Impact of conditional economic incentives and motivational interviewing on health outcomes of adolescents living with HIV in Anambra State, Nigeria: A cluster-randomised trial.

Background: Adolescents living with HIV (ALHIV) have had worse outcomes compared to adults. They face enormous difficulty in accessing HIV care services. We hypothesize that conditional economic incentives (CEI) and motivational interviewing could increase retention in care, medication adherence and ultimately viral load suppression. Therefore, we evaluated the one-year impact of conditional economic incentives and motivational interviewing on the health outcomes of ALHIV in Anambra State, Nigeria. Methods: Using a cluster-randomised design, we examined the one-year (from December 1, 2018, to November 30, 2019), individual-level impact of an Incentive Scheme comprising conditional economic incentives and motivational interviewing on achieving undetectable viral load (primary outcome), CD4+ count, adherence to antiretroviral therapy and retention in care (secondary outcomes) by ALHIV in Anambra State, Nigeria. Twelve HIV treatment hospitals were stratified according to the type of clinic (secondary or tertiary) and randomly assigned to the intervention arm or control arm to receive the Incentive Scheme or routine care, respectively. ALHIV aged 10-19 years, initiated into HIV care for a minimum of 6 months, and who adhered poorly to medications (<100% adherence rate) were eligible for the study. Participants in the intervention arm received motivational interviewing at the study baseline and every visit. They also received US$5.6 when HIV viral load (VL) was <20 copies/mL at month 3, US$2.8 if the VL remained suppressed at months 6 and 9, and US$5.6 if the VL remained <20 copies/mL at month 12. Results: Of the 246 trial participants, 119 were in the intervention while 127 were in the control arm. There was no difference in the baseline characteristics of the participants between the intervention and control arm except for the number of participants with undetectable viral load and the number of participants with ≥95% adherence. Although participants in the intervention arm had a 10.1% increase while those in the control arm had a 1.6% decrease in proportion with undetectable viral load (≤20 copies/ml) after 12 months, the change in the primary outcome was not statistically significant. Similarly, the differences in the secondary outcomes were not statistically significant. Conclusion: The Incentive Scheme did not improve the virologic outcome of ALHIV after 12 months. Differences in the secondary outcomes after 12 months were also not significantly different from the baseline. Trial registration: We registered the trial retrospectively with The Pan African Clinical Trials Registry: https://pactr.samrc.ac.za/(PACTR201806003040425) on 2/2/2018.

Cost-effectiveness and feasibility of conditional economic incentives and motivational interviewing to improve HIV health outcomes of adolescents living with HIV in Anambra State, Nigeria.

BACKGROUND: In sub-Saharan Africa, there is increasing mortality and morbidity of adolescents due to poor linkage, retention in HIV care and adherence to antiretroviral therapy (ART). This is a result of limited adolescent-centred service delivery interventions. This cost-effectiveness and feasibility study were piggybacked on a cluster-randomized trial that assessed the impact of an adolescent-centred service delivery intervention. The service delivery intervention examined the impact of an incentive scheme consisting of conditional economic incentives and motivational interviewing on the health outcomes of adolescents living with HIV in Nigeria. METHOD: A cost-effectiveness analysis from the healthcare provider's perspective was performed to assess the cost per additional patient achieving undetected viral load through the proposed intervention. The cost-effectiveness of the incentive scheme over routine care was estimated using the incremental cost-effectiveness ratio (ICER), expressed as cost/patient who achieved an undetectable viral load. We performed a univariate sensitivity analysis to examine the effect of key parameters on the ICER. An in-depth interview was conducted on the healthcare personnel in the intervention arm to explore the feasibility of implementing the service delivery intervention in HIV treatment hospitals in Nigeria. RESULT: The ICER of the Incentive Scheme intervention compared to routine care was US$1419 per additional patient with undetectable viral load. Going by the cost-effectiveness threshold of US$1137 per quality-adjusted life-years suggested by Woods et al., 2016, the intervention was not cost-effective. The sensitivity test showed that the intervention will be cost-effective if the frequency of CD4 count and viral load tests are reduced from quarterly to triannually. Healthcare professionals reported that patients' acceptance of the intervention was very high. CONCLUSION: The conditional economic incentives and motivational interviewing was not cost-effective, but can become cost-effective if the frequency of HIV quality of life indicator tests are performed 1-3 times per annum. Patients' acceptance of the intervention was very high. However, healthcare professionals believed that sustaining the intervention may be difficult unless factors such as government commitment and healthcare provider diligence are duly addressed. TRIAL REGISTRATION: This trial is registered in the WHO International Clinical Trials Registry through the WHO International Registry Network ( PACTR201806003040425 ).

Biochemical changes in tuberculosis.

INTRODUCTION: tuberculosis (TB) remains a global health issue with high morbidity and mortality rates especially in the developing countries. It is a multi-organ disease and can influence biochemical changes. This study sought to determine the influence of tuberculosis and its drug treatment on serum biochemical parameters in patients in Nigeria. METHODS: it was a descriptive observational cohort study on 150 subjects whose blood samples were analyzed for serum albumin, serum sodium, and serum potassium. The subjects were grouped into 3: TB group= 50 new TB subjects not on treatment, F group= 50 TB subjects on treatment for 2/12 or more and C group= 50 non-TB control subjects. These biochemical variables were compared between the 3 groups. RESULTS: male/female ratio was 1: 1.5, mean age 37.1±0.92 years, and range 18-65 years. The differences in mean values of serum albumin, calcium and sodium between the three groups were significant (p<0.001), whereas that of serum potassium was not significant (p=0.056). Those patients with new case TB had a significantly lower serum sodium, serum albumin and serum calcium than the control group and those on treatment, p<0.001. There was significant positive correlation between serum albumin and serum calcium (r=0.0.420, p<0.001) as well as serum sodium (r=0.310, p<0.001) in the study population. Similarly, the correlation between serum calcium and serum sodium was positive and significant (r=0.200, p=0.014). In contrast, the correlation between serum potassium and serum albumin and that between serum potassium and serum calcium was not significant. CONCLUSION: tuberculosis with or without anti-tuberculous medications was associated with significant reduction in serum albumin, serum sodium and serum calcium in this study.

Pre-operative pulmonary assessment and risk factors for post-operative pulmonary complications in elective abdominal surgery in Nigeria.

BACKGROUND AND OBJECTIVES: Post-operative pulmonary complications (PPCs) are recurring causes of rising morbidity and mortality in surgeries. This study sought to evaluate pre-operative risk factors for PPCs in abdominal surgerypatients in Nigeria. METHODOLOGY: This was a prospective study in patients booked for surgery in 2014. Biodata, medical his tory, pre-operative respiratory and cardiovascular examination findings, body mass index, serum albumin, serum urea, ventilatory function, chest x-rays and oxygen saturation were obtained. The association between pre-operative variables and PPCs was determined. RESULTS: The pre-operative spirometry was predominantly restrictive (62%). Overall, the prevalence of PPCs was 52%. This included non-productive cough (14%), isolated productive cough (10%), productive cough with abnormal chest finding (16%), pneumonia (8%), pleural effusion (5%), ARDS (2%). Percentage predicted FEV1 and FVC were lower in participants with PPCs. (p= 0.03 and p=0.01respectively). Pre-operative cough, shortness of breath and consolidation were associated with PPCs (p< 0.05). Post-operative respiratory rate and pulse rate in participants with PPCs were higher than the values in those without PPCs (p=0.03 and p=0.05). CONCLUSION: The prevalence of PPCs was high in this study. Pre-operative cough, shortness of breath, consolidation, abnormally low percentage predicted FEV1 and FVC were associated with PPCs.