'I will welcome this one 101%, I will so embrace it': a qualitative exploration of the feasibility and acceptability of HIV self-testing among men who have sex with men (MSM) in Lagos, Nigeria.

Men who have sex with men (MSM) are disproportionately affected by HIV in Nigeria. A key strategy in reducing transmission is to increase HIV testing uptake and linkage to treatment for those who test positive. HIV self-testing (HIVST) is an innovative strategy with the potential to increase uptake of HIV testing among key populations at higher risk for HIV. We conducted 23 in-depth-interviews with MSM and two focus group discussions with key opinion leaders to explore perceptions about the feasibility and acceptability of oral HIVST among MSM in Lagos, Nigeria. HIVST was highly acceptable because it was considered convenient to use, painless, private and addressed concerns about stigma. Concerns cited by participants included comprehensibility of instructions to perform and interpret results correctly, as well as lack of support mechanisms to facilitate post-test follow-up and linkage to care. Provision of adequate pre-test information was considered vital as part of the kit distribution process to ensure seamless use of HIVST kits. One-on-one peer-to-peer distribution strategies and retail outlets that facilitate anonymous pick-up are potential distribution channels identified in this study. Overall, our findings suggest that an HIVST program that incorporates these considerations would improve access to HIV testing among MSM in Nigeria.

High SARS-CoV-2 seroprevalence in Lagos, Nigeria with robust antibody and cellular immune responses.

Background: Early evidence suggested that the impact of the COVID-19 pandemic was less severe in Africa compared to other parts of the world. However, more recent studies indicate higher SARS-CoV-2 infection and COVID-19 mortality rates on the continent than previously documented. Research is needed to better understand SARS-CoV-2 infection and immunity in Africa. Methods: In early 2021, we studied the immune responses in healthcare workers (HCWs) at Lagos University Teaching Hospital (n = 134) and Oxford-AstraZeneca COVID-19 vaccine recipients from the general population (n = 116) across five local government areas (LGAs) in Lagos State, Nigeria. Western blots were used to simultaneously detect SARS-CoV-2 spike and nucleocapsid (N) antibodies (n = 250), and stimulation of peripheral blood mononuclear cells with N followed by an IFN-γ ELISA was used to examine T cell responses (n = 114). Results: Antibody data demonstrated high SARS-CoV-2 seroprevalence of 72·4% (97/134) in HCWs and 60·3% (70/116) in the general population. Antibodies directed to only SARS-CoV-2 N, suggesting pre-existing coronavirus immunity, were seen in 9·7% (13/134) of HCWs and 15·5% (18/116) of the general population. T cell responses against SARS-CoV-2 N (n = 114) were robust in detecting exposure to the virus, demonstrating 87·5% sensitivity and 92·9% specificity in a subset of control samples tested. T cell responses against SARS-CoV-2 N were also observed in 83.3% of individuals with N-only antibodies, further suggesting that prior non-SARS-CoV-2 coronavirus infection may provide cellular immunity to SARS-CoV-2. Conclusions: These results have important implications for understanding the paradoxically high SARS-CoV-2 infection with low mortality rate in Africa and supports the need to better understand the implications of SARS-CoV-2 cellular immunity.

Uptake of HIV self-testing and linkage to treatment among men who have sex with men (MSM) in Nigeria: A pilot programme using key opinion leaders to reach MSM.

INTRODUCTION: HIV self-testing (HIVST) offers an alternative to facility-based HIV testing services, particularly for populations such as men who have sex with men (MSM) who may fear accessing testing due to stigma, discrimination and criminalization. Innovative HIV testing approaches are needed to meet the goal of 90% of people living with HIV being diagnosed. This study piloted an intervention to distribute oral HIVST kits to MSM through key opinion leaders (KOLs) in Lagos, Nigeria and assessed the feasibility, acceptability, uptake of HIVST and linkage to HIV treatment. METHODS: A cohort study was conducted (May through September 2017) with 319 participants who were recruited by 12 KOLs through their networks. A baseline survey was conducted at the time of the oral HIVST kit (OraQuick® HIV antibody test) distribution to eligible MSM followed by a 3-month follow-up survey to assess usage of and experience with the HIVST kits. Each participant was given two kits. RESULTS: The median age of the participants was 25 years, 88.7% were literate and 17.9% were first-time testers. Of the 257 participants (80.7% retention) who completed the three-month follow-up interview, 97.7% reported using the HIVST kit and 14 (5.6%) self-reported an HIV positive result. A quarter (22.7%) tested themselves the same day they received the kit, and 49.4% tested within one week. Almost all participants reported that the HIVST kit instructions were easy or somewhat easy to understand (99.6%) and perform the test (98.0%). The most common reasons they liked the test were ease of use (87.3%), confidentiality/privacy (82.1%), convenience (74.1%) and absence of needle pricks (64.9%). All 14 participants who tested positive had sought confirmatory testing and initiated HIV treatment by the time of the three-month survey. CONCLUSIONS: HIVST distribution through KOLs was feasible and oral self-testing was highly acceptable among this urban MSM population. Despite concerns about linkage to treatment when implementing self-testing, this study showed that linkage to treatment can be achieved with active follow-up and access to a trusted MSM-friendly community clinic that offers HIV treatment. HIVST should be considered as an additional option to standard HIV testing models for MSM.

Challenges for the sexual health and social acceptance of men who have sex with men in Nigeria.

Little research exists regarding men who have sex with men and sexual risk in Nigeria. Prior to the implementation of a targeted HIV/STI prevalence study, structured focus groups incorporating anonymous questionnaires were conducted with members of this population in secure locations in Nigeria. A purposive sample of men was recruited by word-of-mouth. Five focus groups were conducted with a total of 58 men. Mean age was 27 years (range 16-58); 60% had post-secondary education; 56% were employed full or part-time; 83% were Christian; 16% were Muslim; 66% self-identified as bisexual; 31% as homosexual. Participants' experiences were diverse, with ethnic, religious and class distinctions strongly structuring sexual expression. Same-sex community networks were hidden, with social activities taking place in non-commercial, private venues. Socially ostracized by culture, religion, and political will, the risks embodied within same-sex activity are high. For Nigeria--a nation culturally rich and religiously devout--the implications for public health policy are complex. However, these research findings suggest that immediate action is vital to mitigate the impacts of HIV and other STIs.