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Background: Worldwide, tuberculosis (TB) is one of the top 10 causes of death. Drug resistant tuberculosis has lately become a major public health problem that threatens progress made in Tuberculosis (TB) care and control worldwide. The aim of this study was to determine the prevalence of Pre-extensive drug resistant TB among MDR TB in North Central of Nigeria. Methods: This study was conducted from October, 2018 to August, 2019 with 150 samples. In Nigeria, guidelines for DR-TB as recommended by WHO is followed. All the samples from the patients who gave their consent were transported to a zonal reference TB laboratory (ZRL). Results: Mean age was 38.6 ± 13.4 years with peak age at 35-44. Out of these 103 samples processed with LPA, 101(98%) were rifampicin resistant and 2 were rifampicin sensitive, 99(96%) were INH resistant and 4 (4%) were INH sensitive, 5(5%) were fluoroquinolone resistant, 98(95%) were fluoroquinolone sensitive, 12 (12%) were Aminoglycoside + Capreomycin resistant, 91(83%) were Aminoglycoside + Capreomycin sensitive. Conclusion: Multidrug resistant TB and its severe forms (Pre-extensive & extensively drug resistant TB) can be detected early with rapid tool- Line Probe Assay rapid and prevented timely by early initiation on treatment. Keywords: Pre-XDR TB; line probe assay in a high TB burden country.

Background We identified a HIV-positive cohort in virologic failure (VF) who re-suppressed without drug switch. We characterized their drug resistance mutations (DRM) and adherence profiles to learn how to better manage HIV drug resistance. A retrospective cohort study utilizing clinical data and stored samples. Patients received ART at three Nigerian treatment centres. Plasma samples stored when they were in VF were genotyped. Result Of 126 patients with samples available, 57 were successfully genotyped. From ART initiation, the proportion of patients with adherence ≥90% increased steadily from 54% at first high viral load (VL) to 67% at confirmed VF, and 81% at time of re-suppressed VL. Sixteen (28%) patients had at least one DRM. Forty-six (81%) patients had full susceptibility to the three drugs in their first-line (1 L) regimen. Thirteen (23%) were resistant to at least one antiretroviral drug but three were resistant to drugs not used in Nigeria. Ten patients had resistance to their 1 L drug(s) and six were fully susceptible to the three drugs in the recommended second-line regimen. Conclusion This cohort had little drug resistance mutations. We conclude that if adherence is not assured, patients could exhibit virologic failure without having developed mutations associated with drug resistance.

Background In 2016, Nigeria transitioned to ‘Test & Treat’, a policy where all people living with HIV (PLHIV) are treated with lifelong antiretroviral therapy (ART). There are unique challenges achieving viral suppression in ALHIV mainly due to increased stigma & lack of social support. Hypothesis tested was ART adherence effect on viral load outcome. We examined viral suppression among adolescents living with HIV in Western Nigeria. Methods This study was an observational prospective cohort study of adolescents living with HIV (ALHIV) already initiated on antiretroviral therapy for at least six months, enrolled in health facilities across supported facilities in Western Nigeria, during a 12-month observation period starting October 2016 till September 2017. Quantitative viral load analysis was done using Polymerase Chain Reaction, Roche Cobas Taqman 96 Analyzer. Results A total of 126 (64 males & 62 females) subjects were recruited. The mean age of 13.58 ± 4.26 years. 83 (65.9%) & 71 (56.3%) had viral suppression of Conclusion ART adherence counseling is key to the achieving viral suppression and determine infection prognosis, thus, developing robust continuous quality improvement (CQI) plans to address issues across the cascade ultimately helping in the monitoring of HIV/AIDS disease progression and decrease treatment failure tendencies. Disclosure No significant relationships.

Background Tuberculosis is a leading killer among people living with human immunodeficiency virus (HIV). HIV-infected individuals with latent TB are approximately 20–30 times more likely to develop TB disease, at a rate of 8–10% per year, with the disease estimated to cause approximately 9 million cases annually and 1.5 million deaths. Hypothesis tested was site of infection effect on tuberculosis on tuberculosis treatment outcome. This study determined the diagnostic validity and reliability of Xpert MTB/RIF in identifying the presence of Pulmonary Tuberculosis (PTB) among HIV patients in South Western Nigeria. Methods This study was a prospective analytical study among HIV patients between ages 15 – 60 years who are infected with HIV seen from January 2015 - June 2017. Patients with signs and symptoms of Pulmonary Tuberculosis (PTB) were enrolled and submitted sputum for Acid Fast Bacilli (AFB) smear and Xpert MTB/RIF. This was processed following protocol for pulmonary samples for Xpert MTB/Rif. All samples were processed for AFB smear and Xpert MTB/RIF as part of the procedure for PTB diagnosis. Results A total of 300 patients were enrolled in the study. The mean age ± SD is 37.11 ± 15.27 years. One hundred and thirty five (45.0%) of them are males while one hundred and sixty five (55.0%) are females. Xpert MTB/RIF has a sensitivity of 93.0% and specificity of 98.5%. The main factor associated with tuberculosis treatment outcome was the site of infection (χ² = 19.01, df = 1, p = 0.001) as 233 (77.7%) of the patients were declared cured after six month treatment course. Conclusion Use of Xpert MTB/RIF as a screening tool has a great performance for rapid diagnosis of Mycobacterium tuberculosis might effectively reduce the risk of multi-drug resistant tuberculosis (MDR-TB) in HIV care and treatment settings and improve the prognosis of affected patients. Disclosure No significant relationships.

Background HIV pandemic has continued to be a huge challenge in Nigeria, with the problem of stigmatization reducing the chances of early determination of the HIV status of pregnant women. Hypotheses tested were the influence of maternal antiretroviral therapy (ART) use and infant’s feeding option on baby’s final early infant diagnosis (EID) outcome. The study was aimed at evaluating the variables associated with mother-to-child transmission of HIV & the factors associated with the transmission of the infection from the mothers. Methods This study was a prospective cohort study of HIV-exposed infants conducted in Western Nigeria, between January 2015 and September 2017. Dried Blood Spots (DBS) were analysed using polymerase chain reaction technique. All data collected using Epidata and were statistically analysed, using statistical package for the social sciences (SPSS). Results A total of 197 pregnancies resulting in 200 live births, 91 (45.5%) female and 109 (54.5%) male exposed to HIV were recruited. The overall MTCT rate was found to be 1.5% after cessation of all exposures, with two of these babies given mixed-feeding and their mothers not taking anti-retroviral therapy during pregnancy. The factors associated with MTCT in the univariate analysis include HIV diagnosis late during pregnancy, virological suppression & late ART commencement. Maternal antiretroviral therapy (ART) use & infant feeding option were found to have significant effect on baby early infant diagnosis (EID) outcome (χ² = 15.40, df = 2, P = 0.001; χ² = 12.67, df = 2, P = 0.001). Conclusion The diagnosis of HIV and antiretroviral therapy coverage prior to pregnancy are the main factors in the prevention and elimination of mother-to-child transmission of HIV, thus, the achievement of the 90–90–90 goals in HIV-infected women would make it possible to achieve the goal of eliminating perinatal HIV transmission in Nigeria. Disclosure No significant relationships.

Background Continuous Quality Improvement (CQI) is a quality management process that encourages all health care team members to continuously ask critical questions especially using CQI initiative that employs a Plan-Do-Study-Act (PDSA) cycle to test a proposed change or initiative. Granular Site Management (GSM) was established to enhance identification of innovations or best practices and scale across facilities and ensuring resources application efficiency. The aim of the study was thus to improve key indicators in HIV program treatment cascade in Western Nigeria. Methods The CQI implementation was in four selected (secondary & tertiary) facilities where a cumulative 6000 patients living with HIV (PLHIV) in care. The major drivers of poor performance on key program indicators were identified with underlying causes, in-depth analysis & review of performance done then using CQI approach to implement change strategies for improvement, monitor and periodically evaluate change ideas for improved outcomes. Results A total of four facilities were included in this study. Escort service was implemented for all newly identified HIV positive patients which made linkage to care improve from 50% to 95% within a space of six months. Task shifting & sharing, improved health education for clients, introduction of biometrics capturing for all clients and creation of additional hub for sample logging to viral load reference laboratory all helped to improve viral load uptake & suppression from 80% respectively. Other CQI initiatives also greatly improved the positivity rate, total number of positives placed on treatment and retention in care. Conclusion This CQI initiative using GSM approach has been used to achieve peer learning and cross fertilization of change ideas among facilities thus encouraging them to innovate and have a problem solving approach to achieve programmatic best practices thus ensuring program & resources application efficiency. Disclosure No significant relationships.

Background: Many lines of evidence point to HIV-1 subtype-specific differences in the development of drug resistance mutations. While variation between subtype C and others has been extensively explored, there has been less emphasis on subtypes common to West Africa. We examined a previously described national survey of pretreatment drug resistance in HIV-1-infected Nigerian children aged Methods: Five hundred and forty-nine dried blood spots, from 15 early infant diagnostic facilities in Nigeria, were amplified and HIV-1 polymerase was sequenced. Four hundred and twenty-four were analysed for surveillance drug resistance mutations (SDRMs). Associations between subtype and SDRMs were evaluated by Fisher's exact test and logistic regression analysis, controlling for geographical region and exposure.Results: Using the sub-subtypes of HIV-1 G defined by Delatorre et al. (PLoS One 2014; 9: e98908) the most common subtypes were CRF02_AG (174, 41.0%), GWA-I (128, 30.2%), GWA-II (24, 5.7%), GCA (11, 2.6%), A (21, 5.0%) and CRF06_cpx (18, 4.2%). One hundred and ninety infants (44.8%) had ≥1 NNRTI mutation, 92 infants (21.7%) had ≥1 NRTI mutation and 6 infants (1.4%) had ≥1 PI mutation. By logistic regression, 67N was more common in GWA-II/GCA than CRF02_AG (OR 12.0, P = 0.006), as was 70R (OR 23.1, P = 0.007), 184I/V (OR 2.92, P = 0.020), the presence of ≥1 thymidine analogue mutation (TAM) (OR 3.87, P = 0.014), ≥1 type 2 TAM (OR 7.61, P = 0.001) and ≥1 NRTI mutation (OR 3.26, P = 0.005).Conclusions: This dataset reveals differences among SDRMs by subtype; in particular, between the GWA-II and GCA subclades, compared with CRF02_AG and GWA-I.

BackgroundAlthough there are a number of studies comparing the currently recommended preferred and alternative first-line (1L) antiretroviral therapy (ART) regimens on clinical outcomes, there are limited data examining the impact of 1L regimen choice and duration of virologic failure (VF) on accumulation of drug resistance mutations (DRM). The patterns of DRM from patients failing zidovudine (AZT)-containing versus tenofovir (TDF)-containing ART were assessed to evaluate the predicted susceptibility to second-line (2L) nucleoside reverse-transcriptase inhibitor (NRTI) backbone options in the context of an ongoing programmatic setting that uses viral load (VL) monitoring.MethodsPaired samples from Nigerian ART patients who experienced VF and switched to 2L ART were retrospectively identified. For each sample, the human immunodeficiency virus (HIV)-1 polymerase gene was sequenced at 2 time points, and DRM was analyzed using Stanford University’s HIVdb program.ResultsSequences were generated for 191 patients. At time of 2L switch, 28.2% of patients on AZT-containing regimens developed resistance to TDF, whereas only 6.8% of patients on TDF-containing 1L had mutations compromising susceptibility to AZT. In a stratified evaluation, patients with 0–6 months between tested VL samples had no difference in proportion compromised to 2L, whereas those with >6 months between samples had a statistically significant difference in proportion with compromised 2L NRTI. In multivariate analyses, patients on 1L AZT had 9.90 times higher odds of having a compromised 2L NRTI option than patients on 1L TDF.ConclusionsIn the context of constrained resources, where VL monitoring is limited, we present further evidence to support use of TDF as the preferred 1L NRTI because it allows for preservation of the recommended 2L NRTI option.

Introduction: From 2004–2012, the Harvard/AIDS Prevention Initiative in Nigeria, funded through the US President’s Emergency Plan for AIDS Relief programme, scaled up HIV care and treatment services in Nigeria. We describe the methodologies and collaborative processes developed to improve laboratory capacity significantly in a resource-limited setting. These methods were implemented at 35 clinic and laboratory locations.Methods: Systems were established and modified to optimise numerous laboratory processes. These included strategies for clinic selection and management, equipment and reagent procurement, supply chains, laboratory renovations, equipment maintenance, electronic data management, quality development programmes and trainings.Results: Over the eight-year programme, laboratories supported 160 000 patients receiving HIV care in Nigeria, delivering over 2.5 million test results, including regular viral load quantitation. External quality assurance systems were established for CD4+ cell count enumeration, blood chemistries and viral load monitoring. Laboratory equipment platforms were improved and standardised and use of point-of-care analysers was expanded. Laboratory training workshops supported laboratories toward increasing staff skills and improving overall quality. Participation in a World Health Organisation-led African laboratory quality improvement system resulted in significant gains in quality measures at five laboratories.Conclusions: Targeted implementation of laboratory development processes, during simultaneous scale-up of HIV treatment programmes in a resource-limited setting, can elicit meaningful gains in laboratory quality and capacity. Systems to improve the physical laboratory environment, develop laboratory staff, create improvements to reduce costs and increase quality are available for future health and laboratory strengthening programmes. We hope that the strategies employed may inform and encourage the development of other laboratories in resource-limited settings.

This study was carried out to characterize HIV-1 reverse transcriptase (RT) mutations in vertically infected infants in Jos, Nigeria. DNA was extracted from peripheral blood mononuclear cells of 102 infants, aged 0 to 6 months, born to HIV-1-infected mothers who had received peripartum single-dose nevirapine prophylaxis. PCR-based diagnosis revealed that 14 infants (13.7%) were infected with HIV-1. Phylogenetic analyses of RT revealed wide viral diversity, with CRF02_AG, subtype G, subsubtype A3, CRF06_cpx, and a subtype D recombinant present in the population. Four of 13 (31%) infants had NNRTI resistance mutations--V179I (2 infants), Y181C, and V179E. Intriguingly, subtype G sequences did not have NNRTI mutations but rather carried a Q207N mutation, which may undergo negative selection under drug pressure. Our data suggest wide diversity for vertically transmitted HIV-1 viruses in Nigeria and highlight the potential significance of transmitting rare mutations in subtype G.

The World Health Organization (WHO) recommends periodic surveillance of transmitted drug resistance (TDR) in communities in which antiretroviral therapy (ART) has been scaled-up for greater than 3 years. We conducted a survey of TDR mutations among newly detected HIV-infected antiretroviral (ARV)-naive pregnant women. From May 2010 to March 2012, 38 ARV-naive pregnant women were recruited in three hospitals in Jos, Plateau state, north central Nigeria. Eligible subjects were recruited using a modified version of the binomial sequential sampling technique recommended by WHO. HIV-1 genotyping was performed and HIV-1 drug resistance mutations were characterized according to the WHO 2009 surveillance drug resistance mutation (SDRM) list. HIV subtypes were determined by phylogenetic analysis. The women's median age was 25.5 years; the median CD4+ cell count was 317 cells/μl and the median viral load of 16 was 261 copies/ml. Of the 38 samples tested, 34 (89%) were successfully genotyped. The SDRM rate was