Willingness-to-pay for a population-based-prostate-specific antigen screening for prostate cancer in Anambra State, Southeast, Nigeria: a contingent valuation study

Background: Early diagnosis of cancer precursors improves treatment outcomes. Organized screening for prostate cancer is still uncommon in Nigeria, and if it is added to the national health budget, it may necessitate additional co-financing alternatives. Objectives: The study aims to evaluate the maximum willingness- to- pay amount and acceptability of a Population-based screening for prostate cancer among a group of Nigerian men. Methods: The study was a cross-sectional survey-based study conducted among men drawn from different districts of the state. The payment card elicitation format was used to estimate the average maximum WTP amount. Multivariate Logistic regression was used to evaluate the correlates of WTP. Result: A total of 439(81.9%) participants were willing to pay for the screening while only 97(18.1%) of the participants rejected the screening. The average WTP amount was US$6.01(mean ± median ± SD 6.01±4.12±5.75). Residence and knowledge of the disease were the major predictors. Conclusion: The findings showed that men in Anambra state Nigerian were willing to pay an average of US$6.01 for the Population-based screening. Even though the stated WTP amount seems low compared to the conventional cost of opportunistic screening (between USD 21), the majority of the participants 439(81.9%) willing to pay for the screening should be capitalized upon in finding alternative financing options for the program. Keywords: Willingness to pay (WTP); prostate-specific antigen (PSA); Population-based screening; prostate cancer; contingent valuation study; Anambra state; Nigeria

Effects of nutritional supplements on the re-infection rate of soil-transmitted helminths in school-age children: A systematic review and meta-analysis.

BACKGROUND:The effect of nutritional supplements on the re-infection rate of species-specific soil-transmitted helminth infections in school-aged children remains complex and available evidence on the subject matter has not been synthesized. METHODS:The review included randomised controlled trials (RCTs) and cluster RCTs investigating food supplements on school-aged children between the age of 4-17 years. A search for RCTs was conducted on eight databases from inception to 12th June 2019. Cochrane Risk of Bias tool was used to assess the risk of bias in all included studies. Meta-analysis and narrative synthesis were conducted to describe and analyze the results of the review. Outcomes were summarized using the mean difference or standardized mean difference where appropriate. RESULTS:The search produced 1,816 records. Six studies met the inclusion criteria (five individually RCTs and one cluster RCT). Four studies reported data on all three STH species, while one study only reported data on Ascaris lumbricoides infections and the last study reported data on only hookworm infections. Overall, the risk of bias in four individual studies was low across most domains. Nutritional supplementation failed to statistically reduce the re-infection rates of the three STH species. The effect of nutritional supplements on measures of physical wellbeing in school-aged children could not be determined. CONCLUSIONS:The findings from this systematic review suggest that nutritional supplements for treatment of STH in children should not be encouraged unless better evidence emerges. Conclusion of earlier reviews on general populations may not necessarily apply to children since children possibly have a higher re-infection rate

Conditional economic incentives and motivational interviewing to improve adolescents’ retention in HIV care and adherence to antiretroviral therapy in Southeast Nigeria: study protocol for a cluster randomised trial

Abstract Background Adolescent HIV patients face enormous difficulty in accessing HIV care services. Given their vulnerability to risk-taking behaviour, this group also have worse treatment outcomes compared to other age groups. Poor treatment outcomes will impact negatively on HIV/AIDS management and control particularly in sub-Saharan Africa (SSA) as more than eight out of ten of the world’s HIV-infected adolescents live in this region of the world. Limited evidence exists on the effectiveness of service delivery interventions to support adolescents’ retention on antiretroviral therapy (ART) and adherence to ART. This trial is designed to evaluate the impact of conditional economic incentive and motivational interviewing on adolescents’ retention in HIV care and adherence to ART in Anambra State, Southeast Nigeria. Methods/design The study will be a cluster randomised controlled trial that will be conducted in selected HIV treatment hospitals in Anambra State, Nigeria. Based on sample size calculation, 12 HIV treatment hospitals from Anambra will be selected for the study. Six HIV treatment hospitals each will be randomised to either the intervention or the control arm. A structured adherence support scheme termed the ‘Incentive Scheme’ will be applied to the intervention arm while the control arm will receive routine HIV care (usual care). Additionally, patients in the intervention arm will receive motivational interviewing at baseline and following initiation of antiretroviral therapy (ART), they will receive a gift voucher of US$5.6 when HIV viral load (VL) is < 20 copies/mL at 12 weeks, a gift voucher of US$2.8 if the VL remains suppressed for the next 3 months, and the next 6 months, and finally a gift voucher of US$5.6 if the VL remains < 20 copies/mL at 1 year. All gift vouchers will be conditional not only on VL results but attending the motivational interviews. The primary outcome for the trial will be the difference between groups in the proportion with HIV VL suppression (≤ 20 copies/mL) by 12 months and then 24 months after withdrawal of incentive. Discussion The findings of this proposed trial will provide evidence on the feasibility of applying conditional economic incentives combined with motivational interviewing to improve retention and adherence to antiretroviral therapy of adolescents living with HIV in Nigeria and possibly in other sub-Saharan African countries. Trial registration Registered in the Pan African Clinical Trials Registry, ID: PACTR201806003040425. Registered on 2 February 2018