In the management of chronic conditions like HIV, the continuity of service delivery is necessary to achieve desired outcomes, such as HIV viral load suppression, behavioral change, improved health, and client satisfaction. The transition phase-when a project closes and another starts-is a potential period of service delivery disruption. Active management of this transition period is important to prevent disruptions, especially for key populations who may be stigmatized and have limited options for accessing HIV services. We analyzed this transition period between July and December 2022 between 2 projects that provided HIV prevention services, management of sexually transmitted infections, and linkage to HIV treatment and other complementary services to key populations in Zambia. To ensure a smooth project transition, we implemented a set of interventions, including joint planning for project transition, strategic leadership, trust-building initiatives, active community and stakeholder engagement, repeated stakeholder reassurance, open communication, and transparent data sharing. After transitioning to the new project, we noted that all 3 service types of interest experienced at least a 20% increase over the levels achieved in the last month of the closing project. This increase contrasts with the assumption that all service types delivered through project structures would decline to zero persons reached within 2 months of project closing if the next project did not commence seamlessly. The decrease in service delivery was averted with the intentional transition interventions. Additionally, we recorded operational gains, such as stakeholder satisfaction, adequate assets transfer, stability in project service delivery location, and reduced personnel anxiety. We conclude that active multipartite management of the transition phase for projects is essential for ensuring uninterrupted service delivery and sustaining good outcomes for clients. Donors, health system managers, and program managers should actively require and design sound transition management plans as part of their program designs. In the aftermath of recent abrupt cuts in US Government development sector funding that allowed no planned transitions, it is important that surviving programs carefully imbibe lessons shared in this paper to protect years-and sometimes decades-of program gains.

Background: Amid the dwindling donor support for HIV in Nigeria, there is an urgent need for additional domestic HIV funding. This study estimates the required financial resources for people living with HIV (PLHIV) and the potential magnitude of domestic resources for HIV through the National Health Insurance Scheme (NHIS) and by prioritizing HIV within the health budget. Methods: We estimated the resource needs for providing antiretroviral therapy (ART) to adults, children, and pregnant women living with HIV under 3 scenarios: current coverage rates, coverage rates based on historical trends, and a rapid scale-up situation. We conducted a fiscal space analysis to estimate the potential contribution from macroeconomic growth, the NHIS, and prioritizing HIV within the health budget from 2020 to 2025. Results: At current coverage rates, the annual treatment costs for adults would range between US$ 505 million in 2020 to US$ 655 million in 2025; for children, it ranges from US$ 33.5 million in 2020 to US$ 32 million in 2025. The annual costs of providing PMTCT at current coverage rates range from US$ 65 million in 2020 to US$ 72 million in 2025. An additional US$ 319 million could potentially be generated between 2020 and 2025 through the NHIS for HIV. Prioritizing HIV within the health budget can generate an additional US$ 686 million. Conclusion: Substantial domestic funds can be mobilized by these means to sustain the HIV response. However, because this additional funding may not be sufficient to cover all PLHIV, a phased approach, initially prioritizing certain populations such as children or pregnant women, is recommended.

Background: The use of face masks as a public health approach to limit the spread of coronavirus disease 2019 (COVID-19) has been the subject of debate. One major concern has been the spread of misinformation via social media channels about the implications of the use of face masks. We assessed the association between social media as the main COVID-19 information source and perceived effectiveness of face mask use. Methods: In this survey in six sub-Saharan African countries (Botswana, Kenya, Malawi, Nigeria, Zambia and Zimbabwe), respondents were asked how much they agreed that face masks are effective in limiting COVID-19. Responses were dichotomised as ‘agree’ and ‘does not agree’. Respondents also indicated their main information source including social media, television, newspapers, etc. We assessed perceived effectiveness of face masks, and used multivariable logistic models to estimate the association between social media use and perceived effectiveness of face mask use. Propensity score (PS) matched analysis was used to assess the robustness of the main study findings. Results Among 1988 respondents, 1169 (58.8%) used social media as their main source of information, while 1689 (85.0%) agreed that face masks were effective against COVID-19. In crude analysis, respondents who used social media were more likely to agree that face masks were effective compared with those who did not [odds ratio (OR) 1.29, 95% confidence interval (CI): 1.01–1.65]. This association remained significant when adjusted for age, sex, country, level of education, confidence in government response, attitude towards COVID-19 and alternative main sources of information on COVID-19 (OR 1.33, 95%CI: 1.01–1.77). Findings were also similar in the PS-matched analysis. Conclusion: Social media remains a viable risk communication channel during the COVID-19 pandemic in sub-Saharan Africa. Despite concerns about misinformation, social media may be associated with favourable perception of the effectiveness of face masks.

Measles is a highly contagious infection that can cause severe illness in children. Vaccination is the primary means of controlling the infection, with elimination a possibility. However, the measles-containing vaccine coverage in sub-Saharan Africa (SSA) is 70% while that for Nigeria is 54% according to official estimates and 64.7% from household surveys. This review aims to identify factors that contribute to the poor coverage rate and proposes appropriate recommendations to address these factors. We conducted a comprehensive search of five databases (MEDLINE, Embase, Global Health, CINAHL Plus and PubMed) using the PICOTS (population, intervention, comparison, outcome, timing, study type) framework. The search was conducted in September 2017 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and inclusion criteria were studies conducted in SSA, that evaluated measles vaccine coverage gaps, evaluated strategies for improving measles vaccination coverage and were published in English. The database search yielded 23 publications. Several different factors influencing measles vaccine coverage were identified and were grouped into four main areas: immunization system, information and communication, family characteristics and parental attitudes and knowledge. Fears and misconceptions were common reasons for non-vaccination. Activities to improve vaccination coverage were identified, including structural reforms such as siting health centres within or proximal to target communities, improving female literacy and conducting measles vaccination campaigns. Multiple reasons for poor measles vaccination coverage were identified. Factors influencing the immunization system and information and communication factors can be fixed at the country level, but challenges relating to family characteristics and parental attitudes and knowledge require solutions adapted to the community of concern. However, vaccination campaigns are an effective means of improving vaccination coverage and they reduce geographic and socio-economic inequities.

IntroductionHIV incidence estimates are important to characterize the status of an epidemic, identify locations and populations at high risk and to guide and evaluate HIV prevention interventions. We used the limiting antigen avidity assay (LAg) as part of a recent infection testing algorithm to estimate HIV incidence in the Akwa Ibom AIDS Indicator Survey (AKAIS), Nigeria. MethodsIn 2017, AKAIS, a cross-sectional population-based study was conducted at the household (HH) level in 31 local government areas (LGAs) of Akwa Ibom state. Of the 8963 participants aged >= 15 years who were administered questionnaires for demographic and behavioural data, 8306 consented to HIV rapid testing. Whole-blood specimens were collected from 394 preliminary HIV-seropositive individuals for CD4+ cell count determination and plasma storage. Samples were shipped to a central quality laboratory for HIV confirmatory testing and viral load determination. A total of 370 HIV-positive specimens were tested for the recent HIV infection using the LAg assay. ResultsOf the 8306 consenting adults, the HIV prevalence was 4.8%. Of the 370 HIV-positive samples tested for HIV recency, the median age was 35 years, 48.8% had CD4+ cell count >500/mm(3) and 81.3% was not virally suppressed. Viral suppression was greater among females (21%) than for males (13%). A total of 11 specimens were classified as recent based on the LAg assay and HIV viral load >= 1000 copies/mL. The weighted, adjusted HIV-1 incidence was 0.41/100 person-years (95% CI 0.16 to 0.66); translating to 13,000 new cases of HIV infections annually in Akwa Ibom, a state with a population of 5.5 million. The HIV incidence rate was similar in females and males (0.41% and 0.42% respectively). The incidence rate was the highest among participants aged 15 to 49 years (0.44%, 95% CI 0.15 to 0.74) translating to 11,000 new infections annually, about 85% of all new infections in the state. ConclusionsThe finding of the high HIV incidence among the 15 to 49-year age group calls for renewed and innovative efforts to prevent HIV infection among young adults in Akwa Ibom state.

Introduction as the COVID-19 pandemic rages on, sub-Saharan Africa remains at high risk given the poor adherence to pandemic control protocols. Misconceptions about the contagion may have given rise to adverse risk behaviours across population groups. This study evaluates risk perception among 2,244 residents of seven countries in sub-Saharan Africa (Botswana, Kenya, Malawi, Nigeria, Tanzania, Zambia and Zimbabwe) in relation to socio-demographic determinants. Methods an online survey was conducted via social media platforms to a random sample of participants. Risk perception was evaluated across six domains: loss of income, food scarcity, having a relative infected, civil disorder, criminal attacks, or losing a friend or relative to COVID-19. A multivariable ordinal logistic regression was conducted to assess socio-demographic factors associated with the perceived risk of being affected by COVID-19. Results 595 (27%) respondents did not consider themselves to be at risk, while 33% perceived themselves to be at high risk of being affected by the pandemic with respect to the six domains evaluated. Hospital-based workers had the highest proportional odds (3.5; 95%CI: 2.3-5.6) high perceived risk. Teenage respondents had the highest predictive probability (54.6%; 95% CI: 36.6-72.7%) of perceiving themselves not to be at risk of being affected by COVID-19, while Zambia residents had the highest predictive probability (40.7%; 95% CI: 34.3-47.0%) for high-risk perception. Conclusion this study reveals the need to increase awareness of risks among socio-demographic groups such as younger people and the unemployed. Targeted risk communication strategies will create better risk consciousness, as well as adherence to safety measures.

Integrated Development Generally Refers To Integrated Implementation Of Quality Interventions Within Or Across Sectors Aimed At Stimulating Development. Funders/Donors, Policymakers, And Programme Managers Are Key Stakeholder Groups That Determine The Success Of Integrated Development Interventions. A Shared Convergence In Their Perspectives Enables Joint Plans And Actions. Our Objectives Were To Determine The Perspectives Of Integrated Development, Among Selected Stakeholder Groups In Nigeria, And To Discuss Implications For Practice. This Was A Quantitative Survey. We Used A Multi-Stage Random Sampling Technique To Select A Representative Sample Of 301 Key Stakeholders In Nigeria. We Analysed The Data Using SPSS. Almost Half (49.5%) Of These Respondents Were Senior Level Stakeholders And 46.5% Of Them Had Over 10 Years Of Experience. Respondents’ Perspectives Of The Meaning Of Integrated Development Varied. Respondents Mostly (69.8%) Felt That ID Meant Multi-Sectoral Interventions. Perspectives Also Varied By Stakeholder Type, Sector And Characteristics. Enhancing Collaborations And Strengthening Human Capacity Was The Predominant Benefit Among Funders/Donors (70.4%) While The Most Predominantly Expressed Benefit Among The Policy Makers (78.9%) And Programme Managers (78.3%) Was That ID Yields More Impactful And Sustainable Interventions. These Findings Clearly Show That Nuanced Communication Of Integrated Development Is Needed To Achieve Consensus And Programme Success.

Regular internet access is suggested to facilitate Comprehensive Correct HIV/AIDS Knowledge (CCAK). We assessed this association using the 2018 Nigeria Demographic Health Survey data, including 30,784 participants. CCAK was defined as knowing two primary HIV prevention methods, healthy-looking persons can have HIV, and rejecting two HIV misconceptions. Regular internet access was defined as at least weekly internet access. Using survey-featured multivariable logistic regression, we assessed this association. Overall, 49.6% (12,385) of participants had CCAK, while 17.4% (4,080) had regular internet access. People with regular internet access had higher odds of CCAK (aOR 1.55, 95% CI 1.38 - 1.73), confirming the association.

### Summary box The COVID-19 pandemic started in late 2019 in Wuhan province, China, and was reported on 30 December 2019 to the WHO.1 By 30 January 2020, WHO declared the outbreak a public health emergency of international concern.2 As of 4 May 2020, the WHO had documented 3 407 747 confirmed cases and 238 198 deaths worldwide.3 Worldwide economic disruption has resulted from COVID-19 control measures such as stay at home orders (‘lockdowns’). The United Nations Conference on Trade and Development estimates that the cost of the outbreak globally is US$2 trillion so far and predicts a global recession in 2020.4 The deceleration in global economic growth has demand-side causes, such as lockdowns and rising unemployment, and supply-side causes, such as a weakened global supply of many goods due to the abrupt shutdown of production lines. Nigeria has experienced these health and economic impacts. Its first case was identified on 27 February 2020 and by 2 May 2020, there were 2170 confirmed cases and 38 deaths.5 The relatively low number of cases and deaths compared with countries with similar populations in Africa (e.g. Egypt) may be due to limited test kits and laboratories, under-reporting and public health control measures. In this commentary, we describe the economic shocks …

Background: Despite huge investments in HIV prevention, treatment, and care in sub-Saharan Africa, fewer than one in 10 individuals knows their HIV status, and 40% of individuals living with HIV are not cognisant of their positive status. Efforts to improve and strengthen HIV service delivery, particularly in HIV testing, are necessary to increase efficiency in HIV case finding and optimise service delivery. Standard approaches to HIV testing have not been effective in addressing this gap. Our objective was to evaluate a targeted approach for HIV case identification in a PEPFAR-supported HIV programme in Nigeria. Methods: Between October, 2016, and June, 2017, we implemented a strategy that included index client testing, geo-targeted HIV testing, and provider-initiated counselling and testing in 14 local government areas in Akwa Ibom, southern Nigeria. The tests were administered in conjunction with the conventional method of testing and were in line with the PEPFAR impact agenda. We estimated the number of individuals who needed to be tested by each method in order to meet a benchmark of 8000 new diagnoses per quarter. We described dispersion using median and IQR. Findings: Conventional methods in the 14 local government areas required testing of 600 000 individuals (median 50 000 [IQR 741 000]) whereas using our targeted approach, we met 60% of the benchmark in each quarter by testing 214 000 individuals on average (median 14 000 [IQR 12 000]). Interpretation: We demonstrated that use of a targeted approach to HIV testing can increase the efficiency of case identification. This process can therefore help increase early initiation of treatment and retention of subjects diagnosed with HIV. Funding: PEPFAR.

Significant gaps persist in providing HIV treatment to all who are in need. Restricting care delivery to healthcare facilities will continue to perpetuate this gap in limited resource settings. We assessed a large‐scale community‐based programme for effectiveness in identifying people living with HIV and linking them to antiretroviral treatment.

Medication adherence is a major determinant of antiretroviral treatment (ART) success. Promptness in medication refill pick-ups may give an indication of medication adherence. This study determined medication refill adherence among HIV positive patients on ART and its association with treatment outcomes in HIV treatment centers in Nigeria. This retrospective multi-center cohort study involved a review of ART refill records for 3534 HIV-positive patients aged 18–60 years who initiated first-line ART between January 2008 and December 2009 and were on therapy for ≥18 months after ART initiation. Drug refill records of these patients for 10 consecutive refill visits after ART initiation were analyzed. The first ten consecutive refill appointment-keeping rates after ART initiation ranged from 64.3 % to 76.1 % which decreased with successive visits. Altogether, 743 (21.1 %) patients were deemed adherent, meaning they picked up their drugs within 7 days of the drug refill appointment date on at least nine out of ten refill visits. The adherent group of patients had a mean CD4 cells increase of 206 ± 6.1 cells/dl after 12 months of ART compared to 186 ± 7.1 cells/dl reported among the nonadherent group (p = 0.0145). The proportion of patients in the adherent category who showed no OIs after 12 months on ART (81 %) was significantly higher when compared to the proportion in the non-adherent category (23.5 %), (p = 0.008). The multivariate analysis showed that the odds of being adherent was 2–3 times more in patients who had a baseline CD4 count of less than 200 cells/dl compared to those with a baseline CD4 of >350 cells/dl. (AOR 2.43, 95 % CI 1.62–3.66). In addition, for patients with baseline CD4 cell count of 201–350 cells/dl, the odds of being adherent was found to be 1.9 compared to those with baseline CD4 of greater than 350 cells/dl (AOR 1.93, 95 % CI 1.27–2.94). Pharmacy refill data can serve as an adherence measure. Adherence to on-time drug pickup on ≥90 % of refill appointments was associated with a better CD4 count response and a reduction in the presence of opportunistic infections in ART patients after 12 months of treatment.

IntroductionAs the world is making progress towards elimination of mother-to-child transmission of HIV, poor coverage of PMTCT services in Nigeria remains a major challenge. In order to address this, scale-up was planned with activities organized into 3 phases. This paper describes the process undertaken in eight high burden Nigerian states to rapidly close PMTCT coverage gaps at facility and population levels between February 2013 and March 2014.MethodsActivities were grouped into three phases pre-assessment phase (engagement of a wide range of stakeholders), assessment (rapid health facility assessment, a cross sectional survey using mixed methods conducted in the various states between Feb and May 2013 and impact modelling), and post-assessment (drawing up costed state operational plans to achieve eMTCT by 2015, data-driven smart scale-up).ResultsOver a period of 10 months starting June 2013, 2044 facilities were supported to begin provision of PMTCT services. This increased facility coverage from 8% to 50%. A 246% increase was also recorded in the number of pregnant women and their families who have access to HIV testing and counselling in the context of PMTCT. Similarly, access to antiretrovirals for PMTCT has witnessed a 152% increase in these eight states between October 2013 and October 2014.ConclusionA data-driven and participatory approach can be used to rapidly scale-up PMTCT services at community and facility levels in this region. These results present us with hope for real progress in Nigeria. We are confident that the efforts described here will contribute significantly to eliminating new pediatric HIV infection in Nigeria.

BACKGROUND:Despite the upsurge in support and intervention of donor agencies in HIV care and treatment programing in Sub-Sahara African, antiretroviral (ART) programs are still confronted with access and coverage challenges which influence enrolment of new patients. This study investigated the validity of point of care BD FACSPresto™ CD4 analyzer for CD4+ cell count, overall agreement, correlation, sensitivity, and specificity in comparison to a reference standard flow cytometry method. We also assessed the feasibility of use among non-laboratorians.METHODS:Blood samples from 300 HIV infected individuals were analyzed for CD4+ T cell and CD4%, using finger prick capillary sample from 150 PMTCT clients and 150 ART clients at Murtala Mohammed Specialist Hospital, Kano, Nigeria. Their venous samples were compared on a flow cytometry reference method using BD FACSCount CD4+ count system. The accuracy of the BD FACSPresto machine in comparison to BD FACSCount was evaluated. Statistical analysis was carried out using STATA (version 12). Bland-Altman method and correlation analysis were used to analyze agreement between both measurements. In addition, sensitivity and specificity of both measurements were determined. Statistical significance was set at p-value <0.05.RESULTS:The mean bias and limit of agreement for CD4+ count between BD FACSPresto and BD FACS count machine were 7.49 (95% CI: 2.44 to 12.54) and -8.14 to 96.39 respectively. Further analysis revealed close agreement between BD FACSPresto and BD FACSCount with no significant difference between the two methods (p = .0.95). Using a threshold of 500 cells/μL, sensitivity and specificity of BD FACSPresto were 95.1% and 97.1% respectively, compared to BD FACSCount. There was no statistically significant difference in the misclassification between BD FACSPresto and BD FACSCount results (p = 0.23). Furthermore, sensitivity and specificity were similar when BD FACSPresto machine was operated by a nurse or laboratory scientist, there was no substantial difference in testing variability observed between laboratory and non-laboratory operators using the BD FACSPresto analyzer.CONCLUSIONS:Overall, BD FACSPresto Point of Care CD4+ count finger stick capillary blood results is a reliable method in comparison to venous sample cytometry method and no significant difference variability observed between laboratory personnel and non-laboratory operators. The BD FACSPresto is simple, more robust and easy to use equipment without significant variability in reliability by non-laboratory health care workers hence will be a valuable instrument in increasing access and coverage of CD4 estimations in developing countries. The introduction of the BD FACSPresto POC analyzer has a high potential in reducing patients waiting time and improving the overall quality of ART service and clients' satisfaction especially in rural settings.

This study describes the characteristics of caregivers, examines the relationships between caregivers and their children and analyzes the experiences and challenges of caring for orphans and vulnerable children (OVC) faced by caregivers in the community. Using a combination of questionnaire, informant interviews and focus group discussions, data were collected from 150 female and male caregivers in Cross Rivers State and the Federal Capital Territory selected through convenient sampling. Careful analysis of the data revealed that majority of the caregivers were women, mostly widows caring for about 3-6 children. They were largely married with primary or no formal education. Most of them were engaged in petty trading and farming. Their incomes were generally low, less than 10,000 naira (approximately 52 dollars) per annum. Challenges of caring for children were listed to include; lack of access to education, nutrition, inadequate clothing and shelter and lack of psychosocial support in that order. Family supports to these caregivers have either dwindled considerably or non-existent. In the words of these caregivers, our relatives have their own problems in this era of economic crisis to bother about the problems of other people. A few of the organized supports came from non-governmental organizations and faith-based organizations in the form of handouts to meet needs of food and school supplies. These do not address the root cause of caregivers' problems of lack of skills and income generation for sustainable care. The study recommends empowering caregivers as a sustainable approach to the problem of vulnerable children in the community.

Introduction: Despite the success derived from antiretroviral therapy, drug resistance (DR) mutations are known to develop and are major impediments to treatment of HIV patients.Therefore, periodic assessment of HIVDR is needed to ensure continuous HAART efficacy.This study assessed the magnitude of drug resistance as well as HIV genetic variability in drug-naïve and treated patients in Nigeria.Methodology: Genotypic analysis was performed by sequencing plasma specimens from 40 individuals in a cross sectional study involving 202 HIV infected patients from all the six geopolitical zones of Nigeria.Sequences were analyzed for presence of HIVDR mutation using the algorithm in Stanford HIVDR database and confirmed by IAS-USA 2009 mutation list.Phylogenetic and recombination analyses were done using PAUP V4.0 and REGA V2.0 respectively.Results: Major DR mutations were detected in the reverse transcriptase (RT) gene of 5 (33%) drug experienced and 2 (8%) naïve patients.Most common mutations were M184V and K103N with no protease (PR) mutations detected.Thymidine analogue mutations (TAMs) and a complex multi resistance mutation Q151M were detected in 3 samples.Polymorphic substitutions were observed in both PR and RT gene.Phylogenetic analysis revealed Group M isolates of G (20), J (1), circulating recombinant forms: CRF02_AG (14), CRF-18-cpx (1), CRF06_cpx (3) and a unique AD recombinant (1).Conclusion: Our findings corroborate previous studies on circulating DR viruses in Nigeria while genetic diversity is on the increase.In view of ART scale-up, monitoring the resistance