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Background Recording and reporting health data in facilities is the backbone of routine health information systems which provide data collected by health facility workers during service provision. Data is firstly collected in a register, to record patient health data and care process, and tallied into nationally designed reporting forms. While there is anecdotal evidence of large numbers of registers and reporting forms for primary health care (PHC) facilities, there are few systematic studies to document this potential burden on health workers. This multi-country study aimed to document the numbers of registers and reporting forms use at the PHC level and to estimate the time it requires for health workers to meet data demands. Methods In Cambodia, Ghana, Mozambique, Nigeria and Tanzania, a desk review was conducted to document registers and reporting forms mandated at the PHC level. In each country, visits to 16 randomly selected public PHC facilities followed to assess the time spent on paper-based recording and reporting. Information was collected through self-reports of estimated time use by health workers, and observation of 1360 provider-patient interactions. Data was primarily collected in outpatient care (OPD), antenatal care (ANC), immunization (EPI), family planning (FP), HIV and Tuberculosis (TB) services. Result Cross-countries, the average number of registers was 34 (ranging between 16 and 48). Of those, 77% were verified in use and each register line had at least 20 cells to be completed per patient. The mean time spent on recording was about one-third the total consultation time for OPD, FP, ANC and EPI services combined. Cross-countries, the average number of monthly reporting forms was 35 (ranging between 19 and 52) of which 78% were verified in use. The estimated time to complete monthly reporting forms was 9 h (ranging between 4 to 15 h) per month per health worker. Conclusions PHC facilities are mandated to use many registers and reporting forms pausing a considerable burden to health workers. Service delivery systems are expected to vary, however an imperative need remains to invest in international standards of facility-based registers and reporting forms, to ensure regular, comparable, quality-driven facility data collection and use.

Nigeria's national health information system (HIS) data sources are grouped into institutional and population based data that traverse many government institutions. Communication and collaboration between these institutions are limited, fraught with fragmentation and challenges national HIS functionality.The objective of this paper was to share insights from and the implications of a recent review of Nigeria's HIS policy in 2014 that resulted in its substantial revision. We also highlight some subsequent enactments.In 2013, Nigeria's Federal Ministry of Health launched an inter-ministerial and multi-departmental review of the National Health Management Information System policy of 2006. The review was guided by World Health Organization's 'Framework and Standards for Country Health Information Systems'. The key finding was a lack of governance mechanisms in the execution of the policy, including an absent data management governance process. The review also found a multiplicity of duplicative, parallel reporting tools and platforms.Recommendations for HIS Policy revisions were proposed to and implemented by the Federal Government of Nigeria. The revised HIS policy now provides for a strong framework for the leadership and governance of the HIS with early results.

Background Master facility lists (MFL) maintain an important standard (unique identifier) in country health information systems that will aid integration and interoperability of multiple health facility based data sources. However, this standard is not readily available in several low and middle income countries where reliable data is most needed for efficient planning. The World Health Organization in 2012 drew up guidelines for the creation of MFLs in countries but this guideline still requires domestication and process modeling for each country adopting it. Nigeria in 2013 published a paper-based MFL directory which it hopes to migrate to an electronic MFL registry for use across the country. Objective To identify the use cases of importance in the development of an electronic health facility registry to manage the MFL compiled in Nigeria. Methods Potential use cases for the health facility registry were identified through consultations with key informants at the Federal Ministry of Health. These will serve as input into an electronic MFL registry development effort. Results The use cases identified include: new health facility is created, update of status of health facility, close-out, relocation, new information available, delete and management of multi-branch health facility. Conclusion Development of an application for the management of MFLs requires proper architectural analysis of the manifestations that can befall a health facility through its lifecycle. A MFL electronic registry will be invaluable to manage health facility data and will aid the integration and interoperability of health facility information systems.

BACKGROUND: This study provides population-based estimates of HIV prevalence and factors associated with HIV infection among men who have sex with men (MSM) in 3 large cities in Nigeria. We aimed to increase the knowledge base of the evolving HIV epidemic among MSM highlight risk factors that may fuel the epidemic and inform future HIV prevention packages. METHODS: A total of 712 MSM aged 18 years and older living in Abuja Ibadan and Lagos were recruited using respondent-driven sampling. Participants completed a behavioral questionnaire and tested for HIV. Population-based estimates were obtained using RDSAT software. Factors associated with HIV infection were ascertained using multiple logistic regression adjusting for RDSAT individualized weights. RESULTS: A high proportion of MSM reported high-risk behaviors including unprotected anal sex with men (30-50%) unprotected vaginal sex with women (40%) bisexual behavior (30-45%) and never been tested for HIV (40-55%). The population-based estimates of HIV among MSM in the 3 cities were 34.9% 11.3% and 15.2% respectively. In Abuja HIV was significantly associated with unprotected sex and transactional sex. In Ibadan HIV was significantly associated with unprotected sex and self-identified bisexual. In Lagos HIV was significantly associated with the older age. CONCLUSIONS: HIV prevalence among MSM in the 3 cities was 4-10 times higher than the general population prevalence and was behaviorally linked. In response to a complex set of risks and disadvantages that put African MSM at a greater risk of HIV infection future interventions targeting MSM should focus on a comprehensive approach that combines behavioral biomedical and structural interventions.

Nigeria accounts for 9% of the global HIV burden and is a signatory to Millennium Development Goals as well as the post-2015 Sustainable Development Goals. This paper reviews maturation of her HIV M&E system and preparedness for monitoring of the post-2015 agenda. Using the UNAIDS criteria for assessing a functional M&E system, a mixed-methods approach of desk review and expert consultations, was employed. Following adoption of a multi-sectoral M&E system, Nigeria experienced improved HIV coordination at the National and State levels, capacity building for epidemic appraisals, spectrum estimation and routine data quality assessments. National data and systems audit processes were instituted which informed harmonization of tools and indicators. The M&E achievements of the HIV response enhanced performance of the National Health Management Information System (NHMIS) using DHIS2 platform following its re-introduction by the Federal Ministry of Health, and also enabled decentralization of data management to the periphery. A decade of implementing National HIV M&E framework in Nigeria and the recent adoption of the DHIS2 provides a strong base for monitoring the Post 2015 agenda. There is however a need to strengthen inter-sectoral data linkages and reduce the rising burden of data collection at the global level.

This report describes a pilot study, conducted in Nigeria, of the World Health Organization protocol for monitoring human immunodeficiency virus (HIV) drug resistance (HIVDR) and associated program factors among patients receiving first-line antiretroviral therapy (ART). In 2008, 283 HIV-infected patients starting ART were consecutively enrolled at 2 ART clinics in Abuja. Twelve months after ART initiation, 62% were alive and on first-line ART, 3% had died, 1% had transferred out of the program, and 34% were lost to follow-up. Among patients on first-line ART at 12 months, 90% had viral suppression. However, in view of the high loss to follow-up rate (34%), strategies for patient retention and tracking are critical to minimize possible HIVDR and optimize treatment outcomes.

The Nigeria National Response Management Information System (NNRIMS), developed in 2004 as a framework for monitoring and evaluating the country’s response to HIV, does not function at an optimum level due to several challenges, including a bewildering proliferation of vertical reporting systems, competition among sectors, and the nascent nature of the monitoring and evaluation (M&E) sub-systems within many institutions. An assessment of the existing M&E system was conducted to verify whether the system has the capacities to provide essential data for monitoring the epidemic and identifying critical programming gaps. Nigeria’s National Agency for the Control of AIDS (NACA) used an organizing framework for a national HIV M&E system developed by UNAIDS, to assess the strengths and weaknesses of the NNRIMS to generate data for evidence-based decisionmaking. The participatory approach used during an assessment workshop ensured that the process was country-led and -owned to build consensus and local capacity, and that it encouraged adoption of a single national-level multisectoral HIV M&E system. The assessment found an operable M&E system at the national level but a much weaker system at the state and local levels and across seven other sectors. There are multiple data collection and reporting tools at the facility level that lead to vertical reporting systems, which increases the burden of reporting at lower levels, especially by service providers. Human resources are being developed, but problems remain with the quantity and quality of staff. Data use, though evident at the national level, is still very weak among five of the seven sectors assessed. The assessment results have been used to develop a national costed M&E workplan to which all stakeholders contributed in a coordinated response to strengthen the system.

Introduction: Routine Health Information Systems (RHIS) are increasingly transitioning to electronic platforms in several developing countries. Establishment of a Master Facility List (MFL) to standardize the allocation of unique identifiers for health facilities can overcome identification issues and support health facility management. The Nigerian Federal Ministry of Health (FMOH) recently developed a MFL, and we present the process and outcome.Methods: The MFL was developed from the ground up, and includes a state code, a local government area (LGA) code, health facility ownership (public or private), the level of care, and an exclusive LGA level health facility serial number, as part of the unique identifier system in Nigeria. To develop the MFL, the LGAs sent the list of all health facilities in their jurisdiction to the state, which in turn collated for all LGAs under them before sending to the FMOH. At the FMOH, a group of RHIS experts verified the list and identifiers for each state.Results: The national MFL consists of 34,423 health facilities uniquely identified. The list has been published and is available for worldwide access; it is currently used for planning and management of health services in Nigeria.Discussion: Unique identifiers are a basic component of any information system. However, poor planning and execution of implementing this key standard can diminish the success of the RHIS.Conclusion: Development and adherence to standards is the hallmark for a national health information infrastructure. Explicit processes and multi-level stakeholder engagement is necessary to ensuring the success of the effort.

BACKGROUND: Female sex workers (FSWs) account for about 20% of new HIV infections in Nigeria. We estimated the change in HIV prevalence and sexual risk behaviors between 2 consecutive rounds of integrated biological and behavioral surveillance surveys (IBBSSs) and determined correlates of HIV transmission among FSWs. METHODS: In 2007 and 2010 HIV prevalence and risk behavior data on brothel-based (BB) and non-brothel-based (NBB) FSWs from the integrated biological and behavioral surveillance survey were evaluated in 6 Nigerian states. Logistic regression was used to identify correlates of HIV infection. RESULTS: A total of 2897 and 2963 FSWs were surveyed in 2007 and 2010 respectively. Overall HIV prevalence decreased in 2010 compared to 2007 (20% vs. 33%; P < 0.001) with similar magnitude of declines among BB-FSW (23% vs. 37%; P < 0.0001) and NBB-FSW (16% vs. 28%; P < 0.0001). Consistent condom use with boyfriends in the last 12 months was lower in 2010 compared to 2007 overall (23% vs. 25%; P = 0.02) and among BB-FSWs (17% vs. 23%; P < 0.01] while NBB-FSWs showed a marginal increase (30% vs. 27%; P = 0.08). FSWs residing in the Federal Capital Territory [adjusted odds ratio (AOR): 1.74 (1.34 - 2.27)] and Kano state [AOR: 2.07 (1.59 - 2.70)] were more likely to be HIV-positive while FSWs recruited in 2010 [AOR: 0.81 (0.77-0.85)] and those who had completed secondary education [AOR: 0.70 (0.60-0.80)] were less likely to be HIV-positive. CONCLUSIONS: Results suggest significant progress in reducing the burden of HIV among FSWs in Nigeria although low condom use with boyfriends continued to be a potential bridge between FSWs and the general population. Venue-based prevention programs are needed to improve safer sex practices among BB-FSWs.

Background. Antiretroviral therapy (ART) is being administered in developing nations at unprecedented numbers following the World Health Organization’s (WHO) development of standardized first-line drug regimens. To ensure continued efficacy of these drug regimens, WHO recommends monitoring virological responses and development of human immunodeficiency virus (HIV) drug resistance (HIVDR) in HIV-infected patients in a prospective cohort. The current study compared dried fluid spot specimens with the reference standard plasma specimens as a practical tool for viral load (VL) and HIVDR genotyping in resource-limited settings. Methods. Dried blood spot (DBS), dried plasma spot (DPS), and plasma specimens were collected from 173 –patients receiving ART at 2 hospital sites in Abuja, Nigeria. HIV-1 VL analysis was performed using NucliSENS EasyQ HIV-1 v1.1 RUO test kits. Genotyping of the HIV-1 pol gene was performed using a broadly sensitive in-house assay. Results. Direct comparison of VL levels showed that DBS specimens, and not DPS specimens, gave results comparable to those of plasma specimens (P 5 .0619 and .0007, respectively); however, both DBS and DPS specimens had excellent correlation with plasma specimens in predicting virological failure (VL, $1000 copies/mL) in patients (j 5 0.78 and 0.83, respectively). Of the 18 specimens with a plasma VL $1000 copies/mL, HIVDR genotyping rates were 100% in DBS and 38.9% in DPS specimens, and DBS specimens identified 61 of 65 HIVDR mutations (93.8%) identified in plasma specimens. Conclusions. Our results indicate that DBS specimens could be used for surveys to monitor HIVDR prevention failure in resource-limited settings.

Objective To evaluate HIV and syphilis prevalence among men who have sex with men (MSM) in Nigeria, and assess their HIV-related risk behaviours and exposure to HIV prevention interventions. Methods Cross-sectional study using respondent-driven sampling conducted in Lagos, Kano and Cross River states, Nigeria, between July and September 2007. Results A total of 879 MSM participated, 293 from each state. Eight participants (1.1%, CI 0.1% to 2.2%) in Cross River, 27 (9.3%, CI 5.7% to 15.4%) in Kano and 74 (17.4%, CI 12.3% to 23.2%) in Lagos tested positive for HIV. No syphilis was detected. The median age was 22 years. MSM reported an average of 4.2 male anal sex partners in the past 6 months. Between 24.4% (Lagos) and 36.0% (Kano) of MSM reported selling sex to other men. Up to 49.7% of MSM reported sex with a girlfriend and ≤6.5% purchased sex from female sex workers. Consistent condom use in commercial sex with other men over the past 6 months ranged from 28.0% (Cross River) to 34.3% (Kano), in contrast to between 23.9% (Kano) and 45.8% (Lagos) for non-commercial sex. Associations with HIV positivity included age in the three states, having been the receptive partner in anal sex in the past 6 months in Lagos and in Lagos and Kano feeling at risk of HIV. Conclusion Large differentials in HIV prevalence between states together with high mobility, inconsistent condom use and behavioural links with female sex partners, have the potential for further HIV transmission within MSM networks, and between MSM and the general population.

Background MSM are at a high risk of HIV. Due to their risk, they are potential population for HIV vaccine trials. Nigeria conducted 2010 Integrated Biological Behavioral Surveillance Survey (IBBSS) among the high risk groups. Unfortunately, MSM had the second highest HIV prevalence after female sex workers, and some with female partners. Thus, HIV prevention among MSM is of great national importance. This study evaluates predictors of their risky behavior which will be useful in enrolling them for future HIV vaccine trials. Methods

Introduction Youths are particularly vulnerable to HIV/AIDS, sexual and reproductive health problems, which are major challenges to their health and development. There is a need to estimate HIV prevalence and understand predictors among them towards implementation of appropriate and evidence-based national interventions. Methods A 2007 nationally representative household survey was analysed. It involved 4633 youths aged between 15 and 24 years. HIV prevalence and behavioural indicators were assessed. Logistic regression was used to model predictors of HIV infection. Results Mean age was 19.1±2.8 years; 50.9% male and 49.1% female. Youth HIV prevalence was 2.4% (national prevalence was 3.6%); young women HIV prevalence was 2.9% and male counterpart 1.9%. Sexual debut 1 month; 18.4% had more than one sexual partner; 80.7% knew male condom protected against pregnancy; 75.6% knew male condom protected against HIV/AIDS. 81.9% had sexual intercourse in the last 12 months of which 45.8% used condom, and 10.5% were engaged in intergenerational sex with partners ≥10 years. Risks for HIV infection were away from home for >1 month AOR=2.1 95% CI 1.3 to 2.7; being a female AOR 3.4 95% CI 2.8 to 6.7; sex without condom AOR=2.1 95% CI 1.4 to 5.6 while having at least secondary education was protective with AOR: 0.7 95% CI 0.3 to 0.9. Conclusion Youths accounted for 67% of HIV prevalence in Nigeria with young women disproportionately affected by HIV. Youths need appropriate and targeted behavioural interventions that involve partner reduction, consistent condom use and avoidance of intergenerational sex.

Background Sexually transmitted infections (STI) including syphilis are associated with risks of acquiring HIV infection. Behaviours that increase STI also play important role in increasing the risk of HIV. Transport workers are highly mobile population often predisposed to STI including HIV due to the nature of their business. Similarly, they are potential bridge population between female sex workers and the general population. This study assesses relationship between syphilis and HIV among transport workers in Nigeria. Methods Secondary data analysis of a survey conducted in 2007 among 2233 transport workers in six Nigerian states. Time location sampling was employed. The relationship between HIV and syphilis was evaluated using multivariate logistic regressions while controlling for confounding factors such as demographic, knowledge and behavioural variables. Results Median age was 33 years with age range: 18–49 years and all participants were male. Syphilis prevalence among transport workers was 1.6%. State-level prevalence of syphilis was: 4.2% in Anambra, 1.1% in Cross Rivers, 0.7% in Edo state, 1.8% in FCT, 0.8% in Kano and 1.9% in Lagos. HIV prevalence was 3.8% with the highest prevalence (6%) in Cross Rivers and the lowest (1.6%) in Kano. Also, 33.5% had genital discharge; 14.5% had genital ulcers/sores; 12.2% used marijuana; 25.0% were away from home for >1 month; 55.5% had secondary education and 67.2% had ever been married. Only 17.3% used condom in the last sex with non-regular partner; 31.0% had sex with a girlfriend in the past 12 months and 4.3% paid for sex in the last 12 months. Syphilis was not associated with HIV infection OR=1.54 95% CI 0.90 to 2.65. However, risks for HIV infection included being away from home for >1 month OR=1.8 95% CI 1.4 to 2.3; sex without condom in the last 12 months OR=1.5 95% CI 1.2 to 1.9; sex with female sex workers OR 1.7 95% CI 1.2 to 2.2 while secondary education was protective with OR: 0.6 95% CI 0.4 to 0.8. Conclusions More researches are needed to investigate the relationship between syphilis and HIV in Nigeria as little evidence is available from the national survey. These findings have implication of promoting secondary education and condom uptake in non-marital relationships among transport workers in Nigeria.