Correlates of antiretroviral coverage for prevention of mother-to-child transmission of HIV in sub-Saharan Africa.

Antiretroviral (ARV) drugs are effective in the prevention of mother-to-child transmission of HIV (PMTCT), however many sub-Saharan African countries are yet to achieve universal ARV coverage among pregnant women living with HIV. This study examined factors associated with ARV coverage for PMTCT in 41 sub-Saharan Africa countries. Country-level aggregated data were obtained from the Joint United Nations Programme on HIV/AIDS, World Health Organization, and United Nations Children's Fund. Using Spearman's rho and point-biserial correlation, we conducted bivariate analyses between ARV coverage for PMTCT and the following variables: stigma, antenatal care (ANC) uptake, institutional delivery, community delivery of ARV drugs, number of HIV testing and counselling (HTC) facilities, and density of skilled health workers. We also performed a multivariate median regression with the significant correlates. P < .05 was considered statistically significant for all the tests. The median ARV coverage for PMTCT was 76% (IQR: 55-85%). ARV coverage for PMTCT was significantly associated with HTC facilities (r = 0.46, p = .004), institutional delivery (r = 0.48, p = .002), ANC uptake: at least one visit (r = 0.54, p = .001), and stigma (r=-0.52, p = .003). In the multivariate analysis, only stigma remained statistically significant (ß = -0.6, 95% CI = -1.13, -0.07, p = .03). To eliminate perinatal transmission of HIV in sub-Saharan Africa, interventions that will address stigma-related barriers to uptake of PMTCT services are needed. More research on country-specific population-level correlates of ARV coverage for PMTCT is recommended.

Immune response to hepatitis B vaccine among children under 5 years in Africa: a meta-analysis.

BACKGROUND: Hepatitis B virus (HBV) infection in Africa is mostly acquired before the age of 5 years through vertical or horizontal routes. While all the countries in the World Health Organization African region have introduced HBV vaccination into their national immunization programs, the rate of protective immune response to HBV vaccine among children in Africa has not been systematically synthesized. In this study, we estimated the HBV vaccine seroprotection rate (defined as anti-HBs titer ≥ 10 IU/L) and the associated factors among under-five children who completed a primary series of HBV vaccination in Africa. METHODS: We systematically searched PubMed, Web Science, and Scopus databases from inception to May 2022 for potentially eligible studies. The pooled seroprotection rate was estimated using a random-effects model with Freeman-Tukey double arcsine transformation and the associated factors were examined using odds ratio estimated by the DerSimonian and Laird method. RESULTS: From the 1063 records identified, 29 studies with a total sample size of 9167 under-five children were included in the meta-analysis. The pooled seroprotection rate was 89.23% (95% CI 85.68-92.33%, I2 = 95.96%, p < 0.001). In the subgroup analyses, there was a significant difference in the rate by the assay method, vaccine dose, and vaccine combination. HIV-positive children had lower odds of achieving seroprotection when compared with HIV-negative children (OR = 0.22, 95%CI 0.12-0.40). CONCLUSIONS: The majority of under-five children in Africa achieved seroprotection after completing three or four doses of HBV vaccine. However, the rate was lower among children living with HIV. This calls for interventions to timely identify and address nonresponse to HBV vaccine, particularly among immunosuppressed children.

Barriers to hepatitis B virus screening of pregnant women in primary healthcare centers in Nigeria: health workers' perspective.

BACKGROUND: Hepatitis B virus (HBV) screening is an important component of antenatal care for pregnant women in Nigeria. However, the screening rates remain low, particularly at primary healthcare centers (PHCs). The objective of this study was to identify the barriers affecting antenatal HBV screening in PHCs in Nigeria from the perspective of health workers. METHODS: We conducted a survey among 30 health workers from 30 PHCs (one per PHC) across three states (Akwa Ibom, Anambra, and Kaduna) in Nigeria. An open-ended questionnaire was used to obtain written responses on the perceived barriers limiting antenatal HBV screening in PHCs and their recommended solutions to the identified barriers. The data were analyzed using an inductive thematic approach. RESULTS: The perceived barriers exist at patient, provider and health system levels. They included: lack of test kits, unaffordability of HBV test, shortage of trained personnel, poor awareness among pregnant women, knowledge of HBV among health workers, high cost of antiviral treatment, and unavailability of HBV vaccine. The recommended solutions to the identified barriers were: making test kits and vaccines available and free, creating awareness about HBV, and capacity-building interventions for health workers. CONCLUSIONS: HBV screening of pregnant women attending PHCs in Nigeria appears to be affected by multilevel barriers. As the country continues to work towards eliminating HBV, these highlighted barriers at the patient, provider and health system levels must be addressed through effective and sustainable interventions.

The coverage of hepatitis B birth dose vaccination in Nigeria: Does the place of delivery matter?

BACKGROUND: Hepatitis B birth dose (HepB-BD) vaccination coverage remains suboptimal in Nigeria. While evidence suggests that institutional delivery is associated with the uptake of HepB-BD vaccine, little is known about how the uptake differs by facility ownership (public or private). This study examined the HepB-BD vaccination coverage by place of delivery in Nigeria. METHODS: This study is a secondary analysis of data on 6143 children aged 12-23 mo obtained from the 2018 Nigeria Demographic and Health Survey. We assessed the association between HepB-BD vaccination and the place of delivery using logistic regression models. RESULTS: About 53% of the children received the HepB-BD vaccine. Approximately 77, 83 and 33% of those delivered at a public health facility, private health facility and at home received the HepB-BD vaccine, respectively. After controlling for child- and maternal-level factors, the odds of receiving HepB-BD vaccine were significantly lower in children delivered at a private health facility (adjusted OR [aOR]=0.77, 95% CI 0.59 to 0.99) or at home (aOR=0.48, 95% CI 0.36 to 0.63). Wealth index and region of residence were significantly associated with the receipt of HepB-BD vaccination in all three places of delivery. CONCLUSIONS: Children are less likely to receive the HepB-BD vaccine if they are delivered at a private health facility or at home. There is a need for private health sector engagement for immunization service delivery and innovative community-based interventions to reach the children delivered at home.

A systematic review and meta-analysis of the prevalence of hepatitis B virus infection among pregnant women in Nigeria.

BACKGROUND: Nigeria has a high burden of hepatitis B virus (HBV) infection, commonly acquired through vertical transmission. However, there is a lack of an efficient surveillance system for monitoring and understanding the epidemiology of HBV among pregnant women. Building on a previous review on the prevalence of HBV in Nigeria (2000-2013), we conducted a systematic review and meta-analysis of HBV prevalence among pregnant women in Nigeria. METHODS: Four electronic databases PubMed, Embase, Global Health, and Scopus were systematically searched from January 2014 to February 2021. We also searched the African Journal Online and manually scanned the reference lists of the identified studies for potentially eligible articles. Observational studies that reported the prevalence of HBsAg and/or HBeAg among pregnant women in peer-reviewed journals were included in the study. We performed a meta-analysis using a random-effects model. We defined HBV infection as a positive test to HBsAg. RESULTS: From the 158 studies identified, 20 studies with a total sample size of 26, 548 were included in the meta-analysis. The pooled prevalence of HBV infection among pregnant women across the studies was 6.49% (95% confidence interval [CI] = 4.75-8.46%; I2 = 96.7%, p = 0.001; n = 20). The prevalence of HBV was significantly lower among pregnant women with at least secondary education compared with those with no education or primary education (prevalence ratio = 0.7, 95% CI = 0.58-0.87; n = 10). However, the prevalence of HBV was not significantly different by age, religion, marital status, or tribe. The prevalence of HBV was not significantly different among pregnant women with previous surgery, blood transfusion, multiple lifetime sex partners, tribal marks, tattoos, scarification, or sexually transmitted infections, compared with those without these risk factors. From a total sample size of 128 (n = 7), the pooled prevalence of HBeAg among HBV-infected pregnant women was 14.59% (95% CI = 4.58-27.99%; I2 = 65.5%, p = 0.01). Subgroup analyses of HBV infection by study region and screening method, and meta-regression analysis of the study year, sample size, and quality rating were not statistically significant. CONCLUSIONS: There is an intermediate endemicity of HBV infection among pregnant women in Nigeria. Interventions, such as routine antenatal HBV screening, antiviral prophylaxis for eligible pregnant women, and infant HBV vaccination should be scaled up for the prevention of perinatal transmission of HBV infection in Nigeria.

Age-responsive human immunodeficiency virus target setting: an opportunity to improve health outcomes among males in Sub-Saharan Africa.

While there has been some progress in expanding human immunodeficiency virus (HIV) services for females, HIV prevention and treatment coverage among males remain poor. The widening disparity between males and females has garnered little attention- a cause for concern. In this article, we highlight the need to reach more males with HIV services and the importance of disaggregated data to identify age- and gender-specific gaps in HIV service delivery.

Factors associated with skilled attendants at birth among married adolescent girls in Nigeria: evidence from the Multiple Indicator Cluster Survey, 2016/2017.

BACKGROUND: This study examines the factors associated with skilled birth attendants at delivery among married adolescent girls in Nigeria. METHODS: The study was a secondary data analysis of the fifth round of the Multiple Indicator Cluster Survey conducted between September 2016 and January 2017. Married adolescent girls aged 15-19 y who had live births in the last 2 y preceding the survey were included in the analysis. We performed univariate and multivariate logistic regression analyses with a skilled birth attendant (doctor, nurse or midwife) at delivery as the outcome variable and sociodemographic, male partner- and maternal health-related factors as explanatory variables. RESULTS: Of the 789 married adolescent girls, 387 (27% [95% CI=22.8-30.7]) had a skilled birth attendant at delivery. In the adjusted model, adolescent girls who were aged ≥18 y (ref: <18 y), primiparous (ref: multiparous), had antenatal care (ANC) provided by skilled healthcare providers (ref: no ANC), belonged to at least the poor and middle wealth index quintiles (ref: poorest), and resided in the south west zone (ref: north central), independently had a significantly higher likelihood of having a skilled birth attendant at delivery. CONCLUSIONS: Interventions that will reduce pregnancy in younger adolescent girls, poverty, and increase ANC provided by skilled attendants, are likely to improve deliveries assisted by skilled birth attendants among married adolescent girls in Nigeria.