Motivational Groups Support Adherence to Antiretroviral Therapy and use of Risk Reduction Behaviors in HIV Positive Nigerian Women: A Pilot Study

Nigerian women comprise the fastest growing group of persons with AIDS in Africa. Antiretroviral therapy has transformed the course of HIV/AIDS to a treatable, chronic illness worldwide. The purpose of this pilot study was to assess the efficacy of a group intervention using motivational interviewing (MI) to promote adherence to antiretroviral therapy (ART) and use of risk reduction behaviors (RRB) among HIV-infected women in Nigeria. Recruited participants (n=60) were randomly assigned to the motivational group or the health promotion program (HPP) control group. The 6 month follow-up results indicate that, compared to the control group, MI participants reported significantly higher levels of adherence to ART, higher knowledge of HIV, higher use of condoms/protection during sexual encounters and decision-making not to have sex when no protection was available. The MI participants also had fewer mean number of sexual partners. MI in group format shows promise in promoting adherence to ART and use of RRB in HIV-infected Nigerian women. (Afr J Reprod Health 2012; 16[3]: 14-26).Les femmes nigérianes constituent le groupe de personnes atteintes du sida en Afrique qui s'élargit de manière de plus en plus rapide. La thérapie antirétrovirale a transformé le cours du VIH / SIDA à une maladie soignable et chronique dans le monde entier. Le but de cette étude pilote était d'évaluer l'efficacité d'une intervention de groupe en utilisant l'entrevue de motivation (IM) pour promouvoir l'adhésion à la thérapie antirétrovirale (TAR) et à l'utilisation des comportements de réduction des risques (CRR) parmi les femmes séropositives au Nigéria. Les participantes recrutées (n = 60) ont été assignées aléatoirement au groupe de motivation ou au groupe du programme témoin de la promotion de la santé (PPS). Les résultats complémentaires (n = 48) indiquent que par rapport au groupe témoin, les participantes de l'IM ont signalé les niveaux significativement plus élevés de l'adhésion à la TAR, un niveau plus élevé de connaissance du VIH, une plus grande utilisation du préservatif ou de protection lors de rapports sexuels et la prise de décision de ne pas avoir des rapports sexuels et la prise de décision de ne pas avoir des rapports sexuels quand il n'y a pas de protection. Les participantes de l'IM avaient également moins du nombre moyen de partenaires sexuels. L'IM en format de groupe est prometteur quand il s'agit de l'adhésion à la TAR et à l'utilisation de CRR chez les femmes nigérianes séropositives (Afr J Reprod Health 2012; 16[3]: 14-26)

La caractérisation épidemiologique et comportementale de la connaissance de l'usage du préservatif et du modelage chez le personnel militaire

How accurately condoms are being used vary across populations and knowledge of the factors determining its proper use remains unclear. Knowledge of such differentials and determinants would aid in evaluating the contributions of condom use to HIV epidemic reduction. Baseline data from the Situationally Focused Individual HIV/AIDS intervention to promote HIV protective behavior among 2,213 Nigerian Military Personnel were analyzed. Educational status as a predictor variable was assessed using univariable and multivariable logistic regression model. Compared to those with less than high school education, those with high school and some college education were two times more likely to demonstrate knowledge of condom use and modeling, prevalence odds ratio (POR), 2.32, 95% Confidence Interval (CI)=1.60-3.37. After adjustment for the relevant covariates, higher education attainment was associated with nonsignificant 62% increase in knowledge and modeling, POR, 1.62, 95% CI=0.78-3.38. This study is indicative of low knowledge of condom use and modeling among the Nigerian military personnel; as well as a direct correlation between education attainment and knowledge of condom use and modeling.La caractérisation épidemiologique et comportementale de la connaissance de l'usage du préservatif et du modelage chez le personnel militaire. La façon efficace dont l' on utilise les préservatifs varie à travers les populations et la connaissance des facteurs qui déterminant son bon usage n'est pas claire. Une connaissance des tels différentiels et déterminants aiderait à évaluer des contributions du bon usage des préservatifs en vue de la réduction de l'épidémie du VIH. Les données initiales de base qui ont été obtenues à partir de l'intervention du VIH/SID par rapport à l'individu sur qui on a concentré de manière situationnelle afin de promouvoir le comportement protecteur du VIH chez 2,213 personnel militaire nigérian ont été analysées. A l'aide de la cote composite des six démarches pour la connaissance de l'usage du préservatif et le modelage comme le variable de conséquence, nous avons examiné le niveau d'éducation comme un variable de l' indice, le modelage avec un univariable non-conditionnel et la régressive logistique multivariable. Quand on compare ceux qui n'ont pas eu l'éducation secondaire à ceux qui l'ont eu, les derniers avaient deux fois plus la possibilité de démontrer la connaissancede l'usage du préservatif et du modelage; le rapport de prévalence, 2,2,95% l'interval de Confiance IC= 1,60 - 3,37. Pourtant, l'association qui a été significative statistiquement n'a pas persisté après l'ajustement pour les co-variables; la prévalence du rapport, 1,62,95%IC=0,78 - 3,38. Cette étude montre une faible connaissance de l'usage du préservatif et du modelage parmi le personnel militaire nigérian; elle montre aussi l'influence des autres caractérisques en ce qui concerne le rôle de l'acquis de l'éducation dans la connaissance de l'usage du préservatif et du modelage

Effectiveness of a video-based motivational skills-building HIV risk-reduction intervention for female military personnel

Anecdotal evidence suggests that the HIV/AIDS prevalence rates in several African armed forces are high, with gender inequality rendering female military personnel more vulnerable to the disease. The objective of this study was to replicate a successful videotape-based HIV prevention intervention among Nigerian female military personnel in an effort to establish the cross-cultural stability, feasibility and cost-effectiveness of this approach in resource-limited countries. Enlisted women (N 346) were recruited from two cantonments in Southwestern Nigeria and randomly assigned to either (a) a 5-session video-based, small group, cognitive-behavioral, HIV prevention intervention, or (b) a 5-session, video-based, contact-matched, HIV education control condition. Participants provided self-report of their HIV/AIDS-related knowledge and sexual behaviors at baseline, 3 and 6 months after completing the intervention. The results indicate that the motivational skills-building intervention did not improve participants' knowledge of HIV/AIDS any better than did the HIV education control condition at each assessment period, but it significantly increased condom use among women in this group by 53.6% at 3-month follow-up. HIV preventive behaviors among women in the motivational skills-building intervention group improved significantly, being 2 and 3 times more, compared to women in the HIV education control group at 3-month and 6-month follow-up assessments. The intervention also significantly improved behavioral intentions of participants as well as reduced alcohol use before sex by 25%, after 3 months; and number of sexual partners by 12% after 6 months. Women in the intervention group were five times more likely than women in HIV education control group to suggest that their new male partners use condom. These findings indicate that a videotape-based, HIV prevention intervention is a feasible and effective approach to HIV prevention among female military personnel from sub-Saharan Africa.HIV/AIDS Risk behaviors Military personnel Nigeria Women Video-based intervention

Depression, suicidality, and alcohol use disorder among people living with HIV/AIDS in Nigeria

© 2017 The Author(s). Background: People Living with HIV/AIDS (PLHIV) face various day-to-day and long-term personal, interpersonal, social, physical and psychological challenges as a result of, and in addition to the health conditions they are susceptible to due to their HIV status. There is a dearth of large-scale research to provide robust prevalence estimates of mental health problems among PLHIV, especially in Nigeria. This study aimed to ascertain the prevalence and factors associated with major depressive episodes, suicidality, and alcohol use disorder among people living with HIV/AIDS in Nigeria. Methods: A survey of 1187 participants aged 18 years and above was conducted within three HIV treatment centres in Abuja, Nigeria. Depression, suicidality, and alcohol use disorder modules of the WHO World Mental Health Composite International Diagnostic Interview questionnaire were used for this study. A socio-demographic questionnaire was also used to collect other health and demographic data. Descriptive statistics (frequency distribution, percentage, mean, median, mode, and standard deviation) and regression analyses were conducted to explore associations between mental health problems and demographic and other health-related factors. Results: Twelve-month prevalence rates were 28.2% for major depressive episodes, 2.9% for suicidal ideation, 2.3% for suicide attempts, 7.8% for harmful alcohol use, 7.0% for alcohol abuse, and 2.2% for alcohol dependence. Major depressive episodes were significantly associated with having planned suicide and marital status. Suicidal ideation was significantly associated with major depressive episodes, marital status, and religion. Females were less likely to be diagnosed with alcohol disorders. Conclusions: Some people living with HIV/AIDS also tend to suffer from depression, suicidality, and alcohol use disorders. These findings highlight the need for the integration of mental health services into HIV/AIDS care in Nigeria

Which HIV-infected adults with high CD4 T-cell counts benefit most from immediate initiation of antiretroviral therapy? : a post-hoc subgroup analysis of the START trial

Background: Immediate initiation of antiretroviral therapy (ART) in asymptomatic adults with CD4 counts higher than 500 cells per mu L, as recommended, might not always be possible in resource-limited settings. We aimed to identify subgroups of individuals who would benefit most from immediate treatment. Methods: The START trial was a randomised controlled trial in asymptomatic, HIV-positive adults previously untreated with ART. Participants with CD4 counts higher than 500 cells per mu L were randomly assigned to receive immediate ART or to defer ART until CD4 counts were lower than 350 cells per mu L. The primary endpoint of the study was serious AIDS-defining illnesses or death from AIDS and serious non-AIDS illnesses or non-AIDS-related death. In this post-hoc analysis, we estimated event rates and absolute risk reduction with immediate versus deferred ART, overall and by subgroup. Subgroups were prespecified in the study protocol or formed post hoc on the basis of baseline characteristics associated with morbidity and mortality in people with HIV. For continuous characteristics, approximate terciles were chosen as subgroup cutoff points, unless different cutoffs were clinically meaningful (eg, age >= 50 years). We estimated the number needed to treat immediately with ART for 1 year to prevent one primary event. Heterogeneity in the absolute risk reduction between subgroups was assessed with bootstrap tests. The START trial is registered with ClinicalTrials.gov, number NCT00867048. Findings: Between April 15, 2009, and Dec 23, 2013, we enrolled 4684 participants from 35 countries across five continents, of whom 2325 were assigned to immediate ART and 2359 were assigned to deferred ART. The primary endpoint occurred in 42 participants in the immediate ART group (0.58 events per 100 person-years) and 100 participants in the deferred ART group (1.37 events per 100 person-years). The absolute risk reduction was 0.80 (95% CI 0.48-1.13) per 100 person-years with immediate treatment, and the number needed to treat immediately to prevent one event was 126 (95% CI 89-208). Significant heterogeneity in absolute risk reduction with immediate ART was found across subgroups according to age (p=0.0022), CD4 to CD8 ratio (p=0.0007), and plasma HIV RNA viral load (p=0.033) at baseline. The highest absolute risk reductions and the lowest numbers needed to treat were found in participants aged 50 years or older, those with CD4 to CD8 ratios of less than 0.5, and those with plasma HIV RNA viral loads of 50 000 copies per mL or higher. Interpretation: Asymptomatic, ART-naive adults with CD4 counts higher than 500 cells per mu L who are older, have a low CD4 to CD8 ratio, or a high plasma HIV RNA viral load benefit most from immediate initiation of ART and should be prioritised for treatment