Adaptation plays a critical role in implementation science (IS) by optimizing the fit of evidence-based interventions (EBIs) to local contexts and populations. Adaptation is especially relevant in digital health, where technologies, user preferences, and needs evolve rapidly. Yet, methodological approaches to guide and document adaptation processes are seldom included. Grounded in an IS framework, we describe a multi-phase process and results for the adaptation of a digital health intervention (DHI) for HIV prevention and treatment for sexual and gender minority (SGM) youth in Malawi, Kenya, Nigeria, and Zambia. Guided by the Assessment, Decision, Administration, Production, Topical Experts, Integration, Training, and Testing (ADAPT-ITT) model, we adapted the EBI HealthMpowerment (HMP) DHI for SGM youth. We conducted eight focus group discussions with SGM youth (N = 80) living with or at risk for HIV and four with other key experts (N = 29) to inform app adaptations. Rapid qualitative analyses were conducted, and the findings were summarized using the Mobile App Rating Scale. Subsequently, we conducted beta testing with 40 SGM youth to assess the app’s usability with the validated System Usability Scale. The data were collected from June 2024 to April 2025. Most HMP adaptations were within two domains of the Mobile App Rating Scale: Engagement and Information Quality. Engagement adaptations focused on increasing support and reducing provider response times through the app, along with added gamification. Information Quality adaptations focused on expanding resources (e.g., mental health, economic strengthening) and ensuring that healthcare referrals made via the app were to SGM-competent providers. Functionality enhancements included adding content in local languages and integrating WhatsApp. Data safety was prioritized and addressed by creating an emergency lockout code. For Subjective Quality, participants perceived the app favorably for its support for medication adherence. Results from the beta testing indicated a score of 70.0, indicating above-average usability. Modifications were made to the ADAPT-ITT model to embed consultations with key experts throughout the different phases. The HMP app was collaboratively and iteratively adapted with SGM youth and key partners. This methodological approach enhances HMP’s functionality, quality, and safety, increasing the likelihood of success in future trials and scale-up. NCT06350682. Registered on February 20, 2024. https://reporter.nih.gov/project-details/11373152

In Nigeria, sexual and gender minorities (SGM) experience disproportionately high rates of depression, exacerbated by layered stigma related to gender identity and HIV status. However, little is known about how HIV status may modify the relationship between gender identity and depression in this context. We conducted a cross-sectional analysis using baseline data from 977 SGM participants recruited through respondent-driven sampling at an SGM-friendly clinic in Abuja, Nigeria (2023-2024). Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9), with scores ≥10 indicating major depression symptomatology. We employed multivariable logistic regression to examine associations between gender identity, HIV status, and depression, including interaction effects. Overall, 18% of participants exhibited major depression symptomatology. Depressive symptoms were more common among transgender women (25%) and non-binary individuals (26%) than cisgender men (16%), and higher among persons living with HIV (PLHIV; 20%) compared to those without (15%). In adjusted models, both transgender women (aOR 2.05; 95% CI: 1.09-3.88) and non-binary individuals (aOR 2.38; 95% CI: 1.43-3.95) had higher odds of depression than cisgender men. Financial insecurity (aOR 5.78; 95% CI: 3.77-8.86) and employment (aOR 1.73; 95% CI: 1.18-2.52) were also independently associated with depression. Notably, the joint effect of non-cisgender identity and HIV was supra-additive: PLHIV who were non-binary had an aOR of 4.10 (95% CI: 2.16-7.77) for depression, with a relative excess risk due to interaction (RERI) of 2.96. HIV status modifies the association between gender identity and depression among SGM in Nigeria. These findings underscore the need for intersectional, stigma-informed mental health interventions and affirming care models that address the unique vulnerabilities faced by PLHIV with non-cisgender identities.

Background Sexual minority men (SMM) in Nigeria face a disproportionate burden of HPV-related diseases, yet HPV vaccination uptake remains limited due to structural, financial, and sociocultural barriers. Understanding SMM's preferences for vaccination delivery is critical to designing accessible, affirming, and equitable prevention strategies. Methods A discrete choice experiment (DCE) was conducted with 250 SMM receiving HIV-related care at an affirming clinic in Abuja, Nigeria. Seven attributes were identified through literature review and stakeholder engagement. Participants completed 12 choice tasks comparing hypothetical HPV vaccination scenarios. Hierarchical Bayes estimation was used to derive individual-level utilities and attribute importance scores. Results Participants strongly preferred receiving HPV-related services in SMM-affirming settings and at no cost. Setting type (19.4%) and cost (19.2%) were the most influential attributes, followed by wart prevention (11.4%) and information availability (7.8%). Services described as protecting others from HPV-related outcomes, prevent warts, and require moderate travel (60 min) were moderately preferred. Higher levels of vaccine protection and information availability were less influential in decision-making. Conclusions Preferences among SMM in Nigeria emphasize the need for free, affirming, and inclusive HPV vaccination services. Addressing structural barriers, especially stigma and cost, will be essential to increasing vaccine uptake. Findings support targeted, community-informed strategies to reduce HPV disparities and promote health equity.

Context-specific adaptation of implementation strategies is an important component of promoting evidence-based intervention use. But guidance on systematic approaches is limited. Here we described our mixed method approach to adapting (Study 1) and monitoring (Study 2) a champion implementation strategy to improve implementation of anal cancer prevention procedures at an HIV clinic in Abuja, Nigeria. Building from existing literature, in Study 1, an implementation team of eight Nigerian stakeholders adapted a champion implementation strategy model. Team members ranked different attributes in terms of their importance for defining the strategy. The responses were aggregated and presented to the team who then discussed until consensus was reached on the operationalization of the strategy. In Study 2 we monitored the implementation of the strategy by one champion over six weeks by collecting daily checklists and weekly reflections from the champion. Study 1 team members described the champion as needing to be reliable and confident in using anal cancer prevention procedures, with responsibilities that included providing mentorship and raising awareness. In Study 2 the champion reported engaging in strategy-related activities 75

Clinical trials involving sexual minority adolescents and young men in low- and middle-income countries have historically been limited due to a combination of structural, social, and scientific barriers that often hinder their participation. In addition, researchers lack the cultural competence or knowledge of inclusive recruitment strategies to effectively engage these populations. In this commentary, we describe the experiences, challenges, and opportunities in establishing youth advisory boards as a pathway to entry into the community, overcoming exclusion, building trust, and incorporating the voices of under-served sexual minority adolescents and young men in clinical trials and the development of community-informed interventions. Trial registration: ClinicalTrials.gov NCT06350682. Registered on February 10, 2026.

Abstract Background This study examined the role of emotional support networks in shaping health-related communication among sexual minority men (SMM) living with HIV in Nigeria, a context where criminalization and stigma limit social integration and access to care. We conducted a cross-sectional survey of 250 SMM receiving HIV care at an SMM-affirming clinic in Abuja. Methods Participants completed a structured questionnaire assessing demographics, HIV-related characteristics, HPV knowledge, anal cancer awareness, and emotional support network composition. Emotional support network attributes were compared by duration of HIV diagnosis (≤ 5 years vs. >5 years), and logistic regression models assessed factors associated with discussing anal cancer within support networks. Results Participants living with HIV for > 5 years had larger emotional support networks and were more likely to report discussing same-sex relationship issues and anal cancer with alters. Discussing same-sex relationships and receiving medical care support from alters were strongly associated with increased likelihood of discussing anal cancer. Network density (e.g., how well alters know one another) did not differ by duration of HIV diagnosis. Conclusion These findings highlight the influence of interpersonal trust and relationship context on communication about stigmatized health topics. Leveraging emotional support networks, particularly for individuals newly diagnosed with HIV, may strengthen engagement in preventive cancer care and improve health outcomes for SMM in hostile sociopolitical environments.

Background Sexual minority men (SMM) living with HIV face an elevated risk of anal cancer, and SMM-affirming HIV clinics serve as vital entry points for cancer prevention. We evaluated human papillomavirus (HPV) knowledge, vaccine acceptability and whether time living with HIV was associated with anal cancer symptom awareness.Methods A cross-sectional survey was conducted at an HIV clinic offering anal cancer prevention in Abuja, Nigeria. Descriptive statistics were used to summarize HPV knowledge and vaccine acceptability. Multivariable negative binomial regression evaluated the number of anal cancer symptoms correctly reported using adjusted prevalence ratios (aPR) and 95% confidence intervals (CIs).Results Among 249 SMM living with HIV, 20.5% reported having heard of HPV. Fewer than 20% correctly identified key anal cancer symptoms, including anal bleeding (15.7%) and a lump or mass in the anus (16.9%). Time living with HIV was initially associated with anal cancer symptom awareness, but not after adjustment (aPR 1.02, 95% CI 0.98-1.07). Other independent predictors of anal cancer symptom awareness were anal cancer screening (aPR 1.51, 95% CI 1.15-1.97) and knowing HPV vaccine can prevent anal cancer (aPR 1.52, 95% CI 1.18-1.98). Despite low HPV awareness, 93.6% of participants reported willingness to receive HPV vaccine.Conclusion Integrating cancer prevention services into SMM-affirming HIV care may offer an opportunity to strengthen HPV-related knowledge and reduce cancer disparities.

SARS-CoV-2 population-based seroprevalence surveys are useful for estimating the extent of SARS-CoV-2 infections, which may be underestimated by COVID-19 case counts. Surveys conducted in October 2020 in four Nigerian states showed that SARS-CoV-2 seroprevalence ranged from 9.3% in Gombe (northeast) to 25.2% in Enugu (southeast) after the first COVID-19 wave, more than 100 and 700 times higher than the official number of COVID-19 cases in these two states, respectively. We conducted a serosurvey after the second COVID-19 wave to evaluate the extent of SARS-CoV-2 infections, attitudes to COVID-19 vaccines, and COVID-19 vaccination coverage in two regions of Nigeria. Using the World Health Organization (WHO) Unity protocol, 34 enumeration areas (EAs) each in the Federal Capital Territory (FCT) (Northcentral Zone) and Kano State (Northwest Zone) were sampled in June 2021, using probability proportional to estimated size; 20 households in one EA were randomly selected. All consenting and assenting members of a household were asked about risk behaviors; adults who were 18 years and above (the eligible population for COVID-19 vaccination in Nigeria) responded to questions on COVID-19 vaccine attitudes and receipt. Blood and nasal/oropharyngeal samples were taken from all consenting and assenting household members. Blood samples collected were tested with the Luminex xMAP® SARS-CoV-2 Multi-Antigen IgG Assay and swabs by reverse-transcriptase-PCR (RT-PCR). Overall response rates were 76.8% in the FCT (n = 1,505 blood draws) and 80.4% in Kano State (n = 2,178 blood draws). Following the second COVID-19 wave in Nigeria, more than 40% of residents in the FCT (40.3%, 95% CI: 34.7–45.9) and Kano State (42.6%, 95% CI: 39.4–45.8) had evidence of prior SARS-CoV-2 infection. There were no active SARS-CoV-2 infections detected by RT-PCR in either the FCT or Kano State. In the FCT and Kano State, 3.4% and 1.6% of people surveyed reported receipt of any COVID-19 vaccine, three months after vaccines were available in country. In the FCT, 77.5% of adults were aware of COVID-19 vaccines, of whom 46.9% reported willingness to receive them. In Kano State, 48.7% of adults were aware of COVID-19 vaccines, of whom 61.1% were willing to receive them. In both regions, about 84% of those reporting unwillingness to accept COVID-19 vaccines cited concerns over vaccine safety. “Serosurvey findings revealed that SARS-CoV-2 infection was far more widespread in both the Federal Capital Territory and Kano State than indicated by reported case numbers. Despite high awareness, COVID-19 vaccine uptake remained low, primarily due to concerns about vaccine safety. These results highlight the urgent need for targeted risk communication to address vaccine hesitancy and improve coverage. Serosurveys provide valuable insights that can guide public health interventions and future pandemic preparedness in Nigeria.”

BACKGROUND:To generate COVID-19 vaccine safety data in Nigeria, passive reporting was supplemented with cohort event monitoring (CEM), an active surveillance system. We described reactogenicity within 7 days and adverse events up to 3 months after each AstraZeneca or Moderna COVID-19 vaccine dose while assessing the feasibility of implementing CEM in a low- to middle-income country (LMIC) during a mass vaccination campaign. METHODS:Participants were aged ≥18 years with access to mobile phones who received the first dose of an authorized COVID-19 vaccine from participating health facilities in 6 states of Nigeria during September and October 2021. Data collectors interviewed participants via phone on days 0, 3, 7, and thereafter every 7 days for 3 months. The same schedule was restarted if a participant received a second vaccine dose. Proportions of participant-reported adverse events following COVID-19 vaccine receipt were calculated. Investigation and causality assessment were conducted on deaths using the World Health Organization causality guidelines. RESULTS:We enrolled 12,317 participants (AstraZeneca 6990; Moderna 5327); 6167/6990 (88.2 %) AstraZeneca and 4879/5327 (91.6 %) Moderna recipients completed a follow-up interview days 0-7 after the first dose; among them, 2685/6167 (43.5 %) AstraZeneca and 3533/4879 (72.4 %) Moderna recipients reported local reactions and 2456/6167 (39.8 %) AstraZeneca and 2087/4879 (42.8 %) Moderna recipients reported systemic reactions. Overall, 3891/6990 (55.7 %) AstraZeneca and 3978/5327 (72.8 %) Moderna recipients received a second dose of COVID-19 vaccine, among whom 897/3891 (23 %) AstraZeneca and 1979/3978 (49.7 %) Moderna recipients reported local reactions and 727/3891 (18.7 %) AstraZeneca and 1680/3978 (42.2 %) Moderna recipients reported systemic reactions. Among all enrolled, 11 died; there was no evidence to suggest any deaths were vaccine-related. CONCLUSIONS:No unexpected patterns of adverse events were detected, providing additional data on the safety of these COVID-19 vaccines in Nigerian adults. We demonstrated that implementing CEM was feasible and may be valuable for safety monitoring of vaccines introduced in LMICs.

Anal cancer poses a significant risk for sexual minority males (SMM) living with HIV, with a 100-fold higher incidence compared to the general population. Despite success in high-income settings, training on anal cancer prevention in Africa faces challenges due to limited resources and lack of trained practitioners. We evaluated adapting training using an implementation science framework in a Nigerian SMM-friendly clinic. The Consolidated Framework for Implementation Research (CFIR) Card Game assessed barriers to training on anal cancer prevention. Stakeholders ranked the importance of different CFIR constructs. Sessions were conducted separately for internal stakeholders, external stakeholders, and patients. Facilitators identified barriers using culturally adapted text and a hybrid format for consensus discussion. Potential strategies to overcome the barriers were identified with the CFIR-Expert Recommendations for Implementing Change (ERIC) Matching Tool. The CFIR card game was conducted in August 2023 with 20 participants (Internal: 4, External: 8, Patients: 8). Internal stakeholders identified adaptability, cost, and the absence of external change agents. External stakeholders highlighted adaptability, design quality, and financial burden, proposing advocacy and local discussions. Patients expressed concerns about adaptability and external policies affecting trust and acceptance, emphasizing strategic adaptations and local involvement. The CFIR-ERIC Matching Tool recommended identifying champions and altering incentives as strategies. Incorporating champion roles, local adaptations, policy enforcement, and financial support can enhance training on anal cancer prevention in Nigeria. The findings stress the importance of cultural sensitivity and engagement with local stakeholders to support training practitioners in anal cancer prevention.

Sexual and gender minority people (SGM) in Nigeria experience disproportionate HIV burden, with an HIV prevalence four to ten times higher than the national average. Better understanding the factors that create HIV vulnerability in this population is important for designing effective interventions, particularly in a context largely hostile to SGM. We assessed a conceptual model describing a syndemic of discrimination, material insecurity, depression, substance use, intimate partner violence, and police and other violence among SGM in Abuja, Nigeria. As part of a larger, longitudinal study examining noncommunicable disease outcomes within this population, we conducted a mixed methods analysis using both quantitative intake data (n=515) as well as data from three focus groups (n=36), collected from July 2023 through May 2024. We tested for intercorrelations among syndemic components, and associations between a cumulative syndemic index and HIV status using modified Poisson regression. We also conducted a convergent qualitative assessment of the conceptual model in three focus group discussions. Finally, we examined co-prevalence of syndemic components highlighted in our qualitative findings. There were consistent intercorrelations among syndemic components, supporting the presence of a syndemic. After adjustment for sociodemographic factors, every quartile-unit increase in the syndemic index was associated with an 18% increase in prevalence of HIV (aPR=1.18, 95% CI 1.07, 1.29). Additionally, our qualitative findings highlighted relationships between discrimination, material insecurity, and depression as especially relevant among this population. When using our quantitative data to examine the co-prevalence of pairs of syndemic components identified as particularly salient in our qualitative analyses, nearly every relationship was significantly stronger than expected. We found strong evidence of a syndemic of discrimination, material insecurity, depression, substance use, intimate partner violence, and police and other violence among SGM in Abuja, Nigeria as salient to the health outcomes of SGM in Nigeria. Overall, our findings highlight the presence of a multilevel syndemic that informs multilevel intervention targets. Interventions must target not simply the individual level, but also incorporate larger scale social and structural change efforts.

Background:Discussion of HIV and other sexually transmitted infections among sex partners facilitates risk reduction. We evaluated HIV/STI-related communications, including broad assessment of any self-reported discussion of the topic and specific discussion of each partner's HIV status, among a historically marginalized and presently criminalized community of sexual and gender minorities (SGM) in Nigeria.Methods:From 2013 to 2018, we enrolled SGM aged 18+ years in Lagos or 16+ years in Abuja who reported anal sex with men. At enrollment and 3-, 9-, and 15-month follow-up visits, participants were asked about their sexual behaviors and communications with main sexual partners (MSP) and casual sexual partners (CSP). Questions included "have you talked with your [MSP/CSP] about sexually transmitted infections and HIV?" Multivariable robust Poisson regression with generalized estimating equations was used to estimate adjusted relative risks (aRRs) and 95% confidence intervals (CIs) for factors potentially associated with HIV/STI-related communications with some or all of each type of sexual partner.Results:Among 2795 SGM enrolled with median age 23 years (interquartile range 20-27), questions about HIV/STI-related communications with MSP were answered by 2436 (87.2%) and with CSP by 2398 (85.9%) SGM. Communication with MSP was reported by 68.1% (1659/2436), of whom 897 (54.1%) discussed their own HIV status and 925 (55.8%) discussed their partner's status. Communication with CSP was reported by 43.9% (1052/2398), of whom 389 (37.0%) discussed their own HIV status and 385 (36.6%) discussed their partner's status. Among participants with both MSP and CSP, HIV/STI-related communication with MSP was more common among participants with higher than secondary education [aRR 1.40 (95% CI: 1.24 to 1.58)], who were divorced/separated/widowed [aRR 1.19 (95% CI: 1.06 to 1.33)], who discussed their HIV status with CSP [aRR 1.18 (95% CI: 1.10 to 1.25)], discussed CSP's HIV status [aRR 1.20 (95% CI: 1.13 to 1.27)], and used a condom at last sex with CSP [aRR 1.16 (95% CI: 1.08 to 1.25)]. HIV/STI-related communication with CSP was more common among participants with higher than secondary education [aRR 1.36 (95% CI: 1.12 to 1.66)], who were divorced/separated/widowed [aRR 1.38 (95% CI: 1.13 to 1.69)], who discussed their HIV status with MSP [aRR 1.47 (95% CI: 1.27 to 1.69)], who discussed CSP's HIV status [aRR 1.22 (95% CI: 1.06 to 1.40)], and used a condom at last sex with CSP [aRR 1.22 (95% CI: 1.08 to 1.38)].Conclusions:HIV/STI-related communications with main and casual sex partners were both associated with safer sex with CSP. HIV prevention and treatment programs for SGM should promote open communications in sexual relationships and consider deployment of modern strategies to facilitate disclosure, especially in settings with criminalizing legislation.

Background Human papillomavirus (HPV)-associated cancers are a global concern, particularly for sexual minority men (SMM). Understanding awareness and the determinants of these beliefs is crucial for developing educational programs to reduce HPV-associated cancers. This study explored awareness and determinants of beliefs about HPV's carcinogenicity among SMM living with and without HIV in Nigeria.Methods Participants were recruited through secure social media platforms in Abuja, Nigeria. REDCap surveys captured demographics, sexual practices and participants' beliefs regarding HPV's role in cancer. Multivariable logistic regression modeling was used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI) for the relationships between individual characteristics and belief levels stratified by those living with and without HIV.Results Of 982 participants, the median age was 29 years (interquartile range: 26-34); 64.1% were living with HIV, and 9.7% believed HPV causes cancer. Awareness was highest for anal (82.1%) and penile cancers (15.8%) and less so for oropharyngeal and female HPV-associated cancers (range: 3-7%). Anogenital warts increased the odds of awareness for SMM living with HIV (aOR: 6.4, CI: 3.0-13.6) and for individuals without HIV (aOR: 4.8, CI: 1.6-14.2). Living with HIV for over 6 years was independently associated with a two-fold increased knowledge about HPV's carcinogenicity (aOR: 2.1, CI: 1.1-4.1).Conclusions Awareness of HPV's carcinogenicity was low; however, those who were aware were more likely to identify male HPV-associated cancers relevant to their own cancer risk. Formalizing targeted education in HIV care settings may promote knowledge and advocacy for prevention strategies.

Introduction:Nigeria ranks second in Africa for the highest number of mpox cases. This study aimed to evaluate the knowledge and awareness of mpox among Nigerians living in endemic regions and their willingness to accept the mpox vaccine when available. Methods:we conducted a cross-sectional study using a multi-stage sampling technique. Data was collected from eligible individuals in Bayelsa, Delta, Lagos, and Rivers, Nigeria, between September 1 and November 30, 2023, using a standardized structured questionnaire. Descriptive analysis was conducted, and inferential analyses were performed using binary logistic regression (p < 0.05). Results:five hundred and twenty-four (524) persons with a mean age of 33.9 ± 10.4 years participated in this study. Fifty-eight percent (58%) were aware of mpox, and 15.5% of participants had heard about the mpox vaccine. Participants from Delta State were 70 percent less likely, while those from Lagos and Rivers States were 2.5 times and 1.04 times, respectively (OR= 2.48, p=0.012; OR= 1.04, p=0.89) more likely to receive the mpox vaccine when compared with participants from Bayelsa State. Eighty-four (84.5%) of respondents were unwilling to take the vaccine if they had to pay for it. Conclusion:although many people were aware of the mpox infection, only a few people were aware of the vaccine. Health intervention programs to improve knowledge of mpox and increase the uptake of mpox vaccines should be co-designed with community stakeholders, while mpox vaccines, when available, should be made accessible at subsidized or at no cost to Nigerians to improve uptake.

BACKGROUND:Sexual and gender minorities (SGM) bear a high burden of HIV. The age of anal sexual debut may influence HIV care engagement. Our objective was to evaluate this relationship to help health care providers promote and anticipate future HIV care engagement among at-risk SGM. METHODS:The TRUST/RV368 study provided HIV testing and treatment at SGM-friendly clinics in Abuja and Lagos, Nigeria. Self-reported age of sexual debut was dichotomized as <16 or ≥16 years. Multivariable logistic models estimated adjusted odds ratios (aOR) and 95% confidence intervals (CI) for the association of sexual debut with (1) HIV testing history, (2) HIV testing at the clinics, (3) initiation of antiretroviral therapy (ART) within 6 months of a clinic diagnosis, and (4) viral suppression within 12 months of ART initiation. RESULTS:Of the 2680 participants, 30% (n = 805) reported a sexual debut <16 years. Those with an <16-year debut had significantly more receptive sex partners, condomless sex, and transactional sex (all P < 0.01) and were 24% less likely to have tested for HIV before enrollment (aOR: 0.76; CI: 0.62 to 0.93). However, <16-year debut was not associated with HIV testing, receiving ART, or achieving viral suppression once engaged with TRUST/RV368 (all P > 0.05). CONCLUSIONS:SGM with <16-year debut engaged in behaviors that could increase HIV risk and were less likely to have a history of HIV testing. However, once enrolled in SGM-friendly clinics, uptake of HIV care was not associated with <16-year debut, suggesting that SGM-friendly care models may promote HIV care engagement.

Two vaccines, the JYNNEOS and ACAM 2000 have been approved for use for Mpox protection, however vaccine hesitancy and vaccine refusal poses a significant challenge in its uptake. This study explored participants’ awareness of Mpox, willingness, and barriers to receiving the approved Mpox vaccines when they become available in Nigeria. This was a qualitative cross-sectional study. Participants were recruited using a purposive sampling technique. A total of 16 Focus Group Discussions (FGDs) and 64 in-depth interviews (IDIs) were conducted by trained research assistants among community members in four states in Nigeria (Bayelsa, Delta, Lagos, and Rivers states) between October 1 and November 30, 2023. The interviews were audio-recorded and transcribed before thematic analysis was conducted. One hundred and sixty-four persons, comprising 71 males and 93 females, participated in this study. The anticipated rollout of the Mpox vaccine in Nigeria elicited mixed reactions; while some participants expressed willingness to be vaccinated, others expressed their concerns about the vaccine side effects, vaccine safety, and their mistrust of new vaccines. There were also reports about physical access and financial cost being a barrier to receiving the Mpox vaccine. The study highlights the critical need for more community-based public health education campaigns to enhance awareness and correct misconceptions about Mpox. Effective communication strategies that address specific community issues and emphasize vaccine safety are important for increasing vaccination uptake and controlling the spread of Mpox in Nigeria.

Despite significant progress in HIV prevention and treatment, uptake of evidence-based interventions among adolescents and young adults (AYA), particularly in low- and middle-income countries (LMICs), remains low. Implementation research can optimize strategies to enhance reach, uptake, and equitable access to these innovations. The Prevention and Treatment through a Comprehensive Care Continuum for HIV-affected Adolescents in Resource-Constrained Settings Implementation Science Network (PATC3H-IN) leverages implementation science to strengthen the delivery and sustainability of evidence-based HIV prevention and care for AYA across six countries in sub-Saharan Africa. This paper outlines PATC3H-IN’s goals, summarizes the implementation science (IS) data that will be collected, and highlights the advantages of research networks in advancing science. The PATC3H-IN builds on the existing PATC3H consortium to advance IS research targeting AYA in LMICs. The PATC3H-IN comprises eight Clinical Research Centers (CRCs) located in Nigeria, Uganda, Malawi, South Africa, Zambia, and Tanzania. Representatives from the CRCs were asked to provide information on the IS components of their proposed studies, including details on study populations, IS frameworks, outcomes, and strategies, mechanisms of change, effectiveness outcomes, and documentation of intervention adaptations. The reports from the CRCs were compared to identify opportunities for advancing science across study sites. The PATC3H-IN studies will enroll AYA aged 12–24 years, with some emphasizing key subpopulations, namely AYA living with HIV, sexual and gender minorities, and adolescent girls and young women. All PATC3H-IN studies will be guided by one or more implementation science frameworks and theories, with the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework most frequently cited (n = 4/8). Across the CRCs, 54 unique implementation strategies will be used, with community engagement being the most common. Several studies will document intervention adaptations, and all studies will collect a set of common data elements to facilitate secondary data analyses across projects. The PATC3H-IN represents a significant contribution to advancing HIV prevention and care research for AYA in resource-constrained settings. Findings from PATC3H-IN will extend our understanding of IS in sub-Saharan Africa, a region particularly burdened by HIV, and for AYA who are traditionally under-represented in IS research. Not Applicable.

BACKGROUND:Early detection and treatment of anal precancer via high resolution anoscopy (HRA) is paramount to prevent anal cancer, particularly for populations at heightened risk like sexual minority men (SMM) living with HIV. Successful training and sustainability of cancer screening requires attention to local contexts, best captured by qualitative research. Using the Consolidated Framework for Implementation Research (CFIR), this study investigated factors that challenged or fostered learning and implementing HRA across a variety of stakeholder groups in Abuja, Nigeria. METHODS:Using in-depth qualitative methodology, nineteen semi-structured interviews were conducted in September 2023 with stakeholders - patients who underwent HRA, HRA providers, and health system representatives in Nigeria. Thematic analysis, guided by CFIR, was employed to identify key themes related to the barriers and facilitators to practicing HRA as guided by the International Anal Neoplasia Society. RESULTS:Eight themes were identified across three domains. Barriers included low knowledge and understanding of HRA, with participants explicitly noting the need for more research in low resource settings to garner local acceptance. Participants were concerned about financial costs for the clinic and the patients. Facilitators included organizational buy-in, SMM social networks, and a safe clinic environment to support HRA engagement. Facilitators important for sustainability included acceptance of the research evidence for HRA and recognition of the health benefits. Overall, participants from all stakeholder groups welcomed HRA as a new evidence-based intervention as part of HIV care services. CONCLUSIONS:Our study highlighted the need for localized research, cultural sensitivity, and resource allocation to improve the adoption of HRA in a Nigerian HIV care setting. Organizational buy-in, community engagement, and safe healthcare environments facilitated trust and patient engagement and would promote long term sustainability. Overall, the study provided perspectives from various stakeholders that strengthen clinical proficiency and sustainability of anal cancer screening in Nigeria.