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Unmet need for contraception among human immunodeficiency virus-positive women in Jos, Nigeria: A call to integrate family planning and human immunodeficiency virus services
Tinuade Oyebode, Atiene Sagay, Jonah Musa, Chinedu Ekwempu, Patricia Agaba, John Idoko, Prosper Okonkwo, Phyllis Kanki
January-June 2016, 4(1):13-19
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.
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 indicated that family planning (FP) would be easily accessed in the HIV clinic while male partners (49.4%) encouraged contraception.
Among PLHIVs in northern Nigeria, there is a high rate of unintended pregnancy, and high contraceptive awareness did not translate into usage. Integration of HIV and reproductive health services holds potential to improve FP access and usage by PLHIVs.
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Pancreatic tuberculous abscess mimicking as cystic neoplasm: A rare initial manifestation of AIDS-defining illness
Chanabasappa V Chavadi, Swetha Kory, Pallavi Rao, Ajit Mahale
January-June 2015, 3(1):20-22
A pancreatic tuberculous abscess is extremely rare, considered to be an AIDS-defining illness in HIV-positive patients. It is even rare to present as an initial manifestation of AIDS. We present a case that presented with epigastric pain, fever, and reduced appetite. The cystic pancreatic lesion was identified and computed tomography-guided fine needle aspiration proved it to be a tuberculous abscess, confirmed by demonstration of acid fact
in the pus aspirated. Although rare, it must be considered in the differentials in HIV-positive patients and can be confirmed by minimally invasive image-guided aspiration with microbiological or histopathological evaluation. Etiopathogenesis, presentation, and review of the literature is been summarized.
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Central nervous system toxoplasmosis in human immunodeficiency virus infection: Imaging findings
Adenike Temitayo Adeniji-Sofoluwe
July-December 2014, 2(2):62-64
Toxoplasmosis is one of the most common zoonoses worldwide caused by
. Majority of
infections are asymptomatic or induce transitory and mild symptoms characterized by lymphadenopathy. Risk factors are immunosuppression and pregnancy. Human immunodeficiency virus (HIV) infected persons represent the group at highest risk of developing symptomatic toxoplasmosis especially with a CD4 count of <100, which can be fatal. A middle-aged acute-on-chronic ill-looking, conscious, lethargic but confused, pale man with lymphadenopathy involving the cervical, sub-mental and axillary nodes, and widespread fungal infections is presented. Neurologic imaging is frequently used in the diagnosis of central nervous system (CNS) toxoplasmosis in combination with serology and clinical assessment. Computed tomography scans show multiple, bilateral, contrast-enhancing ("ring enhancing"), focal brain lesions in 70-80% of patients with CNS toxoplasmosis. The course of disease can frequently be fatal if not recognized and treated early as was the case in this patient.
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Effectiveness of prevention of mother-to-child transmission of HIV program in Abuja, Nigeria
Chris O Agboghoroma, Lamidi Isah Audu, Kenneth C Iregbu
January-June 2015, 3(1):7-13
The aim of this study is to evaluate the effectiveness of prevention of mother-to-child transmission (PMTCT) of HIV program in a tertiary level health facility in Abuja, Nigeria.
Materials and Methods:
It was a retrospective study. Records of HIV positive pregnant women who registered and had antenatal care (ANC) in the period January 1, 2006 to December 31, 2008, delivered in the hospital and whose HIV-exposed babies were followed-up to 6 weeks of age when HIV status was determined by DNA polymerase chain reaction techniques were collected and analyzed.
During the 3 years period, 643 pregnant women were HIV-positive. Among these group, 495 delivered in the hospital and 247 had their babies followed-up till the point of HIV testing. The overall MTCT rate was 2.4%, mothers who used triple combination antiretroviral (ARV) therapy or prophylaxis recorded MTCT rate of 1.3% while mothers who received only intrapartum single dose nevirapine had MTCT rate of 37.5%. The majority of the mothers, 186 (76.5%) were delivered by caesarean section, and the MTCT rate in this group was 1.6% while the MTCT rate in mothers who delivered vaginally was 5.5%. Exclusive formula feeding was practiced by 232 (96%) mothers, and had a MTCT rate of 2.1%. While the MTCT rate in mothers who practiced exclusive breastfeeding was 12.5%.
The MTCT rate in the PMTCT program in this study compared favorably with reports from other centers and developed countries where similar interventions are the standard care for HIV-positive women. The finding demonstrates that routine provision of comprehensive PMTCT services including triple combination ARV drugs is feasible and effective in our setting.
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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
Hadiza Khamofu, Edward A Oladele, Uche Ralph-Opara, Titi Badru, Oluwasanmi Adedokun, Mariya Saleh, McPaul Okoye, Olufunsho Adebayo, Kwasi Torpey
July-December 2015, 3(2):34-40
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.
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.
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 (
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 were sustained and coverage widened, an alignment of the country's PMTCT program with the best available scientific evidence could lead to the elimination of mother to child transmission.
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Integrated national guidelines for HIV prevention, treatment, and care: Chapters 5 and 6
Federal Ministry of Health (Nigeria)
July-December 2015, 3(2):47-55
These 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 disseminated.
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