379. Clinical Management of HIV-associated Pneumocystis jirovecii Pneumonia in Rural Nigerian Communities: Public Health Interventions and Impact

Abstract

BackgroundThe prevalence of Pneumocystis jirovecii Pneumonia (PJP) is increasing among vulnerable Persons Living with HIV (PLWH) in rural communities. In such communities, optimum clinical management of PJP in PLWH, is often limited by sub-optimal coordination of healthcare programs and inadequate human resources. The study evaluated the impact of interventions implemented by public health programs, to improve the clinical management of PJP among PLWH in rural Nigerian communities.MethodsThe longitudinal study was done at 30 randomly selected rural communities in Nigeria. Program interventions included: decentralization of comprehensive Anti-Retroviral Therapy (ART) to primary healthcare facilities; and strategic private–public partnerships to ensure provision of free medications for ART and prophylaxis/treatment of PJP, (according to National Treatment Guidelines). Additional interventions included: training of indigenous healthcare workers on clinical management of PJP; task-shifting; routine monitoring and evaluation of PJP indicators to ensure program quality, among others. Real-time data from Patients’ Care Cards were utilized for pre- and post-intervention assessments in January 2014 and January 2019, respectively. Chi-square was applied as inferential statistics; P < 0.05 indicated statistical significance.ResultsThe number of PLWH on ART, who received primary PJP prophylaxis with Trimethoprim-Sulfamethoxazole (TMP-SMX), increased from 2,280 (pre-intervention) to 14,461 (post-intervention). PLWH (55 females; 40 males), exhibited TMP-SMX intolerance and were offered Dapsone for primary PJP prophylaxis. PJP diagnosis and treatment for female PLWH increased from 5% (pre-intervention), to 82% (post-intervention). PJP diagnosis and treatment for male PLWH increased from 3% (pre-intervention), to 79% (post-intervention). Incidences of PJP increased with age, viral load, ART interruption, and late presentation to HIV care. Secondary PJP prophylaxis for PLWH (after the completion of pneumonia treatment) increased from 2% (pre-intervention) to 90% (post-intervention).ConclusionThe interventions significantly improved the clinical management of PJP in PLWH. They are recommended for implementation by health programs in rural communities.Disclosures All authors: No reported disclosures.