Association of first-line combination antiretroviral therapy with malaria among adult HIV-infected persons in Jos, Nigeria: a pilot cross sectional study.

BACKGROUND: Malaria and human immunodeficiency virus (HIV) infection coexist in significant numbers in some geographic areas including sub-Sahara Africa (SSA). HIV-infected patients are a World Health Organization (WHO) recognized high risk group for increased malaria morbidity. Majority of HIV-infected patients undertaking treatment in SSA are on WHO recognized first-line combination antiretroviral therapy (cART). Considering the immunity-enhancing capacity of antiretroviral therapies on people living with HIV, this study aimed to explore the association between first-line combination antiretroviral therapy (cART) with malaria parasitaemia and antigenaemia in adult HIV-infected persons and to determine the predictors of malaria antigenaemia in adult persons living with HIV. METHODS: The study was conducted at the AIDS Prevention Initiative in Nigeria (APIN) Centre, Jos University Teaching Hospital, Jos, Plateau State, from August 2018 to February 2019. Epi Info statistical tool was used to determine the sample size and power of the study. The study population consisted of three groups. The first group comprised first-line cART-experienced adult HIV-seropositive subjects, the second group comprised ARV-naïve HIV-seropositive adults and the third group comprised HIV-seronegative adults. For this pilot study, 60 persons were recruited into each group via convenience sampling. Malaria rapid diagnostic test (RDT) was performed according to manufacturer's instruction for all the study participants using SD Bioline Malaria Ag P.f (HRP2/pLDH) (Standard Diagnostics, Hagal-Dong, Korea). All the study participants also had thick and thin blood film malaria microscopy. Data collected was processed and analyzed using the Stata statistical software version 15 (StataCorp, College Station, Texas). Chi square was used to test the association between malaria and first-line cART exposure. Univariate and multivariate analysis were also done to identify factors that were independently associated with malaria antigenaemia. RESULTS: A total of 180 persons participated in the study and involved 60 participants recruited in each of the three study groups. Overall, the predominant study participants were females (56.67%), traders (27.78%), secondary school leavers (43.33%) and urban dwellers (88.89%). Their mean age and standard deviation was 37.07 ± 11.53 years. Using malaria microscopy, the prevalence of malaria parasitaemia in ARV-naïve HIV-infected persons was 5% and 0% in the first-line cART-experienced HIV-infected persons as well as the HIV-negative persons. Malaria RDT result was positive in 7/60 (11.67%) of the first-line cART experienced HIV-infected participants, 6/60 (10%) of the ARV-naïve HIV-infected group and 1/60 (1.67%) of the HIV-negative group. Of the seven positive malaria RDT results in those on first-line cART, five persons were receiving zidovudine/lamivudine/nevirapine (AZT/3TC/NVP) while the remaining two were receiving tenofovir disoproxil fumarate/lamivudine/efavirenz (TDF/3TC/EFV), thus making an antigenaemia proportion of 16.67% and 6.67% respectively. Being an HIV-infected person on first-line cART (OR = 16.20, p = 0.04), having a headache (OR = 6.21, p = 0.03) and non-usage of window nets (OR = 3.74, p = 0.05) were found to be predictors of malaria antigenaemia. CONCLUSION: Malaria parasite burden in HIV-infected persons on first-line cART is lower than that observed in ARV-naïve HIV-infected persons. Our study suggests that TDF/3TC/EFV may be associated with lower malaria antigenaemia when compared with AZT/3TC/NVP and can be considered an alternative first-line antiretroviral regimen in malaria-endemic regions.

Incident Kaposi sarcoma during the expansion of antiretroviral therapy eligibility in Nigeria: a retrospective cohort study.

INTRODUCTION: The expansion of antiretroviral therapy (ART) eligibility could lead to earlier initiation of Human Immunodeficiency Virus (HIV) treatment and consequently reduce the risk of HIV-associated Kaposi Sarcoma (KS). We investigated the impact of changes in the Nigerian HIV treatment guidelines on KS incidence among adults enrolled in HIV care in Nigeria. METHODS: We analyzed data of adults who enrolled for HIV care from January 2006 to December 2016 at one of Nigeria's largest HIV treatment centers. Based on changes in HIV treatment guidelines, we classified 2006-2009 as the pre-expansion period and 2010-2016 as the post-expansion period. We used Kaplan Meier curves to compare the incidence of KS in the pre-expansion to the post-expansion period. We used Cox regression models to assess the hazard for incident KS between the two periods after adjusting for potential confounders. RESULTS: Among 14,479 patients with HIV, the overall KS incidence was 2.35; 95% CI 2.01-2.74/1,000 person-years. The incidence of KS decreased from 2.53 to 1.58 per 1,000 person-years from 2006 to 2009 to 2010-2016. In models adjusting for age, sex, CD4-T cell count, and ART use, the risk for KS remained lower in 2010-2016 compared to 2006-2009. In analyses restricted to time on ART, there was no significant difference in KS incidence between HIV patients who enrolled in 2006-2009 and 2010-2016 after adjusting for age, sex, and CD4 T-cell count. CONCLUSION: The expansion of ART eligibility was associated with a reduced incidence of HIV-associated KS among adults initiating HIV care in Jos, Nigeria. The reduction was likely driven by earlier enrollment for HIV care and ART initiation.

COVID-19 Subclinical Infection and Immunity: A Review.

The aetiologic agent of COVID-19 is a novel coronavirus, SARS-CoV-2. Like other coronaviruses, it generally induces enteric and respiratory diseases in animals and humans. COVID-19 may be subclinical, and symptomatic, ranging from mild-to-severe disease. The spectrum of presentation is the result of several factors ranging from the inoculum size, inherent host susceptibility, possible cross-reacting circulating antibodies. Subclinical viral infections are associated with widespread community transmission and in some cases like Polio, herd immunity. An understanding of the biology and immune behavior in subclinical coronavirus disease 2019 (COVID-19) might be useful in the quest for vaccine development as well as the current control efforts against the COVID-19 pandemic. We carried out a narrative review of the available literature on the biology, etiopathogenesis, clinical manifestation of SARS-CoV-2 viral infection, focusing on our current understanding of the disease mechanisms and its clinical manifestation, and the host immune response to the infection. We also highlighted some of the research gaps regarding subclinical infection in COVID-19 and its potential application for vaccine development and other preventive efforts toward containing the current COVID-19 pandemic.

At-birth vaccination timeliness: An analysis of inborns in the highlands of Jos, North-Central Nigeria.

INTRODUCTION: Immunisation and vaccination programmes are preventive and cost-effective child health interventions for reducing childhood mortality and disability from infectious diseases. Timely administration of these vaccines is important to ensure their effectiveness in disease prevention. AIM: The aim was to determine the timeliness, barriers and predictors of at-birth vaccinations. MATERIALS AND METHODS: This was a cross-sectional study of 355 mother-newborn pairs using simple random sampling technique by balloting. SPSS version 23.0 was used for data analysis. Crude and adjusted odds ratios (AORs) were used as point estimates in the binary logistic regression model, while 95% confidence interval (CI) was used as the interval estimate. A P < 0.05 was considered statistically significant for the study. RESULTS: The mean age of the mothers was 31.0 ± 6 years. The median age of newborns at vaccination was 18 h (IQR = 1 - 17) h. About 185 (52.1%) of the newborns studied were males. Only 191 (53.8%) newborns received at-birth vaccination within 24 h of life. Weekend delivery, birth outside vaccination days, delivery during public holidays and vaccine stock-outs were barriers to timely vaccinations. Private hospital delivery was an independent predictor of delayed at-birth vaccinations (AOR = 2.616; 95% CI = 1.382-4.951). CONCLUSIONS: Our study has identified weekend delivery, preterm birth, delivery outside vaccination days and vaccines stock-outs as barriers to timely at-birth vaccinations. Private hospital delivery is a significant predictor of delayed at-birth vaccinations.

Head Circumference of Babies at Birth in Nigeria.

BACKGROUND AND OBJECTIVES: Measuring head circumference (HC) of newborns is an important tool for evaluating intra-uterine brain development. HC reference charts currently in use in Nigeria are not representative of the local population. We thus present locally derived HC reference data for Nigerian infants at birth. SUBJECTS AND METHODS: We reviewed birth records of all infants at the Jos University Teaching Hospital (JUTH) over a 10 year period from January 2006. JUTH is a tertiary care center offering obstetric services to a large population of women in Jos and its environs. All births with gestational age between 28 and 42 weeks were included in the study. STATA version 14 was used to calculate gestational age associated HC percentile measurements. RESULTS: We included 18 282 babies to generate the reference values. The mean HC value was 34.4 ± 2.1 cm (M = 34.6 ± 2.16 cm, F = 34.1 ± 2.02 cm, p < 0.001). Our HC reference values significantly differ from the USA and INTERGROWTH-21 charts currently in use in our country. Mean HC was higher in male infants compared with female infants. This difference was uniformly so across all gestational age groups. CONCLUSIONS: The use of our locally derived HC reference values could be more appropriate in defining normal head growth in Nigerian infant populations thereby improving newborn care.

Pathogenesis, diagnostic challenges and treatment of zika virus disease in resource-limited settings.

The association of Zika virus (ZIKV) infection with congenital malformation and neurological sequelae has brought significant global concern. Consequently, the World Health Organization (WHO) declared it "a public health emergency of International concern" on 1 February, 2016. A critical review of its pathogenesis would lead to a better understanding of the clinical features and the neurological complications. This review is based on literature search in PubMed/Medline, Google Scholar and the WHO, http://www.who.int. This include all relevant articles written in English published through June 2018, with subject heading and keywords such as Zika, ZIKV, Zika pathogenesis, diagnosis of Zika, Zika Nigeria, Zika Africa and Zika resource-limited settings. Following ZIKV infection, viraemia ensues targeting primarily the monocytes for both the Asian and African strains. ZIKV infection by an African strain appears to be more pathogenic, in early pregnancy tends to result in spontaneous abortion. Whereas an Asian strain tends to be less pathogenic and more chronic, this allows the pregnancy to continue, ultimately resulting in congenital malformations. There is no routine laboratory diagnosis of ZIKV infection in resource-constrained countries. Serologic tests should be interpreted with caution since there can be cross-reactivity with other flaviviruses, especially in Africa where the burden of infection with flaviviruses is comparatively high. There is a paucity of well-equipped laboratories for comprehensive ZIKV diagnosis. It is imperative to strengthen the health systems, improve health workforce and diagnostic capacity of such settings.

The Importance of Lassa Fever and Its Disease Management in West Africa.

Lassa virus (LASV) is a zoonotic pathogen endemic throughout western Africa and is responsible for a human disease known as Lassa fever (LF). Historically, LASV has been emphasized as one of the greatest public health threats in West Africa, with up to 300,000 cases and 5000 associated deaths per year. This, and the fact that the disease has been reported in travelers, has driven a rapid production of various vaccine candidates. Several of these vaccines are currently in clinical development, despite limitations in understanding the immune response to infection. Alarmingly, the host immune response has been implicated in the induction of sensorineural hearing loss in LF survivors, legitimately raising safety questions about any future vaccines as well as efficacy in preventing potential hearing loss. The objective of this article is to revisit the importance and prevalence of LF in West Africa, with focus on Nigeria, and discuss current therapeutic approaches and ongoing vaccine development. In addition, we aim to emphasize the need for more scientific studies relating to LF-associated hearing loss, and to promote critical discussion about potential risks and benefits of vaccinating the population in endemic regions of West Africa.

Using one health training for interprofessional team building: implications for research, policy, and practice in Nigeria.

In recent years, the concept of One Health (OH) has arisen as an approach that helps to catalyze the creation of transdisciplinary teams needed for surveillance and investigation of emerging disease dynamics. Besides a wealth of descriptions of what the OH approach encompasses, a dearth of information is available regarding the training of individuals in OH competencies. In 2019, the Nigerian Center for Disease Control developed an OH strategic plan to meet the country's human, animal, and environmental health challenges. In response to the demand for clinicians, scientists, climatologists, conservationists, and environmentalists, who have expertise in environment, human, plant, and animal health to work collaboratively in addressing OH challenges in Nigeria. An interprofessional group of faculty from the University of Texas Medical Branch, the University of Jos, and the National Veterinary Research Institute convened to develop a novel OH course 'entitled 'One Health for Translational Team Science. The objective of the course was to explore the evolution of an emerging epidemic, capitalizing on various learning environments, including animal, environmental, human, and public health perspectives. The 6-week course comprised of three parts: 2-weeks virtual part of case-based group discussions focusing on animal and environmental aspects, 2 weeks of individual field experiences, and a final virtual part focusing on human health. Pedagogical tools used were: case-based group discussions, breakout group presentations, role-play activities, field project write-up, peer evaluation, group writing assignments, and weekly reflections with the goal of working in teams to develop and practice the fundamental leadership and management skills in addressing emerging public health challenges. Post-course evaluations showed that all participants felt more confident identifying and practicing the necessary attitudes and skills to participate effectively in the evaluation of an outbreak. Furthermore, the roles, responsibilities, and "One Health ways of thinking" for the various disciplines and professions involved in improving global health were articulated and identified.

Double stigma: a cross-sectional study of Lassa patients with hearing loss in North Central Nigeria.

Introduction: Lassa fever is a zoonotic infectious disease endemic in West Africa with a high case-fatality rate and reported stigmatization of surviving patients. This study examines discrimination among survivors of Lassa fever (LF) complicated by hearing loss (HL). Methods: This cross-sectional qualitative study used an in-depth interview guide to collect information from patients with HL about their experience of stigma. Interviews were conducted by a trained team of interviewers at the Jos University Teaching Hospital between January and April 2022 in Hausa language after informed consent was obtained. Recordings of the interviews were transcribed and translated from Hausa to English. Data analysis was conducted using NVivo software using a thematic framework approach. Results: Most (73%) respondents were male (n = 11); 27% were female (n = 4). The median age was 35 years (interquartile range, 16.5). Some Lassa fever patients experienced stigma and discrimination (53%) including isolation and withdrawal of family and community support during and after illness. HL increased stigma, as some patients were labeled "deaf" by other community members, increasing perceived stigma and devaluation. HL affected the socio-economic wellbeing of some who could not communicate well with their families and customers and constrained social interactions, evoking pain and apathy. Some survivors of LF and victims of its sequelae of HL experienced double stigmatization. While they were ill with LF, a third of respondents reported avoidance and isolation by family and community members who withdrew care and support both to them and their close family members. These forms of stigmatization strained their relationships. Conclusion: There is a need to address stigma in LF survivors who develop HL through concerted community-owned awareness to improve their quality of life along with a robust social support system to aid prevention.

Obesity Defining Criteria, and Association with Cardiovascular Disease Risk Factors Among People Living with HIV in Jos, Nigeria.

Background: Obesity is linked to non-communicable conditions. We looked at obesity using four definable criteria and their relationship to biochemical and inflammatory indicators of cardiovascular diseases (CVDs) in people living with HIV (PLHIV). Methodology: This cross-sectional study involved 140 randomly selected HIV-infected patients attending HIV clinics at the Jos University Teaching Hospital and Faith Alive Foundation in Jos, Nigeria. Anthropometric measurements such as height, weight, waist circumference, and hip circumference were taken to identify those with obesity. Fasting plasma glucose, lipid profile, High-sensitivity CRP (hsCRP), and HIV-related markers were evaluated. Result: The mean (SD) age of the participants was 42.5 (8.8) years, and the majority (71.4%) were females. The prevalence of Obesity based on Body-Mass-Index (BMI), International Diabetes Federation (IDF), Adult Treatment Panel (ATP), and Waist-Hip-Ratio (WHR) criteria were 18.6%, 50.7% 34.3%, and 45.7% respectively. Obesity concordance among the criteria for obesity was highest between IDF and ATP (Kappa= 0.673, p<0.001); and least between BMI vs WHR (Kappa= 0.124, p<0.073). Only 9.3% had obesity by all 4 criteria. BMI was independently associated with hypertension but not glycaemic status nor dyslipidaemia while Obesity by WHR was significantly associated with hypertension and dyslipidaemia, after adjusting for age and sex. There was no significant association between Obesity by all the criteria and HIV-related parameters such as duration of HIV infection, Antiretroviral (ARV) use, and CD4 counts (p>0.05). Conclusion: Our study urges a unified assessment of obesity and a more prominent use of parameters of central obesity, for assessing cardiovascular risk in PLHIV.

Performance evaluation of SARS-CoV-2 rapid diagnostic tests in Nigeria: A cross-sectional study.

The COVID-19 pandemic challenged health systems globally. Reverse transcription polymerase chain reaction (RT-PCR) is the gold standard for detecting the presence of SARS-CoV-2 in clinical samples. Rapid diagnostic test (RDT) kits for COVID-19 have been widely used in Nigeria. This has greatly improved test turnover rates and significantly decreased the high technical demands of RT-PCR. However, there is currently no nationally representative evaluation of the performance characteristics and reliability of these kits. This study assessed the sensitivity, specificity, and predictive values of ten RDT kits used for COVID-19 testing in Nigeria. This large multi-centred cross-sectional study was conducted across the 6 geo-political zones of Nigeria over four months. Ten antigen (Ag) and antibody (Ab) RDT kits were evaluated, and the results were compared with RT-PCR. One thousand, three hundred and ten (1,310) consenting adults comprising 767 (58.5%) males and 543 (41.5%) females participated in the study. The highest proportion, 757 (57.7%), were in the 20-39 years' age group. In terms of diagnostic performance, Lumira Dx (61.4, 95% CI: 52.4-69.9) had the highest sensitivity while MP SARS and Panbio (98.5, 95% CI: 96.6-99.5) had the highest specificity. For predictive values, Panbio (90.7, 95% CI: 79.7-96.9) and Lumira Dx (81.2, 95% CI: 75.9-85.7) recorded the highest PPV and NPV respectively. Ag-RDTs had better performance characteristics compared with Ab-RDTs; however, the sensitivities of all RDTs in this study were generally low. The relatively high specificity of Ag-RDTs makes them useful for the diagnosis of infection in COVID-19 suspected cases where positive RDT may not require confirmation by molecular testing. There is therefore the need to develop RDTs in-country that will take into consideration the unique environmental factors, interactions with other infectious agents, and strains of the virus circulating locally. This may enhance the precision of rapid and accurate diagnosis of COVID-19 in Nigeria.

Metabolic Syndrome in HIV: Prevalence, correlates, concordance of Diagnostic Criteria and relationship to Carotid Intimal Media Thickness in a Sub-Saharan Population.

Background: The prevalence and usefulness of MetS in determining CVD risk in at-risk populations are influenced by its definition. In a cohort of HIV-positive Nigerians, we evaluated MetS based on various defining criteria, their agreement with one another, and their association to a CVD endpoint, Carotid-Intimal-Media-Thickness (CIMT). Methodology: In this cross-sectional study, 145 HIV-positive individuals who were enrolled in HIV clinics at the Faith Alive Foundation and Jos University Teaching Hospital in Jos, Nigeria, were randomly chosen. Biophysical and anthropometric measurements including blood pressure, height, weight, waist circumference, and hip-circumference, as well as clinical records, CIMT, fasting plasma glucose, and lipid profile, were assessed. Result: The median (Interquartile range) age of the participants was 41 (35-88) years, and the majority (71.7%) were females. The prevalence of metabolic syndrome (MetS) by the Adult Treatment Panel-III (ATP), International Diabetes Federation (IDF), and Joint Interim Statement (JIS) criteria were 30.3%, 32.4%, and 35.2% respectively. MetS by all criteria was more prevalent among females and participants ≥ 40 years, p<0.05. Low HDLc (93.6-95.5%), Central obesity (86.3-95.5%), and hypertension (80.9-86.4%) were the most frequent components of MetS. HIV-related parameters were not associated with MetS. The overall agreement among MetS criteria was almost perfect between IDF and JIS criteria (k=0.94); and strong between IDF vs., ATP (k=0.82) and ATP vs. JIS (k=0.89). There was no significant difference in the median CIMT in PLHIV with and without MetS across all defining criteria. Conclusion: The prevalence of MetS in PLHIV is relatively high, particularly among females and older individuals. The correlations between the defining criteria were fairly strong and consistent across subpopulations of PLHIV. MetS based on these criteria, however, do not significantly correlate with rising CIMT.

Clinical profile and Predictors of Outcomes of Hospitalized Patients with Laboratory-Confirmed Severe Acute Respiratory Syndrome Coronavirus 2 in Nigeria: A Retrospective Analysis of 13 High Burden States in Nigeria.

Background: The majority of global COVID deaths have occurred in developed countries. Not much is known about the clinical outcomes for the patients admitted with COVID in Nigeria. We thus described the clinical characteristics, outcomes, and predictors of outcomes of hospitalized Nigerian COVID-19 patients. Methodology: We performed multilevel and mixed effects regression, Kaplan-Meir survival, and Cox proportionate hazards analyses to evaluate factors associated with death in patients admitted for COVID-19 in 13 high-burden states of Nigeria between 25th February 2020 and 30th August 2021. Results: Of the 3462 patients (median age, 40 years (interquartile range 28 years 54 years), 2,990(60.6%) were male and, 213(6.15%) of them died while on admission. Male sex (adjusted odds ratio [aOR], 1.78 [95% confidence interval {CI}, 1.23-2.56]), age group 45-65 years (OR, 3.93 [95% CI, 1.29-12.02]), age group 66-75 years (aOR, 5.37 [95% CI, 1.68-17.14]), age group > 75 years (aOR, 6.81 [95% CI, 2.04-22.82]), chronic cardiac disease (aOR, 3.07 [95% CI, 1.20-7.86]), being diabetic (aOR, 2.16 [95% CI, 1.41-3.31]), and having chronic kidney disease (OR, 11.01 [95% CI, 2.74-44.24]),were strongly associated with increased odds of death. Having concurrent malaria (aOR, 0.45 [95% CI, 0.16-1.28]), use of Azithromycin for treatment (aOR, 0.33 [95% CI, 0.19-0.54]), and use of Chloroquine/Hydroxychloroquine for treatment (aOR, 0.07 [95% CI, 0.03-0.14]) were significantly associated with decreased odds of death. Conclusions: The cumulative probability of death of male patients, diabetics, hypertensives, and patients with CKD was higher than that of female patients and those without those comorbidities while concurrent malaria and use of chloroquine/hydroxychloroquine in the treatment regimen were associated with a decreased risk of dying in patients treated in our isolation centers.

Analysis of sensorineural hearing loss in patients attending an otolaryngology clinic in North Central Nigeria.

Hearing loss is the third leading cause of years lived with disability. Approximately 1.4 billion people have hearing loss, of which 80% reside in low- and middle-income countries with limited audiology and otolaryngology care available to them. The objective of this study was to estimate period prevalence of hearing loss and audiogram patterns of patients attending an otolaryngology clinic in North Central Nigeria. A 10-year retrospective cohort study was carried out analyzing 1507 patient records of pure tone audiograms of patients at the otolaryngology clinic at Jos University Teaching Hospital, Plateau State, Nigeria. Prevalence of hearing loss of moderate or higher grade increased significantly and steadily after age 60. Compared to other studies, there was a higher prevalence of overall sensorineural hearing loss (24-28% in our study compared to 1.7-8.4% globally) and higher proportions of the flat audiogram configuration among the younger age patients (40% in younger patients compared to 20% in patients older than 60 years). The higher prevalence of the flat audiogram configuration compared to other parts of the world may be suggestive of an etiology specific to this region, such as the endemic Lassa Fever and Lassa virus infection in addition to cytomegalovirus or other viral infections associated with hearing loss.

A multicenter survey of asymptomatic cryptococcal antigenemia among patients with advanced HIV disease in Nigeria.

As of 2018, cryptococcal antigen (CrAg) screening in patients with advanced human immunodeficiency virus (HIV) disease (AHD) was not routinely implemented in Nigeria despite being recommended in the national HIV treatment guidelines. Our aim was to determine the prevalence and risk factors for asymptomatic cryptococcal antigenemia in adult people living with HIV (PLHIV) in Nigeria to advocate for the implementation of routine CrAg screening. A descriptive cross-sectional study and CrAg screening of consecutive adult PLHIV with CD4 counts ≤200 cells/µL was conducted from April 2018 to April 2019 at HIV clinics in eleven tertiary hospitals spread across Nigeria's six geopolitical regions. Prevalence of asymptomatic cryptococcal antigenemia was estimated by facility and geopolitical zone. Logistic regression was conducted to identify risk factors for cryptococcal antigenemia. In total, 1,114 patients with AHD were screened. The overall prevalence of asymptomatic cryptococcal antigenemia was 3.9% with wide variation across facilities (range: 0/75 [0%]- 15/122 [12.3%]) and geopolitical zones (range: 0/75 [0%]-19/279 [6.8%]). Prevalence of antigenemia was highest in the South-West (19/279 [6.8%]) and lowest in the North-East (0/75 [0%]). Prevalence was 5.2% (26/512) and 3.2% (18/561) in patients with CD4<100 and CD4 of 101-200, respectively. Of all patients with antigenemia, 50% were on antiretroviral therapy (ART) at the time of having a positive CrAg test. In adjusted analysis, cryptococcal antigenemia was significantly less in patients on ART and patients who had completed any formal education. The survey showed a high overall burden of cryptococcal antigenemia in Nigeria, with variable prevalence across geopolitical regions. We provided valuable evidence for implementing routine CrAg screening of AHD patients in Nigeria which has commenced in selected centres.

Epidemiological review of confirmed Lassa fever cases during 2016-2018, in Plateau State, North Central Nigeria.

Lassa fever (LF) is endemic in West Africa and constitutes a significant public health concern due to its potential for epidemics and associated high mortality. The first reported case and management of Lassa fever in Plateau State occurred more than 50 years ago. We set out to undertake a three-year epidemiological review of LF cases in Plateau State, North Central Nigeria. This is a retrospective study of all confirmed LF cases in Plateau State between 2016 and 2018. Plateau state Lassa fever- Line list and patient case records were used to extract relevant data. Lassa PCR was carried out at the NCDC accredited Laboratory network. Data analysis was done using STATA version SE14.1. Forty-four persons (44) had confirmed LF over the examined period, 18 (41%) in 2016, 15 (34%) in 2017 and 11 (25%) in 2018. The mean age was 29.7±14.6 years and 53% were males. Sixty-six percent (66%) of the patients resided in rural areas. It affected all local government areas (LGA) in the state except Pankshin, Jos East and Kanke LGAs. Twenty-five percent (25%) of the cases occurred among underprivileged communities of Jos North and another 25% in rural dwellers of Langtang North. Fifty-nine percent (59%) of cases occurred during the 1st quarter, 27% the 2nd quarter and 18% the 3rd quarter of the year. The case fatality rate was 57%. LF is endemic in Plateau State. Prevention strategies must be sustained year round and target the youth, urban and rural underprivileged communities. There is also need for case management improvement to reduce mortality.

Analyses of Kaposi Sarcoma trends among adults establishing initial outpatient HIV care in Nigeria: 2006-2017.

BACKGROUND: The incidence of Human Immunodeficiency Virus (HIV)-associated Kaposi Sarcoma (KS) in the pre-antiretroviral therapy (ART) population remains high in several countries in sub-Saharan Africa. We examined trends of KS prevalence in adults, establishing initial outpatient HIV care from 2006 to 2017 in Nigeria. METHODS: We analyzed data of 16,431 adults (age ≥ 18 years) enrolled for HIV care from January 1, 2006, to December 31, 2017, in a large clinic in Jos, Nigeria. KS at enrollment was defined as KS recorded in the electronic health record within 30 days of clinic enrollment. Time trends were compared among four periods: 2006-2008, 2009-2011, 2012-2014, and 2015-2017 using logistic regression models. Annual trends were analyzed using join point regression and restricted splines. RESULTS: The study population had a mean age 35.1 (standard deviation, SD 9.5) years, and were 65.7% female (n = 10,788). The mean CD4 cell count was 220 (95% CI 117-223). The overall KS prevalence at entry was 0.59% (95% CI 0.48-0.72). Compared to 2006-2008, KS prevalence was significantly higher in 2009-2011 (adjusted odds ratio 5.07 (95% CI 3.12-8.24), p < 0.001), but remained unchanged in subsequent periods. Male sex and low CD4 T-cell count independently increased odds for KS. CONCLUSIONS: Despite ART expansion, KS at enrollment showed no significant decline. The low CD4 cell count, across all periods, indicates delay in enrollment for HIV care, which increases KS risk. Interventions aimed at early HIV diagnosis and linkage to ART is critical to KS risk reduction in this population.

A standardised Phase III clinical trial framework to assess therapeutic interventions for Lassa fever.

BACKGROUND: Only one recommendation currently exists for the treatment of Lassa fever (LF), which is ribavirin administered in conjunction with supportive care. This recommendation is primarily based on evidence generated from a single clinical trial that was conducted more than 30 years ago-the methodology and results of which have recently come under scrutiny. The requirement for novel therapeutics and reassessment of ribavirin is therefore urgent. However, a significant amount of work now needs to be undertaken to ensure that future trials for LF can be conducted consistently and reliably to facilitate the efficient generation of evidence. METHODOLOGY: We convened a consultation group to establish the position of clinicians and researchers on the core components of future trials. A Core Eligibility Criteria (CEC), Core Case Definition (CCD), Core Outcome Set (COS) and Core Data Variables (CDV) were developed through the process of a multi-stakeholder consultation that took place using a modified-Delphi methodology. RESULTS: A consensus position was achieved for each aspect of the framework, which accounts for the inclusion of pregnant women and children in future LF clinical trials. The framework consists of 8 core criteria, as well as additional considerations for trial protocols. CONCLUSIONS: This project represents the first step towards delineating the clinical development pathway for new Lassa fever therapeutics, following a period of 40 years without advancement. Future planned projects will bolster the work initiated here to continue the advancement of LF clinical research through a regionally-centred, collaborative methodology, with the aim of delineating a clear pathway through which LF clinical trials can progress efficiently and ensure sustainable investments are made in research capacity at a regional level.

Sensorineural hearing loss (SNHL) as an adverse event following immunization (AEFI): Case definition & guidelines for data collection, analysis, and presentation of immunization safety data.

This is a Brighton Collaboration case definition of the term "Sensorineural Hearing Loss" to be utilized in the evaluation of adverse events following immunization. The case definition was developed by a group of experts convened by the Coalition for Epidemic Preparedness Innovations (CEPI) in the context of active development of vaccines for Lassa Fever and other emerging pathogens. The case definition format of the Brighton Collaboration was followed to develop a consensus definition and define levels of diagnostic certainty, after an exhaustive review of the literature and expert consultation. The document underwent peer review by the Brighton Collaboration Network.

Assessment of hand hygiene facilities and staff compliance in a large tertiary health care facility in northern Nigeria: a cross sectional study.

BACKGROUND: The burden of healthcare-associated infection (HAI) is 2 to 18 times higher in developing countries. However, few data are available regarding infection prevention and control (IPC) process indicators in these countries. We evaluated hand hygiene (HH) facilities and compliance amongst healthcare workers (HCW) in a 600-bed healthcare facility in Northcentral Nigeria providing tertiary care service for a catchment population of about 20 million. METHODS: An in-house facility assessment tool and the World Health Organization (WHO) direct observation method were used to assess the HH facilities and compliance, respectively. Factors associated with good compliance were determined by multivariate analysis. RESULTS: The facility survey was carried out in all 46 clinical units of the hospital. 72% of the units had no poster or written policy on HH; 87% did not have alcohol-based hand rubs; 98% had at least one handwash sink; 28% had flowing tap water all day while 72% utilized cup and bucket; and 58% had no hand drying facilities. A total of 406 HH opportunities were observed among 175 HCWs. The overall compliance was 31%, ranging from 18% among ward attendants to 82% among medical students. Based on WHO "5 moments" for HH, average compliance was 21% before patient contact, 23% before aseptic procedure, 63% after body fluid exposure risk, 41% after patient contact and 40% after contact with patients' surrounding. Being a medical student was independently associated with high HH compliance, adjusted odds ratio: 13.87 (1.70-112.88). CONCLUSIONS: Availability of HH facilities and HCW compliance in a large tertiary hospital in Nigeria is poor. Our findings confirm that HCWs seem more sensitized to their risk of exposure to potential pathogens than to the prevention of HAI cross-transmission. Inadequate HH facilities probably contributed to the poor compliance. Specific measures such as improved facilities, training and monitoring are needed to improve HH compliance.