Predictors of tuberculosis treatment outcomes among people living with HIV in some States in Nigeria.

Introduction: tuberculosis (TB) and Human Immunodeficiency Virus (HIV) remain major public health threats globally and worse when they co-exist in susceptible individuals. The study examined TB treatment outcomes and their predictive factors among people living with HIV (PLHIVs). Methods: a review of TB/HIV co-infected patients who had TB treatments across comprehensive antiretroviral therapy (ART) sites with ≥500 patients was conducted in seven United States of America President's Emergency Plan for AIDS Relief (PEPFAR)-supported States in Nigeria. Data on patient background, HIV and TB care, and TB treatment outcomes were collected using an Excel abstraction template. The data was analyzed using SPSS and an association was examined using a chi-square test while binary logistic regression was used to determine predictors of TB treatment outcomes (P< 0.05). Results: two thousand six hundred and fifty-two co-infected patients participated in the study. The mean age of participants was 37 ± 14 years. A majority had TB treatment success (cured = 1059 (39.9%), completed = 1186 (44.7%)). Participants who had pulmonary TB, virally suppressed and commenced isoniazid (INH) before TB diagnosis were more likely to have a favorable TB treatment outcome compared to those who had extrapulmonary TB (AOR = 7.110, 95% CI = 1.506 - 33.565), virally unsuppressed (AOR = 1.677, 95% CI = 1.036 - 2.716) or did not commence INH before TB diagnosis (AOR = 1.486, 95% CI = 1.047 - 2.109). Conclusion: site of infection, immune status, exposure to ART, and INH prophylaxis were found to predict TB treatment outcomes among PLHIVs. Stakeholders should ensure early commencement of ART and INH prophylaxis for PLHIVs.

Cervical cancer screening and treatment for PLWHIV: experiences from an innovative program in Nigeria.

BACKGROUND: We evaluated cervical cancer program for women living with HIV (WLHIV) to determine program screening rate, primary case finder screening accuracy and treatment and post-treatment screening rate among screen-positive patients. METHODS: A ten-month review of cervical cancer program data among WLHIV aged 15-49 years on HIV care across forty-one comprehensive ART sites, supported by APIN (a PEPFAR implementing partner) for cervical cancer screening and treatment in Nigeria, was conducted from October 2020 to July 2021. Initial screening was done using visual inspection with acetic acid (VIA) followed by a gynaecologist expert review through a program-designed software named AVIVA, as a confirmatory test. Associations were measured between the primary case finder screening accuracy and study covariates at p-value of 0.05. RESULTS: About 10,289 asymptomatic women aged 15-49 years living with HIV were screened for cervical cancer by primary case finders using VIA-based screening test. About 732 (7.1%) had a positive screening test suggestive of precancerous lesions or cervical cancer. Three hundred and fifteen (43.0%) of VIA positive women had treatment using thermal ablation and less than one-third (21.6%) of those treated came back for post-treatment screening test. Primary case finder screening sensitivity, specificity, positive predictive and negative predictive accuracy using gynaecologist review as confirmatory test were 60.8%, 71.5%, 41.7% and 84.5% respectively. Overall screening accuracy was 68.8%. CONCLUSION AND RECOMMENDATIONS: This innovative approach to cervical cancer screening among WLHIV yielded modest results in preventing program error and wastages. Wider deployment of expert-based reviews of VIA though AVIVA software might be a veritable approach to improve screening accuracy in low resource settings.

AVIVA: a telehealth tool to improve cervical cancer screening in resource-constrained settings.

Cervical cancer accounts for 21.7% of all cancer deaths in the sub-Saharan Africa with a case fatality rate of 68%. Nigeria's Federal Ministry of Health has adopted cervical cancer screening (CCS) using visual inspection with acetic acid or Lugol's iodine (VIA/VILI) and cryotherapy treatment for precancerous lesions as the preferred screening and treatment strategy. Using the Exploration, Preparation, Implementation and Sustainment Framework, our study documents our experience during the development, piloting and roll-out of the APIN Public Health Initiatives (APIN)-developed VIA Visual Application (AVIVA) for CCS using the VIA method in 86 APIN-supported health facilities across 7 states in Nigeria. Between December 2019 and June 2022, with the aid of 9 gynaecologists and 133 case finders, a total of 29 262 women living with HIV received VIA-based CCS and 1609 of them were VIA-positive, corresponding to VIA positivity rate of 5.5%. Over the 30 months duration and the 5 phases of CCS scale-up, AVIVA development and expansion, a total of 1247 cases were shared via the AVIVA App (3741 pictures), with 1058 of such cases undergoing expert review, corresponding to a reviewer rate of 84.8%. Overall, the use of the AVIVA App improved both the VIA-positive and VIA-negative concordance rates by 16 percentage points each (26%-42% and 80%-96%, respectively) from baseline to the end of the study. We concluded that the AVIVA App is an innovative tool to improve CCS rates and diagnostic precision by connecting health facility staff and expert reviewers in resource-limited settings.

Toward Strengthening the Capacity of the Health System: A Cross-Sectional Study of Factors Predicting Quality of Life in 545 Nigerian Children Exposed to Sexual Abuse.

In Nigeria, the predictors of quality of life among children exposed to sexual abuse are unknown. Addressing this gap may strengthen the capacity of the health system to care for this population. Thus, this cross-sectional study selected 545 (mean age = 14.4 ± 1.4 years) Nigerian children exposed to sexual abuse. Results show that self-compassion, resilience, and meaning in life jointly predicted quality of life and explained 39% variance. The independent prediction of each predictor variable shows that self-compassion, resilience, and meaning in life have significant independent predictions, with self-compassion showing the greatest independent prediction, followed by resilience and meaning in life. Sex, age, and how long ago respondents were exposed to sexual abuse jointly predicted quality of life and explained 6% variance. However, how long ago respondents were exposed to sexual abuse shows a significant independent prediction. Results offer clinical implications that may strengthen the capacity of the health system to care for this population.

Black People Narrate Inequalities in Healthcare Systems that Hinder COVID-19 Vaccination: Evidence from the USA and the UK.

The coronavirus disease 2019 (COVID-19) pandemic is an unprecedented global health emergency. As a novel condition, there is no known definitive treatment for the condition, except for the use of vaccines as a control measure. In the literature, the issue of inequalities in healthcare systems has been documented as a hindrance to COVID-19 vaccination; however, the specific inequalities in healthcare systems that hinder COVID-19 vaccination are poorly understood. Guided by the fundamental cause theory (FCT), this study aims to address this gap among Black people, a minority group vulnerable to inequalities in healthcare systems. Thirty-five Black people (age range = 21-58 years) residing in either the United States of America (USA) or the United Kingdom (UK) participated in this study. Qualitative data were collected and analyzed using thematic analysis. Most USA participants and a few UK participants narrated that no inequalities in healthcare systems hinder them from receiving COVID-19 vaccines. Contrarily, most UK participants and a few USA participants narrated inequalities in healthcare systems that hinder them from receiving COVID-19 vaccines. These are mistrust of the healthcare system, health policies regarding COVID-19 vaccination, historical factors (such as historical abuse of Black bodies by health professionals), residential location, and dissatisfaction with health services. In terms of what governments must do to correct these inequalities, participants recommended the need for acknowledgment and community engagement. This is the first international collaboration to examine this problem. Important implications for theory, healthcare systems, and COVID-19 vaccination program planning are highlighted. Finally, there are members of other minority groups and vulnerable communities who are not Black people. Such groups could face unique inequalities that hinder COVID-19 vaccination. Therefore, future studies should include such groups.

Building a national framework for multicentre research and clinical trials: experience from the Nigeria Implementation Science Alliance.

There is limited capacity and infrastructure in sub-Saharan Africa to conduct clinical trials for the identification of efficient and effective new prevention, diagnostic and treatment modalities to address the disproportionate burden of disease. This paper reports on the process to establish locally driven infrastructure for multicentre research and trials in Nigeria known as the Nigeria Implementation Science Alliance Model Innovation and Research Centres (NISA-MIRCs). We used a participatory approach to establish a research network of 21 high-volume health facilities selected from all 6 geopolitical zones in Nigeria capable of conducting clinical trials, implementation research using effectiveness-implementation hybrid designs and health system research. The NISA-MIRCs have a cumulative potential to recruit 60 000 women living with HIV and an age-matched cohort of HIV-uninfected women. We conducted a needs assessment, convened several stakeholder outreaches and engagement sessions, and established a governance structure. Additionally, we selected and trained a core research team, developed criteria for site selection, assessed site readiness for research and obtained ethical approval from a single national institutional review board. We used the Exploration, Preparation, Implementation, Sustainment framework to guide our reporting of the process in the development of this network. The NISA-MIRCs will provide a nationally representative infrastructure to initiate new studies, support collaborative research, inform policy decisions and thereby fill a significant research infrastructure gap in Africa's most populous country.

Consistent condom use and associated factors among HIV positive women of reproductive age on anti-retroviral treatment in Ogun State, Nigeria.

Introduction: consistent condom use remains an integral and essential part of comprehensive Human Immunodeficiency Virus (HIV) prevention and care programme. This study assessed consistent use of condom among HIV-positive women of reproductive age on antiretroviral treatment and its associated factors. Methods: a cross-sectional survey of 360 women living with HIV (WLHIV) receiving treatment in four APIN Public Health Initiatives, Nigeria supported President's Emergency Plan for AIDS Relief (PEPFAR) comprehensive Antiretroviral Therapy (ART) sites in Ogun State was conducted from October 2018 to March 2019. Information were collected on consistent condom use among respondents and their associated factors using a pre-tested questionnaire. Data were analysed using SPSS IBM version, with statistical significance set at 0.05. Results: the mean age of the women was 38.1 ± 5.8 years. About two-fifth (39.4%) of the respondents reported consistent use of condom. Of the 142 respondents who reported inconsistent use of condom, 51.6% and 37.5% mentioned sexual displeasure and partner's disagreement respectively as reasons for inconsistent use. Factors associated with consistent condom use were marital status (p < 0.001), respondent's occupation (p = 0.040), partner's occupation (p = 0.012) and partner's HIV status (p = 0.045). Respondents with HIV negative partners were 1.8 times more likely to use condom consistently compared to those with HIV positive partners (AOR = 1.826, CI = 1.018 - 3.274). Conclusion: this study concludes that there is poor consistent condom use among WLHIV in Ogun State. The rate is worse among the sero-concordant partners than the sero-discordant partners. More needs to be done through behaviour change communication aimed at improving consistent condom use among HIV clients.

Improving coverage and completion rate of isoniazid preventive therapy among eligible HIV patients using quality improvement approaches: a case study of State Hospital, Ijebu Ode, Ogun State, Nigeria.

INTRODUCTION: Tuberculosis (TB) is a major killer of people living with HIV. One key strategy to reduce the incidence of tuberculosis in HIV patients is the use of Isoniazid Preventive Therapy (IPT). However, coverage of IPT among eligible HIV clients is poor. This study aims to improve IPT coverage using quality improvement approaches that help identify the root cause and improve coverage of isoniazid preventive therapy. METHODS: The quality improvement (QI) project spanned over six months corresponding to three PDSA cycles. Root causes for low IPT initiation and completion in State Hospital Ijebu Ode were identified using fishbone analysis. The root causes were subjected to prioritization matrix and implementation plan was developed for the first two root causes with the highest composite matrix scores. Longitudinal data were collected over the six months period with learning session at the end of every two-month PDSA cycle. Data was analyzed using Microsoft Excel 2010 and presented in charts and tables. RESULTS: The two most contributory factors to low IPT initiation and completion in the facility with prioritization matrix scores of 30 and 25 respectively were poor tracking system for IPT eligible clients and poor documentation of IPT commencement in the patients care cards and IPT registers. Findings showed improvement in both IPT initiation and completion with increase in initiation rate from 11% to above 50%, and increase in completion rate from 53% to 95.4%. CONCLUSION: The use of quality improvement approaches can improve coverage and completion rate of IPT among eligible HIV patients. Government and health programmers should support facilities to apply QI approaches to solving health service delivery.

Pediatric to adult healthcare transitioning for adolescents living with HIV in Nigeria: A national survey.

INTRODUCTION: The period of transition from pediatric to adult care has been associated with poor health outcomes among 10-19 year old adolescents living with HIV (ALHIV). This has prompted a focus on the quality of transition services, especially in high ALHIV-burden countries. Due to lack of guidelines, there are no healthcare transition standards for Nigeria's estimated 240,000 ALHIV. We conducted a nationwide survey to characterize routine transition procedures for Nigerian ALHIV. MATERIALS AND METHODS: This cross-sectional survey was conducted at public healthcare facilities supported by five local HIV service implementing partners. Comprehensive HIV treatment facilities with ≥1 year of HIV service provision and ≥20 ALHIVs enrolled were selected. A structured questionnaire assessed availability of treatment, care and transition services for ALHIV. Transition was defined as a preparatory process catering to the medical, psychosocial, and educational needs of adolescents moving from pediatric to adult care. Comprehensive transition services were defined by 6 core elements: policy, tracking and monitoring, readiness evaluation, planning, transfer of care, and follow-up. RESULTS: All 152 eligible facilities were surveyed and comprised 106 (69.7%) secondary and 46 (30.3%) tertiary centers at which 17,662 ALHIV were enrolled. The majority (73, 48.3%) of the 151 facilities responding to the "clinic type" question were family-centered and saw all clients together regardless of age. Only 42 (27.8%) facilities had an adolescent-specific HIV clinic; 53 (35.1%) had separate pediatric/adolescent and adult HIV clinics, of which 39 (73.6%) reported having a transfer/transition policy. Only 6 (15.4%) of these 39 facilities reported having a written protocol. There was a bimodal peak at 15 and 18 years for age of ALHIV transfer to adult care. No surveyed facility met the study definition for comprehensive transition services. CONCLUSIONS: Facilities surveyed were more likely to have non-specialized HIV treatment services and had loosely-defined, abrupt transfer versus transition practices, which lacked the core transition elements. Evidence-based standards of transitional care tailored to non-specialized HIV treatment programs need to be established to optimize transition outcomes among ALHIV in Nigeria and in similar settings.

Risk and protective factors for adolescent substance use: a comparative study of secondary school students in rural and urban areas of Osun State, Nigeria.

BACKGROUND: Substance use is a leading adolescent health problem globally, but little is known regarding associated factors for adolescent substance use in Nigeria. This study compared the prevalence of substance use among in-school adolescents in urban and rural areas of Osun State, Nigeria, and identified risk and protective factors. METHODS: This cross-sectional study involved 600 randomly selected adolescents (aged 10-19 years) from rural and urban areas of Osun State, Nigeria. Data were collected using the facilitated self-completed questionnaire method. Binary logistic regression was used to examine the association of individual, peer, and parental factors with adolescent substance use. Adjusted odds ratio (OR) and 95% confidence interval (CI) were obtained. RESULTS: About two-thirds of respondents had used substances in both rural (65.7%) and urban areas (66.0%) (p=0.93). Logistic analysis showed private school attendance as a risk factor for substance use (OR=2.32, 95% CI=1.20-4.46) and adolescent disapproval of adult substance use as a protective factor (OR=0.47, 95% CI=0.27-0.82) in rural areas. For urban areas, having friends who use substances (OR=4.04, 95% CI=1.39-11.6) and a mother having had tertiary education (OR=3.34, 95% CI=1.06-10.4) were risk factors while parental disapproval of substance use (OR=0.50, 95% CI=0.28-0.90) was a protective factor. CONCLUSION: Lifetime prevalence of substances is high among in-school adolescents in Osun State. The risk and protective factors for adolescent substance use somewhat differ for rural and urban areas, and these have implications for designing effective intervention strategies.