Abstract
Background: Very high rates of late or no ART initiation remains a persistent challenge to the achievement of PEPFAR 95-95-95 targets despites new NAIIS report stating prevalence of HIV in Nigeria as 1.5%. This study assessed the impact of accompanied referral (AR) and effective counseling (EC) on enrolment and ART treatment commencement of newly diagnosed HIV positive patients. 
 Methods: This study is a Quasi- experimental and analyzed routine program data on linkage from October 2017 – October 2019 for 45 health facilities in two States in South-West Nigeria. The first 6 months (Q1 and Q2 FY18) had no intervention while accompanied referral (AR) was implemented in Q3 and Q4 FY18. EC was implemented with AR in Q1&Q2 FY19 and was followed up till Q3 and Q4 FY19. Data analysis was done using SPSS and significance fixed at P < 0.05
 Results: A total of 6114 newly identified HIV-positive clients were identified; mean age was 35.7 ± 13.9 and 31.5% were in the 30-39 years age bracket. Index Testing contributed 28.7% of the HIV positive Clients identified. Percentage Enrolment in Q1 and Q2FY18 increased from 65.8% and 65.6% respectively to 89.9% and 83.8% in Q3 and Q4 FY18. This increased to 99.6% in Q1FY19, 100% in Q2, 99.7% in Q3 and 99.9% in Q4FY19. Percentage linkage to ART in Q1 and Q2FY18 increased from 61.9% and 65.6% respectively to 85.4% and 75.7% in Q3 and Q4 FY18. This increased to 98.8% in Q1FY19, 99.5% in Q2, 99.7% in Q3 and 99.2% in Q4FY19.
 Conclusion: AR coupled with EC had the best impact on enrolment, initiation on ART, time to enrolment and initiation.
Highlights
For the first time, the achievement of PEPFAR 95-95-95 targets looked in sight when NAIIS reported the current prevalence of HIV among adult in Nigeria to be 1.5% and estimated that only 1.9million people are living with HIV as against the previous estimates [1]
Our study showed that the implementation of accompanied referral had significant effect on enrolment and eventual start of ART
This study has showed that implementing accompanied referral with effective counseling can significantly improve enrolment and linkage as well as reduce time to initiation on ART
Summary
The achievement of PEPFAR 95-95-95 targets looked in sight when NAIIS reported the current prevalence of HIV among adult in Nigeria to be 1.5% and estimated that only 1.9million people are living with HIV as against the previous estimates [1]. Accompanied referral services by patient escorts, usually case managers that escort newly identified HIV positive clients from testing points to the treatment centres for enrolment and initiation on treatment have been proved to improve linkage to ART [6]. They provide treatmentnavigation services including introducing facility staff, providing psychosocial counseling and support, and helping clients understand the locations, content, and sequence of clinical, laboratory, and pharmaceutical services. This study aimed at assessing the impact of accompanied referral service alone on enrolment and ART initiation and evaluate the impact of combined enhanced counseling and accompanied referral on enrollment and ART initiation of newly diagnosed HIV positive patients
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