Trends in Human Immunodeficiency Virus Care Outcomes among Key Populations: Evidence from High-Burden States

Background: With an estimated two million people living with human immunodeficiency virus (HIV), Nigeria’s HIV epidemic is a significant public health concern. Objectives: This study examines the state-level trends in HIV care outcomes among key populations (KPs) in the three high-burden Nigerian states. Material and Methods: This study employed a retrospective quantitative design to analyze HIV care outcomes in three high-burden Nigerian states (Akwa Ibom, Cross River, and Lagos) from 2019 to 2024. It focused on KPs, using secondary data from 60,852 individuals enrolled in HIV care at 14 Heartland Alliance one-stop shops (OSSs) across the states. Data were analyzed using the Statistical Package for the Social Sciences version 28. Results: The majority (98.4%) of KPs were on the tenofovir disoproxil fumarate/lamivudine/dolutegravir (TDF/3TC/DTG) regimen. OSS services were distributed across Lagos and Cross River (35.7% each), with Akwa Ibom at 28.6%. Most participants (92.9%) were actively receiving treatment, with 98.4% achieving viral suppression. Viral load suppression trends showed improvements, though slight decreases occurred in 2024. Participants in Lagos and Akwa Ibom were more likely to achieve viral suppression compared to Cross River (adjusted odds ratio [AOR]: 2.854, p < 0.001; AOR: 1.308, p = 0.012, respectively). KPs on the TDF/3TC/DTG regimen had a higher likelihood of viral suppression than other regimens (AOR: 25.929, p < 0.001). Long-term antiretroviral therapy (ART) (>1 year) significantly improved suppression rates (AOR: 118.529, p < 0.001). Active ART patients were more likely to achieve viral suppression than inactive patients (AOR: 3.850, p < 0.001). Conclusion: The findings suggest that while the overall ART program in Nigeria is successful, tailored interventions are required to address the needs of more vulnerable KPs.