Osaro Mgbere

Adherence to antiretroviral therapy in Nigeria: an overview of research studies and implications for policy and practice

Both Human Immunodeficiency Virus (HIV) infection and AIDS remain major public health crises in Nigeria, a country which harbors more people living with HIV/AIDS than any country in the world, with the exception of South Africa and India. In response to the HIV pandemic, global and international health initiatives have targeted several countries, including Nigeria, for the expansion of antiretroviral therapy (ART) programs for the increasing number of affected patients. The success of these expanded ART initiatives depends on the treated individual’s continual adherence to antiretroviral (ARV) drugs. Thirteen peer-reviewed studies concerning adherence to ART in Nigeria were reviewed with very few pediatric and adolescent studies being found. Methodologies of adherence measurement were analyzed and reasons for nonadherence were identified in the geopolitical zones in the federal republic of Nigeria. The results of the literature review indicate that adherence to ART is mixed (both high and low adherence) with patient self-recall identified as the common method of assessment. The most common reasons identified for patient nonadherence include the cost of therapy (even when the drugs are heavily subsidized), medication side effects, nonavailability of ARV drugs, and the stigma of taking the drugs. This manuscript highlights the policy and practice implications from these studies and provides recommendations for future ART program management.

Elevation in D-dimer concentrations is positively correlated with gestation in normal uncomplicated pregnancy

Background D-dimer levels have been reported to increase progressively during pregnancy, but how this affects Nigerian women is not well known. Objective This study aims to determine the D-dimer concentration and its relationship to other coagulation parameters among pregnant women in Port Harcourt, Nigeria. Method In a cross-sectional observational study conducted in Port Harcourt, Nigeria, 120 pregnant women and 60 nonpregnant controls, drawn from a tertiary health institution in the Niger Delta, Nigeria, were assessed, using the standard procedures, for the following parameters: D-dimer concentration, prothrombin time, activated partial thromboplastin time, platelet count, hemoglobin, and packed cell volume. Results The median D-dimer concentration of 153.1 ng/mL in the pregnant group was found to be significantly elevated when compared with the control value of 118.5 ng/mL (t = 2.348, P = 0.021). Conversely, there was a marked depression in the platelet count among pregnant women (193.5 × 109/L) when compared with 229.0 × 109/L in the control group (t = 3.424; P = 0.001). There was no statistically significant difference in the values for the prothrombin time and the activated partial thromboplastin time between pregnant and nonpregnant women. D-dimer values correlated positively and significantly with gestation (r = 0.36; P < 0.01) and negatively with international normalized ratio values (r = −0.281; P < 0.05). About 63.3% of the pregnant women had normal D-dimer values (0–200 ng/mL), 26.7% of the pregnant women had elevated D-dimer levels (201–499 ng/mL), while 10.0% of the pregnant women were found to be at risk of thrombosis (D-dimer > 500 ng/mL). A linear relationship was found to exist between D-dimer and gestation (y = 8.355x + 36.55; R2 = 0.130; P < 0.005). Conclusion 10% of the pregnant women in this population had elevated D-dimer levels over 500 ng/mL, and through comparison with what has been reported in the literature, there is the possibility that this group may be at risk of thrombosis. Further studies, incorporating other diagnostic parameters, may be needed before a more logical conclusion can be drawn, since the D-dimer is not a specific test.

Routine HIV testing in health care settings: the deterrent factors to maximal implementation in sub-Saharan Africa.

The sub-Saharan region of Africa is the most severely affected HIV/AIDS region in the world. The population of this region accounts for 67% of all people living with HIV/AIDS and 72% of all AIDS-related deaths. As international collaboration makes access to HIV treatment more widely available in this region the need to increase the population’s awareness of its serostatus becomes greater. The incorporation of provider-initiated HIV testing and counseling (routine HIV testing model) as part of a routine medical care would not only increase the population’s serostatus awareness but also lead to a better understanding of HIV prevention and treatment and ultimately, increased utilization of available HIV/AIDS prevention programs on a much larger scale. This mini-review summarizes some important regional, sociocultural, economic, legal, and ethical issues that may be deterrent factors to maximal implementation and integration of provider initiated HIV testing and counseling as part of routine medical care in the sub-Saharan African region.

Predictors of frequency of condom use and attitudes among sexually active female military personnel in Nigeria.

Background Despite awareness of condom efficacy, in protecting against both human immunodeficiency virus/sexually transmitted diseases (HIV/STDs) and unintended pregnancy; some females find it difficult to use or permit condom use consistently because of the power imbalances or other dynamics operating in their relationships with males. The purpose of this study was to determine the factors that predict the frequency of condom use and attitudes among sexually active female military personnel in Nigeria. Methods This study used a cross-sectional design in which a total of 346 responses were obtained from consenting female military personnel in two cantonments in Southwestern Nigeria between 2006 and 2008. The study instrument was designed to assess HIV/acquired immunodeficiency syndrome (AIDS) knowledge (HAK), HIV risk behaviors (HRB), alcohol and drug use, condom attitudes and barriers (CAS) condom use self-efficacy (CUS) and social support to condom use (SSC). The sociodemographic characteristics of participants were also captured. Univariate analysis and multivariable logistic regression were used for modeling the predictors of condom use. Results The results showed that 63% of the respondents reported using condoms always, 26% sometimes used condoms and 11% never used condoms during a sexual encounter in the past three months. Univariate analysis revealed that significant associations existed between CAB (P < 0.05), HRB (P < 0.01) and SSC (P < 0.01) with the frequency of condom use. The following sociodemographic variables: age, marital status, number of children, employment status and type of sexual relationship were also significantly (P ≤ 0.05) associated with consistent condom use in the study group. Multivariate analysis indicated that marital status, type of relationship and CAB were the only significant predictors (r2 = 0.37; P ≤ 0.05) of condom use behaviors after adjusting for all other factors in the model. Conclusions Findings indicate that consistent condom use could be enhanced through gender-specific intervention programs that incorporate the predictor variables identified. These are likely to be successful in decreasing sexual risk behaviors in the subpopulation.

Managing the Personal Side of Health Care among Patients with HIV/AIDS A Pilot Study of Providers’ Perspectives

The study describes the HIV care providers’ sociodemographic and medical practice characteristics and the health care services offered to patients during medical care encounters in Houston/Harris County, Texas. We used data from the pilot cycle of the Centers for Disease Control and Prevention Medical Monitoring Project Provider Survey conducted in June to September 2009. The average age and HIV care experience of the providers were 46.7 and 11.7 years, respectively, and they provided care to an average of 113 patients monthly. The average proportion of HIV-infected patients seen per month by race/ethnicity was 43.3% for blacks, 28.5% for whites, 26.6% for Hispanics, 1.3% for Asians, and 0.6% for other races. A total of 67% of providers offered HIV testing to all patients 13 to 64 years of age. Most HIV care providers (73.9%) reported that patients in their practices sought HIV care only after experiencing symptoms. Understanding the HIV care delivery system from providers’ perspectives may help enhance support services, patients’ ongoing care and retention, leading to improved health outcomes.

System and Patient Barriers to Care among People Living with HIV/AIDS in Houston/Harris County, Texas: HIV Medical Care Providers' Perspectives.

In the United States, a considerable number of people diagnosed with HIV are not receiving HIV medical care due to some barriers. Using data from the Medical Monitoring Project survey of HIV medical care providers in Houston/Harris County, Texas, we assessed the HIV medical care providers’ perspectives of the system and patient barriers to HIV care experienced by people living with HIV/AIDS (PLWHA). The study findings indicate that of the 14 HIV care barriers identified, only 1 system barrier and 7 patient barriers were considered of significant (P ≤ .05) importance, with the proportion of HIV medical care providers’ agreement to these barriers ranging from 73.9% (cost of health care) to 100% (lack of social support systems and drug abuse problems). Providers’ perception of important system and patient barriers varied significantly (P ≤ .05) by profession, race/ethnicity, and years of experience in HIV care. To improve access to and for consistent engagement in HIV care, effective intervention programs are needed to address the barriers identified especially in the context of the new health care delivery system.

Determinants of Fruits and Vegetables Consumption Among Persons With Doctor-Diagnosed Chronic Diseases

Objective: The objective of this study was to examine the factors associated with fruits and vegetables consumption pattern among persons with doctor-diagnosed chronic diseases. Method: The authors examined cross-sectional, random-digit-dialed health survey data collected in 2008 in Houston, Texas, a city with a diverse ethnic population. The survey sample, which was designed to represent all households with telephones, was drawn using standard list–assisted random-digit-dialing methodology from telephone exchanges that serve the study area. A total of 1001 households were interviewed, and data obtained were subjected to both bivariate and multivariate analyses. Results: Findings from this study indicate that fruits and vegetables consumption for persons with single chronic disease was significantly predicted (R2 = 0.83) by the participants’ age, educational level, and insurance status. None of the covariates considered in the study were significant predictors of fruits and vegetables consumption pattern among persons who had multiple chronic diseases. But when the subpopulation with any number of chronic diseases was considered, only gender (P < .05) and marital status (P < .001) were noted as the significant predictors of fruits and vegetables (R2 = 0.34). Conclusion: More public health efforts are needed to make individuals with chronic diseases aware of the importance of consumption of fruits and vegetables. Clinicians and health care professionals should be encouraged to emphasize the importance of consumption of fruits and vegetables in their routine practice to the patients with chronic disease(s), especially to those who are unmarried and male.

Disparities in Fruits and Vegetables Consumption in Houston, Texas Implications for Health Promotion

Background: The consumption of the recommended amount of fruits and vegetables is believed to help prevent nutrient deficiency disorders and lower the risk of several chronic diseases. Information on the disparity of fruit and vegetable consumption may be useful in designing targeted health promotion programs for increasing fruit and vegetable consumption. The objective of this pilot study was to examine disparities in fruit and vegetable consumption among Houston residents based on sociodemographic characteristics. Methods: The authors conducted bivariate and multivariate analyses to examine the associations between sociodemographic characteristics and fruit and vegetable consumption using a random digit dialing (RDD) health survey data (N = 1001) collected in Houston, Texas. Results: Bivariate analysis showed that there were significant associations between fruit and vegetable consumption and education (P < .01); race/ethnicity (P < .001); marital status (P < .001); and employment status (P < .05). Multivariate analysis indicated that fruit and vegetable consumption pattern could be significantly (P ≤ .05) predicted by gender, race, and marital status. Respondents who were of other race category were less likely than whites to consume fruits and vegetables, while married respondents and women were more likely to consume fruits and vegetables compared to the unmarried and men, respectively. Implications: Health promotion programs aimed at increasing the consumption of fruits and vegetables should consider developing targeted intervention for men, people with less formal education, minority race/ethnicity, people who are unemployed, and those who are unmarried.

Frequency and Determinants of Preventive Care Counseling by HIV Medical Care Providers during Encounters with Newly Diagnosed and Established HIV-Infected Patients

This study evaluates the frequency and determinants of preventive care counseling by HIV medical care providers (HMCPs) during encounters with newly diagnosed and established HIV-infected patients. Data used were from a probability sample of HMCPs in Houston/Harris County, Texas, surveyed in 2009. Overall, HMCPs offered more preventive care counseling to newly diagnosed than the established patients (adjusted odds ratio [AOR] = 7.28; 95% confidence interval [CI] = 2.86-16.80). They were more likely to counsel newly diagnosed patients than the established ones on medication and adherence (AOR = 14.70; 95% CI = 1.24-24.94), HIV risk reduction (AOR = 5.91; 95% CI = 0.48-7.13), and disease screening (AOR = 7.20; 95% CI = 0.72-11.81). HIV medical care providers who were less than 45 years of age, infectious disease specialists, and had less than 30 minutes of encounter time were less likely to counsel patients regardless of the status. Our findings suggest the need for HMCPs to improve their preventive care counseling efforts, in order to help patients build skills for adopting and maintaining safe behavior that could assist in reducing the risk of HIV transmission.

Alloantibodies to human platelet glycoprotein antigens (HPA) and HLA class 1 in a cross section of Nigerian antenatal women.

The prevalence of antibodies to human platelet antigens (HPA) and human leukocyte antigens (HLA) class 1 antigens among Nigerian pregnant women has not been reported in our country. This study was therefore aimed at screening the obstetric population for evidence of alloimmunization due to human platelet and HLA class 1 antigens. One hundred and forty four (144) pregnant women attending the obstetric clinic of Military Hospital, Port Harcourt, participated in the study. Their sera were tested for antibodies to HPA and HLA class 1 antigens using GTI PakPlus solid phase ELISA Kit. The total prevalence rate of antibody production was 60.5% (87 out of 144). Among the positive samples, 60 had platelet glycoprotein specific antibodies (41.7%) and 27 had HLA class 1 antibodies (18.8%). In 39.6% of the pregnant women, both platelet specific antibodies and HLA class 1 antibodies appeared. The prevalence of platelet specific glycoprotein antibodies were obtained as follows: GP 11b/111a 12 (8.3%), GP 1a/11a 35 (20.8%), GP Ib/IX 18 (12.5%) and GP IV 9 (6.3%). The prevalence of each platelet antibody subgroup was obtained as follows: anti-HPA-1a,-3a,-4a (4.2%), anti-HPA-1b,-3b,-4a (4.2%), anti-HPA-30 5a and anti-GP Ib/IX (12.5% each), anti-HPA-5b (8.3%) and anti-GP IV (6.3%). A high prevalence rate of human platelet arid cytotoxic antibodies has been observed in our obstetric population. There is need to establish platelet serology laboratory for the proper antenatal and postnatal management of pregnant mothers in this region.