Sexual and Reproductive Behaviour of HIV-positive Men and the Response of the Health Care Service: A Mixed Methods Study in Kano, Northern Nigeria

Background: HIV/AIDS remains a major public health challenge in sub-Saharan Africa. Despite their important role in the spread of HIV, the impact of a HIV-positive diagnosis and treatment on the sexual and reproductive behaviour of heterosexual Nigerian men is under-researched. Aim: To determine the sexual and reproductive behaviour of HIV-positive men in Kano, Nigeria in the era of antiretroviral therapy and the health care service response. Methods: A sequential, explanatory mixed methods design was used. First, a quantitative study collected and analyzed survey data on a clinic-based sample of HIV-positive men (n=270) and matched controls (n=270). This was followed by in-depth interviews with a sub-sample of survey participants (n=22) and health workers/health managers (n=5). Findings: Compared to controls, a greater proportion of HIV-positive men were sexually active (91.9% vs. 82.2%, P<0.05). However, they had reduced coital frequency, out of fear of transmission, psychological effect, energy expenditure and perceived nutrient loss. Post-diagnosis consistent condom use was higher compared to controls (18.9% vs. 13.0%, P<0.05). Lack of interest, reduced pleasure, partner’s refusal and desire to conceive were the reasons for low condom use. A smaller proportion of HIV-positive men desired more children than controls (79.3% vs. 91.1%, P<0.05) and intent to have a child within three years (57.0% vs. 67.0%, P<0.05). Being married and employed significantly predicted sexual activity among HIV-positive men. Also, marital status, religion and spousal HIV status predicted risky sexual behaviour while fertility intention was predicted by marital status and duration, religion, employment and existing children. Late diagnosis, inadequate health worker safe conception skills were evident. Conclusions: The majority of HIV-positive men were sexually active and desired to have children, but the health care service response was inadequate. The findings highlight the need for improved reproductive health education and services to reduce risky behaviour and promote safe conception

The effectiveness of education intervention program for improving knowledge, attitude and practice related to hepatitis-B infection among non-medical and non-veterinary undergraduate university student in northern Nigeria, a randomized control community trial

Background: The endemicity of Hepatitis B virus (HBV) infection is leveling off in sub-Saharan Africa; it remains at an unacceptable high level (≥8%, to <2%) with global prevalence of 3·61%. The present study assessed the effectiveness of a peer-led HBV prevention education intervention in Usman Danfodiyo University Sokoto, Nigerian on youth’s HBV-related knowledge,attitude,and practices. Methods: In a peer-led single blind randomized controlled community trial conducted between April and December 2015. 390students were selected and randomized into the intervention and control arms, each arm with 195 respondents; five out of 12 faculties were selected using multi-staged random sampling. Four surveys were conducted(baseline, immediately, three and six months using self-administered questionnaire.Analysis of data were conducted using SPSS version 22. Results: The overall response rate during the four survey were 100%, 99.4%, 98.9% and 98.4%for intervention group and 100%, 100%, 99.4%,and 98.9% for the control arm respectively. Hepatitis B- related knowledge, attitude,and practices of the respondents were statistically significant between the intervention and the control arms at immediately, three and six month’s follow-up assessment with no statistical significant difference at baseline assessment (knowledge 14.3%, 66.95%, & 62.7%, HBV-related attitude 23.56%,40.68%, & 46.12% and HBV-related preventive practices 26.14%, 6.53%,& 11.9%). Conclusions: The present study has shown an evident for its effectiveness on HBV-related knowledge, attitude and preventive practice among the undergraduate non-medical and non-veterinary university students of Usman Danfodiyo University Sokoto Nigeria

Assessment of in-service training and continuing education (IST/CE) for frontline health workers in Bauchi and Cross River states, Nigeria

Training contributes tremendously to the development and sustenance of health workers’ competencies for quality healthcare services. Although Nigeria has a higher stock of human resources for health compared to other African countries, the World Health Organization argues that its distribution is highly skewed toward urban areas. Building and maintaining staff capacities requires continuing professional development through in-service training (IST) and continuing education (CE). This study assesses current IST and CE for health workers in Bauchi and Cross River states to provide evidence to inform policy and planning and improve implementation of capacity-building for health workers in Nigeria

Correlates of postpartum sexual activity and contraceptive use in Kano, northern Nigeria

Practices related to resumption of coitus after childbirth remains poorly documented in Nigeria. This study examined factors associated with sexual intercourse, delivery-coitus interval, and contraceptive use among postpartum women attending a tertiary centre in Kano, northern Nigeria. A cross section of 317 women attending immunization, postnatal and family planning clinics within 12 months of childbirth was interviewed using a structured questionnaire. Vaginal intercourse was resumed by most women (n=212; 66.9%, 95% Confidence Interval (CI) = 61.8%, 72.2%) with delivery-coitus resumption interval (mean ± SD) of 9.6±5.2 weeks postpartum. The majority (67.9%) resumed sexual activity within 8 weeks of delivery. Nearly two-thirds 65.6% (n=139/212) of the sexually active women reported current use of contraceptives. Onset of postpartum sexual activity was independently associated with mode of delivery adjusted odds ratio (AOR) (95%CI)= 1.10 (1.03,1.78), baby‘s age AOR (95%CI) =2.10 (1.27, 8.70), number of living children AOR (95%CI)=1.21 (1.07,1.79), onset of menstruation AOR (95%CI)=0.34 (0.17,0.69) and co-habitation AOR (95%CI)=0.47 (0.016, 0.14). Contraceptive use was predicted by educational status, sexual activity, baby‘s age and menstruation. Most women attending maternal and child health clinics resumed sexual intercourse within 2 months of delivery, but only two-thirds used modern contraceptive methods. Contraceptive counseling should commence early, preferably during pregnancy.Keywords: sexual intercourse, postpartum, contraceptive use, predictors, Nigeri

Knowledge, attitude and preventive practices regarding tuberculosis and its predictors among HIV patients in General Hospital, Minna, North-Central, Nigeria

Introduction: Tuberculosis is the commonest cause of death among HIV patients in Nigeria. Though tuberculosis is common among HIV patients, their knowledge about transmission and prevention is poor. Objective: To determine knowledge, attitude and preventive practices regarding tuberculosis and its predictors among HIV patients receiving treatment. Methods: A cross sectional study was carried out involving 226 randomly selected HIV patients receiving care at General Hospital, Minna. Study duration was from June 2015 to July 2017. Data on socio-demographic characteristics, psychosocial factors, knowledge, attitude and preventive practices regarding tuberculosis was collected using a self-administered, WHO modified, pretested and validated questionnaires. Data collected was analysed using SPSS version 22. Results: Out of 226 respondents, 60(26.5%) had poor knowledge, 123(54.4%) had negative attitude and 48(21.2%) had poor preventive practices regarding tuberculosis. The predictors of knowledge were age (B=0.087, 95%CI=0.031, 0.143, p=0.002), depression (B=-0.444, 95%CI=-0.673,-0.214, p<0.001) monthly income (B=-0.058, 95%CI=-0.095, -0.021, p=0.002) and marital status (B=-1.276, 95%CI=-2.525,-0.025, P=0.046). The predictors of attitude were anxiety (B=-0.395, 95%CI=-0.584, -0.206, p<0.001), cigarette smoking (B=4.473, 95%CI=0.992, 7.954, p=0.012) and duration of HIV infection (B=0.371, 95%CI=0.110, 0.631, p=0.005). The predictors of practice were depression (B=-0.176, 95%CI=-0.276, -0.076, p=0.001), cigarette smoking (B=2.200, 95%CI=0.926, 3.474, p=0.001) and duration of HIV infection (B=0.098, 95%CI=0.003, 0.194, p=0.043). Conclusion: Overall, knowledge and practices regarding tuberculosis prevention were good, but attitude was poor. The predictors of knowledge, attitude and preventive practices were age, depression, anxiety, cigarette smoking, monthly income, marital status and duration of HIV infection

Effectiveness of clinician client centered counseling on condom use and status disclosure of adult HIV positive patients enrolled in care in Yola, Nigeria: a randomized clinical trial

This study assessed the effectiveness of a developed and implemented Clinician Client Centered Counseling Module on improving condom use and increasing HIV status disclosure to spouses and or sex partners of adult patients living with HIV enrolled in care in Yola, Nigeria. The study was a three arm randomized single blind clinical trial involving 386 randomly selected and allocated adult patients living with HIV who were enrolled into ART care at any of the four comprehensive ART sites in Yola. A clinician client centered training module was developed based on the Information Behavior and Motivation (IBM) Model. Nine Clinicians involved in ART care were trained with this module to deliver a 10 to 15 minutes clinic based intervention (Clinician Client Centered counseling). Intervention group one received two counseling sessions; at baseline and at two month, intervention group two received a counseling session at baseline and the control group received routine care. An interviewer administered structured questionnaire was used for data collection. Data was collected at baseline, two months and six months. Outcome measures were condom use and HIV status disclosure. Data was analyzed using SPSS version 22. At six months a significantly higher median condom use score was seen in intervention group one compared to intervention group two (1.00 vs 0.50; p = 0.01), and in intervention group one compared to the control group (1.00 vs 0.00; p = 0.01). A significant change in median condom use scores from baseline to 6 months was seen for intervention group one (p = 0.02). At six months a significantly higher mean HIV status disclosure was seen in intervention group one compared to the control group (0.30 vs 0.25; p = 0.01) and in the intervention group two compared to the control group (0.30 vs 0.25; p = 0.01). A significant main effect for time was seen for HIV status disclosure to spouse and/or sexual partners (p = 0.01). Clinician Client Centered counseling is an effective behavioral intervention in improving condom use and status disclosure of adult patients living with HIV

Knowledge and attitudes of adult HIV positive patients to HIV/AIDS in Selected ART Clinics in Yola, Nigeria

Though cases of AIDS are visible in Nigeria and awareness of HIV is high, correct knowledge on HIV transmission and prevention has remained low with significant numbers of people living with HIV/AIDS having low attitudes towards life and the disease itself. This study determined the baseline knowledge on HIV transmission and prevention, and attitudes towards HIV/AIDS of adult HIV positive patient enrolled into care at all four comprehensive antiretroviral therapy (ART) sites in Yola, Nigeria. Baseline reports on the knowledge and attitudes of adult HIV positive patients were obtained from a three arm randomized single blind clinical trial involving 386 randomly selected adult HIV patients who were enrolled into ART care at all four comprehensive ART sites in Yola. An administered, validated structured questionnaire was used for data collection. Outcome measures were sound knowledge on HIV transmission and prevention, and attitudes towards HIV/AIDS. Data was analyzed using SPSS version 22. Test of significance was at α level 0.05. Overall 237 (61.4%) had sound knowledge on HIV transmission and prevention, while 346 (89.6%) of respondents had high attitudes towards HIV/AIDS. Though majority of respondents had sound knowledge on HIV transmission and prevention as well as high attitudes towards HIV/AIDS, interventions to improve knowledge and attitudes among this group of individuals would improve positive preventive strategies

Predictors of Safer Conception Practices Among HIV-Infected Women in Northern Nigeria

Background: Persons living with HIV often face discrimination in safe sex and reproductive choices, especially in low-resource settings. This study assessed fertility desires and intentions, risk perception and correlates of ever use of at least one safer conception method among HIV-infected women attending a tertiary health facility in Kano, Nigeria.Methods: Structured questionnaires were administered to a cross section of 328 of 427 eligible HIV-infected women. Fertility desires and intentions, risk perception and safer conception practice were analyzed. Logistic regression was employed to assess for predictors. Results: Of the 328 respondents, 150 respondents (45.7%) wanted more children. The proportions of respondents aware of their transmission risk during pregnancy, delivery, and breastfeeding were 69.5%, 75.3%, and 78.9%, respectively. Further, 68.9% of respondents were aware of the prospects of bearing HIV-negative children without infecting their partners. About 64.8% of women were aware of at least one safer conception method. Safer conception methods ever-used by the participants include: antiretroviral therapy (ART) (36.7%), timed unprotected intercourse with (10.9%), and without pre-exposure prophylaxis (PrEP) (17.2%), intravaginal insemination (7.3%) and intrauterine insemination (4.7%). Safer conception practice was predicted by marital status (married versus single, adjusted odds ratio [AOR] = 1.50, 95% CI = 1.10-3.55), parity (2-4 versus 0, AOR = 12.1, 95% CI = 3.7-39.8), occupation (civil servants versus traders, AOR = 0.37, 95% CI = 0.16-0.86), husband’s serostatus (seroconcordant versus serodiscordant) (AOR = 1.51, 95% CI = 1.13-4.64), couple contraceptive use (users versus non-users) (AOR = 1.62, 95% CI = 1.16-5.83) and transmission risk perception (high risk versus low/no risk) (AOR = 2.14, 95% CI = 1.18-3.90).Conclusion: We found high levels of fertility desires and intentions and moderate risk perception among a cohort of HIV-infected women in urban Kano, Nigeria. The use of safer conception practices was not common. Our findings underscore the need for healthcare provider capacity building to enhance safer conception counseling and service delivery

Should They Also Have Babies? Community Attitudes Toward Sexual and Reproductive Rights of People Living With HIV/AIDS in Nigeria

Background: People living with HIV have the right to healthy, satisfying sex lives and to appropriate services to ensure their sexual and reproductive health, including having healthy children. The reproductive rights of people living with HIV/AIDS are, however, often met with skepticism and discrimination, despite recent advances in HIV treatment. Objective: To assess the attitudes of community members in Kano, Nigeria, toward the right of persons living with HIV/AIDS to have healthy sexual relationships and bear children. Methods: A cross-section of 399 adults was interviewed using pretested structured questionnaires. Logistic regression analysis was used to obtain adjusted estimates for predictors of agreement with the rights of persons with HIV/AIDS to bear children. Findings: A substantial proportion of respondents (28.6%) strongly agreed and agreed (10.5%) that persons with HIV/AIDS should not be allowed to marry. More than a fifth of the respondents disagreed (16.0%) and strongly disagreed (8.0%) with the rights of HIV-infected persons to bear children. Agreement with the statement “HIV-infected persons should have biological children” was independently associated with higher educational status (adjusted odds ratio: 2.26, 95% confidence interval: 1.82-6.73) and awareness of prevention of mother-to-child HIV transmission effectiveness (adjusted odds ratio: 2.53, 95% confidence interval: 1.92-5.37). Of those who agreed that HIV-infected persons should have children (n = 253), 17.8% and 26.1% strongly agreed and agreed, respectively, that persons living with HIV/AIDS should be restricted to having fewer children. Further, 11.5% and 4.8% of respondents disagreed and strongly disagreed, respectively, that infertile HIV-infected couples should receive fertility treatment. Conclusions: People living with HIV/AIDS face discriminatory attitudes to their reproductive rights in northern Nigeria. There is a need for effective, culturally appropriate information, education, and communication approaches to improving community perceptions of sexual and reproductive rights of people living with HIV/AIDS

Poliovirus seroprevalence before and after interruption of poliovirus transmission in Kano State, Nigeria.

INTRODUCTION: In September 2015, Nigeria was removed from the list of polio-endemic countries after more than 12months had passed since the detection of last wild poliovirus case in the country on 24 July 2014. We are presenting here a report of two polio seroprevalence surveys conducted in September 2013 and October 2014, respectively, in the Kano state of northern Nigeria. METHODS: Health facility based seroprevalence surveys were undertaken at Murtala Mohammad Specialist Hospital, Kano. Parents or guardians of children aged 6-9months, 36-47months, 5-9years and 10-14years in 2013 and 6-9months and 19-22months (corresponding to 6-9months range at the time of 2013 survey) in 2014 presenting to the outpatient department, were approached for participation, screened for eligibility and asked to provide informed consent. A questionnaire was administered and a blood sample collected for polio neutralization assay. RESULTS: Among subjects aged 6-9months in the 2013 survey, seroprevalence was 58% (95% confidence interval [CI] 51-66%) to poliovirus type 1, 42% (95% CI 34-50%) to poliovirus type 2, and 52% (95% CI 44-60%) to poliovirus type 3. Among children 36-47months and older, seroprevalence was 85% or higher for all three serotypes. In 2014, seroprevalence in 6-9month infants was 72% (95% CI 65-79%) for type 1, 59% (95% CI 52-66%) for type 2, and 65% (95% CI 57-72%) for type 3 and in 19-22months, 80% (95% CI 74-85%), 57% (49-63%) and 78% (71-83%) respectively. Seroprevalence was positively associated with history of increasing oral poliovirus vaccine doses. CONCLUSIONS: There was significant improvement in seroprevalence in 2014 over the 2013 levels indicating a positive impact of recent programmatic interventions. However the continued low seroprevalence in 6-9month age is a concern and calls for improved immunization efforts to sustain the polio-free Nigeria