BACKGROUND:Human immunodeficiency virus (HIV) viral load (VL) monitoring is critical for antiretroviral therapy (ART) management. Point-of-care (POC) VL testing has been reported to be feasible and preferred over standard-of-care (SOC) testing in many low- and middle-income country settings where rapid results could improve patient outcomes. METHODS:The timeliness of receipt of VL results was evaluated in an open-label, randomized, controlled trial among patients newly initiating ART. Clinical outcomes with POC VL monitoring using Cepheid Xpert vs SOC VL at Jos University Teaching Hospital and Comprehensive Health Centre Zamko in Nigeria were assessed. We determined time between specimen collection and recording of VL in patient charts, receipt of results, and ART switch for those who met virologic failure criteria. RESULTS:Between April 2018 and October 2019, we screened 696 ART-naive individuals; 273 were randomized to POC and 268 to SOC HIV-1 VL testing. Participants in the POC arm received VL results significantly faster than those in the SOC arm (0.1 median days, interquartile range [IQR], 0.1-0.2 vs 143.1 days, IQR, 56.0-177.1, respectively; P < .0001). Participants in the POC arm with confirmed virologic failure vs those in the SOC arm were switched more rapidly to a second-line regimen (0 median days, IQR, 0-28 vs 66 days, IQR, 63-123, respectively; P = .03). CONCLUSIONS:POC VL testing resulted in significant improvement in the timeliness of VL result receipt by patients and use for effective HIV clinical management. In patients experiencing VL failure, POC monitoring enabled prompt switching to second-line ART regimens. CLINICAL TRIALS REGISTRATION:NCT03533868.

Despite being on antiretroviral therapy, during unprotected sex, a HIV-infected pregnant woman can transmit HIV not only to a HIV-negative sexual partner but also pose a risk for reinfection with new or resistant viral strains between her and a HIV-positive sexual partner, and ultimately to her baby. Condom use is a recognized strategy to reduce this risk if practiced consistently. This study set out to determine condom use and associated factors among a cohort of women who attended PMTCT clinic in Jos University Teaching hospital. Methods: Ninety-six enrolled women provided information about themselves and their male partners via a questionnaire, and other relevant information was obtained from their hospital records. Data obtained was analyzed using Epi info version 7 (CDC Atlanta, GA). The mean age of the women was 36.4±4.5 years. They were predominantly married (90.6%), Christians (75.0%), and educated above primary school level (88.6%). The mean age of the male partners was 45.3±6.1 years and over half of them (57.3%) were HIV-positive. The prevalence of consistent condom use in the participants was low (26.0%). Only 4.2% of male partners had ever received counselling in the PMTCT clinic. Factors significantly associated with condom use were younger age of male partner (mean ± SD=43.0±4.7 years), younger age of pregnant women (mean ± SD=34.2±3.3 years), Christian faith of the women, male partners having ever accompanied their pregnant woman for counselling in the PMTCT clinic and viral load of < 1000 copies/ml (P value=0.0290, 0.0035, 0.0440, 0.0227 and 0.0045 respectively). The practice of consistent condom use among male partners of HIV-positive pregnant women attending PMTCT clinic in JUTH was low, suggesting the need for improved strategies to optimize its usage. Involvement of male partners in PMTCT counselling is significantly associated with consistent condom use and should therefore be advocated to augment efforts towards fighting sexual and perinatal HIV transmission.

Background. Point-of-care (POC) viral load (VL) tests provide results within hours, enabling same-day treatment interventions. We assessed treatment outcomes with POC vs standard-of-care (SOC) VL monitoring. Methods. We implemented a randomized controlled trial at an urban and rural hospital in Nigeria. Participants initiating antiretroviral therapy (ART) were randomized 1:1 for monitoring via the POC Cepheid Xpert or SOC Roche COBAS (v2.0) HIV-1 VL assays. Viral suppression (VS) and retention in care at 12 months were compared via intention-to-treat (ITT) and per-protocol (PP) analyses. Post-trial surveys for POC patients and healthcare workers (HCWs) evaluated acceptability. Results. During April 2018-October 2019, 268 SOC and 273 POC patients enrolled in the trial. Viral suppression at <1000 copies/mL at 12 months was 59.3% (162/273) for POC and 52.2% (140/268) for SOC (P = .096) in ITT analysis and 77.1% (158/205) for POC and 65.9% (137/208) for SOC (P = .012) in PP analysis. Retention was not significantly different in ITT analysis but was 85.9% for POC and 76.9% for SOC (P = .02) in PP analysis. The increased VS in the POC arm was attributable to improved retention and documentation of VL results. POC monitoring was preferred over SOC by 90.2% (147/163) of patients and 100% (15/15) of HCWs thought it facilitated patient care. Conclusions. POC VL monitoring did not improve 12-month VS among those with results but did improve retention and VS documentation and was preferred by most patients and HCWs. Further research can inform best POC implementation conditions and approaches to optimize patient care.

Background There appears to be a bilateral relationship between HIV infection and intestinal helminthic infection. However, there is a paucity of data comparing the determinants of intestinal helminthic infection in the human immunodeficiency virus (HIV) sero-positive and sero-negative adults. Methods A cross-sectional study was conducted where eight hundred HIV sero-positive adults were recruited with an equal number of matched controls from two sites into the study from January to December 2015. Data were collected using a structured interviewer-administered questionnaire and stool samples were screened for intestinal helminths using the Kato-Katz method. Results The prevalence of intestinal helminths was 16.3% and 16.4% among the HIV sero-positive and sero-negative population respectively. Bivariate analysis showed that there was a significant association between treatment of drinking water and presence of intestinal helminthiasis in the HIV sero-positive population (OR=0.67, 95% confidence interval, CI 0.45-1.00 P=0.05) whereas the location of residence (OR=1.77, CI=1.21-2.58 P=0.00) and whether fruits and vegetables are washed or not before eating (OR=2.84, CI=1.18-6.83 P=0.04) were associated with having intestinal helminths in the HIV sero-negative population. A binary logistic regression showed that in the HIV infected arm, drinking untreated water (OR=1.60, CI=1.06 – 2.42) was a determinant of intestinal helminths infection. Having more than a primary school education (OR=0.61, CI=0.38-0.97) and residing in the rural area (OR=1.78,CI=1.21-2.60) were determinants in the HIV sero-negative arm. Conclusions There was no significant difference in the prevalence of intestinal helminths between the HIV sero-positive and sero-negative populations. However, the determinants associated with human intestinal helminthic infection differed significantly between the two populations. Strategies to eliminate intestinal helminths in these populations have to be contextualised appropriately taking into account wider social determinants.

The Human Immunodeficiency Virus pandemic is negatively affecting the reproductive health of women in Nigeria. It is associated with increased morbidity and mortality, especially where secondary infections exist. Studies document that HIV positive women are prone to reproductive and urinary tract infections, and due to physiologic changes in pregnancy, there is higher incidence of urinary infections among pregnant women, with or without symptoms. This prospective cohort study investigates for asymptomatic bacteriuria in pregnancy among HIV seropositive women, to identify if HIV positivity confers additional risks for occurrence. We recruited 119 pregnant HIV positive women and 152 HIV negative controls from Jos University teaching hospital and Faith Alive hospital in Jos, Nigeria and screened for asymptomatic bacteriuria. Bacteriuria was confirmed when two separate urine samples, in the same woman, showed presence of 105 CFU/ml (100,000 organisms) of same species. Laboratory personnel performing tests were unaware of participants HIV status. Antibiotic sensitivity were determined and participants were followed-up/evaluated for features of pyelonephritis throughout antenatal care. Prevalence was determined and analysis to determine if HIV positivity conferred risks. There were 22 women with confirmed bacteriuria, with prevalence of 8.1% among all participants, with 9.4% (14) among HIV Negative cohort and 6.8% (8) of HIV positive women. HIV status, demography and previous pyelonephritis/UTI were not statistically associated with development of asymptomatic bacteriuria. Two women with medical conditions (Diabetes and Sickle cell disease) had confirmed bacteriuria, but numbers were insufficient to deduce an association. Staphylococcus aureus predominated (78.6%) among HIV negative, while for HIV positive women, Escherichia coli and Staphylococcus aureus each affected 44.4%. Antibiotic sensitivity favoured Cefuroxime in both HIV positive and negative women, but organisms were resistant to penicillins and Nitrofurantoin. Treatment was not possible because of antibiotics cost and/or unwillingness of participants to receive treatment for an asymptomatic condition. Analysis of the HIV positive cohort showed no further conferment of risk by CD4 counts, viral load, duration of HIV positivity, the anti-retroviral drug type/class or duration/adherence to ARVs. No woman with CD4 count >500 cells/mm3 developed asymptomatic bacteriuria but there was no statistical association. Similarly, women who had undetectable viral load had lower bacteriuria rates, while women with high viral load had higher rates of asymptomatic bacteriuria, but this was only significant when analysis was performed using the logarithm of viral load.

Background In Nigeria, the effect of Hepatitis B virus (HBV) on long-term liver outcomes in persons with HIV (PLH) has not been described. We determined changes in liver stiffness measure (LSM) using transient elastography over 6 years in HIV mono-infected and HIV-HBV co-infected Nigerians initiating antiretroviral therapy (ART) and factors associated with LSM decline. Methods This single centre, cohort study enrolled ART-naïve HIV mono- and HIV-HBV co-infected adults (≥18 years) at the APIN Public Health Initiatives–supported HIV Care and Treatment Centre at Jos University Teaching Hospital, Nigeria, from 7/2011 to 2/2012. LSM at baseline, Years 3 and 6 were analysed using longitudinal models to estimate changes over time and their predictors. Results Data from 100 (31%) HIV-HBV co-infected and 225 (69%) HIV mono-infected participants were analysed. Median LSM at baseline was 6.10 (IQR: 4.60–7.90) kPa in co-infected and 5.10 (IQR: 4.40–6.10) kPa in mono-infected participants. In adjusted analyses, average LSM was not significantly different between Year 0 and 3 (β = 0.02, −0.22 to 0.26, p = 0.87 and Year 0 and 6 (β = −0.02, −0.23 to 0.27, p = 0.88) in both groups ( p>0.05), but co-infected participants had significantly higher LSM than mono-infected throughout follow-up (β = 0.018, 0.019–0.28, p < 0.001). Year 3 LSM differed according to ART initiation status by Year 3 (initiators - non-initiators: −0.87, −1.70 to −0.29). Conclusion In this cohort, LSM remained higher among HIV-HBV co-infected versus HIV mono-infected participants throughout follow-up. Our findings emphasize the continuing need for monitoring of liver outcomes in HIV-HBV co-infected populations on ART and the importance of preventing HBV infection among PLH to optimize liver health.

Transmission of Human Immunodeficiency Virus from a pregnant HIV-infected woman to her unborn child is one of the ways through which new HIV infections can be acquired. Utilization of contraceptives among HIV-positive women can prevent unintended pregnancies, and the use of dual methods reduces the risk of transmission of sexually transmitted infections including HIV, hence the need to support contraception in them. This study sought to describe the various choices of contraception used by women accessing family planning services integrated with the antiretroviral therapy facility of Jos University Teaching Hospital. In a retrospective study, relevant information was extracted from the records of all women who had sought contraception in the Family Planning unit of the facility from 1st March 2019 – 29th February 2020. The data obtained was analysed using EPI info 7 statistical software. Results: A total of 137 records were reviewed. The most frequent choice of contraception was hormonal implants (61.3%), while the least frequent choice was using condoms alone (1.5%). Less than half (46.7%) of them used dual contraception. Secondary and tertiary educational status, as well as disclosure of HIV-positive status to partner were significantly associated with utilization of dual contraceptive methods (P value =0.0010 and 0.0245 respectively; Odds ratio =5.8199 and 4.3307 respectively). Conclusion: Integration of family planning services with HIV care as a strategy for the prevention of unintended pregnancy is promoted in this facility but there is need to improve the uptake particularly of dual method of contraception. There is also need for inclusion of IUCD in the choices of contraception offered as this method is highly effective, long lasting and has been proven to be safe in well selected HIV patients. Furthermore, screening the clients to identify unmet needs and implementing strategies to meet those needs would enhance the impact of family planning.

Clinical depression has been associated with various chronic disease conditions. The chronic course of HIV, fostered by the use of antiretroviral therapy in infected patients, puts them at risk of developing clinical depression which unfortunately, is often underdiagnosed and therefore undertreated. The study estimated the prevalence of depression and associated factors amongst adult patients receiving antiretroviral therapy in a clinic in Jos, using the PHQ-9 questionnaire. Three hundred and fourteen patients with a mean age of 45 ± 10 years were enrolled in a descriptive cross-sectional study. There were 63 males and 251 females, with mean known duration of HIV infection of 11 ± 4 years. Depression was found to be common in the group. Thirty one percent of the patients had depression, and of these, 83 (85%) had mild depression while 12 (12%) had moderate depression and 3 (3%) had moderately severe depression. The factors associated with depression in these patients were analysed using logistic regression. Female gender (P=0.02) as well as age equal to or greater than 45 years (P= 0.03) were shown to be significantly associated with depression. When encountered in such patients, the factors identified to be associated with depression, should serve not only to raise the index of suspicion towards this diagnosis but should also prompt the need to screen for depression. This will contribute to enhancing the chances of diagnosing and treating depression in HIV.

The chronicity of HIV infection predisposes the infected to mental health problems such as depression that demand a need for social support. The perception of social support is key to its beneficial effects. This study aimed to assess the level of perceived social support and its association with depression among patients infected with HIV in a hospital in Jos, Nigeria. In a cross-sectional study, 386 participants selected by systematic random sampling were interviewed to obtain their sociodemographic information, and they were assessed for perceived social support and depression using the Multidimensional Scale of Perceived Social Support and the PHQ-9 Questionnaire respectively. Data was analysed using Epi info version 7. Half the proportion of participants (50.5%) had a moderate level of perceived social support, while 39.9% and 9.6% had low and high levels of perceived social support respectively. Female gender, age ≥ 45 years, absence of a history of being affiliated with a HIV support group, low educational status, low income, unemployment and shorter duration of known HIV diagnosis were negatively associated with lower levels of perceived social support. The prevalence of depression was 32.6%, and lower levels of perceived social support were significantly associated with depression. The results suggest gaps in the social support needs of the participants. This highlights a need for interventions aimed at improving the perception of social support among people living with HIV. Further studies are needed to identify those unmet needs so as to device strategies to address them in order to close the gaps in perception and enhance mental health in HIV care.

Background : Hypertension is a major risk factor for cardiovascular disease, yet many health care workers rarely check their blood pressure. The detection of hypertension among health care workers is key to prevention of hypertension, its attendant complications in the community and a strategy for health care workers retention. Objective : To determine the prevalence and correlates of undiagnosed hypertension among health care workers in a secondary health care facility. Methods : Using a structured questionnaire, sociodemographic variables and risk factors for hypertension were obtained. Measurements of blood pressure, weight, height and waist circumference were carried out and body mass index calculated. Results : The prevalence of hypertension was 41.9%. The prevalence of undiagnosed hypertension was 35.1%. Multivariate analysis showed that age greater than 42 years (OR=0.24; 95%CI: 0.10-0.72) is a significant correlate of undiagnosed hypertension. Those who self-reported that they had been diagnosed to have hypertension were 15.5% of the study population. Among those who had self-reported hypertension, 79.1% were found to have hypertension by the researchers while among those who had no history of hypertension, 35.1% were hypertensive. When a history of hypertension is used as a screening test for the diagnosis of hypertension, it gave a sensitivity of 29.2%, a specificity of 94.4%, a positive predictive value of 79.1%, a negative predictive value of 64.9% and an accuracy of 67.1%. Conclusion : One in three persons had undiagnosed hypertension and those who were over 42 years are at risk for undiagnosed hypertension. This calls for urgent workplace strategies to create more awareness as a prevention and control strategy for the facility and the general population. Key words :

Abstract Background Older age at initiation of combination antiretroviral therapy (cART) has been associated with poorer clinical outcomes. Our objectives were to compare outcomes between older and younger patients in our clinical cohort in Jos, Nigeria. Methods This retrospective cohort study evaluated patients enrolled on cART at the Jos University Teaching Hospital, Nigeria between 2004 and 2012. We compared baseline and treatment differences between older (≥50 years) and younger (15–49 years) patients. Kaplan-Meier analysis and Cox proportional hazard models estimated survival and loss to follow-up (LTFU) and determined factors associated with these outcomes at 24 months. Results Of 8352 patients, 643 (7.7%) were aged ≥50 years. The median change in CD4 count from baseline was 151 vs 132 (P = .0005) at 12 months and 185 vs 151 cells/mm3 (P = .03) at 24 months for younger and older patients, respectively. A total of 68.9% vs 71.6% (P = .13) and 69.6% vs 74.8% (P = .005) of younger and older patients achieved viral suppression at 12 and 24 months, with similar incidence of mortality and LTFU. In adjusted hazard models, factors associated with increased risk of mortality were male sex, World Health Organization (WHO) stage III/IV, and having a gap in care, whereas being fully suppressed was protective. The risk of being LTFU was lower for older patients, those fully suppressed virologically and with adherence rates >95%. Male sex, lack of education, WHO stage III/IV, body mass index <18.5 kg/m2, and having a gap in care independently predicted LTFU. Conclusions Older patients achieved better viral suppression, and older age was not associated with increased mortality or LTFU in this study.

We compared the prevalence of menopause symptoms between women living with HIV to their HIV-negative peers and determined predictors of severe menopause symptoms in Jos, Nigeria. This descriptive cross-sectional study included 714 women aged 40–80 years. We compared prevalence and severity of menopause symptoms using the menopause rating scale (MRS). Logistic regression analysis was used to determine the predictors of severe symptoms. Six-hundred and seven (85.0%) were HIV-positive, with a mean duration of infection of 5.6 ± 2.7 years. The mean age of the cohort was 46 ± 5 years. The most prevalent menopause symptoms were hot flushes (67.2%), joint and muscle discomfort (66.2%), physical/mental exhaustion (65.3%), heart discomfort (60.4%), and anxiety (56.4%). The median MRS score was higher for HIV-positive compared to HIV-negative women (p = 0.01). Factors associated with severe menopause symptoms included HIV-positive status (aOR: 3.01, 95% CI: 1.20–7.54) and history of cigarette smoking (aOR: 4.18, 95% CI: 1.31–13.26). Being married (aOR: 0.49, 95% CI: 0.32–0.77), premenopausal (aOR: 0.60, 95% CI: 0.39–0.94), and self-reporting good quality of life (aOR: 0.62. 95% CI: 0.39–0.98) were protective against severe menopause symptoms. We found HIV infection, cigarette smoking, quality of life, and stage of the menopause transition to be associated with severe menopause symptoms. As HIV-positive populations are aging, additional attention should be given to the reproductive health of these women.

Objective: To describe the prevalence of female sexual dysfunction (FSD) and its determinants among women with HIV infection enrolled for care and treatment in an ambulatory care setting.Methods: A questionnaire-based cross-sectional survey was conducted among women attending the HIV clinic of Jos University Teaching Hospital, Nigeria, between March 2013 and February 2014. The self-administered Female Sexual Function Index (FSFI) was used to assess FSD; a score of less than 26.55 indicated FSD. Pearson coefficient was used to assess interdomain correlation, and multiple linear regression was used to identify factors associated with FSD.Results: Among 370 participants, 330 (89.2%, 95% confidence interval [CI] 85.6%-92.2%) had FSD. The overall median FSFI score was 19.2 (interquartile range [IQR] 6.4-23.9). The arousal domain had the lowest subscore (median 2.7, IQR 0.0-3.6). The highest interdomain correlations were between lubrication and orgasm (r=0.87), arousal and lubrication (r=0.84), and arousal and orgasm (r=0.81) domains. Satisfactory health (=3.34, 95% CI 1.16-5.52) and history of alcohol use (=2.38, 95% CI 0.28-4.47) were independently associated with FSD.Conclusion: FSD was prevalent among women with HIV infection. Care providers need to routinely address FSD as part of a comprehensive care package in the study setting.

Due to similar routes of transmission, human immunodeficiency virus infection is often associated with the risk of co-infection with hepatitis B and/or C virus infection, the consequence of which is an accelerated progression to chronic liver disease. Screening for hepatitis and early commencement of antiretroviral therapy with tenofovir-based dual Nucleoside Reverse Transcriptase Inhibitor (NRTI) backbone has been recommended for co-infected persons as this could reduce the disease burden in them. Unfortunately, in developing countries, due to financial constraints, very few HIV care programs can provide these benefits for their patients. This study was undertaken at a center where hepatitis screening and tenofovir-based regimen were available, and aimed to assess the presence of co-infection with Hepatitis B and/or Hepatitis C in a population of HIV patients, and its impact on the choice of NRTI backbone in the patients’ antiretroviral regimen. Methods: After excluding 12 records due to missing hepatitis screening results, data of 140 HIV-infected patients enrolled at the Jos University Teaching Hospital antiretroviral therapy (ART) clinic, who also received home based care from September 2008 to December 2013, were reviewed. Relevant information was extracted and analyzed using Epi info version 7. Results: Of 140 patients, 22.8% and 8.6% tested positive to HBV and HCV respectively, while 4.3% tested positive to both HBV and HCV. The age group 30-39 years had the highest frequency of those co-infected. More females tested positive to HBV (71.9%) and HCV (66.7%), but equal proportions of both genders had both HBV and HCV (50%). Of those who tested positive to hepatitis (81.6%) were on ART as follows: 22 (84.6%) of HBV co-infected, 3 (50%) of HCV co-infected and 6 (100%) of HBV/HCV co-infected were on the recommended ART regimen that contained dual NRTI backbone while 3 (11.5%) of HBV co-infected and 1(16.7%) of HCV co- infected were on ART regimen with the less ideal mono NRTI backbone. Three (eight percent) patients with hepatitis (1 HBV and 2 HCV) were not on ART. Conclusion: The rate of co-infection with HBV and HCV was high among these patients, and consequently, a majority of them were on the recommended dual NRTI backbone regimen. This reflects a reasonable extent of conformity with recommendations for HIV-hepatitis care. There is however a need to evolve improved strategies to ensure that, all patients are screened and placed on the appropriate regimen.

Objectives: Effective antiretroviral therapy has prolonged the survival of patients with HIV. Accordingly, studies of the consequences of ageing are increasingly important. We determined the prevalence of early menopause (EM) and its associated factors in a cohort of HIV-infected and HIV-negative controls in Jos, Nigeria. Methods: HIV-infected women accessing care in an ambulatory setting and their negative counterparts from the general population were included. Menopause was defined as having gone one year since the last menstrual period. EM was defined as the onset of menopause at <= 45 years of age. Baseline characteristics were compared and logistic regression analyses were used to determine factors independently associated with EM. Results: Out of a total of 253 women included, 58 attained menopause early, giving an EM prevalence of 22.9% (95% confidence interval [CI] 17.9-28.6%). Women with EM were younger (P<0.001) and had been infected with HIV for a shorter period (P=0.007). Baseline CD4+ cell count (P=0.66) and viral load (P=0.15) were similar among those with and without EM. For all subjects, HIV infection (adjusted odds ratio [AOR]=10.95, 95% CI 1.39-86.33) and sexual activity (AOR=2.37, 95% CI 1.24-4.52) were associated with EM while early menarche (AOR=14.88, 95% CI 1.37-161.10) and sexual activity (AOR=2.02, 95% CI 1.03-3.96) were independently associated with EM. Conclusion: Over a quarter of our postmenopausal women attained menopause early. No HIV-related factor predicted EM in this study. A better understanding of ageing in these women is important to determine a more appropriate disease-management approach during this period of life.

Home based care (HBC) is a key component of care and support for people infected with human immunodeficiency virus (HIV). Understanding the pattern of HBC needs in a population is beneficial in planning and providing optimal HBC services for the people. This retrospective study assessed the pattern of home based care needs and services in patients of the adult antiretroviral therapy (ART) clinic of Jos University Teaching Hospital (JUTH), Jos, Nigeria. All documented home based care visits to patients of the clinic from September 2008 to December 2013 were reviewed. Relevant information was obtained from the patients’ clinical and home visit records. Data was analysed using Epi info version 7 statistical software. A total of 152 patients with 542 home visits were reviewed. There were 112 (73.7%) females and 40 (26.3%) males, with a mean age of 34±8.9 years at the time of initial home visits. The three commonest primary reasons for home visits were psychological counselling (22.7%), adherence counselling (15.5%) and ill-health (12.4%), while follow up visits accounted for 32.5% of the home visits. The 3 most frequent services provided during home visits were counselling on clients medication for adherence (77.5%), basic nursing care (61.6%), and psychological counselling (41.5%). By December 2013, out of 152 patients reviewed, 61.8% were alive, 15.1% had died and 23.1% were lost to follow up. The services provided during home visits extended beyond the patients’ perceived needs (primary reasons for visit). Home based care brings to light some patient needs that may not be evident or catered for at the facility level of care. This supports the endorsement of home based care as a useful strategy to complement facility care towards achieving an overall patient well-being. Key words: Home based care, human immunodeficiency virus (HIV), adult, Nigeria.

Scabies is a common skin infestation, endemic in developing countries, usually affecting families and large groups of people living together. The intense discomfort caused by the primary disease, the life threatening complications from secondary bacterial infection, along with the challenges and costs of correct diagnosis and proper treatment make it a public health problem. Sufficient knowledge about scabies by healthcare professionals is an essential tool in fighting the scourge of scabies. Methods: We undertook a survey to assess the level of knowledge about scabies among clinical medical students, potential doctors who had completed postings in dermatology and paediatrics where the subject of scabies is routinely taught, with the aim of identifying any possible needs for an improved education on this topic. Self-administered questionnaires were distributed to a cohort of clinical medical students in a university, selected by multi-staged random sampling. Results: Of 140 medical students surveyed, the overall mean knowledge score was 7.8±2.4 out of a maximum of 14 correct answers. Only 13(9.3%) of them had satisfactory scores (≥ 75%). Neither gender, number of years in medical school or having seen at least one clinical case of scabies influenced the knowledge. Conclusion: There exists a poor knowledge of scabies among clinical students who are potential doctors.

OBJECTIVE To determine the prevalence and risk factors for chronic obstructive pulmonary disease (COPD) among HIV-infected adults in Nigeria. DESIGN Cross-sectional study. METHODS HIV-infected adults aged ≥ 30 years with no acute ailments accessing care at the antiretroviral therapy clinic of Jos University Teaching Hospital were enrolled consecutively. Participants were interviewed to obtain pertinent demographic and clinical information, including exposure to risk factors for COPD. Post-bronchodilator spirometry was carried out. HIV related information was retrieved from the clinic medical records. COPD case-definition was based on the Global Initiative for Obstructive Lung Disease (GOLD) criteria using post-bronchodilator FEV1/FVC <0.7. COPD prevalence was also calculated using the lower limit of normal for FEV1/FVC criteria (LLN) from the European Respiratory Society normative equation. Factors associated with COPD were determined using logistic regression models. RESULTS Study population comprised 356 HIV infected adults with mean age of 44.5 (standard deviation, 7.1) years and 59% were female. The mean time elapsed since HIV diagnosis was 7.0 (SD, 2.6) years and 97.5% of the respondents were on stable ART with virologic suppression present in 67.2%. Prevalence of COPD were 15.4% (95% confidence interval [CI] 11.7-19.2), 12.07% (95% CI 8.67-15.48), 22.19% (95% CI 18.16-26.83) using GOLD, ERS LLN and GLI LLN diagnostic criteria respectively. In multivariate analyses adjusting for gender, exposure to cigarette smoke or biomass, history of pulmonary tuberculosis, use of antiretroviral therapy, current CD4 T-cell count and HIV RNA, only age > 50 years was independently associated with COPD with OR 3.4; 95% CI 1.42-8.17 when compared to ages 30-40 years. CONCLUSION HIV-associated COPD is common in our population of HIV patients.