Determinants of treatment seeking behaviour for sexually transmitted infections in Nigeria.

About 376 million new cases of sexually transmitted infections (STI) are reported annually across the globe. Also, untreated STI result in increased risks of complications including HIV, infertility and congenital infections. In Nigeria, enabling factors for STI transmission has increased in recent times. Thus, good treatment seeking behaviour is critical for the management of STI among people with sexually transmitted infections in Nigeria. Secondary data from the 2018 Nigeria Demographic and Health Survey dataset were used. The survey was conducted across Nigeria following a-2 stage stratified cluster sampling design from a sample of 4,997 women and 653 men aged 15 - 49 years who reported an STI history. Only 46.1% of the men and 55.7% of the women sought treatment for STI. Men who reported having genital ulcer were 3 times more likely to seek treatment, and women with genital ulcers were 2 times more likely to seek treatment than those who did not have genital ulcers. There is the need to reinforce HIV/STI messaging and health education campaigns in order to sensitize more people on transmission, symptoms and treatment of STI. Also, equitable mechanisms for financing STI treatment should be incorporated into the Nigerian health system in order to increase access for people of poorer economic status.

The Role of Telemedicine in Addressing Access to Sexual and Reproductive Health Services in sub-Saharan Africa during the COVID-19 Pandemic.

The outbreak of COVID-19 threatens continued access to non-urgent healthcare including sexual and reproductive health (SRH) services. With the epicentre of the outbreak projected to shift to sub-Saharan Africa (SSA) after making significant impact in China, Europe, USA, and South America, it is necessary for countries in this region to begin to plan for how to tackle a rapid surge in cases. Health facilities are already being primed for increased presentation of COVID-19 cases. As countries prepare, they also need to consider how non-urgent services will not be interrupted. Estimates of a potential disruption in access to long and short acting contraceptives for up to 12 months will result in an additional 15 million unintended pregnancies and additional 28,000 maternal deaths. Thus, effort must be made to ensure that the gains made in SRH outcomes over several years are not lost. The potential of utilizing telemedicine to continue to offer healthcare services to the population for non-urgent care needs to be considered. It will not only provide for continued access to important services that can be delivered remotely but will reduce the risks of COVID-19 infection for both the client and the health workers.

Gender-Based Violence following Social Media Acquaintance in Nigeria.

In Nigeria, the growth in mobile phone use has provided the opportunity for increased access to the internet, and through this, the social media. The social media in turn offers tremendous communication benefits but also results in some undesirable consequences. One of such is the experience of Gender-Based Violence (GBV). Internet searches using Google Search and Google Scholar in addition to information available to the authors from news media is reported in this study. Five cases were selected for reporting. All cases selected had first contact with their perpetrator(s) on Facebook. The perpetrators were usually men, older than the victims (24-34 years for perpetrators compared with 17-25 years for the victims). The victims experienced physical, psychological, sexual and economic violence from their aggressors. One case resulted in the death of the victim, while two required hospitalization following severe trauma. Three of the victims were raped, while rape was attempted for the other two cases. GBV associated with acquaintances made on social media channels is emerging as a new social problem in Nigeria. Interventions to educate female social media users about this potential danger are urgently necessary.

Rethinking HIV prevalence determination in developing countries.

The process for HIV prevalence determination using antenatal clinic (ANC) sentinel surveillance data has been plagued by criticisms of its biasness. Exploring other means of HIV prevalence determination is necessary to validate that estimates are near actual values or to replace the current system. We propose a data collection model that leverages the increasing adoption and penetration of the Internet and mobile technology to collect and archive routine data from HIV counseling and testing (HCT) client intake forms from all HCT centers and prevention of mother-to-child transmission (PMTCT) sites in a country. These data will then be mined to determine prevalence rates and risk factors at the community level. The need to improve the method for the generation of HIV prevalence rates has been repeatedly echoed by researchers though no one has been able to fashion out a better and more reliable way to the current ANC sentinel surveillance method at a reasonable cost. The chance of using routinely generated data during HCT and PMTCT is appealing and needs to be envisioned as the technology to achieve this is increasingly becoming available and affordable in countries worst hit by the pandemic. Triangulating data generated from routine HCT and PMTCT sites with data from sentinel surveillance and where the confidence of its quality is assured, as the sole source of HIV prevalence rate determination and behavioral risk assessment will improve the acceptance by communities and drive evidence-based interventions at the community level.

Willingness to pay for antiretroviral therapy, viral load, and premium services; A contingent valuation survey of people living with HIV in southern Nigeria.

BACKGROUND: With stagnating funding for HIV and AIDS control programs in Nigeria, alternative funding models for antiretroviral therapy (ART) including out of pocket payment are being considered to sustain momentum epidemic control targets. We assessed willingness to pay for ART related services, and factors associated with willingness to pay. METHODS: Between July and August 2019, we conducted a survey among people living with HIV (PLHIV) on ART in 3 states in southern Nigeria. Randomly sampled respondents on ART for at least 6 months, aged ≥ 18 years, able to communicate in English or pidgin English, and consenting to the survey were enrolled. Respondents were asked if they were willing to pay for clinical consultation, antiretroviral drugs (ARVs), viral load testing services and premium ART services (including fast track services). Respondents indicating willingness to pay for any of these services were asked the maximum amount they were willing to pay using contingent valuation methodology. We assessed the weighted proportions of PLHIV on ART willing to pay for ART and used survey-featured logistic regression measures to assess sociodemographic and ART related factors associated with willingness to pay for ART services. RESULTS: Overall, 1,598 PLHIV with a mean age of 39.03 years (standard deviation [SD]: 11.23 years), were included in this analysis. Of these, 65.8% (1,079), 73.9% (1,192), 61.0% (995) and 33.6% (472) were willing to pay for ART consultation, ARVs, viral load testing services and premium ART services respectively. The median maximum amount PLHIV were willing to pay for clinical consultation and for ARVs was NGN1,000 (USD equivalent of $2.78; interquartile range [IQR]: 500-2,000) respectively, and NGN2,500 (USD equivalent of $6.94; IQR: NGN1,000-5,000) and NGN2,000 (USD equivalent of $5.56; IQR: NGN1,000-3,000) for viral load testing and premium ART services respectively. Receiving ART in Lagos state, being employed and having a monthly income of NGN100,000 or more was associated with willingness to pay for the various ART services. CONCLUSION: We found generally high-level of willingness to pay for ART consultation, ARVs and viral load testing services but low willingness to pay for premium ART services among PLHIV on ART. The maximum amount PLHIV were willing to pay for various ART services fell short of benchmarks for alternative funding but can potentially supplement ART by funding differentiated service delivery models that require nominal amounts to facilitate person-centered differentiated service delivery models.

Lessons learned in the deployment of a HIV counseling and testing management information system on a new project.

OBJECTIVE: To share our experience on how we used simple but detailed processes and deployed a management information system on a new HIV counseling and testing (HCT) project in Nigeria. DESIGN: The procedures used in this study were adopted for their strength in identifying areas of continuous improvement as the project was implemented. METHODS: We used an iterative brainstorming technique among 30 participants (volunteer counselors and project management staff) as well as iterative quality audits to identify several limitations to the success of the project and to propose solutions. We then implemented the solutions and reevaluated for performance. Findings from the evaluations were then reintroduced into the brainstorming and planning sessions. RESULTS: Several limitations were identified with the most prominent being the poor documentation of records at the site and the lack of a document transfer trail for audit purposes. CONCLUSION: Communication, cohesion and team focus are necessary to achieve success on any new project. Institutionalizing routine HIV behavioral surveillance using data collected at HCT will help in streamlining interventions that will be evidence-based.