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Life sciences · Journal article
International Journal of Tropical Disease & Health · August 18, 2026
Encouraging direction, but not yet definitive.
This convergent mixed-methods study quantifies viral suppression (68.3%) and its independent predictors among 542 people living with HIV in Port Harcourt, Nigeria, identifying modifiable factors (adherence, treatment buddy support, differentiated service delivery) and barriers (depression, stigma, private facility care). The cross-sectional design constrains causal interpretation, but the findings align qualitative and quantitative evidence on service gaps (mental health screening, ART stockouts, private-sector surveillance) that warrant targeted intervention.
Convergent parallel mixed-methods study: cross-sectional quantitative survey with qualitative key informant interviews. People living with HIV receiving care at eight facilities in Port Harcourt Local Government Area, Rivers State, Nigeria (1 public tertiary facility, model primary health centres, private facilities). Mean age 35.2 years (SD 10.4, median 34, IQR 27–42); 62.4% female. Eligibility criteria not specifi…. Intervention: Differentiated service delivery (DSD) enrolment; treatment buddy support; high adherence (measured by MMAS-8); mental health screening (PHQ-9); facility type (public vs. private). Compared with: Standard care (implicit in cross-sectional design); comparison by facility type (public tertiary vs. primary health centres vs. private); DSD enrolment vs. non-enrolment. n = 542. Port Harcourt Local Government Area, Rivers State, Nigeria; eight facilities (public tertiary, primary health centres, private facilities).
Overall viral suppression rate was 68.3%, below the 95-95-95 target High adherence independently predicted suppression with AOR 2.94 (p<0.001) Treatment buddy support associated with suppression (AOR 1.72, p=0.01)
Safety was not reported in the material analysed. Check the source before drawing any conclusion about harm.
Clinicians and programme managers in resource-limited urban settings should prioritise adherence support, treatment buddy systems, and differentiated service delivery models to increase viral suppression toward 95%. Mental health integration (PHQ-9 screening) and correction of ART supply chain failures are supported as high-yield complementary interventions, particularly for private-sector providers who currently show poorer suppression outcomes and absent surveillance participation.
A mixed-methods cross-sectional study identifying actionable clinical and health-system predictors of viral suppression in a resource-limited urban African setting, with clear effect sizes and implementation gaps, but limited by cross-sectional design and single-region geography.
As stated by the source record.
Quoted from the source exactly as published.
Clinicians and programme managers in resource-limited urban settings should prioritise adherence support, treatment buddy systems, and differentiated service delivery models to increase viral suppression toward 95%. Mental health integration (PHQ-9 screening) and correction of ART supply chain failures are supported as high-yield complementary interventions, particularly for private-sector providers who currently show poorer suppression outcomes and absent surveillance participation.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
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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