Treatment-shortening regimens for tuberculosis: updates and future priorities.

In the past 2 years, remarkable advances have been made in shortening tuberculosis (TB) treatment. In particular, four clinical trials (Study 31/A5349, Nix-TB, ZeNix and TB-PRACTECAL) have provided evidence of the efficacy of regimens based on new and repurposed drugs: the 4-month regimen for drug-susceptible TB, and the 6-month bedaquiline-pretomanid-linezolid regimen with or without moxifloxacin for multidrug-resistant/rifampicin-resistant TB. Even if the evidence at the basis of these new regimens is compelling, several questions remain open, particularly concerning linezolid dose finding, the upsurging threat of bedaquiline-resistant Mycobacterium tuberculosis and the feasibility of applying these results to the paediatric population. Several ongoing trials may fill the remaining gaps and produce further reliable evidence to address the outstanding questions in TB treatment shortening.

A Comparative Analysis of Patient Profiles and Health Service Utilization between Patent Medicine Vendors and Community Pharmacists in Nigeria.

BACKGROUND: This study examined Nigeria's socio-demographic profiles and health service utilization patterns of Patent Medicine Vendors (PMVs) and Community Pharmacists (CPs). METHOD: A cross-sectional study using a structured self-administered questionnaire among 405 retail outlets (322 PMVs and 83 CPs) across 16 Lagos and Kebbi Local Government Areas (LGAs) between June 2020 and December 2020. RESULTS: Results showed that 60.4% were male, 76.3% from Lagos, 58.3% had tertiary education, and 74.1% had medical training. Cough and fever were common symptoms. Significant differences were found in the utilization of STD services (PMVs: 9.2%, CPs: 12.3%, p = 0.03), services by age <15 (PMVs: 54.3, CPs: 61.2, p < 0.001), and utilization by males (PMVs: 50.8, CPs: 47.1, p = 0.013). The study revealed that men visited PMVs more, while CPs used more STI services and childhood visits. CONCLUSIONS: The findings suggest that expanding health services among PMVs could target male-dominant diseases, and capacity building of CPs on syndromic STI management could reduce the STI burden.

Ending the TB pandemic: the urgency of a new and improved TB vaccine and the World Health Organization's TB Vaccine Accelerator Council.

We support the World Health Organization (WHO) recent decision to create a council to accelerate the development of a tuberculosis (TB) vaccine. With over 10 million new cases and 1.4 million deaths in 2020 alone, new and improved vaccines are urgently needed. Recent advancements in TB vaccine research offer hope, but a lack of funding, coordination and understanding of immune responses have impeded progress. A TB Vaccine Accelerator Council aims to bring together resources and expertise to overcome these obstacles and speed up development. Support and investment in research are crucial to ultimately eradicate TB and achieve the WHO goal of ending TB by 2035.

Preferences for oral- vs blood-based human immunodeficiency virus self-testing: A scoping review of the literature.

BACKGROUND: The evidence on preferences for oral- vs blood-based human immunodeficiency virus self-testing (HIVST) has been heterogenous and inconclusive. In addition, most evaluations have relied on hypothetical or stated use cases using discreet choice experiments rather than actual preferences among experienced users, which are more objective and critical for the understanding of product uptake. Direct head-to-head comparison of consumer preferences for oral- versus blood-based HIVST is lacking. AIM: To examine the existing literature on preferences for oral- vs blood-based HIVST, determine the factors that impact these preferences, and assess the potential implications for HIVST programs. METHODS: Databases such as PubMed, Medline, Google Scholar, and Web of Science were searched for articles published between January 2011 to October 2022. Articles must address preferences for oral- vs blood-based HIVST. The study used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist to ensure the quality of the study. RESULTS: The initial search revealed 2424 records, of which 8 studies were finally included in the scoping review. Pooled preference for blood-based HIVST was 48.8% (9%-78.6%), whereas pooled preference for oral HIVST was 59.8% (34.2%-91%) across all studies. However, for male-specific studies, the preference for blood-based HIVST (58%-65.6%) was higher than that for oral (34.2%-41%). The four studies that reported a higher preference for blood-based HIVST were in men. Participants considered blood-based HIVST to be more accurate and rapid, while those with a higher preference for oral HIVST did so because these were considered non-invasive and easy to use. CONCLUSION: Consistently in the literature, men preferred blood-based HIVST over oral HIVST due to higher risk perception and desire for a test that provides higher accuracy coupled with rapidity, autonomy, privacy, and confidentiality, whereas those with a higher preference for oral HIVST did so because these were considered non-invasive and easy to use. Misinformation and distrust need to be addressed through promotional messaging to maximize the diversity of this new biomedical technology.

Acceptability and strategies for enhancing uptake of human immunodeficiency virus self-testing in Nigeria.

BACKGROUND: In 2019, the Nigerian Ministry of Health published the first operational guidelines for human immunodeficiency virus self-testing (HIVST) to improve access to human immunodeficiency virus (HIV) testing services among undertested populations in the country. Also, as part of the campaign to increase HIV testing services in Nigeria, the Nigerian Ministry of Health developed standard operating procedures for using HIVST kits. AIM: To systematically review the acceptability and strategies for enhancing the uptake of HIVST in Nigeria. METHODS: The systematic review was conducted and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Different databases were searched to get the necessary materials needed for this review. Standardized forms developed by the authors were used for data extraction to minimize the risk of bias and ensure that the articles used for the study were properly screened. Identified articles were first screened using the titles and their abstracts. The full papers were screened, and the similarities of the documents were determined. Qualitative, quantitative, and mixed-method studies were evaluated using the Critical Appraisal Skills Programme and Critical Appraisal Framework criteria. RESULTS: All the publications reviewed were published between 2015 and 2022, with 33.3% published in 2021. Most (77.8%) of the studies were cross-sectional, 43.3% were conducted in Lagos State, and 26.3% were conducted among young people. The study revealed a high level of acceptability of HIVST. Certain factors, such as gender, sexual activity, and previous testing experience, influence the acceptability of HIV self-testing, with some individuals more likely to opt-out. The cost of the kit was reported as the strongest factor for choosing HIVST services, and this ranged from 200 to 4000 Naira (approximately United States Dollar 0.55-11.07), with the majority willing to pay 500 Naira (approximately United States Dollar 1.38). Privately-owned, registered pharmacies, youth-friendly centres, supermarkets, and online stores were the most cited access locations for HIVST. The least influential attribute was the type of specimen needed for HIVST. Strategies addressing cost and preferred access points and diverse needs for social media promotion, local translation of product use instructions, and HIVST distribution led by key opinion leaders for key populations were found to significantly enhance HIVST uptake and linkage to care. CONCLUSION: HIVST acceptability is generally high from an intention-to-use perspective. Targeted strategies are required to improve the acceptability of HIV self-testing, especially among males, sexually active individuals, and first-time testers. Identified and proposed uptake-enhancing strategies need to be investigated in controlled settings and among different populations and distribution models in Nigeria.

Health-Seeking Behavior Regarding Coughs in Urban Slums in Lagos, Nigeria.

BACKGROUND: TB is a major cause of morbidity and mortality, with slum residents being disproportionately affected. This study aimed to assess health-seeking behavior among adult residents of slum communities presenting with coughs in Lagos, Nigeria. METHODS: A community-based, cross-sectional study was conducted across six urban slums in Nigeria as part of community outreaches to mark World TB Day. A structured, pretested questionnaire was used to capture relevant sociodemographic details and questions regarding symptoms of coughs and related symptoms as well as care-seeking behavior. Data were explored, analyzed, and presented using descriptive statistics. RESULTS: A total of 632 respondents participated in this study. The majority were 25-34 years old (24.7%), male (65.8%), Christian (55.7%), married (73.7%), with secondary education (37.8%), with 3-4 persons per household (41%) and with 1-2 persons per room (44.5%). In total, 26.6% had had a cough for two weeks or more and were considered as presumptive TB patients. Overall, 37.2% of respondents with a cough visited patent proprietary medicine vendors (PPMVs) as the first port of call. Good health-seeking behavior was exhibited by only 36.2% of respondents. In total, 38.9% delayed seeking care from a health facility (government or private) more than one month after the onset of symptoms. None of the factors included in the multivariate analysis showed a significant association with good health-seeking behavior (i.e., visiting government or private hospitals/clinics). CONCLUSIONS: The poor health-seeking behavior, delay in seeking TB care and preference for PPMVs emphasizes the need for National tuberculosis programs (NTPs) to further engage these informal providers in TB prevention, diagnosis and treatment services in urban slum communities.

Tuberculosis management and referral practices among traditional medicine practitioners in Lagos, Nigeria.

Introduction: Despite the potential role of Traditional Birth Attendants (TBAs) and Traditional Healers (THs), little is known about their knowledge of tuberculosis (TB) management and referral practices in Nigeria. Objective: To determine knowledge and self-reported practices of traditional birth attendants and traditional healers in managing TB in Lagos, Nigeria. Methods: A cross-sectional study of 120 THs and TBAs in three high TB burden Local Government Areas (LGAs) in Lagos, Nigeria. Data were collected between April 2018 to September 2018 through interviewer-administered questionnaires. We used Statistical Package for Social Sciences software for data analyses. Independent predictors of being TBA or TH were determined using logistic regression at the statistical significance of P<0.05 and 95% confidence interval. Results: TB knowledge increased from 52.7% pre-test to 61.7% post-test and did not differ between TBAs and THs. Of the 120 Traditional Medical Practitioners studied, 70% (84) never treated TB; 57.3 % (69) ever referred chronic cough patients to a health facility; 90% (108) were willing to collaborate with National Tuberculosis, Leprosy and Buruli Ulcer Control Programme (NTBLCP), 85% (102) attached monetary and token incentive as a condition for the collaboration. THs had decreased odds of ever referring TB patient to the hospital (AOR: 0.3, 95% CI:0.14-0.64, P=0.002); currently referring TB patients (AOR: 0.06, 95% CI:0.02-0.17, P<0.0001) and consulting <40 patients in a year (AOR: 0.22,95% CI:0.09-0.53, P<0.0001). Conclusion: Majority of the THs and TBAs were willing to collaborate with NTBLCP in the identification and referral of Presumptive TB patients. We suggest that NTBLCP empowers the TBAs and THs to help with an early referral of TB patients.

Stocking Practices of Anti-Tuberculosis Medications among Community Pharmacists and Patent Proprietary Medicine Vendors in Two States in Nigeria.

BACKGROUND: Evidence has shown that non-fixed-dose combination (non-FDC) anti-TB drugs could promote the spread of drug-resistant tuberculosis (DR-TB). We aimed to determine anti-TB medication stocking and dispensing practices among patent medicine vendors (PMVs) and community pharmacists (CPs) and their determinants. METHOD: This was a cross-sectional study using a structured, self-administered questionnaire among 405 retail outlets (322 PMVs and 83 CPs) across 16 Lagos and Kebbi local government areas (LGAs) between June 2020 and December 2020. Data were analyzed with Statistical Program for Social Sciences (SPSS) for Windows version 17 (IBM Corp., Armonk, NY, USA). Chi-square test and binary logistic regression were used to assess the determinants of anti-TB medication stocking practices at a p-value of 0.05 or less for statistical significance. RESULTS: Overall, 91%, 71%, 49%, 43% and 35% of the respondents reported stocking loose rifampicin, streptomycin, pyrazinamide, isoniazid and ethambutol tablets, respectively. From bivariate analysis, it was observed that being aware of directly observed therapy short course (DOTS) facilities (OR 0.48, CI 0.25-0.89, p < 0.019) and having previous training on TB (OR 0.32, CI 0.14-0.73, p < 0.005) reduced the odds of stocking anti-TB medication, while operating more than 1 shop (OR 3.32, CI 1.44-7.57, p = 0.004), having 3 or more apprentices (OR 5.31, CI 2.74-10.29, p < 0.001) and seeing over 20 clients/day (OR 3.02, CI 1.18-7.71, p = 0.017) increased the odds of stocking loose anti-TB medications. From multivariate analysis, it was observed that only the variable having three or more apprentices (OR 10.23, CI 0.10-0.49, p = 0.001) significantly increased the odds of stocking anti-TB medications. CONCLUSIONS: The stocking of non-FDC anti-TB medications was high and largely determined by the number of apprentices among PMVs and CPs in Nigeria, and this may have serious implications for drug resistance development. However, the results linking the stocking of anti-TB to the number of apprentices should be interpreted cautiously as this study did not control for the level of sales in the pharmacies. We recommend that all capacity-building and regulatory efforts for PMVs and CPs in Nigeria should include not just the owners of retail premises but also their apprentices.

Completion of 6-mo isoniazid preventive treatment among eligible under six children: A cross-sectional study, Lagos, Nigeria.

BACKGROUND: Nigeria is one of the thirty high burden countries with significant contribution to the global childhood tuberculosis epidemic. Tuberculosis annual risk for children could be as high as 4% particularly in high tuberculosis (TB) prevalent communities. Isoniazid (INH) Preventive Therapy has been shown to prevent TB incidence but data on its implementation among children are scarce. AIM: To determine the completion of INH among under six children that were exposed to adults with smear positive pulmonary TB in Lagos, Nigeria. METHODS: This was a hospital-based retrospective cross-sectional review of 265 medical records of eligible children < 6 years old enrolled for INH across 32 private hospitals in Lagos, Nigeria. The study took place between July and September 2020. Data was collected on independent variables (age, gender, type of facility, TB screening, dose and weight) and outcome variables (INH outcome and proportion lost to follow up across months 1-6 of INH treatment). RESULTS: About 53.8% of the participants were female, 95.4% were screened for TB and none was diagnosed of having TB. The participants' age ranged from 1 to 72 mo with a mean of 36.01 ± 19.67 mo, and 40.2% were between the ages of 1-24 mo. Only 155 (59.2%) of the 262 participants initiated on INH completed the six-month treatment. Cumulatively, 107 (41.0%) children were lost to follow-up at the end of the sixth month. Of the cumulative 107 loss to follow-up while on INH, largest drop-offs were reported at the end of month 2, 52 (49%) followed by 20 (19%), 17 (16%), 11 (10.2%) and 7 (6.5%) at months 3, 4, 5 and 6 respectively. The analysis showed that there was no significant association between age, gender, type of facility and completion of INH treatment (P > 0.005). CONCLUSION: This study demonstrated suboptimal INH completion rate among children with only 6 out of 10 children initiated on INH who completed a 6-mo treatment in Lagos, Nigeria. The huge drop-offs in the first 2 mo of INH calls for innovative strategies such as the use of 60-d INH calendar that would facilitate reminder and early engagement of children on INH and their caregivers in care and across the entire period of treatment.

Do private health providers adhere to National Tuberculosis Guideline while assigning treatment outcome? Findings from a lower middle-income country.

Background: Treatment success rate is an important indicator to measure the performance of the National Tuberculosis Program (NTP). There are concerns about the quality of outcome data from private facilities engaged by NTP. Adherence of private providers of tuberculosis care to NTP guideline while assigning treatment outcomes to patients is rarely investigated. We aimed to determine whether Lagos private for-profit (PFP) and private not-for-profit (PNFP) facilities adhere to domestic TB guideline while assigning treatment outcome and the availability of periodic sputum acid-fast bacilli (AFB) results. Method: A retrospective review of facility treatment register and treatment cards of TB patients managed between January and December 2016 across 10 private directly observed treatment short-course (DOTS) facilities involved in the public-private mix (PPM) in Lagos, Nigeria. The study took place between January and June 2019. Results: Of the 1,566 patients, majority (60.7%) were male, >30 years (50.2%), HIV-negative (88.4%), and attended PNFP (78.5%). The reported treatment success rate (TSR) was 84.2% while the actual TSR was 53.8%. In total, 91.1, 77.6, and 70.3% of patients had sputum acid-fast bacilli (AFB) at 2/3, month 5, and month 6, respectively, while 68.6% had all the three sputum AFB in the register. Healthcare workers (HCWs) were adherent in assigning treatment outcome for 65.6% of TB patients while 34.4% of patients were assigned incorrect treatment outcomes. Most variations between reported and actual treatment outcomes were found with cured (17%) and completed (13.4%). Successful and unsuccessful outcomes were overreported by 30.4% and 4.1%, respectively. DOTS providers in private facilities with available TB guideline (OR 8.33, CI 3.56-19.49, p < 0.0001) and PNFP facility (OR 4.42, CI 1.91-10.3, p = 0.001) were more likely to adhere to National TB Guideline while assigning TB treatment outcome. Conclusion: Frontline TB providers in Lagos private hospitals struggled with assigning correct treatment outcome for TB patients based on NTBLCP guideline. Increased access to all the periodic follow-up AFB tests for TB patients on treatment and availability of National TB Guideline for referencing could potentially improve the adherence of private TB service providers while assigning TB treatment outcomes.

Chest X-ray Features in Drug-Resistant Tuberculosis Patients in Nigeria; a Retrospective Record Review.

Chest X-ray (CXR) characteristics of patients with drug-resistant tuberculosis (DR-TB) depend on a variety of factors, and therefore, identifying the influence of these factors on the appearance of DR-TB in chest X-rays can help physicians improve diagnosis and clinical suspicion. Our aim was to describe the CXR presentation of patients with DR-TB and its association with clinical and demographic factors. A retrospective analysis of the CXRs of DR-TB patients in Nigeria between 2010 and 2016 was performed, reviewing features of chest radiographs, such as cavitation, opacity and effusion, infiltration and lung destruction. The association of these abnormal CXR findings with clinical and demographic characteristics was evaluated using bivariate and multivariate models, and a p-value < 0.05 was considered statistically significant with a 95% confidence interval. A total of 2555 DR-TB patients were studied, the majority (66.9%) were male, aged 29−38 years (36.8%), previously treated (77%), from the South West treatment zone (43.5%), HIV negative (76.7%) and bacteriologically diagnosed (89%). X-ray findings were abnormal in 97% of the participants, with cavitation being the most common (41.5%). Cavitation, effusion, fibrosis, and infiltration were higher in patients presenting in the South West zone and in those previously treated for DR-TB, while lung destruction was significantly higher in patients who are from the South South zone, and in those previously treated for DR-TB. Patients from the South East zone (AOR: 6.667, 95% CI: 1.383−32.138, p = 0.018), the North East zone (AOR: 6.667, 95% CI: 1.179−37.682, p = 0.032) and the North West zone (AOR: 6.30, 95% CI: 1.332−29.787, p = 0.020) had a significantly increased likelihood of abnormal chest X-ray findings, and prior TB treatment predisposed the patient to an increased likelihood of abnormal chest X-ray findings compared to new patients (AOR: 8.256, 95% CI: 3.718−18.330, p = 0.001). The finding of a significantly higher incidence of cavities, effusions and fibrosis in DR-TB patients previously treated could indicate late detection or presentation with advanced DR-TB disease, which may require a more individualized regimen or surgical intervention.

Knowledge of International Standards for Tuberculosis Care among Private Non-NTP Providers in Lagos, Nigeria: A Cross-Sectional Study.

Studies specifically evaluating tuberculosis knowledge among private non-NTP providers using the International Standards for Tuberculosis Care (ISTC) framework are scarce. We evaluated the knowledge of ISTC among private non-NTP providers and associated factors in urban Lagos, Nigeria. We performed a cross-sectional descriptive study using a self-administered questionnaire to assess different aspects of tuberculosis management among 152 non-NTP providers in Lagos, Nigeria. The association between the dependent variable (knowledge) and independent variables (age, sex, qualifications, training and years of experience) was determined using multivariate logistic regression. Overall, the median knowledge score was 12 (52%, SD 3.8) and achieved by 47% of the participants. The highest knowledge score was in TB/HIV standards (67%) and the lowest was in the treatment standards (44%). On multivariate analysis, being female (OR 0.3, CI: 0.1−0.6, p < 0.0001) and being a nurse (OR 0.2, CI: 0.1−0.4, p < 0.0001) reduced the odds of having good TB knowledge score, while having previously managed ≥100 TB patients (OR 2.8, CI: 1.1−7.2, p = 0.028) increased the odds of having good TB knowledge. Gaps in the knowledge of ISTC among private non-NTP providers may result in substandard TB patient care. Specifically, gaps in knowledge of standard TB regimen combinations and Xpert MTB/RIF testing stood out. The present study provides evidence for tailored mentorship and TB education among nurses and female private non-NTP providers.

Rethinking Public Private Mix (PPM) Performance in the Tuberculosis Program: How Is Care Seeking Impacting This Model in High TB Burden Countries?

In many high TB burden countries with enormous private-sector presence, up to 60-80% of the initial health-seeking behavior occurs in the private sector when people fall sick. Private-sector providers are also perceived to offer poorer-quality health service, and contribute to TB notification gaps and the spread of multidrug-resistant tuberculosis (MDR-TB). Recent efforts have focused on the expansion of TB services among private providers through public-private mix (PPM) initiatives. However, whether such efforts have matched the contribution of the private sector in TB notification, considering its enormous health-seeking volume, is debatable. Here, we argue that evaluating PPM program performance on the basis of the proportion of private-sector health seeking and level of undernotification is an imperfect approach due to differentials in tuberculosis risk profiles and access among patient populations seeking private care when compared with the public sector. We suggest a uniform definition of what constitutes PPM, and the standardization of PPM reporting tools across countries, including the ability to track patients who might initially seek care in the private sector but are ultimately publicly notified. PPM programs continue to gain prominence with rapid urbanization in major global cities. A universal health coverage framework as part of the PPM expansion mandate would go a long way to reduce the catastrophic cost of seeking TB care.

How Do Private Providers Unaffiliated With the Nigeria National TB Program Diagnose and Treat Drug-Susceptible TB Patients? A Cross-Sectional Study.

INTRODUCTION: TB diagnosis and treatment practices among private providers not affiliated with the Nigeria National TB Program (NTP) have implications for TB control efforts. Studies evaluating these practices among non-NTP providers are scarce. We aimed to investigate TB diagnosis and treatment practices among non-NTP private providers in urban Lagos State, Nigeria. METHODS: We conducted a cross-sectional study among doctors and nurses operating private facilities not formally affiliated with the NTP for TB case notification. Between May 2018 and January 2019, we implemented a survey using a pretested questionnaire among 152 doctors and nurses attending TB sensitization seminars in Lagos, Nigeria. We used descriptive statistics to summarize the sociodemographic information and proportion of non-NTP providers with different self-reported TB diagnostic, prescription, and monitoring practices. RESULTS: Private non-NTP doctors and nurses self-reported diagnosing TB using 8 different types of tests. Acid-fast bacilli was the most common (39.8%) means of diagnosing TB. Private non-NTP providers also self-reported prescribing 23 different TB regimens, including streptomycin, to treat TB. Only 32.4% of providers self-reported using the correct combinations of anti-TB drugs to treat TB. Additionally, 58.3% of providers prescribed the standard 6-month treatment duration for pulmonary TB patients, and the remaining 41.7% either undertreated or overtreated TB. CONCLUSION: A large proportion of private doctors and nurses not formally affiliated with the NTP in Nigeria were not following the NTP guidelines in the diagnosis and treatment of TB. Overtreatment and undertreatment were common. Engagement of these practitioners by the NTP in the form of supervision, on-the-job mentorship, and other strategies can mitigate the negative effects of their current practices on TB case notification and the spread of drug-resistant strains in Nigeria.

Challenges of Tuberculosis Control in Lagos State, Nigeria: A Qualitative Study of Health-Care Providers' Perspectives.

BACKGROUND: Tuberculosis (TB) burden in Nigeria is a reflection of the challenges of TB control strategy in the country. This study explored the challenges encountered by the health workers in public and private TB treatment centers in Lagos, Nigeria. METHODS: In-depth interviews were held with 34 health workers providing TB services in private and public health facilities and the Lagos state Program Officer between October 1, 2016 and January 31, 2017. The transcripts were read severally and coded for qualitative data analysis. Themes were developed from coding. RESULTS: Insufficient or lack of funds to track patients lost to follow-up, conduct home visits, collect drugs from the central stores, and shortage of laboratory reagents were some of the logistical challenges encountered by the health workers. There was shortage of health workers and some were yet to be trained resulting in work overload. This was situation aggravated by the frequent redeployment and health worker attrition in the public and private sector respectively. CONCLUSION: The government need be proactive and show leadership by finding lasting solutions to the logistical and human resource challenges facing the LAgos State TB and Leprosy Program.

FACTORS ASSOCIATED WITH HIV INFECTION AMONG CLIENTS ACCESSING HIV COUNSELING AND TESTING SERVICES IN A SECONDARY REFERRAL HOSPITAL IN LAGOS, NIGERIA.

BACKGROUND: HIV counselling and testing (HCT) provides an opportunity for people to learn more about the human immune deficiency virus (HIV). This study assessed the knowledge of, and factors associated with, HIV infections among clients assessing HCT services referral hospital in Lagos, Nigeria. MATERIALS AND METHODS: Retrospective review of records of clients who assessed HCT services at Mainland Hospital Lagos, Nigeria, between July 1, 2016, and December 31, 2017, was done. Multivariate analysis was done to identify the factors associated with HIV infection and knowledge of HIV. RESULTS: A total of 4273 clients were screened for HIV within the study period. The mean age of clients was 38.5±14.4. Male: Female ratio was 1:0.87. The prevalence of HIV infection was 19%. Factors associated with HIV infection were: age above 24 years, being female (AOR 1.6 95% CI 1.4-2.0, p<0.001), previous marriage (divorced, widowed, separated) (AOR 2.3 95% CI 1.7- 3.3, p<0.001) and poor knowledge of HIV (AOR 2.9 95% CI 2.2-3.6, p<0.001). Males were 15 times more likely to have good knowledge of HIV than females (AOR 14.5 95% CI 10.5- 20.0, p<0.001). In addition, the clients who were single (AOR 3.6 95% CI 2.4-5.4, p<0.001) and married (AOR 3.9 95% CI 2.9-5.3, p<0.001) were four times more likely to have good knowledge of HIV than clients who were previously married. CONCLUSION: More proactive measures are required to educate the public, especially women who were previously married, on HIV transmission and prevention.