Geographical Disparities in HIV Seroprevalence Among Men Who Have Sex with Men and People Who Inject Drugs in Nigeria: Exploratory Spatial Data Analysis

BACKGROUND: The assessment of geographical heterogeneity of HIV among men who have sex with men (MSM) and people who inject drugs (PWID) can usefully inform targeted HIV prevention and care strategies. OBJECTIVE: We aimed to measure HIV seroprevalence and identify hotspots of HIV infection among MSM and PWID in Nigeria. METHODS: We included all MSM and PWID accessing HIV testing services across 7 prioritized states (Lagos, Nasarawa, Akwa Ibom, Cross Rivers, Rivers, Benue, and the Federal Capital Territory) in 3 geographic regions (North Central, South South, and South West) between October 1, 2016, and September 30, 2017. We extracted data from national testing registers, georeferenced all HIV test results aggregated at the local government area level, and calculated HIV seroprevalence. We calculated and compared HIV seroprevalence from our study to the 2014 integrated biological and behavioural surveillance survey and used global spatial autocorrelation and hotspot analysis to highlight patterns of HIV infection and identify areas of significant clustering of HIV cases. RESULTS: MSM and PWID had HIV seroprevalence rates of 12.14% (3209/26,423) and 11.88% (1126/9474), respectively. Global spatial autocorrelation Moran I statistics revealed a clustered distribution of HIV infection among MSM and PWID with a <5% and <1% likelihood that this clustered pattern could be due to chance, respectively. Significant clusters of HIV infection (Getis-Ord-Gi* statistics) confined to the North Central and South South regions were identified among MSM and PWID. Compared to the 2014 integrated biological and behavioural surveillance survey, our results suggest an increased HIV seroprevalence among PWID and a substantial decrease among MSM. CONCLUSIONS: This study identified geographical areas to prioritize for control of HIV infection among MSM and PWID, thus demonstrating that geographical information system technology is a useful tool to inform public health planning for interventions targeting epidemic control of HIV infection

Estimation of HIV prevalence and burden in Nigeria: a Bayesian predictive modelling studyResearch in context

Summary: Background: The cost of population-based surveys is high and obtaining funding for a national population-based survey may take several years, with follow-up surveys taking up to five years. Survey-based prevalence estimates are prone to bias owing to survey non-participation, as not all individuals eligible to participate in a survey may be reached, and some of those who are contacted do not consent to HIV testing. This study describes how Bayesian statistical modeling may be used to estimate HIV prevalence at the state level in a reliable and timely manner. Methods: We analysed national HIV testing services (HTS) data for Nigeria from October 1, 2020, to September 30, 2021, to derive state-level HIV seropositivity rates. We used a Bayesian linear model with normal prior distribution and Markov Chain Monte Carlo approach to estimate HIV state-level prevalence for the 36 states +1 FCT in Nigeria. Our outcome variable was the HIV seropositivity rates and we adjusted for demographic, economic, biological, and societal covariates collected from the 2018 Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS), 2018 Nigeria Demographic and Health Survey (NDHS) and 2016-17 Multiple Indicator Cluster Surveys (MICS). The estimated population of 15–49 years olds in each state was multiplied by estimates from the estimated prevalence to generate state-level HIV burden. Findings: Our estimated national HIV prevalence was 2.1% (95% CI: 1.5–2.7%) among adults aged 15–49 years in Nigeria, which corresponds to approximately 2 million people living with HIV, compared to previous national HIV prevalence estimates of 1.4% from the 2018 NAIIS and UNAIDS estimation and projection package PLHIV estimation of 1.8 million in 2022. Our modelled HIV prevalence in Nigeria varies by state, with Benue (5.7%, 95% CI: 5.0–6.3) having the highest prevalence, followed by Rivers (5.2%, 95% CI: 4.6–5.8%), Akwa Ibom (3.5%, 95% CI: 2.9–4.1%), Edo (3.4%, 95% CI: 2.9–4.0%) and Taraba (3.0%, 95% CI: 2.6–3.7%) placing fourth and fifth, respectively. Jigawa had the lowest HIV prevalence (0.3%), which was consistent with prior estimates. Interpretation: This model provides a comprehensive and flexible use of evidence to estimate state-level HIV seroprevalence for Nigeria using program data and adjusting for explanatory variables. Thus, investment in program data for HIV surveillance will provide reliable estimates for HIV sub-national monitoring and improve planning and interventions for epidemiologic control. Funding: This article was made possible by the support of the American people through the United States Agency for International Development (USAID) under the U.S. President's Emergency Plan for AIDS Relief (PEPFAR)

Evaluation of the clinical outcomes of the Test and Treat strategy to implement Treat All in Nigeria: Results from the Nigeria Multi-Center ART Study.

In December 2016, the Nigerian Federal Ministry of Health updated its HIV guidelines to a Treat All approach, expanding antiretroviral therapy (ART) eligibility to all individuals with HIV infection, regardless of CD4+ cell count, and recommending ART be initiated within two weeks of HIV diagnosis (i.e., the Test and Treat strategy). The Test and Treat policy was first piloted in 32 local government areas (LGAs). The primary objective of this study was to evaluate the clinical outcomes of adult patients initiated on ART within two weeks of HIV diagnosis during this pilot. We conducted a retrospective cohort analysis of patients who initiated ART within two weeks of new HIV diagnosis between October 2015 and September 2016 in eight randomly selected LGAs participating in the Test and Treat pilot study. 2,652 adults were newly diagnosed and initiated on ART within two weeks of HIV diagnosis. Of these patients, 8% had documentation of a 12-month viral load measurement, and 13% had documentation of a six-month viral load measurement. Among Test and Treat patients with a documented viral load, 79% were suppressed (≤400 copies/ml) at six months and 78% were suppressed at 12 months. By 12 months post-ART initiation, 34% of the patients who initiated ART under the Test and Treat strategy were lost to follow-up. The median CD4 cell count among patients initiating ART within two weeks of HIV diagnosis was 323 cells/mm3 (interquartile range, 161-518). While randomized controlled trials have demonstrated that Test and Treat strategies can improve patient retention and increase viral suppression compared to standard of care, these findings indicate that the effectiveness of Test and Treat in some settings may be far lower than the efficacy demonstrated in randomized controlled trials. Significant attention to the way Test and Treat strategies are implemented, monitored, and improved particularly related to early retention, can help expand access to ART for all patients

An analysis of the uptake of anti-retroviral treatment among pregnant women in Nigeria from 2015 to 2020.

The percentage of Human Immunodeficiency Virus (HIV) positive pregnant women that receive anti-retroviral treatment in Nigeria is low and has been declining. Consequently, 14% of all new infections among children in 2020 occurred in Nigeria. A detailed analysis of available data was undertaken to generate evidence to inform remedial actions. Data from routine service delivery, national surveys and models were analyzed for the six-year period from 2015 to 2020. Numbers and percentages were calculated for antenatal registrations, HIV testing, HIV positive pregnant women and HIV positive pregnant women on antiretroviral treatment. The Mann-Kendall Trend Test was used to determine the presence of time trends when the p-value was less than 0.05. In 2020, only 35% of an estimated 7.8 million pregnant women received antenatal care at a health facility that provided and reported PMTCT services. Within these facilities, the percentage of HIV-positive pregnant women on anti-retroviral treatment from 71% in 2015 to 88% in 2020. However, declining HIV positivity rates at these antenatal clinics and an absence of expansion of PMTCT services to other pregnant women due to cost-efficiency considerations contributed to a progressive decline in national PMTCT coverage rates. To achieve elimination of mother-to-child transmission of HIV, all pregnant women should be offered a HIV test, all who are HIV positive should be given anti-retroviral treatment, and all PMTCT services should be reported