A. Nwandu

Identifying and prioritizing implementation barriers, gaps, and strategies through the Nigeria implementation science alliance: Getting to zero in the prevention of mother-to-child transmission of HIV

Background:In 2013, Nigeria accounted for 15% of the 1.3 million pregnant women living with HIV in sub-Saharan Africa and 26% of new infections among children worldwide. Despite this, less than 20% of pregnant women in Nigeria received an HIV test during pregnancy, and only 23% of HIV-infected pregnant women received appropriate intervention following HIV diagnosis. This article reports findings from 2 structured group exercises conducted at the first Nigeria Implementation Science Alliance Conference to identify (1) barriers and research gaps related to prevention of mother-to-child transmission (PMTCT) and (2) potential strategies and interventions that could address PMTCT challenges. Methods:Two 1-hour structured group exercises were conducted with 10 groups of 14–15 individuals (n = 145), who were asked to brainstorm barriers and strategies and to rank their top 3 in each category. Data analysis eliminated duplicate responses and categorized each of the priorities along the HIV care continuum: HIV diagnosis, linkage to care, or retention in care. Results:Participating stakeholders identified 20 unique barriers and research gaps related to PMTCT across the HIV continuum. Twenty-five unique interventions and implementation strategies were identified. Similar to the barriers and research gaps, these interventions and strategies were distributed across the HIV care continuum. Conclusions:The barriers and strategies identified in this study represent important pathways to progress addressing MTCT. The deliberate involvement of state and federal policy makers, program implementers, and researchers helps ensure that they are relevant and actionable.

Pain Management for Persons Living With HIV Disease Experience With Interprofessional Education in Nigeria

Context: Pain management (PM) has not been routinely incorporated into HIV/AIDS care and treatment in resource-constrained settings. Objectives: We describe training for multidisciplinary teams tasked with integrating care management into HIV clinics to address pain for persons living with HIV in Nigeria. Methods: Education on PM was provided to mixed-disciplinary teams including didactic and iterative sessions following home and hospital visits. Participants identified challenges and performed group problem solving. Results: HIV trainers identified barriers to introducing PM reflecting views of the patient, providers, culture, and the health environment. Implementation strategies included (1) building upon existing relationships; (2) preliminary advocacy; (3) attention to staff needs; and (4) structured data review. Conclusion: Implementing PM in Nigerian HIV clinics requires recognition of cultural beliefs.

Vitiligo immune reconstitution inflammatory syndrome (IRIS)—An incidental finding in a tertiary teaching hospital in southeast Nigeria

ART: antiretroviral therapy HAART: highly active antiretroviral therapy IRIS: immune reconstitution inflammatory syndrome INTRODUCTION Skin diseases occur at every stage of HIV infection. They not only act as markers of disease, they may reflect the underlying immune status. An estimated 90% of HIV-infected individuals will have at least 1 dermatologic manifestation during the course of disease. These diseases may be infections, noninfectious inflammatory conditions, or neoplasms. Pigmentary abnormalities may occur as a side effect of antiretroviral therapy (ART) itself or from effects of drug treatment of opportunistic infections. Vitiligo in a patient with HIV/AIDS was first reported by Duvic et al in 1987. Since then, vitiligo has been reported frequently in HIV and may occur as a result of direct viral infection of melanocytes by HIV, polyclonal B-cell activation against melanocytes, production of g-interferon (toxic to melanocytes), or changes in the balance between helper and suppressor T cells. Some researchers postulate that increased numbers of CD8 cytotoxic T cells in lesional skin and peripheral blood, along with a decrease in CD4 T cells, leads to an increased CD8/CD4 ratio. Reduced numbers of CD4 peripheral T cells usually observed in AIDS patients may favor the development of vitiligo. Although antibodies in vitiligo are commonly directed against melanocyte antigens on the surface of the cells, Kemp et al, using phage display technology with a melanocyte cDNA phage display library, identified melanin-concentrating hormone

Gaps and strategies in developing health research capacity: experience from the Nigeria Implementation Science Alliance

BackgroundDespite being disproportionately burdened by preventable diseases than more advanced countries, low- and middle-income countries (LMICs) continue to trail behind other parts of the world in the number, quality and impact of scholarly activities by their health researchers. Our strategy at the Nigerian Implementation Science Alliance (NISA) is to utilise innovative platforms that catalyse collaboration, enhance communication between different stakeholders, and promote the uptake of evidence-based interventions in improving healthcare delivery. This article reports on findings from a structured group exercise conducted at the 2016 NISA Conference to identify (1) gaps in developing research capacity and (2) potential strategies to address these gaps.MethodsA 1-hour structured group exercise was conducted with 15 groups of 2–9 individuals (n = 94) to brainstorm gaps for implementation, strategies to address gaps and to rank their top 3 in each category. Qualitative thematic analysis was used. First, duplicate responses were merged and analyses identified emerging themes. Each of the gaps and strategies identified were categorised as falling into the purview of policy-makers, researchers, implementing partners or multiple groups.ResultsParticipating stakeholders identified 98 gaps and 91 strategies related to increasing research capacity in Nigeria. A total of 45 gaps and an equal number of strategies were ranked; 39 gaps and 43 strategies were then analysed, from which 8 recurring themes emerged for gaps (lack of sufficient funding, poor research focus in education, inadequate mentorship and training, inadequate research infrastructure, lack of collaboration between researchers, research-policy dissonance, lack of motivation for research, lack of leadership buy-in for research) and 7 themes emerged for strategies (increased funding for research, improved research education, improved mentorship and training, improved infrastructure for research, increased collaboration between academic/research institutions, greater engagement between researchers and policy-makers, greater leadership buy-in for research).ConclusionsThe gaps and strategies identified in this study represent pathways judged to be important in increasing research and implementation science capacity in Nigeria. The inclusion of perspectives and involvement of stakeholders who play different roles in policy, research and implementation activities makes these findings comprehensive, relevant and actionable, not only in Nigeria but in other similar LMICs.

B115 Effects of a Maternal Infant HIV Care Clinic for HIV-infected mothers and exposed infants on follow up postnatal HIV testing and care in Southeastern Nigeria: A retrospective review

Background:Adherence to care and evaluation of HIV-exposed infants remains a challenge. We evaluated the effect of a Maternal Infant HIV Clinic (MIHC) model of care on adherence to a prescribed set of interventions for HIV infected mothers and their infants. Methods:Review of records of 123 HIV-infected pregnant mothers and their infants at PEPFAR-supported programs at 2 teaching hospitals in SE Nigeria. 22 pairs excluded due to missing data. Two groups defined according to whether infant born in the 14 months before or after intervention: Group 1 (July 2009 - Aug 2010) and Group 2 (Sep 2010 - Oct 2011). Group 1 mothers received HIV care at the adult ART clinic and their infants received HIV services within the child welfare clinic however there was no structured approach. Group 2 mother-infant pairs received monthly comprehensive HIV services by trained MIHC team (doctor, nurse, counselor) using an interventions checklist until 18-24 months postpartum. Interventions include ART for all pregnant women, infant diagnostics at 6 weeks and 9-12 months, infant feeding counseling, family planning, and family HCT. Results:There was a large and significant increase in completion of timely first PCR (p=0.0023). Although only 12 Group 2 infants have reached 12 months of age, completion of second PCR has not improved. Conclusions:Implementing a MIHC model of care increases infant testing at two months. Additional research required to identify critical components of the model, whether it can be generalized, and how to further improve completion of care.