Elimination of mother-to-child transmission of HIV (eMTCT) in Western Nigeria: how far have we gone?

Background: HIV pandemic has continued to be a huge challenge in Nigeria, with the problem of stigmatization reducing the chances of early determination of the HIV status of pregnant women, which may increase the chances of transmission to the child from the mother. Hypotheses tested were the influence of maternal antiretroviral therapy (ART) use and infant’s feeding option on baby’s final early infant diagnosis (EID) outcome. The study was aimed at determining the trend as well as diagnosis of HIV infection in exposed infants. It will also determine among infants the factors associated with the transmission of the infection from their mothers.Methods: This study was a prospective cohort study of HIV-exposed infants conducted in Ekiti State, South Western Nigeria, between June 2015 and June 2017. Dried Blood Spots (DBS) were analyzed using polymerase chain reaction technique. All data were statistically analyzed, using statistical package for the social sciences (SPSS) and statistical test of significance was performed with Chi-Square test.Results: A total of 200 infants were included in the study, 91 (45.5%) female and 109 (54.5%) male. Three (1.5%) babies were confirmed positive after cessation of all exposures. Maternal antiretroviral therapy (ART) use has significant effect on baby early infant diagnosis (EID) outcome (χ² = 65.40, df = 2, P = 0.001). Infant feeding option has significant effect on baby early infant diagnosis (EID) outcome (χ² = 132.67, df = 2, P = 0.001). Baby’s mode of delivery have higher association with the final EID outcome of the baby (OR: 1.018, 95% CI: 0.998 – 1.038).Conclusion: ART administration to both HIV-infected mothers and their babies has demonstrated an effective mechanism in the elimination of mother-to-child transmission (eMTCT), as this is evident in the very low positivity outcome. However, the degree to which Cuba, Armenia, Belarus, and Thailand have eliminated HIV transmission from mother-to-baby is achievable in Nigeria through provision of universal access to health care.Key words: infant, mother, dried blood spot, polymerase chain reactio

Adaptation of the Wound Healing Questionnaire universal-reporter outcome measure for use in global surgery trials (TALON-1 study): mixed-methods study and Rasch analysis

BackgroundThe Bluebelle Wound Healing Questionnaire (WHQ) is a universal-reporter outcome measure developed in the UK for remote detection of surgical-site infection after abdominal surgery. This study aimed to explore cross-cultural equivalence, acceptability, and content validity of the WHQ for use across low- and middle-income countries, and to make recommendations for its adaptation.MethodsThis was a mixed-methods study within a trial (SWAT) embedded in an international randomized trial, conducted according to best practice guidelines, and co-produced with community and patient partners (TALON-1). Structured interviews and focus groups were used to gather data regarding cross-cultural, cross-contextual equivalence of the individual items and scale, and conduct a translatability assessment. Translation was completed into five languages in accordance with Mapi recommendations. Next, data from a prospective cohort (SWAT) were interpreted using Rasch analysis to explore scaling and measurement properties of the WHQ. Finally, qualitative and quantitative data were triangulated using a modified, exploratory, instrumental design model.ResultsIn the qualitative phase, 10 structured interviews and six focus groups took place with a total of 47 investigators across six countries. Themes related to comprehension, response mapping, retrieval, and judgement were identified with rich cross-cultural insights. In the quantitative phase, an exploratory Rasch model was fitted to data from 537 patients (369 excluding extremes). Owing to the number of extreme (floor) values, the overall level of power was low. The single WHQ scale satisfied tests of unidimensionality, indicating validity of the ordinal total WHQ score. There was significant overall model misfit of five items (5, 9, 14, 15, 16) and local dependency in 11 item pairs. The person separation index was estimated as 0.48 suggesting weak discrimination between classes, whereas Cronbach's α was high at 0.86. Triangulation of qualitative data with the Rasch analysis supported recommendations for cross-cultural adaptation of the WHQ items 1 (redness), 3 (clear fluid), 7 (deep wound opening), 10 (pain), 11 (fever), 15 (antibiotics), 16 (debridement), 18 (drainage), and 19 (reoperation). Changes to three item response categories (1, not at all; 2, a little; 3, a lot) were adopted for symptom items 1 to 10, and two categories (0, no; 1, yes) for item 11 (fever).ConclusionThis study made recommendations for cross-cultural adaptation of the WHQ for use in global surgical research and practice, using co-produced mixed-methods data from three continents. Translations are now available for implementation into remote wound assessment pathways