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Ibrahim Jahun,1 Emilio Dirlikov,2 Solomon Odafe,1 Aminu Yakubu,1 Andrew T Boyd,2 Pamela Bachanas,2 Charles Nzelu,3 Gambo Aliyu,4 Tedd Ellerbrock,2 Mahesh Swaminathan1 On behalf of CDC Nigeria ART Surge Team1US Centers for Disease Control and Prevention, Division of Global HIV and TB, Center for Global Health - Nigeria, Abuja Federal Capital Territory, Nigeria; 2US Centers for Disease Control and Prevention, Division of Global HIV and TB, Center for Global Health, Atlanta, GA, USA; 3Federal Ministry of Health (FMOH), Abuja, Nigeria; 4National Agency for the Control of AIDS (NACA), Abuja, Federal Capital Territory, NigeriaCorrespondence: Ibrahim JahunCenters for Disease Control and Prevention (CDC)-Nigeria, Embassy of the United States of America, Central Business District, Abuja, Federal Capital Territory, NigeriaTel +234 8037013715Email drjahun@yahoo.co.ukPurpose: The 2018 Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS) showed Nigeria’s progress toward the UNAIDS 90-90-90 targets: 47% of HIV-positive individuals knew their status; of these, 96% were receiving antiretroviral therapy (ART); and of these, 81% were virally suppressed. To improve identification of HIV-positive individuals, Nigeria developed an Enhanced Community Case-Finding Package (ECCP). We describe ECCP implementation in nine states and assess its effect.Methods: ECCP included four core strategies (small area estimation [SAE] of people living with HIV [PLHIV], map of HIV-positive patients by residence, HIV risk-screening tool [HRST], and index testing [IT]) and four supportive strategies (alternative healthcare outlets, performance-based incentives for field testers, Project Extension for Community Healthcare Outcomes, and interactive dashboards). ECCP was deployed in nine of 10 states prioritized for ART scale-up. Weekly program data (October 2019–March 2020) were tracked and analyzed.Results: Of the total 774 LGAs in Nigeria, using SAE, 103 (13.3%) high-burden LGAs were identified, in which 2605 (28.0%) out of 9,294 hotspots were prioritized by mapping newly identified PLHIV by residential addresses. Over 22 weeks, among 882,449 individuals screened using HRST, 723,993 (82.0%) were eligible and tested for HIV (state range, 43.7– 90.4%), out of which 20,616 were positive. Through IT, an additional 3,724 PLHIV were identified. In total, 24,340 PLHIV were identified and 97.4% were linked to life-saving antiretroviral therapy. The number of newly identified PLHIV increased 17-fold over 22 weeks (week 1: 89; week 22: 1,632). Overall mean HIV positivity rate by state was 3.3% (range, 1.8– 6.4%).Conclusion: Using ECCP in nine states in Nigeria increased the number of PLHIV in the community who knew their status, allowing them to access life-saving care and decreasing the risk of HIV transmission.Keywords: ART Surge, small area estimation, HIV risk assessment tool, index partner testing

Background: Malaria is a serious public health problem in many parts of the world, especially in Sub Saharan Africa where Nigeria bears the bulk of the disease. In Nigeria, though Anopheles gambiae is the most dominant species across the country, Anopheles arabiences is the most prevalent in the northern part of Nigeria like Sokoto, while the Anopheles males are predominant in mangrove coastal zones of the country. There are now known five different species of Plasmodium parasites that cause malaria havoc in the globe; Plasmodium falciparum (P. falciparum), P. ovale, P. malaria, P. vivax and P. knowlesi but, out of these species, P. falciparum is the most prevalent and virulent that accounts for about 95 % of all malaria infections in Nigeria. The significance of P.malaria, P. ovale and P. vivax are neglected as non-P. falciparum parasites, which are currently invisible to most public health authorities in Sokoto and Nigeria at large. Aim: Based on those challenges, this study aims to determine this existing Plasmodium species in Sokoto and establish the gold standard malaria diagnosis. In our knowledge, this is the first cross sectional laboratory based descriptive study of plasmodium species in Sokoto, North-Western Nigeria. Result: Our result showed that P. falciparum, P. ovale, P. malaria, and P. vivax are present in Sokoto. Conclusion: Based on our finding, we recommend malaria microscopy as the gold standard of malaria evidence based diagnosis. [ABSTRACT FROM AUTHOR]

Skin cancer, a life-threatening disease, necessitates early detection and accurate classification for successful treatment. Misdiagnoses can lead to significant consequences for patients, highlighting the critical need for improved accuracy. Despite advancements in machine learning (ML) and deep learning (DL) techniques, accurate diagnosis remains challenging due to its complex nature. This comprehensive Systematic Literature Review (SLR) aims to examine the use of ML and DL models in skin cancer detection and classification, including convolutional neural networks (CNNs), recurrent neural networks (RNNs), and transfer learning. Model performance is evaluated based on accuracy, sensitivity, specificity, and precision. Key findings reveal the dominance of DL models, with SVM-PSO emerging as a top-performing hybrid model with 97.50% accuracy. Tailored models, such as M-SVM and FCN-ResAlexNet, demonstrate high accuracy, emphasizing the importance of customization for dermatology tasks. Deep neural networks, such as ResNet-50, ResNet34, Inception V3, and ResNet 152, consistently exhibit strong performance, highlighting the impact of architectural depth. Traditional ML algorithms like Random Forest, KNN, and Naive Bayes face challenges compared to DL models. Furthermore, the analysis explores correlations between dataset size and accuracy, revealing varied model responses. Temporal trends and model-specific analyses uncover outliers, anomalies, and the influence of specific datasets (e.g. imbalanced classes), providing valuable insights for future research and model development. This multifaceted nature of model performance, influenced by factors beyond dataset size, underscores the need for nuanced considerations in dermatology image classification. Overall, the findings of this SLR offer valuable insights for researchers and practitioners, serving as a crucial step towards developing even more accurate and reliable tools for skin cancer diagnosis.

Microalbuminuria is an independent risk factor for cardiovascular diseases (CVD), and it is now considered as an important emerging target for primary prevention strategies in CVD. Restriction of dietary acid intake has been suggested as one possible effective dietary strategy that might offer significant reductions of microalbuminuria. However, reports from previous studies are conflicting. We investigated whether higher dietary acid intake is associated with greater risk of microalbuminuria in apparently healthy adult Nigerians. We assessed dietary intake using a food frequency questionnaire and the Nigerian Food Composition Table. Acid forming potential of our local diets were estimated as Potential Renal Acid Load (PRAL) scores. Urine albumin and creatinine were measured. Microalbuminuria was defined as urinary albumin-creatinine ratio of 30 - 300mg/g. Across the quartiles of the PRAL scores, there was a statistically significant trend with higher intake of dietary acid associated with increased risk of incident microalbuminuria (for trend < 0.05). We conclude that among the subjects in this study higher intake of dietary acid is associated with significant increased risk of microalbuminuria. We recommend further longitudinal studies that will investigate whether lifestyle modification that include restriction of diet with high acid forming potentials, in the general population or among individuals with cardiovascular risk profile, will be a useful approach in lowering the incidence of microalbuminuria and preventing (and/or delay) cardiovascular diseases in our setting. [ABSTRACT FROM AUTHOR]

Background: Malaria is a serious public health problem in many parts of the world, especially in Sub Saharan Africa where Nigeria bears the bulk of the disease. In Nigeria, though Anopheles gambiae is the most dominant species across the country, Anopheles arabiences is the most prevalent in the northern part of Nigeria like Sokoto, while the Anopheles males are predominant in mangrove coastal zones of the country. There are now known five different species of Plasmodium parasites that cause malaria havoc in the globe; Plasmodium falciparum (P. falciparum), P. ovale, P. malaria, P. vivax and P. knowlesi but, out of these species, P. falciparum is the most prevalent and virulent that accounts for about 95 % of all malaria infections in Nigeria. The significance of P.malaria , P. ovale and P. vivax are neglected as non- P. falciparum parasites, which are currently invisible to most public health authorities in Sokoto and Nigeria at large. Aim: Based on those challenges, this study aims to determine this existing Plasmodium species in Sokoto and establish the gold standard malaria diagnosis. In our knowledge, this is the first cross sectional laboratory based descriptive study of plasmodium species in Sokoto, North-Western Nigeria. Result: Our result showed that P. falciparum, P. ovale, P. malaria, and P. vivax are present in Sokoto. Conclusion: Based on our finding, we recommend malaria microscopy as the gold standard of malaria evidence based diagnosis.

Peacock bass (Perciformes, Cichlidae, Cichla) are multi-coloured and highly predatory fish originated from Amazonian region. The species was deliberately introduced into Malaysia freshwater bodies by anglers in the early 1990's for sport fisheries. In this recent study, we found the population of peacock bass in Lake Telabak, a man-made lake in Besut, Terengganu. Using mitochondrial DNA analysis approach, the origin and taxonomy of peacock bass in the lake were clarify. A total of forty fishes were sampled from Lake Telabak for the analysis. Haplotype was detected among all samples. The current study revealed that Cichla spp. in Lake Telabak are closer to Cichla ocellaris (Bloch and Schneider, 1801) with a sequence similarity of 99.72% as blasted at the National Center for Biotechnology Information (NCBI) database. The evolutionary history inferred using the maximum likelihood method in the molecular phylogenetic analysis also confirmed the species as C. ocellaris, but no record found concerning their origin. The Tasik Telabak peacock bass also match with the Cichla temensis which is traced to the Amazonas and Parà states of Brazil (Manaus, Novo Airão, Tapajós and Tefé). [ABSTRACT FROM AUTHOR]

The analysis of changes in water quality in a monitoring network system is important because the sources of pollution vary in time and space. This study utilized analysis of the water quality index calculation, hierarchical cluster analysis, and mapping. This was achieved by assessing the water quality parameters of the samples collected from Galma River in Zaria, Northwestern Nigeria in wet and dry seasons. The Analysis shows that sampling point number 15 located downstream of the river has the largest number of water quality index of 105.77 and 126.34, while sampling points 1 located upstream of the river has 62.71 and 78.09 in both wet and dry seasons respectively. This indicates that all the monitoring sites were polluted and the water could be utilized for industrial and irrigation specified due to the purposes only. Hierarchical cluster analysis and mapping revealed consistency and variations. For both networks, cluster 1 is located in the middle of the river watershed, while clusters 2, 3 and 4 show variations within the river watershed. 3 sampling points in wet season located at the upstream of the river were specified for Irrigation and Industrial uses, while the rest of the sampling points in both seasons were specified for irrigation purpose only. From this study, water quality index and multivariate techniques for environmental management can be employed in monitoring river resources, and research of this kind can help inadequate planning and management of the river system. [ABSTRACT FROM AUTHOR]

The study adopted survey research design. The population of the study consisted 1200 respondents comprising (staff of the Zamfara State Agricultural Development Project, FADAMA III Project, IFAD, Animal rearers and Farmers). Instruments of data collection used for the study were questionnaire, interview and discussions. One thousand two hundred questionnaires were distributed to respondents and only 988 (82.2%) were dully returned and found usable. The results of the responses were interpreted using simple percentage and frequency tables. The findings of the study include, that 95% of Zamfara State population are farmers, Maru and Gusau Local Government Areas recorded the highest farmers' population. It was also discovered that there was a high rate of awareness of climate change information in the State with Radio, Television, extension services as major sources of climate change information in the State. It was also discovered that farmers in the State utilize climate change information like taking decisions on what and when to plant, planting improved crop varieties among others. There is also the challenges of reduction in annual rainfall, deforestation, insect-pests attack, high temperature among others. Recommendation was made for intensified awareness campaign on climate change, increased budgetary allocation to the agricultural sector for more mitigation and adaptation capacity for the farmers. [ABSTRACT FROM AUTHOR]

The production and characterization of biosurfactant by Candida boleticola H09 and Rhodotorula bogoriensis H15 were examined in this study. Seven agro-waste substrates (corn cob, cassava effluent, maize bran, rice straw, banana peels, corn husk and sugar cane bagasse) were used for yeast growth. The substrates supported yeast growth with banana peels having the highest optical density (OD) of 0.704 for S. cerevisiae H02; 0.417 for C. boleticola H09 and 0.458 for R. bogoriensis H15. This was followed by corn husk, maize bran and cassava effluent. These four substrates, which supported growth of yeasts were used in biosurfactants production by the yeasts. The result revealed that R. bogoriensis H15 had the highest yield of 2.62 g/l on corn husk, 2.02 g/l on maize bran, 1.16 g/l on cassava effluent and 0.5 g/l on banana peels. Chemical characterization of the biosurfactants was done using GC-MS and the results obtained indicated that they were glycolipids composed of palmitic hexadecanoic, octadecanoic acids, methyl esters and hydroxylated fatty acids linked to a decanoic acid. Fourier transform infrared (FTIR) analysis showed that the surfactants consisted of carboxyl, hydroxyl and sugar derivative groups. Specifically, C. boleticola H09 and R. bogoriensis H15 produced biosurfactants designated as lactonic sophorolipid Bios-H09 and acid sophorolipid Bios-H15 respectively. The potentials of the biosurfactants to serve as detergent additive as well as detergent was evaluated on a white cotton cloth soiled with 3 ml motor oil using shake flask method. So-Klin detergent had 66.15 % wash followed by mixture of So-Klin and Bios-H09 (58.8 %), So-Klin and Bios-H15 (28 %), Bios-H09 (24.7 %), Bios-H15 (15.8 %) and distilled water (4 %). The potential of the biosurfactant to enhance crude oil recovery was also examined using sand pack column method. Bios- H09 enhanced oil recovery of 47.75 %, Bios-H15 recovered 32.25 % and distilled water (control) recovered 15.25 % of crude oil. The results suggest that C. boleticola H09 and R. bogoriensis H15 are good candidates for the production of biosurfactants, particularly sophorolipids that can be used for enhanced oil recovery. [ABSTRACT FROM AUTHOR]

BackgroundThe Nigeria AIDS Indicator and Impact Survey (NAIIS), a cross-sectional household survey, was conducted in 2018 with primary objectives to estimate HIV prevalence, HIV-1 incidence, and status of UNAIDS 90-90-90 cascade. We conducted retrospective analysis of the performance of HIV rapid tests and the national HIV testing algorithm used in Nigeria.MethodsThe national algorithm included Determine HIV-1/2 as test 1 (T1), Unigold HIV-1/2 as test 2 (T2), and StatPak HIV-1/2 as the tie-breaker test (T3). Individuals reactive with T1 and either T2 or T3 were considered HIV-positive. HIV-positive specimens from the algorithm were further confirmed for the survey using supplemental test Geenius HIV-1/2. If Geenius did not confirm HIV-positive status, HIV-1 Western blot was performed. We calculated the concordance between tests and positive predictive value (PPV) of the algorithm on unweighted data.ResultsOf 204,930 participants (ages ≥18 months) 5,103 (2.5%) were reactive on T1. Serial testing of T1 reactive specimens with T2 or if needed by tiebreaker T3 identified 2958 (1.44%) persons as HIV-positive. Supplemental testing confirmed 2,800 (95%) as HIV-positive (HIV-1 = 2,767 [98.8%]; HIV-2 = 5 [0.2%]; dual infections = 22 [0.8%]). Concordance between T1 and T2 was 56.6% while PPV of the national algorithm was 94.5%.ConclusionsOur results show high discordant rates and poor PPV of the national algorithm with a false-positive rate of about 5.5% in the NAIIS survey. Considering our findings have major implications for HIV diagnosis in routine HIV testing services, additional evaluation of testing algorithm is warranted in Nigeria.

Large amounts of patient vital/physiological signs data are usually acquired in hospitals manually via centralized smart devices. The vital signs data are occasionally stored in spreadsheets and may not be part of the clinical cloud record; thus, it is very challenging for doctors to integrate and analyze the data. One possible remedy to overcome these limitations is the interconnection of medical devices through the internet using an intelligent and distributed platform such as the Internet of Things (IoT) or the Internet of Health Things (IoHT) and Artificial Intelligence/Machine Learning (AI/ML). These concepts permit the integration of data from different sources to enhance the diagnosis/prognosis of the patient’s health state. Over the last several decades, the growth of information technology (IT), such as the IoT/IoHT and AI, has grown quickly as a new study topic in many academic and business disciplines, notably in healthcare. Recent advancements in healthcare delivery have allowed more people to have access to high-quality care and improve their overall health. This research reports recent advances in AI and IoT in monitoring vital health signs. It investigates current research on AI and the IoT, as well as key enabling technologies, notably AI and sensors-enabled applications and successful deployments. This study also examines the essential issues that are frequently faced in AI and IoT-assisted vital health signs monitoring, as well as the special concerns that must be addressed to enhance these systems in healthcare, and it proposes potential future research directions.

Artificial intelligence (AI) and wearable sensors are gradually transforming healthcare service delivery from the traditional hospital-centred model to the personal-portable-device-centred model. Studies have revealed that this transformation can provide an intelligent framework with automated solutions for clinicians to assess patients’ general health. Often, electronic systems are used to record numerous clinical records from patients. Vital sign data, which are critical clinical records are important traditional bioindicators for assessing a patient’s general physical health status and the degree of derangement happening from the baseline of the patient. The vital signs include blood pressure, body temperature, respiratory rate, and heart pulse rate. Knowing vital signs is the first critical step for any clinical evaluation, they also give clues to possible diseases and show progress towards illness recovery or deterioration. Techniques in machine learning (ML), a subfield of artificial intelligence (AI), have recently demonstrated an ability to improve analytical procedures when applied to clinical records and provide better evidence supporting clinical decisions. This literature review focuses on how researchers are exploring several benefits of embracing AI techniques and wearable sensors in tasks related to modernizing and optimizing healthcare data analyses. Likewise, challenges concerning issues associated with the use of ML and sensors in healthcare data analyses are also discussed. This review consequently highlights open research gaps and opportunities found in the literature for future studies.

In recent times, the growth of the Internet of Things (IoT), artificial intelligence (AI), and Blockchain technologies have quickly gained pace as a new study niche in numerous collegiate and industrial sectors, notably in the healthcare sector. Recent advancements in healthcare delivery have given many patients access to advanced personalized healthcare, which has improved their well-being. The subsequent phase in healthcare is to seamlessly consolidate these emerging technologies such as IoT-assisted wearable sensor devices, AI, and Blockchain collectively. Surprisingly, owing to the rapid use of smart wearable sensors, IoT and AI-enabled technology are shifting healthcare from a conventional hub-based system to a more personalized healthcare management system (HMS). However, implementing smart sensors, advanced IoT, AI, and Blockchain technologies synchronously in HMS remains a significant challenge. Prominent and reoccurring issues such as scarcity of cost-effective and accurate smart medical sensors, unstandardized IoT system architectures, heterogeneity of connected wearable devices, the multidimensionality of data generated, and high demand for interoperability are vivid problems affecting the advancement of HMS. Hence, this survey paper presents a detailed evaluation of the application of these emerging technologies (Smart Sensor, IoT, AI, Blockchain) in HMS to better understand the progress thus far. Specifically, current studies and findings on the deployment of these emerging technologies in healthcare are investigated, as well as key enabling factors, noteworthy use cases, and successful deployments. This survey also examined essential issues that are frequently encountered by IoT-assisted wearable sensor systems, AI, and Blockchain, as well as the critical concerns that must be addressed to enhance the application of these emerging technologies in the HMS.

Background: Community Treatment Initiative (CTI) was developed in northern Nigeria as an intervention to link a cohort of people living with HIV (PLHIV) who refused antiretroviral treatment through a conventional linkage method to care and treatment. The CTI attempted to take treatment to PLHIV in the community. Methods: This was a non-control interventional study that evaluated the proportion of linkage-resistant PLHIV linked to treatment through the CTI in nine geographical areas. Data were collected between October and December 2015. Linkage-resistant PLHIV were identified and linked to treatment using the CTI. Data were analyzed using Excel and IBM SPSS version 20.0. The simple proportion was used to estimate the linkage-resistant PLHIV who were eventually linked and retained in care and who ultimately achieved virological suppression (viral load

BackgroundIneffective linkage to care (LTC) is a known challenge for community HIV testing. To overcome this challenge, a robust linkage to care strategy was adopted by the 2018 Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS). The NAIIS linkage to care strategy was further adapted to improve Nigeria's programmatic efforts to achieve the 1st 90 as part of the Nigeria Antiretroviral Therapy (ART) Surge initiative, which also included targeted community testing. In this paper we provide an overview of the NAIIS LTC strategy and describe the impact of this strategy on both the NAIIS and the Surge initiatives.MethodsThe NAIIS collaborated with community-based organizations (CBOs) and deployed mobile health (mHealth) technology with real-time dashboards to manage and optimize community LTC for people living with HIV (PLHIV) diagnosed during the survey. In NAIIS, CBOs' role was to facilitate linkage of identified PLHIV in community to facility of their choice. For the ART Surge, we modified the NAIIS LTC strategy by empowering both CBOs and mobile community teams as responsible for not only active LTC but also for community testing, ART initiation, and retention in care.ResultsOf the 2,739 PLHIV 15 years and above identified in NAIIS, 1,975 (72.1%) were either unaware of their HIV-positive status (N = 1890) or were aware of their HIV-positive status but not receiving treatment (N = 85). Of these, 1,342 (67.9%) were linked to care, of which 952 (70.9%) were initiated on ART. Among 1,890 newly diagnosed PLHIV, 1,278 (67.6%) were linked to care, 33.7% self-linked and 66.3% were linked by CBOs. Among 85 known PLHIV not on treatment, 64 (75.3%) were linked; 32.8% self-linked and 67.2% were linked by a CBO. In the ART Surge, LTC and treatment initiation rates were 98% and 100%, respectively. Three-month retention for monthly treatment initiation cohorts improved from 76% to 90% over 6 months.ConclusionsActive LTC strategies by local CBOs and mobile community teams improved LTC and ART initiation in the ART Surge initiative. The use of mHealth technology resulted in timely and accurate documentation of results in NAIIS. By deploying mHealth in addition to active LTC, CBOs and mobile community teams could effectively scale up ART with real-time documentation of client-level outcomes.

Abstract - Indoor air contains a complex mixture of microorganisms, microorganism fragments, and by products such as molds, bacteria, endotoxins, mycotoxins, and volatile microbial organic compounds. Airborne fungi and bacteria can be toxic, allergenic and/or infectious. A research was conducted to determine the number and types of airborne fungal spores in Buildings of Usmanu Danfodiyo University Sokoto, Nigeria. Five (5) areas were chosen within the University for the Survey, these were student Hostel, Staff Quarters, Botanical garden, Microbiology laboratory and city campus of Usmanu Danfodiyo University. . A total number of fifteen (15) petri dishes containing potato dextrose agar each were vertically placed in each sampler and exposed at end of each height and site for 10 and 20 minutes respectively. A total of thirteen (13) different fungal specie were identified namely; Aspergillus niger, A. flavus, A fumigates, A. ustus, A. terreus, Fusarium solani, F. oxysporum, Alterneria altenata, Rhizopus oryzae, R. stolonifer, Helminthosporum sp., Penicillum candidum and Absedia corymbifera. Aspergillus niger had the highest frequency of occurrence of (14.9%), Helminthosporus species had the least frequency of occurrence of (1.5%). Conclusively it was observed that the concentration of fungal spores was high in the upper surface than the ground level at the time of the survey.

Introduction: Nigeria has the fastest-growing HIV epidemic in West and Central Africa and key populations (KPs) bear a higher burden of HIV. This integrated biological and behavioural surveillance survey was conducted among female sex workers (FSW), men who have sex with men (MSM), people who inject drugs (PWID) and transgender (TG) populations to understand the changing dynamics of HIV to improve HIV prevention efforts in Nigeria., Methods: Using a cross-sectional design, data were collected between October and November 2020 in 12 states, from randomly selected KP members using multistage probability sampling. Behavioural data were collected using a structured questionnaire followed by three rapid HIV tests. The study was approved by ethical review boards in Nigeria and Canada and all ethical considerations including maintaining the privacy and confidentiality of all study subjects were followed., Results: A total number of 17 975 KP members were interviewed, with a response rate of over 98.0%. A weighted HIV prevalence of 28.8% (95% CI 27.4% to 30.2%), 25.0% (95% CI 23.7% to 26.3%), 15.5% (95% CI 14.3% to 16.4%) and 10.9% (95% CI 9.9% to 11.8%) was found among TGs, MSMs, FSWs and PWIDs respectively. A high number of sex partners and consistent condom use were low for all types of KPs, especially with regular partners. Both MSM and TGs reported high rates of unprotected receptive anal intercourse ranging between 71.2% and 85.0%. Nearly 60.0% of PWID shared their used syringe with another PWID. Overall, 90.2% FSWs, 77.2% MSM, 81.9% TGs and 84.3% PWID were ever tested for HIV., Conclusion: This study highlights the progressing trends of HIV prevalence among all KPs in Nigeria. A focused prevention approach is needed to control the emerging epidemic among KPs who constitute the epicentre of the HIV epidemic in Nigeria., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Effective HIV prevention programme coverage is necessary to achieve Nigeria's goal of ending the epidemic by 2030. Recent evidence highlights gaps in service coverage and utilization across the country. The Effective Programme Coverage framework is a Programme Science tool to optimize a programme's population-level impact by examining gaps in programme coverage using data generated through programme-embedded research and learning. We apply the framework using Integrated Biological and Behavioural Surveillance Survey (IBBSS) data from Nigeria to examine coverage of four prevention interventions-condoms, HIV testing, and needle and syringe programmes (NSP)-among four key population groups-female sex workers (FSW), men who have sex with men (MSM), people who inject drugs (PWID) and transgender people., Methods: Data from Nigeria's 2020 IBBSS, implemented in 12 states, were analysed to examine HIV prevention programme coverage among key populations. For each key population group and prevention intervention of interest, weighted IBBSS data were used to retrospectively generate coverage cascades that identify and quantify coverage gaps. Required coverage targets were informed by targets articulated in Nigeria's National HIV/AIDS Strategic Framework or, in their absence, by guidelines from policy normative bodies. Availability-, outreach- and utilization coverage proxy indicators were defined using variables from IBBSS data collection tools. Sankey diagrams are presented to visualize pathways followed by participants between coverage cascade steps., Results: Required coverage targets were missed for HIV testing and NSP among all key population groups. Condom availability coverage surpassed required coverage targets among FSW and MSM, while utilization coverage only among FSW exceeded the 90% required coverage target. Outreach coverage was low for all key population groups, falling below all required coverage targets., Conclusions: Our findings identify critical gaps in HIV prevention programme coverage for key populations in Nigeria and demonstrate non-linear movement across coverage cascades, signalling the need for innovative solutions to optimize coverage of prevention services. Programme-embedded research is required to better understand how key population groups in Nigeria access and use different HIV prevention services so that programmes, policies and resource allocation decisions can be optimized to achieve effective programme coverage and population-level impact., (© 2024 The Author(s). Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of International AIDS Society.)

As antiretroviral treatment (ART) coverage for people living with HIV (PLHIV) increases, HIV programmes require up-to-date information about evolving HIV risk behaviour and transmission risk, including those with low-level viremia (LLV; >50 to ≤1000 copies/mL), to guide prevention priorities. We aimed to assess differences in sexual risk behaviours, distribution of viral load (VL) and proportion of transmission across PLHIV subgroups. We analysed data from Population-based HIV Impact Assessment surveys in 14 sub-Saharan African countries during 2015-2019. We estimated adjusted prevalence ratios (aPR) of self-reported HIV high-risk behaviour (multiple partners and condomless sex) across cascade stages via generalised estimation equations. We modelled the proportions of transmission from each subgroup using relative self-reported sexual risk, a Hill function for transmission rate by VL, and proportions within cascade stages from surveys and UNAIDS country estimates for 2010-2020. Compared to PLHIV with undetectable VL (≤50 copies/mL), undiagnosed PLHIV (aPR women: 1.28 [95% CI: 1.08-1.52]; men: 1.61 [1.33-1.95]) and men diagnosed but untreated (2.06 [1.52-2.78]) were more likely to self-report high-risk sex. High-risk behaviour was not significantly associated with LLV. Mean VL was similar among undiagnosed, diagnosed but untreated, and on ART but non-suppressed sub-groups. Across surveys, undiagnosed and diagnosed but untreated contributed most to transmission (40-91% and 1-41%, respectively), with less than 1% from those with LLV. Between 2010 and 2020, the proportion of transmission from individuals on ART but non-suppressed increased. In settings with high ART coverage, effective HIV testing, ART linkage, and retention remain priorities to reduce HIV transmission. Persons with LLV are an increasing share of PLHIV but their contribution to HIV transmission was small. Improving suppression among PLHIV on ART with VL ≥1000 copies/mL will become increasingly important., Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: Jeffrey W. Imai-Eaton has received grants/contracts from NIH and WHO, consulting fees from BAO Systems, support for attending meetings from UNAIDS, SACEMA and the International AIDS Society and is a member of the editorial board for PLOS Global Public Health. Olanrewaju Edun has received consulting fees from University of Cape Town and WHO and support for attending meetings from UNAIDS. All other authors have declared that no competing interests exist., (Copyright: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.)

Background: Timely and reliable data are crucial for clinical, epidemiologic, and program management decision making. Electronic health information systems provide platforms for managing large longitudinal patient records. Nigeria implemented the National Data Repository (NDR) to create a central data warehouse of all people living with human immunodeficiency virus (PLHIV) while providing useful functionalities to aid decision making at different levels of program implementation., Objective: We describe the Nigeria NDR and its development process, including its use for surveillance, research, and national HIV program monitoring toward achieving HIV epidemic control., Methods: Stakeholder engagement meetings were held in 2013 to gather information on data elements and vocabulary standards for reporting patient-level information, technical infrastructure, human capacity requirements, and information flow. Findings from these meetings guided the development of the NDR. An implementation guide provided common terminologies and data reporting structures for data exchange between the NDR and the electronic medical record (EMR) systems. Data from the EMR were encoded in extensible markup language and sent to the NDR over secure hypertext transfer protocol after going through a series of validation processes., Results: By June 30, 2021, the NDR had up-to-date records of 1,477,064 (94.4%) patients receiving HIV treatment across 1,985 health facilities, of which 1,266,512 (85.7%) patient records had fingerprint template data to support unique patient identification and record linkage to prevent registration of the same patient under different identities. Data from the NDR was used to support HIV program monitoring, case-based surveillance and production of products like the monthly lists of patients who have treatment interruptions and dashboards for monitoring HIV test and start., Conclusion: The NDR enabled the availability of reliable and timely data for surveillance, research, and HIV program monitoring to guide program improvements to accelerate progress toward epidemic control., Competing Interests: None declared., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Background: In Nigeria, results from the pilot of the Test and Treat strategy showed higher loss to follow up (LTFU) among people living with HIV compared to before its implementation. The aim of this evaluation was to assess the effects of antiretroviral therapy (ART) initiation within 14 days on LTFU at 12 months and viral suppression., Methods: We conducted a retrospective cohort study using routinely collected de-identified patient-level data hosted on the Nigeria National Data Repository from 1,007 facilities. The study population included people living with HIV age ≥15. We used multivariable Cox proportional frailty hazard models to assess time to LTFU comparing ART initiation strategy and multivariable log-binomial regression for viral suppression., Results: Overall, 26,937 (38.13%) were LTFU at 12 months. Among individuals initiated within 14 days, 38.4% were LTFU by 12 months compared to 35.4% for individuals initiated >14 days (p<0.001). In the adjusted analysis, individuals who were initiated ≤14 days after HIV diagnosis had a higher hazard of being LTFU (aHR 1.15, 95% CI 1.10-1.20) than individuals initiated after 14 days of HIV diagnosis. Among individuals with viral load results, 86.2% were virally suppressed. The adjusted risk ratio for viral suppression among individuals who were initiated ≤14 days compared to >14 days was not statistically significant., Conclusion: LTFU was higher among individuals who were initiated within 14 days compared to greater than 14 days after HIV diagnosis. There was no difference for viral suppression. The provision of early tailored interventions to support newly diagnosed people living may contribute to reducing LTFU., Competing Interests: The authors have declared that no competing interests exist., (Copyright: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.)

Objectives: Non-disclosure of positive HIV status in population-based surveys causes underestimation of national HIV diagnosis and biases inferences about engagement in the care continuum. This study investigated individual and household factors associated with HIV non-disclosure to survey interviewers in Nigeria., Design: Secondary analysis of a cross sectional population-based household HIV survey., Methods: We analyzed data from adults aged 15-64 years who tested positive for HIV and had antiretroviral drugs (ARVs) in their blood from a nationally representative HIV sero-survey conducted in Nigeria in 2018. We considered ARV use as a proxy for knowledge of HIV diagnosis; thus, respondents who self-reported to be unaware of their HIV status were classified as non-disclosers. We estimated the associations between non-disclosure and various sociodemographic, clinical, and household characteristics using weighted logistic regression., Results: Among 1266 respondents living with HIV who were taking ARVs, 503 (40%) did not disclose their HIV status to interviewers. In multivariable statistical analyses, the adjusted odds of non-disclosure were highest among respondents aged 15-24 years, those with less than a primary school education, and those who were the only person living with HIV in their household., Conclusions: Non-disclosure of positive HIV status to survey personnel is common among adults who are receiving treatment in Nigeria. These findings highlight the importance of validating self-reported HIV status in surveys using biomarkers of ARV use. Meanwhile, it is crucial to improve disclosure by strengthening interview procedures and tailoring strategies towards groups that are disproportionately likely to underreport HIV diagnoses., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Background: HIV transmission can occur with a viral load of at least 200 copies per mL of blood and low-level viraemia can lead to virological failure; the threshold level at which risk for virological failure is conferred is uncertain. To better understand low-level viraemia prevalence and outcomes, we analysed retrospective longitudinal data from a large cohort of people living with HIV on antiretroviral therapy (ART) in Nigeria., Methods: In this retrospective cohort study using previously collected longitudinal patient data, we estimated rates of virological suppression (≤50 copies per mL), low-level viraemia (51-999 copies per mL), virological non-suppression (≥1000 copies per mL), and virological failure (≥2 consecutive virological non-suppression results) among people living with HIV aged 18 years and older who initiated and received at least 24 weeks of ART at 1005 facilities in 18 Nigerian states. We analysed risk for low-level viraemia, virological non-suppression, and virological failure using log-binomial regression and mixed-effects logistic regression., Findings: At first viral load for 402 668 patients during 2016-21, low-level viraemia was present in 64 480 (16·0%) individuals and virological non-suppression occurred in 46 051 (11·4%) individuals. Patients with low-level viraemia had increased risk of virological failure (adjusted relative risk 2·20, 95% CI 1·98-2·43; p<0·0001). Compared with patients with virological suppression, patients with low-level viraemia, even at 51-199 copies per mL, had increased odds of low-level viraemia and virological non-suppression at next viral load; patients on optimised ART (ie, integrase strand transfer inhibitors) had lower odds than those on non-integrase strand transfer inhibitors for the same low-level viraemia range (eg, viral load ≥1000 copies per mL following viral load 400-999 copies per mL, integrase strand transfer inhibitor: odds ratio 1·96, 95% CI 1·79-2·13; p<0·0001; non-integrase strand transfer inhibitor: 3·21, 2·90-3·55; p<0·0001)., Interpretation: Patients with low-level viraemia had increased risk of virological non-suppression and failure. Programmes should revise monitoring benchmarks and targets from less than 1000 copies per mL to less than 50 copies per mL to strengthen clinical outcomes and track progress to epidemic control., Funding: None., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Background: Data on awareness of HIV status among people living with HIV (PLHIV) are critical to estimating progress toward epidemic control. To ascertain the accuracy of self-reported HIV status and antiretroviral drug (ARV) use in the Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS), we compared self-reported HIV status with HIV rapid diagnostic test (RDT) results and self-reported ARV use with detectable blood ARV levels., Methods: On the basis of responses and test results, participants were categorized by HIV status and ARV use. Self-reported HIV status and ARV use performance characteristics were determined by estimating sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Proportions and other analyses were weighted to account for complex survey design., Results: During NAIIS, 186,405 participants consented for interview out of which 58,646 reported knowing their HIV status. Of the 959 (weighted, 1.5%) who self-reported being HIV-positive, 849 (92.1%) tested HIV positive and 64 (7.9%) tested HIV negative via RDT and polymerase chain reaction test for discordant positive results. Of the 849 who tested HIV positive, 743 (89.8%) reported using ARV and 72 (10.2%) reported not using ARV. Of 57,687 who self-reported being HIV negative, 686 (1.2%) tested HIV positive via RDT, with ARV biomarkers detected among 195 (25.1%). ARV was detected among 94.5% of those who self-reported using ARV and among 42.0% of those who self-reported not using ARV. Overall, self-reported HIV status had sensitivity of 52.7% (95% confidence interval [CI]: 49.4%-56.0%) with specificity of 99.9% (95% CI: 99.8%-99.9%). Self-reported ARV use had sensitivity of 95.2% (95% CI: 93.6%-96.7%) and specificity of 54.5% (95% CI: 48.8%-70.7%)., Conclusions: Self-reported HIV status and ARV use screening tests were found to be low-validity measures during NAIIS. Laboratory tests to confirm self-reported information may be necessary to determine accurate HIV and clinical status for HIV studies in Nigeria., Competing Interests: The authors have no conflicts of interest to disclose.

Objective: Although geographically specific data can help target HIV prevention and treatment strategies, Nigeria relies on national- and state-level estimates for policymaking and intervention planning. We calculated sub-state estimates along the HIV continuum of care in Nigeria., Design: Using data from the Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS) (July-December 2018), we conducted a geospatial analysis estimating three key programmatic indicators: prevalence of HIV infection among adults (aged 15-64 years); antiretroviral therapy (ART) coverage among adults living with HIV; and viral load suppression (VLS) rate among adults living with HIV., Methods: We used an ensemble modeling method called stacked generalization to analyze available covariates and a geostatistical model to incorporate the output from stacking as well as spatial autocorrelation in the modeled outcomes. Separate models were fitted for each indicator. Finally, we produced raster estimates of each indicator on an approximately 5×5-km grid and estimates at the sub-state/local government area (LGA) and state level., Results: Estimates for all three indicators varied both within and between states. While state-level HIV prevalence ranged from 0.3% (95% uncertainty interval [UI]: 0.3%-0.5%]) to 4.3% (95% UI: 3.7%-4.9%), LGA prevalence ranged from 0.2% (95% UI: 0.1%-0.5%) to 8.5% (95% UI: 5.8%-12.2%). Although the range in ART coverage did not substantially differ at state level (25.6%-76.9%) and LGA level (21.9%-81.9%), the mean absolute difference in ART coverage between LGAs within states was 16.7 percentage points (range, 3.5-38.5 percentage points). States with large differences in ART coverage between LGAs also showed large differences in VLS-regardless of level of effective treatment coverage-indicating that state-level geographic targeting may be insufficient to address coverage gaps., Conclusion: Geospatial analysis across the HIV continuum of care can effectively highlight sub-state variation and identify areas that require further attention in order to achieve epidemic control. By generating local estimates, governments, donors, and other implementing partners will be better positioned to conduct targeted interventions and prioritize resource distribution., Competing Interests: The authors have declared that no competing interests exist.

There is limited capacity and infrastructure in sub-Saharan Africa to conduct clinical trials for the identification of efficient and effective new prevention, diagnostic and treatment modalities to address the disproportionate burden of disease. This paper reports on the process to establish locally driven infrastructure for multicentre research and trials in Nigeria known as the Nigeria Implementation Science Alliance Model Innovation and Research Centres (NISA-MIRCs). We used a participatory approach to establish a research network of 21 high-volume health facilities selected from all 6 geopolitical zones in Nigeria capable of conducting clinical trials, implementation research using effectiveness-implementation hybrid designs and health system research. The NISA-MIRCs have a cumulative potential to recruit 60 000 women living with HIV and an age-matched cohort of HIV-uninfected women. We conducted a needs assessment, convened several stakeholder outreaches and engagement sessions, and established a governance structure. Additionally, we selected and trained a core research team, developed criteria for site selection, assessed site readiness for research and obtained ethical approval from a single national institutional review board. We used the Exploration, Preparation, Implementation, Sustainment framework to guide our reporting of the process in the development of this network. The NISA-MIRCs will provide a nationally representative infrastructure to initiate new studies, support collaborative research, inform policy decisions and thereby fill a significant research infrastructure gap in Africa's most populous country., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Population-level health and mortality data are crucial for evidence-informed policy but scarce in Nigeria. To fill this gap, we undertook a comprehensive assessment of the burden of disease in Nigeria and compared outcomes to other west African countries., Methods: In this systematic analysis, using data and results of the Global Burden of Diseases, Injuries, and Risk Factors Study 2019, we analysed patterns of mortality, years of life lost (YLLs), years lived with disability (YLDs), life expectancy, healthy life expectancy (HALE), and health system coverage for Nigeria and 15 other west African countries by gender in 1998 and 2019. Estimates of all-age and age-standardised disability-adjusted life-years for 369 diseases and injuries and 87 risk factors are presented for Nigeria. Health expenditure per person and gross domestic product were extracted from the World Bank repository., Findings: Between 1998 and 2019, life expectancy and HALE increased in Nigeria by 18% to 64·3 years (95% uncertainty interval [UI] 62·2-66·6), mortality reduced for all age groups for both male and female individuals, and health expenditure per person increased from the 11th to third highest in west Africa by 2018 (US$18·6 in 2001 to $83·75 in 2018). Nonetheless, relative outcomes remained poor; Nigeria ranked sixth in west Africa for age-standardised mortality, seventh for HALE, tenth for YLLs, 12th for health system coverage, and 14th for YLDs in 2019. Malaria (5176·3 YLLs per 100 000 people, 95% UI 2464·0-9591·1) and neonatal disorders (4818·8 YLLs per 100 000, 3865·9-6064·2) were the leading causes of YLLs in Nigeria in 2019. Nigeria had the fourth-highest under-five mortality rate for male individuals (2491·8 deaths per 100 000, 95% UI 1986·1-3140·1) and female individuals (2117·7 deaths per 100 000, 1756·7-2569·1), but among the lowest mortality for men older than 55 years. There was evidence of a growing non-communicable disease burden facing older Nigerians., Interpretation: Health outcomes remain poor in Nigeria despite higher expenditure since 2001. Better outcomes in countries with equivalent or lower health expenditure suggest health system strengthening and targeted intervention to address unsafe water sources, poor sanitation, malnutrition, and exposure to air pollution could substantially improve population health., Funding: The Bill & Melinda Gates Foundation., Competing Interests: Declaration of interests GA is a current head of the National Agency for the Control of AIDS. CI and SA held leadership roles in the Nigerian Government during the period of writing of this paper. SA is editor in chief of BMJ Global Health. IA was a scientific and technical adviser to the Nigerian Government Presidential Task Force on COVID-19 and ZI is chair of the Nigerian national ethics committee. IA, FO, GA, SA, and IMOA are members of the Presidential Health Reform Committee. All other authors declare no competing interests., (Copyright © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Competing Interests: Declaration of interests FS, MNS, GA, and BLS are current heads of Nigerian Government health agencies. CI and SHA held leadership roles in the Nigerian Government during the period of writing of this Commission. SA is editor-in-chief of BMJ Global Health. IA was a Scientific and Technical Adviser to the Nigerian Government Presidential Task Force on COVID-19 and ZI is chair of the Nigerian national ethics committee. All other authors declare no competing interests.

Background: In 2018, Nigeria implemented the world's largest HIV survey, the Nigeria AIDS Indicator and Impact Survey (NAIIS), with the overarching goal of obtaining more reliable metrics regarding the national scope of HIV epidemic control in Nigeria., Objective: This study aimed to (1) describe the processes involved in the development of a new database evaluation tool (Database Quality Assurance Score [dQAS]) and (2) assess the application of the dQAS in the evaluation and validation of the NAIIS database., Methods: The dQAS tool was created using an online, electronic Delphi (e-Delphi) methodology with the assistance of expert review panelists. Thematic categories were developed to form superordinate categories that grouped themes together. Subordinate categories were then created that decomposed themes for more specificity. A validation score using dQAS was employed to assess the technical performance of the NAIIS database., Results: The finalized dQAS tool was composed of 34 items, with a total score of 81. The tool had 2 sections: validation item section, which contains 5 subsections, and quality assessment score section, with a score of "1" for "Yes" to indicate that the performance measure item was present and "0" for "No" to indicate that the measure was absent. There were also additional scaling scores ranging from "0" to a maximum of "4" depending on the measure. The NAIIS database achieved 78 out of the maximum total score of 81, yielding an overall technical performance score of 96.3%, which placed it in the highest category denoted as "Exceptional.", Conclusions: This study showed the feasibility of remote internet-based collaboration for the development of dQAS-a tool to assess the validity of a locally created database infrastructure for a resource-limited setting. Using dQAS, the NAIIS database was found to be valid, reliable, and a valuable source of data for future population-based, HIV-related studies., (©Hamisu M Salihu, Zenab Yusuf, Deepa Dongarwar, Sani H Aliyu, Rafeek A Yusuf, Muktar H Aliyu, Gambo Aliyu. Originally published in JMIR Formative Research (https://formative.jmir.org), 28.01.2022.)

Background: To accelerate progress toward the UNAIDS 90-90-90 targets, US Centers for Disease Control and Prevention Nigeria country office (CDC Nigeria) initiated an Antiretroviral Treatment (ART) Surge in 2019 to identify and link 340,000 people living with HIV/AIDS (PLHIV) to ART. Coronavirus disease 2019 (COVID-19) threatened to interrupt ART Surge progress following the detection of the first case in Nigeria in February 2020. To overcome this disruption, CDC Nigeria designed and implemented adapted ART Surge strategies during February-September 2020., Methods: Adapted ART Surge strategies focused on continuing expansion of HIV services while mitigating COVID-19 transmission. Key strategies included an intensified focus on community-based, rather than facility-based, HIV case-finding; immediate initiation of newly-diagnosed PLHIV on 3-month ART starter packs (first ART dispense of 3 months of ART); expansion of ART distribution through community refill sites; and broadened access to multi-month dispensing (MMD) (3-6 months ART) among PLHIV established in care. State-level weekly data reporting through an Excel-based dashboard and individual PLHIV-level data from the Nigeria National Data Repository facilitated program monitoring., Results: During February-September 2020, the reported number of PLHIV initiating ART per month increased from 11,407 to 25,560, with the proportion found in the community increasing from 59 to 75%. The percentage of newly-identified PLHIV initiating ART with a 3-month ART starter pack increased from 60 to 98%. The percentage of on-time ART refill pick-ups increased from 89 to 100%. The percentage of PLHIV established in care receiving at least 3-month MMD increased from 77 to 93%. Among PLHIV initiating ART, 6-month retention increased from 74 to 92%., Conclusions: A rapid and flexible HIV program response, focused on reducing facility-based interactions while ensuring delivery of lifesaving ART, was critical in overcoming COVID-19-related service disruptions to expand access to HIV services in Nigeria during the first eight months of the pandemic. High retention on ART among PLHIV initiating treatment indicates immediate MMD in this population may be a sustainable practice. HIV program infrastructure can be leveraged and adapted to respond to the COVID-19 pandemic., (© 2021. The Author(s).)

Background: The need for accurate HIV annual program planning data motivated the compressed timeline for the 2018 Nigerian HIV/AIDS Indicator and Impact Survey (NAIIS). The survey team used stakeholder cooperation and responsive design, using survey process and paradata to refine survey implementation, to quickly collect high-quality data. We describe processes that led to generation of data for program and funding decisions, ensuring HIV services were funded in 2019., Setting: Nigeria is the most populous country in Africa, with approximately 195 million people in 36 states and the Federal Capital Territory. Challenges include multiple security threats, poor infrastructure, seasonal rains, and varied health system capacity., Methods: Stakeholders worked together to plan and implement NAIIS. Methods from other population-based HIV impact assessments were modified to meet challenges and the compressed timeline. Data collection was conducted in 6 webs. Responsive design included reviewing survey monitoring paradata and laboratory performance. Costs required to correct data errors, for example, staff time and transportation, were tracked., Results: NAIIS data collection was completed in 23 weeks, ahead of the originally scheduled 24 weeks. Responsive design identified and resolved approximately 68,000 interview errors, affecting approximately 62,000 households, saving about US$4.4 million in costs. Biweekly field laboratory test quality control improved from 50% to 100% throughout NAIIS., Conclusions: Cooperation across stakeholders and responsive design ensured timely release of NAIIS results and informed planning for HIV epidemic control in Nigeria. Based on NAIIS results, funds were provided to place an additional 500,000 HIV-positive Nigerians on antiretroviral therapy by the end of 2020, pushing Nigeria toward epidemic control., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background: In Nigeria, there is an estimated 1.9 million people living with HIV (PLHIV), 53% of whom utilize HIV care and services. With decreasing HIV-related deaths and increasing new infections, HIV with its associated comorbidities continue to be a key public health challenge in Nigeria. Untreated, comorbid mental disorders are a critical but potentially modifiable determinant of optimal HIV treatment outcomes. This study aimed to identify the challenges and opportunities related to integrating mental health care into existing HIV programs in Nigeria., Method: Attendees at the Nigeria Implementation Science Alliance (NISA)'s 2019 conference participated in nominal group technique (NGT) exercise informed by the "Exploration, Preparation, Implementation, and Sustainment (EPIS)" framework. The NGT process was conducted among the nominal groups in two major sessions of 30-min phases followed by a 30-min plenary session. Data analysis proceeded in four steps: transcription, collation, theming and content analysis., Results: The two major theoretical themes from the study were - opportunities and challenges of integrating mental health treatment into HIV services. Three sub-themes emerged on opportunities: building on health care facilities for HIV services (screening, counseling, task-sharing monitoring and evaluation frameworks), utilizing existing human resources or workforce in HIV programs (in-service training and including mental health in education curriculum) and the role of social and cultural structures (leveraging existing community, traditional and faith-based infrastructures). Four sub-themes emerged for challenges: double burden of stigma and the problems of early detection (HIV and mental health stigma, lack of awareness), existing policy gaps and structural challenges (fragmented health system), limited human resources for mental health care in Nigeria (knowledge gap and burnout) and dearth of data/evidence for planning and action (research gaps)., Conclusions: Potential for integrating treatments for mental disorders into HIV programs and services exist in Nigeria. These include opportunities for clinicians' training and capacity building as well as community partnerships. Multiple barriers and challenges such as stigma, policy and research gaps would need to be addressed to leverage these opportunities. Our findings serve as a useful guide for government agencies, policy makers and research organizations to address co-morbid mental disorders among PLHIV in Nigeria.

Background: As antiretroviral therapy (ART) programs expand access, there is an increase in burden to a healthcare system. These results are reduced provider-patient contact time and poor programmatic and patient outcomes. Quality management offers providers a standardized approach for addressing the appropriateness of care to be applied in resource-limited settings. This study aimed to determine the trend of performance on HIV/AIDS quality management indicators of health facilities providing ART over a period of 5 years., Methods: The annual performance scores of quality of care (QoC) indicators of 31 health facilities providing ART was extracted from a database covering a period of 5 years (from October 2008 to September 2012). The data are percentages that indicate scores of each health facility assessed based on compliance to National ART guidelines categorized into several indicator domains. A Chi square statistic for the trend, as well as test for departure from the trend line was determined. The p value associated with each indicator provides the significant level for testing an alternative hypothesis that the rate of change over the period considered for that indicator does not equal to zero. The slope of the regression line also gives the magnitude of the rate of change for each indicator by healthcare level across the review period., Results: Generally, performance trends showed improvement across most indicator domains. The highest improvement occurred for "3 month loss to follow-up" and "1 year no-visit", with scores declining from 37 to 3%, and 42% to 12% respectively. However, there was a sharp decline in performance between 2010 and 2012 in weight monitoring of patients (p < 0.01), adherence assessment to ARVs (p < 0.01) and hematocrit measurements (p = 0.01). The aggregate rate of change β, as obtained from the slope of the trend line is highly significant (p < 0.01) for all the quality of care indicators considered, whether improving or declining., Conclusion: Periodic assessment to determine HIV/AIDS quality of care can guide rapid scale-up of services to achieve universal coverage in resource-limited settings. Determining trends to understand patterns is very useful for improving programmatic and patient outcomes.

Calculated N 2 O emission factors (EFs) of applied nitrogen (N) fertilizer are currently based upon a single, universal value advocated by the IPCC (Inter-governmental Panel on Climate Change) even though EFs are thought to vary with climate and soil types. Here, we compiled and analyzed 151 N 2 O EF values from agricultural fields across China. The EF of synthetic N applied to these croplands was 0.60%, on average, but differed significantly among six climatic zones across the country, with the highest EF found in the north subtropical zone for upland fields (0.93%) and the lowest in the middle subtropical zone for paddy fields (0.20%). Precipitation and soil pH, which showed non-linear relationships with EF, are among the factors governing it, explaining 7.0% and 8.0% of the regional variation in EFs, respectively. Annual precipitation was the key factor regulating N 2 O emissions from synthetic N fertilizers. Among crop types, legume crops had the highest EFs, which were significantly (P < 0.05) higher than those of cereals. Total soil N 2 O emissions from fertilized croplands with maize, rice, wheat, and vegetables in China, calculated using the climatic zone (regional) EFs, were estimated to be 239 Gg N yr -1 with an uncertainty of 21%. Importantly, this value was substantially (33%) lower than that (357 Gg N yr -1 ) derived from the IPCC default EF but close to the 253 Gg N yr -1 estimated using crop-specific EFs. N 2 O emissions from applied synthetic N fertilizer accounted for 66.5% of the total annual N 2 O emissions from China's maize, rice, wheat and vegetable fields. Taken together, our study's results strongly suggest that regional EFs should be included for accurate N 2 O inventories from croplands across China., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: Convergence of tuberculosis (TB) and HIV epidemics is associated with higher morbidity and mortality risks and understanding their distribution across key demographic factors is essential for prevention and control. This analysis examines the prevalence of TB, HIV and TB-HIV coinfection across age and gender in patients with presumptive TB seeking care at the National TB and Leprosy Training Center in Nigeria., Methods: Samples from 1603 presumptive pulmonary TB cases who provided informed consent were evaluated with a sequential testing algorithm that included a smear microscopy, cultures in liquid and broth media and then genotyping by Hain line probe assays. HIV was serially tested with two HIV rapid assays and retested with a third assay in non-conclusive samples., Results: Twenty-three percent (375/1603) had confirmed pulmonary TB infection, 23.6% (378/1603) were positive for HIV infection and 26.9% (101/375) of the confirmed TB cases were HIV co-infected. Males had a higher prevalence of TB: 27.6% vs. 18.0%, p < .0001; and a lower prevalence of HIV: 19.0% vs. 29.6%, p < .0001. In the age range of 25-29 years, males were twice as likely to have TB (OR = 2.2; 95% confidence interval [CI]: 1.3-3.9, p = 0.0032) while females were five times more likely to have HIV (OR = 4.8; 95% CI: 2.6-8.9, p < .0001). Persons with TB-HIV coinfection were more likely to be young, female and less likely to be married., Conclusion: Younger females with a high burden of HIV may be under-diagnosed and under-reported for TB in Nigeria. Community programs for intensified and early detection of TB and HIV targeting younger females are needed in this setting., Competing Interests: The authors have declared that no competing interests exist.