article · International Journal of TROPICAL DISEASE & Health
An evaluation of HIV care outcomes across eight public and private health facilities in Port Harcourt, Nigeria, assessed both clinical factors and health systems operations. Among 542 people living with HIV, the overall viral suppression rate was 68.3%, falling well below target thresholds. Older age, female sex, high treatment adherence, treatment buddy support, and enrolment in differentiated service delivery models increased the likelihood of viral suppression. Conversely, depression, social stigma, and receiving care at private facilities reduced the chances of achieving suppression. The health systems review revealed significant operational gaps: 37.5% of facilities experienced antiretroviral therapy stockouts, only 25% provided mental health screening, and private facilities failed to transmit health data to the state electronic medical record system.
Achieving global targets for HIV control relies heavily on keeping patients virally suppressed to prevent transmission and illness. This research demonstrates that clinical outcomes are strongly tied to mental health, social support, and basic healthcare infrastructure, showing that supply chain shortages and fragmented data systems directly undermine treatment success in urban settings.
The findings highlight clear operational needs for healthcare administrators, logistics providers, and digital health developers. Practical applications include implementing integrated electronic medical records to connect private facilities with public reporting systems, alongside digital inventory tools to eliminate drug stockouts. These system interventions are already viable and tested in broader healthcare contexts, but require structured public-private policy mandates to be deployed effectively in this setting.
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Background: Clinical epidemiology and health systems determinants shape HIV care outcomes, yet comparative data on facility types from urban South-South Nigeria remain limited. This study characterised both dimensions for HIV/AIDS care in Port Harcourt Local Government Area (PHALGA), Rivers State, Nigeria. Methods: A convergent parallel mixed-methods study was conducted across eight facilities (a public tertiary facility, model primary health centres, and private facilities). Quantitative data were obtained from a cross‑sectional survey of 542 people living with HIV (PLHIV) using validated tools (MMAS‑8, PHQ‑9, Stigma Index). The primary outcome was viral suppression (<1,000 copies/mL). Multivariable logistic regression identified independent clinical and health system predictors. Qualitative data from 12 key informant interviews (4 clinicians, 5 adherence counsellors, and 3 pharmacists across 6 facilities) were analysed using framework analysis. Results: The mean age of participants was 35.2 years (SD 10.4; median 34, IQR 27–42), and 62.4% (n=338) were female. The overall viral suppression rate was 68.3%. The independent predictors of viral suppression included older age (AOR 1.21 per 10 years, p=0.04), female sex (AOR 1.78, p=0.008), high adherence (AOR 2.94, p<0.001), treatment buddy support (AOR 1.72, p=0.01), and differentiated service delivery (DSD) enrolment (AOR 1.96, p=0.003), while depression (AOR 0.51, p=0.003), stigma (AOR 0.63, p=0.02), and private facility attendance (AOR 0.62, p=0.045) were associated with reduced odds of suppression. Service availability was limited: only 25% of facilities offered mental health screening, 37.5% reported antiretroviral therapy (ART) stockouts, and no private facility transmitted data to the state electronic medical record (EMR) (data extractability: 67.1% private versus 100% public tertiary). Qualitative findings converged on uneven DSD fidelity, absent mental health integration, and weak private-sector surveillance. Conclusion: Viral suppression in PHALGA falls below the 95‑95‑95 target, with meaningful disparities by facility type. Strengthening DSD supply chains to address the 37.5% stockout rate, integrating routine PHQ‑9 screening for depression, and mandating private-sector EMR reporting to close surveillance gaps are essential interventions to improve suppression from 68.3% towards the 95% target.
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DOI: 10.9734/ijtdh/2026/v47i81775
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