Because of the low sensitivity of immunologic criteria, a substantial number of failures are missed, potentially resulting in accumulation of resistance mutations. In addition, specificity and predictive values are low, which may result in large numbers of unnecessary ART switches. Monitoring solely by immunologic criteria may result in increased costs because of excess switches to more expensive ART and development of drug-resistant virus.

This study assessed the prevalence and characteristics of intimate partner violence among women of childbearing age in a primary health centre. With interviewer-administered questionnaire, information on partner violence was elicited from three hundred women of childbearing age selected by systematic sampling in a primary health care (PHC) centre. Over 40% had experienced violence within the last 12 months. Type of marriage and partner's education had effect on violence. Perceived reasons for violence were economic demand (56.1%), reproductive issues (42.5%), alcohol and drugs (61.2%). Forty eight per cent reported to family members. Only 1% reported to the Police. Intimate partner violence is a prevalent public health problem in eastern Nigeria. Health workers and social organisations should recognise the problem and offer necessary support, and women should be empowered RÉSUMÉLa violence du partenaire intime chez les femmes en âge d'avoir des enfants dans un centre des services médicaux primaries au Nigéria. Cette étude a etude a évalué la prévalence et les caractéristiques de la violence du partenaire intime chez les femmes en âge d'avoir des enfants, dans un centre des services médicaux primaries. A l'aide d'un questionnaire administé par l'intervieweur, nous avons recueilli des renseignements sur la violence du partenaire de trios cents femmes en âge d'avoir des enfants. Elles ont été selectionnées à travers un échantillon systématique dans un centre des services médicaux primaries (SMP). Plus de 40% avaient vécu la violence ces douze derniers mois. Le type de mariage et le niveau de scolarité du partenaire avaient un effet sur la violence. Les raisons perçues de la violence étaient l'exigence économique (15,1%), les questions de la reproduction (42,5%), l'alcool et la drogue (61,2%). 48% ont signalé aux members de famille. Seul 1% ont signalé à la police. La violence du partenaire intime est un problème de la santé publique prévalent à l'Est du Nigéria. Il faut que les Assistantes Sociales et les organisations sociales reconnaissent le problème et qu'elles offrent le secours nécessaire. Il faut également rendre les femmes capables d'affronter le problème. (Rev Afr Santé Reprod 2002; 6[3]: 53-58)

Evaluation of time-dependent predictors of loss to follow-up in a large HIV treatment program revealed that early adherence patterns, in addition to CD4 count and viral load, predicted loss to follow-up and should be used as measures in devising targeted interventions to increase program retention.

BackgroundTo date, antiretroviral therapy (ART) guidelines and programs in resource-limited settings (RLS) have focused on 1st- and 2nd-line (2 L) therapy. As programs approach a decade of implementation, policy regarding access to 3rd-line (3 L) ART is needed. We aimed to examine the impact of maintaining patients on failing 2 L ART on the accumulation of protease (PR) mutations.Methods and FindingsFrom 2004–2011, the Harvard/APIN PEPFAR Program provided ART to >100,000 people in Nigeria. Genotypic resistance testing was performed on a subset of patients experiencing 2 L failure, defined as 2 consecutive viral loads (VL)>1000 copies/mL after ≥6 months on 2 L. Of 6714 patients who received protease inhibitor (PI)-based ART, 673 (10.0%) met virologic failure criteria. Genotypes were performed on 61 samples. Patients on non-suppressive 2 L therapy for <12 months prior to genotyping had a median of 2 (IQR: 0–5) International AIDS Society (IAS) PR mutations compared with 5 (IQR: 0–6) among patients failing for >24 months. Patients developed a median of 0.6 (IQR: 0–1.4) IAS PR mutations per 6 months on failing 2 L therapy. In 38% of failing patients no PR mutations were present. For patients failing >24 months, high- or intermediate-level resistance to lopinavir and atazanavir was present in 63%, with 5% to darunavir.ConclusionsThis is the first report assessing the impact of duration of non-suppressive 2 L therapy on the accumulation of PR resistance in a RLS. This information provides insight into the resistance cost of failing to switch non-suppressive 2 L regimens and highlights the issue of 3 L access.

Compared with our matched control group, HIV is associated with significantly increased morbidity, healthcare utilization, public health facility use, lost work time and family time devoted to care-giving. Direct private healthcare costs and indirect income loss per HIV-positive individual were 36 065 Naira, approximately 56% of annual income per capita in affected households. Approximately 40% of these costs were income losses associated with sickness and care-giving. 10% of the cost of HIV is accounted for by public subsidies for health. The largest single cost, representing 54% of the total economic burden of HIV, is for out-of-pocket expenses for healthcare.