Journal Article

Evaluating the impact of health system strengthening on HIV and sexual risk behaviors in Nigeria

Background
We evaluated the impact of health system strengthening (HSS) on HIV prevalence and sexual risk behaviors in Nigeria.

Design
Impact of HSS was evaluated in a cross-sectional analysis using 2 rounds of HIV biobehavioral surveys. Logistic regression was used to assess the impact of the HSS program on HIV and risk behaviors.

Setting
Study was conducted between 2007 and 2012 in 16 states in Nigeria.

Subjects
Using a multistage selection criterion for households, a total of 4856 and 11,712 respondents were surveyed in 2007 and 2012, respectively.

Intervention
HSS for state agencies for the control of AIDS was conducted in 7 states.

Results
Overall change in HIV prevalence between 2007 and 2012 was 6·3% vs. 5·3% (P = 0·113) and 3·0% vs. 5·1% (P < 0·001) in the HSS and non-HSS states, respectively. When controlled for age, gender, HSS intervention, location (rural vs. urban), and year (2007 vs. 2012), respondents in the HSS states were less likely to have acquired HIV (adjusted odds ratio [AOR]: 0.78; 95% confidence interval (CI): 0.63 to 0.96), more likely to have comprehensive HIV knowledge (AOR: 1.28; 95% CI: 1.06 to 1.54), and to use a condom consistently in the past 3 months with boy/girlfriends (AOR: 1.35; 95% CI: 1.03 to 1.79).

Conclusions
HIV prevalence decreased in HSS states between 2007 and 2012. Respondents in HSS states were more likely to have lower HIV prevalence and reduced sexual risk behaviors. There seems to be progress in mitigating the burden of HIV by the reduction of HIV-related risk behaviors through HSS. Thus, HSS intervention needs to be sustained and replicated to achieve a wider impact and coverage.