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BackgroundHuman immunodeficiency virus (HIV) viral load (VL) monitoring is critical for antiretroviral therapy (ART) management. Point-of-care (POC) VL testing has been reported to be feasible and preferred over standard-of-care (SOC) testing in many low- and middle-income country settings where rapid results could improve patient outcomes.MethodsThe timeliness of receipt of VL results was evaluated in an open-label, randomized, controlled trial among patients newly initiating ART. Clinical outcomes with POC VL monitoring using Cepheid Xpert vs SOC VL at Jos University Teaching Hospital and Comprehensive Health Centre Zamko in Nigeria were assessed. We determined time between specimen collection and recording of VL in patient charts, receipt of results, and ART switch for those who met virologic failure criteria.ResultsBetween April 2018 and October 2019, we screened 696 ART-naive individuals; 273 were randomized to POC and 268 to SOC HIV-1 VL testing. Participants in the POC arm received VL results significantly faster than those in the SOC arm (0.1 median days, interquartile range [IQR], 0.1–0.2 vs 143.1 days, IQR, 56.0–177.1, respectively; P < .0001). Participants in the POC arm with confirmed virologic failure vs those in the SOC arm were switched more rapidly to a second-line regimen (0 median days, IQR, 0–28 vs 66 days, IQR, 63–123, respectively; P = .03).ConclusionsPOC VL testing resulted in significant improvement in the timeliness of VL result receipt by patients and use for effective HIV clinical management. In patients experiencing VL failure, POC monitoring enabled prompt switching to second-line ART regimens.Clinical Trials RegistrationNCT03533868.

Background Point-of-care (POC) viral load (VL) tests provide results within hours, enabling same-day treatment interventions. We assessed treatment outcomes with POC vs standard-of-care (SOC) VL monitoring. Methods We implemented a randomized controlled trial at an urban and rural hospital in Nigeria. Participants initiating antiretroviral therapy (ART) were randomized 1:1 for monitoring via the POC Cepheid Xpert or SOC Roche COBAS (v2.0) HIV-1 VL assays. Viral suppression (VS) and retention in care at 12 months were compared via intention-to-treat (ITT) and per-protocol (PP) analyses. Post-trial surveys for POC patients and healthcare workers (HCWs) evaluated acceptability. Results During April 2018–October 2019, 268 SOC and 273 POC patients enrolled in the trial. Viral suppression at Conclusions POC VL monitoring did not improve 12-month VS among those with results but did improve retention and VS documentation and was preferred by most patients and HCWs. Further research can inform best POC implementation conditions and approaches to optimize patient care. Clinical Trials Registration NCT03533868.

HIV viral load (VL) monitoring is critical for antiretroviral therapy (ART) management. Point-of-care (POC) VL testing has been reported to be feasible and preferred over standard of care (SOC) testing in many low- and middle-income country (LMIC) settings, where rapid results could improve patient outcomes.The timeliness of receipt of VL results was evaluated as part of an open label randomized controlled trial among patients newly initiating ART assessing clinical outcomes with POC VL monitoring using Cepheid Xpert® versus SOC VL at Jos University Teaching Hospital (JUTH) and Comprehensive Health Centre Zamko (CHCZ), in Nigeria. We determined the median number of days between specimen collection and recording of VL results in patient charts, patient receipt of results, and ART switch for those meeting virologic failure criteria.Between April 2018 and October 2019, we screened 696 ART-naïve individuals; 273 were randomized to POC and 268 to SOC HIV-1 VL testing. Participants in the POC arm received VL results significantly faster than those in the SOC arm (0.1 median days [IQR:0.1-0.2] versus 143.1 median days [IQR:56.0-177.1], respectively; p 0.0001). Participants in the POC arm with confirmed virologic failure versus those in the SOC arm were switched more rapidly to a second-line regimen (0 median days [IQR:0-28] versus 66 days [IQR:63-123], respectively; p = 0.03).POC VL testing resulted in significant improvement in the timeliness of VL result receipt by patients and use for effective HIV clinical management. In patients experiencing VL failure, POC monitoring enabled prompt switching to second-line ART regimens.

Point-of-care (POC) viral load (VL) tests provide results within hours, enabling same-day treatment interventions. We assessed treatment outcomes with POC versus standard-of-care (SOC) VL monitoring.We implemented a randomized controlled trial at an urban and rural hospital in Nigeria. Participants initiating antiretroviral therapy (ART) were randomized 1:1 for monitoring via the POC Cepheid Xpert® or SOC Roche COBAS® (v2.0) HIV-1 VL assays. Viral suppression (VS) and retention in care at 12 months were compared via intention-to-treat (ITT) and per-protocol (PP) analyses. Post-trial surveys for POC patients and health care workers (HCWs) evaluated acceptability.During April 2018 -October 2019, 268 SOC and 273 POC patients enrolled in the trial. VS at1000 copies/mL at 12 months was 59.3% (162/273) for POC and 52.2% (140/268) for SOC (p = 0.096) in ITT analysis, and 77.1% (158/205) for POC and 65.9% (137/208) for SOC (p = 0.012) in PP analysis. Retention was not significantly different in ITT analysis but was 85.9% for POC and 76.9% for SOC (p = 0.02) in PP analysis. The increased VS in the POC arm was attributable to improved retention and documentation of VL results. POC monitoring was preferred over SOC by 90.2% (147/163) of patients and 100% (15/15) of HCW thought it facilitated patient care.POC VL monitoring did not improve 12-month VS among those with results but did improve retention and VS documentation and was preferred by most patients and HCWs. Further research can inform best POC implementation conditions and approaches to optimize patient care.

Suppl_material for Effect of Baseline Symptom Manifestations on Retention in Care and Treatment among HIV-Infected Patients in Nigeria by Juliet Adeola, Okikiolu Abimbola Badejo, Aimalohi Ahonkhai, Prosper Okonkwo, Patrick Aboh Akande, Charlesnika Tyon Evans, Megan McHugh, Leslie Pierce, Isah Ahmed, Toyin Jolayemi, Babatunde Ladi Akinyemi, Ifeyinwa Onwuatuelo, Robert Murphy, Demetrious Kyriacou, Jonah Musa and Patricia Agaba in Journal of the International Association of Providers of AIDS Care (JIAPAC)

The concepts of relative null, relative semi-null, relative absolute, relative semi-absolute and absolute soft multisets were presented. It is shown that the relative absolute soft multiset is equivalent to the complement of relative null soft multiset, the complement of relative absolute soft multiset is equivalent to the relative null soft multiset. It is further established that a relative semi-absolute soft multiset is equivalent to the complement of a relative semi-null soft multiset and the complement of a relative semi-absolute soft multiset is equivalent to a relative semi-null soft multiset. Related results are also established.Keywords: Multiset, Soft Set, Soft Multiset, absolute soft multiset, relative absolute soft multiset

Aim: The aims of this audit were: To determine the proportion of hyperthyroid patients receiving I-131 therapy in whom treatment with a single fixed dose was successful, as defined by the achievement of euthyroidism or hypothyroidism 6-months after the therapy; To identify patients in whom treatment was not successful and a second dose needed; And, if possible, to establish the factors associated with treatment failure. Methods: A single observer reviewed the records of all patients who received I-131 therapy for hyperthyroidism between 23rd April 2010 and 23rd November 2017 in conjunction with their pre and post treatment thyroid function tests. Results of their thyroid ultrasound were retrieved and documented. The images of their Tc-99m sodium pertechnetate thyroid scans were also retrieved and reprocessed. Results: The records of 409 patients treated between April 2010 and November 2017 were retrieved. 223 (63%) patients were referred by the endocrine clinic at Groote Schuur hospital (GSH. Of the 409 patients, 56 (14%) patients that were excluded because their post therapy records were not available for analysis. Majority of our patients were females 310 (88%). Patients between the ages of 15 and 45 years are more likely to present with Grave’s disease while those aged more than 45 years presented with toxic multinodular gland (p=0.000). Patients that presented between the ages of 15 and 45 years are more likely to have moderately increased pretreatment FT4 (12-51 mmol/L) (p=0.002). We administered a radioiodine therapy dose of 456.6±54.8 MBq (Mean ± SD) to these 409 patients. Among the 353 patients, with complete records, 314(89%) achieved cure at some stage after receiving one dose of RAI; 239(76%) achieving cure ≤ 6 months of therapy and 75(24%) patients after 6 months. In our audit the patients who failed to achieve cure following the first RAI therapy appeared to be younger (median(interquartile range) age 39(16), p= 0.03), have severe hyperthyroidism as demonstrated by higher pre-treatment FT4 (median(interquartile range) 27 pmol/L(30.6), p= 0.05) and high pertechnetate uptake (median(interquartile range) uptake 9.9%(14), p= 0.002) on thyroid scintigraphy. CONCLUSION Our audit showed RAI therapy was found to be successful in 68% of patients at 6 month and 89% at a year. A second therapy with radioactive iodine would be indicated in 32% of patients, as these patients have not achieved cure at 6 months. Patients presenting with severe thyrotoxicity are likely to require more than one RAI therapy. Due to major deficiencies in referral, record keeping and follow up, other factors responsible for treatment were not be able to be evaluated. Based on these findings, suggested areas for further research are: should patients with severe hyperthyroidism be considered for pretreatment with antithyroid medication prior to RAI; would a one year follow up after radioiodine therapy be considered before second RAI. Now that the deficiencies in our current practice have been identified and suggestions put forward to address these deficiencies, a follow up audit would be needed.

Camel contagious ecthyma (CCE) is a viral disease of camelids that is caused by a Parapoxvirus (PPV) which is a DNA virus of the viral family: Poxviridae. Diseases affecting camels in Nigeria are scarcely reported. CCE or the laboratory detection of camel PPV (CPPV) has not been reported in Nigeria. This study investigated and described the clinical presentation of CCE and molecular detection of CPPV in Nigeria. Suspected cases of CCE were reported in a farm, live animal market and abattoir, in three different states (Bauchi, Plateau and Zamfara) in Northern Nigeria. Skin scabs, lungs, liver and intestine samples were collected. Polymerase chain reaction (PCR) was carried out using the primers which targets the RPO30 gene fragment of the genus PPV. The clinical signs observed from the suspected cases of CCE were proliferative skin lesions, papules, scabs on the lips and nares. CPPV was detected in 80.0% (4/5) of the samples collected by PCR. CCE was diagnosed based on clinical signs and PCR results. This is the first report of CCE in Nigeria. Further studies should be carried out to genetically characterize the CPPV circulating in Nigeria.Keywords: Camel contagious ecthyma, Nigeria, Parapoxvirus, Polymerase chain reaction

Research was conducted to evaluate the in-vivo anticoccidial activity of crude leaf powder of Azadirachta indica against Eimeria tenella, the cause of caecal coccidiosis that inflicts heavy economic loss to poultry industry all over the world. A total of 120 broiler chicks were infected via the oropharyngeal route with viable sporulated oocysts of the parasite and allotted to four groups designated 1 to 4 and each group replicated 3 times with 10 birds per replicate in a completely randomized design. Groups 1 and 2 were fed diet containing 100g and 50g leaf powder of the evaluated material per Kg of feed respectively. Group 3 was treated with 0.3g (preventive dose) of AmproliumR per liter of drinking water while group 4 was left without treatment. The test substance given especially at the rate of 100g demonstrated efficacy in decreasing oocysts shedding, minimizing diarrhea, alleviating caecal damage and lowering morbidity caused the parasite but less than the conventional drug. However, its effect in reducing blood loss and mortality was almost similar that of the standard drug (P≤0.05). Although the test material had slight negative effect on feed consumption and weight gain but it can still be used for prophylactic control of coccidioisis especially when there is resistance to conventional anticoccidial drugs or where they are not available or affordable.