In North-central Nigeria where HIV is prevalent, ART started before pregnancy is enormously effective in preventing mother-to-child transmission. Adoption of WHO 'Option B+' deserves serious consideration in such settings.

Introduction Adherence to antiretroviral therapy (ART) and retention in treatment programs are required for successful virologic suppression and treatment outcomes. As the number of adolescents living with HIV continues to increase globally, more information about adherence and retention patterns during and through transition from child- to adult-centered care is needed to ensure provision of a high level of care and inform development of targeted interventions to improve patient outcomes in this vulnerable population. In this analysis, we sought to describe long-term trends in adherence, retention, and virologic suppression in adolescents receiving ART at a pediatric HIV clinic in Nigeria through transition to the adult clinic. Setting The Jos University Teaching Hospital, United States President’s Emergency Plan for AIDS Relief (PEPFAR)-funded HIV clinic in Jos, Plateau State, Nigeria. Methods We conducted a retrospective observational longitudinal evaluation of data that had been collected during the course of care in a large pediatric ART program in Nigeria. We used descriptive statistics to define our patient population and quantify retention from ART initiation through adolescence and transition to adult-centered care. Logistic regression was used to evaluate predictors of loss to follow-up. We used medication possession ratio (MPR) to quantify adherence for each year a patient was on ART. To evaluate adherence and virologic suppression, we measured the proportion of patients with ≥95% MPR and the proportion with virologic suppression (viral load ≤400 copies/mL) within each age cohort, and used bivariate analyses to examine any association between MPR and VL suppression for all person-years observed. Results A total of 476 patients received at least one dose of ART as an adolescent (ages 10–19 years). The proportions of patients lost to follow-up were: 11.9% (71/597) prior to adolescence, 19.1% (31/162) during adolescence, and 13.7% (10/73) during transition to adult-centered care. While over 80% of patients had ≥95% medication adherence in all age groups, their viral load suppression rates through adolescence and post-transition were only 55.6%–64.0%. For patients that successfully transitioned to adult-centered care, we observed 87.7% (50/57) retention at month 12 post-transition, but only 34.6% (9/26) viral load suppression. Conclusions Our evaluation found considerable proportions of adolescents lost to follow-up throughout the ART program cascade. We also found discrepancies between the proportions of patients with ≥95% MPR and the proportions with VL suppression, suggesting that true medication adherence in this population may be poor. Significant attention and targeted interventions to improve retention and adherence focused on adolescents are needed in order for global programs to achieve 90-90-90 goals.

Background: Childhood epilepsy causes a tremendous burden for the child, the family, society as well as the healthcare system. Adherence toantiepileptic drugs (AEDs) is key to treatment success, one of the main causes of unsuccessful treatment for epilepsy is poor adherence to medications. Nonadherence in children with epilepsy presents a potential ongoing challenge for achieving a key therapeutic goal of seizure control.Aim: To determine the prevalence and factors associated with nonadherence to AEDs among children with epilepsy at Jos University Teaching Hospital, Jos, Nigeria.Methodology: This cross sectional study was done to assess the prevalence and factors associated with non-adherence to AEDs among children with epilepsy from November 2019 to February 2020. A structured questionnaire was used to collect relevant information on the adherence of studysubjects to AEDs based on self/ caregiver report. Part of the questionnaire was derived from Morisky Medication Adherence Scale (MMAS-8).Results: One hundred and ninety four subjects were recruited for the study. The prevalence of nonadherence to AEDs was 44.8%. Factors significantly associated with non-adherence were low socioeconomic status, multiple drug therapy and long duration of treatment. The main reasons for nonadherence were financial constraint, forgetfulness, lack of improvement and medication side effects.Conclusion: Non-adherence to medication is common among children with epilepsy and it hampers the key therapeutic goal of seizure control. Improving per capita income of families, providing universal health insurance, medication reminders and appropriate education/counseling will reduce non-adherence and improve the long term outcome of childhood epilepsy in our region. Key words: Epilepsy, Children, Ant i -epilept ic drugs, Nonadherence, Prevalence, Associated factors, Jos, Nigeria.

IntroductionCryptosporidium is an important cause of diarrhea in children and immune-compromised individuals. Recent advances in molecular diagnostics have led to the discovery of subtype families that are thought to be more commonly associated with diarrhea. We aimed to isolate and characterize Cryptosporidium spp among children with diarrhea in Jos, Nigeria.MethodsStool samples were collected from165 children aged 0-5 years with diarrhea. Cryptosporidium oocysts were examined by wet mount preparation, using formalin ether and a modified acid fast staining method. DNA was extracted from positive samples using QIAamp DNA stool mini kit and PCR-RFLP assay was carried out after quantification. Genotyping and phylogenetic analysis were done to determine the subtype families and their relatedness.ResultsFrom the 165 children studied, 8 (4.8%) were infected with Cryptosporidium. PCR-RFLP assay and genotype characterization found the following Cryptosporidium species: C. hominis 6 (75%) and C. parvum 2 (25.0%), with family subtypes Id-5, Ie-1 and IIa-1, IId-1 respectively.The most common species was C. hominis and the frequent subtype was C. hominis-Id 5 (62.5%).ConclusionCryptosporidium is not an uncommon cause of diarrhea in children, with C. hominis being the dominant species. Also C. hominis Id is the commonest sub-family subtype. Put together, zoonotic species may be an important cause of diarrhea in children aged 0-5 years in Jos, Nigeria.