BackgroundIndividuals living with HIV/AIDS in sub-Saharan Africa generally take more than 90% of prescribed doses of antiretroviral therapy (ART). This number exceeds the levels of adherence observed in North America and dispels early scale-up concerns that adherence would be inadequate in settings of extreme poverty. This paper offers an explanation and theoretical model of ART adherence success based on the results of an ethnographic study in three sub-Saharan African countries.Methods and FindingsDeterminants of ART adherence for HIV-infected persons in sub-Saharan Africa were examined with ethnographic research methods. 414 in-person interviews were carried out with 252 persons taking ART, their treatment partners, and health care professionals at HIV treatment sites in Jos, Nigeria; Dar es Salaam, Tanzania; and Mbarara, Uganda. 136 field observations of clinic activities were also conducted. Data were examined using category construction and interpretive approaches to analysis. Findings indicate that individuals taking ART routinely overcome economic obstacles to ART adherence through a number of deliberate strategies aimed at prioritizing adherence: borrowing and “begging” transport funds, making “impossible choices” to allocate resources in favor of treatment, and “doing without.” Prioritization of adherence is accomplished through resources and help made available by treatment partners, other family members and friends, and health care providers. Helpers expect adherence and make their expectations known, creating a responsibility on the part of patients to adhere. Patients adhere to promote good will on the part of helpers, thereby ensuring help will be available when future needs arise.ConclusionAdherence success in sub-Saharan Africa can be explained as a means of fulfilling social responsibilities and thus preserving social capital in essential relationships.

Information is very scarce on the prevalence of hepatitis-B virus (HBV) infection among blood donors and patients with human immunodeficiency virus (HIV) infection in Nigeria. Hepatitis-B surface antigen (HBsAg) ELISA was used to determined the prevalence of HBsAg among 175 blood donors (aged 20-40 years) and Key words: hepatitis B virus -human immunodeficiency virus -blood donor -prevalenceHepatitis B virus (HBV) is the most common cause of serious liver infection in the world. It is estimated that worldwide more than two billion people have been infected by HBV and 350 million people have chronic infection (Drosten et al. 2004). The HBV, highly contagious and relatively easy to transmit from one infected individual to another, by blood-to-blood contact, during birth, unprotected sex, and by sharing needles, has relatively higher prevalence in the tropics (Finlayson et al. 1999).Nigeria is classified among the group of countries highly endemic for HBV infection. About 75% of the Nigerian population is reportedly likely to have been exposed to HBV at one time or the other in their life (Sirisena et al. 2002). There is a high level of occurrence of blood demanding health conditions in many parts of sub-Saharan Africa. In Nigeria the increase in road accidents, pregnancy-related hemorrhage, armed robbery attacks, and violent events, increase the possibility of the transmission of HBV (and other blood-borne pathogens) through contaminated blood as reported by United Nations System in Nigeria (UNSN 2001).Coinfection with HBV and human immunodeficiency virus (HIV) is a rapidly growing public health concern. The sub-Saharan Africa has been most severely affected by the HIV/AIDS pandemic with almost 9% of its adult (2003). The report also indicated that some parts of the country were worse affected than others but no state is unaffected. All the states of Nigeria have general population epidemics of over 1% with some areas having prevalence higher than 10%. Furthermore, the infection cuts across both sexes and all age groups but youths between the ages 20-29 years are more infected. According to UNAIDS (2000), the HIV prevalence rate among Nigerian girls (15-24 years) by the end of 1999, was in the range of 4.35 to 5.89 compared to boys to 1.68 to 3.35 in the same age range.Information is very scarce on the prevalence of HBV among healthy blood donors and patients with HIV infection in Nigeria. As a result of this dearth of information, guidelines, and other adequate information on the preventive and control measures are essentially lacking in many settings in Nigeria. Our objective therefore was to determine the prevalence of HBV infection among voluntary blood donors and HIV-infected individuals using HBsAg serological assay, with the view to establishing effective guidelines on the prevention and control of HBV infection in this part of the globe.This study was part of preliminary investigation leading to advanced research on HBV and HIV coinfection in Nigeria.

A total of 2,570 apparently healthy human immunodeficiency virus-negative adults from the six geopolitical zones in the country were enrolled in our study in 2006. The samples were assayed using the Cyflow technique. Data were analyzed using the Statistical Package for Social Scientists (SPSS). The majority (64%) of the participants had CD4 counts within the range of 501 to 1,000 cells/l. The reference range for CD4 was 365 to 1,571 cells/l, while the reference range for CD8 was 145 to 884 cells/l.In Nigeria, although country-specific reference ranges for some hematological measures have been determined (3,5,6), national data for CD4 reference values are still not available. Prior to a few recent monocenter studies carried out among defined populations of healthy Nigerians (2, 13), CD4 reference range values from literature based on studies in western countries were largely employed for clinical decision making.However, as the access to treatment increased in Nigeria, it became critically necessary to determine on a national level the reference values for CD4 cell counts and the factors that may affect it. This was necessary to inform the clinicians of the required minimal range for the initiation of antiretroviral therapy, and also for accurate monitoring of responses to therapy and other treatment outcomes.The national study reported in this document was a multicenter study conducted among healthy human immunodeficiency virus (HIV)-negative adult Nigerians, in eight sites across the six geopolitical zones of the country. Therefore, the objective of this study was to establish the normal reference values of CD4 and CD8, as well as CD4/CD8 lymphocyte ratios, indigenous to Nigeria.This project was carried out as a cross-sectional study among apparently healthy Nigerians aged 18 years and older who tested HIV negative at voluntary counseling and testing site sites. Exclusion criteria included pregnancy, sickle cell anemia, or clinical illness.A 5-ml sample of blood was collected from each participant by venipuncture into a Vacutainer EDTA bottle. These samples were retested using the Genie II kit (Bio-Rad), which is a rapid HIV serology test kit. Only samples that were confirmed negative were assayed for CD4 and CD8 cell counts concurrently using the Cyflow technique, with an instrument known as the Cyflow counter (Partec). This instrument is for counting and analyzing particles and cells. The first step in the measurement of cells is staining with a fluorescent dye. The fluorescent molecules are taken up by the cells. The cells are individually illuminated by light of a defined wavelength. The light activates the fluorescent molecules so that they emit light of a characteristic color (wavelength). This fluorescent light is filtered out, and its intensity is measured by a ploidy analyzer for each single cell. The fluorescence light intensity emitted by a labeled cell is proportional to its CD4 or CD8 content. For cell counting or concentration determination, the sample volume detector measures exactly 0.2 ml of th...

ObjectivesOur objectives were to assess trends in late presentation and advanced HIV disease (AHD) and determine associated risk factors. MethodsWe conducted a retrospective cohort analysis of patients who had received care and treatment at the AIDS Prevention Initiative Nigeria Plus (APIN)/Harvard School of Public Health− President's Emergency Plan for AIDS Relief (PEPFAR) programme at the Jos University Teaching Hospital, Jos, Nigeria from 2005 to 2010. We used the European Consensus Definition to assess trends in late presentation (CD4 count < 350 cells/μL or AIDS-defining illness) and AHD (CD4 count < 200 cells/μL or AIDS-defining illness) and evaluated associated risk factors using logistic regression methods. ResultsAmong 14 487 eligible patients, 12 401 (85.6%) were late presenters and 9127 (63.0%) presented with AHD. Late presentation decreased from 88.9% in 2005 to 80.1% in 2010 (P < 0.001). Similarly, AHD decreased from 67.8% in 2005 to 53.6% in 2010 (P < 0.001). In logistic regression models adjusting for sociodemographic and biological variables, male sex [adjusted odds ratio (aOR) = 1.80; 95% confidence interval (CI) 1.60-2.04], older age (aOR = 1.37; 95% CI 1.22-1.54), civil service employment (aOR = 1.48; 95% CI 1.00-2.21), referral from out-patient (aOR = 2.18; 95% CI 1.53-3.08) and in-patient (aOR = 1.55; 95% CI 1.11-2.17) services, and hepatitis B virus (aOR = 1.43; 95% CI 1.26-1.63) and hepatitis C virus (aOR = 1.18; 95% CI 1.02-1.37) coinfections were associated with late presentation. Predictors of AHD were male sex (aOR = 1.67; 95% CI 1.54-1.82), older age (aOR = 1.26; 95% CI 1.16-1.36), unemployment (aOR = 1.34; 95% CI 1.00-1.79), referral from out-patient (aOR = 2.40; 95% CI 1.84-3.14) and in-patient (aOR = 1.97; 95% CI 1.51-2.57) services and hepatitis B virus coinfection (aOR = 1.30; 95% CI 1.19-1.42). ConclusionsEfforts to reduce the proportion of patients who first seek care at late stages of disease are needed. The identified risk factors should be utilized in formulating targeted public health interventions to improve early diagnosis and presentation for HIV care.