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1.
MMWR Morb Mortal Wkly Rep ; 70(12): 421-426, 2021 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-33764965

RESUMO

In 2018, an estimated 1.8 million persons living in Nigeria had HIV infection (1.3% of the total population), including 1.1 million (64%) who were receiving antiretroviral therapy (ART) (1). Effective ART reduces morbidity and mortality rates among persons with HIV infection and prevents HIV transmission once viral load is suppressed to undetectable levels (2,3). In April 2019, through the U.S. President's Emergency Plan for AIDS Relief (PEPFAR),* CDC launched an 18-month ART Surge program in nine Nigerian states to rapidly increase the number of persons with HIV infection receiving ART. CDC analyzed programmatic data gathered during March 31, 2019-September 30, 2020, to describe the ART Surge program's progress on case finding, ART initiation, patient retention, and ART Surge program growth. Overall, the weekly number of newly identified persons with HIV infection who initiated ART increased approximately eightfold, from 587 (week ending May 4, 2019) to 5,329 (week ending September 26, 2020). The ART Surge program resulted in 208,202 more HIV-infected persons receiving PEPFAR-supported ART despite the COVID-19 pandemic (97,387 more persons during March 31, 2019-March 31, 2020 and an additional 110,815 persons during April 2020-September 2020). Comprehensive, data-guided, locally adapted interventions and the use of incident command structures can help increase the number of persons with HIV infection who receive ART, reducing HIV-related morbidity and mortality as well as decreasing HIV transmission.


Assuntos
Antirretrovirais/uso terapêutico , COVID-19 , Infecções por HIV/tratamento farmacológico , Cooperação Internacional , Desenvolvimento de Programas , Centers for Disease Control and Prevention, U.S. , Infecções por HIV/epidemiologia , Humanos , Nigéria/epidemiologia , Avaliação de Programas e Projetos de Saúde , Estados Unidos/epidemiologia
2.
J Infect Dis ; 205(8): 1239-47, 2012 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-22357663

RESUMO

BACKGROUND: Acute phase of human immunodeficiency virus (HIV) infection (AHI) may account for a significant proportion of HIV-1 transmission. We identified and characterized individuals in Nigeria with AHI. METHODS: Individuals were tested using a combination of rapid HIV testing in mobile units and laboratory-based specimen pooling for nucleic acid amplification testing. Genome sequences were characterized. A linear segmented regression model was fit to serial viral load (VL) measurements to characterize early VL profiles. RESULTS: Sixteen AHIs were identified from 28 655 persons screened. Specimens were genotyped: 7 (43.8%) were CRF02_AG, 6 (37.5%) were subtype G, 1 (6.3%) was CRF06_cpx, and 2 (12.5%) were unique recombinant forms. No antiretroviral resistance mutations were detected. The mean duration of high VL burden from peak to nadir was 76 days (95% confidence interval [CI], 58-93 days), and the mean rate of viremic control was -0.66 log(10) VL per month. The mean VL at set-point was 4.5 log(10) copies/mL (95% CI, 3.9-5.1 log(10) copies/mL). CONCLUSIONS: This study is the first to characterize AHI among Nigerians identified as HIV infected before seroconversion who would be otherwise missed by conventional HIV testing. Infections by HIV subtypes in Nigeria exhibit long periods of high viral burden, which can contribute to increased transmissibility.


Assuntos
Fármacos Anti-HIV/farmacologia , Infecções por HIV/epidemiologia , HIV-1 , Doença Aguda , Adolescente , Adulto , Farmacorresistência Viral/genética , Feminino , Genótipo , HIV-1/efeitos dos fármacos , HIV-1/genética , Humanos , Masculino , Dados de Sequência Molecular , Nigéria/epidemiologia , Filogenia , RNA Viral/sangue , Fatores de Risco , Carga Viral , Adulto Jovem
3.
BMJ Glob Health ; 8(11)2023 11 30.
Artigo em Inglês | MEDLINE | ID: mdl-38035733

RESUMO

INTRODUCTION: Recent outbreaks of mpox are characterised by changes in the natural history of the disease, the demographic and clinical characteristics of the cases, and widening geographical distribution. We investigated the role of HIV and other sexually transmitted infections (STIs) coinfection among cases in the re-emergence of mpox to inform national and global response. METHODS: We conducted a national descriptive and case-control study on cases in the 2017-2019 Nigerian mpox outbreak. Mpox cases were age, sex and geographical area matched each with two randomly selected controls from a representative national HIV/AIDS survey. Logistic regression was used to investigate the association between HIV infection and the risk of mpox acquisition and death. RESULTS: Among 204 suspected mpox cases, 86 were confirmed (median age 31 years (IQR 27-38 years), mostly males (61 cases, 70.9%). Three-fifths of mpox cases had serological evidence of one or more STIs with 27.9% (24/86) coinfected with HIV. The case fatality rate was 9.4% (8/86) and 20.8% (5/24) overall and in HIV positive cases respectively. Mpox cases were more likely to have HIV coinfection compared with an age, gender and geography-matched control group drawn from the general population (OR 45 (95% CI 6.1 to 333.5, p=0.002) and when compared with non mpox rash cases (7.29 (95% CI 2.6 to 20.5, p<0.0001)). HIV coinfection and young age were associated with mortality among mpox cases (aOR 13.66 (95% CI 1.88 to 98.95, p=0.010) and aOR 0.90 (0.82-0.97, p=0.008), respectively). CONCLUSION: HIV infection was associated with a higher risk of contracting and dying from mpox. Children are also at high risk of death. STIs in mpox cases may be suggestive of high-risk sexual behaviours among these individuals.


Assuntos
Coinfecção , Infecções por HIV , Mpox , Adulto , Feminino , Humanos , Masculino , Estudos de Casos e Controles , Coinfecção/epidemiologia , Infecções por HIV/epidemiologia , Nigéria/epidemiologia
4.
Curr HIV Res ; 19(3): 248-259, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33622225

RESUMO

BACKGROUND: We investigated if initiating preventive care against HIV vertical transmission by antenatal HIV screening is independent of the patients' source of financial reimbursement for the care received in sub-Saharan Africa (SSA). METHODS: Using information from the WHO's Global Health Expenditure Database and the Demographic Health Surveys Database for 27 sub-Saharan countries, we used Spearman's correlation and adjusted survey logistic regression to determine the potential relationship between enrollment in health insurance and the likelihood that expectant mothers would be offered antenatal HIV screening. RESULTS: We found that expectant mothers covered by health insurance were more than twice as likely to be offered antenatal screening for HIV compared to the uninsured. The likelihood differed by the type of insurance plan the expectant mother carried. DISCUSSION: Health insurance is more of a financial tool that this study finds to be necessary to boost the uptake of preventive and therapeutic HIV care in SSA. CONCLUSION: The ensuing disparity in receiving proper care could hinder the goals of 90-90-90 and the forthcoming 95-95-95 plan in SSA.


Assuntos
Infecções por HIV/diagnóstico , Seguro Saúde/economia , Seguro Saúde/estatística & dados numéricos , Complicações Infecciosas na Gravidez/diagnóstico , Gestantes , Diagnóstico Pré-Natal/economia , Diagnóstico Pré-Natal/estatística & dados numéricos , Adulto , África Subsaariana , Feminino , Infecções por HIV/economia , Humanos , Gravidez , Complicações Infecciosas na Gravidez/economia
5.
PLoS One ; 13(1): e0190286, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29320531

RESUMO

BACKGROUND: The landscape of Human Immunodeficiency Virus (HIV) epidemic control is shifting with the United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 benchmarks for epidemic control. Community-based Antiretroviral Therapy (CART) models have improved treatment uptake and demonstrated good clinical outcomes. We assessed the feasibility of integrating community pharmacy as a task shift structure for differentiated community ART in Abuja-Nigeria. METHODS: Stable patients on first line ART regimens from public health facilities were referred to community pharmacies in different locations within the Federal Capital Territory, Abuja for prescription refills and treatment maintenance. Bio-demographic and clinical data were collected from February 25, 2016 to May 31st, 2017 and descriptive statistics analysis applied. The outcomes of measure were prescription refill and patient retention in care at the community pharmacy. RESULTS: Almost 10% of stable patients on treatment were successfully devolved from eight health facilities to ten community pharmacies. Median age of the participants was 35 years [interquartile range (IQR); 30, 41] with married women in the majority. Prescription refill was 100% and almost all the participants (99.3%) were retained in care after they were devolved to the community pharmacies. Only one participant was lost-to-follow-up as a result of death. CONCLUSION: Excellent prescription refill and high retention in care with very low loss-to-follow-up were associated with the community pharmacy model. The use of community pharmacy for community ART is feasible in Nigeria. We recommend the scale up of the model in all the 36 states of Nigeria.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Serviços Comunitários de Farmácia/organização & administração , Adulto , Contagem de Linfócito CD4 , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Organizacionais , Nigéria , Projetos Piloto , Prática de Saúde Pública , Encaminhamento e Consulta , Carga Viral , Adulto Jovem
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