Can the UNAIDS modes of transmission model be improved? A comparison of the original and revised model projections using data from a setting in west Africa.

OBJECTIVE: The UNAIDS modes of transmission model (MoT) is a user-friendly model, developed to predict the distribution of new HIV infections among different subgroups. The model has been used in 29 countries to guide interventions. However, there is the risk that the simplifications inherent in the MoT produce misleading findings. Using input data from Nigeria, we compare projections from the MoT with those from a revised model that incorporates additional heterogeneity. METHODS: We revised the MoT to explicitly incorporate brothel and street-based sex-work, transactional sex, and HIV-discordant couples. Both models were parameterized using behavioural and epidemiological data from Cross River State, Nigeria. Model projections were compared, and the robustness of the revised model projections to different model assumptions, was investigated. RESULTS: The original MoT predicts 21% of new infections occur in most-at-risk-populations (MARPs), compared with 45% (40-75%, 95% Crl) once additional heterogeneity and updated parameterization is incorporated. Discordant couples, a subgroup previously not explicitly modelled, are predicted to contribute a third of new HIV infections. In addition, the new findings suggest that women engaging in transactional sex may be an important but previously less recognized risk group, with 16% of infections occurring in this subgroup. CONCLUSION: The MoT is an accessible model that can inform intervention priorities. However, the current model may be potentially misleading, with our comparisons in Nigeria suggesting that the model lacks resolution, making it challenging for the user to correctly interpret the nature of the epidemic. Our findings highlight the need for a formal review of the MoT

Contact Tracing in an African Megacity during COVID 19: Lessons Learned

Contact tracing is the process of identifying, assessing, and managing people who have been exposed to a disease to prevent onward transmission.  It is an essential public health tool and a crucial component to the on-going COVID-19 pandemic response in Lagos State, Nigeria. This contact tracing exercise is the largest one to be conducted in the megacity and is leveraging on the expertise of professionals across different strata of the health care system. Following the confirmation of a positive case of COVID-19; the State‘s contact tracing team commenced investigations by identifying contacts and following them up daily for 14 days from the last point of exposure. In the process of conducting this large-scale exercise, several lessons that can improve contact tracing outcomes such as the need for community mobilizers and decentralization, the importance of technology and communication campaigns were learnt and can serve as good practice for other implementers. Keywords: Contact Tracing, COVID-19   La recherche des contacts est le processus d'identification, d'évaluation et de gestion des personnes qui ont été exposées à une maladie afin de prévenir la transmission ultérieure. Il s'agit d'un outil de santé publique essentiel et d'un élément crucial de la riposte en cours à la pandémie de COVID-19 dans l'État de Lagos, au Nigéria. Cet exercice de recherche des contacts est le plus important de la mégapole et met à profit l'expertise de professionnels de différentes strates du système de santé. À la suite de l a confirmation d‘un cas positif de COVID-19, l‘équipe de recherche des contacts de l‘État a ouvert des enquêtes en identifiant les contacts et en les suivant quotidiennement pendant 14 jours à compter du dernier point d‘exposition. Dans le processus de réalisation de cet exercice à grande échelle, plusieurs leçons qui peuvent améliorer les résultats de la recherche des contacts tels que le besoin de mobilisateurs communautaires et la décentralisation, l'importance de la technologie et des campagnes decommunication ont été apprises et peuvent servir de bonnes pratiques pour d'autres exécutants. Mots-clés: Recherche de contacts, COVID-1

Expanding access to maternal health services for pregnant adolescent girls

A significant proportion of pregnant adolescent girls do not seek appropriate care during pregnancy because antenatal care services are ill-adapted to their age-group. To bridge this gap, the Lagos State Government established a ―Young Moms Clinic‖ where antenatal care services uniquely tailored to the needs of pregnant adolescents was piloted for six months. During this period, 106 pregnant adolescent girls enrolled in the clinic and 98% of them completed the minimum four ANC visits required of them. In addition, they acquired knowledge on newborn care, sexual reproductive health and were either re-integrated back to school or empowered with income-generating skills following delivery. In this regard, the Young Mom‘s Clinic is a promising approach to meet the needs of pregnant adolescent girls as it expanded their access to the type of specialized care not readily accessible to them within public health facilities. (Afr J Reprod Health 2021; 25[6]: 15-19)

Number of FSW spots by state.

<p>Number of FSW spots by state.</p

Number of Key Informant Interviews by State, Sex and Educational level.

<p>Number of Key Informant Interviews by State, Sex and Educational level.</p

Number of key informants by type of key informant and by state.

<p>Number of key informants by type of key informant and by state.</p

Percentage distribution of FSWs by type of spot by state, Nigeria, 2012.

<p>Percentage distribution of FSWs by type of spot by state, Nigeria, 2012.</p

Estimated number of FSWs by state, by LGA and average number of FSWs/1000 adult men per state, Nigeria, 2012.

<p> Per 1000 adult men refers to men age >18 years of age.</p