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Papers by Obinna Onyekwena

Research paper thumbnail of The future of HIV testing in eastern and southern Africa: Broader scope, targeted services

• Scale-up of HIV testing services (HTS), primarily through routine offer of HIV testing in healt... more • Scale-up of HIV testing services (HTS), primarily through routine offer of HIV testing in health services, has led to an increase in the proportion of people with HIV who know their status and are accessing HIV treatment.

Research paper thumbnail of The future of HIV testing in eastern and southern Africa: Broader scope, targeted services

PLOS Medicine, Mar 14, 2023

Research paper thumbnail of Patients’ demographic and clinical characteristics and level of care associated with lost to follow-up and mortality in adult patients on first-line ART in Nigerian hospitals

Journal of the International AIDS Society, 2012

Introduction: Clinical outcome is an important determinant of programme success. This study aims ... more Introduction: Clinical outcome is an important determinant of programme success. This study aims to evaluate patients' baseline characteristics as well as level of care associated with lost to follow-up (LTFU) and mortality of patients on antiretroviral treatment (ART). Methods: Retrospective cohort study using routine service data of adult patients initiated on ART in 2007 in 10 selected hospitals in Nigeria. We captured data using an electronic medical record system and analyzed using Stata. Outcome measures were probability of being alive and retained in care at 12, 24 and 36 months on ART. Potential predictors associated with time to mortality and time to LTFU were assessed using competing risks regression models. Results: After 12 months on therapy, 85% of patients were alive and on ART. Survival decreased to 81.2% and 76.1% at 24 and 36 months, respectively. Median CD4 count for patients at ART start, 12, 18 and 24 months were 152 (interquartile range, IQR: 75 to 242), 312 (IQR: 194 to 450), 344 (IQR: 227 to 501) and 372 (IQR: 246 to 517) cells/ml, respectively. Competing risk regression showed that patients' baseline characteristics significantly associated with LTFU were male (adjusted sub-hazard ratio, sHR 01.24 [95% CI: 1.08 to 1.42]), ambulatory functional status (adjusted sHR01.25 [95% CI: 1.01 to 1.54]), World Health Organization (WHO) clinical Stage II (adjusted sHR01.31 [95% CI: 1.08 to 1.59]) and care in a secondary site (adjusted sHR 00.76 [95% CI: 0.66 to 0.87]). Those associated with mortality include CD4 count B50 cells/ml (adjusted sHR02.84 [95% CI: 1.20 to 6.71]), WHO clinical Stage III (adjusted sHR 02.67 [95% CI: 1.26 to 5.65]) and Stage IV (adjusted sHR 05.04 [95% CI: 1.93 to 13.16]) and care in a secondary site (adjusted sHR02.21 [95% CI: 1.30 to 3.77]). Conclusions: Mortality was associated with advanced HIV disease and care in secondary facilities. Earlier initiation of therapy and strengthening systems in secondary level facilities may improve retention and ultimately contribute to better clinical outcomes.

Research paper thumbnail of HIV prevalence and risk behaviours among men having sex with men in Nigeria

Sexually Transmitted Infections, 2011

HIV prevalence and risk behaviours among men http://sti.bmj.com/content/87/1/65.full.html Updated... more HIV prevalence and risk behaviours among men http://sti.bmj.com/content/87/1/65.full.html Updated information and services can be found at: These include: Data Supplement http://sti.bmj.com/content/suppl/2010/06/02/sti.2008.034991.DC1.html "Web Only Data" References http://sti.bmj.com/content/87/1/65.full.html#ref-list-1 ABSTRACT Objective To evaluate HIV and syphilis prevalence among men who have sex with men (MSM) in Nigeria, and assess their HIV-related risk behaviours and exposure to HIV prevention interventions. Methods Cross-sectional study using respondent-driven sampling conducted in Lagos, Kano and Cross River states, Nigeria, between July and September 2007. Results A total of 879 MSM participated, 293 from each state. Eight participants (1.1%, CI 0.1% to 2.2%) in Cross River, 27 (9.3%, CI 5.7% to 15.4%) in Kano and 74 (17.4%, CI 12.3% to 23.2%) in Lagos tested positive for HIV. No syphilis was detected. The median age was 22 years. MSM reported an average of 4.2 male anal sex partners in the past 6 months. Between 24.4% (Lagos) and 36.0% (Kano) of MSM reported selling sex to other men. Up to 49.7% of MSM reported sex with a girlfriend and #6.5% purchased sex from female sex workers.

Research paper thumbnail of Patients’ demographic and clinical characteristics and level of care associated with lost to follow-up and mortality in adult patients on first-line ART in Nigerian hospitals

Journal of the International AIDS Society, 2012

Introduction: Clinical outcome is an important determinant of programme success. This study aims ... more Introduction: Clinical outcome is an important determinant of programme success. This study aims to evaluate patients' baseline characteristics as well as level of care associated with lost to follow-up (LTFU) and mortality of patients on antiretroviral treatment (ART). Methods: Retrospective cohort study using routine service data of adult patients initiated on ART in 2007 in 10 selected hospitals in Nigeria. We captured data using an electronic medical record system and analyzed using Stata. Outcome measures were probability of being alive and retained in care at 12, 24 and 36 months on ART. Potential predictors associated with time to mortality and time to LTFU were assessed using competing risks regression models. Results: After 12 months on therapy, 85% of patients were alive and on ART. Survival decreased to 81.2% and 76.1% at 24 and 36 months, respectively. Median CD4 count for patients at ART start, 12, 18 and 24 months were 152 (interquartile range, IQR: 75 to 242), 312 (IQR: 194 to 450), 344 (IQR: 227 to 501) and 372 (IQR: 246 to 517) cells/ml, respectively. Competing risk regression showed that patients' baseline characteristics significantly associated with LTFU were male (adjusted sub-hazard ratio, sHR 01.24 [95% CI: 1.08 to 1.42]), ambulatory functional status (adjusted sHR01.25 [95% CI: 1.01 to 1.54]), World Health Organization (WHO) clinical Stage II (adjusted sHR01.31 [95% CI: 1.08 to 1.59]) and care in a secondary site (adjusted sHR 00.76 [95% CI: 0.66 to 0.87]). Those associated with mortality include CD4 count B50 cells/ml (adjusted sHR02.84 [95% CI: 1.20 to 6.71]), WHO clinical Stage III (adjusted sHR 02.67 [95% CI: 1.26 to 5.65]) and Stage IV (adjusted sHR 05.04 [95% CI: 1.93 to 13.16]) and care in a secondary site (adjusted sHR02.21 [95% CI: 1.30 to 3.77]).

Research paper thumbnail of The future of HIV testing in eastern and southern Africa: Broader scope, targeted services

• Scale-up of HIV testing services (HTS), primarily through routine offer of HIV testing in healt... more • Scale-up of HIV testing services (HTS), primarily through routine offer of HIV testing in health services, has led to an increase in the proportion of people with HIV who know their status and are accessing HIV treatment.

Research paper thumbnail of The future of HIV testing in eastern and southern Africa: Broader scope, targeted services

PLOS Medicine, Mar 14, 2023

Research paper thumbnail of Patients’ demographic and clinical characteristics and level of care associated with lost to follow-up and mortality in adult patients on first-line ART in Nigerian hospitals

Journal of the International AIDS Society, 2012

Introduction: Clinical outcome is an important determinant of programme success. This study aims ... more Introduction: Clinical outcome is an important determinant of programme success. This study aims to evaluate patients' baseline characteristics as well as level of care associated with lost to follow-up (LTFU) and mortality of patients on antiretroviral treatment (ART). Methods: Retrospective cohort study using routine service data of adult patients initiated on ART in 2007 in 10 selected hospitals in Nigeria. We captured data using an electronic medical record system and analyzed using Stata. Outcome measures were probability of being alive and retained in care at 12, 24 and 36 months on ART. Potential predictors associated with time to mortality and time to LTFU were assessed using competing risks regression models. Results: After 12 months on therapy, 85% of patients were alive and on ART. Survival decreased to 81.2% and 76.1% at 24 and 36 months, respectively. Median CD4 count for patients at ART start, 12, 18 and 24 months were 152 (interquartile range, IQR: 75 to 242), 312 (IQR: 194 to 450), 344 (IQR: 227 to 501) and 372 (IQR: 246 to 517) cells/ml, respectively. Competing risk regression showed that patients' baseline characteristics significantly associated with LTFU were male (adjusted sub-hazard ratio, sHR 01.24 [95% CI: 1.08 to 1.42]), ambulatory functional status (adjusted sHR01.25 [95% CI: 1.01 to 1.54]), World Health Organization (WHO) clinical Stage II (adjusted sHR01.31 [95% CI: 1.08 to 1.59]) and care in a secondary site (adjusted sHR 00.76 [95% CI: 0.66 to 0.87]). Those associated with mortality include CD4 count B50 cells/ml (adjusted sHR02.84 [95% CI: 1.20 to 6.71]), WHO clinical Stage III (adjusted sHR 02.67 [95% CI: 1.26 to 5.65]) and Stage IV (adjusted sHR 05.04 [95% CI: 1.93 to 13.16]) and care in a secondary site (adjusted sHR02.21 [95% CI: 1.30 to 3.77]). Conclusions: Mortality was associated with advanced HIV disease and care in secondary facilities. Earlier initiation of therapy and strengthening systems in secondary level facilities may improve retention and ultimately contribute to better clinical outcomes.

Research paper thumbnail of HIV prevalence and risk behaviours among men having sex with men in Nigeria

Sexually Transmitted Infections, 2011

HIV prevalence and risk behaviours among men http://sti.bmj.com/content/87/1/65.full.html Updated... more HIV prevalence and risk behaviours among men http://sti.bmj.com/content/87/1/65.full.html Updated information and services can be found at: These include: Data Supplement http://sti.bmj.com/content/suppl/2010/06/02/sti.2008.034991.DC1.html "Web Only Data" References http://sti.bmj.com/content/87/1/65.full.html#ref-list-1 ABSTRACT Objective To evaluate HIV and syphilis prevalence among men who have sex with men (MSM) in Nigeria, and assess their HIV-related risk behaviours and exposure to HIV prevention interventions. Methods Cross-sectional study using respondent-driven sampling conducted in Lagos, Kano and Cross River states, Nigeria, between July and September 2007. Results A total of 879 MSM participated, 293 from each state. Eight participants (1.1%, CI 0.1% to 2.2%) in Cross River, 27 (9.3%, CI 5.7% to 15.4%) in Kano and 74 (17.4%, CI 12.3% to 23.2%) in Lagos tested positive for HIV. No syphilis was detected. The median age was 22 years. MSM reported an average of 4.2 male anal sex partners in the past 6 months. Between 24.4% (Lagos) and 36.0% (Kano) of MSM reported selling sex to other men. Up to 49.7% of MSM reported sex with a girlfriend and #6.5% purchased sex from female sex workers.

Research paper thumbnail of Patients’ demographic and clinical characteristics and level of care associated with lost to follow-up and mortality in adult patients on first-line ART in Nigerian hospitals

Journal of the International AIDS Society, 2012

Introduction: Clinical outcome is an important determinant of programme success. This study aims ... more Introduction: Clinical outcome is an important determinant of programme success. This study aims to evaluate patients' baseline characteristics as well as level of care associated with lost to follow-up (LTFU) and mortality of patients on antiretroviral treatment (ART). Methods: Retrospective cohort study using routine service data of adult patients initiated on ART in 2007 in 10 selected hospitals in Nigeria. We captured data using an electronic medical record system and analyzed using Stata. Outcome measures were probability of being alive and retained in care at 12, 24 and 36 months on ART. Potential predictors associated with time to mortality and time to LTFU were assessed using competing risks regression models. Results: After 12 months on therapy, 85% of patients were alive and on ART. Survival decreased to 81.2% and 76.1% at 24 and 36 months, respectively. Median CD4 count for patients at ART start, 12, 18 and 24 months were 152 (interquartile range, IQR: 75 to 242), 312 (IQR: 194 to 450), 344 (IQR: 227 to 501) and 372 (IQR: 246 to 517) cells/ml, respectively. Competing risk regression showed that patients' baseline characteristics significantly associated with LTFU were male (adjusted sub-hazard ratio, sHR 01.24 [95% CI: 1.08 to 1.42]), ambulatory functional status (adjusted sHR01.25 [95% CI: 1.01 to 1.54]), World Health Organization (WHO) clinical Stage II (adjusted sHR01.31 [95% CI: 1.08 to 1.59]) and care in a secondary site (adjusted sHR 00.76 [95% CI: 0.66 to 0.87]). Those associated with mortality include CD4 count B50 cells/ml (adjusted sHR02.84 [95% CI: 1.20 to 6.71]), WHO clinical Stage III (adjusted sHR 02.67 [95% CI: 1.26 to 5.65]) and Stage IV (adjusted sHR 05.04 [95% CI: 1.93 to 13.16]) and care in a secondary site (adjusted sHR02.21 [95% CI: 1.30 to 3.77]).