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Yaws is a chronic, relapsing disease of skin, bone, and cartilage caused by Treponema pallidum subsp. pertenue. Yaws was last reported in Nigeria in 1996, although neighboring countries have recently reported cases. We investigated serological evidence for yaws among children aged 0–14 years in Nigeria by measuring antibodies to the treponemal antigens rp17 and TmpA in blood specimens from a 2018 nationally representative HIV survey using a multiplex bead assay. The presence of antibodies to both antigens (“double positive”) likely reflects current or recent treponemal infection. Overall, 1.9% (610/31,549) of children had anti-TmpA antibodies, 1.5% (476/31,549) had anti-rp17 antibodies, and 0.1% (39/31,549) were double positive. Among households, 0.5% (84/18,021) had a double-positive child, with a clustering of double-positive children. Although numbers are low, identification of antibodies to both TmpA and rp17 may warrant investigation, including more granular epidemiologic and clinical data, to assess the potential for continuing yaws transmission in Nigerian children.

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.

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.

Human Immunodeficiency Virus (HIV) diagnosis remains the gateway to HIV care and treatment. However, due to changes in HIV prevalence and testing coverage across different geopolitical zones, it is crucial to evaluate the national HIV testing algorithm as false positivity due to low prevalence could be detrimental to both the client and the service delivery. Therefore, we evaluated the performance of the national HIV rapid testing algorithm using specimens collected from multiple HIV testing services (HTS) sites and compared the results from different HIV prevalence levels across the six geopolitical zones of Nigeria. The evaluation employed a dual approach, retrospective, and prospective. The retrospective evaluation focused on a desktop review of program data (n = 492,880) collated from patients attending routine HTS from six geopolitical zones of Nigeria between January 2017 and December 2019. The prospective component utilized samples (n = 2,895) collected from the field at the HTS and tested using the current national serial HIV rapid testing algorithm. These samples were transported to the National Reference Laboratory (NRL), Abuja, and were re-tested using the national HIV rapid testing algorithm and HIV-1/2 supplementary assays (Geenius to confirm positives and resolve discordance and multiplex assay). The retrospective component of the study revealed that the overall proportion of HIV positives, based on the selected areas, was 5.7% (28,319/492,880) within the study period, and the discordant rate between tests 1 and 2 was 1.1%. The prospective component of the study indicated no significant differences between the test performed at the field using the national HIV rapid testing algorithm and the re-testing performed at the NRL. The comparison between the test performed at the field using the national HIV rapid testing algorithm and Geenius HIV-1/2 supplementary assay showed an agreement rate of 95.2%, while that of the NRL was 99.3%. In addition, the comparison of the field results with HIV multiplex assay indicated a sensitivity of 96.6%, the specificity of 98.2%, PPV of 97.0%, and Kappa Statistic of 0.95, and that of the NRL with HIV multiplex assay was 99.2%, 99.4%, 99.0%, and 0.99, respectively. Results show that the Nigeria national serial HIV rapid testing algorithm performed very well across the target settings. However, the algorithm’s performance in the field was lower than the performance outcomes under a controlled environment in the NRL. There is a need to target testers in the field for routine continuous quality improvement implementation, including refresher trainings as necessary.

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.

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.

Background Ineffective 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. Methods The 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. Results Of 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. Conclusions Active 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.

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 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 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.