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Ezenwosu OU, Olawepo JO, Lacroix-Willliamson LJ, Itanyi IU, Ogidi A, Onyeka TC, Gully M, Gregory M, Breeze JL, Ibemere S, Idemili-Aronu N, Molnar BE, Ezeanolue EE. Health education to promote knowledge about sickle cell disease and newborn screening in pregnant women: a community-based pilot study using the healthy beginning initiative. BMC Pregnancy Childbirth 2024; 24:321. [PMID: 38671412 PMCID: PMC11046861 DOI: 10.1186/s12884-024-06498-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Pregnancy presents a critical period for any maternal and child health intervention that may impact the health of the newborn. With low antenatal care attendance by pregnant women in health facilities in Nigeria, community-based programs could enable increased reach for health education about sickle cell disease (SCD) and newborn screening (NBS) among pregnant women. This pilot study aimed to assess the effect of education on the knowledge about SCD and NBS among pregnant women using the Healthy Beginning Initiative, a community-based framework. METHODS A pre-post study design was used to evaluate knowledge of SCD and NBS in a convenience sample of 89 consenting pregnant women from three communities. Participants were given surveys prior to and following completion of a health education session. McNemar's test was used to compare the proportion of participants with correct responses. The level of significance was taken as p < 0.05. RESULTS Compared to pre-test values, post-test values showed that participants understood that SCD is hereditary (93.3% vs. 69.7%), both parents must have at least one gene for someone to have SCD (98.9% vs. 77.5) and blood test is the right way to know if one has SCD (98.8% vs. 78.7%). Also, a large proportion of participants (post-test ~ 89.9%; compared to pre-test ~ 23.6%) understood that the chance of conceiving a child with SCD was 25% for a couple with the sickle cell trait (SCT). Knowledge of the possibility of diagnosing SCD shortly after birth was highly increased in the post test phase of the study when compared to the pre-test phase (93.3% vs. 43.9%, respectively). Concerning the overall knowledge scores, those with high level of knowledge significantly increase from 12.6% pretest to 87.4% posttest (p = 0.015). CONCLUSION The health education intervention was associated with significant improvement on almost all measures of SCD knowledge. Focused health education for pregnant women using community structures can improve knowledge of SCD and NBS.
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Affiliation(s)
- Osita U Ezenwosu
- Center for Translation and Implementation Research, University of Nigeria, Enugu, Nigeria.
- Department of Pediatrics, College of Medicine, University of Nigeria, Enugu, Nigeria.
| | - John O Olawepo
- Center for Translation and Implementation Research, University of Nigeria, Enugu, Nigeria
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
- Institute for Health Equity and Social Justice Research, Northeastern University, Boston, MA, USA
| | - Lorraine J Lacroix-Willliamson
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
- Institute for Health Equity and Social Justice Research, Northeastern University, Boston, MA, USA
| | - Ijeoma U Itanyi
- Center for Translation and Implementation Research, University of Nigeria, Enugu, Nigeria
- Department of Community Medicine, University of Nigeria, Enugu, Nigeria
| | - Amaka Ogidi
- Center for Translation and Implementation Research, University of Nigeria, Enugu, Nigeria
| | - Tonia C Onyeka
- Center for Translation and Implementation Research, University of Nigeria, Enugu, Nigeria
- Department of Anesthesia/Pain & Palliative Care Unit, University of Nigeria, Enugu, Nigeria
| | - Madeline Gully
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
| | - Maisha Gregory
- School of Nursing, Bouvé College of Health Sciences, Northeastern University, Boston, USA
| | - Janis L Breeze
- Tufts Clinical and Translational Science Institute, Institute for Clinical Research and Health Policy Studies, Tufts University, Tufts Medical Center, Boston, MA, USA
| | - Stephanie Ibemere
- Duke University School of Nursing, Duke Global Health Institute, Durham, NC, USA
| | - Ngozi Idemili-Aronu
- Center for Translation and Implementation Research, University of Nigeria, Enugu, Nigeria
| | - Beth E Molnar
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
- Institute for Health Equity and Social Justice Research, Northeastern University, Boston, MA, USA
| | - Echezona E Ezeanolue
- Center for Translation and Implementation Research, University of Nigeria, Enugu, Nigeria
- Healthy Sunrise Foundation, Las Vegas, NV, USA
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Olakunde BO, Itanyi IU, Olawepo JO, Liu L, Bembir C, Idemili-Aronu N, Lasebikan NN, Onyeka TC, Dim CC, Chigbu CO, Ezeanolue EE, Aarons GA. Comparative effectiveness of implementation strategies for Accelerating Cervical Cancer Elimination through the integration of Screen-and-treat Services (ACCESS study): protocol for a cluster randomized hybrid type III trial in Nigeria. Implement Sci 2024; 19:25. [PMID: 38468266 PMCID: PMC10926605 DOI: 10.1186/s13012-024-01349-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 02/03/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Despite the increased risk of cervical cancer (CC) among women living with HIV (WLHIV), CC screening and treatment (CCST) rates remain low in Africa. The integration of CCST services into established HIV programs in Africa can improve CC prevention and control. However, the paucity of evidence on effective implementation strategies (IS) has limited the success of integration in many countries. In this study, we seek to identify effective IS to enhance the integration of CCST services into existing HIV programs in Nigeria. METHODS Our proposed study has formative and experimental activities across the four phases of the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework. Through an implementation mapping conducted with stakeholders in the exploration phase, we identified a core package of IS (Core) and an enhanced package of IS (Core+) mostly selected from the Expert Recommendations for Implementing Change. In the preparation phase, we refined and tailored the Core and Core+ IS with the implementation resource teams for local appropriateness. In the implementation phase, we will conduct a cluster-randomized hybrid type III trial to assess the comparative effectiveness of Core versus Core+. HIV comprehensive treatment sites (k = 12) will be matched by region and randomized to Core or Core+ in the ratio of 1:1 stratified by region. In the sustainment phase, we will assess the sustainment of CCST at each site. The study outcomes will be assessed using RE-AIM: reach (screening rate), adoption (uptake of IS by study sites), IS fidelity (degree to which the IS occurred according to protocol), clinical intervention fidelity (delivery of CC screening, onsite treatment, and referral according to protocol), clinical effectiveness (posttreatment screen negative), and sustainment (continued integrated CCST service delivery). Additionally, we will descriptively explore potential mechanisms, including organizational readiness, implementation climate, CCST self-efficacy, and implementation intentions. DISCUSSION The assessment of IS to increase CCST rates is consistent with the global plan of eliminating CC as a public health threat by 2030. Our study will identify a set of evidence-based IS for low-income settings to integrate evidence-based CCST interventions into routine HIV care in order to improve the health and life expectancy of WLHIV. TRIAL REGISTRATION Prospectively registered on November 7, 2023, at ClinicalTrials.gov no. NCT06128304. https://classic. CLINICALTRIALS gov/ct2/show/study/NCT06128304.
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Affiliation(s)
- Babayemi O Olakunde
- Department of Community Prevention and Care Services, National Agency for the Control of AIDS, Abuja, Nigeria
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
| | - Ijeoma U Itanyi
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
- Department of Community Medicine, College of Medicine, University of Nigeria Nsukka, Enugu, Nigeria
| | - John O Olawepo
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
- Department of Health Sciences, Northeastern University, Boston, MA, USA
| | - Lin Liu
- Herbert Wertheim School of Public Health & Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Chinenye Bembir
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
| | - Ngozi Idemili-Aronu
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
- Department of Sociology and Anthropology, University of Nigeria Nsukka, Enugu, Nigeria
| | - Nwamaka N Lasebikan
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
- Oncology Center, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Tonia C Onyeka
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
- Department of Anaesthesia/Pain & Palliative Care Unit, College of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Cyril C Dim
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
- Department of Obstetrics and Gynecology, College of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Chibuike O Chigbu
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
- Department of Obstetrics and Gynecology, College of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Echezona E Ezeanolue
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
- HealthySunrise Foundation, Las Vegas, NV, USA
| | - Gregory A Aarons
- Department of Psychiatry, University of California San Diego, La Jolla, CA, 92093-0812, USA.
- UC San Diego ACTRI Dissemination and Implementation Science Center, La Jolla, CA, USA.
- Moores Cancer Center, University of California San Diego, La Jolla, CA, 92093, USA.
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Olakunde BO, Itanyi IU, Onyeka TC, Paintsil E, Torpey K, Lasebikan N, Chigbu CO, Ezeanolue EE. Hepatitis B vaccine birth dose coverage among hepatitis B-exposed and hepatitis B-unexposed infants: evidence from the Healthy Beginning Initiative program in Benue State, Nigeria. Pan Afr Med J 2024; 47:67. [PMID: 38681098 PMCID: PMC11055182 DOI: 10.11604/pamj.2024.47.67.40466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 01/16/2024] [Indexed: 05/01/2024] Open
Abstract
Introduction Nigeria offers universal hepatitis B birth-dose vaccine (HepB-BD) for the prevention and control of hepatitis B (HepB). While prior studies suggest low coverage of HepB-BD in Nigeria, there is a paucity of evidence on the association between the uptake of HepB-BD and maternal HepB status. This study aimed to determine HepB-BD coverage and the associated factors among infants of HepB-positive and -negative women in Nigeria. Methods the study was a secondary analysis of data from the Healthy Beginning Initiative program conducted between June 2016 and October 2018 in Benue State, Nigeria. The analysis was restricted to data from a cohort of 6269 mothers who had HepB screening during pregnancy and completed the HepB infant immunization question in the post-delivery survey. The association between the coverage of HepB-BD and maternal HepB status, sociodemographic characteristics, and obstetric factors were determined using crude and adjusted relative risks. Results about 10% of the women tested HepB positive. The coverage of HepB-BD was 64% (63.2% among infants of HepB-positive mothers and 63.8% among HepB-negative mothers). The likelihood of infants of HepB-positive mothers receiving HepB-BD was not significantly different from infants of HepB-negative mothers (aRR=0.97, 95%CI= 0.92-1.04). Among HepB-positive mothers, infants of mothers younger than 20 years (aRR=1.49, 95%CI=1.03-2.16) or those who received antenatal care (aRR=1.41, 95%CI=1.16-1.71) were more likely to receive HepB-BD, while mothers with no previous pregnancies (aRR=0.73, 95%CI=0.59-0.91) were less likely to receive HepB-BD. Among HepB-negative mothers, infants of less-educated mothers were less likely to receive HepB-BD (aRR=0.96, 95%CI=0.92-0.99), whereas infants of mothers who received antenatal care (aRR=1.23, 95%CI=1.16-1.31) or had an institutional delivery were more likely (aRR=1.29, 95%CI=1.23-1.36) to receive HepB-BD. Conclusion: our findings highlight the need to improve HepB-BD uptake, particularly among HepB-exposed infants who are at risk of perinatal transmission of HepB.
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Affiliation(s)
- Babayemi Oluwaseun Olakunde
- Department of Community Prevention and Care Services, National Agency for the Control of AIDS, Abuja, Nigeria
- Center for Translation and Implementation Research, University of Nigeria, Nsukka, Enugu, Nigeria
| | - Ijeoma Uchenna Itanyi
- Center for Translation and Implementation Research, University of Nigeria, Nsukka, Enugu, Nigeria
- Department of Community Medicine, College of Medicine, University of Nigeria, Nsukka, Enugu, Nigeria
| | - Tonia Chinyelu Onyeka
- Center for Translation and Implementation Research, University of Nigeria, Nsukka, Enugu, Nigeria
- Department of Anesthesia/Pain and Palliative Care Unit, College of Medicine, University of Nigeria, Nsukka, Nigeria
| | - Elijah Paintsil
- Department of Pediatrics, Yale School of Medicine, New Haven, CT 06510, USA
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06510, USA
- Department of Pharmacology, Yale School of Medicine, New Haven, CT, USA
| | - Kwasi Torpey
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Legon-Accra, Ghana
| | - Nwamaka Lasebikan
- Center for Translation and Implementation Research, University of Nigeria, Nsukka, Enugu, Nigeria
- Department of Radiation Medicine, College of Medicine, University of Nigeria, Nsukka, Enugu, Nigeria
| | - Chibuike Ogwuegbu Chigbu
- Center for Translation and Implementation Research, University of Nigeria, Nsukka, Enugu, Nigeria
- Department of Obstetrics and Gynaecology, College of Medicine, University of Nigeria, Nsukka, Enugu, Nigeria
| | - Echezona Edozie Ezeanolue
- Center for Translation and Implementation Research, University of Nigeria, Nsukka, Enugu, Nigeria
- Department of Paediatrics, College of Medicine, University of Nigeria, Nsukka, Enugu, Nigeria
- Healthy Sunrise Foundation, Nevada, USA
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Agbo UM, Nche GC. Suspecting the Figures: What Church Leaders Think About Government's Commitment to Combating COVID-19 in Nigeria. JOURNAL OF ASIAN AND AFRICAN STUDIES 2023; 58:725-746. [PMID: 37461428 PMCID: PMC10345814 DOI: 10.1177/00219096211069645] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Public trust in government can significantly determine the outcome of health policies in any society. Hence, studies have been gauging peoples' level of trust in their governments' commitment and capacity to win the fight against COVID-19. However, these studies have omitted religious leaders. This is despite the fact that religious leaders play key roles in the area of health in many societies. The present study, therefore, explored the opinions church leaders have about the credibility of the COVID-19 statistics and other government responses in Nigeria. Data were collected through semi-structured interviews with 18 church leaders drawn from Anglican, Catholic, and Pentecostal churches in Nigeria. A descriptive narrative approach was employed in the thematic organization and analysis of data. Findings show that only one participant expressed confidence in the credibility of the COVID-19 statistics and other government's responses. The rest, with the exception of one participant who was uncertain, was distributed between those who believe the statistics and other government efforts are exaggerated and those who believe they are false. The study also found that denominational affiliation mattered with respect to the perceptions about the credibility of the COVID-19 statistics and other government responses. Implications of findings for policy and research are discussed.
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Affiliation(s)
| | - George C. Nche
- George C. Nche, Department of Religion Studies, University of Johannesburg, Johannesburg, PO Box 524 / Cnr Kingsway & University Road, Auckland Park 2006, South Africa.
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Itanyi IU, Iwelunmor J, Olawepo JO, Gbadamosi S, Ezeonu A, Okoli A, Ogidi AG, Conserve D, Powell B, Onoka CA, Ezeanolue EE. Acceptability and user experiences of a patient-held smart card for antenatal services in Nigeria: a qualitative study. BMC Pregnancy Childbirth 2023; 23:198. [PMID: 36949403 PMCID: PMC10031993 DOI: 10.1186/s12884-023-05494-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/03/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND Poor maternal, newborn and child health outcomes remain a major public health challenge in Nigeria. Mobile health (mHealth) interventions such as patient-held smart cards have been proposed as effective solutions to improve maternal health outcomes. Our objectives were to assess the acceptability and experiences of pregnant women with the use of a patient-held smartcard for antenatal services in Nigeria. METHODS Using focus group discussions, qualitative data were obtained from 35 pregnant women attending antenatal services in four Local Government Areas (LGAs) in Benue State, Nigeria. The audio-recorded data were transcribed and analyzed using framework analysis techniques such as the PEN-3 cultural model as a guide. RESULTS The participants were 18-44 years of age (median age: 24 years), all were married and the majority were farmers. Most of the participants had accepted and used the smartcards for antenatal services. The most common positive perceptions about the smartcards were their ability to be used across multiple health facilities, the preference for storage of the women's medical information on the smartcards compared to the usual paper-based system, and shorter waiting times at the clinics. Notable facilitators to using the smartcards were its provision at the "Baby showers" which were already acceptable to the women, access to free medical screenings, and ease of storage and retrieval of health records from the cards. Costs associated with health services was reported as a major barrier to using the smartcards. Support from health workers, program staff and family members, particularly spouses, encouraged the participants to use the smartcards. CONCLUSION These findings revealed that patient-held smart card for maternal health care services is acceptable by women utilizing antenatal services in Nigeria. Understanding perceptions, barriers, facilitators, and supportive systems that enhance the use of these smart cards may facilitate the development of lifesaving mobile health platforms that have the potential to achieve antenatal, delivery, and postnatal targets in a resource-limited setting.
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Affiliation(s)
- Ijeoma Uchenna Itanyi
- Department of Community Medicine, College of Medicine, University of Nigeria Nsukka, Enugu, Nigeria
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
| | - Juliet Iwelunmor
- Department of Behavioral Science and Health Education, Saint Louis University, Saint Louis, USA
| | - John Olajide Olawepo
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
| | - Semiu Gbadamosi
- Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA
| | - Alexandra Ezeonu
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
| | - Adaeze Okoli
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
| | - Amaka Grace Ogidi
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
| | - Donaldson Conserve
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, USA
| | - Byron Powell
- Brown School, Washington University in St. Louis, Washington, USA
| | - Chima Ariel Onoka
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
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Akinnusi OO, Bello AJ, Adeleye IA, Nutor JJ. Evaluation of HIV infection in febrile patients visiting health centers in Lagos, Nigeria. BMC Res Notes 2022; 15:71. [PMID: 35183247 PMCID: PMC8858461 DOI: 10.1186/s13104-022-05961-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 02/07/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Acute febrile infections compatible with malaria are the most prevalent presentation at sub-Saharan African health clinics, accounting for 30-50% of outpatient visits. Acute human immunodeficiency virus (HIV) infection can mimic acute malaria symptoms. As a result, screening people with malaria symptoms for HIV infection is critical. The goal of our study was to find out how common HIV infection was among feverish patients. RESULTS Out of the 310 individuals screened, 9 (3.0%) had HIV-1 infection, with 5 (55.5%) being females and 4 (44.4%) being males. This study found no evidence of HIV-2 infection or HIV-1/HIV-2 co-infection. HIV infection was found in 1-3% of patients with probable malaria at different sites in Lagos, Nigeria.
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Affiliation(s)
- Ololade O Akinnusi
- Department of Microbiology, University of Lagos, Akoka, Lagos State, Nigeria
| | - Adebayo J Bello
- Department of Cell Biology and Genetics, University of Lagos, Akoka, Lagos State, Nigeria.,Evercare Laboratory, Evercare Hospital, Lekki, Lagos State, Nigeria
| | - Isaac A Adeleye
- Department of Microbiology, University of Lagos, Akoka, Lagos State, Nigeria
| | - Jerry John Nutor
- Department of Family Health Care Nursing, School of Nursing, University of California San Francisco, 2 Koret Way, Suite N431G, San Francisco, CA, 94143, USA.
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Montandon M, Efuntoye T, Itanyi IU, Onoka CA, Onwuchekwa C, Gwamna J, Schwitters A, Onyenuobi C, Ogidi AG, Swaminathan M, Oko JO, Ijaodola G, Odoh D, Ezeanolue EE. Improving uptake of prevention of mother-to-child HIV transmission services in Benue State, Nigeria through a faith-based congregational strategy. PLoS One 2021; 16:e0260694. [PMID: 34855849 PMCID: PMC8638953 DOI: 10.1371/journal.pone.0260694] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 11/15/2021] [Indexed: 11/18/2022] Open
Abstract
Background Nigeria has low antiretroviral therapy (ART) coverage among HIV-positive pregnant women. In a previous cluster-randomized trial in Nigeria, Baby Shower events resulted in higher HIV testing coverage and linkage of pregnant women to ART; here, we assess outcomes of Baby Shower events in a non-research setting. Methods Baby Shower events, including a prayer ceremony, group education, music, gifting of a “mama pack” with safe delivery supplies, and HIV testing with ART linkage support for HIV-positive pregnant women, were conducted in eighty sites in Benue State, Nigeria. Client questionnaires (including demographics, ANC attendance, and HIV testing history), HIV test results, and reported linkage to ART were analyzed. Descriptive data on HIV testing and ART linkage data for facility-based care at ANC clinics in Benue State were also analyzed for comparison. Results Between July 2016 and October 2017, 10,056 pregnant women and 6,187 male partners participated in Baby Shower events; 61.5% of women attended with a male partner. Nearly half of female participants (n = 4515, 44.9%) were not enrolled in ANC for the current pregnancy, and 22.3% (n = 2,241) of female and 24.8% (n = 1,532) of male participants reported they had never been tested for HIV. Over 99% (n = 16,240) of participants had their HIV status ascertained, with 7.2% of females (n = 724) and 4.0% of males (n = 249) testing HIV-positive, and 2.9% of females (n = 274) and 2.3% of males (n = 138) receiving new HIV-positive diagnoses. The majority of HIV-positive pregnant women (93.0%, 673/724) were linked to ART. By comparison, at health facilities in Benue State during a similar time period, 99.7% of pregnant women had HIV status ascertained, 8.4% had a HIV-positive status, 2.1% were newly diagnosed HIV-positive, and 100% were linked to ART. Conclusion Community-based programs such as the faith-based Baby Shower intervention complement facility-based approaches and can reach individuals who would not otherwise access facility-based care. Future Baby Showers implementation should incorporate enhanced support for ART linkage and retention to maximize the impact of this intervention on vertical HIV transmission.
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Affiliation(s)
- Michele Montandon
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
- * E-mail:
| | - Timothy Efuntoye
- Centers for Disease Control and Prevention, Abuja, Federal Capital Territory, Nigeria
| | - Ijeoma U. Itanyi
- University of Nigeria Center for Translation and Implementation Research, Nsukka, Enugu, Nigeria
- Department of Community Medicine, University of Nigeria, Nsukka, Enugu, Nigeria
| | - Chima A. Onoka
- University of Nigeria Center for Translation and Implementation Research, Nsukka, Enugu, Nigeria
- Department of Community Medicine, University of Nigeria, Nsukka, Enugu, Nigeria
| | | | - Jerry Gwamna
- Centers for Disease Control and Prevention, Abuja, Federal Capital Territory, Nigeria
| | - Amee Schwitters
- Centers for Disease Control and Prevention, Abuja, Federal Capital Territory, Nigeria
| | - Chibuzor Onyenuobi
- Centers for Disease Control and Prevention, Abuja, Federal Capital Territory, Nigeria
| | - Amaka G. Ogidi
- University of Nigeria Center for Translation and Implementation Research, Nsukka, Enugu, Nigeria
| | - Mahesh Swaminathan
- Centers for Disease Control and Prevention, Abuja, Federal Capital Territory, Nigeria
| | | | - Gbenga Ijaodola
- Nigeria Federal Ministry of Health, National AIDS and STI Control Program, Abuja, Federal Capital Territory, Nigeria
| | - Deborah Odoh
- Nigeria Federal Ministry of Health, National AIDS and STI Control Program, Abuja, Federal Capital Territory, Nigeria
| | - Echezona E. Ezeanolue
- University of Nigeria Center for Translation and Implementation Research, Nsukka, Enugu, Nigeria
- Healthy Sunrise Foundation, Las Vegas, NV, United States of America
- Department of Pediatrics and Child Health, College of Medicine, University of Nigeria, Nsukka, Enugu, Nigeria
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Community based screening for sickle haemoglobin among pregnant women in Benue State, Nigeria: I-Care-to-Know, a Healthy Beginning Initiative. BMC Pregnancy Childbirth 2021; 21:498. [PMID: 34238241 PMCID: PMC8268197 DOI: 10.1186/s12884-021-03974-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 06/29/2021] [Indexed: 11/25/2022] Open
Abstract
Background Haemoglobin genotype screening at prenatal care offers women an opportunity to be aware of their genotype, receive education on sickle cell disease (SCD) and may increase maternal demand for SCD newborn screening. In developed countries, most pregnant women who access prenatal care and deliver at the hospital receive haemoglobin genotype screening. In settings with low prenatal care attendance and low hospital deliveries, community-based screening may provide similar opportunity for pregnant women. We assessed the feasibility and acceptability of integrating haemoglobin genotype screening into an existing community-based HIV program. Methods Onsite community-based integrated testing for HIV, hepatitis B virus and haemoglobin electrophoresis, were conducted for pregnant women and their male partners. Community Health Advisors implementing the NIH and PEPFAR-supported Healthy Beginning Initiative (HBI) program provided education on SCD, collected blood sample for haemoglobin electrophoresis and provided test results to participants enrolled into the HBI program. We concurrently conducted a cross-sectional study using a pretested, semi-structured, interviewer administered questionnaire to collect demographic data and assess awareness of individual haemoglobin “genotype” among HBI pregnant women participants. Results In this study, 99.9% (10,167/10,168) of pregnant women who received education on SCD accepted and completed the survey, had blood drawn for haemoglobin electrophoresis and received their results. A majority of participating pregnant women (97.0%) were not aware of their haemoglobin “genotype”. Among the participants who were incorrect about their haemoglobin “genotype”, 41.1% (23/56) of women who reported their haemoglobin “genotype” as AA were actually AS. The odds of haemoglobin “genotype” awareness was higher among participants who were in younger age group, completed tertiary education, had less number of pregnancies, and attended antenatal care. Overall prevalence of sickle cell trait (AS) was 18.7%. Conclusions It is feasible to integrate haemoglobin “genotype” testing into an existing community-based maternal-child program. Most pregnant women who were unaware of their haemoglobin “genotype” accepted and had haemoglobin genotype testing, and received their test results. Increasing parental awareness of their own haemoglobin “genotype” could increase their likelihood of accepting newborn screening for SCD. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03974-4.
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Talla C, Uchenna Itanyi I, Tsuyuki K, Stadnick N, Grace Ogidi A, Oluwaseun Olakunde B, Patel D, Okpanachi Oko J, Aarons G, Ariel Onoka C, Edozie Ezeanolue E. Hepatitis B infection and risk factors among pregnant women and their male partners in the Baby Shower Programme in Nigeria: a cross-sectional study. Trop Med Int Health 2021; 26:316-326. [PMID: 33247862 PMCID: PMC7925376 DOI: 10.1111/tmi.13531] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To determine the population prevalence and determinants of hepatitis B (Hep B) status, and status discordance, among pregnant women and their male partners in Nigeria. METHODS Cross-sectional study assessing the seroprevalence of Hep B virus in a cohort of 16 920 pregnant women and their male partners in northcentral Nigeria. Rapid HBsAg antibody test was used for Hep B diagnosis. Demographic, socio-economic and behavioural information was collected through interviewer-administered questionnaires and evaluated as determinants of Hep B status and couple status discordance using logistic regression. RESULTS Of 16 920 participants who had a Hep B test result, 6750 couples and 1316 discordant couples were identified. The prevalence of Hep B among all participants was 10.9%, with lower prevalence among pregnant women (10.2%) than their male partners (11.9%), P < 0.001. The prevalence of Hep B sero-discordance among couples was 19.5% (1316/6750). Younger age, prior Hep B testing and a prior positive Hep B test increased the odds of Hep B infection while being a woman decreased the odds of Hep B among all participants, and among couples. Furthermore, polygamy (adjusted odds ratio [AOR]: 1.49, 95% confidence interval [CI]: 1.19-1.87), prior Hep B testing (AOR: 2.38, 95% CI: 1.14-4.97) and a prior positive Hep B test result were significant determinants of status discordance among the participating couples. CONCLUSION The prevalence of Hep B among pregnant women and their male partners in northcentral Nigeria is high. A large-scale intervention is required to reduce Hep B prevalence in this setting.
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Affiliation(s)
- Carol Talla
- Caritas Nigeria, Abuja, Federal Capital Territory, Nigeria
| | - Ijeoma Uchenna Itanyi
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
- Department of Community Medicine, University of Nigeria Nsukka, Enugu, Nigeria
| | - Kiyomi Tsuyuki
- Division of Infectious Diseases & Global Public Health, Department of Medicine, University of California, San Diego, USA
| | - Nicole Stadnick
- Department of Psychiatry, University of California, San Diego, USA
- UC San Diego Dissemination and Implementation Science Center, USA
| | - Amaka Grace Ogidi
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
| | - Babayemi Oluwaseun Olakunde
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
- National Agency for the Control of AIDS, Abuja, Nigeria
| | | | | | - Gregory Aarons
- Department of Psychiatry, University of California, San Diego, USA
- UC San Diego Dissemination and Implementation Science Center, USA
| | - Chima Ariel Onoka
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
- Department of Community Medicine, University of Nigeria Nsukka, Enugu, Nigeria
| | - Echezona Edozie Ezeanolue
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
- Healthy Sunrise Foundation, USA
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Iheanacho T, Nduanya UC, Slinkard S, Ogidi AG, Patel D, Itanyi IU, Naeem F, Spiegelman D, Ezeanolue EE. Utilizing a church-based platform for mental health interventions: exploring the role of the clergy and the treatment preference of women with depression. Glob Ment Health (Camb) 2021; 8:e5. [PMID: 34026236 PMCID: PMC8127631 DOI: 10.1017/gmh.2021.4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/28/2020] [Accepted: 01/17/2021] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Training lay people to deliver mental health interventions in the community can be an effective strategy to mitigate mental health manpower shortages in low- and middle-income countries. The healthy beginning initiative (HBI) is a congregation-based platform that uses this approach to train church-based lay health advisors to conduct mental health screening in community churches and link people to care. This paper explores the potential for a clergy-delivered therapy for mental disorders on the HBI platform and identifies the treatment preferences of women diagnosed with depression. METHODS We conducted focus group discussion and free-listing exercise with 13 catholic clergy in churches that participated in HBI in Enugu, Nigeria. These exercises, guided by the positive, existential, or negative (PEN-3) cultural model, explored their role in HBI, their beliefs about mental disorders, and their willingness to be trained to deliver therapy for mental disorders. We surveyed women diagnosed with depression in the same environment to understand their health-seeking behavior and treatment preferences. The development of the survey was guided by the health belief model. RESULTS The clergy valued their role in HBI, expressed understanding of the bio-psycho-socio-spiritual model of mental disorders, and were willing to be trained to provide therapy for depression. Majority of the women surveyed preferred to receive therapy from trained clergy (92.9%), followed by a psychiatrist (89.3%), and psychologist (85.7%). CONCLUSION These findings support a potential clergy-focused, faith-informed adaptation of therapy for common mental disorders anchored in community churches to increase access to treatment in a resource-limited setting.
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Affiliation(s)
| | - Ujunwa Callista Nduanya
- Center for Translation and Implementation Research, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
- Department of Psychiatry, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | | | - Amaka Grace Ogidi
- Center for Translation and Implementation Research, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - Dina Patel
- Healthy Sunrise Foundation, Las Vegas, NV, USA
| | - Ijeoma Uchenna Itanyi
- Center for Translation and Implementation Research, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
- Department of Community Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | | | | | - Echezona E. Ezeanolue
- Center for Translation and Implementation Research, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
- Healthy Sunrise Foundation, Las Vegas, NV, USA
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Banigbe BF, Itanyi IU, Ofili EO, Ogidi AG, Patel D, Ezeanolue EE. High prevalence of undiagnosed hypertension among men in North Central Nigeria: Results from the Healthy Beginning Initiative. PLoS One 2020; 15:e0242870. [PMID: 33253296 PMCID: PMC7703905 DOI: 10.1371/journal.pone.0242870] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 11/10/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The prevalence of hypertension in Nigeria is high and growing. The burden and risk factor distribution also vary by geographical zone. Information about prevalence, risk factors and disease status awareness are needed to guide evidence based public health response at the national and sub- national levels. PURPOSE This paper describes the prevalence of hypertension and its correlates, as well as hypertension status awareness among men in North Central, Nigeria. METHODS A cross sectional survey was administered to male partners of pregnant women participating in the Healthy Beginning Initiative program from 2016-2018. Information on socio-demographic characteristics, risk factors, physical measurement and blood pressure readings were collected using a standardized protocol. Data was analyzed with simple and multiple logistic regression. RESULTS The 6,538 men had a median age of 31 years [IQR: 26-37]. The prevalence of hypertension was 23.3% (95% CI: 22.3%-24.4%), while 46.7% had prehypertension. The odds of hypertension was associated with increasing age (OR:1.02, CI:1.01-1.03), being overweight (aOR:1.5,CI:1.3-1.8), being obese (aOR:2.6,CI:2.0-3.3), living in an urban area (aOR:1.6,CI:1.2-2.1), and alcohol use in the 30 days prior (aOR:1.2,CI:1.1-1.4). Overall, 4.5% (297/6,528) of participants had ever been told they have hypertension. Among the 23.3% (1,527/6,528) with hypertension, 7.1% (109/1,527) were aware of their disease status. Men aged 41-50 years (aOR: 1.8, CI: 1.0-3.3), and > 50 years (aOR: 2.2, CI: 1.1-4.3), had higher odds disease status awareness. Living in an urban area was associated with lower odds (aOR: 0.2, CI: 0.03-0.7) of hypertension status awareness. CONCLUSION This study showed that hypertension is already a significant public health burden in this population and that disease awareness level is very low. Alcohol use and obesity were associated with hypertension, highlighting some modifiable cardiovascular disease risk factors that are prevalent in the study population. Taken together, these findings can inform the design of interventions for primary and secondary cardiovascular disease prevention in Nigeria and similar settings.
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Affiliation(s)
- Bolanle Feyisayo Banigbe
- APIN Public Health Initiatives, Abuja, Nigeria
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Ijeoma Uchenna Itanyi
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
- Department of Community Medicine, University of Nigeria Nsukka, Enugu, Nigeria
| | - Elizabeth Odilile Ofili
- Clinical Research Center, Morehouse School of Medicine, Atlanta, Georgia, United States of America
- Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia, United States of America
| | - Amaka Grace Ogidi
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
| | - Dina Patel
- Healthy Sunrise Foundation, Las Vegas, Nevada, United States of America
| | - Echezona Edozie Ezeanolue
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
- Healthy Sunrise Foundation, Las Vegas, Nevada, United States of America
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Ghoma Linguissi LS, Sagna T, Soubeiga ST, Gwom LC, Nkenfou CN, Obiri-Yeboah D, Ouattara AK, Pietra V, Simpore J. Prevention of mother-to-child transmission (PMTCT) of HIV: a review of the achievements and challenges in Burkina-Faso. HIV AIDS (Auckl) 2019; 11:165-177. [PMID: 31440104 PMCID: PMC6664853 DOI: 10.2147/hiv.s204661] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 06/14/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Burkina-Faso's HIV/AIDS program is one of the most successful in Africa, with a declining HIV prevalence and treatment outcomes that rival those of developed countries. Prevention of mother-to-child transmission (PMTCT) guidelines in Burkina-Faso, initiated in the year 2000, were revised in 2004, 2006 and 2010. The guideline document has since undergone several stages of improvement, largely based on recommendations from WHO, with adaptations by local experts in the field. Option B+ adopted since August 2014 in Burkina-Faso has enabled maintenance of mothers on longer treatment and increasing their survival and that of their children. Through this review, we describe the achievements and challenges of HIV PMTCT programs in Burkina-Faso. AIMS OF STUDY This study had the following objectives: 1) describing the historical perspective of PMTCT implementation in Burkina-Faso; 2) presenting the effectiveness of interventions at improving PMTCT service delivery and promoting retention of mothers and babies in care; and 3) determining the impact of male partner involvement on PMTCT in Burkina-Faso. METHODOLOGY A literature search was conducted in PubMed and Google. Search terms included the following keywords: "HIV testing"; "prevention"; "mother"; "child"; "male partner"; "counseling"; "involvement"; "participation"; and the grouped terms "PMTCT and partners"; "VCT"; "barriers and/or factors"; "Male involvement in PMTCT"; and "Burkina-Faso". Data collection took place from May to October 2015. The search was limited to articles published between January 2002 and December 2015. UNICEF and UNAIDS web sites were also used to find relevant abstracts and documents. RESULTS Studies have revealed that with PMTCT, HIV transmission rate moved from 10.4% in 2006 to 0% in 2015. The PMTCT program remains the best way to care for HIV-infected pregnant women and their babies. The current PMTCT policy is based on evidence that male partner involvement is associated with women's completion of PMTCT. CONCLUSION This study shows that the reduction in mother to child transmission of HIV in Burkina-Faso over the years is mainly due to the improvement of PMTCT programs. Efforts still need to be made about the involvement of male partners.
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Affiliation(s)
- Laure Stella Ghoma Linguissi
- Laboratoire de Biologie Moléculaire et de Génétique, Université Ouaga I Pr Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
- Institut National de Recherche en Sciences de la Santé (IRSSA), Brazzaville, Republic of Congo
| | - Tani Sagna
- Institut de Recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso
- Centre de Recherche Biomoleculaire Pietro Annigoni (CERBA), Ouagadougou, Burkina Faso
| | - Serge Théophile Soubeiga
- Laboratoire de Biologie Moléculaire et de Génétique, Université Ouaga I Pr Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
- Centre de Recherche Biomoleculaire Pietro Annigoni (CERBA), Ouagadougou, Burkina Faso
| | - Luc Christian Gwom
- “Chantal Biya” International Reference Centre for Research on HIV/Aids Prevention and Management (CBIRC), Yaoundé, Cameroon
| | - Céline Nguefeu Nkenfou
- “Chantal Biya” International Reference Centre for Research on HIV/Aids Prevention and Management (CBIRC), Yaoundé, Cameroon
- Higher Teachers’ Training College, University of Yaoundé I, Yaoundé, Cameroon
| | - Dorcas Obiri-Yeboah
- Department of Microbiology and Immunology, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Abdoul Karim Ouattara
- Laboratoire de Biologie Moléculaire et de Génétique, Université Ouaga I Pr Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
- Centre de Recherche Biomoleculaire Pietro Annigoni (CERBA), Ouagadougou, Burkina Faso
| | - Virginio Pietra
- Centre de Recherche Biomoleculaire Pietro Annigoni (CERBA), Ouagadougou, Burkina Faso
| | - Jacques Simpore
- Laboratoire de Biologie Moléculaire et de Génétique, Université Ouaga I Pr Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
- Centre de Recherche Biomoleculaire Pietro Annigoni (CERBA), Ouagadougou, Burkina Faso
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Conserve DF, Issango J, Kilale AM, Njau B, Nhigula P, Memiah P, Mbita G, Choko AT, Hamilton A, King G. Developing national strategies for reaching men with HIV testing services in Tanzania: results from the male catch-up plan. BMC Health Serv Res 2019; 19:317. [PMID: 31109335 PMCID: PMC6528365 DOI: 10.1186/s12913-019-4120-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 04/24/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND According to the 2016-2017 Tanzania HIV Impact Survey, 55% of men diagnosed with HIV during the survey self-reported that they were unaware of their HIV status. As a response, the Government of Tanzania launched a Test and Treat campaign in June 2018 with a focus on reaching men and developed the 2018-2020 Male Catch-Up plan. This article reports (1) the enablers and barriers of HIV testing services (HTS) uptake among men (2) and describes the strategies that were proposed as part of the Male Catch-Up Plan to address some of these barriers. METHOD Qualitative in-depth interviews were conducted with 23 men in Dar es Salaam to explore HTS enablers and barriers. To develop the Male Catch-Up Plan strategies, a desk review of published studies, and analyses of national implementers of HIV/AIDS interventions were conducted. An additional 123 interviews were also carried out with key implementers of HIV/AIDS interventions, healthcare workers, secondary school boys and members of the community in Iringa and Tanga. RESULTS Enablers of HTS included the desire to check one's health, high HIV risk perception, wanting to protect oneself if tested negative, and being encouraged by their sexual partners. Barriers of HTS were fear of a positive test result, and low HIV risk perception. Proposed strategies from the Male Catch-Up Plan to address these barriers included non-biomedical and biomedical approaches. Non-biomedical strategies are social and cultural approaches to promote an enabling environment to encourage health seeking behavior, safe behavior, and providing peer education programs and social marketing to promote condoms. Biomedical approaches consisted of expanding targeted HIV testing, HIV self-testing, and integrating HIV services with other health services. CONCLUSION A number of barriers contribute to the low uptake of HTS among men in Tanzania. National strategies have been developed to address these HTS barriers and guide the national Test and Treat campaign focusing on increasing HTS uptake among men.
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Affiliation(s)
- Donaldson F. Conserve
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC USA
| | - Jumanne Issango
- Tanzania Commission for AIDS (TACAIDS), Dar es Salaam, Tanzania
| | | | - Bernard Njau
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Patrick Nhigula
- Darla Moore School of Business, University of South Carolina, Columbia, USA
| | | | | | - Augustine T. Choko
- Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Akeen Hamilton
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC USA
| | - Gary King
- Department of Biobehavioral Health, Pennsylvania State University, University Park, State College, PA USA
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14
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Gbadamosi SO, Itanyi IU, Menson WNA, Olawepo JO, Bruno T, Ogidi AG, Patel DV, Oko JO, Onoka CA, Ezeanolue EE. Targeted HIV testing for male partners of HIV-positive pregnant women in a high prevalence setting in Nigeria. PLoS One 2019; 14:e0211022. [PMID: 30699160 PMCID: PMC6353157 DOI: 10.1371/journal.pone.0211022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 01/07/2019] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Partner HIV testing during pregnancy has remained abysmally low in sub-Saharan Africa, particularly in Nigeria. Males rarely attend antenatal clinics with their female partners, limiting the few opportunities available to offer them HIV testing. In this study, we evaluated the scale-up of the Healthy Beginning Initiative (HBI), a community-driven evidenced-based intervention to increase HIV testing among pregnant women and their male partners. Our objectives were to determine the: (1) male partner participation rate; (2) prevalence of HIV among male partners of pregnant women; (3) factors associated with HIV positivity among male partners of HIV-positive pregnant women. METHODS We reviewed program data of expectant parents enrolled in HBI in Benue State, north-central Nigeria. During HBI, trained lay health workers provided educational and counseling sessions, and offered free onsite integrated testing for HIV, hepatitis B virus and sickle cell genotype to pregnant women and their male partners who participated in incentivized, church-organized baby showers. Each participant completed an interviewer-administered questionnaire on demographics, lifestyle habits, and HIV testing history. Chi-square test was used to compare the characteristics of HIV-positive and HIV-negative male partners. Simple and multivariable logistic regression models were used to determine the association between participants' characteristics and HIV positivity among male partners of HIV-positive women. RESULTS Male partner participation rate was 57% (5264/9231). Overall HIV prevalence was 6.1% (891/14495) with significantly higher rates in women (7.4%, 681/9231) compared to men (4.0%, 210/5264). Among the 681 HIV-positive women, 289 male partners received HIV testing; 37.7% (109/289) were found to be HIV-positive. In multivariate analysis, older age (adjusted odds ratio [aOR]: 2.45, 95% confidence interval [CI]: 1.27-4.72 for age 30-39 years vs. <30 years; aOR: 2.39, CI: 1.18-4.82 for age ≥40 years vs. <30 years) and self-reported daily alcohol intake (vs. never (aOR: 0.35, CI: 0.13-0.96)) were associated with HIV positivity in male partners of HIV-positive women. CONCLUSION The community-based congregational approach is a potential strategy to increase male partner HIV testing towards achieving the UNAIDS goal of 90% HIV screening. Targeting male partners of HIV-positive women for screening may provide a higher yield of HIV diagnosis and the opportunity to engage known positives in care in this population.
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Affiliation(s)
- Semiu Olatunde Gbadamosi
- Florida International University Robert Stempel College of Public Health & Social Work, Miami, FL, United States of America
| | - Ijeoma Uchenna Itanyi
- Department of Community Medicine, College of Medicine, University of Nigeria, Nsukka, Enugu, Nigeria
| | | | - John Olajide Olawepo
- School of Community Health Sciences, University of Nevada-Las Vegas, Las Vegas, NV, United States of America
| | - Tamara Bruno
- Independent Researcher, Las Vegas, NV, United States of America
| | - Amaka Grace Ogidi
- Research Resource Center, College of Medicine, University of Nigeria, Nsukka, Enugu, Nigeria
| | - Dina V. Patel
- HealthySunrise Foundation, Las Vegas, NV, United States of America
| | | | - Chima Ariel Onoka
- Department of Community Medicine, College of Medicine, University of Nigeria, Nsukka, Enugu, Nigeria
| | - Echezona Edozie Ezeanolue
- HealthySunrise Foundation, Las Vegas, NV, United States of America
- Department of Pediatrics and Child Health, College of Medicine, University of Nigeria, Nsukka, Enugu, Nigeria
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Iheanacho T, Stefanovics E, Ezeanolue EE. Clergy's Beliefs About Mental Illness and Their Perception of Its Treatability: Experience from a Church-Based Prevention of Mother-to-Child HIV Transmission (PMTCT) Trial in Nigeria. JOURNAL OF RELIGION AND HEALTH 2018; 57:1483-1496. [PMID: 29335920 DOI: 10.1007/s10943-017-0545-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Clergy participating in the Healthy Beginning Initiative (N = 45), a program utilizing church workers to integrate packages of care into church activities, completed a 43-item self-administered questionnaire assessing their attitudes and beliefs about mental disorders and perception of their treatability. A majority believed that drug/alcohol use, stress and genetic inheritance could cause mental illness and that society needed to adopt more tolerant attitude toward people with mental disorders. Clergy with contact with people with mental disorders were more likely to perceive depression as treatable. In conclusion, participants had positive attitudes toward mental disorders with some believing that they are treatable.
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Affiliation(s)
- Theddeus Iheanacho
- Department of Psychiatry, Yale University School of Medicine, 300 George St., Suite 901, New Haven, CT, 06511, USA.
| | - Elina Stefanovics
- Department of Psychiatry, Yale University School of Medicine, 300 George St., Suite 901, New Haven, CT, 06511, USA
| | - Echezona E Ezeanolue
- HealthySunrise Foundation, 8752 Castle Ridge Ave, Las Vegas, NV, 89129, USA
- University of Nevada School of Medicine, 2040 W. Charleston Blvd. Suite 402, Las Vegas, NV, 89102, USA
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Ezeanolue EE, Pharr JR, Patel DV, Ezeanolue CO, Obiefune MC, Ogidi AG, Ehiri JE. Developing a Theoretical Framework for a Complex Maternal-Child Health Intervention: Health Beginning Initiative. Health Promot Pract 2018; 20:941-950. [PMID: 29938536 DOI: 10.1177/1524839918782929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A theoretical framework serves as a roadmap for the implementation and application of a complex, health promotion intervention; is used to test hypotheses; and guides analysis and evaluation of the intervention. The purpose of this article is to demonstrate how a theoretical framework was developed and used to guide the implementation of Healthy Beginning Initiative (HBI) to promote uptake of HIV services in a low-income country. We used the guide for developing a theoretical framework published in Health Promotion Practice. Developing the theoretical framework included seven steps: (1) identifying the essential elements of the intervention; (2) identifying the variables and the context; (3) listing the postulated mechanisms, mediating variables, and postulated outcomes; (4) identifying existing theoretical models supporting the theoretical framework underdevelopment; (5) scripting the theoretical framework into either a figure or sets of statements; (6) conducting content and face validation of the theoretical framework; and (7) revising the theoretical framework. The theoretical framework was developed and used to evaluate HBI's impact on HIV testing, linkage to care and retention in care for pregnant women, their male partners, and newborns. The theoretical framework will also be adapted for other screenings and other settings while remaining true to the essential elements of HBI.
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Affiliation(s)
| | | | | | | | | | - Amaka G Ogidi
- Prevention, Education, Treatment, Training and Research-Global Solutions, Enugu, Enugu State, Nigeria
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Sam-Agudu NA, Aliyu MH, Adeyemi OA, Oronsaye F, Oyeledun B, Ogidi AG, Ezeanolue EE. Generating evidence for health policy in challenging settings: lessons learned from four prevention of mother-to-child transmission of HIV implementation research studies in Nigeria. Health Res Policy Syst 2018; 16:32. [PMID: 29665809 PMCID: PMC5905153 DOI: 10.1186/s12961-018-0309-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 04/02/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Implementation research (IR) facilitates health systems strengthening and optimal patient outcomes by generating evidence for scale-up of efficacious strategies in context. Thus, difficulties in generating IR evidence, particularly in limited-resource settings with wide disease prevention and treatment gaps, need to be anticipated and addressed. Nigeria is a priority country for the prevention of mother-to-child transmission of HIV (PMTCT). This paper analyses the experiences of four PMTCT IR studies in Nigeria, and proffers solutions to major challenges encountered during implementation. STUDIES INCLUDED AND FINDINGS Multicentre PMTCT IR studies conducted in Nigeria during the Global Plan's assessment period (2011 to 2015) were included. Four studies were identified, namely The Baby Shower Trial, Optimizing PMTCT, MoMent and Lafiyan Jikin Mata. Major common challenges encountered were categorised as 'External' (beyond the control of study teams) and 'Internal' (amenable to rectification by study teams). External challenges included healthcare worker strikes and turnover, acts and threats of ethnic and political violence and terrorism, and multiplicity of required local ethical reviews. Internal challenges included limited research capacity among study staff, research staff turnover and travel restrictions hindering study site visits. Deliberate research capacity-building was provided to study staff through multiple opportunities before and during study implementation. Post-study employment opportunities and pathways for further research career-building are suggested as incentives for study staff retention. Engagement of study community-resident personnel minimised research staff turnover in violence-prone areas. CONCLUSIONS The IR environment in Nigeria is extremely diverse and challenging, yet, with local experience and anticipatory planning, innovative solutions can be implemented to modulate internal challenges. Issues still remain with healthcare worker strikes and often unpredictable insecurity. There is a dire need for cooperation between institutional review boards across Nigeria in order to minimise the multiplicity of reviews for multicentre studies. External challenges need to be addressed by high-level stakeholders, given Nigeria's crucial regional and global position in the fight against the HIV epidemic.
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Affiliation(s)
- Nadia A. Sam-Agudu
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria
- Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD United States of America
| | - Muktar H. Aliyu
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN United States of America
- Vanderbilt Institute for Global Health, Nashville, TN United States of America
| | - Olusegun A. Adeyemi
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD United States of America
| | - Frank Oronsaye
- Center for Integrated Health Programs, Abuja, Federal Capital Territory Nigeria
| | - Bolanle Oyeledun
- Center for Integrated Health Programs, Abuja, Federal Capital Territory Nigeria
| | - Amaka G. Ogidi
- Research Resource Centre, University of Nigeria Nsukka, Enugu, Nigeria
| | - Echezona E. Ezeanolue
- HealthySunrise Foundation, Las Vegas, NV United States of America
- Department of Paediatrics and Child Health, University of Nigeria Nsukka, Enugu, Nigeria
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Gbadamosi SO, Eze C, Olawepo JO, Iwelunmor J, Sarpong DF, Ogidi AG, Patel D, Oko JO, Onoka C, Ezeanolue EE. A Patient-Held Smartcard With a Unique Identifier and an mHealth Platform to Improve the Availability of Prenatal Test Results in Rural Nigeria: Demonstration Study. J Med Internet Res 2018; 20:e18. [PMID: 29335234 PMCID: PMC5789164 DOI: 10.2196/jmir.8716] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 12/08/2017] [Accepted: 01/02/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Community-based strategies to test for HIV, hepatitis B virus (HBV), and sickle cell disease (SCD) have expanded opportunities to increase the proportion of pregnant women who are aware of their diagnosis. In order to use this information to implement evidence-based interventions, these results have to be available to skilled health providers at the point of delivery. Most electronic health platforms are dependent on the availability of reliable Internet connectivity and, thus, have limited use in many rural and resource-limited settings. OBJECTIVE Here we describe our work on the development and deployment of an integrated mHealth platform that is able to capture medical information, including test results, and encrypt it into a patient-held smartcard that can be read at the point of delivery without the need for an Internet connection. METHODS We engaged a team of implementation scientists, public health experts, and information technology specialists in a requirement-gathering process to inform the design of a prototype for a platform that uses smartcard technology, database deployment, and mobile phone app development. Key design decisions focused on usability, scalability, and security. RESULTS We successfully designed an integrated mHealth platform and deployed it in 4 health facilities across Benue State, Nigeria. We developed the Vitira Health platform to store test results of HIV, HBV, and SCD in a database, and securely encrypt the results on a Quick Response code embedded on a smartcard. We used a mobile app to read the contents on the smartcard without the need for Internet connectivity. CONCLUSIONS Our findings indicate that it is possible to develop a patient-held smartcard and an mHealth platform that contains vital health information that can be read at the point of delivery using a mobile phone-based app without an Internet connection. TRIAL REGISTRATION ClinicalTrials.gov NCT03027258; https://clinicaltrials.gov/ct2/show/NCT03027258 (Archived by WebCite at http://www.webcitation.org/6owR2D0kE).
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Affiliation(s)
- Semiu Olatunde Gbadamosi
- Global Health Initiative, School of Community Health Sciences, University of Nevada, Las Vegas, Las Vegas, NV, United States
| | - Chuka Eze
- Vitira Health, Arlington, VA, United States
| | | | - Juliet Iwelunmor
- Department of Behavioral Science and Health Education, St Louis University, St Louis, MO, United States
| | - Daniel F Sarpong
- Center for Minority Health and Health Disparities Research and Education, Xavier University, New Orleans, LA, United States
| | | | - Dina Patel
- Global Health Initiative, School of Community Health Sciences, University of Nevada, Las Vegas, Las Vegas, NV, United States
| | | | | | - Echezona Edozie Ezeanolue
- Global Health Initiative, School of Community Health Sciences, University of Nevada, Las Vegas, Las Vegas, NV, United States
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Slinkard SA, Pharr JR, Bruno T, Patel D, Ogidi A, Obiefune M, Ezeanolue EE. Determinants of Infant Mortality in Southeast Nigeria: Results from the Healthy Beginning Initiative, 2013-2014. Int J MCH AIDS 2018; 7:1-8. [PMID: 30305984 PMCID: PMC6168798 DOI: 10.21106/ijma.229] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Neonatal mortality due to preventable factors occurs at high rates throughout sub-Saharan Africa. Community-based interventions increase opportunities for prenatal screening and access to antenatal care services (ANC) services. The Healthy Beginning Initiative (HBI) provided congregation-based prenatal screening and health counseling for 3,047 women in Enugu State. The purpose of this study was to identify determinants for infant mortality among this cohort. METHODS This was a prospective cohort study of post-delivery outcomes at 40 churches in Enugu State, Nigeria between 2013 and 2014. Risk factors for infant mortality were assessed using chi square, odds ratios, and multiple logistic regression. RESULTS There were 2,436 live births from the 2,379 women who delivered (55 sets of twins and one set of triplets), and 99 cases of neonatal/early postneonatal mortality. The neonatal mortality rate was 40.6 per 1,000 live births. Risk factors associated with neonatal mortality were lack of access to ANC services [OR= 8.81], maternal mortality [OR= 15.28], caesarian section [OR= 2.47], syphilis infection [OR= 6.46], HIV-positive status [OR= 3.87], and preterm birth [OR= 14.14]. CONCLUSIONS AND GLOBAL HEALTH IMPLICATIONS These results signify that culturally-acceptable community-based interventions targeted to increase access to ANC services, post-delivery services for preterm births, and HIV and syphilis screening for expectant mothers are needed to reduce infant mortality in resource-limited settings.
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Affiliation(s)
- Samantha A Slinkard
- University of Nevada, Las Vegas, School of Community Health Sciences. 4505 S. Maryland Pkwy, Las Vegas, NV 89154, USA
| | - Jennifer R Pharr
- University of Nevada, Las Vegas, School of Community Health Sciences. 4505 S. Maryland Pkwy, Las Vegas, NV 89154, USA
| | - Tamara Bruno
- University of Nevada, Las Vegas, School of Community Health Sciences. 4505 S. Maryland Pkwy, Las Vegas, NV 89154, USA
| | - Dina Patel
- University of Nevada, Las Vegas, School of Community Health Sciences. 4505 S. Maryland Pkwy, Las Vegas, NV 89154, USA
| | - Amaka Ogidi
- Research Resource Centre, University of Nigeria, Enugu, College of Medicine. University Road, 410001, Nsukka, Enugu State, NIGERIA
| | - Michael Obiefune
- Institute of Human Virology, University of Maryland School of Medicine. 655 W. Balitimore St, Balitimore, MD 21201, USA
| | - Echezona E Ezeanolue
- University of Nevada, Las Vegas, School of Community Health Sciences. 4505 S. Maryland Pkwy, Las Vegas, NV 89154, USA
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Aarons GA, Sklar M, Mustanski B, Benbow N, Brown CH. "Scaling-out" evidence-based interventions to new populations or new health care delivery systems. Implement Sci 2017; 12:111. [PMID: 28877746 PMCID: PMC5588712 DOI: 10.1186/s13012-017-0640-6] [Citation(s) in RCA: 205] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 08/18/2017] [Indexed: 01/03/2023] Open
Abstract
Background Implementing treatments and interventions with demonstrated effectiveness is critical for improving patient health outcomes at a reduced cost. When an evidence-based intervention (EBI) is implemented with fidelity in a setting that is very similar to the setting wherein it was previously found to be effective, it is reasonable to anticipate similar benefits of that EBI. However, one goal of implementation science is to expand the use of EBIs as broadly as is feasible and appropriate in order to foster the greatest public health impact. When implementing an EBI in a novel setting, or targeting novel populations, one must consider whether there is sufficient justification that the EBI would have similar benefits to those found in earlier trials. Discussion In this paper, we introduce a new concept for implementation called “scaling-out” when EBIs are adapted either to new populations or new delivery systems, or both. Using existing external validity theories and multilevel mediation modeling, we provide a logical framework for determining what new empirical evidence is required for an intervention to retain its evidence-based standard in this new context. The motivating questions are whether scale-out can reasonably be expected to produce population-level effectiveness as found in previous studies, and what additional empirical evaluations would be necessary to test for this short of an entirely new effectiveness trial. We present evaluation options for assessing whether scaling-out results in the ultimate health outcome of interest. Conclusion In scaling to health or service delivery systems or population/community contexts that are different from the setting where the EBI was originally tested, there are situations where a shorter timeframe of translation is possible. We argue that implementation of an EBI in a moderately different setting or with a different population can sometimes “borrow strength” from evidence of impact in a prior effectiveness trial. The collection of additional empirical data is deemed necessary by the nature and degree of adaptations to the EBI and the context. Our argument in this paper is conceptual, and we propose formal empirical tests of mediational equivalence in a follow-up paper.
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Affiliation(s)
- Gregory A Aarons
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA. .,Child and Adolescent Services Research Center, San Diego, CA, USA.
| | - Marisa Sklar
- Department of Psychiatry and Human Behavior, Brown University, Box G-A1, Providence, RI, USA
| | - Brian Mustanski
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Nanette Benbow
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - C Hendricks Brown
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Linkage to Care, Early Infant Diagnosis, and Perinatal Transmission Among Infants Born to HIV-Infected Nigerian Mothers: Evidence From the Healthy Beginning Initiative. J Acquir Immune Defic Syndr 2017; 72 Suppl 2:S154-60. [PMID: 27355503 PMCID: PMC5113229 DOI: 10.1097/qai.0000000000001051] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In 2014, Nigeria accounted for 33% of all new childhood HIV infections that occurred among the 22 Global Plan priority countries where 80% of HIV-infected women reside. Even with a vertical HIV transmission rate of 27%, only 6% of infants born to HIV-infected women in Nigeria receive early infant diagnosis (EID). This article reports rates of antiretroviral prophylaxis, EID, and mother-to-child transmission in a congregation-based Healthy Beginning Initiative (HBI) designed to increase HIV testing among pregnant women in southeast Nigeria. METHODS This is a nested cohort study of HIV-exposed infants (HEI) within the HBI trial originally designed as a 2-arm cluster randomized trial. HIV-infected mothers and infants were followed between January 2013 and August 2014. RESULTS Across both arms of the study, 72 HIV-infected women delivered 69 live infants (1 set of twins) and 4 had miscarriages. Of the 69 live-born HEI, HIV status was known for 71% (49/69), 16% (11/69) died before sample collection, and 13% (9/69) were lost to follow-up. Complete information was available for 84% of HEI (58/69), of which 64% (37/58) received antiretroviral prophylaxis. Among the 49 infants tested for HIV, 88% (43/49) received EID within 2 months and 12% (6/49) received antibody testing after 18 months. The mother-to-child transmission rate was 8.2% (4/49). CONCLUSIONS EID was higher and HIV transmission rate was lower among the HBI participants compared to reported rates in 2014. However, further progress is needed to achieve goals of elimination of infant HIV infection.
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Ezeanolue EE, Gbadamosi SO, Olawepo JO, Iwelunmor J, Sarpong D, Eze C, Ogidi A, Patel D, Onoka C. An mHealth Framework to Improve Birth Outcomes in Benue State, Nigeria: A Study Protocol. JMIR Res Protoc 2017; 6:e100. [PMID: 28550003 PMCID: PMC5466701 DOI: 10.2196/resprot.7743] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 04/25/2017] [Accepted: 04/27/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The unprecedented coverage of mobile technology across the globe has led to an increase in the use of mobile health apps and related strategies to make health information available at the point of care. These strategies have the potential to improve birth outcomes, but are limited by the availability of Internet services, especially in resource-limited settings such as Nigeria. OBJECTIVE Our primary objective is to determine the feasibility of developing an integrated mobile health platform that is able to collect data from community-based programs, embed collected data into a smart card, and read the smart card using a mobile phone-based app without the need for Internet access. Our secondary objectives are to determine (1) the acceptability of the smart card among pregnant women and (2) the usability of the smart card by pregnant women and health facilities in rural Nigeria. METHODS We will leverage existing technology to develop a platform that integrates a database, smart card technology, and a mobile phone-based app to read the smart cards. We will recruit 300 pregnant women with one of the three conditions-HIV, hepatitis B virus infection, and sickle cell trait or disease-and four health facilities in their community. We will use Glasgow's Reach, Effectiveness, Adoption, Implementation, and Maintenance framework as a guide to assess the implementation, acceptability, and usability of the mHealth platform. RESULTS We have recruited four health facilities and 300 pregnant women with at least one of the eligible conditions. Over the course of 3 months, we will complete the development of the mobile health platform and each participant will be offered a smart card; staff in each health facility will receive training on the use of the mobile health platform. CONCLUSIONS Findings from this study could offer a new approach to making health data from pregnant women available at the point of delivery without the need for an Internet connection. This would allow clinicians to implement evidence-based interventions in real time to improve health outcomes. TRIAL REGISTRATION ClinicalTrials.gov NCT03027258; https://clinicaltrials.gov/ct2/show/NCT03027258 (Archived by WebCite at http://www.webcitation.org/6owR2D0kE).
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Affiliation(s)
- Echezona Edozie Ezeanolue
- Global Health Initiative, School of Community Health Sciences, University of Nevada, Las Vegas, NV, United States
| | - Semiu Olatunde Gbadamosi
- Global Health Initiative, School of Community Health Sciences, University of Nevada, Las Vegas, NV, United States
| | | | - Juliet Iwelunmor
- Department of Kinesiology and Community Health, University of Illinois, Urbana-Champaign, IL, United States
| | - Daniel Sarpong
- Center for Minority Health and Health Disparities Research and Education, Xavier University, Louisiana, LA, United States
| | - Chuka Eze
- Vitira LLC, Arlington, VA, United States
| | | | - Dina Patel
- Global Health Initiative, School of Community Health Sciences, University of Nevada, Las Vegas, NV, United States
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Gunn JKL, Ehiri JE, Jacobs ET, Ernst KC, Pettygrove S, Center KE, Osuji A, Ogidi AG, Musei N, Obiefune MC, Ezeanolue CO, Ezeanolue EE. Prevalence of Caesarean sections in Enugu, southeast Nigeria: Analysis of data from the Healthy Beginning Initiative. PLoS One 2017; 12:e0174369. [PMID: 28355302 PMCID: PMC5371319 DOI: 10.1371/journal.pone.0174369] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 03/07/2017] [Indexed: 11/29/2022] Open
Abstract
Background In order to meet the Sustainable Development Goal to decrease maternal mortality, increased access to obstetric interventions such as Caesarean sections (CS) is of critical importance. As a result of women’s limited access to routine and emergency obstetric services in Nigeria, the country is a major contributor to the global burden of maternal mortality. In this analysis, we aim to establish rates of CS and determine socioeconomic or medical risk factors associated with having a CS in Enugu, southeast Nigeria. Methods Data for this study originated from the Healthy Beginning Initiative study. Participant characteristics were obtained from 2300 women at baseline via a semi-structured questionnaire. Only women between the ages of 17–45 who had singleton deliveries were retained for this analysis. Post-delivery questionnaires were used to ascertain mode-of-delivery. Crude and adjusted logistic regressions with Caesarean as the main outcome are presented. Results In this sample, 7.22% women had a CS. Compared to women who lived in an urban setting, those who lived in a rural setting had a significant reduction in the odds of having a CS (aOR: 0.58; 0.38–0.89). Significantly higher odds of having a CS were seen among those with high peripheral malaria parasitemia compared to those with low parasitemia (aOR: 1.54; 1.04–2.28). Conclusion This study revealed that contrary to the increasing trend in use of CS in low-income countries, women in this region of Nigeria had limited access to this intervention. Increasing age and socioeconomic proxies for income and access to care (e.g., having a tertiary-level education, full-time employment, and urban residence) were shown to be key determinants of access to CS. Further research is needed to ascertain the obstetric conditions under which women in this region receive CS, and to further elucidate the role of socioeconomic factors in accessing CS.
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Affiliation(s)
- Jayleen K. L. Gunn
- Department of Epidemiology and Biostatistics, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, United States of America
- * E-mail:
| | - John E. Ehiri
- Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, United States of America
| | - Elizabeth T. Jacobs
- Department of Epidemiology and Biostatistics, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, United States of America
- University of Arizona Cancer Center, Tucson, Arizona, United States of America
| | - Kacey C. Ernst
- Department of Epidemiology and Biostatistics, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, United States of America
| | - Sydney Pettygrove
- Department of Epidemiology and Biostatistics, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, United States of America
| | | | - Alice Osuji
- Prevention, Education, Treatment, Training and Research-Global Solutions-PeTR-GS, Enugu, Enugu State, Nigeria
| | - Amaka G. Ogidi
- Prevention, Education, Treatment, Training and Research-Global Solutions-PeTR-GS, Enugu, Enugu State, Nigeria
| | - Nnabundo Musei
- Prevention, Education, Treatment, Training and Research-Global Solutions-PeTR-GS, Enugu, Enugu State, Nigeria
| | - Michael C. Obiefune
- Healthy Sunrise Foundation, Castle Ridge Avenue, Las Vegas, Nevada, United States of America
- Institute of Human Virology, University of Maryland, Baltimore, Maryland, United States of America
| | - Chinenye O. Ezeanolue
- Prevention, Education, Treatment, Training and Research-Global Solutions-PeTR-GS, Enugu, Enugu State, Nigeria
| | - Echezona E. Ezeanolue
- Prevention, Education, Treatment, Training and Research-Global Solutions-PeTR-GS, Enugu, Enugu State, Nigeria
- Healthy Sunrise Foundation, Castle Ridge Avenue, Las Vegas, Nevada, United States of America
- Department of Pediatrics, University of Nevada School of Medicine, Las Vegas, Nevada, United States of America
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What do You Need to Get Male Partners of Pregnant Women Tested for HIV in Resource Limited Settings? The Baby Shower Cluster Randomized Trial. AIDS Behav 2017; 21:587-596. [PMID: 27933462 PMCID: PMC5288443 DOI: 10.1007/s10461-016-1626-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Male partner involvement has the potential to increase uptake of interventions to prevent mother-to-child transmission of HIV (PMTCT). Finding cultural appropriate strategies to promote male partner involvement in PMTCT programs remains an abiding public health challenge. We assessed whether a congregation-based intervention, the Healthy Beginning Initiative (HBI), would lead to increased uptake of HIV testing among male partners of pregnant women during pregnancy. A cluster-randomized controlled trial of forty churches in Southeastern Nigeria randomly assigned to either the HBI (intervention group; IG) or standard of care referral to a health facility (control group; CG) was conducted. Participants in the IG received education and were offered onsite HIV testing. Overall, 2498 male partners enrolled and participated, a participation rate of 88.9%. Results showed that male partners in the IG were 12 times more likely to have had an HIV test compared to male partners of pregnant women in the CG (CG = 37.71% vs. IG = 84.00%; adjusted odds ratio = 11.9; p < .01). Culturally appropriate and community-based interventions can be effective in increasing HIV testing and counseling among male partners of pregnant women.
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Ehiri JE, Iwelunmor J, Iheanacho T, Blackstone S, Obiefune MC, Ogidi AG, Ahunanya FU, Nnadi D, Patel D, Hunt AT, Ezeanolue EE. Using a Cultural Framework to Understand Factors Influencing HIV Testing in Nigeria. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2016; 37:33-42. [PMID: 28030987 PMCID: PMC5645216 DOI: 10.1177/0272684x16685258] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
With support from the U.S. President's Emergency Plan for AIDS Relief and the global fund for HIV, tuberculosis, and malaria, Nigeria offers free services for prevention of mother-to-child transmission of HIV. However, uptake of these services is low, and pediatric transmission of HIV remains a significant public health challenge. Using the PEN-3 cultural model as the theoretical framework, we examined social, cultural, and contextual factors that influenced uptake of HIV counseling and testing among pregnant women and their male partners. This was a qualitative study of participants in the Healthy Beginning Initiative (HBI), a congregation-based program to prevent mother-to-child transmission of HIV in Enugu, southeast Nigeria. We conducted eight focus group discussion sessions with 83 pregnant women and their male partners. Participants' perspectives on why they did or did not test for HIV were obtained. The most cited reasons for getting tested for HIV included the following: "the need to know one's status", "the role of prenatal testing" (positive perceptions); "the role of the church", "personal rapport with healthcare worker" (positive enablers); and the "influence of marriage" (positive nurturer). The most cited reason for not testing were: "fear of HIV test", "shame associated with HIV+ test results", "conspiratorial beliefs about HIV testing" (negative perceptions); "lack of confidentiality with HIV testing", (negative enabler); and "HIV-related stigma from family and community systems" (negative nurturer). Overall, numerous facilitators and barriers influence uptake of HIV testing in the study setting. Public health practitioners and policymakers need to consider how sociocultural and religious factors unique to specific local contexts may promote or hinder uptake of available HIV/AIDS prevention and care interventions.
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Affiliation(s)
- John E. Ehiri
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Juliet Iwelunmor
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, IL, USA
| | - Theddeus Iheanacho
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Sarah Blackstone
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, IL, USA
| | - Michael C. Obiefune
- Prevention, Education, Treatment, Training and Research-Global Solutions, Enugu State, Nigeria
| | - Amaka G. Ogidi
- Prevention, Education, Treatment, Training and Research-Global Solutions, Enugu State, Nigeria
| | - Frances U. Ahunanya
- Prevention, Education, Treatment, Training and Research-Global Solutions, Enugu State, Nigeria
| | - Donatus Nnadi
- Prevention, Education, Treatment, Training and Research-Global Solutions, Enugu State, Nigeria
| | - Dina Patel
- Global Health and Implementation Research Initiatives, School of Community Health Sciences, University of Nevada, Las Vegas, NV, USA
| | - Aaron T. Hunt
- Global Health and Implementation Research Initiatives, School of Community Health Sciences, University of Nevada, Las Vegas, NV, USA
| | - Echezona E. Ezeanolue
- Global Health and Implementation Research Initiatives, School of Community Health Sciences, University of Nevada, Las Vegas, NV, USA
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Burnham-Marusich AR, Ezeanolue CO, Obiefune MC, Yang W, Osuji A, Ogidi AG, Hunt AT, Patel D, Ezeanolue EE. Prevalence of Sickle Cell Trait and Reliability of Self-Reported Status among Expectant Parents in Nigeria: Implications for Targeted Newborn Screening. Public Health Genomics 2016; 19:298-306. [PMID: 27614873 PMCID: PMC5052321 DOI: 10.1159/000448914] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 08/06/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Sickle cell disease (SCD) is a life-threatening, autosomal recessive blood disorder prevalent in sub-Saharan Africa. We identified the prevalence of sickle cell trait (SCT) among pregnant women and their male partners in Enugu State, Nigeria, and determined the accuracy of self-reported sickle cell status and its reliability for identifying high-risk newborns for targeted screening. METHODS We conducted a nested cohort study of expectant parents enrolled in the Healthy Beginning Initiative (HBI). The HBI is a cluster-randomized trial of a congregation-based approach designed to increase HIV testing. Participants completed a survey regarding self-awareness of their sickle cell genotype and consented to genotype screening by cellulose acetate electrophoresis. RESULTS SCT prevalence (HbAS) was 22% (746/3,371). Only 50% of participants provided an accurate self-report. Self-report accuracy was significantly different (p < 0.0001) between individuals who reported having SCT or SCD (61% accuracy) versus those who reported not having SCT or SCD (86% accuracy). Demographic variables including gender, age, household size, employment, education, and home location were significantly associated with providing an accurate self-report. CONCLUSIONS Low numbers of accurate parental self-reports, coupled with a high SCT prevalence in Nigeria, could limit the efficacy of targeted newborn screening. However, our data indicate that it is feasible to integrate sickle cell screening for pregnant women with existing, community-based health care programs developed by the President's Emergency Plan for AIDS Relief (PEPFAR), such as the HBI. Expanding screening programs could enable the development of targeted newborn screening based on maternal genotype that could identify all newborns with SCD in resource-limited settings.
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Affiliation(s)
- Amanda R. Burnham-Marusich
- University of Nevada School of Medicine; Department of Microbiology and Immunology; 1664 N. Virginia St, Reno, NV, USA
| | | | - Michael C Obiefune
- Institue of Human Virology, University of Maryland, Baltimore; 620 W Lexington St, Baltimore, MD 21201
- HealthySunrise Foundation, 8752 Castle Ridge Avenue, Las Vegas, NV 89129
- Prevention, Education, Treatment, Training and Research-Global Solutions-PeTR-GS, Plot 25 Liberty Estate, Independence Layout Enugu, 400001, Enugu State, Nigeria
| | - Wei Yang
- School of Community Health Sciences, University of Nevada, Reno, MS-274, RM212, Lombardi Recreation Center, Reno, NV 89557
| | - Alice Osuji
- Prevention, Education, Treatment, Training and Research-Global Solutions-PeTR-GS, Plot 25 Liberty Estate, Independence Layout Enugu, 400001, Enugu State, Nigeria
| | - Amaka G. Ogidi
- Prevention, Education, Treatment, Training and Research-Global Solutions-PeTR-GS, Plot 25 Liberty Estate, Independence Layout Enugu, 400001, Enugu State, Nigeria
| | - Aaron T. Hunt
- HealthySunrise Foundation, 8752 Castle Ridge Avenue, Las Vegas, NV 89129
- School of Community Health Sciences, University of Nevada, Las Vegas; 4505 S. Maryland Parkway • Box 454009 • Las Vegas, NV 89154-4009, USA, 1-702-895-2687
| | - Dina Patel
- HealthySunrise Foundation, 8752 Castle Ridge Avenue, Las Vegas, NV 89129
- School of Community Health Sciences, University of Nevada, Las Vegas; 4505 S. Maryland Parkway • Box 454009 • Las Vegas, NV 89154-4009, USA, 1-702-895-2687
| | - Echezona E. Ezeanolue
- HealthySunrise Foundation, 8752 Castle Ridge Avenue, Las Vegas, NV 89129
- School of Community Health Sciences, University of Nevada, Las Vegas; 4505 S. Maryland Parkway • Box 454009 • Las Vegas, NV 89154-4009, USA, 1-702-895-2687
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Ezeanolue EE, Obiefune MC, Ezeanolue CO, Ehiri JE, Osuji A, Ogidi AG, Hunt AT, Patel D, Yang W, Pharr J, Ogedegbe G. Effect of a congregation-based intervention on uptake of HIV testing and linkage to care in pregnant women in Nigeria (Baby Shower): a cluster randomised trial. LANCET GLOBAL HEALTH 2016; 3:e692-700. [PMID: 26475016 DOI: 10.1016/s2214-109x(15)00195-3] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 06/23/2015] [Accepted: 07/02/2015] [Indexed: 12/27/2022]
Abstract
BACKGROUND Few effective community-based interventions exist to increase HIV testing and uptake of antiretroviral therapy (ART) in pregnant women in hard-to-reach resource-limited settings. We assessed whether delivery of an intervention through churches, the Healthy Beginning Initiative, would increase uptake of HIV testing in pregnant women compared with standard health facility referral. METHODS In this cluster randomised trial, we enrolled self-identified pregnant women aged 18 years and older who attended churches in southeast Nigeria. We randomised churches (clusters) to intervention or control groups, stratified by mean annual number of infant baptisms (<80 vs ≥80). The Healthy Beginning Initiative intervention included health education and on-site laboratory testing implemented during baby showers in intervention group churches, whereas participants in control group churches were referred to health facilities as standard. Participants and investigators were aware of church allocation. The primary outcome was confirmed HIV testing. This trial is registered with ClinicalTrials.gov, identifier number NCT 01795261. FINDINGS Between Jan 20, 2013, and Aug 31, 2014, we enrolled 3002 participants at 40 churches (20 per group). 1309 (79%) of 1647 women attended antenatal care in the intervention group compared with 1080 (80%) of 1355 in the control group. 1514 women (92%) in the intervention group had an HIV test compared with 740 (55%) controls (adjusted odds ratio 11·2, 95% CI 8·77-14·25; p<0·0001). INTERPRETATION Culturally adapted, community-based programmes such as the Healthy Beginning Initiative can be effective in increasing HIV screening in pregnant women in resource-limited settings. FUNDING US National Institutes of Health and US President's Emergency Plan for AIDS Relief.
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Affiliation(s)
| | - Michael C Obiefune
- Prevention, Education, Treatment, Training and Research-Global Solutions-PeTR-GS, Enugu, Enugu State, Nigeria
| | | | - John E Ehiri
- Department of Health Promotion Sciences/Global Health Institute, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Alice Osuji
- Prevention, Education, Treatment, Training and Research-Global Solutions-PeTR-GS, Enugu, Enugu State, Nigeria
| | - Amaka G Ogidi
- Prevention, Education, Treatment, Training and Research-Global Solutions-PeTR-GS, Enugu, Enugu State, Nigeria
| | - Aaron T Hunt
- Department of Pediatrics, University of Nevada School of Medicine, Las Vegas, NV, USA
| | - Dina Patel
- Department of Pediatrics, University of Nevada School of Medicine, Las Vegas, NV, USA
| | - Wei Yang
- School of Community Health Sciences, University of Nevada, Reno, NV, USA
| | - Jennifer Pharr
- School of Community Health Sciences, University of Nevada, Las Vegas, NV, USA
| | - Gbenga Ogedegbe
- New York University Langone Medical Center, and NYU College of Global Public Health, New York, NY, USA
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Bhardwaj S, Carter B, Aarons GA, Chi BH. Implementation Research for the Prevention of Mother-to-Child HIV Transmission in Sub-Saharan Africa: Existing Evidence, Current Gaps, and New Opportunities. Curr HIV/AIDS Rep 2016; 12:246-55. [PMID: 25877252 DOI: 10.1007/s11904-015-0260-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Tremendous gains have been made in the prevention of mother-to-child HIV transmission (PMTCT) in sub-Saharan Africa. Ambitious goals for the "virtual elimination" of pediatric HIV appear increasingly feasible, driven by new scientific advances, forward-thinking health policy, and substantial donor investment. To fulfill this promise, however, rapid and effective implementation of evidence-based practices must be brought to scale across a diversity of settings. The discipline of implementation research can facilitate this translation from policy into practice; however, to date, its core principles and frameworks have been inconsistently applied in the field. We reviewed the recent developments in implementation research across each of the four "prongs" of a comprehensive PMTCT approach. While significant progress continues to be made, a greater emphasis on context, fidelity, and scalability-in the design and dissemination of study results-would greatly enhance current efforts and provide the necessary foundation for future evidence-based programs.
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Gunn JKL, Ehiri JE, Jacobs ET, Ernst KC, Pettygrove S, Kohler LN, Haenchen SD, Obiefune MC, Ezeanolue CO, Ogidi AG, Ezeanolue EE. Population-based prevalence of malaria among pregnant women in Enugu State, Nigeria: the Healthy Beginning Initiative. Malar J 2015; 14:438. [PMID: 26542777 PMCID: PMC4635587 DOI: 10.1186/s12936-015-0975-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 10/28/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malaria adversely affects pregnant women and their fetuses or neonates. Estimates of the malaria burden in pregnant women based on health facilities often do not present a true picture of the problem due to the low proportion of women delivering at these facilities in malaria-endemic regions. METHODS Data for this study were obtained from the Healthy Beginning Initiative using community-based sampling. Self-identified pregnant women between the ages of 17-45 years were recruited from churches in Enugu State, Nigeria. Malaria parasitaemia was classified as high and low based on the malaria plus system. RESULTS Of the 2069 pregnant women for whom malaria parasitaemia levels were recorded, over 99 % tested positive for malaria parasitaemia, 62 % showed low parasitaemia and 38 % high parasitaemia. After controlling for confounding variables, odds for high parasitaemia were lower among those who had more people in the household (for every one person increase in a household, OR = 0.94, 95 % CI 0.89-0.99). CONCLUSION Results of this study are consistent with hospital-based estimates of malaria during pregnancy in southeastern Nigeria. Based on the high prevalence of malaria parasitaemia in this sample, education on best practices to prevent malaria during pregnancy, and resources in support of these practices are urgently needed.
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Affiliation(s)
- Jayleen K L Gunn
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Ave Drachman Hall, PO Box 245163, Tucson, AZ, 85724, USA.
| | - John E Ehiri
- Department of Health Promotion Sciences/Global Health Institute, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA.
| | - Elizabeth T Jacobs
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Ave Drachman Hall, PO Box 245163, Tucson, AZ, 85724, USA. .,University of Arizona Cancer Center, Tucson, AZ, USA.
| | - Kacey C Ernst
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Ave Drachman Hall, PO Box 245163, Tucson, AZ, 85724, USA.
| | - Sydney Pettygrove
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Ave Drachman Hall, PO Box 245163, Tucson, AZ, 85724, USA.
| | - Lindsay N Kohler
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Ave Drachman Hall, PO Box 245163, Tucson, AZ, 85724, USA.
| | - Steven D Haenchen
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Ave Drachman Hall, PO Box 245163, Tucson, AZ, 85724, USA.
| | - Michael C Obiefune
- Prevention, Education, Treatment, Training and Research-Global Solutions-PeTR-GS, Enugu, Enugu State, Nigeria.
| | | | - Amaka G Ogidi
- Prevention, Education, Treatment, Training and Research-Global Solutions-PeTR-GS, Enugu, Enugu State, Nigeria.
| | - Echezona E Ezeanolue
- Global Health and Implementation Science Initiative, School of Community Health Sciences, University of Nevada, Las Vegas, NV, USA.
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Iheanacho T, Kapadia D, Ezeanolue CO, Osuji AA, Ogidi AG, Ike A, Patel D, Stefanovics E, Rosenheck R, Obiefune M, Ezeanolue EE. Attitudes and beliefs about mental illness among church-based lay health workers: experience from a prevention of mother-to-child HIV transmission trial in Nigeria. ACTA ACUST UNITED AC 2015; 9:1-13. [PMID: 26807146 PMCID: PMC4706033 DOI: 10.1080/17542863.2015.1074260] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 07/15/2015] [Indexed: 12/02/2022]
Abstract
Common mental disorders are prevalent in Nigeria. Due to stigma and a limited number of trained specialists, only 10% of adults with mental illness in Nigeria receive any care. The Healthy Beginning Initiative is a community-based maternal/child health program that includes screening for perinatal depression and was implemented by lay, volunteer, church-based health advisors (CHAs). The aim of the study was to assess the beliefs and attitudes about mental illness among the CHAs. The study used a cross-sectional survey of 57 CHAs, who completed a 43-item, self-administered questionnaire that assessed their beliefs and attitudes about mental illness. The response rate was 71%. Respondents were mostly female (79%), married (83%) and aged 40–49 years (M = 41.16 SD = 10.48). Most endorsed possession by evil spirits (84%), traumatic events (81%) and witchcraft (60%) as causes of mental illness. A majority (69%) believed that people with mental illness were a nuisance, and less than half (46%) believed that mental disorders were illnesses like any other illness. It is concluded that stigmatizing attitudes and beliefs about mental illness are common among the CHAs. Training for lay health workers in Nigeria should include education on the known bio-psycho-social basis of mental disorders and the role of social inclusion in recovery.
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Affiliation(s)
- Theddeus Iheanacho
- Department of Psychiatry, Yale University School of Medicine , New Haven , USA
| | | | | | - Alice A Osuji
- Prevention, Education, Treatment, Training and Research Global Solutions , Enugu , Nigeria
| | - Amaka G Ogidi
- Prevention, Education, Treatment, Training and Research Global Solutions , Enugu , Nigeria
| | - Anulika Ike
- Prevention, Education, Treatment, Training and Research Global Solutions , Enugu , Nigeria
| | - Dina Patel
- HealthySunrise Foundation, Las Vegas, USA; University of Nevada School of Medicine, Las Vegas, USA
| | - Elina Stefanovics
- Department of Psychiatry, Yale University School of Medicine , New Haven , USA
| | - Robert Rosenheck
- Department of Psychiatry, Yale University School of Medicine , New Haven , USA
| | - Michael Obiefune
- HealthySunrise Foundation, Las Vegas, USA; Prevention, Education, Treatment, Training and Research Global Solutions, Enugu, Nigeria
| | - Echezona E Ezeanolue
- HealthySunrise Foundation, Las Vegas, USA; University of Nevada School of Medicine, Las Vegas, USA
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Ezeanolue EE, Iwelunmor J, Asaolu I, Obiefune MC, Ezeanolue CO, Osuji A, Ogidi AG, Hunt AT, Patel D, Yang W, Ehiri JE. Impact of male partner's awareness and support for contraceptives on female intent to use contraceptives in southeast Nigeria. BMC Public Health 2015; 15:879. [PMID: 26358642 PMCID: PMC4566290 DOI: 10.1186/s12889-015-2216-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Accepted: 09/03/2015] [Indexed: 11/23/2022] Open
Abstract
Background Despite the growing body of evidence on use of modern contraceptives among women in sub-Saharan African countries, little is known about the broader context in which female decision-making concerning contraceptive use occurs, particularly the role of their male partners’ awareness and support of modern contraceptives. Methods We conducted a cross-sectional survey of 2468 pregnant women and their male partners enrolled in the Healthy Beginning Initiative (HBI), an intervention to increase HIV testing among pregnant women in Enugu, southeast Nigeria. The aims of this study were to determine: 1) male partners’ awareness of, and support for, female contraceptive methods, and 2) influence of male partners’ contraceptive awareness and support on pregnant women’s expressed desire to use contraception. We used logistic regression models to examine the association between male partners’ awareness and support of modern contraceptives on their spouses’ desire to use contraceptives. Results Men’s awareness of, and support for, use of modern contraceptives were significantly associated with their female partners’ desire to use contraception. A majority of the men who were aware of modern contraceptives (66.5 %) and those who supported their spouses’ use of contraception (72.5 %) had partners who expressed a desire to use contraception. Men who were aware of female contraception were 3 times more likely to have spouses who desired to use contraception (AOR = 3.17, 95 % C.I: 2.70–3.75). In addition, men who showed support for their spouses’ use of contraception were over 5 times more likely to have spouses who indicated a desire to use contraception (AOR = 5.76, 95 % C.I: 4.82–6.88). Living in a household of 5 or more people (AOR = 1.45, 95 % C.I: 1.23–1.72) and residing in an urban area (AOR = 0.81, 95 % C.I: 0.67–0.97) were also significantly associated with women’s expressed desire to use modern contraception. Conclusion Men’s awareness of, and support for, use of modern contraceptives were markedly associated with their spouses’ desire to use contraception. This underscores the need for men’s involvement in programs that seek to address women’s uptake of contraception in low and middle income countries.
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Affiliation(s)
- Echezona E Ezeanolue
- Global Health and Implementation Science Initiatives, School of Community Health Sciences, University of Nevada, 4505 S. Maryland Pkwy, Box 453064, Las Vegas, 89154, NV, USA.
| | - Juliet Iwelunmor
- Department of Kinesiology and Community Health, University of Illinois, Urbana-Champaign, 123 Huff Hall, 1206S, Fourth St., Champaign, IL, 61820, USA.
| | - Ibitola Asaolu
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave., Tucson, Arizona, 85724, USA.
| | - Michael C Obiefune
- Prevention, Education, Treatment, Training and Research-Global Solutions-PeTR-GS, Plot 25 Liberty Estate, Independence Layout Enugu, 400001, Enugu State, Nigeria.
| | | | - Alice Osuji
- Prevention, Education, Treatment, Training and Research-Global Solutions-PeTR-GS, Plot 25 Liberty Estate, Independence Layout Enugu, 400001, Enugu State, Nigeria.
| | - Amaka G Ogidi
- Prevention, Education, Treatment, Training and Research-Global Solutions-PeTR-GS, Plot 25 Liberty Estate, Independence Layout Enugu, 400001, Enugu State, Nigeria.
| | - Aaron T Hunt
- Global Health and Implementation Science Initiatives, School of Community Health Sciences, University of Nevada, 4505 S. Maryland Pkwy, Box 453064, Las Vegas, 89154, NV, USA.
| | - Dina Patel
- Prevention, Education, Treatment, Training and Research-Global Solutions-PeTR-GS, Plot 25 Liberty Estate, Independence Layout Enugu, 400001, Enugu State, Nigeria.
| | - Wei Yang
- School of Community Health Sciences, University of Nevada, MS-274, RM212, Lombardi Recreation Center, Reno, NV, 89557, USA.
| | - John E Ehiri
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave., Tucson, Arizona, 85724, USA.
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Patel U, Pharr JR, Ihesiaba C, Oduenyi FU, Hunt AT, Patel D, Obiefune M, Chukwumerije N, Ezeanolue EE. Ebola Outbreak in Nigeria: Increasing Ebola Knowledge of Volunteer Health Advisors. Glob J Health Sci 2015; 8:72-8. [PMID: 26234990 PMCID: PMC4803986 DOI: 10.5539/gjhs.v8n1p72] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 04/03/2015] [Accepted: 03/23/2015] [Indexed: 11/12/2022] Open
Abstract
In many low-income countries, volunteer health advisors (VHAs) play an important role in disseminating information, especially in rural or hard-to-reach locations. When the world’s largest outbreak of Ebola virus disease (EVD) occurred in 2014, a majority of cases were concentrated in the West African countries of Guinea, Liberia, and Sierra Leone. Twenty cases were reported in Nigeria initially and there was a need to rapidly disseminate factual information on Ebola virus. In southeast Nigeria, a group of VHAs was being used to implement the Healthy Beginning Initiative [HBI], a congregation based intervention to increase HIV testing among pregnant women and their male partners. The purpose of this study was to assess the baseline and post EVD training knowledge of VHAs during the outbreak in Nigeria. In September 2014, 59 VHAs attending a HBI training workshop in the Enugu State of Nigeria participated in an Ebola awareness training session. Participants completed a 10-item single-answer questionnaire that assessed knowledge of Ebola epidemiology, symptoms, transmission, prevention practices, treatment and survival prior to the Ebola awareness training. After the training, the VHAs repeated the questionnaire. Answers to pre and post questionnaires were analyzed using paired t-tests. Multiple linear regression was used to examine the relationship between pre and post total questionnaire scores and age, education, current location and employment. The average pre-test score was 7.3 and average post-test score was 7.8 which was a significant difference (t=-2.5, p=0.01). Prior to the training, there was a significant difference in Ebola knowledge based on the VHAs education only (p<0.01). After training, education was no longer significant for Ebola knowledge. Existing community health programs can be used as a platform to train VHAs in times of epidemics for quick dissemination of vital health information in areas lacking adequate health infrastructure and personnel.
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Impact of HIV testing and counseling (HTC) knowledge on HIV prevention practices among traditional birth attendants in Nigeria. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:1969-82. [PMID: 25674783 PMCID: PMC4344704 DOI: 10.3390/ijerph120201969] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 02/03/2015] [Indexed: 11/21/2022]
Abstract
Nigeria is second in the world for the number of people with HIV and has a high rate of mother-to-child transmission (MTCT). Over 60% of births in Nigeria occur outside of health care facilities, and because of this, Traditional Birth Attendants (TBAs) play a significant role in maternal and child health. It is important that TBAs be knowledgeable about HIV prevention. The purpose of this study was to determine the impact of HIV testing and counseling (HTC) knowledge on the HIV prevention practices among TBAs in Nigeria. Five hundred TBAs were surveyed. Chi-square and logistic regression were used to assess differences in HIV prevention practices between TBAs with and without HTC knowledge. TBAs with HTC knowledge are significantly more likely to engage in HIV prevention practices than TBAs without HTC. Prevention practices included: wearing gloves during delivery (p < 0.01), sterilization of delivery equipment (p < 0.01), participation in blood safety training (p < 0.01), and disposal of sharps (p < 0.01). As long as a high percent of births occur outside health care facilities in Nigeria, there will be a need for TBAs. Providing TBAs with HTC training increases HIV prevention practices and can be a key to improve maternal and child health.
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Iheanacho T, Obiefune M, Ezeanolue CO, Ogedegbe G, Nwanyanwu OC, Ehiri JE, Ohaeri J, Ezeanolue EE. Integrating mental health screening into routine community maternal and child health activity: experience from Prevention of Mother-to-child HIV transmission (PMTCT) trial in Nigeria. Soc Psychiatry Psychiatr Epidemiol 2015; 50:489-95. [PMID: 25201181 PMCID: PMC4322219 DOI: 10.1007/s00127-014-0952-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 08/28/2014] [Indexed: 11/24/2022]
Abstract
PURPOSE Although the prevalence of mental health disorders in Nigeria is comparable to most developed countries, access to mental health care in Nigeria is limited. Improving access to care requires innovative approaches that deliver mental health interventions at the community level. The aim of this study was to determine the feasibility and acceptability of integrating mental health screening into an existing community-based program for prevention of mother-to-child transmission of HIV targeted at pregnant women and their male partners. METHODS Pregnant women and their male partners from 117 churches enrolled in the healthy beginning initiative (HBI) in southeast Nigeria participated in the mental health screening project. Two members from each church were trained as church-based health advisors to administer the 12-item general health questionnaire. RESULTS Ninety-three percent of the pregnant women and their male partners agreed to participate and fully completed the questionnaire. Overall, 21.7 % of the respondents scored above the threshold of 11 indicating significant psychological distress, with women having significantly higher scores than men. CONCLUSION Mental health screening is feasible and well accepted among a cohort of pregnant women and their male partners. Church members can be trained as health advisors to administer mental health screening. Mental health interventions can be developed on the framework of the HBI.
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Affiliation(s)
- Theddeus Iheanacho
- Department of Psychiatry, Yale Univeristy School of Medicine, 300 George Street, New Haven, CT, 06519, USA,
| | - Michael Obiefune
- Prevention, Education, Treatment, Training and Research-Global Solutions-PeTR-GS, 7 Link Road Independence Layout Enugu, 400001 Enugu State Enugu, Nigeria
| | | | - Gbenga Ogedegbe
- School of Medicine, New York University, 550 1st Ave, New York, NY USA
| | - Okey C. Nwanyanwu
- United States Center for Diseases Control and Prevention, Country Office, Abuja, Nigeria
| | - John E. Ehiri
- Division of Health Promotion Sciences/Global Health Institute, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave., Tucson, AZ 85724 USA
| | - Jude Ohaeri
- Department of Psychological Medicine, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Echezona E. Ezeanolue
- Sunrise Foundation, Plot 358 New GRA, Enugu, Nigeria ,Department of Pediatrics, University of Nevada School of Medicine, 2040 West Charleston Boulevard, Las Vegas, NV USA
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Iwelunmor J, Ezeanolue EE, Airhihenbuwa CO, Obiefune MC, Ezeanolue CO, Ogedegbe GG. Socio-cultural factors influencing the prevention of mother-to-child transmission of HIV in Nigeria: a synthesis of the literature. BMC Public Health 2014; 14:771. [PMID: 25079673 PMCID: PMC4133635 DOI: 10.1186/1471-2458-14-771] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 07/17/2014] [Indexed: 12/15/2022] Open
Abstract
Background Currently, Nigeria alone accounts for 30% of the burden of mother-to-child transmission of HIV. This review explores the socio-cultural factors influencing prevention of mother-to-child transmission of HIV (PMTCT) service uptake in Nigeria. Methods Using the PEN-3 cultural model as a guide, we searched electronic databases and conducted a synthesis of empirical studies conducted from 2001 to 2013 that reported the perceptions people have towards PMTCT, the enablers/resources that influence PMTCT service uptake, and the role of nurturers/family or community in shaping actions and decisions towards PMTCT service uptake. Results A total of 42 articles meeting the search criteria were retained in this review. Thirty-six (36) were quantitative cross-sectional surveys; three were mixed methods, while three were qualitative studies. The findings highlight that there are perceptions, ranging from positive to negative that influence PMTCT service uptake in Nigeria. Furthermore, lack of available, accessible, acceptable, and affordable resources negatively influence decisions and actions towards PMTCT. Finally, family contexts matter with decisions and actions towards PMTCT service uptake in Nigeria particularly with disclosure and non-disclosure of sero-positive status, fertility intentions and infant feeding choices. Conclusion As ambitious goals are established and unprecedented resources deployed towards the elimination of mother-to-child transmission of HIV globally by 2015, there is clearly a need to develop effective family-oriented, culture-centered community-based PMTCT programs in Nigeria so as to improve the low uptake of PMTCT services.
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Affiliation(s)
- Juliet Iwelunmor
- Department of Kinesiology and Community Health, University of Illinois, Urbana-Champaign, 123 Huff Hall, 1206 S, Fourth St, Champaign, IL 61820, USA.
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