Unmet need for contraception among human immunodeficiency virus-positive women in Jos, Nigeria: A call to integrate family planning and human immunodeficiency virus services

Posted 2017-07-13 00:00:00 by: The HealthFolk Team

Tinuade Oyebode, Atiene Sagay, Jonah Musa, Chinedu Ekwempu, Patricia Agaba, John Idoko, Prosper Okonkwo, Phyllis KankiJournal of HIV and Human Reproduction 2016 4(1):13-19PURPOSE: In the prevention of mother-to-child transmission (PMTCT) of human immunodeficiency virus (HIV), contraception is one of the four strategies proposed by the World Health Organization. Closing the gaps of unmet need for contraception among people living with HIV (PLHIVs) is critical, especially for Nigeria which contributes about 30% of global PMTCT burden. We assessed contraceptive utilization and needs, partner support, and planning of pregnancies among female PLHIVs receiving care at the HIV Treatment Centre of Jos University Teaching Hospital (JUTH). MATERIALS AND METHODS: Structured questionnaires were administered to 350 postpartum women attending the PMTCT Unit of HIV Clinic of the JUTH in 2009 using a convenience sampling method. This was to access their knowledge and utilization of contraception. All were receiving PMTCT follow-up and were within 18 months postpartum. The data were analyzed with the Epi Info Statistical Package version 3.3. RESULTS: The participants' ages ranged 19–44 years and 81.4% were Christians. Most (36.1%) were homemakers and 87.1% were married. About 44.1% were discovered to be HIV positive during antenatal care, and 47.6% of husbands were HIV positive. The previous pregnancies had been planned in 38%, thus 62% of preceding pregnancies were unplanned, while 33.8% did not desire more children. Contraception awareness was high (84.5%) but 87.1% of the participants used no form of female contraception and 81.4% admitted regular sexual activity. Among those who did not desire more pregnancies, only 48.4% used modern female contraception. Majority (80.7%) of the respondents ...

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Policy brief on increasing partner disclosure among human immunodeficiency virus-infected persons in stable relationship in Nigeria

Posted 2017-07-13 00:00:00 by: The HealthFolk Team

Layi S Babatunde, Oluwaseyi T Babatunde, Susan M OladejiJournal of HIV and Human Reproduction 2016 4(1):1-7Human immunodeficiency virus (HIV) infection contributes significantly to early death. Rate of partner disclosure is low among HIV-infected person in stable relationship preventing uptake of HIV prevention, treatment, and care by partners. Persons in stable relationship account for about 50% new infection in Nigeria largely resulting from nondisclosure by HIV-infected partner. Partner notification (PN) strategies are available for HIV-infected persons in stable relationship. In spite of the perceived barriers to partner disclosure among HIV-infected persons in stable relationship, there is ample evidence they will positively respond to PN service. The incorporation of PN strategy into the 2014 Integrated National Guideline for HIV Prevention, Treatment, and Care has created a window of opportunity for local action on PN in HIV-infected persons in stable relationship. This evidence brief summarizes available evidence on PN strategies for increasing PN among HIV-infected persons in stable relationship. The evidence brief is intended to contribute to the local implementation strategy on PN in HIV prevention, treatment, and care as specified in the Integrated National Guidelines for HIV Prevention, Treatment, and Care in Nigeria. It is also aimed at senior management teams in state agencies for the control of AIDS and all local government health departments in ...

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The human immunodeficiency virus infection is associated with positive iron balance among subjects in Nnewi, South East Nigeria

Posted 2017-07-13 00:00:00 by: The HealthFolk Team

Patrick O Manafa, John C Aneke, Chide E Okocha, Stella-Maris C Okeke, Nancy C Ibeh, George O Chukwuma, Ejike K NweneJournal of HIV and Human Reproduction 2016 4(1):8-12BACKGROUND: The human immunodeficiency virus (HIV) infection is associated with a number of metabolic derangements which have a remarkable impact on disease mortality and morbidity. OBJECTIVE: To evaluate the effect of HIV infection on iron status in apparently healthy seropositive adult subjects seen at a tertiary hospital in South East Nigeria. SUBJECTS AND METHODS: A total of eighty subjects were recruited for the study which comprised of randomly selected forty HIV seropositive and seronegative individuals, respectively. Each participant had 5 ml of blood collected for serum ferritin, iron, total binding capacity (TIBC), and percentage saturation of transferrin estimation. Ferritin was determined using the enzyme-linked immunosorbent assay technique while iron and TIBC were measured by spectrophotometry; percentage transferrin saturation was calculated using the standard formula. Statistical analysis was performed using SPSS (version 20), the Student's t-test was used for the comparison of means while the level of statistical significance was set at P< 0.05. RESULTS: The means of serum ferritin and transferrin saturation were significantly higher (164.30 ± 138.52 ng/ml vs. 88.10 ± 57.75 ng/ml; P= 0.002 and 44.67 ± 12.95% vs. 32.42 ± 4.67%; P< 0.001, respectively) while the mean of serum TIBC was significantly lower (346.25 ± 81.83 μg/dl vs. 395.20 ± 66.70 μg/dl; P= 0.004, respectively) in test subjects compared with controls. Serum iron was not significantly different in the two populations of study subjects (P = 0.30). CONCLUSION: Infection with the HIV is associated with significant tissue iron loading; ...

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Troponin I as marker of subclinical cardiac injury in human immunodeficiency virus-seropositive patients in Sokoto, Nigeria

Posted 2017-07-13 00:00:00 by: The HealthFolk Team

Aminu Bello, Abdullah S Mainasara, Hamidu M Liman, Umar Hayatu, Abdullahi F Abubakar, Kasimu Saidu, Bashar Sani, Aminu A UmarJournal of HIV and Human Reproduction 2016 4(1):20-26INTRODUCTION: Myocardial injury remains a challenging health issue among human immunodeficiency virus (HIV)/acquired immuno deficiency syndrome patients, and the importance for the estimation of cardiac troponin I (cTnI) as a tool for early detection of cardiac injury has been proven by many studies. This study examined the specificity of cTnI estimation and other cardiac enzymes in detection of subclinical cardiac injury in HIV-positive patients. MATERIALS AND METHODS: One hundred and forty patients and 70 controls between the ages of 15–80 years were studied. The patients were grouped into three categories: seventy patients on highly active antiretroviral therapy (HAART), seventy on HAART-naïve patients, and seventy were recruited as controls. RESULTS: The values (mean ± standard error of mean) of cTnI, total creatine kinase (TCK), creatine kinase muscle and brain subtype (CKMB), and lactate dehydrogenase (LDH) in patients on HAART were 3.32 ± 0.32 ng/mL, 83.52 ± 9.69 IU/L, 30.79 ± 2.02 IU/L, and 517.4 ± 19.23 IU/L, respectively. For the HAART-naïve patients, the values were 2.37 ± 0.22 ng/mL, 72.53 ± 6.47 IU/L, 51.02 ± 10.86 IU/L, and 439 ± 17.72 IU/L whereas for controls the values were 1.62 ± 0.19 ng/mL, 54.86 ± 5.82 IU/L, 15.60 ± 1.63 IU/L, and 355.30 ± 23.40 IU/L with P values <0.0001, 0.0265, 0.0007, <0.0001 which were statistically significant for cTnI, TCK, CKMB, and LDH, respectively. However, all the parameters studied were found to be elevated in patients than in the controls. CONCLUSIONS: The study showed that about 121 (86.4%) of studied cases ...

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Assessment of Metabolic syndrome among adult human immunodeficiency virus/acquired immunodeficiency syndrome patients in a tertiary health facility in Southeast Nigeria

Posted 2016-07-14 00:00:00 by: The HealthFolk Team

Victoria N Uwanuruochi, Favour S Michael, Kelechukwu Uwanuruochi, Christian Okafor, Esther N Ofoegbu, Basden J Onwubere, John M OliJournal of HIV and Human Reproduction 2015 3(2):41-46Context: Metabolic syndrome (MS) on the background of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome has not been reported from Southeast Nigeria. Aims: We sought to determine the prevalence of MS among HIV-infected Nigerians seen at the Federal Medical Centre, Umuahia, its correlation with highly active antiretroviral therapy (HAART) and other demographics. A total of 105 HAART-treated and 60 HAART-naοve patients were reviewed. Settings and Design: This study was cross-sectional, and the data were prospectively collected. Methodology: They were matched for sex and age. Anthropometric data including current weight and height, waist circumference, blood pressure, as well as blood lipids and fasting glucose were measured. MS was determined using National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III criteria. Statistical Analysis Used: SPSS version 17.0 (Chicago IL, USA) was used for data collection and analysis. Results: There was 24.3% overall prevalence of MS in the study population, 28.8% in HAART-treated, and 25% in HAART-naïve patients (P = 0.554). The prevalence of MS components was as follows: hypertension (49.7%), impaired fasting glucose (9.62%), hypertriglyceridemia (32.0%), low high-density lipoprotein-cholesterol (44.2%), and central obesity (22.1%). Correlation of MS with female gender was highly significant (r = −0.306, P = 0.002). Conclusions: MS was not significantly associated with the use of HAART in our patients but correlated with female ...

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Risky sexual behavior and associated factors among married people receiving antiretroviral therapy in a tertiary hospital in Ondo State, Nigeria

Posted 2016-07-14 00:00:00 by: The HealthFolk Team

Ayodeji M Adebayo, Olayinka S Ilesanmi, Faith O AleleJournal of HIV and Human Reproduction 2015 3(2):29-33Background: Risky sexual behavior (RSB) increases the risk of human immunodeficiency virus (HIV) transmission. There are few documented studies on the pattern of RSB and associated factors among people living with HIV. This study aimed to determine the pattern and proportion of HIV-positive patients with RSB and and its associated factors at the Federal Medical Centre, Owo, Ondo State, Nigeria. Methods: A cross-sectional study of 314 sexually active persons receiving antiretroviral therapy treatment for at least 1 month was done using a semi-structured interviewer-administered questionnaire. Study-related data were obtained and analyzed using Statistical Package for the Social Science version 21.0. Bivariate analysis to find the association between age, sex, level of education, and occupation and RSB was explored with Chi-square test. Results: The mean age of respondents was 38.6 &#897; 8.6 years while 43.6% were male. At least one RSB was reported in 42.4% (n = 314). RSBs such as nonconsistent condom use was reported by 25.2%, multiple sexual partners by 4.8%, not knowing partner's HIV status (16.1%), and nondisclosure of status to sexual partner (12.1%). Females (47.5%) were more likely to engage in RSB compared to males (35.8%), P = 0.038. Nonconsistent condom use was reported by 32.2% of females compared to 16.1% of males, P = 0.001. Not being sure of partner's status was responsible for RSB in 21.5% of females compared to 10.2% of males, P = 0.008. Having multiple sexual partners was more in male 10.9%, P < 0.001. Conclusion: RSB occurs more in females and the risk of transmitting HIV to serodiscordant partner exists. Counseling and targeted behavioral change intervention should be instituted to reduce ...

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Decline in positivity rates among HIV-exposed infants with changes in prevention of mother-to-child transmission antiretroviral regimens in Nigeria: Evidence from 7 years of field implementation

Posted 2016-07-14 00:00:00 by: The HealthFolk Team

Hadiza Khamofu, Edward A Oladele, Uche Ralph-Opara, Titi Badru, Oluwasanmi Adedokun, Mariya Saleh, McPaul Okoye, Olufunsho Adebayo, Kwasi TorpeyJournal of HIV and Human Reproduction 2015 3(2):34-40Objective: Demonstrate if the introduction of more and more efficacious antiretroviral (ARV) combinations for prevention of mother-to-child transmission (PMTCT) over time translated into a declining HIV-infection among HIV-exposed infants. Methods: This was a retrospective review of routinely collected PMTCT service data from 2008 to 2014 in 682 secondary and tertiary health facilities across Nigeria. The ARV regimen was measured by the proportions of different ARV regimens received by HIV-positive pregnant women each year and the HIV-infection among infants was determined by the rate of HIV-positive polymerase chain reaction tests each year. The District Health Information Software (DHIS) was used to extract data from health facilities. The same DHIS was used to aggregate and analyze data. Results: Maternal HIV positivity rates varied from 4.1% in 2008, 2.9% in 2011, and 3.2% in 2012, then declined steadily to 1.9% in 2014. The total number of pregnant women who tested positive for HIV and received different ARV regimen for PMTCT during the period (2008-2014) was 63,774; ranging from 7506 in 2008 to 10,388 in 2014. Uptake of single dose nevirapine by the positive pregnant women was 34.4%, 41.6%, and 45.9% in 2008, 2009, and 2010, respectively. HIV positive pregnant women on triple ARVs (prophylaxis or treatment) increased from 22% in 2008 to 99% in 2014. Infant HIV positivity rates showed a steady decline over the years, from 38% in 2008 to 6% in 2014 (P < 0.001). Conclusions: We demonstrated the declining trend of HIV-infection among HIV-exposed infant in Nigeria as more and more efficacious ARV regimens were available for HIV-positive pregnant women. We conclude that if current efforts ...

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Integrated national guidelines for HIV prevention, treatment, and care: Chapters 5 and 6

Posted 2016-07-14 00:00:00 by: The HealthFolk Team

Federal Ministry of Health (Nigeria) Journal of HIV and Human Reproduction 2015 3(2):47-55These guidelines were developed taking into consideration the guiding principles of the WHO 2013 consolidated guidelines on the use of antiretrovirals (ARVs) and the President's Comprehensive Response Plan for HIV/AIDS in Nigeria. It is intended to fast-track the achievement of universal access to HIV prevention, treatment, care, and support in Nigeria. Guiding principles of these Guidelines includes the followings: (a) Public health approach - In line with the National scale-up strategy of decentralization and integration, these guidelines are based on a public health approach to scaling up the use of ARV drugs for HIV treatment and prevention. The public health approach will ensure access to high-quality services at all levels of the health-care system including the community and primary health care settings, with a focus on the best practices that are commensurate with available resources at all levels. (b) Implementation based on national context - Implementation of the recommendations in these guidelines will be informed by national context, including HIV epidemiology, availability of resources, the organization and capacity of the health system, and anticipated cost-effectiveness. While aiming to achieve attainment of the global milestones, the best practices within the country will be further refined, promoted, implemented, and scaled up nationwide. (c) Strengthening health systems through innovation and learning - Strengthening health systems recommended and described in these guidelines will be implemented with a view to strengthening the continuum of HIV care and broader health systems, especially primary care and chronic care. As more lessons are learned from ongoing integration and decentralization of HIV services at lower-level health facilities, implementation is encouraged and findings widely ...

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Experience of HIV voluntary counseling and testing in antenatal women at a tertiary health centre of North India

Posted 2015-11-09 00:00:00 by: The HealthFolk Team

Saroj Singh, Shikha Singh, Ruchika Garg, Indira SarinJournal of HIV and Human Reproduction 2015 3(1):14-19 Background: Integrating routine HIV counseling and testing as a mandatory part of antenatal care in India has led all pregnant women enter into the prevention of mother to child transmission (PMTCT) of HIV program. Despite such strategies, the effective execution and uptake of these programs remains a major obstacle. It is thus, important to understand the experiences of pregnant women undergoing HIV testing to detect the flaws on the part of the provider and the benefiter and eliminate them to strengthen the PMTCT services. Aim: We studied the acceptability of HIV voluntary counseling and testing (VCT) in antenatal women attending a tertiary health center of the North India. The impact of the sociodemographic factors on HIV prevalence and uptake of PMTCT was also studied, and the possible reasons for dropouts were determined. Methods: Pretest counseling was performed, and sociodemographic data and blood samples were collected from the consenting antenatal pregnant women. Samples were tested for HIV antibodies as per the World Health Organization guidelines. Data were analyzed and presented as mean, percentages, and tables. Results: Of 30,150 pregnant women counseled, 23,464 (77.82&#37;) underwent testing. 136/23,464 women tested seropositive. The prevalence of HIV in antenatal women was found to be 0.58&#37;. The majority of these women were young and belonged to the age group 20&#8211;24 years (0.23&#37;). 22&#37; refused testing, the reasons for which were sought. Strong associations were found between the HIV seroreactive status and marital status, low education status, low social class, high parity, and unemployment. Conclusion: To eliminate pediatric transmission of HIV and to create more awareness regarding HIV infection and MTCT, there is a need to make VCT and PMTCT programs more acceptable to the population. The ...

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Human immunodeficiency virus-positive women: Pregnancy, delivery outcomes, and complications at the Korle-Bu Teaching Hospital in Accra, Ghana

Posted 2015-11-09 00:00:00 by: The HealthFolk Team

Joseph D Seffah, RA Kwame-Aryee, Richard M.K Adanu, Lorna A Renner, Margaret LarteyJournal of HIV and Human Reproduction 2015 3(1):1-6 Objective: To study the delivery outcomes and complications associated with human immunodeficiency virus (HIV) positive women. Patients and Methods: A clinical audit from January 2006 to December 2009 involving patients accessing antenatal and delivery services at the Korle-Bu Teaching Hospital and using the voluntary counseling and testing/prevention of mother-to-child transmission services. Results:. HIV-positive women on the highly active antiretroviral therapy and ART prophylaxis had a mean CD4 count of 681 cells/ul (range: 412&#8211;810). Those who were not on any prophylaxis had a mean count of 288 cells/ul (range: 34&#8211;601). The study and comparison populations had similar mean ages; 29.8 years and 28.4 years, respectively (P &#61; 0.09). About half the HIV-positive women had vaginal delivery though none had an episiotomy, forceps, or vacuum delivery. The HIV-positive women had a caesarean section rate of 55&#37; and the rate in the HIV-negative women was 21&#37; (P &#60; 0.001). About 50&#37; of the caesarean deliveries were done as emergencies. The mean birth weight was lower in the HIV-positive women; 2.9 kg versus 3.1 kg, respectively (P &#61; 0.08). The perinatal losses were significantly higher in the study population; 95 versus 70 (P &#61; 0.04). The mean placenta weight was smaller in the study population; 510 g versus 550 g (P &#61; 0.04). Conclusion: Among the HIV-positive parturient, the caesarean delivery rate was about 50&#37; and the neonatal outcomes were significantly worse than in the HIV-negative ...

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