IntroductionSignificant gaps persist in providing HIV treatment to all who are in need. Restricting care delivery to healthcare facilities will continue to perpetuate this gap in limited resource settings. We assessed a large‐scale community‐based programme for effectiveness in identifying people living with HIV and linking them to antiretroviral treatment.MethodsA retrospective secular trend study of 14 high burden local government areas of Nigeria was conducted in which two models of community antiretroviral treatment delivery were implemented: Model A (on‐site initiation) and Model B (immediate referral) clusters. Model A cluster offered services within communities, from HIV diagnosis to immediate antiretroviral therapy initiation and some follow‐up. Model B cluster offered services for HIV diagnosis up to baseline evaluation and provided referral for antiretroviral therapy initiation to nearest health facility providing HIV services. For controls, we selected and cluster‐matched 34 local government areas where community antiretroviral treatment delivery was not implemented. Outcomes of interest were: the number of people identified as HIV positive and the number of HIV‐positive individuals started on antiretroviral treatment; from June 2014 to May 2016. We used interrupted time‐series analysis to estimate outcome levels and trends across the pre‐and post‐intervention periods.ResultsBefore community antiretrovial treatment introduction, Model A cluster identified, per 100,000 catchment population, 500 HIV‐positives (95% CI: 399.66 to 601.41) and initiated 216 HIV‐positives on antiretroviral treatment (95% CI: 152.72 to 280.10). Model B cluster identified 32 HIV‐positives (95% CI: 25.00 to 40.51) and initiated 8 HIV‐positives on antiretroviral treatment (95% CI: 5.54 to 10.33). After commART introduction, Model A cluster showed an immediate significant increase in 744 HIV‐positive persons (p = 0.00, 95% CI: 360.35 to 1127.77) and 560 HIV‐positives initiated on treatment (p = 0.00, 95% CI: 260.56 to 859.64). Model B cluster showed an immediate significant increase in 30 HIV‐positive persons identified (p = 0.01, 95% CI: 8.38 to 51.93) but not in the number of HIV‐positives initiated on treatment. Model B cluster showed increased month‐on‐month trends of both outcomes of interest (3.4, p = 0.02, 95% CI: 0.44 to 6.38).ConclusionBoth community‐models had similar population‐level effectiveness for rapidly identifying people living with HIV but differed in effectively transitioning them to treatment. Comprehensiveness, integration and attention to barriers to care are important in the design of community antiretroviral treatment delivery.
The aim of this study was to describe and evaluate the impact of the programme intervention of the Rivers State Antiretroviral Treatment (ART) Surge, a collaboration between the US President's Emergency Plan for AIDS Relief (PEPFAR) and the State Ministry of Health, to increase HIV case-finding and ART access in Rivers State, the state with the largest ART gap among people living with HIV (PWH) in Nigeria.Design: During April 2019ÀSeptember 2020, the intervention included six specific strategies: using local government area-level ART gap analysis to guide case-finding; expanding targeted community testing; tailoring comprehensive key population HIV services; engaging HIV treatment programme stakeholders; synchronizing team efforts; and using near real-time data for programme action.Methods: Weekly reported facility and community data on tests conducted, PWH diagnosed, and PWH initiated on ART were aggregated. The total number of PWH maintained on ART was reported quarterly.Results: During May 2019ÀSeptember 2020, the weekly number of newly diagnosed PWH initiated on ART supported by PEPFAR in Rivers State increased from 82 to 1723. During October 2019ÀSeptember 2020, the monthly number of people screened for HIV testing eligibility in the community increased from 44 000 to 360 000. During April 2019ÀSeptember 2020, the total number of PWH on ART supported by PEPFAR statewide increased by 3.8 times, from 26 041 to 99 733. Conclusion:The strategies applied by HIV program stakeholders contributed to scaleup of PWH identification and ART linkage within the Rivers State ART Surge. Continued
Introduction the knowledge of epidemiologic and clinical variables in patients with SARS- CoV-2 infection provides evidence and lessons that are useful for the pandemic response, with consideration of National and sub-National variations. The objective of this study was to characterize and describe the clinical and epidemiologic features of all the hospitalised patients with COVID-19 in Rivers State Nigeria, from March to August 2020. Methods a prospective descriptive multi-center study of patients with positive SARS-CoV-2 RT PCR, who were hospitalised for treatment and self-isolation in four treatment centers in Rivers state, Nigeria. Results the mean age of all the patients was 39.21 ± 12.31 years, with a range of 2 to 77 years. The majority of patients were in the 31 to 40-year (33.0%), 41 to 50-year (23.1%) and 18-to 30-year (22.0%) age groups. The patient population included 474 (73.4%) males and 172 (26.6%) females, with 93 (14.4%) healthcare workers. A history of contact and travel was established in 38.5% and at least one comorbid disease condition was present in 32.8% of patients. Patients with severe disease were 61 (9.45%), while the overall case fatality rate was 2%. The leading comorbid disease conditions were Hypertension in 23.8% and diabetes in 7.7% of patients. Fever (26.0%), dry Cough (17.6%), dyspnoea (12.7%), anosmia (12.7%) and headache (9.9%) were the most common symptoms. The presence of comorbidity and increasing age predicted death from COVID-19. Conclusion the clinical and epidemiologic characteristics of this cohort of hospitalised patients show significant similarities with existing trends from previously reported studies, with contextual peculiarities.
Background This research explored awareness, perception, and practice of COVID 19 prevention among residents of communities in all the local government areas (districts) in Rivers State during the early stages of the pandemic response. Design This was a descriptive cross-sectional survey which employed an interviewer-administered four-page questionnaire built into the Open Data Kit application for android phones. Knowledge and practice scores were computed by scoring every correct response/action as 1 and wrong responses as 0. Knowledge was graded as excellent for scores of ≥80%, good for scores of 50-79% and poor for scores of <50%. Respondents who washed all critical parts of the hand were categorized as having correct handwashing practice. Setting Rivers State in the South-South region of Nigeria had recorded over 2000 cases of COVID 19 as of 18th August 2020, ranking 5th among the high burden states in Nigeria. As with any epidemic of an infectious nature, panic, fear, and misconceptions are rife. Risk communication utilizes multi-faceted activities geared towards facilitating correct and consistent knowledge and prevention practice. Participants Study involved 1,294 adult community residents in the 23 districts of the state. Results The respondents were aged between 18 and 80 years with average age of 39.6 years (SD = 11.9 years). A total of 710 (54.9%) were male, 476 (36.8%) were unemployed with 685 (52.9%) having secondary education. Almost all respondents 1,271 (98.2%) had heard about COVID 19. The three most common sources of information about COVID 19 were radio jingles 1102 (86.7%), television adverts 940 (74.0%) and announcements in Church 612 (48.2%). Overall, 608 (47.0%) of the respondents had poor knowledge of COVID 19. About 1167 (90.2%) of the respondents who were aware of COVID 19 acknowledged that COVID 19 is a problem in the state while 443 (34.9%) respondents believed they were unlikely contract the virus. Only 505 (39.0%) of the respondents washed all critical parts of the hand correctly. Conclusion Risk communication interventions during pandemics need to be based on an understanding of the gaps in knowledge, attitude, perceptions, and practice. Broadcast media has a pivotal role to play in risk communication for behaviour change for the control of current and future epidemics in this population.
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