The prognostic significance of asymptomatic bacteriuria resides in the observation that the prevalence is, relatively, high in persons with certain medical conditions, such as diabetes mellitus and pregnancy. This prevalence might, even, be higher in patients with human immunodeficiency virus infection. Hence, this study set out to determine the prevalence of asymptomatic bacteriuria among symptom free and newly enrolled HIV infected pregnant women attending PMTCT unit of Antiretroviral clinic of University College Hospital, Ibadan, Nigeria between 1st May and 30th September 2007. Information was obtained on the socio-demographic characteristics of the subjects, CD4 count and viral load. Microbial culture was carried out on aseptically collected urines from the patients. Statistical analysis was done with SPSS 12 package. There were 161analyzable samples from the participants. The mean age and gestational age at presentation of participants was 30.49 ± 4.3 years and 27.3± 3.2 weeks, respectively with modal parity of 2. Twenty-five (15.5%) of the urine samples significantly grew bacteria. The CD4 cells were significantly lower and the viral loads significantly higher (250.52 Vs 355.57 cells/mm3; 88,731 Vs 55,384 copies/ml; p=

Purpose: Universal coverage of cervical cancer screening remains elusive in most low- and middle-income countries (LMICs), home to the greatest burden of this preventable disease. Implementation of a cytology-based screening strategy in these countries is challenging. Also, there is shortage of health care workers (HCWs) to implement the low-technology, cheaper, but equally effective, methods like visual inspection with acetic acid. However, the implementation of HIV programs in LMICs has introduced the innovation of task shifting and task sharing, using the community health extension workers (CHEWs) and community health officers (CHOs) to complement clinical HCWs, especially at the primary health care, level with good outcome. Hence, this study leveraged this strategy.Methods: We piloted a study to improve knowledge and practice skills of CHEWs and CHOs in a rural community of Oyo state, Nigeria, through training and participatory supervision to screen for cervical cancer using visual inspection with acetic acid and link positive cases for treatment with cryotherapy.Results: A total of 51 HCWs, including doctors, nurses, CHEWs, and CHOs, were trained during the study to provide cervical cancer screening services. After the training, cervical cancer and its prevention knowledge improved from 52.4% before training to 91.5% immediate after training. Over 12 months, 950 eligible women were screened, of whom 848 (89.3%) were screened by CHEWs and CHOs. Of the 63 rescreened by CHEWs and CHOs (data grouped), and nurses, 88.1% and 92.3%, respectively, agreed with expert team review, with κ statistics of 0.76 and 0.84, respectively.Conclusion: This pilot project showed the ability of CHEWs and CHOs to identify cervical dysplasia was good and that of nurses was very good with appropriate competency training to achieve universal coverage of cervical cancer screening in LMICs.

INTRODUCTION: Cervical precancer screening with same day treatment facilitates maximization of benefits of secondary prevention of cervical cancer. This is particularly important for women living with human immunodeficiency virus (WLHIV) infection because of their exceptional risk for cervical cancer. The availability of HIV programmes in low- and middle-income countries (LMICs) provide unique opportunity for possible introduction “human papillomavirus (HPV) screening followed by visual inspection after application of acetic acid (VIA) with same day treatment of eligible patients”. This study piloted this concept. METHODS: In this prospective, cohort study, 98 WLHIV had HPV and VIA screening for cervical precancer lesions in a HIV clinic in Nigeria. Participants positive to HPV and/or VIA had biopsies from the visible lesions or quadrant of transformation zone. Participants positive to VIA and/or HPV16 or HPV18/45 had same-day thermal ablation treatment and the number of cases documented. The HPV, VIA and scenario of HPV followed by VIA results were compared with histologically confirmed cervical lesion grade 2 or worse statistically. RESULTS: Same day treatment was achieved in 95.0% of eligible cases. Statistically, sensitivity and specificity of VIA was 25.0% and 50.0% and HPV had 95.5% and 75.0%, respectively. In the HPV screening with VIA triage, sensitivity dropped to 45.5% but specificity improved to 100.0%. CONCLUSION: Triaging HPV positive test with VIA for same-day treatment in cervical precancer screening among PLWHIV looks feasible. The improved specificity will reduce the overtreatment rate, loss to follow-up associated with repeat clinic visits and improve completion of continuum of care.

The aim of the descriptive, cross sectional, questionnaire-based study reported here was to explore the causes of low productivity in non-communicable diseases research among postgraduate scholars and early career researchers in Nigeria and identify measures that could facilitate increased research output. The 89 respondents were masters-level, doctoral scholars and resident doctors who attended a workshop. Majorities of the respondents (over 70%) either agreed or strongly agreed that factors contributing to poor non-communicable diseases research productivity include a dearth of in-country researchers with specialized skills, inability of Nigerian researchers to work in multidisciplinary teams, poor funding for health research, sub-optimal infrastructural facilities, and limited use of research findings by policy makers. Almost all the respondents (over 90%) agreed that potential strategies to facilitate non-communicable diseases research output would include increased funding for research, institutionalization of a sustainable, structured capacity building program for early career researchers, establishment of Regional Centers for Research Excellence, and increased use of research evidence to guide government policy actions and programs.

Aims: To explore the impact of enhanced adherence counseling (EAC) in achieving viral suppression among our patients unsuppressed viral load in a large Anti-retroviral therapy (ART) program in South West Nigeria. Study Design: This study was a descriptive cross-sectional review of patients’ records. Place and Duration of Study: The study was conducted in human immunodeficiency virus (HIV) Program located in Infectious Disease Institute, College of Medicine, University of Ibadan, Nigeria involving review of data of patients with unsuppressed viral loads between 1^st March 2017 – 30^th September 2018. Methodology: We described the viral loads (VL) outcomes of patients with VLs >1 000 copies/ml after at least 6 months on ART and a comprehensive 3 monthly EAC support programme. We calculated adherence using pharmacy refill data. Patients with one VL measurement after the EAC sessions were eligible for analysis. Results: Out of 400 patients with VL >1 000 copies/ml reviewed during the study period, only 204(51.0%) were virally suppressed at the end of the 3 EAC sessions. Those with initial VLs between 1000-5000cp/ml had the highest adherence rate (73.0%) and VL suppression rate (68%). The youngest age group (16-30 years) had the least adherence (55.2%) and the least viral suppression (44.8%) while the oldest age groups (61-80years) were the most adherent (69.0%) and the most virally suppressed (55.2%). The proportion of patients on second line regimen were significantly more virally suppressed than those on the first line regimen (P <0.002). Conclusion: This study showed the role EAC in accomplishing VL suppression and the need to intensify adherence counseling at commencement of highly active anti-retroviral therapy (HAART) to strengthen adherence in people living with HIV (PLHIV) and consequently preventing raised VL at the next laboratory testing of viral load. We strongly advocate for better measurement of adherence to antiretroviral therapy that will be accessible and reliable as this was a limitation of this study.

To address poor outcomes among adolescents and young adults living with HIV (AYA-HIV), iCARE Nigeria successfully piloted two-way text message antiretroviral therapy (ART) reminders together with peer navigation. Study participants had significant improvement in ART adherence and viral suppression at 48 weeks. Understanding facto of this intervention. We used explanatory, mixed methods to assess implementation outcomes (feasibility, acceptability, and adoption) and identify implementation strategies used or adapted to promote intervention success. Quantitative data included participant surveys, program records, and back-end mHealth data, and were summarized using descriptive statistics. Qualitative data were collected from key informants and focus group discussions with program staff and summarized using directed content analysis. iCARE Nigeria was feasible as evidenced by ease of recruitment, high retention of patients and peer navigators (PN), and successful deployment of initial text message reminders (99.9%). Most participants (95%) and PN (90%) found text message reminders were not bothersome or intrusive. Implementation strategies employed to facilitate intervention success included: (1) selecting, training, supervising, and matching of PN to patients; (2) tailoring frequency (daily to weekly) and mode of communication between PN and patients according to patient need; (3) routine screening for adherence challenges; (4) changing phone airtime stipends from monthly to weekly in response to rapid depletion; and (5) conducting telecommunication needs assessments, to identify and troubleshoot implementation barriers (issues with mobile devices, power availability). iCARE Nigeria was feasible and acceptable with high adoption by stakeholders. The implementation strategies identified here can be tailored for intervention scale-up in similar environments to promote ART adherence for AYA-HIV.