Awareness of and willingness to use pre-exposure prophylaxis to prevent HIV infection among female sex workers in Anambra State, south-eastern Nigeria

Background: Pre-exposure prophylaxis (PrEP) is a highly effective preventive measures against HIV infection but its success is strongly based on adherence, which in turn depends on willingness to use. This study is aimed at assessing the level of awareness and willingness to use PrEP to prevent HIV infection among female sex workers (FSWs) in Anambra State, Nigeria, and to identify factors that influence willingness to use PrEP. Methodology: The study was a cross-sectional survey involving 265 brothel-based FSWs recruited through snowballing technique. A structured questionnaire was used to collect relevant information on demographic characteristics, awareness of HIV/AIDS and transmission route, attitudes/behavior related to HIV/AIDS, and awareness of and willingness to use PrEP. Univariate and bivariate analyses with Chi square test (with Odds ratio and 95% confidence interval) was used to determine association of socio-demographic and predictive factors with willingness to use PrEP. Statistical significance was considered when p value was less than 0.05. Results: Of 265 FSW respondents, only 81 (31.2%) have heard of PrEP, 10 (3.9%) indicated they have previously used PrEP while 91.0% indicated willingness to use PrEP. Univariate analysis showed that FSWs in Onitsha had a significantly higher odds (OR=28.6, 95% CI=1.718-476.82, p=0.0006) while those from Awka had a significantly lower odds (OR=0.184, 95% CI=0.0704-0.1812, p=0.0004) of willingness to use PrEP. Also, FSWs with monthly income less than 18,000 Naira had a lower odd of willingness to use PrEP (OR=0.3980, 95% CI=0.1593-0.9945, p=0.08). Bivariate analysis shows that FSWs who wish to have more knowledge of HIV/AIDS had higher odd of willingness to use PrEP than those who did not wish to have more knowledge (OR=4.235, 95% CI=1.577­11.374, p=0.0066). Similarly, FSWs who are worried of being discriminated against have a lower odd of willingness to use PrEP than those who are not worried of being discriminated against (OR=0.3921, 95% CI=0.1582-0.9718, p=0.0439). Conclusion: Our study showed low awareness but high willingness to use PrEP among FSWs in Anambra State,Nigeria. Cost, HIV/AIDS knowledge and fear of discrimination are significant predicting factors of willingness to use HIV PrEP and should be considered when formulating PrEP policy. Adequate enlightenment on PrEP should be emphasized among FSWs.

Seroincidence of Human Herpes Virus 2 Among Ante-natal Clinic Attendees in Benin, Nigeria.

Background: Human Herpes Virus 2 (HSV-2) infection has been shown to be significantly associated with several obstetric complications, especially if the infection occurred during the pregnancy. Advocacy for policy formulation and the design of interventions requires local data on the risk factors for incident HSV-2 infection. The aim of this study is to assess HSV-2 sero-incidence among pregnant women in Benin and the effect of socio-demographic factors, HIV status, and HSV-1 status. Study Location, Design and Duration: Pregnant women attending ante-natal clinic in University of Benin Teaching Hospital and Central Hospital, Benin were prospectively recruited. A cross-sectional study was done and baseline data, obtained. The HSV-2 seronegative participants were followed up till the last clinic appointments [the closest appointment to their expected delivery dates (EDD)]. The study took place between November 2011 and December 2012. Methods: On recruitment a structured self-administered questionnaire was used to capture their socio-demographic data. Obstetric data was obtained from the patients’ case notes. Their HSV-1 and HSV-2 serostatuses were determined using an HSV glycoprotein G-based type-specific ELISA technique. Their HIV statuses were also determined. All those who were seronegative for HSV-2 were retested for HSV-2 six months later and/or on their last clinic appointment before the EDD. Incidence rates were calculated per person-years. Data analysis utilized SPSS version 16 software. Results: Out of the 674 participants, 315(46.8%) were HSV-2 seropositive while 359 (53.2%) were seronegative. 15.9% (57) of the HSV-2 sero-negative ones were lost to follow-up, giving a response rate of 84.1%. Seroincidence rate was found to be 17.9 per 100 person-years. There was significant association of seroincidence with younger reproductive age groups, unmarried status, and education below secondary level. Relative Risk (RR) and Incidence rate ratio (IRR) of HSV-2 infection among the HIV-infected cohort were 55.15 [95%CI:17.0-179.1] and 72.37 [95% CI:71.11-73.63] respectively. The RR and IRR among the HSV-1-seronegative cohort were 1.43 [95%CI:0.64-3.17] and 11.62 [95%CI:9.60-13.64] respectively. Conclusion: Seroincidence rate of HSV-2 infection among pregnant women in Benin was found to be 17.9 per 100 person-years. Positive HIV status, young age, unmarried status, and low education level were indicators of increased risk of incident HSV-2 infection.

Validity of Acid-Fast Smear of Gastric Aspirates for the Diagnosis of Childhood Pulmonary Tuberculosis among Human Immunodeficiency Virus-Infected Children.

Background/Aims: Gastric aspirate specimen is accepted as an alternative specimen of choice to sputum in the diagnosis of childhood pulmonary tuberculosis (TB); and specimen microscopy is usually the only available bacteriologic confirmatory test for streaming cases into the National TB Control Programme treatment protocol. Doubts expressed about the continued relevance of this test among the HIV-infected are based on observations that the bacteriologic yield of acid-fast smears of gastric aspirate specimens from these patients is markedly reduced. This study is aimed at determining the validity of acid-fast smear of gastric aspirates among the HIV-infected and compare with those of the HIV-uninfected. Design, Place and Duration of Study: Diagnostic study. Suspected tuberculosis patients registered in the paediatrics department of University of Benin Teaching Hospital were prospectively recruited from January 2010 to March, 2011. Methodology: A total of 263 children were recruited. Voluntary counseling and testing for HIV was done for each child. Two to three gastric aspirate specimens were also collected from each child using standard gastric aspirate (GA) collection protocols. On each specimen, Zeihl-Neelsen (ZN) staining and culture on Ogawa medium were done. After two or more weeks of incubation, typical acid-fast bacilli isolates on Ogawa medium, which failed to grow on para-nitrobenzoic acid-Ogawa (PNB-Ogawa) media were taken as positive culture for Mycobacterium tuberculosis complex (MTBC). MTBC Culture was taken as the “Reference test” for calculations of sensitivity and specificity. Results: Of the 263 children surveyed 116 (44.0%) were HIV-infected while 147 (56.0%) of them were HIV-uninfected. Among HIV-infected patients, the sensitivity was 38.3% [95%CI:24.4 – 52.2] while the specificity was 95.7% [95% CI:90.9 – 100.0]. Among the HIV-uninfected patients, the sensitivity was 22.0%[95%CI:10.5 – 33.5] while the specificity was 99.0%[95% CI:96.9 -100.0]. The sensitivity of the acid-fast smear in the HIV-infected group of patients was significantly higher than that of the HIV-uninfected group (p = 0.0401).The difference in specificity between the two groups was not statistically significant (p=0.496). There was also no significant difference in their respective positive-predictive values (85.7 vs 91.7)(p = 0.60). Conclusion: The sensitivity of GA acid-fast smear was significantly higher among the HIV infected group.

Seroprevalence of Cytomegalovirus among HIV-Infected Adult Patients on HAART.

Background/Aims: Cytomegalovirus is one of the opportunistic infections associated with significantly high morbidity and mortality among patients living with HIV/AIDS. Clinical manifestation of CMV infection is worse among HIV patients not receiving highly active antiretroviral therapy (HAART) than those receiving HAART. This study is aimed at investigating the seroprevalence of CMV among HIV-infected adults on HAART. Study Design: This is a cross sectional study. Place and Duration of Study: HIV Outpatient Clinic of University of Benin Teaching Hospital between April and September, 2011. Methodology: A total of 342 HIV infected adult patients on HAART attending the HIV Outpatients Clinic of the University of Benin Teaching Hospital between April and September 2011, were screened for CMV IgG and IgM using ELISA method. Clinical stage of HIV disease and CD4+ cell counts were also evaluated. Data was analyzed using SPSS version 17. Results: Of the 342 patients studied 338 (98.8%) were sero-positive for CMV IgG antibodies while 24 (7.0%) demonstrated sero-positivity for CMV IgM antibodies. The seroprevalence of CMV IgM was significantly higher in patients in WHO clinical stages 3-4 (10.9%) than those in stages 1-2 (4.7%) (p = 0.04). There is no significant statistical difference in sereoprevalences of IgG and IgM with respect to sex, age, and CD4+ cell counts. Conclusion: Clinical stage of HIV/AID is an important risk factor for reactivation or re-infection of CMV and may prompt early diagnosis and management of active CMV infection.

Seroprevalence of Cytomegalovirus (CMV) Amongst Voluntary Blood Donors in University of Benin Teaching Hospital (UBTH), Edo State, Nigeria.

Aim: To investigate the seroprevalence of cytomegalovirus (CMV) among voluntary blood donors in University of Benin Teaching Hospital (UBTH), Nigeria with the purpose of determining whether routine CMV screening for donors is justified or not. Place and Duration of Study: Department of Haematology and Department of Medical Microbiology, University of Benin Teaching Hospital (UBTH), Benin city, Nigeria, between May and September, 2010. Methodology: Sera from randomly selected one hundred and ninety-two (192) voluntary blood donors, consisting of 176 males and 16 females that visited the hospital from May to September 2010 were evaluated for CMV-IgG and IgM antibodies using an enzyme-linked immunosorbent assay (ELISA) based kit. Results: Seroprevalence for CMV-IgG and IgM were 95.8% and 3.1% respectively. All female donors (n=16) were positive for IgG. A total of 114 out of 192 (59.4%) donors were within the age bracket of 30-39 years. A prevalence of 100% for CMV IgG antibody was observed in age group ≥50 years, Conclusion: Routine screening of donors for CMV-IgG antibody would amount to waste of resources given the high prevalence of 95.8%. Periodic screening to identify the small percentage of seronegative blood donors (4.2%) who are needed for the ever increasing number of immunosuppressed recipients is recommended.