Evaluation of the effectiveness of prevention of mother to child transmission of HIV (PMTCT) Interventions in two selected health facilities in Adamawa State, Nigeria

Magister Public Health - MPH (Public Health)Most (90%) Human Immunodeficiency Virus (HIV) positive children are infected through mother to child transmission of HIV (MTCT). Without any interventions the risk of MTCT is between 20% and 45% at the final endpoint of 18 - 24 months. Efficacy studies have however proven that with antiretroviral interventions, MTCT risk can be reduced to less than 2% or 5% in non-breastfeeding and breastfeeding populations respectively. It is important to evaluate the effectiveness of Prevention of MTCT (PMTCT) interventions in routine health facility settings where service delivery may not be optimal. The current pool of evidence on PMTCT effectiveness in Sub-Saharan Africa is limited and no PMTCT effectiveness study has been conducted in Adamawa State, Nigeria since the programme started in 2007

Trends and predictors of mother-to-child transmission of HIV in an era of protocol changes: Findings from two large health facilities in North East Nigeria

Research studies have demonstrated a reduction in the risk of mother-to-child transmission of HIV (MTCT) to less than 2%, or 5% in non-breastfeeding and breastfeeding populations, respectively, with antiretroviral interventions

Factors that influence pharmacists' efforts in addressing substance use in Nigeria: An exploratory study

Introduction: Substance use is a major global public health problem. Over the years, the burden of substance use has increased worldwide, with Nigeria having a prevalence that is substantially above the global average. Tackling this challenge requires a collaborative effort between different health professionals. Despite the critical roles pharmacists could play in substance use prevention and management, exploration of pharmacists' role in mitigating substance use in society has received limited attention in most sub-Saharan countries. In this study, we explored the experiences of pharmacists in substance use prevention and management. Methods: We conducted semi-structured interviews to explore pharmacists' perceptions of their roles in the prevention and management of substance use in Nigeria. Following data transcription, we conducted a thematic content analysis. Results: The four major themes that emerged included 1) the extent of pharmacists' involvement in the decision-making process for addressing substance use, 2) factors that influence pharmacists efforts in addressing substance use in Nigeria, 3) how to improve rational prescribing practices and, 4) capacity building to enhance pharmacists participation in addressing substance use. Conclusion: Pharmacists have the opportunity to play critical roles in the prevention and management of substance use, but several individual and systemic challenges limit their full potential. Addressing these challenges is crucial in increasing pharmacists' participation in preventing and managing substance use

Pharmacovigilance reporting during seasonal malaria chemoprevention campaign: Findings from northern Nigeria

Background: Seasonal malaria chemoprevention (SMC) campaign is known to reduce malaria-related morbidity and mortality among children aged 3 -59 months in the Sahel regions of Africa. However, the success of the intervention may be adversely affected by the absence of a robust pharmacovigilance system to monitor safety. This paper aims to describe our pharmacovigilance reporting experience during the campaigns conducted across seven states in Nigeria in 2020. Methods: The SMC campaigns were held over four cycles from July to November 2020, with nearly 12 million eligible children reached by trained community drug distributors. Suspected adverse drug reactions were reported routinely through the national pharmacovigilance (PV) system. Completed PV forms submitted to the National Agency for Food, Drugs Administration and Control were retrieved and analyzed. Results: The adverse drug reaction (ADR) reporting across the seven states was low, with no ADR reports from five states. The ADRs reported included abdominal pain, weakness, diarrhea, fever, rash, and vomiting. Vomiting was the most reported ADR, accounting for almost half (28/57) of all reported cases. Children aged 12–59 months accounted for most (∼86%, 49/57) of the ADR reports, with over 70% (40/57) of these reports completed by community health extension workers. The system organ classification of ADRs showed that the gastrointestinal system was mainly affected (65%, 37/57). Conclusion: Our experience suggests gaps with the pharmacovigilance surveillance system, highlighting the need to consider an active surveillance system, address behavioural factors, and explore the use of a digital reporting system

Evaluating the impact of the blood glucose test strips reimbursement limitations in the British Columbia PharmaCare plan on utilization, costs and health outcomes

The full abstract for this thesis is available in the body of the thesis, and will be available when the embargo expires.Medicine, Faculty ofPopulation and Public Health (SPPH), School ofGraduat

Country ownership and sustainability of Nigeria’s HIV/AIDS Supply Chain System: qualitative perceptions of progress, challenges and prospects

Abstract Background The emergency response phase to HIV epidemic in Nigeria and other countries saw to the deployment of donors’ resources with little consideration for country ownership (CO) and sustainability. The progress that has been made in the fight against the pandemic has however precipitated a paradigm shift towards CO and sustainability. With the decline in donors’ funding, countries must continually evaluate their readiness to own and sustain their HIV response especially the supply chain system (SCS) and bridge any observed gaps. This study assessed the current understanding of CO and sustainability of Nigeria’s HIV/AIDS SCS, established progress that has been made, identified challenges that may be hampering CO and possible recommendations to address these challenges. It also explored opportunities that the country can leverage on. Methods We conducted a cross sectional descriptive study through semi-structured interview of twelve purposefully selected key informants involved in HIV/AIDS supply chain management. Transcribed qualitative data were analyzed using a thematic approach. Results Among other submissions, respondents acknowledged that CO involves non-government stakeholders. Key CO and sustainability achievements were: development of national strategic plans and policy documents, establishment of coordinating structures, allocation of funds for some logistics activities at the state level and payment of salaries of government staff, institution of pre-service training, use of logistics data for decision making and the unification of the hitherto parallel HIV/AIDS supply chains. Challenges included: inadequate domestic funding, bureaucratic bottlenecks and inadequate manpower at the health facility level. Respondents recommended more political commitment and increased government funding, exploration of alternative sources of funding, improved accountability, effective healthcare workforce planning and local manufacture of HIV commodities. Existing structures and programmes that the country can leverage on included: Nigeria Supply Chain Integration Project, National Health Insurance Scheme and the private sector. Conclusions Nigeria has made some progress towards achieving CO and sustainability. The country however needs to address financial and human resource gaps through innovative resource mobilization and effective workforce planning. As other countries plan for CO and sustainability, it is important to secure political buy-in and adopt a working definition for CO and sustainability while resource mobilization and workforce planning should be prioritized

Trends and predictors of mother-to-child transmission of HIV in an era of protocol changes: Findings from two large health facilities in North East Nigeria.

BACKGROUND:Research studies have demonstrated a reduction in the risk of mother-to-child transmission of HIV (MTCT) to less than 2%, or 5% in non-breastfeeding and breastfeeding populations, respectively, with antiretroviral interventions. However, the risk of MTCT in routine health-facility settings, where service delivery is usually sub-optimal needs monitoring. METHOD:We conducted a retrospective review of data from 2008-2014, in two health facilities in Adamawa State, Nigeria. Descriptive statistics were used to estimate overall MTCT rate and MTCT rate by year, and period of prevention of mother-to-child transmission of HIV (PMTCT) protocol implementation. We conducted simple and multiple logistic-regression analyses, to identify predictors of MTCT. RESULTS:Data from 1,651 mother-to-infant pairs, with HIV deoxyribonucleic acid (DNA) polymerase-chain reaction (PCR) test results from 2008 (n = 49), 2009 (n = 246), 2010 (n = 280), 2011 (n = 335), 2012 (n = 290), 2013 (n = 225) and 2014 (n = 226) were analysed. The overall MTCT rate among HIV exposed infants (HEIs) was 9.7% (95% CI 8.3% - 11.1%) at a median age of 8 weeks (IQR = 6-20). The MTCT rate decreased from 14.3% (4.4%-24.2%) in 2008 to 4.9% (2.1%-7.7%) in 2014 (p = 0.016). The MTCT rate was the lowest (5.4% [3.7% - 7.0%]) when all pregnant women living with HIV received triple antiretroviral therapy, as treatment or prophylaxis (ARVT/P). Using the pooled data, we found that infant age, breastfeeding option, antiretroviral regimen and year were predictors of MTCT. The adjusted odds of MTCT were significantly higher, when neither mother nor HEI received ARVT/P (Adjusted odds ratio (AOR) 26.4 [14.0-49.8], and lower amongst infants born in 2012, compared with those born in 2008 (AOR 0.2 [0.0-1.0]). CONCLUSION:The MTCT rate declined significantly between 2008 and 2014 in these two routine health-facility settings in Nigeria. Our study suggests that ARVT/P yields the lowest MTCT. Thus, efforts to scale up lifelong ARVT/P (Option B+) in Nigeria should be accelerated