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.

Isolated pulmonary metastases in pancreatic ductal adenocarcinoma: a review of current evidence.

Despite recent advances in cancer therapeutics, pancreatic ductal adenocarcinoma (PDAC) remains a lethal disease with a 5-year overall survival of only 10%. Since either at or within a few months of diagnosis, most patients with PDAC will present with metastatic disease, a more individualized approach to select patients who may benefit from more aggressive therapy has been suggested. Although studies have reported improved survival in PDAC and isolated pulmonary metastasis (ISP) compared to extrapulmonary metastases, such findings remain controversial. Furthermore, the added benefit of pulmonary metastasectomy and other lung-directed therapies remains unclear. In this review, we discuss the metastatic pattern of PDAC, evaluate the available evidence in the literature for improved survival in PDAC and ISP, evaluate the evidence for the added benefit of pulmonary metastasectomy and other lung-directed therapies, identify prognostic factors for survival, discuss the biological basis for the reported improved survival and identify areas for further research.

A Review of Community Awareness for Colorectal Cancer Screening and Prevention in North and Central Asian Countries.

OBJECTIVES: Colorectal cancer (CRC) incidence and mortality rates are increasing in low- and middle-income countries (LMIC), including North and Central Asian countries (NCAC). Screening and risk factor reduction can aid in the prevention of colorectal cancer, but communities lack awareness of these screening programs. The review assessed community awareness about CRC screening and prevention in NCAC to facilitate cancer control policies. Study type and methods: For this scoping review, we searched PubMed/Medline, Embase, and the Cochrane Library for articles on community awareness about CRC screening and prevention in NCAC according to inclusion and exclusion criteria. RESULTS: Eight of 677 articles from five of the 15 NCAC countries met the criteria. Most of the studies utilized a survey design. The results indicated low awareness of the availability of CRC screening and poor knowledge of CRC symptoms. Knowledge of CRC screening modalities was also inadequate. Some countries also lack CRC screening programs. CONCLUSION: Community unawareness is a significant barrier to screening program utilization and sustenance. Community health awareness programs (CHAP) are needed to improve the uptake of CRC screening in NCAC. The NCAC should include CHAP as an integral component of the CRC control plan. Long-term cancer control in LMIC could be adapted using the step-ladder pyramidal approach.

All-cause and in-hospital mortality after aspirin use in patients hospitalized with COVID-19: a systematic review and meta-analysis.

Background: With the results of the largest randomized controlled trial (RECOVERY) and the most extensive retrospective cohort study on coronavirus disease 2019 (COVID-19) recently published, we performed a meta-analysis on the association of aspirin with mortality of COVID-19. We aimed to investigate the role of aspirin in COVID-19 hospitalizations. Materials and Methods: We searched PubMed, EMBASE and Cochrane databases for studies from 1 January 2020 until 20 July 2022, that compared aspirin versus non-aspirin use in hospitalized COVID-19 patients. We excluded case reports, review articles and studies on non-hospitalized COVID-19 infections. We used the inverse variance method and random effects model to pool the individual studies. Results: Ten observational studies and one randomized controlled trial met the criteria for inclusion. There were 136 695 total patients, of which 27 168 were in the aspirin group and 109 527 were in the non-aspirin group. Aspirin use was associated with a 14% decrease in all-cause mortality compared with non-aspirin use in patients hospitalized with COVID-19 [relative risk (RR) 0.86, confidence interval (95% CI) 0.76-0.97; P = 0.002; I 2 =64%]. Among subgroups of studies reporting in-hospital mortality in COVID-19 hospitalizations, aspirin use was associated with a 16% decrease in in-hospital mortality compared with non-aspirin use (RR 0.84, 95% CI 0.71-0.99; P = 0.007; I 2 =64%). Conclusion: Our study shows that aspirin decreases in-hospital mortality in patients hospitalized with COVID-19. Further studies are needed to assess which COVID-19 patient populations benefit most, such as patients on aspirin for primary versus secondary prevention of atherosclerotic disease. In addition, significant bleeding also needs to be considered when assessing the risk-benefit of aspirin use.

The role of immunotherapy plus chemotherapy versus chemotherapy alone as first-line treatment for advanced non-small cell lung cancer: an updated systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Recently published randomized controlled trials (RCTs) showed improved overall survival (OS) and progression-free survival (PFS) with the combination of immunotherapy and chemotherapy as compared to chemotherapy alone in advanced non-small cell lung cancer (NSCLC). We aimed to provide a systematic review and meta-analysis of RCTs regarding the efficacy and safety of immunotherapy and chemotherapy combinations for advanced NSCLC. METHODS: On December 23rd, 2021, we searched databases for RCTs that reported PFS and OS as primary outcomes. RESULTS: We included 11 RCTs with 6,386 patients (3,850 in the combination therapy group and 2,536 in the chemotherapy group). Combination therapy was associated with an improvement in PFS (HR: 0.60; 95% CI: 0.54, 0.66; P < 0.00001) andOS (HR: 0.77; 95% CI: 0.68, 0.87; P ≤ 0.0001), compared to chemotherapy. There were no significant differences between both groups in terms of treatment-related adverse events (TRAEs) (RR: 1.07; 95% CI: 0.99, 1.16; P = 0.09). CONCLUSION: The combination of immunotherapy and chemotherapy as first-line treatment for advanced NSCLC significantly improved PFS and OS compared to chemotherapy alone without a significant increase in the overall TRAEs.

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.

mHealth Interventions for Treatment Adherence and Outcomes of Care for Cardiometabolic Disease Among Adults Living With HIV: Systematic Review.

BACKGROUND: The success of antiretroviral therapy has led to an increase in life expectancy and an associated rise in the risk of cardiometabolic diseases (CMDs) among people living with HIV. OBJECTIVE: Our aim was to conduct a systematic review to synthesize the existing literature on the patterns of use and effects of mobile health (mHealth) interventions for improving treatment adherence and outcomes of care for CMD among people living with HIV. METHODS: A systematic search of multiple databases, including PubMed-MEDLINE, Embase, CINAHL, Scopus, Web of Science, African Journals online, ClinicalTrials.gov, and the World Health Organization Global Index Medicus of peer-reviewed articles, was conducted with no date or language restrictions. Unpublished reports on mHealth interventions for treatment adherence and outcomes of care for CMD among adults living with HIV were also included in this review. Studies were included if they had at least 1 component that used an mHealth intervention to address treatment adherence or 1 or more of the stated outcomes of care for CMD among people living with HIV. RESULTS: Our search strategy yielded 1148 unique records. In total, 10 articles met the inclusion criteria and were included in this review. Of the 10 studies, only 4 had published results. The categories of mHealth interventions ranged from short messaging, telephone calls, and wearable devices to smartphone and desktop web-based mobile apps. Across the different categories of interventions, there were no clear patterns in terms of consistency in the use of a particular intervention, as most studies (9/10, 90%) assessed a combination of mHealth interventions. Short messaging and telephone calls were however the most common interventions. Half of the studies (5/10, 50%) reported on outcomes that were indirectly linked to CMD, and none of them provided reliable evidence for evaluating the effectiveness of mHealth interventions for treatment adherence and outcomes of care for CMD among people living with HIV. CONCLUSIONS: Due to the limited number of studies and the heterogeneity of interventions and outcome measures in the studies, no definitive conclusions could be drawn on the patterns of use and effects of mHealth interventions for treatment adherence and outcomes of care for CMD among people living with HIV. We therefore recommend that future trials should focus on standardized outcomes for CMD. We also suggest that future studies should consider having a longer follow-up period in order to determine the long-term effects of mHealth interventions on CMD outcomes for people living with HIV. TRIAL REGISTRATION: PROSPERO International Prospective Register of Systematic Reviews CRD42018086940; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42018086940.

An Ecologic Study of Disparities in COVID-19 Incidence and Case Fatality in Oakland County, MI, USA, During a State-Mandated Shutdown.

INTRODUCTION: Data from the USA reveal disparities in hospitalization and mortality from coronavirus disease 2019 (COVID-19). Social determinants of health (SDoH) could account for disparities in disease incidence and outcomes. We investigated the association between zip code racial composition and COVID-19 incidence and case fatality in Oakland County, MI. METHODS: We conducted an ecological study using publicly available data on COVID-19 in 70 zip codes in Oakland County, MI. We obtained demographic surrogate markers of SDoH by zip code from the US Census Bureau website. Using negative binomial regression models, we investigated the association between the percentage of Blacks in each zip code and COVID-19 incidence and case fatality, including markers of SDoH as potential confounders. RESULTS: Reported COVID-19 cases ranged from 13.2 to 255.2 per 10,000 population. Each percentage increase in Blacks within a zip code was associated with a 3% increase in COVID-19 cases (95% CI: 1.02 to 1.04, p ≤ 0.0001), and this remained significant after adjusting for income or poverty level, number of persons per household, mode of transportation, age, and level of education (incidence rate ratio: 1.02, 95% CI: 1.01 to 1.03, p ≤ 0.0001). Zip codes with a higher percentage of Blacks also experienced a faster increase in COVID-19 rates from April 3 to May 16. However, the proportion of Blacks in a zip code was not associated with case fatality. CONCLUSION: Zip codes with larger Black populations were disproportionately affected by COVID-19.

A systematic review of the effectiveness of employer-led interventions for drug misuse.

AIMS: Employers in the United States incur substantial costs associated with substance use disorders. Our goal was to examine the effectiveness of employer-led interventions to reduce the adverse effects of drug misuse in the workplace. METHODS: We conducted a systematic review of studies that evaluated the effectiveness of recommended workplace interventions for opioids and related drugs: employee education, drug testing, employee assistance programs, supervisor training, written workplace drug-free policy, and restructuring employee health benefit plans. We searched PubMed MEDLINE, EMBASE (embase.com), PsycINFO (Ebsco), ABI Inform Global, Business Source Premier, EconLit, CENTRAL, Web of Science (Thomson Reuters), Scopus (Elsevier), Proquest Dissertations, and Epistemonikos from inception through May 8, 2019, with no date or language restrictions. We included randomized controlled trials, quasi-experimental studies, and cross-sectional studies with no language or date restrictions. The Downs and Black questionnaire was used to assess the quality of included studies. The results were reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. RESULTS: In all, 27 studies met our inclusion criteria and were included in the systematic review. Results were mixed, with each intervention shown to be effective in at least one study, but none showing effectiveness in over 50% of studies. Studies examining the impact of interventions on workplace injuries or accidents were more commonly reported to be effective. Although four studies were randomized controlled trials, the quality of all included studies was "fair" or "poor." CONCLUSIONS: Despite the opioid epidemic, high-quality studies evaluating the effectiveness of employer-led interventions to prevent or reduce the adverse effects of substance use are lacking. Higher quality and mixed methods studies are needed to determine whether any of the interventions are generalizable and whether contextual adaptations are needed. In the meantime, there is a reason to believe that commonly recommended, employer-led interventions may be effective in some environments.

Shift work and long work hours and their association with chronic health conditions: A systematic review of systematic reviews with meta-analyses.

BACKGROUND: Previous reviews have demonstrated that shift work and long work hours are associated with increased risk for chronic conditions. However, these reviews did not comprehensively assessed the body of evidence, and some were not conducted in a systematic manner. A better understanding of the health consequences of shift work and long work hours will aid in creating policy and practice recommendations. This review revisits the epidemiologic evidence on the association of shift work and long work hours with chronic conditions with particular emphasis on assessing the quality of the evidence. METHODS AND FINDINGS: We conducted a systematic review of systematic reviews with meta-analyses (SR-MA) that assessed the link between shift work or long work hours and chronic conditions (PROSPERO CRD42019122084). We evaluated the risk of bias of each SR-MA using AMSTAR v2 and assessed the overall evidence for each condition using the GRADE approach. We included 48 reviews covering cancers, cardiovascular diseases, metabolic syndrome and related conditions, pregnancy complications, depression, hypertension, and injuries. On average, only 7 of 16 AMSTAR items were fulfilled. Few SR-MAs had a registered protocol and nearly all failed to conduct a comprehensive search. We found moderate grade evidence linking shift work to breast cancer and long work hours to stroke. We found low grade evidence linking both shift work and long work hours with low to moderate increase in risk for some pregnancy complications and cardiovascular diseases. Low grade evidence also link long work hours and depression. CONCLUSIONS: Moderate grade evidence suggest that shift work and long work hours increase the risk of breast cancer and stroke, but the evidence is unclear on other chronic conditions. There is a need for high-quality studies to address this gap. Stakeholders should be made aware of these increased risks, and additional screening and prevention should be considered, particularly for workers susceptible to breast cancer and stroke.

HIV-1 Central Nervous System Compartmentalization and Cytokine Interplay in Non-Subtype B HIV-1 Infections in Nigeria and Malawi.

HIV-1 compartmentalization in the central nervous system (CNS) and its contribution to neurological disease have been well documented. Previous studies were conducted among people infected with subtypes B or C where CNS compartmentalization has been observed when comparing viral sequences in the blood to virus in cerebrospinal fluid (CSF). However, little is known about CNS compartmentalization in other HIV-1 subtypes. Using a deep sequencing approach with Primer ID, we conducted a cross-sectional study among Nigerian and Malawian HIV-1 cohorts with or without fungal Cryptococcus infection diagnosed as cryptococcal meningitis (CM) to determine the extent of CSF/CNS compartmentalization with CM. Paired plasma and CSF samples from 45 participants were also analyzed for cytokine/chemokine levels. Viral populations comparing virus in the blood and the CSF ranged from compartmentalized to equilibrated, including minor or partial compartmentalization or clonal amplification of a single viral sequence. The frequency of compartmentalized viral populations in the blood and CSF was similar between the CM- and CM+ participants. We confirmed the potential to see compartmentalization with subtype C infection and have also documented CNS compartmentalization of an HIV-1 subtype G infection. Cytokine profiles indicated a proinflammatory environment, especially within the CSF/CNS. However, sCD163 was suppressed in the CSF in the presence of CM, perhaps due to elevated levels of IL-4, which were also a feature of the cytokine profile, showing a distinct cytokine profile with CM.

Absence of human leukocyte antigen-B*57:01 amongst patients on antiretroviral therapy in Nigeria: Implications for use of abacavir.

Background: The presence of human leukocyte antigen (HLA) B*57:01 allele predicts hypersensitivity reaction (HSR) to abacavir (ABC), a nucleoside reverse-transcriptase inhibitor used for human immunodeficiency virus (HIV) treatment. However, the prevalence of this allele amongst Nigerians with HIV is yet to be established. We aimed to determine the prevalence of HLA-B*57:01 allele amongst Nigerians with HIV infection. Methods: We conducted a multicentre cross-sectional epidemiologic survey. Between April 2016 and April 2017, patients were enrolled across five HIV treatment facilities in Nigeria. Participants' demographic information and their history of ABC exposure were obtained, and venous blood was obtained for HLA typing. Results: One thousand five hundred and four (1504) adults were enrolled, with a mean age of 44.6 ± 10.7 years, 1078 (71.7%) were female. 1463 (97.3%) were on antiretroviral therapy. ABC use was reported by 12 (0.8%) participants and none reported HSR. Of 1500 blood samples that were processed, 1458 (97.2%) were successfully typed. Of these, 132 (9.1%) were HLA-B*57 positive using non-specific low-resolution HLA-B*5701 primer mix. On further analysis, none of the 132 samples (0%) had the HLA-B*5701 allele. Conclusion: HLA-B*5701allele is rare amongst Nigerians.

Clinical risk factors associated with multidrug-resistant tuberculosis (MDR-TB) in Mali.

BACKGROUND: MDR-TB is a major threat to global TB control. In 2015, 580,000 were treated for MDR-TB worldwide. The worldwide roll-out of GeneXpert MTB/RIF® has improved diagnosis of MDR-TB; however, in many countries laboratories are unable to assess drug resistance and clinical predictors of MDR-TB could help target suspected patients. In this study, we aimed to determine the clinical factors associated with MDR-TB in Bamako, Mali. METHODS: We performed a cross-sectional study of 214 patients with presumed MDR-TB admitted to University of Bamako Teaching Hospital, Point-G between 2007 and 2016. We calculated crude and adjusted odds ratios for MDR-TB disease diagnosis using SPSS. RESULTS: We found that age ≤40years (OR=2.56. 95% CI: 1.44-4.55), two courses of prior TB treatment (OR=3.25, 95% CI: 1.44-7.30), TB treatment failure (OR=3.82, 95% CI 1.82-7.79), sputum microscopy with 3+ bacilli load (OR=1.98, 95% CI: 1.13-3.48) and a history of contact with a TB patient (OR=2.48, 95% CI: 1.11-5.50) were significantly associated with confirmation of MDR-TB disease. HIV was not a risk factor for MDR-TB (aOR=0.88, 95% CI: 0.34-1.94). CONCLUSION: We identified several risk factors that could be used to identify MDR-TB suspects and prioritize them for laboratory confirmation. Prospective studies are needed to understand factors associated with TB incidence and clinical outcomes of TB treatment and disease.

The efficacy of smoking cessation interventions in low- and middle-income countries: a systematic review and meta-analysis.

AIMS: To summarize evidence for the efficacy of smoking cessation interventions in low- and middle-income countries (LMICs). DESIGN: Systematic review and meta-analysis of randomized controlled trials. SETTING: LMICs as defined by the World Bank. PARTICIPANTS: Adult current cigarette smokers residing in LMICs. INTERVENTIONS: Behavioral and/or pharmacotherapy smoking cessation interventions. MEASUREMENTS: PubMed MEDLINE, EMBASE (embase.com), Cochrane Central Register of Controlled Trials (Wiley), PsycINFO (Ebsco), SciELO, WHO Global Index Medicus and Scopus were searched from inception to 4 April 2018. Only studies with at least 6 months of follow-up were included. We used the most rigorous assessment of abstinence reported by each study. Effect sizes were computed from abstracted data. Where possible, a meta-analysis was performed using Mantel-Haenzel random-effect models reporting odds ratios (OR) and 95% confidence intervals (CI). FINDINGS: Twenty-four randomized controlled trials were included. Six investigated the efficacy of pharmacological agents. Four trials that compared nicotine replacement therapy (NRT) to placebo found NRT improved cessation rates (n : NRT 546, control 684, OR = 1.76, 95% CI = 1.30-2.77, P < 0.001, I2  = 13%). Eight trials found that behavioral counseling was more effective than minimal interventions (e.g. brief advice); n : Counseling 2941, control 2794, OR = 6.87, 95% CI = 4.18-11.29, P < 0.001, I2  = 67%). There was also evidence of the benefit of brief advice over usual care (n : Brief advice 373, control 355, OR = 2.46, 95% CI = 1.56-3.88, P < 0.001, I2  = 0%). CONCLUSION: Nicotine replacement therapy, behavioral counseling and brief advice appear to be effective in aiding smoking cessation in low- and middle-income countries. There is limited rigorous research on other smoking cessation interventions in these regions.

Obesity and obstructive sleep apnea risk among Nigerians.

BACKGROUND: The contribution of obesity to obstructive sleep apnea (OSA) is poorly described in Nigeria. We aimed to compare OSA risk between obese and nonobese adults in urban Nigeria. MATERIALS AND METHODS: An analytic cross-sectional study was conducted. Participants were interviewed using the World Health Organization Non-Communicable Disease questionnaire. OSA risk assessment was performed using the STOP-BANG questionnaire. A total score of ≥3 on the STOP-BANG questionnaire indicated OSA risk, whereas a score ≥5 indicated high OSA risk. Obesity was defined as body mass index (BMI) >30 kg/m2. Relationship between obesity and OSA was tested using chi-square and logistic regression models used to control for confounding factors. RESULTS: There were 744 respondents, with a mean age of 44 (standard deviation 10) years. A total of 206 [27.7%, 95% confidence interval (CI) 24.46-30.9] respondents were obese (BMI ≥30 kg/m2). A total of 307 (41.3%, 95% CI 37.7-44.9) respondents scored ≥3 on the STOP-BANG questionnaire, whereas 37 (4.9%, 95% CI 3.6-6.7) scored ≥5. More number of obese than nonobese [57.8% (119/206) versus 34.9% (188/538)] respondents met the criteria for OSA risk (P < 0.001). Similarly, more obese persons [10.3% (21/206)] met the criteria for high-risk OSA compared to the nonobese [3% (16/538)]; P < 0.001. In logistic regression models adjusted for cigarette smoking and alcohol consumption, the odds for OSA risk was 15.76 (95% CI 7.44-33.9) in persons with BMI >35 kg/m2 compared to those with a BMI range of 18.5-24.99. CONCLUSION: Obesity and OSA may be more prevalent in Nigeria than previously predicted. Obesity independently increased OSA risk in this population.

The prevalence of and factors associated with tobacco smoking behavior among long-distance drivers in Lagos, Nigeria.

BACKGROUND: Factors associated with tobacco smoking are useful in designing tobacco control programs. OBJECTIVES: To estimate the prevalence of and factors associated with tobacco smoking among long-distance drivers. METHODS: This was a cross-sectional study. Stratified cluster sampling approach was used to select drivers based on if they received annual health screening (AHS) or not (non AHS). We used a structured questionnaire to obtain information and weighted the resulting observations to derive population based estimates. Association between tobacco smoking and socio-demographic factors was explored in multivariate models. RESULTS: 414 male drivers, mean age 43.6 (standard error 0.6) years. Population weighted prevalence of current smoking was 18.9% (95% CI: 14.3-23.4) of all drivers, 6.5% (95% CI: 2.6-10.4) of AHS drivers and 19.5 (95% CI: 14.7-24.2) of non AHS drivers (p<0.001). In multivariate models, having close friends that smoked (OR= 6.36, 95% CI= 2.49 - 16.20) cargo driving (OR= 2.58, 95% CI= 1.29 - 5.15) and lower education levels (OR for post-secondary education vs. primary education or less= 0.17, 95% CI= 0.04 - 0.81) were associated with current smoking. CONCLUSION: Prevalence of tobacco smoking is higher among non AHS compared to AHS drivers. Having close friends that smoked, cargo driving, and lower education levels were associated with current smoking.

A survey of non-communicable diseases and their risk factors among university employees: a single institutional study.

BACKGROUND: The incidence of non-communicable diseases (NCDs) is rising globally, with its attendant morbidity and mortality, especially in developing countries. This study evaluated the prevalence of NCDs and their risk factors among members of a university community. METHODS: All employees of the university were invited to the University health clinic for screening, using the World Health Organisation's STEPwise approach to NCDs. RESULTS: A total of 883 (521; 59.0% males) employees with a mean age of 44 ± 10 years were studied. The median (IQR) number of NCD risk factors was three (two to three) per participant. The most common NCD risk factors were inadequate intake of fruit and vegetables (94.6%; 95% CI: 92.8-95.9), physical inactivity (77.8%; 95% CI: 74.9-80.5%) and dyslipidaemia (51.8%; 95% CI: 48.4-51.6%). Others included obesity (26.7%; 95% CI: 23.9-29.8%), alcohol use (24.0%; 95% CI: 21.3-27.0%) and cigarette smoking (2.9%; 95% CI: 2.0-4.3). Hypertension was the most common NCD (48.5%; 95% CI: 45.1-51.8%), followed by chronic kidney disease (13.6%; 95% CI: 11.4-16.1) and diabetes mellitus (8.0%; 95% CI: 6.4-10.1). There was no gender-specific difference in the prevalence of NCDs. CONCLUSION: This study identified that NCDs and their modifiable risk factors are highly prevalent in this community. Workplace policy to support the adoption of healthy living is needed.

Erratum to: Outcome of HIV-associated lymphoma in a resource-limited setting of Jos, Nigeria.

[This corrects the article DOI: 10.1186/s13027-017-0144-7.].

Evaluation of gene xpert for routine diagnosis of HIV-associated tuberculosis in Nigeria: A prospective cohort study.

BACKGROUND: Xpert MTB/Rif (Xpert) is described as a game changer in tuberculosis (TB) control. We evaluated the impact of Xpert on diagnosis, time to treatment, and treatment outcome among patients with HIV associated TB in Nigeria. METHODS: Adults with HIV being evaluated for pulmonary TB (PTB) were consecutively enrolled into the study cohort. At baseline, expectorated sputa were examined using Xpert and smear microscopy for Mycobacterium tuberculosis (MTB) and acid fast bacilli, respectively. Patients diagnosed with TB were followed-up until 6 months post TB diagnosis. TB was defined as sputum positive by smear microscopy, Xpert detection of MTB (bacteriologically confirmed case), or clinician diagnosed TB with initiation of full TB treatment (clinical diagnosis). Time to treatment was time from first clinic presentation for TB evaluation to initiation of TB treatment. We examined the proportion PTB patients with a positive Xpert result and compared time to TB treatment and outcome of TB treatment in patients based on sputum test results. RESULTS: A total of 310 adults with HIV were enrolled. The median CD4 cell count was 242 (interquartile range (IQR) 120-425) cells/mm3 and 88.1% were receiving antiretroviral therapy (ART). PTB was diagnosed in 76 (24.5%) patients, with 71 (93.4%) being bacteriologically confirmed. Among patients with PTB, 56 (73.7%) were Xpert positive. Median time to treatment was 5 (IQR 2-8) days and 12 (IQR 5-35) days in patient with and without Xpert positive results, respectively; p = 0.005. Overall 73.1% had symptom free survival at 6 months post PTB treatment initiation with no significant differences observed based on TB test method. 10 (14.9%) died within 6 months of TB treatment initiation. In analysis adjusted for age, sex, and mode of diagnosis (Xpert positive or negative), only ART use independently predicted mortality (AOR 0.10; 95% CI 0.01-0.93). CONCLUSION: The use of Xpert for routine care reduced time to PTB treatment, but did not improve survival in patients with HIV treated for susceptible PTB.

Outcome of HIV-associated lymphoma in a resource-limited setting of Jos, Nigeria.

BACKGROUND: Lymphoma is a leading cause of cancer-related death among human immunodeficiency virus (HIV)-infected individuals in the current era of potent anti-retroviral therapy (ART). Globally, mortality after HIV-associated lymphoma has profound regional variation. Little is known about HIV-associated lymphoma mortality in Nigeria and other resource-limited setting in sub-Saharan Africa. Therefore, we evaluated the all-cause mortality after lymphoma and associated risk factors including HIV at the Jos University Teaching Hospital (JUTH) Nigeria. METHODS: We conducted a ten-year retrospective cohort study of lymphoma patients managed in JUTH. The main outcome measured was all-cause mortality and HIV infection was the main exposure variable. Overall death rate was estimated using the total number of death events and cumulative follow up time from lymphoma diagnosis to death. Cox proportional hazard regression was used to assess factors associated with mortality after lymphoma diagnosis. RESULTS: Out of 40 lymphoma patients evaluated, 8(20.0%) were HIV positive and 32(80.0%) were HIV negative. After 127.63 person- years of follow-up, there were 16 deaths leading to a crude mortality rate of 40.0 per 100 person-years. The 2-year probability of survival was 30% for HIV-infected patients and 74% for HIV-uninfected. Median survival probability for HIV-infected patients was 2.1 years and 7.6 years for those without HIV. Unadjusted hazard of death was associated with late stage, HR 11.33(95% CI 2.55, 50.26,p = 0.001); low cumulative cycles of chemotherapy, HR 6.43(95% CI 1.80, 22.89,p = 0.004); greater age, HR 5.12(95% CI 1.45,18.08,p = 0.01); presence of comorbidity, HR 3.43(95% CI 1.10,10.78,p = 0.03); and HIV-infection, HR 3.32(95% CI 1.05, 10.51,p = 0.04). In an adjusted model only stage was significantly associated with death, AHR 5.45(1.14-26.06, p = 0.03). CONCLUSION: Our findings suggest that HIV- infection accounted for three times probability of death in lymphoma patients compared to their HIV-uninfected counterparts due to late stage of lymphoma presentation in this population. Also initiation of chemotherapy was associated with lower probability of death among lymphoma patients managed at JUTH, Nigeria. Earlier stage at lymphoma diagnosis and prompt therapeutic intervention is likely to improve survival in these patients. Future research should undertake collaborative studies to obtain comprehensive regional data and identify unique risk factors of poor outcomes among HIV-infected patients with lymphoma in Nigeria.