There is limited capacity and infrastructure in sub-Saharan Africa to conduct clinical trials for... more There is limited capacity and infrastructure in sub-Saharan Africa to conduct clinical trials for the identification of efficient and effective new prevention, diagnostic and treatment modalities to address the disproportionate burden of disease. This paper reports on the process to establish locally driven infrastructure for multicentre research and trials in Nigeria known as the Nigeria Implementation Science Alliance Model Innovation and Research Centres (NISA-MIRCs). We used a participatory approach to establish a research network of 21 high-volume health facilities selected from all 6 geopolitical zones in Nigeria capable of conducting clinical trials, implementation research using effectiveness-implementation hybrid designs and health system research. The NISA-MIRCs have a cumulative potential to recruit 60 000 women living with HIV and an age-matched cohort of HIV-uninfected women. We conducted a needs assessment, convened several stakeholder outreaches and engagement session...
Supplemental material, sj-pdf-1-qhr-10.1177_10497323211023164 for Health care Providers' Perc... more Supplemental material, sj-pdf-1-qhr-10.1177_10497323211023164 for Health care Providers' Perceptions About Overweight and Obesity Among People Living With Human Immunodeficiency Virus in Nigeria by John O. Olawepo, Jennifer R. Pharr, Raisa Kabir and Ayodotun Olutola in Qualitative Health Research
Appendix_1_UNN_Short_Course__Schedule_ for Effectiveness of a Comprehensive 4-Week Course in HIV ... more Appendix_1_UNN_Short_Course__Schedule_ for Effectiveness of a Comprehensive 4-Week Course in HIV Medicine for Postgraduate Doctors at University of Nigeria: A Preservice Education Initiative by Anthea Nwandu, Cassidy Wayne Claassen, David James Riedel, Theresa Madubuko, Ayodotun Olutola, Eugene Onu, Chinwe Onyekonwu, Emmanuel Nwobi, and Chinwe Chukwuka in Journal of the International Association of Providers of AIDS Care (JIAPAC)
SPIRIT 2013 Checklist: recommended items to address in a clinical trial protocol and related docu... more SPIRIT 2013 Checklist: recommended items to address in a clinical trial protocol and related documents. (DOC 118 kb)
Attribution License, which permits unrestricted use, distribution, and reproduction in any medium... more Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Nigeria has the world largest burden of paediatric HIV and is also highly endemic for Hepatitis B virus (HBV). However, relatively little is known regarding the prevalence of HBV-HIV coinfections among Nigerian children. Methods. A retrospective study among treatment naive HIV-infected children attending the pediatric clinic of the APIN Plus/Harvard PEPFAR program of the Federal Medical Centre, Makurdi, between June 2008 and June 2012. Results. The mean age of the 395 subjects studied was 7.53 ± 4.23 years. Thirty-one subjects (7.8%) were positive for HBV. No subject was HIV-HBV-HCV triply infected. Significantly higher HIV-HBC coinfections were found, in older subjects (11–15 years), subjects that did not receive nor complete Hepatitis B vaccinations, and subjects that had a severe immunosuppression of < 15 % with respective...
effects of leisure activities and psychosocial support on medication adherence and clinic attenda... more effects of leisure activities and psychosocial support on medication adherence and clinic attendance among children on antiretroviral therapy emmanuel Adémólá
Background; Studies on HIV-Hepatitis C viral (HCV) co-infections in Nigeria have been done essent... more Background; Studies on HIV-Hepatitis C viral (HCV) co-infections in Nigeria have been done essentially among adult and pregnant women with a few in pediatric population. The study aims at documenting the burden and the characteristics of HIVHCV co-infections in a cohort of Nigerian children. Methods; A retrospective study among treatment-naive HIV-infected children attending pediatric clinic of the AIDS PREVENTION INITIATIVE IN NIGERIA Plus/Harvard PEPFAR program of the Federal Medical Centre, Makurdi, between June 2008 and June 2012. Inclusion criteria included all subjects who were screened and got results for viral hepatitis B (HBV) and C. Results; The age range of the included 395 subjects was 16 months to 15 years with a mean age of 7.53±4.23 years including 205 males and 190 females. Nine subjects (2.3%) tested positive for HCV. Thirty one subjects (7.8%) were positive for HBV. No subject was HIV-HBV-HCV triply infected. Significantly more male subjects were HIV-HCV co-infecte...
Background. Nigeria has the world largest burden of paediatric HIV and is also highly endemic for... more Background. Nigeria has the world largest burden of paediatric HIV and is also highly endemic for Hepatitis B virus (HBV). However, relatively little is known regarding the prevalence of HBV-HIV coinfections among Nigerian children. Methods. A retrospective study among treatment naive HIV-infected children attending the pediatric clinic of the APIN Plus/Harvard PEPFAR program of the Federal Medical Centre, Makurdi, between June 2008 and June 2012. Results. The mean age of the 395 subjects studied was 7.53 ± 4.23 years. Thirty-one subjects (7.8%) were positive for HBV. No subject was HIV-HBV-HCV triply infected. Significantly higher HIV-HBC coinfections were found, in older subjects (11–15 years), subjects that did not receive nor complete Hepatitis B vaccinations, and subjects that had a severe immunosuppression of < 15% with respective P values of 0.00, 0.01, and 0.00. HIV-HBV co-infection did not significantly impact on other baseline characteristics including, gender, WHO clin...
HIV infection was associated with significant weight loss before the advent of potent antiretrovi... more HIV infection was associated with significant weight loss before the advent of potent antiretroviral therapy (ART). Weight gain while on treatment was seen as a clinical indicator of treatment success. Perceptions of health care providers (HCPs) about obesity among people living with (PLHIV) were examined. We conducted 16 key informant interviews with HCPs in two states in southeastern Nigeria, which were then coded thematically. The respondents included seven physicians, four nurses, three adherence counselors, and two pharmacists. The analysis revealed three key themes: HCPs do not see excess weight gain as a problem; there are several challenges in managing obesity among PLHIV; and comorbidities play a role in the management of obesity among PLHIV. We conclude that obesity among PLHIV is an important clinical issue that HCPs need to address with the commencement of ART.
The proportion of people living with HIV (PLHIV) who are overweight or obese is rising, leading t... more The proportion of people living with HIV (PLHIV) who are overweight or obese is rising, leading to a double epidemic of HIV and obesity. The purpose of this retrospective longitudinal study was to examine changes in body mass index (BMI) among PLHIV who were new to antiretroviral therapy (ART) in two states in Southeastern Nigeria. The BMI at baseline and 12 months were compared and the difference in proportions in each BMI category was tested. The association between the BMI at 12 months and the demographic and/or clinical variables was examined using multiway analysis of covariance. The study included 2,146 participants. After 12 months on ART, the number of participants who were obese increased by 135% (81 to 190), while those who were underweight decreased by 130% (306 to 133). Overall, the BMI increased in 30.2% of the participants. Further analysis showed that age (p=.009; η2=.005), baseline BMI (p<.001; η2=.435), baseline regimen (p<.001; η2=.031), HIV stage (p=.039; η2...
Abstract This paper draws on fieldwork at three camps for internally displaced persons (IDPs) in ... more Abstract This paper draws on fieldwork at three camps for internally displaced persons (IDPs) in Northeast Nigeria. It interrogates the pre-displacement experiences of participants, their transition to and experiences of internal displacement, vignettes of life at IDP camps, their relationship with host communities, the non-universality of experiences of sexual and gender-based violence among female IDPs (despite the particularities of experiences of women and young girls) and the resilience and agency of IDPs. The paper argues that scholarly engagement with IDPs and their social conditions should go beyond fixation on or fetishisation of poverty. Overall, the paper contributes to the empirical literature on conditions of internal displacement in sub-Saharan Africa.
Journal of the International Association of Providers of AIDS Care (JIAPAC)
There is a critical shortage of trained human immunodeficiency virus (HIV) providers in resource-... more There is a critical shortage of trained human immunodeficiency virus (HIV) providers in resource-limited settings. To strengthen preservice HIV training for postgraduate health care providers, University of Maryland’s Institute of Human Virology and Center for Clinical Care and Research Nigeria collaborated with University of Nigeria to plan and implement a comprehensive 4-week course in HIV medicine. The first course was piloted with 30 postgraduate doctors. Mean objective structured clinical examinations (OSCE), pretest, and posttest scores score were 51%, 53%, and 75%, respectively; follow-up examination at 6 months showed mean score of 74%. In multivariate regression analysis, pretest score was positively associated with posttest score (22.03, P < .001) and OSCE (0.29, P = .04), age negatively associated with pretest score (−0.94, P = .001), and female gender positively associated with OSCE score (6.15, P = .05). Six- and 18-month online surveys revealed trainees continued to...
In the original publication [1] the figure captions of Figs. 2 and 3 were reversed. The correct v... more In the original publication [1] the figure captions of Figs. 2 and 3 were reversed. The correct version can be found in this Erratum.
Despite being disproportionately burdened by preventable diseases than more advanced countries, l... more Despite being disproportionately burdened by preventable diseases than more advanced countries, low- and middle-income countries (LMICs) continue to trail behind other parts of the world in the number, quality and impact of scholarly activities by their health researchers. Our strategy at the Nigerian Implementation Science Alliance (NISA) is to utilise innovative platforms that catalyse collaboration, enhance communication between different stakeholders, and promote the uptake of evidence-based interventions in improving healthcare delivery. This article reports on findings from a structured group exercise conducted at the 2016 NISA Conference to identify (1) gaps in developing research capacity and (2) potential strategies to address these gaps. A 1-hour structured group exercise was conducted with 15 groups of 2-9 individuals (n = 94) to brainstorm gaps for implementation, strategies to address gaps and to rank their top 3 in each category. Qualitative thematic analysis was used....
Adolescents living with HIV (ALHIV) have worse health outcomes than other populations of people l... more Adolescents living with HIV (ALHIV) have worse health outcomes than other populations of people living with HIV. Contributing factors include lack of standard and comprehensive procedures for ALHIV transitioning from pediatric to adult care. This has contributed to poor retention at, and following transition, which is problematic especially in high ALHIV-burden, resource-limited settings like Nigeria. Using a two-arm cluster randomized control design, the Adolescent Coordinated Transition (ACT) trial will measure the comparative effectiveness of a graduated transition and organized support group intervention against the usual practice of abrupt transfer of Nigerian ALHIV from pediatric to adult care. This study will be conducted at 12 secondary and tertiary healthcare facilities (six intervention, six control) across all six of Nigeria's geopolitical zones. The study population is 13- to 17-year-old ALHIV (N = 216, n = 108 per study arm) on antiretroviral therapy. Study particip...
There is limited capacity and infrastructure in sub-Saharan Africa to conduct clinical trials for... more There is limited capacity and infrastructure in sub-Saharan Africa to conduct clinical trials for the identification of efficient and effective new prevention, diagnostic and treatment modalities to address the disproportionate burden of disease. This paper reports on the process to establish locally driven infrastructure for multicentre research and trials in Nigeria known as the Nigeria Implementation Science Alliance Model Innovation and Research Centres (NISA-MIRCs). We used a participatory approach to establish a research network of 21 high-volume health facilities selected from all 6 geopolitical zones in Nigeria capable of conducting clinical trials, implementation research using effectiveness-implementation hybrid designs and health system research. The NISA-MIRCs have a cumulative potential to recruit 60 000 women living with HIV and an age-matched cohort of HIV-uninfected women. We conducted a needs assessment, convened several stakeholder outreaches and engagement session...
Supplemental material, sj-pdf-1-qhr-10.1177_10497323211023164 for Health care Providers' Perc... more Supplemental material, sj-pdf-1-qhr-10.1177_10497323211023164 for Health care Providers' Perceptions About Overweight and Obesity Among People Living With Human Immunodeficiency Virus in Nigeria by John O. Olawepo, Jennifer R. Pharr, Raisa Kabir and Ayodotun Olutola in Qualitative Health Research
Appendix_1_UNN_Short_Course__Schedule_ for Effectiveness of a Comprehensive 4-Week Course in HIV ... more Appendix_1_UNN_Short_Course__Schedule_ for Effectiveness of a Comprehensive 4-Week Course in HIV Medicine for Postgraduate Doctors at University of Nigeria: A Preservice Education Initiative by Anthea Nwandu, Cassidy Wayne Claassen, David James Riedel, Theresa Madubuko, Ayodotun Olutola, Eugene Onu, Chinwe Onyekonwu, Emmanuel Nwobi, and Chinwe Chukwuka in Journal of the International Association of Providers of AIDS Care (JIAPAC)
SPIRIT 2013 Checklist: recommended items to address in a clinical trial protocol and related docu... more SPIRIT 2013 Checklist: recommended items to address in a clinical trial protocol and related documents. (DOC 118 kb)
Attribution License, which permits unrestricted use, distribution, and reproduction in any medium... more Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Nigeria has the world largest burden of paediatric HIV and is also highly endemic for Hepatitis B virus (HBV). However, relatively little is known regarding the prevalence of HBV-HIV coinfections among Nigerian children. Methods. A retrospective study among treatment naive HIV-infected children attending the pediatric clinic of the APIN Plus/Harvard PEPFAR program of the Federal Medical Centre, Makurdi, between June 2008 and June 2012. Results. The mean age of the 395 subjects studied was 7.53 ± 4.23 years. Thirty-one subjects (7.8%) were positive for HBV. No subject was HIV-HBV-HCV triply infected. Significantly higher HIV-HBC coinfections were found, in older subjects (11–15 years), subjects that did not receive nor complete Hepatitis B vaccinations, and subjects that had a severe immunosuppression of < 15 % with respective...
effects of leisure activities and psychosocial support on medication adherence and clinic attenda... more effects of leisure activities and psychosocial support on medication adherence and clinic attendance among children on antiretroviral therapy emmanuel Adémólá
Background; Studies on HIV-Hepatitis C viral (HCV) co-infections in Nigeria have been done essent... more Background; Studies on HIV-Hepatitis C viral (HCV) co-infections in Nigeria have been done essentially among adult and pregnant women with a few in pediatric population. The study aims at documenting the burden and the characteristics of HIVHCV co-infections in a cohort of Nigerian children. Methods; A retrospective study among treatment-naive HIV-infected children attending pediatric clinic of the AIDS PREVENTION INITIATIVE IN NIGERIA Plus/Harvard PEPFAR program of the Federal Medical Centre, Makurdi, between June 2008 and June 2012. Inclusion criteria included all subjects who were screened and got results for viral hepatitis B (HBV) and C. Results; The age range of the included 395 subjects was 16 months to 15 years with a mean age of 7.53±4.23 years including 205 males and 190 females. Nine subjects (2.3%) tested positive for HCV. Thirty one subjects (7.8%) were positive for HBV. No subject was HIV-HBV-HCV triply infected. Significantly more male subjects were HIV-HCV co-infecte...
Background. Nigeria has the world largest burden of paediatric HIV and is also highly endemic for... more Background. Nigeria has the world largest burden of paediatric HIV and is also highly endemic for Hepatitis B virus (HBV). However, relatively little is known regarding the prevalence of HBV-HIV coinfections among Nigerian children. Methods. A retrospective study among treatment naive HIV-infected children attending the pediatric clinic of the APIN Plus/Harvard PEPFAR program of the Federal Medical Centre, Makurdi, between June 2008 and June 2012. Results. The mean age of the 395 subjects studied was 7.53 ± 4.23 years. Thirty-one subjects (7.8%) were positive for HBV. No subject was HIV-HBV-HCV triply infected. Significantly higher HIV-HBC coinfections were found, in older subjects (11–15 years), subjects that did not receive nor complete Hepatitis B vaccinations, and subjects that had a severe immunosuppression of < 15% with respective P values of 0.00, 0.01, and 0.00. HIV-HBV co-infection did not significantly impact on other baseline characteristics including, gender, WHO clin...
HIV infection was associated with significant weight loss before the advent of potent antiretrovi... more HIV infection was associated with significant weight loss before the advent of potent antiretroviral therapy (ART). Weight gain while on treatment was seen as a clinical indicator of treatment success. Perceptions of health care providers (HCPs) about obesity among people living with (PLHIV) were examined. We conducted 16 key informant interviews with HCPs in two states in southeastern Nigeria, which were then coded thematically. The respondents included seven physicians, four nurses, three adherence counselors, and two pharmacists. The analysis revealed three key themes: HCPs do not see excess weight gain as a problem; there are several challenges in managing obesity among PLHIV; and comorbidities play a role in the management of obesity among PLHIV. We conclude that obesity among PLHIV is an important clinical issue that HCPs need to address with the commencement of ART.
The proportion of people living with HIV (PLHIV) who are overweight or obese is rising, leading t... more The proportion of people living with HIV (PLHIV) who are overweight or obese is rising, leading to a double epidemic of HIV and obesity. The purpose of this retrospective longitudinal study was to examine changes in body mass index (BMI) among PLHIV who were new to antiretroviral therapy (ART) in two states in Southeastern Nigeria. The BMI at baseline and 12 months were compared and the difference in proportions in each BMI category was tested. The association between the BMI at 12 months and the demographic and/or clinical variables was examined using multiway analysis of covariance. The study included 2,146 participants. After 12 months on ART, the number of participants who were obese increased by 135% (81 to 190), while those who were underweight decreased by 130% (306 to 133). Overall, the BMI increased in 30.2% of the participants. Further analysis showed that age (p=.009; η2=.005), baseline BMI (p<.001; η2=.435), baseline regimen (p<.001; η2=.031), HIV stage (p=.039; η2...
Abstract This paper draws on fieldwork at three camps for internally displaced persons (IDPs) in ... more Abstract This paper draws on fieldwork at three camps for internally displaced persons (IDPs) in Northeast Nigeria. It interrogates the pre-displacement experiences of participants, their transition to and experiences of internal displacement, vignettes of life at IDP camps, their relationship with host communities, the non-universality of experiences of sexual and gender-based violence among female IDPs (despite the particularities of experiences of women and young girls) and the resilience and agency of IDPs. The paper argues that scholarly engagement with IDPs and their social conditions should go beyond fixation on or fetishisation of poverty. Overall, the paper contributes to the empirical literature on conditions of internal displacement in sub-Saharan Africa.
Journal of the International Association of Providers of AIDS Care (JIAPAC)
There is a critical shortage of trained human immunodeficiency virus (HIV) providers in resource-... more There is a critical shortage of trained human immunodeficiency virus (HIV) providers in resource-limited settings. To strengthen preservice HIV training for postgraduate health care providers, University of Maryland’s Institute of Human Virology and Center for Clinical Care and Research Nigeria collaborated with University of Nigeria to plan and implement a comprehensive 4-week course in HIV medicine. The first course was piloted with 30 postgraduate doctors. Mean objective structured clinical examinations (OSCE), pretest, and posttest scores score were 51%, 53%, and 75%, respectively; follow-up examination at 6 months showed mean score of 74%. In multivariate regression analysis, pretest score was positively associated with posttest score (22.03, P < .001) and OSCE (0.29, P = .04), age negatively associated with pretest score (−0.94, P = .001), and female gender positively associated with OSCE score (6.15, P = .05). Six- and 18-month online surveys revealed trainees continued to...
In the original publication [1] the figure captions of Figs. 2 and 3 were reversed. The correct v... more In the original publication [1] the figure captions of Figs. 2 and 3 were reversed. The correct version can be found in this Erratum.
Despite being disproportionately burdened by preventable diseases than more advanced countries, l... more Despite being disproportionately burdened by preventable diseases than more advanced countries, low- and middle-income countries (LMICs) continue to trail behind other parts of the world in the number, quality and impact of scholarly activities by their health researchers. Our strategy at the Nigerian Implementation Science Alliance (NISA) is to utilise innovative platforms that catalyse collaboration, enhance communication between different stakeholders, and promote the uptake of evidence-based interventions in improving healthcare delivery. This article reports on findings from a structured group exercise conducted at the 2016 NISA Conference to identify (1) gaps in developing research capacity and (2) potential strategies to address these gaps. A 1-hour structured group exercise was conducted with 15 groups of 2-9 individuals (n = 94) to brainstorm gaps for implementation, strategies to address gaps and to rank their top 3 in each category. Qualitative thematic analysis was used....
Adolescents living with HIV (ALHIV) have worse health outcomes than other populations of people l... more Adolescents living with HIV (ALHIV) have worse health outcomes than other populations of people living with HIV. Contributing factors include lack of standard and comprehensive procedures for ALHIV transitioning from pediatric to adult care. This has contributed to poor retention at, and following transition, which is problematic especially in high ALHIV-burden, resource-limited settings like Nigeria. Using a two-arm cluster randomized control design, the Adolescent Coordinated Transition (ACT) trial will measure the comparative effectiveness of a graduated transition and organized support group intervention against the usual practice of abrupt transfer of Nigerian ALHIV from pediatric to adult care. This study will be conducted at 12 secondary and tertiary healthcare facilities (six intervention, six control) across all six of Nigeria's geopolitical zones. The study population is 13- to 17-year-old ALHIV (N = 216, n = 108 per study arm) on antiretroviral therapy. Study particip...
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