A three-pronged, locally rooted biomedical informatics (BMI) capacity strengthening approach contributes to the transformation of BMI education and research in Mozambique. This program integrates faculty fellowships, a new BMI track in a master's program, and annual workshops and bootcamps to drive sustainable change, improve practitioners' BMI skills, and strengthen institutional research capacity. Continuous evaluation is integral to program success. Multiple evaluation methods were used to assess implementation and outcomes. Pre- and post-workshop surveys measured changes in knowledge and skills. Independent samples t-tests assessed differences between pre- and post-training responses. Course evaluations and exit focus groups obtained feedback about the fellowship. Findings indicated training efficacy and growth in BMI knowledge and research skills. Integrated, continuously evaluated BMI training can contribute to sustainable workforce and research capacity development in sub-Saharan Africa.

Background:People living with HIV (PLWH) exhibit two-fold higher incidence of cardiovascular disease compared to HIV-negative persons. However, predictors of cardiovascular disease risk in PLWH are still evolving. The objective of this study is to evaluate the predictors of cardiovascular disease among PLWH in Nigeria. Methods:This cross-sectional study was conducted among adult patients attending a large HIV clinic in Kano, northern Nigeria. We used systematic sampling to recruit participants and computed their 5-year projected CVD risk using the Data collection on Adverse effects of Anti-HIV Drugs (DAD) equation. Results:The majority of participants were female (70.6%). The estimated median 5-year CVD risk was 0.7% (interquartile range, IQR 0.4, 10). The majority of participants (58.9%) had a low risk of developing cardiovascular disease, while 28.9% had a moderate risk. Cardiovascular disease was associated with elevated high-sensitivity C-reactive protein (hsCRP) > 3.03 mg/L [adjusted odds ratio, aOR: 4.58, 95% CI: 2.09-10.04), p = 0.001], increasing age [aOR 2.38, 95% CI (1.48-4.50), p = 0.020], male sex [aOR 2.16, 95% CI (1.03-4.53), p = 0.040] and hypercholesterolemia [aOR 3.03, 95% CI (1.68-4.86), p = 0.005]. Conclusion:The majority of PLWH in our setting have low to moderate risk of developing cardiovascular disease. Cardiovascular disease risk was associated with elevated hsCRP, increasing age, male sex, and hypercholesterolemia. Our findings highlight the importance of early CVD risk stratification to prevent morbidity and mortality among PLWH.

Introduction : In Mozambique, where the HIV burden remains high, community antiretroviral therapy dispensation by health care providers (cARTd) was introduced during the COVID-19 public health emergency to mitigate service disruptions and reduce lost to follow-up (LTFU). The strategy was subsequently expanded to support ART continuity amid seasonal flooding and other structural barriers. Trained staff delivered ART and adherence counseling through targeted home visits to individuals missing scheduled appointments, facilitating return to facility-based care. We applied the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to evaluate cARTd’s impact on reintegration, retention, and viral load suppression in Zambézia Province. Methods : We retrospectively analysed individual-level data from 68 health facilities (June 2021–September 2023), comparing cARTd recipients to facility-based ART dispensation (hfARTd) recipients. Outcomes included cARTd coverage, time to ART dispensation, time to health facility return, LTFU (> 59 days late), retention on ART (< 60 days late), and viral load suppression (< 1,000 copies/ml). Mixed-effects models adjusted for sex, locale, and age were fitted. Results : All 68 facilities implemented cARTd. Among 223,911 eligible patients (mean age 33.3 years, 65.9% female), cARTd coverage was 55.6%. Twelve months prior to cARTd eligibility, LTFU was higher among cARTd recipients (30.8%) than hfARTd recipients (21.2%). Recipients of cARTd received ART sooner (median of 13 vs. 16 days; adjusted hazard ratio [aHR] = 1.08 [95% confidence interval (CI):1.07–1.09], p < 0.001) and returned to the facility faster (median of 3 vs. 0 days before scheduled visit; aHR = 1.30 [95%CI:1.28–1.33], p < 0.001) than hfARTd recipients. At 12 months post-return, LTFU was 24.4% among cARTd recipients compared with 23.3% among hfARTd recipients, while 12-month retention rates were higher among cARTd recipients (81.6% vs. 75.9%; adjusted odds ratio [aOR] = 1.44 [95%CI:1.35–1.54], p < 0.001). Conversely, proportion of viral suppression was lower among cARTd recipients (92.9% vs. 95.0%; aOR = 0.66 [95%CI:0.60–0.72], p < 0.001). Conclusions : Compared to facility-based recipients, community ART dispensation effectively reached individuals at higher risk of LTFU and improved continuum of care outcomes, including faster return to facility-based care, and more favorable retention. Community-based ART delivery shows promise for sustaining HIV care during public health crises in resource-constrained settings.

Neonatal mortality is a significant contributor to under-five deaths in sub-Saharan Africa. Despite progress, evidence on survival dynamics and clinical determinants among hospitalized neonates in Zambia remains limited, particularly in resource-constrained tertiary settings. To determine the incidence of neonatal mortality and identify independent clinical predictors of death among neonates admitted to a tertiary neonatal intensive care unit (NICU) in southern Zambia. This retrospective cohort study analyzed 690 neonates admitted to Livingstone University Teaching Hospital between May 2025 and January 2026. Survival probabilities were estimated using Kaplan–Meier methods over 5215 neonate-days, and independent predictors were identified via Cox proportional hazards regression. The mortality proportion was 13.0

We introduce a novel semiparametric estimator for Mann-Whitney-type causal effects based on the cumulative probability model (CPM). CPMs are rank-based, invariant to monotone transformations of the outcome, and offer flexible outcome regression under confounding. We formalize the estimation under causal consistency, no interference, ignorability, and positivity assumptions, and develop accompanying inference procedures. Through simulations with varying sample sizes and effect magnitudes, the CPM estimator shows reduced variability and improved predictive accuracy relative to mis-specified parametric transformations. We demonstrate its applicability in a large cohort of people with HIV (PWH) in Northern Nigeria by assessing the causal effect of HIV status on albuminuria levels. Overall, our results highlight the value of robust semiparametric methods for causal inference in observational settings beyond average treatment effects. Findings should be interpreted in light of the observational design and the potential for unmeasured confounding.

ABSTRACT Introduction Latin America is a key region in advancing efforts to end the HIV epidemic globally. Despite breakthroughs in HIV treatment and prevention in the last 20 years, as well as region‐wide improvements in health infrastructure and policies, there has been a 13% increase in new acquisitions in Latin America from 2010 to 2024. The Caribbean, Central and South America network for HIV epidemiology (CCASAnet), established in 2006, is one of seven regions in the International epidemiology Databases to Evaluate AIDS (IeDEA). CCASAnet contributes substantially to regional science and the development of national and region‐wide policies. Here, we describe data sources and operational methodologies employed by CCASAnet, as well as the current state of the cohort. Methods CCASAnet data are collected using standardized data elements, including demographic information, HIV disease history, laboratory data, antiretroviral regimens, co‐infections and comorbidities. Data collection has expanded to include prospective data such as substance use, antiretroviral therapy adherence, geriatric syndromes and tuberculosis treatment. All clinical sites retain ownership of their data, and CCASAnet data contribute as able to global IeDEA‐level projects. Robust data quality initiatives and statistical methods have strengthened the cohort. Results CCASAnet consists of nine clinics across seven countries (Argentina, Brazil, Chile, Haiti, Honduras, Mexico and Peru). Over 61,000 adults and children living with HIV have contributed observational data through December 2023. While CD4 at enrolment has remained largely unchanged, time to antiretroviral therapy initiation has decreased, retention in care has improved and the proportion with undetectable HIV RNA has dramatically increased. Co‐infections and AIDS‐defining malignancies remain a cause of morbidity and mortality, but non‐communicable diseases have also increased. Overall mortality trends in the region have improved over time, with some notable exceptions. Conclusions Underscoring the importance of maintaining longitudinal collaborations and data collection, CCASAnet remains the largest source of high‐quality data for HIV epidemiology in Latin America and serves as an important evidence base for informing global and regional policy and stakeholder decisions related to the HIV epidemic.

Sample size calculations can be challenging with skewed continuous outcomes in randomized controlled trials (RCTs). Standard t-test-based calculations may require data transformation, which may be difficult before data collection. Calculations based on individual and clustered Wilcoxon rank-sum tests have been proposed as alternatives, but these calculations for clustered data assume no ties in continuous outcomes, and clustered Wilcoxon rank-sum tests perform poorly with heterogeneous cluster sizes. Recent work has shown that continuous outcomes can be robustly analyzed using ordinal cumulative probability models. Analogously, sample size calculations for ordinal outcomes can be a robust design strategy for continuous outcomes. We show that Whitehead's sample size calculations for independent ordinal outcomes can naturally extend to continuous outcomes. We extend these calculations to cluster RCTs using a design effect incorporating rank intraclass correlation coefficients. Therefore, we provide a unifying, simple approach for designing individual and cluster RCTs for continuous or ordinal outcomes that makes minimal assumptions on the distribution of the still-to-be-collected outcome. We conduct simulations to evaluate our approach's performance and illustrate its application in multiple RCTs: an individual RCT with skewed continuous outcomes, a cluster RCT with skewed continuous outcomes, and a non-inferiority cluster RCT with an irregularly distributed count outcome.

We report preliminary safety and tolerability data from 66 persons living with HIV (PLWH) (≥ 18 years old) who received escalating dosages of lisinopril or matched placebo, in addition to antiretroviral therapy in northern Nigeria. We monitored for adverse events (AEs) by reviewing patient history, laboratory data, and clinic data at each follow-up visit. We then characterized all AEs in terms of “relatedness” to study intervention and graded based on severity (1–5 grading scale) using the Division of AIDS Toxicity Grading Scale, version 2.1. For this study, we monitored 66 participants over 7 months. Among 33 participants on lisinopril, 14 (42.4

The physical, psychosocial, and environmental well-being of people living with HIV, particularly older adults, is receiving greater attention as more individuals with HIV reach older ages. This study explored health-related quality of life (HRQOL) and its associated factors among HIV-positive adults aged 50 years and older attending a tertiary facility in northern Nigeria. A cross-sectional study was conducted with 222 participants recruited using systematic random sampling. The WHOQOL-HIV BREF instrument was used to assess HRQOL alongside clinical and sociodemographic data. Data analysis was performed using SPSS version 24. Overall, 59% of participants reported good HRQOL, with the environmental domain showing the highest scores, while the physical and social domains had the lowest scores. Chronic comorbidities were observed in 74.8% of participants. Multivariate logistic regression identified religion, family support, asymptomatic status, and the absence of dyspepsia or visual impairment as factors associated with good HRQOL. In summary, among older adults living with HIV in northern Nigeria, just over half reported good HRQOL. HRQOL was independently associated with comorbidity status, symptom burden, and family support. Achieving the "fourth 90" will require HIV care that extends beyond viral suppression to address comorbid conditions and strengthen social support systems.

OBJECTIVE:This study aimed to assess the burden, severity, and pattern of coronary artery disease (CAD) in people with HIV (PWH), as well as its relationship with metabolic syndrome, inflammation, and endothelial dysfunction. DESIGN:Cross-sectional study. METHODS:A comparative cross-sectional study was conducted on 72 PWH and 72 matched people without HIV at Aminu Kano Teaching Hospital (AKTH), in Kano, northern Nigeria. Data collection included demographics, metabolic parameters, viral load, brachial artery flow-mediated dilation (BAFMD) assessed via ultrasound, and coronary artery calcification (CAC) scores obtained using electrocardiogram (ECG)-gated computed tomography. CAD predictors were analyzed using t tests, linear regression, and chi-squared/Fisher's exact tests ( P  ≤ 0.05). RESULTS:Among 144 participants (72 PWH, 72 controls), PWH had higher CAD prevalence (31.9 vs. 4.2%, P  < 0.001) and mean CAC scores (23.2 vs. 2.7, P  < 0.001). CAD was significantly associated with longer ART duration ( P  = 0.04), higher BMI ( P  = 0.005), and reduced BAFMD ( P  = 0.020). In controls, hs-CRP predicted CAD ( P  = 0.004). CONCLUSION:PWH in northern Nigeria have a higher burden of CAD compared to HIV-negative controls, with greater CAC and endothelial dysfunction, independent of viral load status. These findings highlight the need for routine cardiovascular screening and integration of cardiovascular disease prevention into HIV care.

Background and Objective The Vanderbilt-Nigeria Research Ethics Training Program (V-NET) is an innovative research ethics training program that aims to address the increasing demand for research in precision medicine in Africa by building capacity for the ethical design, conduct, and oversight of genetic and genomic research in Nigeria. Methods The program includes creation of a Master of Science (MSc) degree program in research ethics, training of 15 MSc students, and the integration of a genomics-focused ethics curriculum into a faculty enrichment program at Vanderbilt University Medical Center (VUMC), benefiting eight Nigerian researchers over 5 years. Twelve Nigerian Institutional Review Board (IRB) members will participate in a practicum at VUMC to enhance their skills in protocol review and administrative procedures. Other capacity-building activities include an annual workshop for IRB members in Nigeria on the protection of human subjects in research, responsible conduct of research, ethics of genetic/genomic research, and review of genomic research protocols (~150 trainees), and the creation of a curricular toolkit in ethics of genetic/genomic research tailored to Nigerian IRB members, in addition to quarterly webinars. Results V-NET will equip a group of Nigerian scientists with advanced skills, positioning them as leaders in the ethical design and review of genetic and genomic research within Nigeria’s dynamic research environment. Conclusion and Implications for Translation Research ethics training programs are essential for strengthening the ethical design and implementation of clinical and translational research, particularly in low- and middle-income countries.

BACKGROUND:Mozambique implemented a phased roll-out of COVID-19 vaccination in 2021. This study aimed to evaluate COVID-19 vaccine acceptability among higher-risk populations in Zambézia Province. METHODS:A mixed-methods study in Zambézia Province assessed knowledge, perceptions, and acceptability of COVID-19 vaccination. Structured questionnaire-based surveys among community health workers/volunteers, taxi drivers, and persons with HIV; and focus group discussions using semi-structured guides with community/religious leaders, adults aged 18-49 years and adults aged 50+ years were conducted in August-September 2021. Surveys were captured using tablets; group discussions were recorded. Univariate analyses were performed for quantitative data; qualitative data were analyzed thematically. RESULTS:A total of 731 individuals participated (539 survey respondents; 192 discussion respondents); 53% male (n = 386) and 74% urban (n = 544) residents. Most had heard about COVID-19 vaccines, mainly through television and/or radio. Trustworthy information sources mentioned were community leaders and healthcare providers. Among survey respondents, 249/539 (46%) reported having received at least 1 vaccine dose. Motivators for vaccination mentioned by survey respondents were "belief that vaccines protect themselves" (72%), "belief it would protect their family" (17%). Myths and beliefs, misinformation, and long queues were main barriers for vaccination mentioned in group discussions. Participants suggested that campaigns should focus on communication talks led by health professionals, in partnership with community or church leaders and/or community health workers/volunteers. CONCLUSIONS:This study showed that information on COVID-19 vaccination had successfully reached the vast majority of study participants, mainly via radio and television. Targeted campaigns specific for rural and urban contexts can increase awareness and uptake of vaccination.

Objective. Diagnosing adrenal insufficiency in people living with HIV (PLWH) is challenging, especially in resource limited settings. Salivary cortisol assessment, however, is simple, minimally invasive, efficient, and cost-effective, making it a viable alternative. We evaluated whether early morning salivary cortisol measurement among PLWH could replace Synacthen test in Africans. Methods. This cross-sectional study included 201 PLWH recruited from the HIV clinic of a tertiary health facility and a comparison group of 200 HIV-negative individuals. We used a locally established cut off and a low-dose Synacthen test to determine adrenal function. Serum and salivary cortisol samples were obtained simultaneously at baseline and during the test (at 30 and 60 minutes). Results. The prevalence of adrenal insufficiency among PLWH was 54.7% when using a salivary cortisol-based locally established cutoff, compared to 10.5% using a serum derived diagnostic cut-off (p<0.001). Adrenal insufficiency was associated with HIV diagnosis and dolutegravir (DTG) use. Compared to HIV-negative participants, PLWH on DTG had 18 times the odds of developing adrenal insufficiency (adjusted odds ratio [aOR]=18.3, 95% confidence interval [CI]: 9.58-36.5), while PLWH not on DTG had 13 times the odds (aOR=13.7, 95% CI: 6.60-30.3). Conclusion. HIV status is associated with development of adrenal insufficiency. Salivary cortisol measurement could serve as a useful non-invasive tool for diagnosing adrenal insufficiency among PLWH in similar settings.

BACKGROUND:Family support is an important component of family-oriented care and a vital element in the care of patients with chronic illnesses, including HIV/AIDS. We investigated the association between perceived family support and depression among adolescents living with HIV in northern Nigeria. METHODS:This was a cross-sectional study on 125 adolescents (10-19 years of age) presenting for care at a large urban outpatient HIV clinic in Kano, Nigeria. We assessed family support utilizing the Perceived Social Support Family Scale (PSS-Fa) tool, and depression using the Patient Health Questionnaire-9 (PHQ-9) tool. Logistic regression was done to determine the independent relationship between perceived family support and depression. RESULTS:Approximately half of the respondents were males (49.6%). The median age (±IQR) of the participants was 16 (± 4) years. The overall prevalence of depression was 56%. More than half (57.6%) of the respondents reported having strong family support. Depression was independently associated with no family support (adjusted odds ratio, aOR = 3.85, 95% confidence interval, CI = 1.10-13.43), weak family support (aOR = 3.16, 95% CI = 1.04-9.63), and feelings of shame about their HIV status (aOR = 5.20, 95% CI = 1.76-15.35). CONCLUSION:Depression is common among adolescents presenting for HIV care in northern Nigeria and is independently associated with perceived family support and feelings of shame regarding HIV diagnosis. Our findings support routine screening for depression among adolescents with HIV, coupled with the integration of family-oriented care and counseling into routine HIV services for this population.

BACKGROUND:Nigeria is an emerging hub of biomedical research, requiring additional trained bioethicists for ethical oversight of research studies. There are currently two graduate-level health research ethics programs in Nigeria. However, both are in the southern part of the country and no such training programs exist in the north. Strengthening the health research ethics skills and knowledge of Nigerian researchers across the country is necessary given the growing genetics research infrastructure. METHODS:To inform the creation of a Master of Science in Health Research Ethics program in northern Nigeria, we conducted a needs assessment comprised of semi-structured interviews with nine Nigerian bioethics experts. We used the Interpretative Phenomenological Analysis (IPA) method to analyze interview transcriptions. Two authors independently read and coded each respondent's transcript to identify emergent themes that represented each respondent's answers. Within these overarching themes, the data points were grouped into subthemes. RESULTS:Four primary themes emerged with ten subthemes. Respondents believed that the program can fill a gap and strengthen capacity in health research ethics. They emphasized that the curriculum should be developed with an interdisciplinary lens and locally contextualized, and that students should be taught how to think critically through ethical scenarios. Respondents stressed that program leaders should recruit faculty and students locally who have the bandwidth to participate in the program. Finally, respondents noted the program should have university support to be sustainable. CONCLUSION:Our findings will guide the creation of a master's degree program that aims to build capacity in health research ethics in northern Nigeria and enhance the country's growing prominence in global biomedical research. Through our needs assessment, we identified structural and content factors that can guide us in leveraging the strengths of the local institution and leaders in health research ethics while mitigating challenges in establishing this program.

Causal inference literature has extensively focused on binary treatments, with relatively fewer methods developed for multi-valued treatments. In particular, methods for multiple simultaneously assigned treatments remain understudied despite their practical importance. This paper introduces two settings: (1) estimating the effects of multiple treatments of different types (binary, categorical, and continuous) and the effects of treatment interactions, and (2) estimating the average treatment effect across categories of multi-valued regimens. To obtain robust estimates for both settings, we propose a class of methods based on the Double Machine Learning (DML) framework. Our methods are well-suited for complex settings of multiple treatments/regimens, using machine learning to model confounding relationships while overcoming regularization and overfitting biases through Neyman orthogonality and cross-fitting. To our knowledge, this work is the first to apply machine learning for robust estimation of interaction effects in the presence of multiple treatments. We further establish the asymptotic distribution of our estimators and derive variance estimators for statistical inference. Extensive simulations demonstrate the performance of our methods. Finally, we apply the methods to study the effect of three treatments on HIV-associated kidney disease in an adult HIV cohort of 2455 participants in Nigeria.

Background: Antiretroviral therapy has markedly increased life expectancy among people living with human immunodeficiency virus (HIV), yet the long-term impact of chronic HIV infection on women's quality of life (QoL) and sexual functioning remains poorly understood. Female sexual dysfunction (FSD) is common in women and may impair psychological well-being and social relationships. Understanding how HIV infection intersects with FSD and QoL could inform holistic care for women in resource-limited settings.Objective: To compare QoL and FSD between women living with HIV and HIV-negative women and to identify socio-demographic predictors of poor QoL.Methods: We conducted a hospital-based cross-sectional study in 2024 among 200 women on antiretroviral therapy and 200 age-matched HIV-negative women attending the general outpatient clinic at Aminu Kano Teaching Hospital, Kano, Nigeria. Participants were recruited through systematic sampling; research assistants provided study information and obtained written informed consent. Quality of life was assessed with the World Health Organization Quality of Life 26-item Brief questionnaire (WHOQOL-BREF). Female sexual function was screened with the 19-item Female Sexual Function Index (FSFI); a total score ≤26.55 denoted FSD. Data were analyzed using chi-square tests, independent t-tests and multivariable logistic regression.Results: The mean (±SD) age of participants was 37.1 ± 9.4 years. Overall QoL was significantly worse among women with HIV than HIV-negative women (53% vs 63% reporting good QoL, p = 0.043). Mean QoL scores were lower in the HIV-positive group for the psychological (61 ± 18 vs 54 ± 14; p < 0.001) and environmental domains (69 ± 20 vs 65 ± 16; p < 0.001), while physical and social domain scores were comparable. FSD was highly prevalent in both groups (96% in HIV-positive and 98% in HIV-negative participants; p = 0.40), and FSFI scores were not associated with QoL. In multivariable analysis, rural residence (adjusted odds ratio 3.30, 95% CI 1.31-8.98) and primary-level education (aOR 3.06, 95% CI 1.50-6.38) independently predicted poor QoL.Conclusions: Women living with HIV experience poorer overall QoL than HIV-negative peers, particularly in psychological and environmental domains. Interventions that improve living conditions, strengthen psychosocial support and integrate sexual and mental health services into HIV care, are needed to improve the well-being of women in North-western Nigeria.

INTRODUCTION:In 2016, the World Health Organization recommended differentiated service delivery (DSD) as a client-centred approach to simplify HIV care in frequency and intensity, thus reducing the clinic visit burden on individuals and HIV programmes. We describe the scale of DSD implementation among HIV facilities in low- and middle-income countries (LMICs) in Latin America, Africa and the Asia-Pacific before the COVID-19 pandemic. METHODS:We analysed facility-level survey data from HIV care facilities participating in the International epidemiology Databases to Evaluate AIDS consortium in 2019. We used descriptive statistics to summarise the availability of DSD, multi-month dispensing (MMD) and DSD for HIV treatment models. We explored factors associated with DSD implementation using multivariable models. RESULTS:We included 175 facilities in the Asia-Pacific (n = 30), Latin America (n = 8), Central Africa (n = 21), East Africa (n = 74), Southern Africa (n = 28) and West Africa (n = 14). Overall, 133 facilities (76%) reported implementing DSD. Of these, 91% offered DSD for HIV treatment, 61% for HIV testing and 59% for antiretroviral therapy (ART) initiation. The most common duration of ART refills for clinically stable clients was 3MMD, (70%), followed by monthly (14%) and 6MMD (10%). Facility-based individual models were the most frequently available DSD for the HIV treatment model (82%), followed by client-managed group models (60%). Out-of-facility individual models were available at 48% of facilities. Facility-based individual models were particularly common among facilities in East (92%) and Southern Africa (96%). Facilities in medium and high HIV prevalence countries, and those with 3MMD, were more likely to implement DSD. CONCLUSIONS:In 2019, DSD was available in most HIV care facilities globally but was not evenly implemented across regions and HIV services. Most offered facility-based DSD for HIV treatment models and 3MMD for clinically stable clients. Efforts to expand DSD for HIV testing and ART initiation and to offer longer MMD can improve long-term retention in care of people living with HIV in LMICs, while further alleviating the operational burden on healthcare services. These findings from the pre-COVID-19 era underline the need for strengthening DSD in HIV care, which remains at the centre of current efforts towards client-centred care.

IntroductionAntiretroviral therapy (ART) increases the life expectancy of persons living with HIV (PLWH), but not without potentially serious adverse effects. Tenofovir disoproxil fumarate (TDF) can cause nephrotoxicity, manifesting as acute kidney injury (AKI) that may persist after treatment discontinuation. Kidney injury biomarkers such as kidney injury molecule-1 (KIM-1), retinol-binding protein-4 (RBP-4), interleukin-18 (IL-18), and neutrophil gelatinase-associated lipocalin (NGAL) can aid early diagnosis and predict TDF-associated nephrotoxicity. This study aimed to determine whether the change from baseline in urine KIM-1 (δKIM-1) and NGAL (δNGAL) following 2 weeks of TDF use could predict subclinical TDF-associated nephrotoxicity before the overt manifestation as acute kidney disease after 3 months.MethodsA prospective cohort study of 205 PLWH was conducted at the Adult Center for Infectious Disease Research (AIDC) in Lusaka, Zambia. ART-naïve PLWH who were starting treatment with TDF with intact kidney function [estimated glomerular filtration rate (eGFR)> 60 mL/min/1.73m2] were followed at initiation, 2 weeks, and approximately 3 months to determine the incidence of TDF-associated nephrotoxicity. We measured urine KIM-1 and NGAL at baseline and after 2 weeks of treatment to determine if it predicted subclinical nephrotoxicity. The presence of TDF-associated nephrotoxicity was defined according to the established acute kidney disease and disorders criteria (AKD) as having either 1) one or more episodes of eGFR< 60ml/min/1.73m2 within 3 months, 2) a reduction in eGFR of greater than 35% (from baseline) within 3 months, and/or 3) an increase in serum creatinine of more than 50% (from baseline) within 3 months.ResultsThe incidence of TDF-associated nephrotoxicity was 22%. Baseline eGFR, creatinine, age, female sex, and BMI predicted the risk of overt TDF-associated nephrotoxicity. The median baseline KIM-1-to-creatinine and NGAL-1-to-creatinine ratios of the participants who developed overt TDF-associated nephrotoxicity and those who did not were not significantly different. However, every 1 pg/mg increase in δKIM-1 was associated with a 41% higher risk of TDF-associated nephrotoxicity. No association was observed with δNGAL.ConclusionsThe incidence of TDF-associated nephrotoxicity was high. Change in KIM-1 level within 2 weeks of the initiation of TDF treatment predicted subclinical TDF-associated nephrotoxicity before overt manifestation as acute kidney disease while δNGAL within the same period did not predict subclinical TDF-associated nephrotoxicity.

Geographic Information Systems (GIS) have become essential in health sciences for analysing and visualizing health-related spatio-temporal data. This report details the outcomes of a week-long interactive GIS workshop held in Kano, Nigeria, and organized by the Vanderbilt-Nigeria Building Research Capacity in HIV and NCDs (V-BRCH) training programme. The workshop aimed to enhance GIS knowledge and confidence among early-career physician scientists. Thirty-three participants were trained in core GIS competencies, including software selection, data visualization and spatial analysis using Quantum GIS (QGIS). Pre- and post-workshop surveys assessed participants’ knowledge and confidence levels across various GIS topics and competency areas. There was a significant improvement in self-reported participant knowledge across all GIS topic areas evaluated, with the highest percentage gains in geocoding health data (149%) and using QGIS software (135%). The percentage increase in post-workshop confidence was greatest for importing spatial data into QGIS (153%), navigating the QGIS interface (150%) and mapping public health data (150%). Participants rated the workshop highly (4.7/5, 1 = ‘poor’ and 5 = ‘excellent’). Recommendations for course improvement included extending the duration of the workshop, using local data in exercises and employing more visual aids. These findings suggest that GIS training opportunities can be beneficial in building GIS knowledge and enhancing the skills of physician scientists in similar low- and middle-income settings.