Enhancing frontline health workers\u27 abilities to improve MNCH services in Bauchi State through task shifting/sharing

Frontline health workers (FLHWs), including nurses, midwives, community health extension workers, and community health officers, are healthcare providers with the greatest access to clients and patients, and provide initial care to persons in need of health services. In 2014, Nigeria’s 57th National Council on Health approved a task-shifting and sharing (TSS) policy for essential healthcare services as a promising strategy for improving access and efficiency in Nigeria’s health system. Subsequently, FLHWs in Nigeria have been trained for new roles and functions traditionally reserved for mid- or high-level cadres, to optimize available providers and their capacities. This brief reviews the strategy undertaken in Nigeria’s Bauchi state and concludes that optimizing the roles of FLHWs through TSS is a good solution for improving maternal, newborn, and child health (MNCH) services and for addressing health system challenges. Other opportunities include widespread support for improving MNCH care and addressing the unmet need for care and uneven distribution of health professionals

Trend and Determinants of Unmet Need for Family Planning Services among Currently Married Women and Sexually Active Unmarried Women Aged 15-49 in Nigeria (2003—2013)

This study examines trend and determinants of unmet need for family planning (FP) among currently married women and sexually active unmarried women of reproductive age 15-49 in Nigeria over a period of 10 years (2003-2013). Data from three consecutive Nigeria Demographic and Health Surveys (2003, 2008 and 2013) were analyzed. The results show that the unmet need for FP declined between 2008 and 2013 to a level less comparable with the situation in 2003. The significant determinants of unmet need for FP included age, marital status, education, religion, current work status, decision-making on spending personal earnings, gender of household heads, household wealth status, number of living children (including current pregnancy), rural-urban residence, home visit by FP workers and recent exposure to FP messages via mass media. It is therefore necessary that FP programmers continue to develop specific responses that address the barriers to contraceptive use.

HIV risk perception and risk behaviors among men who have sex with men in Nigeria

Background: Some studies have shown that greater perceived vulnerability to HIV is associated with less involvement in risk taking. We evaluated prevalence and correlates of HIV risk perception among men who have sex with men (MSM) in Nigeria. Methods: A cross sectional study using respondent driven sampling (RDS) was conducted in six Nigerian states in 2010. Weighted HIV risk perceptions were calculated using an RDS analytic tool. Logistic regression was used to determine correlates of HIV risk perception, stratified by state. Results: The total number of MSM ranged from 217 in Abuja to 314 in Cross River state. Median age ranged from 22 years in Cross River state to 26 years in Kano. HIV risk perception ranged from 10% in Cross River state to 58% in Kaduna state and was 38%, 44%, 19% and 20% in Kano, Lagos, Abuja and Oyo states respectively. Factors associated with HIV risk perception include purchasing sex (AOR: 3.11, 95% CI: 1.09-8.88) and never being tested for HIV (AOR = 0.34, 95% CI: 0.14 - 0.85] in Cross River; no comprehensive knowledge of HIV (AOR = 0.21, 95% CI: 0.05 - 0.90) and receptive anal partners (AOR = 10.07, 95% CI: 2.07 - 49.02) in Abuja; being older than 25 years (AOR = 0.16, 95% CI: 0.03 - 0.98) in Kano; no exposure to peer education in Kaduna (AOR = 0.08, 95% CI: 0.01 - 0.89); never being tested for HIV in Lagos (AOR = 0.11, 95% CI: 0.03 - 0.40) and Oyo state (AOR = 0.21, 95% CI: 0.06 - 0.80) and selling sex (AOR = 3.24, 95% CI: 1.00 - 10.61) in Oyo state. Conclusion: This study shows that HIV risk perception and comprehensive HIV knowledge are very low among MSM in Nigeria. Heterogeneity in associated factors suggests that targeted interventions are needed to increase HIV risk perception in the different states. The role of HIV counseling and testing in increasing risk perception needs further evaluation

Enhancing frontline health workers\u27 abilities to improve MNCH services in Cross River State through task shifting/sharing

There is a shortage of qualified and skilled health professionals providing cost-effective maternal, newborn, and child health (MNCH) services in Cross River State, Nigeria. Frontline health workers (FLHWs) have the potential to learn new skills as part of a task-shifting and sharing (TSS) policy. This brief highlights the results of the TSS policy in Cross River state: village health workers identify and refer pregnant women in their communities to antenatal clinics and provide oral medications; community health workers perform initial case management and ensure quick referrals to secondary facilities for specialized care; nurses and midwives deliver MNCH interventions that are accessible and affordable to all; only medical officers can repair cervical lacerations, manage pre-eclampsia and eclampsia, and continue management of newborn complications. The brief offers recommendations so that governments can achieve adequate and timely access to high-quality health care through appropriate MNCH interventions, as well as enhancing the abilities of FLHWs to improve MNCH care services through TSS

Is Internalised Homonegativity associated with HIV testing and HIV risk behaviours of men who have sex with men: a multilevel cross-sectional study of sub-Saharan African countries

Objectives This study assessed the associations of Internalised Homonegativity (IH) with HIV testing and risk behaviours of adult men who have sex with men (MSM) in sub-Saharan Africa (SSA) and effect modification by the legal climate.DesignWe used data from the cross-sectional 2019 Global Lesbian, Gay, Bisexual, Transgender and Intersex (LGBTI+) Internet survey study. Setting and participants Overall, the 2019 Global LGBTI Internet Survey collected data from 46 SSA countries. In this secondary analysis, we included data from 3191 MSM in 44 SSA countries as there were no eligible MSM responses in the 2 countries excluded. Outcome measures Our response variables were self-reported binary indicators of ever tested for HIV, recently tested in the past 6 months (from those who reported ever testing), transactional sex (paying for and being paid for sex in the past 12 months), and unprotected anal sex (that is without a condom or pre-exposure prohylaxis (PrEP)) with a non-steady partner (in the past 3 months). Results Our findings showed high levels of IH (range 1-7) in MSM across SSA (mean (SD)=5.3 (1.36)). We found that MSM with higher IH levels were more likely to have ever (adjusted OR (aOR) 1.18, 95% CI 1.03 to 1.35) and recently tested (aOR 1.19, 95% CI 1.07 to 1.32) but no evidence of an association with paying for sex (aOR 1.00, 95% CI 0.89 to 1.12), selling sex (aOR 1.06, 95% CI 0.95 to 1.20) and unprotected sex (aOR 0.99, 95% CI 0.89 to 1.09). However, we observed that a favourable legal climate modifies the associations of IH and paying for sex (aOR 0.75, 95% CI 0.60 to 0.94). Increasing levels of IH had a negative association with paying for sex in countries where same-sex relationships are legal. We found no associations of IH with unprotected anal sex in the population surveyed. Conclusions We confirm that IH is widespread across SSA but in countries that legalise same-sex relationships, MSM were less likely to engage in transactional sex compared with those in countries where homosexuality is criminalised

Individual and partnership characteristics associated with consistent condom use in a cohort of cisgender men who have sex with men and transgender women in Nigeria

This study reports on the individual and partnership characteristics that influence consistent condom use in cisgender men who have sex with men (MSM) and transgender women (TGW) attending trusted community centers that provide HIV prevention and treatment services in Nigeria. Adults assigned male at birth who reported anal sex with male partners who enrolled between March 2013–2019 and had information about at least one male sexual partner were included in these analyses. At enrollment and follow-up visits every 3 months for up to 18 months, participants were administered detailed questionnaires that collected information about demographics, sexual practices, HIV risk behaviors, and characteristics and behaviors of their partners in the previous year (at enrollment) or the preceding 3 to 6-months (at follow-up visits). Logistic regression models with generalized estimating equations were used to assess the odds ratio (OR) and 95% confidence intervals (CI) of individual, partner, and partnership characteristics associated with consistent condom use (CCU). A participant was defined as consistently using condom if they reported always using condoms all the time they had insertive, receptive or both types of anal sex with a male partner. At the individual level, CCU was positively associated with higher education, disclosure of key population status to a healthcare worker and negatively associated with poor access to condoms. At the partner and partnership level, CCU was associated with partners with higher education (aOR: 1.36; 95% CI: 1.07–1.72), casual relationships (aOR: 1.22; 95% CI: 1.11–1.34) and relationships in which partners encouraged the participant to use condoms with other partners (aOR: 1.14; 95% CI: 1.02–1.28). Relationships in which the partner was married to a woman and/or the partner’s HIV status positive or unknown were negatively associated with CCU. These findings suggest that individuals in relationships where partners were more open and encouraged safer sex were more likely to consistently use condoms. HIV prevention programs should consider leveraging communication to sexual partners to encourage condom use as this may support condom use with other sexual partners. Given sustained and growing HIV and STI epidemics among MSM and TGW, even with pre-exposure prophylaxis scale-up, it is crucial to continue to study optimal implementation strategies to increase condom use.https://doi.org/10.1186/s12889-021-11275-

Stroke genetics informs drug discovery and risk prediction across ancestries

Previous genome-wide association studies (GWASs) of stroke - the second leading cause of death worldwide - were conducted predominantly in populations of European ancestry(1,2). Here, in cross-ancestry GWAS meta-analyses of 110,182 patients who have had a stroke (five ancestries, 33% non-European) and 1,503,898 control individuals, we identify association signals for stroke and its subtypes at 89 (61 new) independent loci: 60 in primary inverse-variance-weighted analyses and 29 in secondary meta-regression and multitrait analyses. On the basis of internal cross-ancestry validation and an independent follow-up in 89,084 additional cases of stroke (30% non-European) and 1,013,843 control individuals, 87% of the primary stroke risk loci and 60% of the secondary stroke risk loci were replicated (P < 0.05). Effect sizes were highly correlated across ancestries. Cross-ancestry fine-mapping, in silico mutagenesis analysis(3), and transcriptome-wide and proteome-wide association analyses revealed putative causal genes (such as SH3PXD2A and FURIN) and variants (such as at GRK5 and NOS3). Using a three-pronged approach(4), we provide genetic evidence for putative drug effects, highlighting F11, KLKB1, PROC, GP1BA, LAMC2 and VCAM1 as possible targets, with drugs already under investigation for stroke for F11 and PROC. A polygenic score integrating cross-ancestry and ancestry-specific stroke GWASs with vascular-risk factor GWASs (integrative polygenic scores) strongly predicted ischaemic stroke in populations of European, East Asian and African ancestry(5). Stroke genetic risk scores were predictive of ischaemic stroke independent of clinical risk factors in 52,600 clinical-trial participants with cardiometabolic disease. Our results provide insights to inform biology, reveal potential drug targets and derive genetic risk prediction tools across ancestries.</p

Stroke genetics informs drug discovery and risk prediction across ancestries

Previous genome-wide association studies (GWASs) of stroke — the second leading cause of death worldwide — were conducted predominantly in populations of European ancestry1,2. Here, in cross-ancestry GWAS meta-analyses of 110,182 patients who have had a stroke (five ancestries, 33% non-European) and 1,503,898 control individuals, we identify association signals for stroke and its subtypes at 89 (61 new) independent loci: 60 in primary inverse-variance-weighted analyses and 29 in secondary meta-regression and multitrait analyses. On the basis of internal cross-ancestry validation and an independent follow-up in 89,084 additional cases of stroke (30% non-European) and 1,013,843 control individuals, 87% of the primary stroke risk loci and 60% of the secondary stroke risk loci were replicated (P < 0.05). Effect sizes were highly correlated across ancestries. Cross-ancestry fine-mapping, in silico mutagenesis analysis3, and transcriptome-wide and proteome-wide association analyses revealed putative causal genes (such as SH3PXD2A and FURIN) and variants (such as at GRK5 and NOS3). Using a three-pronged approach4, we provide genetic evidence for putative drug effects, highlighting F11, KLKB1, PROC, GP1BA, LAMC2 and VCAM1 as possible targets, with drugs already under investigation for stroke for F11 and PROC. A polygenic score integrating cross-ancestry and ancestry-specific stroke GWASs with vascular-risk factor GWASs (integrative polygenic scores) strongly predicted ischaemic stroke in populations of European, East Asian and African ancestry5. Stroke genetic risk scores were predictive of ischaemic stroke independent of clinical risk factors in 52,600 clinical-trial participants with cardiometabolic disease. Our results provide insights to inform biology, reveal potential drug targets and derive genetic risk prediction tools across ancestries

Prevalence and Correlates of HIV, Syphilis, Hepatitis B, Hepatitis C Infections and Sexual Behaviours of Men who have Sex with Men in Two Cities in Nigeria

Globally, men who have sex with men (MSM) continue to be disproportionately affected by the HIV pandemic. However, prior to this study, very little was known about the magnitude and factors that heighten MSM's vulnerabilities to HIV and other STIs in Nigeria. A cross-sectional survey was administered to 1,125 consenting MSM in Lagos and Ibadan recruited through modified respondent driven strategy. Sero-prevalence of HIV, hepatitis B (HBV), hepatitis C (HCV) and syphilis and levels of unprotected anal intercourse (UAI) were determined using data adjusted for network size and unweighted data for the pooled sample. Correlates of HIV, HBV, HCV and UAI were examined using multiple logistic regression analyses. Results revealed relatively young sexually active men who engaged in multiple concurrent sexual relationships with both men and women. More than half of the men self-identified as bisexual, and 44.4% as homosexual. High levels of risky sexual behaviours were demonstrated with over two-thirds of MSM in Ibadan (65.5%) and Lagos (69.7%) reporting UAI with their male partners in the previous 6 months. Correlates of URAI included homosexual identity, older age, lack of social support, and douching. Prevalence of previously undiagnosed HIV infection were four times higher in Lagos 12.7% (95% CI 10.6-15.0), and Ibadan 11.2% (95% CI 5.7-16.2) than the national HIV prevalence among Nigerian men. Prevalence of HBV (10.1% and 18.0%); HCV (2.8% and 4.3%) and current active syphilis (0.03%) infections in Lagos and Ibadan respectively were also high. Correlates of HIV were URAI and UIAI with men and women, condom breakage, homosexual identity, increasing age, employment, sexual activities with non-African white men and internalized homophobia. Bisexual identity, UIAI with male sex partners, and low self-esteem were associated with HBV infection. Correlates of HCV were URAI and reported sex with men who had lower educational status. This study confirms the existence of MSM who engage in risky behaviours with very limited access to appropriate HIV and STI prevention services.Ph.D

Socio-demographic factors associated with uptake of HIV counseling and testing (HCT) among Nigerian youth

Background: HCT is an important gateway for HIV prevention interventions as it educates sero-negative individuals on HIV preventive behaviours and enables seropositive individuals to gain access to treatment, care and support services. We evaluated the socio-demographic factors associated with HCT-uptake among Nigerian youth aged 15–24. Methods: Secondary data analysis was conducted on Nigeria\u27s 2012 National HIV/AIDS & Reproductive Health Survey data. Multivariable log-binomial regression analysis was used to estimate adjusted prevalence ratio (APR) with 95% Confidence intervals. Results: Of the 10,091 youth, half were aged 15–19, 66.9% were single, 65.7% were rural dwellers, 20.7% had no education, 46% were students & 31.1% were employed. About 10.5% ever had HCT & 3.5% tested positive in the survey. Multivariable analysis revealed that the aged 20–24 [APR=1.67(1.41-1.96)] were more likely to have had HCT than the aged 15–19. HCT-uptake increased with educational level [primary-APR=2.29(1.59-3.32); secondary—APR=3.48(2.54-4.77) & higher-APR=6.68(4.66-9.58)]. The non-Catholic [APR=1.60(1.36-1.89)] and the Catholics [APR=1.85(1.51-2.26)] Christians were more likely to have had HCT than the Muslims. Those having comprehensive knowledge of HIV [APR=2.09(1.83-2.39)] were twice more likely to have had HCT. Students [APR=0.80(0.67-0.94)] were less likely to have had HCT than the employed. Those from poor-households [APR=0.63(0.51-0.77)] were less likely to have had HCT than those from average-households. Conclusions: HCT-uptake among young Nigerians is very low despite the increased availability of free HCT services in the country. The fact that being employed and having higher educational level and household wealth are associated with HCT-uptake suggests that socio-economic barriers to HCT-uptake persist among young people. The association with age may be due to age of consent barriers faced by adolescents. More youth-friendly interventions aimed at increasing HCT-uptake among young Nigerians are urgently needed