Barriers to HIV Prevention and Treatment Services in Achieving Epidemic Control Among Key Population in Nigeria: An Implementation Science Study on NAHI Project.

ObjectiveThis mixed-method cross-sectional study identified different barriers faced by key population in accessing HIV services hindering epidemic control on National Aligned HIV/AIDS Initiative (NAHI) in Nigeria.MethodologyData were collected from 1932 participants (≥18 years) in 12 NAHI states using structured surveys and analyzed with SPSS. Focus Group Discussion and Key Informant Interview were conducted among 312 KPs and 12 health workers respectively and thematically analyzed using NVivo.ResultsFrom 1932 respondents, 40% were Female Sex Workers (FSW), 37% Men who have Sex with Men (MSM) and 24% People who inject drugs (PWID). About 82% self-reported receiving HIV testing, 67% accessed prevention services and 63% currently receiving ART treatment among participants. Major barriers faced by KP included distance to facilities (57%), financial constraints (30%) and stigma (24%). Socioeconomic status significantly predicted risky behaviors (R = 0.201, p < 0.001). Qualitative findings highlighted abuse and violence, attitude of health workers, mental health, homelessness and drug stock-outs, as barriers.ConclusionStructural, biomedical, and behavioral barriers hinder HIV epidemic control among KPs in Nigeria. Multilevel interventions addressing commodity supply, socioeconomic support, abuse and stigma reduction are critical to improve HIV outcomes in Nigeria.