Few clinical settings in resource-limited countries perform CD4+ T-lymphocyte counts required as a baseline test for antiretroviral therapy. We investigated CD4 count in newly diagnosed HIV-infected patients attending our treatment centre and evaluated suitability of total lymphocyte count (TLC) as a surrogate marker for CD4+T-lymphocyte count required as a yardstick for initiating antiretroviral therapy. Usefulness of TLC as a surrogate marker for CD4+T-lymphocyte counts <200, ≤350 and <500cells/µL for HIV-positive patients in our facility was evaluated by 180 pairs of TLC and CD4 counts from 180 newly diagnosed HIV-infected patients and results were compared by linear regression and Spearman's correlation analytical tools. Approximately 72.8% of our patients were diagnosed late as revealed by CD4 count ≤350cells/µL. An overall good correlation was noted between TLC and CD4+Tcell counts (r=0.65, slope=0.69), mean total lymphocyte count of 1.04 ± 0.81, 1.39 ± 1.06 and 1.57 ± 1.13 x 10⁹/L correspond to CD4 lymphocyte counts of <200, ≤350 and < 500cells/µL respectively. When considering initiating HAART for HIV-infected Nigerian clients, TLC can be considered as an inexpensive and easily accessible surrogate marker for predicting CD4+T-lymphocyte at two clinically important CD4 thresholds of CD4 count of ≤350 cells/µL and <500cells/µL.

Background: Payment methods for healthcare services in a country impact the health status of its people and the health indices of the nation. Research findings have shown that care received and obstetric outcomes of women seeking natal care and their newborns are affected by their health insurance status. Objective: Comparative study of obstetric outcomes between women on health insurance scheme and women on out -of-pocket payment. Materials and Methods:The study was a prospective observational one involving1655 women who delivered during the period of the study, out of which 33 were on health insurance and 1622 paid out of pocket for their delivery and care. The study compared the obstetric outcomes between women on health insurance and those who pay out of pocket for obstetric care services. The Statistical Package for Social Sciences (SPSS) version 20.0 was used for the data analysis. Univariate association between mode of payment and obstetric outcomes was explored using Pearson's chi-square test with statistical significance, p-value set at p<0.05. Results: Both the employed (66.7% vs 33.3%) and unemployed (77.1% vs 22.9%) had preponderance for the use of health insurance. There was statistical significance between ethnicity (p=0.03), marital status (p<0.001) and mode of payment. Among those who had preeclampsia, 20% had health insurance while 80% paid out of pocket. All the women (100%) who had intrauterine growth restriction (IUGR) were on health insurance while 76.2% of those who did not have IUGR made use of OOP, with statistical significance (p=0.01). The special care baby unit (SCBU) admission for babies of mothers on health insurance was 9.1% compared to 17.2% of those on out of pocket payments. Babies whose mothers made out of pocket payments suffered early neonatal death (END) compared to none among the babies of those that were insured. Conclusion:The study concluded that out of pocket payment by pregnant women leads to poor obstetric and fetal outcomes.

Background: The challenge of 'safe blood' practice has given rise to several unanswered questions in the practice of immune-hematology and has led to controversies as to which algorithm adopted for HIV testing in prospective blood donors pose the least risk and provide safe blood to recipients of blood transfusion. The aim of this study is to evaluate HIV epidemiology and the outcomes of CDC-UMD serial algorithm II for HIV antibody testing in our resource-limited setting by advancing HIV screening beyond serologic procedure. Material and Methods:A total of 140 prospective blood donors were enrolled in the study between November, 2014 and July, 2015 by consecutive sampling technique. Study used HIV antibody screening based on serial algorithm II as the first-line testing protocol followed by ELISA technique. HIV-DNA confirmation and HIV-RNA quantification were carried out on pooled DBS and plasma samples respectively using real-time PCR. Results:The overall mean age and gender ratio of PBD were 27.9±7.9 years and 1.1:1. Chi square analysis revealed that the PBD had the right knowledge of all the routes of HIV transmission (χ2 range: 63.3 -212.7, p< 0.05). Study showed an overall HIV prevalence of 2.9% irrespective of assay technique with intercategory variation in prevalence. Pooled sero-negative DBS samples analysis by real-time PCR showed absence of occult HIV infection among PBD and viral load of confirmed positive blood donors revealed low viraemia (least being 25copies/ mL). Conclusion:Based on the study findings, HIV rapid antibody testing based on serial algorithm II did not compromise 'safe blood practice'. Adoption of rapid HIV antibody techniques based on serial algorithm II can serve as a surrogate HIV confirmatory technique in PBD where facilities for ELISA or the more costly realtime PCR are unavailable.