Health System Gaps Influencing Early Detection and Treatment of HIV/AIDS in Semi-Urban Communities in Nigeria

Okechukwu Cajethan Madu, Chinaza Faith Patrick, Oluchukwu Jennifer Agufusi, Chidera Ruth Agufusi, Somtochukwu Genevieve Agufusi

Abstract

This study examined health system gaps influencing early detection and treatment of HIV/AIDS in semi-urban communities in Nigeria, focusing on the availability and accessibility of HIV/AIDS testing services, infrastructural and logistical challenges, and the effectiveness of health information systems. Guided by Systems Theory, the study employed a descriptive survey design and multistage sampling. Five high-prevalence states: Benue, Lagos, Taraba, Akwa Ibom, and Imo were purposively selected, with two semi-urban LGAs drawn from each, totalling 12 LGAs. Systematic sampling identified households, and one adult (18+) per household completed the questionnaire. Of 720 electronically distributed questionnaires, 657 were returned. Data were collected between November and December 2025 using a closed-ended instrument and analysed in SPSS v.26 using frequencies and simple percentages. Findings revealed that HIV/AIDS testing in semi-urban areas is inadequate, costly, and difficult to access, with long waiting times and unfriendly staff. Infrastructural gaps, such as shortages of equipment, skilled personnel, and reliable power, delay diagnosis. Logistical barriers such as poor roads, weak transport systems, slow laboratory processes, and ineffective mobile clinics further hinder timely testing. Inefficient health information systems also contribute to delays and missed diagnoses. The study concludes that multiple health system challenges undermine early HIV/AIDS detection in semi-urban Nigeria and recommends improved funding, staffing, infrastructure, service delivery, transport networks, and stronger information systems to support timely diagnosis and care.



Keywords


Early detection; HIV; AIDS; semi-urban communities; infrastructural challenges; logistical barriers; health information systems

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References


1. Shaik, R. A., Holyachi, S. K., Ahmad, M. S., Miraj, M., Kazmi, S. Y., Asad, M. R., Faraz, A., Ramozi, M., & Ahmad, R. K. (2025). The impact of delay in HIV diagnosis on patient survival: analysis of HIV infection trends from 2007 to 2023. BMC Infectious Diseases, 25(1), 177. doi: 10.1186/s12879-024-10412-1

2. Hiner, C. R., Mueller, A. L., Su, H., & Goldstein, H. (2024). Interventions during Early Infection: Opening a Window for an HIV Cure? Viruses, 16(10), 1588. doi: 10.3390/v16101588

3. World Health Organisation. (2023). HIV rapid diagnostic test market landscape. Retrieved from https://cdn.who.int/media/docs/default-source/hq-hiv-hepatitis-and-stis-library/eic-hiv-market-landscape-report_june2023.pdf?sfvrsn=6072a75b_5

4. Madu, U. A. (2021). Effectiveness of social media in unifying fragmented Nigerian societies. Path of Science, 7(12), 3001–3010. doi: 10.22178/pos.77-5

5. Patrick, C. F. (2022). Role of the newspaper in political mobilisation in Nigeria. Path of Science, 8(12), 1008–1013. doi: 10.22178/pos.88-2

6. Hingrat, Q. L., Sereti, I., Landay, A. L., Pandrea, I., & Apetrei, C. (2021). The Hitchhiker's Guide to CD4+ T-Cell depletion in lentiviral infection. A critical review of the dynamics of the CD4+ T cells in SIV and HIV infection. Frontiers in Immunology, 12, 695674. doi: 10.3389/fimmu.2021.695674

7. Thompson, M. A., Horberg, M. A., Agwu, A. L., Colasanti, J. A., Jain, M. K., Short, W. R., Singh, T., & Aberg, J. A. (2020). Primary care guidance for persons with Human Immunodeficiency Virus: 2020 Update by the HIV Medicine Association of the Infectious Diseases Society of America. Clinical Infectious Diseases, 73(11), e3572–e3605. doi: 10.1093/cid/ciaa1391

8. Chou, R., Dana, T., Grusing, S., & Bougatsos, C. (2019). Screening for HIV infection in asymptomatic, nonpregnant adolescents and adults. JAMA, 321(23), 2337. doi: 10.1001/jama.2019.2592

9. Garcia-Broncano, P., Maddali, S., Einkauf, K. B., Jiang, C., Gao, C., Chevalier, J., Chowdhury, F. Z., Maswabi, K., Ajibola, G., Moyo, S., Mohammed, T., Ncube, T., Makhema, J., Jean-Philippe, P., Yu, X. G., Powis, K. M., Lockman, S., Kuritzkes, D. R., Shapiro, R., & Lichterfeld, M. (2019). Early antiretroviral therapy in neonates with HIV-1 infection restricts viral reservoir size and induces a distinct innate immune profile. Science Translational Medicine, 11(520). doi: 10.1126/scitranslmed.aax7350

10. Wang, J., Xiao, N., Zhu, Z., Qiao, H., Zhao, F., Zhang, L., Gou, J., Lu, M., He, Y., Lu, H., & Li, Q. (2025). Comparing acute versus AIDS ART initiation on HIV-1 integration sites and clonal expansion. Signal Transduction and Targeted Therapy, 10(1), 23. doi: 10.1038/s41392-024-02113-7

11. HIV.GOV. (2026). The Global HIV and AIDS Epidemic. Retrieved from https://www.hiv.gov/hiv-basics/overview/data-and-trends/global-statistics

12. Swinkels, H. M., Nguyen, A. D., & Gulick, P. G. (2024). HIV and AIDS. StatPearls Publishing

13. Van Schalkwyk, C., Mahy, M., Johnson, L. F., & Imai-Eaton, J. W. (2024). Updated data and methods for the 2023 UNAIDS HIV estimates. JAIDS Journal of Acquired Immune Deficiency Syndromes, 95(1S), e1–e4. doi: 10.1097/qai.0000000000003344

14. Nwachinemere, O. L., Nyegenye, S., Mwesigwa, A., Bulus, N. G., Gmanyami, J. M., Mukisa, K. A., & Isiko, I. (2025). Trends in HIV-related knowledge, behaviours, and determinants of HIV testing among adolescent women aged 15–24 in Nigeria. Tropical Medicine and Health, 53(1), 79. doi: 10.1186/s41182-025-00737-1

15. UNAIDS. (2020). UNAIDS Data 2020. Retrieved from https://www.unaids.org/sites/default/files/media_asset/2020_aids-data-book_en.pdf

16. Onovo, A. A., Adeyemi, A., Onime, D., Kalnoky, M., Kagniniwa, B., Dessie, M., Lee, L., Parrish, D., Adebobola, B., Ashefor, G., Ogorry, O., Goldstein, R., & Meri, H. (2023). Estimation of HIV prevalence and burden in Nigeria: a Bayesian predictive modelling study. EClinicalMedicine, 62, 102098. doi: 10.1016/j.eclinm.2023.102098

17. Nwanja, E., Nwaokoro, P., Akpan, U., Toyo, O., Ezeh, G., Elechi, I., Idiong, H., Badru, T., Sanwo, O., Idemudia, A., Pandey, S. R., Khamofu, H., & Bateganya, M. (2023). Improved access to HIV diagnosis and linkage to antiretroviral therapy among children in Southern Nigeria: a before-and-after study. BMC Pediatrics, 23(1), 253. doi: 10.1186/s12887-023-04050-w

18. Oseni, Y. O., & Erhun, W. O. (2024). Implementation strategies and outcomes in the delivery of HIV test services (HTS) in community pharmacies in Nigeria. BMC Primary Care, 25(1), 315. doi: 10.1186/s12875-024-02568-1

19. Folorunsho, S., & Suleman, B. (2025). Ageing with HIV in Nigeria: A Narrative review of multimorbidity and healthcare access challenges. Health Science Reports, 8(8), e71184. doi: 10.1002/hsr2.71184

20. Garofalo, R., Adetunji, A., Kuhns, L. M., Omigbodun, O., Johnson, A. K., Kuti, K., Awolude, O. A., Berzins, B., Janulis, P., Okonkwor, O., Oladeji, B., Muldoon, A. L., Amoo, O. P., Atunde, H., Kapogiannis, B., & Taiwo, B. O. (2022). Evaluation of the ICARE Nigeria pilot intervention using social media and peer navigation to promote HIV testing and linkage to care among High-Risk young men. JAMA Network Open, 5(2), e220148. doi: 10.1001/jamanetworkopen.2022.0148

21. Madu, U. A., & Nworie, C. S. (2022). Influence of Ethnocentric Billboard Advertising Messages on Product Consumption in Nigeria: A Study of Hero Lager. Path of Science, 8(5), 7001–7011. doi: 10.22178/pos.81-13

22. O'Brien-Carelli, C., Steuben, K., Stafford, K. A., Aliogo, R., Alagi, M., Johanns, C. K., Ibrahim, J., Shiraishi, R., Ehoche, A., Greby, S., Dirlikov, E., Ibrahim, D., Bronson, M., Aliyu, G., Aliyu, S., Dwyer-Lindgren, L., Swaminathan, M., Duber, H. C., & Charurat, M. (2022). Mapping HIV prevalence in Nigeria using small area estimates to develop a targeted HIV intervention strategy. PLoS ONE, 17(6), e0268892. doi: 10.1371/journal.pone.0268892

23. Madu, C. O. (2024). Gender imbalance in STEM programs in Nigeria. Path of Science, 10(10), 1016–1023. doi: 10.22178/pos.109-26

24. Oturu, K., O'Brien, O., & Ozo-Eson, P. I. (2024). Barriers and enabling structural forces affecting access to antiretroviral therapy in Nigeria. BMC Public Health, 24(1), 105. doi: 10.1186/s12889-023-17271-6

25. Eleje, G. U., Emmanuel, G. O., Akinsolu, F. T., & Foláyan, M. O. (2024). Assessment of the acceptability and detection rate of HIV self-testing in Nigeria: a systematic review and meta-analysis. Discover Epidemics, 1(1). doi: 10.1007/s44203-024-00003-6

26. Madu, O. C., Agufusi, O. J., Agufusi, C. R., & Agufusi, S. (2025). Determinants of antenatal care utilisation among pregnant women in Nigeria. Path of Science, 11(10), 3001. doi: 10.22178/pos.123-5

27. Britannica. (2026). AIDS. Retrieved from https://www.britannica.com/science/AIDS

28. Alexiev, I., & Dimitrova, R. (2025). The origins and genetic diversity of HIV-1: evolutionary insights and global health perspectives. International Journal of Molecular Sciences, 26(22), 10909. doi: 10.3390/ijms262210909

29. World Health Organisation. (2025). HIV and AIDS. Retrieved from https://www.who.int/news-room/fact-sheets/detail/hiv-aids

30. Choudhury, A., Asan, O., & Mansouri, M. (2019). Role of Artificial Intelligence, Clinicians & Policymakers in Clinical Decision Making: A Systems Viewpoint. 5th IEEE International Symposium on Systems Engineering, 1–8. doi: 10.1109/isse46696.2019.8984573

31. Rajan, D., Papanicolas, I., Karanikolos, M., Koch, K., Rohrer-Herold, K., & Figueras, J. (2022). Health system performance assessment. A primer for policymakers. Policy Brief, 49

32. Reid, R. J., Wodchis, W. P., Kuluski, K., Lee-Foon, N. K., Lavis, J. N., Rosella, L. C., & Desveaux, L. (2024). Actioning the Learning Health System: An applied framework for integrating research into health systems. SSM - Health Systems, 2, 100010. doi: 10.1016/j.ssmhs.2024.100010

33. NACA. (2021). National HIV and AIDS Strategic Framework 2021–2025. Retrieved from https://naca.gov.ng/wp-content/uploads/2022/03/National-HIV-and-AIDS-Strategic-Framework-2021-2025-Final.pdf

34. Patel, H. K., Ikpe, S., Bronson, M., Birhanu, S., Abimiku, A., Jahun, I., Detorio, M., Lupoli, K., Yavo, D., Bassey, O. O., Jelpe, T. D., Kagurusi, B., Iriemenam, N. C., Patel, D., Okoye, M. I., Dalhatu, I. T., Ohakanu, S., Voetsch, A. C., Aliyu, S., & Parekh, B. (2022). Performance of HIV rapid testing algorithm in Nigeria: Findings from a household-based Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS). PLOS Global Public Health, 2(7), e0000466. doi: 10.1371/journal.pgph.0000466

35. NACA. (2024). Government Expenditure on Human Resources for HIV in Nigeria: An Assessment of Government Expenditure on Human Resources for HIV in Nigeria. Retrieved from https://naca.gov.ng/wp-content/uploads/2024/08/NACA_HR_Assessement_.pdf

36. Obiezu-Umeh, C., Gbajabiamila, T., Ezechi, O., Nwaozuru, U., Ong, J. J., Idigbe, I., Oladele, D., Musa, A. Z., Uzoaru, F., Airhihenbuwa, C., Tucker, J. D., & Iwelunmor, J. (2021). Young people's preferences for HIV self-testing services in Nigeria: a qualitative analysis. BMC Public Health, 21(1), 67. doi: 10.1186/s12889-020-10072-1

37. Adepoju, V. A., Umebido, C., Adelekan, A., & Onoja, A. J. (2023). Acceptability and strategies for enhancing uptake of human immunodeficiency virus self-testing in Nigeria. World Journal of Methodology, 13(3), 127–141. doi: 10.5662/wjm.v13.i3.127

38. Idigbe, I., Gbaja-Biamila, T., Asuquo, S., Nwaozuru, U., Obiezu-Umeh, C., Tahlil, K. M., Musa, A. Z., Oladele, D., Kapogiannis, B., Tucker, J., Iwelunmor, J., & Ezechi, O. (2022). Using a designathon to develop an HIV Self-Testing intervention to improve linkage to care among youths in Nigeria: Qualitative approach based on a participatory Research action framework. JMIR Formative Research, 7, e38528. doi: 10.2196/38528

39. Adeniran, A., Chieme, C. F., Ojo, Y. O., Oluwole, E., Olujobi, B., & Ilesanmi, M. (2022). HIV, TB and malaria service readiness at the Primary Healthcare Centres (PHCs) in Ekiti State, Nigeria. Pan African Medical Journal, 43, 116. doi: 10.11604/pamj.2022.43.116.35883

40. Bassey, A. E., Olisaeloka, L. C., & Adebisi, Y. A. (2020). Identifying the gaps in HIV prevention and treatment during the COVID-19 pandemic in Nigeria. International Journal of Infection, 8(1). doi: 10.5812/iji.109546

41. Von Bertalanffy, L. (1968). General System Theory: Foundations, Development. New York: George Braziller.

42. Berlin, R., Gruen, R., & Best, J. (2017). Systems Medicine—Complexity within, simplicity without. Journal of Healthcare Informatics Research, 1(1), 119–137. doi: 10.1007/s41666-017-0002-9

43. Issitt, M. (2024). General Systems Theory. Retrieved from https://www.ebsco.com/research-starters/history/general-systems-theory

44. Anderson, B. R. (2016). Improving health care by embracing Systems Theory. Journal of Thoracic and Cardiovascular Surgery, 152(2), 593–594. doi: 10.1016/j.jtcvs.2016.03.029

45. Cuofano, G. (2024). General Systems Theory. Retrieved from https://fourweekmba.com/general-systems-theory/

46. Oluwamotemi, C. A., Okanlawon, F. A., Edoni, E. R., & Adelekan, A. L. (2020). Barriers to effective HIV testing services and strategies to promote them at primary health care facilities in Ibadan, Nigeria. International STD Research & Reviews, 24–32. doi: 10.9734/isrr/2020/v9i230111

47. Madu, C. O. (2024). Understanding COVID-19 vaccine hesitancy in Nigeria through a university community lens. Path of Science, 10(11), 3053. doi: 10.22178/pos.111-10

48. Ahmed, N., Ong, J. J., McGee, K., D'Elbée, M., Johnson, C., Cambiano, V., Hatzold, K., Corbett, E. L., Terris-Prestholt, F., & Maheswaran, H. (2024). Costs of HIV testing services in sub-Saharan Africa: a systematic literature review. BMC Infectious Diseases, 22(1), 980. doi: 10.1186/s12879-024-09770-7

49. Bankole, O. T., & Ajayi, I. O. (2022). Evaluation of diagnostic microbiology capacity and barriers in testing for HIV and TB at peripheral Hospital-Based laboratories in Oyo State, Nigeria. Microbiology Spectrum, 10(1), e0045921. doi: 10.1128/spectrum.00459-21

50. Lankowski, A. J., Siedner, M. J., Bangsberg, D. R., & Tsai, A. C. (2014). Impact of Geographic and Transportation-Related Barriers on HIV Outcomes in Sub-Saharan Africa: a Systematic Review. AIDS and Behaviour, 18(7), 1199–1223. doi: 10.1007/s10461-014-0729-8

51. Okusanya, B., Nweke, C., Akeju, D., & Ehiri, J. (2023). Early infant diagnosis of HIV infection: a mixed-method study of uptake and challenges at primary health centres in Lagos State, Nigeria. BMC Health Services Research, 23(1), 1038. doi: 10.1186/s12913-023-09824-7

52. Adewumi, I. P. (2025). Critical analysis of the infectious disease surveillance and response system in Nigeria. Discover Public Health, 22(1). doi: 10.1186/s12982-025-00668-6


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Copyright (c) 2026 Okechukwu Cajethan Madu, Chinaza Faith Patrick, Oluchukwu Jennifer Agufusi, Chidera Ruth Agufusi, Somtochukwu Genevieve Agufusi

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