Debunking the myths perpetuating low implementation of isoniazid preventive therapy amongst human immunodeficiency virus-infected persons

Isoniazid preventive therapy(IPT) is the administration of isoniazid(INH) to people with latent tuberculosis(TB) infection(LTBI) to prevent progression to active TB disease. Despite being life-saving for human immunodeficiency virus(HIV)-infected persons who do not have active TB, IPT is poorly implemented globally due to misconceptions shared by healthcare providers and policy makers. However, amongst HIV-infected patients especially those living in resource-limited settings with a high burden of TB, available evidence speaks for IPT: Among HIV-infected persons, active TB- the major contraindication to IPT, can be excluded with symptom screening; chest X-ray and tuberculin skin testing are unreliable and often lead to logistic delays resulting in increased numbers of people with LTBI progressing to active TB; the use of IPT has not been found to increase the risk of the development of INH mono-resistance; IPT is cost-effective and cheaper than the cost of treating cases of active TB that would develop without IPT; ART and IPT have an additive effect on the prevention of TB, and both are safe and beneficial even in children. In order to sustain the recorded gains from ART scale-up and to further reduce TB-related morbidity and mortality, more efforts are needed to scale-up IPT implementation globally.

Completion of 6-mo isoniazid preventive treatment among eligible under six children:A cross-sectional study,Lagos,Nigeria

BACKGROUND Nigeria is one of the thirty high burden countries with significant contribution to the global childhood tuberculosis epidemic.Tuberculosis annual risk for children could be as high as 4%particularly in high tuberculosis(TB)prevalent communities.Isoniazid(INH)Preventive Therapy has been shown to prevent TB incidence but data on its implementation among children are scarce.AIM To determine the completion of INH among under six children that were exposed to adults with smear positive pulmonary TB in Lagos,Nigeria.METHODS This was a hospital-based retrospective cross-sectional review of 265 medical records of eligible children<6 years old enrolled for INH across 32 private hospitals in Lagos,Nigeria.The study took place between July and September 2020.Data was collected on independent variables(age,gender,type of facility,TB screening,dose and weight)and outcome variables(INH outcome and proportion lost to follow up across months 1-6 of INH treatment).RESULTS About 53.8%of the participants were female,95.4%were screened for TB and none was diagnosed of having TB.The participants’age ranged from 1 to 72 mo with a mean of 36.01±19.67 mo,and 40.2%were between the ages of 1-24 mo.Only 155(59.2%)of the 262 participants initiated on INH completed the six-month treatment.Cumulatively,107(41.0%)children were lost to follow-up at the end of the sixth month.Of the cumulative 107 loss to follow-up while on INH,largest drop-offs were reported at the end of month 2,52(49%)followed by 20(19%),17(16%),11(10.2%)and 7(6.5%)at months 3,4,5 and 6 respectively.The analysis showed that there was no significant association between age,gender,type of facility and completion of INH treatment(P>0.005).CONCLUSION This study demonstrated suboptimal INH completion rate among children with only 6 out of 10 children initiated on INH who completed a 6-mo treatment in Lagos,Nigeria.The huge drop-offs in the first 2 mo of INH calls for innovative strategies such as the use of 60-d INH calendar that would facilitate reminder and early engagement of children on INH and their caregivers in care and across the entire period of treatment.

Roles of HIV-1 auxiliary proteins in viral pathogenesis and host-pathogen interactions

Active host-pathogen interactions take place during infection of human immunodeficiency virus type 1 (HIV-1). Outcomes of these interactions determine the efficiency of viral infection and subsequent disease progression. HIV- infected cells respond to viral invasion with various defensive strategies such as innate, cellular and humoral immune antiviral mechanisms. On the other hand, the virus has also developed various offensive tactics to suppress these host cellular responses. Among many of the viral offensive strategies, HIV-1 viral auxiliary proteins (Tat, Rev, Nef, Vif, Vpr and Vpu) play important roles in the host-pathogen interaction and thus have significant impacts on the outcome of HIV infection. One of the best examples is the interaction of Vif with a host cytidine deaminase APOBEC3G. Although specific roles of other auxiliary proteins are not as well described as Vif-APOBEC3G interaction, it is the goal of this brief review to summarize some of the preliminary findings with the hope to stimulate further discussion and investiga- tion in this exhilarating area of research.

International NeuroAIDS: prospects of HIV-1 associated neurological com-plications

Neurological complications associated with HIV-1/AIDS are being recognized with a high frequency that parallels the increased number of AIDS cases. The early infiltration by HIV-1 into the nervous system can cause primary and/or secondary neurological complications. The most common neurocognitive disorder is AIDS Dementia Complex (ADC). In developing countries of Asia the three most opportunistic infections are tuberculosis (TB), cryptococcosis, and Pneumocystis carinii pneumonia. Therefore, it is expected that secondary neurological complications due to TB and cryptococcosis will be the most common cause of morbility and mortality in HIV-1/AIDS cases in China. Research of NeuroAIDS in China is necessary to understand the impact and the biology of HIV-1 in the nervous system. Future studies would include, the molecular epidemiology and the description of opportunistic infections associated to HIV-1; the neuropathological description of primary and secondary HIV-1 complications in different groups; the HIV-1 neurot- ropism and immune response studies for China’s unique HIV-1 strains and recombinant forms derived from the nervous system, including experimental models such as the use of transgenic rats; and the study of potential resistant virus, primarily when the anti-retroviral therapy (ART) has not full access in the brain.

HIV-1 Vif Protein Mediates the Degradation of APOBEC3G in Fission Yeast When Over-expressed Using Codon Optimization

Interaction between the HIV-1 Vif protein and the cellular host APOBEC3G protein is a promising target for inhibition of HIV-1 replication. Considering that human cells are a very complicated environment for the study of protein interactions, the goal of this study was to check whether fission yeast could be used as a model cell for studying the Vif-APOBEC3G interaction. Vif and APOBEC3G were expressed in fusion with GFP protein in the S. pombe SP223 strain. Subcellular localizations of Vif and APOBEC3G were observed with fluorescent microscopy. Codon optimization was used to over express the Vif protein in S. pombe cells. The degradation of APOBEC3G mediated by Vif was tested through expressing Vif and GFP-APOBEC3G proteins in the same cell. Western Blot analysis was used to measure the corresponding protein levels under different experimental conditions. The results showed that the Vif protein was predominantly localized in the nucleus of S. pombe cells, APOBEC3G was localized in the cytoplasm and concentrated at punctate bodies that were often in close proximity to the nucleus but were not necessarily restricted from other regions in the cytoplasm. Vif protein expression levels were increased significantly by using codon optimization and APOBEC3G was degraded when Vif was over-expressed in the same S. pombe cells. These results indicate that fission yeast is a good model for studying the interaction between the Vif and APOBEC3G proteins.

Promising Efficacy of the <i>Cola acuminata</i>Plant: A Mini Review

Cola acuminata also known as the bissy nut extract was originally endemic to Africa but is now present in a number of tropical countries including Jamaica. Despite its rich history of ethnomedicinal use and promising bioactivity, there still exists limited research on this plant. Exploring and compiling the ethnomedicinal usage, identified bioactivities and isolates of C. acuminata will prove useful in steering future directional research with the hope of reaping the plant’s full beneficial properties. The plant’s traditional use encompass;cancer treatment, an antidote for poisoning, suppressing one’s appetite, increasing alertness, treating migraine and motion sickness, obtaining a state of euphoria in addition to being used in certain traditional practices. Because of the plant’s copious ethnomedicinal use, researchers were led to believe that the low incidence of prostate cancer evidenced amongst Asians could be as a result of phytochemicals present in the bissy nut. Research conducted in our lab confirmed the anti-cancer potential of the plant and recent research has identified a number of secondary metabolites present in C. acuminata which could be responsible for the observed bioactivities. The plant has also shown promise as an anti-microbial agent. This paper confirms the efficacy of the bissy nut plant both as an ethnomedicine as well as warranting further research that may prove useful both in the pharmaceutical and nutraceutical industries.

Assessment of the Contributions of Private Provider Engagement in Tuberculosis Case Finding and Notification in South West Nigeria

Introduction: Tuberculosis is one of the leading causes of mortalities attributable to an infectious disease. In a private sector-driven health system such as Nigeria, the private health providers are very important stakeholders in tuberculosis diagnosis and management. Unfortunately, there are few data on the level of contribution of these private health providers to the case finding and notification of tuberculosis in Nigeria. Consequently, this study assessed the contribution of the private providers to the diagnosis and treatment of tuberculosis under the Global Fund Private Public Mix New Funding Model (2nd phase) grant (GF PPM NFM2) in the four implementing states of south west Nigeria. Materials and Methods: This is a retrospective, cross-sectional analysis of the NFM2 programme implementation data collected between January 1, 2019 and December 31, 2020. Data was extracted from the routine registers such as the presumptive TB registers;treatment register of the private health facilities engaged for PPM activities between 2019 and 2020. The data was entered and analyzed using Microsoft excel package. The variables were summarized using appropriate charts and table. Results: Concerning the percentage contribution of the Global Fund Private Public Mix (GF PPM) grant to the total state TB case notification, majority of the implementing states show some progressive rise in the contribution of GF PPM to State TB case notification as the grant implementation progressed. Furthermore, at the initial period of the grant implementation, the health facilities seemed to have generated majority of the cases. However, as the grant implementation progressed, the PPMVs were responsible for the diagnosis of majority of the cases. Conclusion: As the grant progressed, there was a progressive increase in the number of presumptive TB cases as well as in the number of notified cases of tuberculosis attributable to private provider engagement.

Assessment of the Affordability of Out-of-Pocket Payments among Some Selected People Living with HIV in Kano, Nigeria

Introduction: With an estimated 1.8 million People Living with HIV (PLHIV), Nigeria’s HIV response is still heavily donor dependent. However, with anticipated decline in donor funding for HIV/AIDS program as the country takes ownership of the program, understanding financing options for PLHIV is important. One of such financing options is affordability of out-of-pocket payments (OOP) for anti-retroviral drugs (ARV) by PLHIV. We assessed affordability of OOP payments for ARVs in Kano State, North-Western Nigeria. Methods: Four Hundred and sixty-nine PLHIV receiving donor-supported-free ARV in Kano, North Western Nigeria were systematically selected and interviewed during routine clinic visits. Affordability for ARV was assessed by a combination of variables including willingness and financial means to incur extra expense for full dose of ARV based on landing and distribution cost of 8.3 USD (about 3,000 NGN) per month dose. Results: Four hundred and sixty-nine respondents were interviewed. Of those, 72 (15.4%, 95% CI: [13.2 - 19.7]) can afford ARV OOP on monthly base. The proportion of males able to pay 3,000 NGN (8.3 USD) or more OOP for ARVs was not different from that of women (15.5% versus 15.2%). Attending school, education level, employment, monthly income and wealth have all been found to be associated with willingness and ability to pay for monthly dose of ARV OOP (p < 0.0001). Conclusion/recommendation: Majority of PLHIV in Kano State may not afford ARV OOP in the event of withdrawal of supports by international donors. Innovative sustainable financing mechanisms from domestic resources are needed for HIV program sustainability.

Commentary on “Prevalence and evolution of drug resistance HIV-1 vari-ants in Henan, China”

Critical to the implementation and scale-up of successful antiretroviral therapy worldwide is an understanding of the efficacy, toxicities and durability of antiretroviral regimens in the specific populations, which they are utilized. In order to obtain this information monitoring and evaluation or operational research must be done in each country or population. The article by Li et al in this issue represents an outstanding example of the importance of data obtained in the populations treated . The authors proactively evaluated the outcomes at 3 and 6 months of 118 and 124 HIV infected individuals, respectively, treated with zidovudine, didanosine and nevirapine in one region in China.

Safe and effective sofosbuvir-based therapy in patients with mental health disease on hepatitis C virus treatment

AIMTo study impact of baseline mental health disease on hepatitis C virus (HCV) treatment; and Beck&rsquo;s Depression Inventory (BDI) changes with sofosbuvir- and interferon-based therapy. METHODSThis is a retrospective cohort study of participants from 5 studies enrolled from single center trials conducted at the Clinical Research Center of the National Institutes of Health, Bethesda, MD, United States. All participants were adults with chronic HCV genotype 1 infection and na&iuml;ve to HCV therapy. Two of the studies included HCV mono-infected participants only (SPARE, SYNERGY-A), and 3 included human immunodeficiency virus (HIV)/HCV co-infected participants only (ERADICATE, PFINPK, and ALBIN). Patients were treated for HCV with 3 different regimens: Sofosbuvir and ribavirin in the SPARE trial, ledipasvir and sofosbuvir in SYNERGY-A and ERADICATE trials, and pegylated interferon (IFN) and ribavirin for 48 wk in the PIFNPK and ALBIN trials. Participants with baseline mental health disease (MHD) were identified (defined as either a DSM IV diagnosis of major depression, bipolar disorder, schizophrenia, generalized anxiety, and post-traumatic stress disorder or requiring anti-depressants, antipsychotics, mood stabilizers or psychotropics prescribed by a psychiatrist). For our first aim, we compared sustained virologic response (SVR) and adherence (pill counts, study visits, and in 25 patients, blood levels of the sofosbuvir metabolite, GS-331007) within each study. For our second aim, only patients with HIV coinfection were evaluated. BDI scores were obtained pre-treatment, during treatment, and post-treatment among participants treated with sofosbuvir-based therapy, and compared to scores from participants treated with interferon-based therapy. Statistical differences for both aims were analyzed by Fisher&rsquo;s Exact, and t-test with significance defined as a P value less than 0.05. RESULTSBaseline characteristics did not differ significantly between all participants with and without MHD groups treated with sofosbuvir-based therapy. Among patients treated with sofosbuvir-based therapy, the percentage of patients with MHD who achieved SVR was the same as those without (SPARE: 60.9% of those MHD compared to 67.6% in those without, P = 0.78; SYNERGY-A: 100% of both groups; ERADICATE: 100% compared to 97.1%). There was no statistically significant difference in pill counts, adherence to study visits between groups, nor mean serum concentrations of GS-331007 for each group at week 2 of treatment (P = 0.72). Among patients with HIV co-infection, pre-treatment BDI scores were similar among patients treated with sofosbuvir, and those treated with interferon (sofosbuvir-based 5.24, IFN-based 6.96; P = 0.14); however, a dichotomous effect on was observed during treatment. Among participants treated with directly acting antiviral (DAA)-based therapy, mean BDI scores decreased from 5.24 (pre-treatment) to 3.28 during treatment (1.96 decrease, P = 0.0034) and 2.82 post-treatment. The decrease in mean score from pre- to post-treatment was statistically significant (-2.42, P = 0.0012). Among participants treated with IFN-based therapy, mean BDI score increased from 6.96 at pre-treatment to 9.19 during treatment (an increase of 2.46 points, P = 0.1), and then decreased back to baseline post-treatment (mean BDI score 6.3, P = 0.54). Overall change in mean BDI scores from pre-treatment to during treatment among participants treated with DAA-based and IFN-therapy was statistically significant (-1.96 and +2.23, respectively; P = 0.0032). This change remained statistically significant when analysis was restricted to participants who achieved SVR (-2.0 and +4.36, respectively; P = 0.0004). CONCLUSIONSofosbuvir-based therapy is safe and well tolerated in patients with MHD. A decline in BDI associated with sofosbuvir-based HCV treatment suggests additional MHD benefits, although the duration of these effects is unknown.

Update on the laboratory diagnosis and monitoring of HIV infection

In China, the estimated number of HIV infected cases is approaching one million. Although public education has been initiated for awareness and behavioral modification for this devastating infection, better diagnostic methods are needed to identify infected persons and manage infection. Simple and more accurate diagnostic tools have become available, particularly for early detection and to monitor treatment in those who receive anti-retroviral treatment. In this short review, we summarize some of the common and new methodologies that can be used in clinical laboratories, in the field, or in private laboratories. These range from simple antibody tests to more sophistical methods that are used to monitor disease progression and identify drug resistance. These tools can assist physicians, medical practitioners, and laboratory personnel to select suitable diagnostic tools for the diagnosis, blood screening, monitoring of disease progression, and for detection of drug resistance to anti-retroviral therapies.

HIV-1 Vpr-induced cell death in Schizosaccharomyces pombe is reminiscent of apoptosis

Human immunodeficiency virus type 1 （HIV-1） Vpr induces cell death in mammalian and fssion yeast cells, suggesting that Vpr may affect a conserved cellular process. It is unclear, however, whether Vpr-induced yeast cell death mimics Vpr-mediated apoptosis in mammalian cells. We have recently identified a number of Vpr suppressors that not only suppress Vpr-induced cell death in fission yeast, but also block Vpr-induced apoptosis in mammalian cells. These findings suggest that Vpr-induced cell death in yeast may resemble some of the apoptotic processes of mammalian cells. The goal of this study was to develop and validate a fission yeast model system for future studies of apoptosis. Similar to Vpr-induced apoptosis in mammalian cells, we show here that Vpr in fission yeast promotes phosphatidylserine externalization and induces hyperpolarization of mitochondria, leading to changes of mitochondrial membrane potential. Moreover, Vpr triggers production of reactive oxygen species （ROS）, indicating that the apoptotic-like cell death might be mediated by ROS. Interestingly, Vpr induces unique morphologic changes in mitochondria that may provide a simple marker for measuring the apoptotic-like process in fission yeast. To verify this possibility, we tested two Vpr suppressors （EF2 and Hspl6） that suppress Vpr-induced apoptosis in mammalian cells in addition to a newly identified Vpr suppressor （Skpl）. All three proteins abolished cell death mediated by Vpr and restored normal mitochondrial morphology in the yeast cells. In conclusion, Vpr-induced cell death in fission yeast resembles the mammalian apoptotic process. Fission yeast may thus potentially be used as a simple model organism for the future study of the apoptotic-like process induced by Vpr and other proapoptotic agents.

Active tracking of rejected dried blood samples in a large program in Nigeria

AIM: To study the impact of rejection at different levels of health care by retrospectively reviewing records of dried blood spot samples received at the molecular laboratory for human immunodeficiency virus(HIV) early infant diagnosis(EID) between January 2008 and December 2012.METHODS: The specimen rejection rate, reasons for rejection and the impact of rejection at different levels of health care was examined. The extracted data were cleaned and checked for consistency and then deduplicated using the unique patient and clinic identifiers. The cleaned data were ciphered and exported to SPSS version 19(SPSS 2010 IBM Corp, New York, United States) for statistical analyses.RESULTS: Sample rejection rate of 2.4%(n = 786/32552) and repeat rate of 8.8%(n = 69/786) were established. The mean age of infants presenting for first HIV molecular test among accepted valid samples was 17.83 wk(95%CI: 17.65-18.01) vs 20.30 wk(95%CI: 16.53-24.06) for repeated samples. HIV infection rate was 9.8% vs 15.9% for accepted and repeated samples. Compared to tertiary healthcare clinics, secondary and primary clinics had twofold and three-fold higher likelihood of sample rejection, respectively(P < 0.05). We observed a significant increase in sample rejection rate with increasing number of EID clinics(r = 0.893, P = 0.041). The major reasons for rejection were improper sample collection(26.3%), improper labeling(16.4%) and insufficient blood(14.8%). CONCLUSION: Programs should monitor pre-analytical variables and incorporate continuous quality improvement interventions to reduce errors associated with sample rejection and improve patient retention.

Practice of cardiopulmonary resuscitation among health care providers in a tertiary health centre in a semi-urban setting

Objectives: To assess the basic knowledge of cardiopulmonary resuscitation (CPR) among health workers in a tertiary health facility in a semi-rural county. Methods: A questionnaire based, cross sectional study involving health care professionals was performed in Federal Medical Centre, Birnin Kudu, Jigawa State, Nigeria from April to July 2017. A purposive sampling method was adopted for subject selection. A pretested self-administered questionnaire was distributed;this included knowledge on basic life support;participation in basic life supportand outcomes. It was adopted from the American Heart Association guidelines for CPR and emergency cardiac care. Results: One hundred and two respondents were recruited (40 doctors and 62 nurses). There were 50 males (49%) and 52 females (51%). Their age ranged from 23 to 54 years with mean of (34.9± 7.4) years. Only 20% of the respondents were aware of circulation, airway and circulation in adult resuscitation;however, 61.0% of all respondents were aware of airway, breathing and circulation of resuscitation in children. Furthermore, only 10% of the respondents were aware of the correct steps of single rescuer resuscitation. Their knowledge was poor about chest compression and ventilation for both adult and children resuscitation. The overall knowledge score ranged from 0.0% to 100% with mean knowledge score of (21.2±18.6)%. The date of last training about CPR had no relationship with the knowledge scores (χ ^2=2.951, P=0.300). The cadre of the respondents (doctors and nurses) had no relationship with their knowledge score (χ^2=0.100, P=0.633 for doctors and nurses;χ^2=7.074, P=0.225 for doctors cadre;χ^2=3.868, P=0.677 for nurses cadre) respectively. Conclusions: The knowledge about CPR among health workers is poor;furthermore, the last date of training about CPR and the cadre of staffs have no relationship with knowledge of CPR.

Baseline Clinical Profile of a “Normal Popu-lation” of HIV Exposed Sero-Negative (HESN) Partners May Impact HIV Biomedical Prevention Studies Negatively

The burden and viral diversity of HIV in Nigeria makes it suitable to evaluate biomedical prevention strategies including HIV vaccines. We document baseline clinical characteristics of a cohort of HIV Exposed Sero-Negative (HESN) partners to highlight background morbidities that might impact the interpretation of research findings especially in low income countries where “normal control” is based on physical appearance and self-reporting. We established a 2-year prospective cohort of HESN, and obtained, at baseline medical history, general physical examination findings and safety laboratory tests results. Among 534 participants with a mean age of 37 ± 9 years, the commonest symptoms were headache (25.5%) and fever (20%), which occurred more among females. Also, 13% reported a history of urethral/vaginal discharge and genital ulcer. High blood pressure (HBP) (i.e. blood pressure ≥ 140/90 mmhg) was a major abnormal examination finding, which occurred more among males (53.2% vs 26.2%, p < 0.01). More female participants had abnormal laboratory results with 31% having low hemoglobin concentration (<12 g/dl, p = 0.021);30% with elevated alanine transaminase level (p = 0.019) and 28% with abnormal blood urea nitrogen level (p = 0.093). HBP and abnormal safety laboratory are significant findings among so called “normal population” that could affect interpretation of research findings of HIV biomedical prevention studies in Nigeria.

Isolation, purification and partial characterization of a glycoside from the Jamaican ball moss plant (<i>Tillandsia recurvata</i>L.)

Initial isolation and characterization screens have been carried out on the Jamaican ball moss (Tillandsia recurvata L.) plant producing a novel complex gly-cosidic compound. This complex glycoside may be responsible for the promising anti-cancer and anti-inflammatory properties of this ball moss plant. A combination of supercritical fluid processing and chromatographic purification was used to produce the isolate. LC-MS analysis showed the presence of a compound with a molecular weight of ~800 and mass spectral (MS-MS and MS-MS-MS) data indicate that this compound may be a glycoside with a molecular mass of 1601.1 Da (negative ionization mode) and possibly contain up to two sialic acids, based on the doubly-charged state of the molecule at neutral pH conditions. 2D-TOCSY NMR spectrum lends evidence to the presence of at least one likely amide to aliphatic proton correlation, indicating the presence of a sialic acid moiety. The main structure of this therapeutic compound appears similar to a soyasaponin.

Strategic Engagement of Private Facilities to Increase Public-Private Mix (PPM) Contribution to Nigeria Tuberculosis Case Notification

Introduction: Finding the missing Tuberculosis (TB) cases remains the single most important priority for TB control in Nigeria. Between 66% - 92% of all cases of respiratory diseases including those with symptoms suggestive of TB are first seen byprivate health providers. Dependable, quality surveillance systems and notification are key roles in health services delivery, particularly as it is related to TB control. However, poor notification has been a challenge. This study was to assess the contribution of the public private mix (PPM) to Nigeria Tuberculosis national case notification. Methods: It was a national cross-sectional study. Data were extracted from the National database and reviewed. Private facilities were engaged in 2017 and assessed over 2018-2020. Interventions included: enrolling private practitioners (Private-For-Profit, Faith Based Organization, Private Medicine Vendors and Community Pharmacists), engaging a private standalone Laboratory for Gene Xpert testing within the network of private facilities, use of Mobile App for easy screening and reporting, instituting a HUB and spoke, and incentives to private providers for participating. Each private provider had a customized approach. Trend analysis was performed using Cochran-Armitage χ2 test for linear trends. Level of significance was at a p value of Results: Total case notification increased from 104,904 cases in 2017 to 138,591 in 2020. There were 2.0% increase in 2018, 13.0% in 2019 and 15.0% in 2020 (p < 0.001). PPM contribution to case notification increased from 10,699 cases in 2017 to 12,625 in 2018, then 17,250 in 2019 and 38,865 in 2020. There were 18.0% increase in 2018, 36.6% in 2019 and 125.3% increase in 2020 (p ). Conclusion: Effective engagement of the private sector in TB control efforts in Nigeria using a variety of approaches resulting in improved TB notification is possible. The National TB Programme should engage all private practitioners such that each practitioner will practice at least one TB service model.

The Use of Sputum Dashboard and Dispatch Riders in Mitigating Delay in Sputum Samples’ Processing—Evidence from an Intervention in Lagos State, Nigeria

The act of referring TB presumptive individuals after verbal screening to another health facility/diagnostic centres for testing often results in large loss to follow-up, owing to the many barriers people face in accessing care. The transportation of sputum samples is an efficient method of increasing access to tuberculosis (TB) diagnostics in areas where testing is not currently available. One of the major reasons for the low yield of TB cases in the field was delay in sputum sample transportation to diagnostic laboratories among other factors. Damien Foundation Belgium, carried out a unique sputum riders initiatives in 20 LGAs of Lagos state between Q3-2019 and Q4-2020. A total of 25 sputum dispatch riders across the 20 LGAs in the State who are monitored routinely on an electronic dashboard were engaged for sputum logistics. Therefore, this report highlights how the initiatives have contributed to increased TB case notification in a densely populated metropolitan city in Nigeria. Overall, 48,265 units of sputum samples were transported to the laboratory from the facilities 99.9% of results which were received from the laboratory by the dispatch riders. The contribution of sputum riders to the overall TB case detection by the project progressively increased from 9% when the intervention began to 57% as at Q4 2020. The transportation of sputum samples by motorcycle dispatch riders is an efficient method of increasing access to TB diagnostic services in communities where testing is not currently available.

Prevalence of Adverse Drug Reactions to Second Line Anti Tuberculosis Drugs in Nigeria: A Cross-Sectional Study

Introduction: Multidrug resistant tuberculosis (MDR-TB) is treated with second line antituberculosis drugs. These drugs are notorious for inflicting serious adverse drug reactions (ADRs), which many studies have shown causes a wide range of economic and health problems including death. Aim: The study examined the prevalence of ADRs, associated risk factors, socio-demographic association and outcomes among patients treated for MDR-TB at a comprehensive tuberculosis treatment center in Nigeria. Method: The study was conducted at the Government Chest Hospital, Jericho, Ibadan. We applied a retrospective assessment of patient treatment data and ADRs reports stored at the study site from March 2013 and February 2016. Subsequently, a prospective study of ADRs was conducted on patients admitted into the same hospital. Causality relationship between the drugs and the reported ADRs was determined with a specially validated tool. The outcomes assessed include recovery from the ADRs, death and permanent deafness from the ADRs. Extracted data were analyzed using SPSS version 22.0. Risk Ratio was calculated for the influence of risk factors for adverse drug reactions. Logistic regression was performed to test for the strength of relationships between risk factors and incidence of ADRs among patients. Result: Almost all the participants in this study reported adverse drug reaction [99% (118/119)]. However, ototoxicity was the most prevalent ADR (35.3%), followed by electrolyte imbalance (12.6%), gastrointestinal track (10.1%) and psychiatric disorders (10.1%). Being older than 35 years and HIV negative or having a healthy BMI were not significant risk factors for developing ADRs. Duration of ADR above one month was significantly associated with the outcome of ADR. Conclusion: Ototoxicity, electrolyte imbalance, psychiatric disorders and gastrointestinal tract problems were the most frequently reported ADRs. Healthcare providers, government and donor agencies supporting the treatment should ensure that hearing aids and other forms of support are readily made available for the affected patients.

A Case Study of Multi Drug-Resistant Tuberculosis (MDR-TB), HIV and Diabetes Mellitus (Dm) Comorbidity: Triple Pathology;Challenges and Prospects

Tuberculosis (TB), diabetes mellitus and HIV co-morbidity is a rare and interrelated health condition with associated high morbidity and mortality especially in developing countries with high prevalence of TB. It has become an emerging concern to epidemiologists and TB control programs due to complexities in its control and management. Managing MDR-TB, DM and HIV comorbidity is challenging, with risk of unfavorable outcome;consequently, close monitoring is necessary. Individuals with weak immunity resulting from diseases such as uncontrolled Diabetes Mellitus (DM) and HIV have a higher risk of developing TB or progression from latent to active TB. We present a 65-year old known diabetic patient who presented to Royal Cross Hospital Ugwueke Abia State, Nigeria with a one-year history of recurrent productive cough with associated night sweats, low grade fever and marked weight loss. A diagnosis of drug-resistant TB with DM/HIV co-morbidity was made and co-managed by experts from the respective clinics and the State TB control program. The patient was declared cured (7 months consecutive negative cultures each taken 30 days apart) after completing 20 months of conventional MDR-TB treatment. The patient showed remarkable clinical improvement including weight gain, good diabetic control and significant increase in CD4 (700 cells). Managing MDR-TB patients with diabetes and HIV is challenging, however, appropriate treatment, psychosocial support, adequate blood sugar control as well as monthly monitoring of patients with requisite investigations are vital in achieving good treatment outcome.