Objectives To evaluate the effectiveness of three models for pre-exposure prophylaxis (PrEP) service delivery to HIV-1 serodiscordant couples in Nigeria. Methods 297 heterosexual HIV-1 serodiscordant couples were recruited into three PrEP delivery models and followed up for 18 months. The models were i) Outpatient clinic model providing PreP in routine outpatient care; ii) Antiretroviral therapy (ART) clinic model providing PrEP in ART clinics; and iii) Decentralized care model providing PrEP through primary and secondary care centres linked to a tertiary care centre. The primary effectiveness endpoint was incident HIV-1 infection. The HIV incidence before and after the study was compared and the incidence rate ratio computed for each model. Survival analysis was conducted, Cox regression analysis was used to compare the factors that influenced couple retention in each of the models. Kaplan-Meier survival analysis was used to estimate the median retention time (in months) of the study participants in each of the study models, and log-rank test for equality of survival functions was conducted to test for significant differences among the three models. Results There was no significant difference (p>0.05) in the couple retention rates among the three models. At months 3, 6 and 9, adherence of the HIV-1-infected partners to ART was highest in the decentralized model, whereas at months 9 and 12, the outpatient model had the highest proportion of HIV-1- uninfected partners adhering to PrEP (p<0.001). The HIV incidence per 100 person-years was zero in the general outpatient clinic and ART clinic models and 1.6 (95% CI: 0.04–9.1) in the decentralized clinic model. The difference in the observed and expected incidence rate was 4.3 (95% CI: 0.44–39.57) for the decentralized clinic model. Conclusion Although incidence of HIV seroconversion was highest in the decentralized clinic model, this difference may be due to the higher sexual risk behavior among study participants in the decentralized model rather than the type of service delivery. The study findings imply that any of the models can effectively deliver PrEP services.
Introduction: Traumatic tympanic membrane (TM) perforation is a commonly encountered otological condition with consequent hearing impairment and potentials for more grievous complications. We aim to establish the prevalence, sex distribution, laterality and aetiological factors associated with traumatic TM perforation in our locality Materials and Method: This is a 10 Year retrospective study involving patients who were managed for traumatic TM perforations at ENT outpatient clinic of Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State. Results: A total of 186 patients were managed for traumatic TM perforation involving 190 ears. The prevalence was 4.9%; 66.1% were males, 33.9% females giving a male to female ratio of 2:1 while age ranges from 1-68 years (mean± SD was 22.23± 15years. Left ear was involved in 54.3% of the cases, right ear in 43.5% and both ears in 2.2%. The commonest cause of traumatic TM perforation was Assaults (58.1%) of various kinds; domestic violence was the commonest, accounting for 22% of all the assault cases followed by assaults from security men (15.1%), then, slap by school teachers, prefects and senior students (10.2%). Mob actions and attacks by Robbers constituted 10.2%. Fifteen percent (15%) of the cases resulted from ear cleaning with cotton bud (10.2%), broom stick (3.2%) and metallic objects (2.2%). Sports related injuries accounted for 2.7% of the cases. Various forms of accidents (8.1%) such as road traffic accidents (1.1%), accidents from work place (3.2%) and fireworks (1.6%) were recorded. Conclusion: The predominance of slap as the major cause of TM perforation resulting from assaults shows how this condition is caused by avoidable circumstances. Every opportunity should be explored to educate the populace on the sequelae of such indiscriminate outburst of anger.
BackgroundThis abstract highlights the ethical and scientific considerations that informed the development and review of the Nigeria PrEP demonstration study protocol.MethodsA desk review was conducted on all the meeting reports that led to the choice of the study design and the decisions made to modify the protocol for the PrEP demonstration project in Nigeria. The study focused on the ethical and scientific rationales for modifying the Partners' PrEP Sero-discordant protocol for this study as well as for the first and second protocol amendments of this study.ResultsThe decision to conduct a PrEP study was based on the outcome of a modelling study that suggested that sero-discordant couples will benefit from access to condom, TasP, and PrEP. Next, the decisions on the target population for the PrEP demonstration study, the models for evaluation at specific project site, and the design of the community engagement programme were reached through a formative research which engaged 611 individuals using multiple media. The study did not exclude study participants based on Hepatitis status and HIV risk profile since Truvada was an effective hepatitis treatment and the prevalence of hepatitis infection is high in Nigeria. Participants' interest in PrEP use was considered enough reason to prescribe PrEP in a country where uptake of ARV is slow and stigma associated with ARV use is high. Also, HIV-negative partners could assess when the viral load of the HIV-positive partner was 400 copies/ml. Since adherence was a challenge for PrEP use, adherence was enhanced through the use of the MEMS Cap.ConclusionsA PrEP demonstration study that mimics real life scenarios for PrEP provision within public health care institutions and is designed on the basis of community consultations, ethical and scientific considerations, will enhance the success of PrEP roll-out in resource-limited settings like Nigeria.
Background: Majority of the solid cancer patients seen in our Centers come with advanced diseases. Some of the cancers are locally advanced, while others are metastatic. Most of these patients who present late belong to the poverty-stricken group in our community. Only few of them can afford costly drugs for their treatment. The government Health Insurance Scheme does not cover cancer patients in Nigeria. Aim: To highlight the importance of immunotherapy in the management of metastatic cancers. Objective: We wish to share our experience in the use of immunotherapy (Bevacizumab) for metastatic cancers in the few patients who could afford the drug, and to highlight the need for reduction of the prices of immunotherapeutic drugs, or for government to subsidize the costs. Methods: From the 1,135 solid cancer patients treated in our two Centers in three years (February 2017 to January 2020), those who presented with metastasis were slated for immunotherapy after we had obtained their immunohistochemistry results. Results: Six hundred and one (601) patients (53.0%) presented late. Three hundred and fi ve (305) of these late presenters (50.7%) came with metastasis. Only 67 (22.0%) out of the 305 metastatic patients could afford immunotherapy, because of high cost. With the exception of one female patient, each of the remaining 66 patients was able to afford only one single dose of Bevacizumab (Avastin) R. Of these patients, one died of Tumor Lysis Syndrome following one single dose of 600 mg of Bevacizumab. There were measurable shrinkages of the tumor burdens, as well as improvement in the quality of life of the remaining 66 patients. Conclusion: Following these encouraging results, immunotherapy for metastatic carcinomas is to be encouraged for wider use, even in resource-deprived economies. Repeated doses will offer the patient greater benefi ts. Government should subsidize the cost of immunotherapeutic drugs so that they would become affordable by majority of those who need them.
Neurofibromatosis type 1 (NF1) is the most common form of neurofibromatosis. It is associated with neurofibromas, gliomas, neurofibrosarcomas, and neuroendocrine and hematopoietic tumors. We present a case of scalp plexiform neurofibromatosis associated with intrathoracic fibrosarcoma.An 18-year-old female presented with a 15-year history of plexiform scalp mass. She had multiple café-aulait patches on her trunk and extremities and a first-degree relative with a plexiform right shoulder mass. She was managed by a multidisciplinary team of plastic and reconstructive surgeons, neurosurgeons, cardiothoracic surgeons, otorhinolaryngologists, ophthalmologists, pulmonologists, and pathologists. The histology of the excised scalp mass was that of a malignant peripheral nerve sheath tumor (neurofibrosarcoma). She subsequently developed upper chest and back pain with associated breathlessness and was found to have an intra-thoracic tumor. She had two sessions of exploratory right thoracotomy with subtotal excision of an aggressive, highly hemorrhagic, infiltrative mucinous tumor. The histology was a fibrosarcoma. The patient died a few hours following the second thoracotomy.NF1 is associated with several tumors, among which are neurofibrosarcomas. Intra-thoracic fibrosarcoma requires aggressive surgical resection; recurrence may be delayed with radiotherapy and chemotherapy. The prognosis is however poor, and survival beyond one year is unusual. Once one tumor is found, other body systems should be evaluated for the possibility of other tumors.
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