身相关，66.3% 与社区组织相关。在 85 名未接受治疗的已知感染者中，64 名（75.3%）存在关联；32.8% 自链接，67.2% 通过 CBO 链接。在 ART Surge 中，LTC 和治疗启动率分别为 98% 和 100%。每月治疗启动队列的三个月保留率在 6 个月内从 76% 提高到 90%。结论 当地 CBO 和移动社区团队采取的积极 LTC 策略改善了 ART Surge 计划中的 LTC 和 ART 启动。移动医疗技术的使用使得 NAIIS 能够及时、准确地记录结果。通过在活跃的 LTC 之外部署 mHealth，CBO 和移动社区团队可以通过实时记录客户级别的结果来有效地扩展 ART。