Olutosin A. Awolude

Recommendations for Cervical Cancer Prevention in Sub-Saharan Africa

Department of Obstetrics and Gynaecology, and Institute of Infectious Diseases and Molecular Medicine, University of Cape Town/Groote Schuur Hospital, Cape Town, South Africa Early Detection and Prevention Section and Screening Group, International Agency for Research on Cancer (WHO-IARC), Lyon, France Infection and Cancer Epidemiology Group, International Agency for Research on Cancer (WHO-IARC), Lyon, France Center for Health Decision Science, Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA Department of Obstetrics and Gynaecology, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria Unit of Infections and Cancer (UNIC), Cancer Epidemiology Research Program (CERP), Institut Català d’Oncologia Catalan Institute of Oncology (ICO), L’Hospitalet de Llobregat Barcelona), Spain CIBER en Epidemiología y Salud Pública (CIBERESP), Spain Gynaecological Oncology Unit, Department of Obstetrics and Gynaecology, College of Medicine, University of Ibadan, Nigeria North Department of Obstetrics and Gynecology, UNC Global Women’s Health, University of

Community attitudes towards childbearing and abortion among HIV-positive women in Nigeria and Zambia.

Although stigma towards HIV-positive women for both continuing and terminating a pregnancy has been documented, to date few studies have examined relative stigma towards one outcome versus the other. This study seeks to describe community attitudes towards each of two possible elective outcomes of an HIV-positive womans pregnancy – induced abortion or birth – to determine which garners more stigma and document characteristics of community members associated with stigmatising attitudes towards each outcome. Data come from community-based interviews with reproductive-aged men and women, 2401 in Zambia and 2452 in Nigeria. Bivariate and multivariate analyses revealed that respondents from both countries overwhelmingly favoured continued childbearing for HIV-positive pregnant women, but support for induced abortion was slightly higher in scenarios in which anti-retroviral therapy (ART) was unavailable. Zambian respondents held more stigmatising attitudes towards abortion for HIV-positive women than did Nigerian respondents. Women held more stigmatising attitudes towards abortion for HIV-positive women than men, particularly in Zambia. From a sexual and reproductive health and rights perspective, efforts to assist HIV-positive women in preventing unintended pregnancy and to support them in their pregnancy decisions when they do become pregnant should be encouraged in order to combat the social stigma documented in this paper.

Does knowledge about antiretroviral therapy and mother-to-child transmission affect the relationships between HIV status and fertility preferences and contraceptive use? New evidence from Nigeria and Zambia.

The increasing availability of antiretroviral therapy (ART) and drug regimens to prevent mother-to-child transmission (PMTCT) has probably changed the context of childbearing for people living with HIV. Using data from 2009-2010 community-based surveys in Nigeria and Zambia, this study explores whether womens knowledge about ART and PMTCT influences the relationship between HIV status and fertility preferences and contraceptive behaviour. The findings show that women living with HIV are more likely to want more children in Nigeria and to want to limit childbearing in Zambia compared with HIV-negative women. While there is no significant difference in contraceptive use by womens HIV status in the two countries, women who did not know their HIV status are less likely to use contraceptives relative to women who are HIV-negative. Knowledge about ART reduces the childbearing desires of HIV-positive women in Nigeria and knowledge about PMTCT increases desire for more children among HIV-positive women in Zambia, as well as contraceptive use among women who do not know their HIV status. The findings indicate that knowledge about HIV prevention and treatment services changes how living with HIV affects childbearing desires and, at least in Zambia, pregnancy prevention, and highlight the importance of access to accurate knowledge about ART and PMTCT services to assist women and men to make informed childbearing decisions. Knowledge about ART and PMTCT should be promoted not only through HIV treatment and maternal and newborn care facilities but also through family planning centres and the mass media.

Human Papillomavirus Infection and Related Cancers in Sub-Saharan Africa: Burden and Tools for Prevention

Cancer of the cervix is the most common cancer among women n sub-Saharan Africa (SSA) [1]. Of the over half a million women ho develop cervical cancer each year, nearly 85% reside in develping countries, where the majority of cervical cancer deaths occur 2]. Human papillomavirus (HPV) is an extremely common sexually ransmitted virus that has a strong causal relationship with cervical ancer globally [3,4]. Recent studies exploring HPV genotyping in nvasive cervical cancer confirmed the high prevalence of HPV16 nd 18 in the African region, and confirmed that these are the most ommon HPV types identified [5,6]. The documented regional variations in cervical cancer incidence n Africa are associated with a number of factors, including differnces in the underlying prevalence of high-risk HPV infection in omen, as well as disparities in the availability of effective cervial cancer diagnosis, treatment, and prevention. Historically, it has roven impossible to initiate and sustain cytology-based cervical ancer screening programs in SSA, resulting in a very high incience of the disease, late presentation, and high mortality. With the ntroduction of primary prevention of HPV infection through vacination, a new paradigm for cervical cancer prevention has been reated; however, the use of and widespread implementation of he prophylactic vaccines pose many challenges in the context of SA, which will be addressed in this Regional Report. The countries onsidered in this Regional Report are listed in Fig. 1.

Patterns and determinants of dropout from maternity care continuum in Nigeria

BackgroundThe maternal, newborn and child health care continuum require that mother/child pair should receive the full package of antenatal, intrapartum and postnatal care in order to derive maximum benefits. Continuity of care is a challenge in sub-Saharan Africa. In this study, we investigate the patterns and factors associated with dropout in the continuum of maternity (antenatal, delivery and postnatal) care in Nigeria.MethodUsing women recode file from the 2013 Nigeria Demographic and Health Survey, we analysed data on 20,467 women with an index birth within 5 years prior to data collection. Background characteristics and pattern of dropouts were summarised using descriptive statistics. The outcome variable was dropout which we explored in three stages: antenatal, antenatal-delivery, delivery-6xa0weeks postnatal visit. Multilevel logistic regression models were fitted to identify independent predictors of dropout at each stage. Measure of effect was expressed as Odds Ratio (OR) with 95xa0% confidence interval (CI).ResultsOverall, 12,392 (60.6xa0%) of all women received antenatal care among whom 38.1xa0% dropout and never got skilled delivery assistance. Of those who received skilled delivery care, 50.8xa0% did not attend postnatal visit. The predictors of dropout between antenatal care and delivery include problem with getting money for treatment (ORu2009=u20091.18, CI: 1.04–1.34), distance to health facility (ORu2009=u20091.31, CI: 1.13–1.52), lack of formal education, being in poor wealth quintile (ORu2009=u20092.22, CI: 1.85–2.67), residing in rural areas (ORu2009=u20091.98, CI: 1.63–2.41). Regional differences between North East, North West and South West were significant. Between delivery and postnatal visit, the same factors were also associated with dropout.ConclusionThe rate of dropout from maternity care continuum is high in Nigeria and driven by low or lack of formal education, poverty and healthcare access problems (distance to facility and difficulty with getting money for treatment). Unexpectedly, dropouts are high in South east and South south as well as in the Northern regions. Intervention programs focusing on community outreach about the benefits of continuum of maternal healthcare package should be introduced especially for women in rural areas and lower socio-economic strata.

P3.55 Pattern of syphilis and hiv co-infections among art treatment naÏve adults in a tertiary institution in ibadan, nigeria

Introduction Syphilis and Human immunodeficiency virus (HIV) infections have been found to be major public health problems in Sub-Saharan Africa. Clinical presentation of syphilis in patients infected with HIV has been described as atypical. This study was aimed to determining the seroprevalence and risk factors of syphilis among HIV infected patients in a tertiary hospital in Nigeria. Methods It is a descriptive cross-sectional survey of 793 HIV- infected patients enrolled at the Anti-Retroviral Treatment (ART) clinic, University College Hospital, Ibadan, Nigeria between July and December 2010. Detailed medical history was obtained from the patients after informed consent. Screening for syphilis using qualitative rapid Plasma Reagin (RPR) was performed on each of the sera/plasma collected from them. Measurement of CD4 + T lymphocyte (CD4) count was carried out by flow cytometry and Roche Ampiclor RNA PCR assay was used for the measurement of plasma HIV RNA (viral load). Data analysis was performed using SPSS version 23. Results A total of 793 participants, 557 females and 236 males were enrolled. The mean age of the patients was 36.99±10.3 years. The overall prevalence of syphilis among this cohort of patients was 1.51% (1.4% in females and 1.7% in males). 30–39 years age groups were mostly affected with 50.0% of the cases of syphilis. The mean age, weight, CD4 count and log viral load for the syphilis co-infected HIV patients were 38.17±8.22 years, 59.8±10.5u2009Kg, 275.92±282.1 cells/mm3 and 4.35±1.37u2009copies/ml respectively compared to 36.97±10.3 years, 56.7±15.5u2009kg, 262.06±256.5 cells/mm3 and 4.62±1.2u2009copies/ml respectively in the population without syphilis co-infection. Syphilis co-infection occurs more among females (OR 1.1, 95%u2009CI (0.75–1.58), and the married (OR 1.1, 95%u2009CI (0.75–1.58) without significant association. Conclusion Our study had revealed a low prevalence of syphilis in patients living with HIV/AIDS. Routine screening and counselling for syphilis should be considered for patients in AIDS care in Sub-Saharan Africa.

HCV co-infection is associated with metabolic abnormalities among HAART naive HIV-infected persons

Objectives: To determine the metabolic abnormalities among Hepatitis C Virus (HCV) co infected HAART naïve HIV infected persons within the adult ARV clinic of the University College Hospital/University of Ibadan, Ibadan, Nigeria Methods: This was a retrospective study involving the review of clinical records of newly recruited HIV-infected persons in the adult antiretroviral (ARV) clinic over a 12 month period (January - December 2006). Baseline results for fasting plasma glucose (FPG) and fasting lipid profile were retrieved. Results: Out of the 1,260 HIV infected persons seen during the study period, HCV co-infection was found in 75 (6%) persons. The median values for total cholesterol, LDL-cholesterol and HDL-cholesterol were lower in the HCV co-infected persons. HIV-HCV co–infection was associated with a 0.31 mmol/L depression in Total Cholesterol (TC). The median FPG concentration was significantly higher in HIV-HCV co–infected than HIV only infected persons (5.33mmol/L vs. 5.00mmol/L, p = 0.047). However, regression analysis showed there was no relationship between the HIV-HCV co infected state and fasting glucose levels. Conclusion: HIV-HCV co-infection may be associated with a predictable decline in plasma cholesterol, but FPG may not be sufficient to demonstrate insulin resistance in these persons.

Seroprevalence and factors associated with hepatitis C coinfection among HIV‑positive pregnant women at the University College Hospital, Ibadan, Nigeria

Aim: This study estimated the hepatitis C virus (HCV) prevalence in a population of human immunodeficiency virus (HIV) infected pregnant women, compared women who were positive or negative for HCV and described risk factors associated with HCV infection. Materials and Methods: A retrospective, case control study was conducted at the University College Hospital, Ibadan among 1821 women. Twenty-six (1.65%) women were HCV positive, 139 (8.83%) were HBsAg positive and 1407 (89.33%) were negative for both viruses. Three patients (0.19%) were positive for both viruses. These patients, i.e., the HBsAg positive women and 246 women with no result, for either virus were excluded from analysis. Data from 1433 pregnant women is presented. Chi square test and student′s t-test examined associations, with level of significance set at P < 0.05. Results: Overall, the mean age of the HCV positive women was lower (26.77 ± 6.53 vs. 28. 95 years ± 5.33; P = 0.04), most women had attained primary (28.49%) or secondary (42.44%) education, over 90% were married and heterosexual sex (88.67%) was the most likely risk for HIV. HCV prevalence was higher in the lower age groups (5% in the ≤ 19 years group, P = 0.021). The coinfected had more unmarried women (3.6% vs. 1.7%; P = 0.164) and more likely to indicate blood transfusion as a risk factor for HIV (6.2%; P = 0.34). Conclusion: Only age showed any significant association with HCV infection. Lack of identifiable risk factors sum up challenges for developing screening strategies in sub-Saharan Africa. Further studies will identify factors facilitating HCV transmission in the region.