Prevalence of antibodies to Hepatitis C virus among Nigerian patients with HIV infection

Nigeria belongs to the group of countries highly endemic for viral hepatitis; unfortunately information on the prevalence of hepatitis C amongst patients with HIV in Nigeria is very scarce. This hospital-based investigation was conducted at two major hospitals in Jos, Nigeria from June 2002 through May 2003. Serum samples from 490 confirmed HIV infected patients were assayed for the presence of antibodies to HCV, using a third generation enzyme linked immunosorbent assay. Twenty eight (5.7%; 95% CI 3.66-7.76%) of the patients had antibodies to HCV. The prevalence of HCV antibodies was higher among the males (7.5%; 95% CI 3.83-11.09%) than the females (4.5%; 95% CI 2.10-6.88%). Statistical analysis showed no significant difference (x2 = 1.917, df =1, p=0.05). Individuals of the age group 41-50 years had the highest prevalence of HCV antibodies (15.4%; 95% CI. 7.37-23.29%), followed by those of age group 31-40 years (7.4%; 95%, CI 3.70-11.20%). A significant difference was observed in the association between age and prevalence of HCV antibodies (x2 = 24.151, df = 4, p =0.05). Early diagnosis of HCV in people with HIV infection is advocated to reduce risk of HCV related advanced liver disease

Investigating the Effect of Varying Tubing Air Concentration during the Descaling of Petroleum Production Tubing using Multiple High-Pressure Nozzles

Despite the continued research effort on erosion behaviour of multiple flat fan nozzles in removing different types of scale deposits from petroleum production tubing, effect of chamber air concentration and nozzles configuration is yet to be given detail consideration. This study, therefore, considers the utilization of multiple high-pressure sprays at different chamber air concentration to enhance the rate of scale removal from petroleum production tubing. Additionally, options of altering chamber air/water ratio and header configurations for more effective scale removal were explored. So also, the relationship of nozzle header arrangement towards the removal of paraffin of different stages of deposition in petroleum production tubing have been studied. Consequently, theselection of chamber air concentration and header configuration (nozzles arrangement) for effective scale removal was found to be governed by the shape and type of the scale deposit. More so, the descaling capacity increases with decrease in number of nozzlesdue to pressure drop effect irrespective of the type or shape of the scale deposit. This novel descaling experiment of utilising 10 MPa injection pressure from 25 mm jetting position averagely removes hollow paraffin deposits that ranges from 44 to 280 g and 34 to 89g of solid shaped paraffin as a result of altering nozzles configuration. Correspondingly, an average removal difference ranging from 48 to 270 g of hollow shaped and 35 to 218 g of solid shaped paraffin depositwas recorded as a result of compressing the chamber pressure by 0.2 MPa and subsequently suctioning it by -0.008 MPa respectively

Genetic diversity of Mycobacterium tuberculosis Complex in Jos, Nigeria

<p>Abstract</p> <p>Background</p> <p>Nigeria has a high tuberculosis incidence, and genotyping studies of <it>Mycobacterium tuberculosis </it>Complex (MTC) in the country are necessary in order to improve our understanding of the epidemic.</p> <p>Methods</p> <p>Isolates of MTC were isolated from cases of pulmonary tuberculosis in Jos, North Central region of Nigeria during 2006-2008. Drug susceptibility test (DST) was performed on 77 of 111 isolates by proportion method on Lowenstein Jensen (LJ) slope while genotyping of mycobacterial DNA was performed by spoligotyping. The SpolDB4 database and the model-based program 'spotclust' were used to assign isolates to families, subfamilies and variants.</p> <p>Results</p> <p>A total of 111 pulmonary isolates from consecutive tuberculosis patients in the city of Jos, Plateau State, Nigeria were spoligotyped. A total of 84 (76%) of the isolates belonged to the Latin American Mediterranean (LAM) family. Of these, 78 isolates were assigned to the LAM10 lineage. Among these, 66 exhibited identical spoligopatterns. Drug susceptibility profiles obtained were not consistently associated with any spoligopattern.</p> <p>Conclusions</p> <p>The dominance of few <it>M. tuberculosis </it>lineages suggests either a high rate of transmission, frequent import of closely related strains, or a highly conserved genotype. It remains to be confirmed whether the predominance of identical LAM10 represent an outbreak.</p> <p>Spoligotyping was useful to gain an overall understanding of the local TB epidemic. This study demonstrated that the incidence of TB in Jos, Nigeria may be caused by a few successful <it>M. tuberculosis </it>families, dominated by the LAM10 family.</p

Investigating the Impact of Non-Hydrodynamically Connected Descaling Parameters in the Removal of Different Stages of Paraffin Deposits Using Multiple Nozzles in Petroleum Production Tubing

Despite the continued research efforts in understanding the erosional behaviors of multiple flat fan nozzles in the removal of different types of scale deposits from petroleum production tubing. The non-hydrodynamically connected descaling parameters such as stand-off distance, nozzle arrangement and chamber pressure have not been duly considered up to date. This research utilizes 3-flat fan high-pressure nozzles at a high injection pressure of 10 MPa to remove paraffin deposits at different growth stages from petroleum production tubing to evaluate the effects of the descaling parameters on scale removal. A stand-off distance of 25 mm, 50 mm and 75 mm; nozzle arrangement in novel orientations (triangle, diagonal &amp; right-angle) involving 7-nozzles header and chamber pressures (in compression – 0.2 MPa and vacuum -8.0 x10-3 MPa) were utilized as the varying non-hydrodynamically connected parameters. Generally, the selection of both nozzle arrangement and chamber air concentration was found to be governed by the type and shape of the deposit in question while the scale removal capability was found to be reduced with an increase in stand-off distance due to poor jet contact. An average hollow shaped paraffin removal of 276 g, 259 g and 226 g were recorded at ambient condition across the respective stand-off distance of the three respective nozzles arrangements. While the introduction of 0.2 MPa compressed air significantly increased the respective removal of the early stage paraffin deposition to 342 g, 299 g and 277 g respectively. Also, more hollow shaped removal improvement of 366 g, 320 g and 288 g were achieved after suctioning the chamber by -0.008 MPa, while simultaneously pumping water at 10 MPa. The case of solid shaped paraffin signifying complete tubing blockage was not effective at ambient condition, with average paraffin removal of 99 g, 126 g and 112 g respectively. However, the introduction of compressed chamber air registered the best solid paraffin removal results of 235 g, 286 g and 256 g respectively. Whereas the suction operation recorded an average removal of 229 g, 270 g and 250 g of paraffin across the respective jet positions and nozzle configurations. This result provides a practical approach to the removal of organic scales deposits at varying descaling conditions of injection pressure, standoff distance and nozzle arrangement

Explaining Adherence Success in Sub-Saharan Africa: An Ethnographic Study

Background: Individuals living with HIV/AIDS in sub-Saharan Africa generally take more than 90% of prescribed doses of antiretroviral therapy (ART). This number exceeds the levels of adherence observed in North America and dispels early scale-up concerns that adherence would be inadequate in settings of extreme poverty. This paper offers an explanation and theoretical model of ART adherence success based on the results of an ethnographic study in three sub-Saharan African countries. Methods and Findings: Determinants of ART adherence for HIV-infected persons in sub-Saharan Africa were examined with ethnographic research methods. 414 in-person interviews were carried out with 252 persons taking ART, their treatment partners, and health care professionals at HIV treatment sites in Jos, Nigeria; Dar es Salaam, Tanzania; and Mbarara, Uganda. 136 field observations of clinic activities were also conducted. Data were examined using category construction and interpretive approaches to analysis. Findings indicate that individuals taking ART routinely overcome economic obstacles to ART adherence through a number of deliberate strategies aimed at prioritizing adherence: borrowing and “begging” transport funds, making “impossible choices” to allocate resources in favor of treatment, and “doing without.” Prioritization of adherence is accomplished through resources and help made available by treatment partners, other family members and friends, and health care providers. Helpers expect adherence and make their expectations known, creating a responsibility on the part of patients to adhere. Patients adhere to promote good will on the part of helpers, thereby ensuring help will be available when future needs arise. Conclusion: Adherence success in sub-Saharan Africa can be explained as a means of fulfilling social responsibilities and thus preserving social capital in essential relationships

Modelling the impact and cost-effectiveness of combination prevention amongst HIV serodiscordant couples in Nigeria.

OBJECTIVE: To estimate the impact and cost-effectiveness of treatment as prevention (TasP), pre-exposure prophylaxis (PrEP) and condom promotion for serodiscordant couples in Nigeria. DESIGN: Mathematical and cost modelling. METHODS: A deterministic model of HIV-1 transmission within a cohort of serodiscordant couples and to/from external partners was parameterized using data from Nigeria and other African settings. The impact and cost-effectiveness were estimated for condom promotion, PrEP and/or TasP, compared with a baseline where antiretroviral therapy (ART) was offered according to 2010 national guidelines (CD4 <350 cells/μl) to all HIV-positive partners. The impact was additionally compared with a baseline of current ART coverage (35% of those with CD4 <350 cells/μl). Full costs (in US $2012) of programme introduction and implementation were estimated from a provider perspective. RESULTS: Substantial benefits came from scaling up ART to all HIV-positive partners according to 2010 national guidelines, with additional smaller benefits of providing TasP, PrEP or condom promotion. Compared with a baseline of offering ART to all HIV-positive partners at the 2010 national guidelines, condom promotion was the most cost-effective strategy [US$1206/disability-adjusted-life-year (DALY)], the next most cost-effective intervention was to additionally give TasP to HIV-positive partners (incremental cost-effectiveness ratio US $1607/DALY), followed by additionally giving PrEP to HIV-negative partners until their HIV-positive partners initiate ART (US$7870/DALY). When impact was measured in terms of infections averted, PrEP with condom promotion prevented double the number of infections as condom promotion alone. CONCLUSIONS: The first priority intervention for serodiscordant couples in Nigeria should be scaled up ART access for HIV-positive partners. Subsequent incremental benefits are greatest with condom promotion and TasP, followed by PrEP

High-risk human papilloma virus and cervical abnormalities in HIV-infected women with normal cervical cytology

Background: The prevalence of High-Risk Human papilloma virus (HR-HPV), a necessary cause of invasive cervical cancer (ICC) is relatively high in HIV infected women. Gaps exist in our knowledge of the optimal approaches for managing women who have HR-HPV with normal cervical cytology (NCC) particularly in settings of HIV infection. Methods: Between May 2012 and June 2013 we conducted a colposcopic assessment of HIV-infected women with prior (NCC) and known HR-HPV status to compare cervical abnormalities in women with and without HR-HPV. Colposcopic examinations were done at the Operation Stop Cervical Cancer (OSCC) unit of the Jos University Teaching Hospital (JUTH), Jos, Nigeria. Abnormal colposcopic finding (ACF) was defined as areas of aceto-white epithelium involving the squamo-coulumnar junction, areas of punctation, mosaic pattern or atypical vessels. We compared proportions of ACF as well as histologic grades of cervical intra-epithelial neoplasia (CIN) in women with or without HR-HPV. Statistical analysis was done on STATA. Results: We conducted colposcopic examinations in 78 out of 89 (86.5%) eligible women. The mean age of the cohort was 32.4 years (SD ±4.6) with a median 32 years (IQR 29–36). After a mean follow up time of 20.1 months from the initial cervical pap cytology and HR-HPV testing, we found 12 of 78 (15.4%) women with ACF. The odds for an ACF was statistically higher [OR = 4.0 (95% CI: 1.1-14.7)] in women with HR-HPV compared to those without. Of the twelve women with ACF, subsequent histologic examination of colposcopically directed cervical biopsies confirmed CIN 1 in 4 cases (33.3%), CIN 2 in 1 case (8.3%), CIN 3 in 2 cases (16.7%), carcinoma-in-situ (CIS) in 2 cases (16.7%), and normal cervix in 3 (25.0%). Overall, the proportion of women detected with any grade of CIN was 11.5% (9/78) and 6.4% (5/78) were CIN 2 or greater lesion (CIN2+). Conclusion: HIV-infected women with NCC and HR-HPV had a four-fold higher likelihood for an ACF. The practice of early colposcopic examination of HIV-infected women with prior NCC and HR-HPV may increase early detection of higher grade CIN and CIS cancer stages in our setting

Treatment Outcomes in a Decentralized Antiretroviral Therapy Program: A Comparison of Two Levels of Care in North Central Nigeria

Background. Decentralization of antiretroviral therapy (ART) services is a key strategy to achieving universal access to treatment for people living with HIV/AIDS. Our objective was to assess clinical and laboratory outcomes within a decentralized program in Nigeria. Methods. Using a tiered hub-and-spoke model to decentralize services, a tertiary hospital scaled down services to 13 secondary-level hospitals using national and program guidelines. We obtained sociodemographic, clinical, and immunovirologic data on previously antiretroviral drug naïve patients aged ≥15 years that received HAART for at least 6 months and compared treatment outcomes between the prime and satellite sites. Results. Out of 7,747 patients, 3729 (48.1%) were enrolled at the satellites while on HAART, prime site patients achieved better immune reconstitution based on CD4+ cell counts at 12 (P < 0.001) and 24 weeks (P < 0.001) with similar responses at 48 weeks (P = 0.11) and higher rates of viral suppression (<400 c/mL) at 12 (P < 0.001) and 48 weeks (P = 0.03), but similar responses at 24 weeks (P = 0.21). Mortality was 2.3% versus 5.0% (P < 0.001) at prime and satellite sites, while transfer rate was 8.7% versus 5.5% (P = 0.001) at prime and satellites. Conclusion. ART decentralization is feasible in resource-limited settings, but efforts have to be intensified to maintain good quality of care

Immunogenicity and safety of 13-valent pneumococcal conjugate vaccine (PCV13) formulated with 2-phenoxyethanol in multidose vials given with routine vaccination in healthy infants: An open-label randomized controlled trial.

BACKGROUND: This open-label randomized controlled trial in infants compared safety, tolerability, and immunogenicity of the 13-valent pneumococcal conjugate vaccine (PCV13) formulated with the preservative 2-phenoxyethanol (2-PE) in a multidose vial (MDV) to the current PCV13 without 2-PE in a single-dose syringe (SDS). METHODS: Gambian infants were randomized 1:1 to receive PCV13 as either MDV or SDS at ages 2, 3, and 4months. Serotype-specific antipneumococcal antibody responses and opsonophagocytic activity ([OPA]; subset) were measured at age 5months. Noninferiority was declared if the lower bound of the 97.5% CI for the difference (MDV-SDS) in proportions of subjects achieving IgG concentrations ≥0.35μg/mL (primary endpoint) was greater than -10%. IgG geometric mean concentrations (GMCs) were noninferior if the lower limit of the two-sided 97.5% CI of the geometric mean ratio (MDV vs SDS) was greater than 0.5. Reactogenicity and other adverse events were collected. RESULTS: 500 participants were randomized and vaccinated; 489 (MDV: n=245; SDS: n=244) completed the trial. Noninferiority of MDV was demonstrated for all serotypes as measured by percentage of subjects achieving antibody responses above ≥0.35μg/mL. IgG GMCs (coprimary endpoint) also demonstrated noninferiority of MDV; OPA results supported these findings. Safety and tolerability were comparable between groups. CONCLUSIONS: PCV13 in MDV was safe and immunogenic when administered according to the routine schedule to infants. MDV was noninferior to SDS for all 13 pneumococcal serotypes. Comparable immunogenicity and safety profiles of PCV13 MDV and SDS suggest PCV13 MDV can help optimize vaccination in resource-limited settings. ClinicalTrials.gov NCT01964716 https://clinicaltrials.gov/ct2/show/NCT01964716