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Background:  There is increasing access to HIV drugs (3TC, d4T, NPV, and AZT) and care in Nigeria as a result of increased commitment on the part of the government, private initiatives, and assistance from non-governmental organizations (NGO). This study examines ART use in the scale-up of HIV/AIDS treatment among HIV⁺ adults in southwestern Nigeria.

Methods:  A cross-sectional survey was conducted from January 2003 till September 2004. Data were obtained from interviews conducted with 689 randomly selected HIV⁺ adults from a random sample of 5 public and 5 private centers in southwestern Nigeria. The questionnaire highlighted socio-demographics, antiretroviral use/adherence, side effects, hindrances to care, hospital facilities, sexual behavior, traditional health beliefs, and views on better treatment/care. Logistic regression analyses were used to test for demographic differences.

Results:  Eighty-four percent of the subjects were on ARV, 64% were male, and the median age was 32 years. The median baseline CD4 count was 212 cells/mL, and 80% of those on ART had increased CD4 counts after 6 months (statistically significant p <0.001) with remarkable clinical improvement. Only 8% had been or were aware of their viral load; 28% were on prophylactic TB drugs, while 14% were on antifungal. Eighteen percent had been confirmed with TB and the remainder were either unsure or unaware of their TB status. Non adherence was noted in 14% due to cost of drugs; accessibility to treatment with care; intolerable side effects; poor knowledge; inconsistent drug supply; and traditional health beliefs. Stopping and changing of ART occurred in 19% due to side effects. Thirty-two percent were constantly followed up, although no follow-up incentives were in place. Ninety-six percent in the survey advocated thorough decentralization of HIV treatment, especially at the primary care level, where more outlets were needed.

Conclusions:  The increasing use of ARV has decreased death associated with HIV infection. Then study identified several other areas to support improved outcomes. These include improving the supply chain in drug distribution—for example initiating ART drug manufacturing locally. Increased awareness/information on HIV drugs; care, and support, as well as more treatment centers and strengthened training for AIDS medical personnel are also important. Good monitoring and evaluation of progress and outcome of treatment and resistance, laboratory service and electronic medical record should be put in place in all centers. These goals can best be will be achieved through an improved commitment by all stakeholders involved in the treatment, care, and prevention of AIDS,

Keywords: Scaling-up; Antiretroviral Therapy; HIV positive Adults