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Papers by Madu Onyema

International Journal of Science and Healthcare Research Vol.9; Issue: 1; Jan.-March 2024 Website: ijshr.com Original Research Article ISSN: 2455-7587, 2024

ABSTRACT Background: Tuberculosis (TB) remains a significant global health challenge, particularl... more ABSTRACT
Background: Tuberculosis (TB) remains a significant global health challenge, particularly in high-burden countries like Nigeria. Despite efforts to combat TB, a substantial number of cases remain undiagnosed and untreated, contributing to the continued spread of the disease. In response to this public health crisis, the USAID/Nigeria Tuberculosis Local Organization (USAID/Nigeria TB LON) project, implemented by the Equitable Health Access Initiative (EHAI) in Lagos State, initiated a novel approach to TB case finding. This journal article provides an overview of the strategies, activities, challenges, and achievements of the Program within the USAID TB LON 3 project in Lagos State, with a focus on the period from March to September 2021
Methods: This approach involves collaboration with Traditional Medicine Practitioners (TMPs) to identify and link presumptive TB cases to testing and treatment services.
Result: From March to September 2021, only 30 out of the 94 TMPs trained reported a total of 8,333 clients screened for Tuberculosis infections across 7 LGAs in Lagos State. 715 presumptive TB cases were identified (representing 0.09% of screened cases) and 628 samples were further evaluated for TB (88% of identified presumptive cases) with 12 confirmed TB-positive cases reported (2% of presumptive cases), 11 linked to treatment, and 1 death reported.
Conclusion: This research offers compelling evidence supporting the efficacy of engaging Traditional Medicine Practitioners (TMPs) in enhancing active Tuberculosis (TB) case finding in Lagos State. The substantial and positive impact observed underscores the potential of this approach to play a pivotal role in TB control initiatives, fortifying the healthcare system's resilience in addressing TB within the community outside hospital facilities.

Keywords: Tuberculosis (TB), Traditional Medicine Practitioners (TMP),

South African Medical Journal, 2014

South Africa (SA) is in a unique position to move towards virtual elimination of new HIV infectio... more South Africa (SA) is in a unique position to move towards virtual elimination of new HIV infections in children by 2015 (defined as a <2% rate of mother-tochild transmission (MTCT) of HIV at 6 weeks and a <5% rate at 18 months. [1] There has been a massive scale-up of the prevention of mother-to-child transmission (PMTCT) of HIV programme. The SA PMTCT Evaluation showed 3.5% MTCT at 4-8 weeks of age in 2010. [2] When the survey was repeated in 2011, the MTCT rate was 2.7%. The survey also showed that the proportion of eligible pregnant women taking triple antiretrovirals (ARVs) increased from 33.1% in 2010 to 46.2% in 2011. [2] The National Strategic Plan on HIV, STIs and TB 2012-2016 sets a goal of 'Reducing MTCT to less than 2% at six weeks post-delivery and less than 5% at 18 months of age by 2016'. [3] To reach the ambitious goals of achieving virtual elimination of MTCT and putting all pregnant women on treatment, it is critical to scale up the PMTCT programme across all healthcare facilities in the country. It is also important to understand challenges and bottlenecks at facility and district level to ensure tailored and contextualised responses that will enable results to be achieved at the local level. Several initiatives implemented in SA showed that decentralised planning and monitoring produce results. [4-6] These initiatives were implemented in a few facilities and focused primarily around the use of data and working with programme managers to gain an in-depth understanding of data. Quality improvement initiatives implemented at facility level using participatory data-driven approaches and on-site monitoring and supervisory support have shown improvement in PMTCT coverage and service delivery. [7,8] Between June and November 2011, the National Department of Health (NDoH) developed an action framework for eliminating MTCT of HIV by 2015 in SA. The framework is entitled 'No child born with HIV by 2015 and improving the health and wellbeing of mothers, partners and babies in South Africa'. [9] The over-arching foundation of the national action framework is the need for evidencebased, accelerated programme scale-up and delivery of quality services with innovation. The framework proposed that data-driven action plans are needed for all the districts and provinces. These action plans could then inform provincial and district-specific work planning, implementation and monitoring. This paper describes the process undertaken by the NDoH, in collaboration with partners, to develop, implement and monitor a datadriven intervention to improve facility, district, provincial and national PMTCT-related performance. Methods The NDoH, supported by partners, recognised that the backbone of this intervention is a series of critical pathways called the PMTCT cascade that pregnant HIV-positive women need to move through

International Journal of Sciences, 2017

International STD Research & Reviews, 2017

Background: In resource-limited settings, where genotypic drug resistance testing is rarely perfo... more Background: In resource-limited settings, where genotypic drug resistance testing is rarely performed and poor adherence is regarded as the most common reason for treatment failure, programmatic approaches to handling treatment failure are essential. This study is thus aimed at determining and monitoring HIV/AIDS disease progression using viral load to provide prognostic information and evaluate all patients for viral suppression using the World Health Organization (WHO) guideline strategies.

ABSTRACT: Soil erosion persists on agricultural lands in Nigeria. To curb erosive land degradatio... more ABSTRACT: Soil erosion persists on agricultural lands in Nigeria. To curb erosive land degradation requires soil conservation measures that are cheap, replicable and sustainable. The use of vetiver grass (Vetiveria zizanioides) has offered such prospects in a wide range of climatic environments. Although the grass grows in Nigeria, its potential for soil and water conservation and improved crop yield has not been realized, let alone quantified. A study was conducted at the Teaching and Research Farm of the University ofOf Ibadan, Nigeria (7o24 ' N, 3o 54 ' E) for three growing seasons to assess (i) the effectiveness of vetiver grass on soil and water loss, (ii) soil moisture retention and (iii) crop yields. Vetiver strips were established on 6 % slopes at a surface interval of 20m on erosion plots measuring 40m x 3m each. Plots with and without vetiver strips constituted the treatment and control, respectively. Each was replicated thrice and laid out in a randomized comple...

International STD Research & Reviews, 2017

Background: The efficiency and success of antiretroviral therapy (ART) depends on a good level of... more Background: The efficiency and success of antiretroviral therapy (ART) depends on a good level of patient's adherence to a lifelong regimen of antiretroviral (ARV) which is beneficial in reducing the risk of emergence of HIV resistant strains. This adherence is however influenced by several Original Research Article

European Journal of Medical and Health Sciences, 2019

Background: Key populations are defined groups who, due to specific higher-risk behaviour, are at... more Background: Key populations are defined groups who, due to specific higher-risk behaviour, are at increased risk of HIV infection irrespective of the epidemic type or local context. Also, they often have legal and social issues related to their behaviour that increase their vulnerability to HIV. In Nigeria, Key population (KP) groups account for a significant portion of new HIV infections. Directly, FSW, MSM and PWID, who constitute an estimated 1% of the adult Nigerian population, contribute nearly 23% of new HIV infections. About 20% of infections may be attributed to female sex workers, their clients and client partners alone, of which three-fourths may be attributable to brothel-based FSWs. People who inject drugs (PWID), MSM and their partners respectively contribute about 9% and 10% of the annual new infections. These KPs and their partners together, who constitute an estimated 3.4% of the adult population, contribute as much as 40% of new infections Methods: This was a retros...

International Journal of Sciences, 2017

International STD Research & Reviews

Research and Reviews on Healthcare: Open Access Journal, Dec 4, 2018

Background: The poor utilization of data generated from the RHIS in RH/FP has made it difficult t... more Background: The poor utilization of data generated from the RHIS in RH/FP has made it difficult to address some of the challenges associated with the uptake of RH/FP services. Objectives: The literature on health information systems in FP is replete with complaints of the neglect of existing information, yet remarkably little is known regarding the factors that influence acting on routine health information generated in family planning services in Nigeria. The following are the research Questions; what are the factors that facilitate the use of routine health information in FP services and What are the factors that hinder the use of routine health information in FP service? Methods: This was a prospective cross sectional mixed method study carried out over a period of 12 months in three Local government areas in Lagos, southwest Nigeria. Results: There was a very high level (n=374, 88%) of awareness on RHI indicators among the respondents. Over 90% of the respondents reported that Integrating FP into other health interventions, such as HIV, immunizations, deliveries, and post-abortion care (n=388, 91.3%), availability of staff skilled in record-keeping (n=403, 94.8%), management or supervisor’s interest in data quality and data use (n=394, 92.7%), receiving feedback from higher levels on reports sent with collected FP data (n=399, (93.9%) .The commonest hindrances to the use of RHI include poor quality data (n=396; 93.2%), incomplete data (n=399; 93.9%), noninvolvement of policy makers in data collection (n=391; 92.0%) and lack of feedback from higher levels on how data generated has been put to use (n=423; 93.6%). Conclusion: It is hoped that promoting the factors identified as facilitators of RHI and removing those categorized as hindrances in this study would encourage the use of routine health information and ultimately improve family planning services in the state and the nation as a whole.

Research and Reviews on Healthcare: Open Access Journal, Dec 4, 2018

Background: The poor utilization of data generated from the RHIS in RH/FP has made it difficult t... more Background: The poor utilization of data generated from the RHIS in RH/FP has made it difficult to address some of the challenges associated with the uptake of RH/FP services. Objectives: The literature on health information systems in FP is replete with complaints of the neglect of existing information, yet remarkably little is known regarding the factors that influence acting on routine health information generated in family planning services in Nigeria. The following are the research Questions; what are the factors that facilitate the use of routine health information in FP services and What are the factors that hinder the use of routine health information in FP service? Methods: This was a prospective cross sectional mixed method study carried out over a period of 12 months in three Local government areas in Lagos, southwest Nigeria. Results: There was a very high level (n=374, 88%) of awareness on RHI indicators among the respondents. Over 90% of the respondents reported that Integrating FP into other health interventions, such as HIV, immunizations, deliveries, and post-abortion care (n=388, 91.3%), availability of staff skilled in record-keeping (n=403, 94.8%), management or supervisor’s interest in data quality and data use (n=394, 92.7%), receiving feedback from higher levels on reports sent with collected FP data (n=399, (93.9%) .The commonest hindrances to the use of RHI include poor quality data (n=396; 93.2%), incomplete data (n=399; 93.9%), noninvolvement of policy makers in data collection (n=391; 92.0%) and lack of feedback from higher levels on how data generated has been put to use (n=423; 93.6%). Conclusion: It is hoped that promoting the factors identified as facilitators of RHI and removing those categorized as hindrances in this study would encourage the use of routine health information and ultimately improve family planning services in the state and the nation as a whole.

International Journal of Infectious Diseases and Research, 2021

International STD Research & Reviews, 2017

Background: The efficiency and success of antiretroviral therapy (ART) depends on a good level of... more Background: The efficiency and success of antiretroviral therapy (ART) depends on a good level of patient's adherence to a lifelong regimen of antiretroviral (ARV) which is beneficial in reducing the risk of emergence of HIV resistant strains. This adherence is however influenced by several Original Research Article Usman et al.; ISRR, 6(3): 1-8, 2017; Article no.ISRR.38469 2 factors related mainly to patient and medication. This study is therefore carried out to determine the adherence rate of adult patients infected with HIV and identify the factors associated with antiretroviral therapy (ART) interruption or poor adherence. Methods: This cross sectional study was carried out in Ondo & Ekiti States, South Western Nigeria. The target population was adult patients living with HIV and already initiated on ART. Data was collected by trained volunteers and supervised by appointed supervisors, by a face-to-face interview. All data were statistically analysed, using statistical package for the social sciences (SPSS) and statistical test of significance was performed with Chi-Square test. Results: A total of 412 consenting respondents participated in the study with a mean age ± SD is 37.93 ± 9.30 years. 116 (40.8%) of them are males while 244 (59.2%) are females. ART adherence level was 79.6%. The main factor associated with ART adherence was educational status (χ² = 16.18, df = 3, P = 0.001). Drug reminder strategy have lower association with missing ART drug (OR: 0.51, 95% CI: 0.28-0.92) while patients experiencing ART drug side effect have higher association with missing ART drug (OR: 1.82, 95% CI: 1.01-3.28). Conclusion: ART adherence is sub-optimal, with barriers largely patient-dependent thus it is imperative to intensify medication adherence counselling in an holistic behavioural educational improvement strategy aimed at improving the ability to fit therapy into own lifestyle, avoid drug exhaustion, achieve optimal adherence and remarkable patient outcome.

European Journal of Medical and Health Sciences, 2019

Background: Key populations are defined groups who, due to specific higher-risk behaviour, are at... more Background: Key populations are defined groups who, due to specific higher-risk behaviour, are at increased risk of HIV infection irrespective of the epidemic type or local context. Also, they often have legal and social issues related to their behaviour that increase their vulnerability to HIV. In Nigeria, Key population (KP) groups account for a significant portion of new HIV infections. Directly, FSW, MSM and PWID, who constitute an estimated 1% of the adult Nigerian population, contribute nearly 23% of new HIV infections. About 20% of infections may be attributed to female sex workers, their clients and client partners alone, of which three-fourths may be attributable to brothel-based FSWs. People who inject drugs (PWID), MSM and their partners respectively contribute about 9% and 10% of the annual new infections. These KPs and their partners together, who constitute an estimated 3.4% of the adult population, contribute as much as 40% of new infections Methods: This was a retrospective analysis of the programmatic data of an HIV intervention projects among the three key populations in 15 local government areas (LGA) in Lagos, Nigeria, between October 2018 and June 2019. Findings: Among the MSM, HIV positivity rate was 9.6 % (2.9% to 15.2%), about 96% were linked and initiated on antiretroviral drugs (ARV). Six months ART retention rate was 95%. For the FSW, the HIV infection rate was of 5% (1.4%-12.9%) and a linkage and ART initiation rate was 96.5% while the six month ART retention rate was 92%. Among the male PWID the HIV positivity rate was 1.4%. (0.4%-17.3%) while the female PWID HIV positivity rate was 8.14%, which was 8 times the average positivity rate among the male PWID. Linkage and ART initiation rate was 100% among HIV positive PWID but only 50% were still active in care 6months after initiation (ART retention rate). Conclusions: Having attained over 90% ARV initiation and retention rates among MSM, FSW and PWID on the project, achieving the 3rd UNAIDS target of 90% viral suppression in the groups is very much possible with appropriate programming. Also engaging social support service such as the use of peers as case managers is associated with excellent 6 month retention outcome.

Conference Presentations by Madu Onyema

NISA 2019 Conference, 2019

Background: Nigeria with an HIV prevalence of 1.4% has a mixed epidemic, a general epidemic affec... more Background: Nigeria with an HIV prevalence of 1.4% has a mixed epidemic, a general epidemic affecting the general population and concentrated epidemic affecting key and vulnerable populations.. In Nigeria, FSW, MSM and PWID, who constitute an estimated 1% of the adult Nigerian population, contribute nearly 23% of new HIV infections. About 20% of infections may be attributed to female sex workers, their clients and client partners alone, of which three-fourths may be attributable to brothel-based FSWs. People who inject drugs (PWID), MSM and their partners respectively contribute about 9% and 10% of the annual new infections. These KPs and their partners together, who constitute an estimated 3.4% of the adult population, contribute as much as 40% of new infections (1). Drivers of HIV epidemic among the KP include stigma, discrimination, limited KP-friendly services, and other structural barriers like unfavorable legal environment for MSM in Nigeria through the introduction of the Same Sex Prohibition Act. Also the HIV prevention, treatment, and care continuum remains inaccessible for many KP (Baral et al., 2009, Schwartz, 2015). As a result, progress toward ensuring universal access to HIV services for KP, and achieving HIV epidemic control, has been sub-optimal in many SSA countries (WHO, 2016). In a bid to improve access to HIV services among MSM, staffs in selected public and private hospitals were trained to provide key population friendly services and drop-in centres known as OSS were set up to provide comprehensive HIV services under one roof.
Objective: To evaluate differences in rates of HIV infection, ART initiation, viral suppression and retention among MSM referred to OSS and KP friendly centers.
Methods: This was a retrospective analysis of the programmatic data of an HIV intervention projects among the MSM populations in Oyo and Lagos states, Nigeria, between October 2018 and June 2019.The project in Oyo state was centered around OSS while Lagos engaged KP friendly public health centers
Findings: HIV Treatment Cascade
S/N Cascade Levels One Stop Shop(OSS) KP friendly centers P value
1 HIV Testing 3,248 2,707
2 HIV Positive 204 (6.3%) 260(9.6%)
3 ART Linkage 185(90.7%) 250(96.2%)
4 Viral Load Suppression 19/20 (95%) 20/50(40%)
5 Retention 177(95.7%) 229 (91.6%)

Discussion: At the OSS, a total of3, 248 MSM were tested for HIV infection and 204 confirmed HIV infected, giving a positivity rate of 6.3% while on the KP friendly centers project a total of 2,707 were screened for HIV and 260 were confirmed HIV positive giving an infection rate of 9.6%.The difference in number tested for HIV was as a result of the difference in the program targets given to the two states. The HIV infection rate among MSM in Lagos state where the KP friendly centers was engaged can thus be said to be higher than the infection rate among MSM in Oyo state where the OSS center used. ART Linkage and initiation of ART among the positive MSM was higher at 96% with the KP friendly centers compared with the 91% ART initiation rate at the OSS. Viral suppression rate of 95% among MSM enrolled at the OSS was higher than the 40% suppression rate among the infected MSM in care at the KP friendly centers in Lagos. About 96% and 92% of those on ART were still active in care at the OSS and the KP friendly centers respectively 6 months after enrolment.
Conclusions: HIV prevalence among MSM who patronised KP friendly hospitals in Lagos is higher than those who accessed care at the OSS in Oyo state. Linkage to ART for initiation was also higher among MSM referred to KP friendly centers compared to those referred to OSS. However, viral suppression and retention in care at 6months were higher among MSM receiving care at OSS.
Recommendations Therefore a project that combine the benefits of the two modes of interventions will be most ideal for the MSM community.

International Journal of Science and Healthcare Research Vol.9; Issue: 1; Jan.-March 2024 Website: ijshr.com Original Research Article ISSN: 2455-7587, 2024

ABSTRACT Background: Tuberculosis (TB) remains a significant global health challenge, particularl... more ABSTRACT
Background: Tuberculosis (TB) remains a significant global health challenge, particularly in high-burden countries like Nigeria. Despite efforts to combat TB, a substantial number of cases remain undiagnosed and untreated, contributing to the continued spread of the disease. In response to this public health crisis, the USAID/Nigeria Tuberculosis Local Organization (USAID/Nigeria TB LON) project, implemented by the Equitable Health Access Initiative (EHAI) in Lagos State, initiated a novel approach to TB case finding. This journal article provides an overview of the strategies, activities, challenges, and achievements of the Program within the USAID TB LON 3 project in Lagos State, with a focus on the period from March to September 2021
Methods: This approach involves collaboration with Traditional Medicine Practitioners (TMPs) to identify and link presumptive TB cases to testing and treatment services.
Result: From March to September 2021, only 30 out of the 94 TMPs trained reported a total of 8,333 clients screened for Tuberculosis infections across 7 LGAs in Lagos State. 715 presumptive TB cases were identified (representing 0.09% of screened cases) and 628 samples were further evaluated for TB (88% of identified presumptive cases) with 12 confirmed TB-positive cases reported (2% of presumptive cases), 11 linked to treatment, and 1 death reported.
Conclusion: This research offers compelling evidence supporting the efficacy of engaging Traditional Medicine Practitioners (TMPs) in enhancing active Tuberculosis (TB) case finding in Lagos State. The substantial and positive impact observed underscores the potential of this approach to play a pivotal role in TB control initiatives, fortifying the healthcare system's resilience in addressing TB within the community outside hospital facilities.

Keywords: Tuberculosis (TB), Traditional Medicine Practitioners (TMP),

South African Medical Journal, 2014

South Africa (SA) is in a unique position to move towards virtual elimination of new HIV infectio... more South Africa (SA) is in a unique position to move towards virtual elimination of new HIV infections in children by 2015 (defined as a <2% rate of mother-tochild transmission (MTCT) of HIV at 6 weeks and a <5% rate at 18 months. [1] There has been a massive scale-up of the prevention of mother-to-child transmission (PMTCT) of HIV programme. The SA PMTCT Evaluation showed 3.5% MTCT at 4-8 weeks of age in 2010. [2] When the survey was repeated in 2011, the MTCT rate was 2.7%. The survey also showed that the proportion of eligible pregnant women taking triple antiretrovirals (ARVs) increased from 33.1% in 2010 to 46.2% in 2011. [2] The National Strategic Plan on HIV, STIs and TB 2012-2016 sets a goal of 'Reducing MTCT to less than 2% at six weeks post-delivery and less than 5% at 18 months of age by 2016'. [3] To reach the ambitious goals of achieving virtual elimination of MTCT and putting all pregnant women on treatment, it is critical to scale up the PMTCT programme across all healthcare facilities in the country. It is also important to understand challenges and bottlenecks at facility and district level to ensure tailored and contextualised responses that will enable results to be achieved at the local level. Several initiatives implemented in SA showed that decentralised planning and monitoring produce results. [4-6] These initiatives were implemented in a few facilities and focused primarily around the use of data and working with programme managers to gain an in-depth understanding of data. Quality improvement initiatives implemented at facility level using participatory data-driven approaches and on-site monitoring and supervisory support have shown improvement in PMTCT coverage and service delivery. [7,8] Between June and November 2011, the National Department of Health (NDoH) developed an action framework for eliminating MTCT of HIV by 2015 in SA. The framework is entitled 'No child born with HIV by 2015 and improving the health and wellbeing of mothers, partners and babies in South Africa'. [9] The over-arching foundation of the national action framework is the need for evidencebased, accelerated programme scale-up and delivery of quality services with innovation. The framework proposed that data-driven action plans are needed for all the districts and provinces. These action plans could then inform provincial and district-specific work planning, implementation and monitoring. This paper describes the process undertaken by the NDoH, in collaboration with partners, to develop, implement and monitor a datadriven intervention to improve facility, district, provincial and national PMTCT-related performance. Methods The NDoH, supported by partners, recognised that the backbone of this intervention is a series of critical pathways called the PMTCT cascade that pregnant HIV-positive women need to move through

International Journal of Sciences, 2017

International STD Research & Reviews, 2017

Background: In resource-limited settings, where genotypic drug resistance testing is rarely perfo... more Background: In resource-limited settings, where genotypic drug resistance testing is rarely performed and poor adherence is regarded as the most common reason for treatment failure, programmatic approaches to handling treatment failure are essential. This study is thus aimed at determining and monitoring HIV/AIDS disease progression using viral load to provide prognostic information and evaluate all patients for viral suppression using the World Health Organization (WHO) guideline strategies.

ABSTRACT: Soil erosion persists on agricultural lands in Nigeria. To curb erosive land degradatio... more ABSTRACT: Soil erosion persists on agricultural lands in Nigeria. To curb erosive land degradation requires soil conservation measures that are cheap, replicable and sustainable. The use of vetiver grass (Vetiveria zizanioides) has offered such prospects in a wide range of climatic environments. Although the grass grows in Nigeria, its potential for soil and water conservation and improved crop yield has not been realized, let alone quantified. A study was conducted at the Teaching and Research Farm of the University ofOf Ibadan, Nigeria (7o24 ' N, 3o 54 ' E) for three growing seasons to assess (i) the effectiveness of vetiver grass on soil and water loss, (ii) soil moisture retention and (iii) crop yields. Vetiver strips were established on 6 % slopes at a surface interval of 20m on erosion plots measuring 40m x 3m each. Plots with and without vetiver strips constituted the treatment and control, respectively. Each was replicated thrice and laid out in a randomized comple...

International STD Research & Reviews, 2017

Background: The efficiency and success of antiretroviral therapy (ART) depends on a good level of... more Background: The efficiency and success of antiretroviral therapy (ART) depends on a good level of patient's adherence to a lifelong regimen of antiretroviral (ARV) which is beneficial in reducing the risk of emergence of HIV resistant strains. This adherence is however influenced by several Original Research Article

European Journal of Medical and Health Sciences, 2019

Background: Key populations are defined groups who, due to specific higher-risk behaviour, are at... more Background: Key populations are defined groups who, due to specific higher-risk behaviour, are at increased risk of HIV infection irrespective of the epidemic type or local context. Also, they often have legal and social issues related to their behaviour that increase their vulnerability to HIV. In Nigeria, Key population (KP) groups account for a significant portion of new HIV infections. Directly, FSW, MSM and PWID, who constitute an estimated 1% of the adult Nigerian population, contribute nearly 23% of new HIV infections. About 20% of infections may be attributed to female sex workers, their clients and client partners alone, of which three-fourths may be attributable to brothel-based FSWs. People who inject drugs (PWID), MSM and their partners respectively contribute about 9% and 10% of the annual new infections. These KPs and their partners together, who constitute an estimated 3.4% of the adult population, contribute as much as 40% of new infections Methods: This was a retros...

International Journal of Sciences, 2017

International STD Research & Reviews

Research and Reviews on Healthcare: Open Access Journal, Dec 4, 2018

Background: The poor utilization of data generated from the RHIS in RH/FP has made it difficult t... more Background: The poor utilization of data generated from the RHIS in RH/FP has made it difficult to address some of the challenges associated with the uptake of RH/FP services. Objectives: The literature on health information systems in FP is replete with complaints of the neglect of existing information, yet remarkably little is known regarding the factors that influence acting on routine health information generated in family planning services in Nigeria. The following are the research Questions; what are the factors that facilitate the use of routine health information in FP services and What are the factors that hinder the use of routine health information in FP service? Methods: This was a prospective cross sectional mixed method study carried out over a period of 12 months in three Local government areas in Lagos, southwest Nigeria. Results: There was a very high level (n=374, 88%) of awareness on RHI indicators among the respondents. Over 90% of the respondents reported that Integrating FP into other health interventions, such as HIV, immunizations, deliveries, and post-abortion care (n=388, 91.3%), availability of staff skilled in record-keeping (n=403, 94.8%), management or supervisor’s interest in data quality and data use (n=394, 92.7%), receiving feedback from higher levels on reports sent with collected FP data (n=399, (93.9%) .The commonest hindrances to the use of RHI include poor quality data (n=396; 93.2%), incomplete data (n=399; 93.9%), noninvolvement of policy makers in data collection (n=391; 92.0%) and lack of feedback from higher levels on how data generated has been put to use (n=423; 93.6%). Conclusion: It is hoped that promoting the factors identified as facilitators of RHI and removing those categorized as hindrances in this study would encourage the use of routine health information and ultimately improve family planning services in the state and the nation as a whole.

Research and Reviews on Healthcare: Open Access Journal, Dec 4, 2018

Background: The poor utilization of data generated from the RHIS in RH/FP has made it difficult t... more Background: The poor utilization of data generated from the RHIS in RH/FP has made it difficult to address some of the challenges associated with the uptake of RH/FP services. Objectives: The literature on health information systems in FP is replete with complaints of the neglect of existing information, yet remarkably little is known regarding the factors that influence acting on routine health information generated in family planning services in Nigeria. The following are the research Questions; what are the factors that facilitate the use of routine health information in FP services and What are the factors that hinder the use of routine health information in FP service? Methods: This was a prospective cross sectional mixed method study carried out over a period of 12 months in three Local government areas in Lagos, southwest Nigeria. Results: There was a very high level (n=374, 88%) of awareness on RHI indicators among the respondents. Over 90% of the respondents reported that Integrating FP into other health interventions, such as HIV, immunizations, deliveries, and post-abortion care (n=388, 91.3%), availability of staff skilled in record-keeping (n=403, 94.8%), management or supervisor’s interest in data quality and data use (n=394, 92.7%), receiving feedback from higher levels on reports sent with collected FP data (n=399, (93.9%) .The commonest hindrances to the use of RHI include poor quality data (n=396; 93.2%), incomplete data (n=399; 93.9%), noninvolvement of policy makers in data collection (n=391; 92.0%) and lack of feedback from higher levels on how data generated has been put to use (n=423; 93.6%). Conclusion: It is hoped that promoting the factors identified as facilitators of RHI and removing those categorized as hindrances in this study would encourage the use of routine health information and ultimately improve family planning services in the state and the nation as a whole.

International Journal of Infectious Diseases and Research, 2021

International STD Research & Reviews, 2017

Background: The efficiency and success of antiretroviral therapy (ART) depends on a good level of... more Background: The efficiency and success of antiretroviral therapy (ART) depends on a good level of patient's adherence to a lifelong regimen of antiretroviral (ARV) which is beneficial in reducing the risk of emergence of HIV resistant strains. This adherence is however influenced by several Original Research Article Usman et al.; ISRR, 6(3): 1-8, 2017; Article no.ISRR.38469 2 factors related mainly to patient and medication. This study is therefore carried out to determine the adherence rate of adult patients infected with HIV and identify the factors associated with antiretroviral therapy (ART) interruption or poor adherence. Methods: This cross sectional study was carried out in Ondo & Ekiti States, South Western Nigeria. The target population was adult patients living with HIV and already initiated on ART. Data was collected by trained volunteers and supervised by appointed supervisors, by a face-to-face interview. All data were statistically analysed, using statistical package for the social sciences (SPSS) and statistical test of significance was performed with Chi-Square test. Results: A total of 412 consenting respondents participated in the study with a mean age ± SD is 37.93 ± 9.30 years. 116 (40.8%) of them are males while 244 (59.2%) are females. ART adherence level was 79.6%. The main factor associated with ART adherence was educational status (χ² = 16.18, df = 3, P = 0.001). Drug reminder strategy have lower association with missing ART drug (OR: 0.51, 95% CI: 0.28-0.92) while patients experiencing ART drug side effect have higher association with missing ART drug (OR: 1.82, 95% CI: 1.01-3.28). Conclusion: ART adherence is sub-optimal, with barriers largely patient-dependent thus it is imperative to intensify medication adherence counselling in an holistic behavioural educational improvement strategy aimed at improving the ability to fit therapy into own lifestyle, avoid drug exhaustion, achieve optimal adherence and remarkable patient outcome.

European Journal of Medical and Health Sciences, 2019

Background: Key populations are defined groups who, due to specific higher-risk behaviour, are at... more Background: Key populations are defined groups who, due to specific higher-risk behaviour, are at increased risk of HIV infection irrespective of the epidemic type or local context. Also, they often have legal and social issues related to their behaviour that increase their vulnerability to HIV. In Nigeria, Key population (KP) groups account for a significant portion of new HIV infections. Directly, FSW, MSM and PWID, who constitute an estimated 1% of the adult Nigerian population, contribute nearly 23% of new HIV infections. About 20% of infections may be attributed to female sex workers, their clients and client partners alone, of which three-fourths may be attributable to brothel-based FSWs. People who inject drugs (PWID), MSM and their partners respectively contribute about 9% and 10% of the annual new infections. These KPs and their partners together, who constitute an estimated 3.4% of the adult population, contribute as much as 40% of new infections Methods: This was a retrospective analysis of the programmatic data of an HIV intervention projects among the three key populations in 15 local government areas (LGA) in Lagos, Nigeria, between October 2018 and June 2019. Findings: Among the MSM, HIV positivity rate was 9.6 % (2.9% to 15.2%), about 96% were linked and initiated on antiretroviral drugs (ARV). Six months ART retention rate was 95%. For the FSW, the HIV infection rate was of 5% (1.4%-12.9%) and a linkage and ART initiation rate was 96.5% while the six month ART retention rate was 92%. Among the male PWID the HIV positivity rate was 1.4%. (0.4%-17.3%) while the female PWID HIV positivity rate was 8.14%, which was 8 times the average positivity rate among the male PWID. Linkage and ART initiation rate was 100% among HIV positive PWID but only 50% were still active in care 6months after initiation (ART retention rate). Conclusions: Having attained over 90% ARV initiation and retention rates among MSM, FSW and PWID on the project, achieving the 3rd UNAIDS target of 90% viral suppression in the groups is very much possible with appropriate programming. Also engaging social support service such as the use of peers as case managers is associated with excellent 6 month retention outcome.

NISA 2019 Conference, 2019

Background: Nigeria with an HIV prevalence of 1.4% has a mixed epidemic, a general epidemic affec... more Background: Nigeria with an HIV prevalence of 1.4% has a mixed epidemic, a general epidemic affecting the general population and concentrated epidemic affecting key and vulnerable populations.. In Nigeria, FSW, MSM and PWID, who constitute an estimated 1% of the adult Nigerian population, contribute nearly 23% of new HIV infections. About 20% of infections may be attributed to female sex workers, their clients and client partners alone, of which three-fourths may be attributable to brothel-based FSWs. People who inject drugs (PWID), MSM and their partners respectively contribute about 9% and 10% of the annual new infections. These KPs and their partners together, who constitute an estimated 3.4% of the adult population, contribute as much as 40% of new infections (1). Drivers of HIV epidemic among the KP include stigma, discrimination, limited KP-friendly services, and other structural barriers like unfavorable legal environment for MSM in Nigeria through the introduction of the Same Sex Prohibition Act. Also the HIV prevention, treatment, and care continuum remains inaccessible for many KP (Baral et al., 2009, Schwartz, 2015). As a result, progress toward ensuring universal access to HIV services for KP, and achieving HIV epidemic control, has been sub-optimal in many SSA countries (WHO, 2016). In a bid to improve access to HIV services among MSM, staffs in selected public and private hospitals were trained to provide key population friendly services and drop-in centres known as OSS were set up to provide comprehensive HIV services under one roof.
Objective: To evaluate differences in rates of HIV infection, ART initiation, viral suppression and retention among MSM referred to OSS and KP friendly centers.
Methods: This was a retrospective analysis of the programmatic data of an HIV intervention projects among the MSM populations in Oyo and Lagos states, Nigeria, between October 2018 and June 2019.The project in Oyo state was centered around OSS while Lagos engaged KP friendly public health centers
Findings: HIV Treatment Cascade
S/N Cascade Levels One Stop Shop(OSS) KP friendly centers P value
1 HIV Testing 3,248 2,707
2 HIV Positive 204 (6.3%) 260(9.6%)
3 ART Linkage 185(90.7%) 250(96.2%)
4 Viral Load Suppression 19/20 (95%) 20/50(40%)
5 Retention 177(95.7%) 229 (91.6%)

Discussion: At the OSS, a total of3, 248 MSM were tested for HIV infection and 204 confirmed HIV infected, giving a positivity rate of 6.3% while on the KP friendly centers project a total of 2,707 were screened for HIV and 260 were confirmed HIV positive giving an infection rate of 9.6%.The difference in number tested for HIV was as a result of the difference in the program targets given to the two states. The HIV infection rate among MSM in Lagos state where the KP friendly centers was engaged can thus be said to be higher than the infection rate among MSM in Oyo state where the OSS center used. ART Linkage and initiation of ART among the positive MSM was higher at 96% with the KP friendly centers compared with the 91% ART initiation rate at the OSS. Viral suppression rate of 95% among MSM enrolled at the OSS was higher than the 40% suppression rate among the infected MSM in care at the KP friendly centers in Lagos. About 96% and 92% of those on ART were still active in care at the OSS and the KP friendly centers respectively 6 months after enrolment.
Conclusions: HIV prevalence among MSM who patronised KP friendly hospitals in Lagos is higher than those who accessed care at the OSS in Oyo state. Linkage to ART for initiation was also higher among MSM referred to KP friendly centers compared to those referred to OSS. However, viral suppression and retention in care at 6months were higher among MSM receiving care at OSS.
Recommendations Therefore a project that combine the benefits of the two modes of interventions will be most ideal for the MSM community.