Background: A substantial number of persons living with HIV (PLWH) in Nigeria do not experience d... more Background: A substantial number of persons living with HIV (PLWH) in Nigeria do not experience durable viral suppression on first-line antiretroviral therapy (ART). Understanding risk factors for first-line treatment failure informs patient monitoring practices and distribution of limited resources for second-line regimens. We determined predictors of immunologic and virologic failures in a large ART delivery program in Abuja, Nigeria. Methods: A retrospective cohort study was conducted at the University of Abuja Teaching Hospital, a tertiary health care facility, using data from February 2005 to December 2014 in Abuja, Nigeria. All PLWH aged ≥ 15 years who initiated ART with at least 6-month follow-up and one CD4 measurement were included. Immunologic failure was defined as a CD4 decrease to or below pre-ART level or persistent CD4 < 100 cells per mm 3 after 6 months on ART. Virologic failure (VF) was defined as two consecutive HIV-1 RNA levels > 1000 copies/mL after at least 6 months of ART and enhanced adherence counselling. HIV drug resistance (Sanger sequences) was analyzed using the Stanford HIV database algorithm and scored for resistance to common nucleoside reverse transcriptase inhibitors (NRTIs) and nonnucleoside reverse transcriptase inhibitors (NNRTIs). Univariate and multivariate log binomial regression models were used to estimate relative risks (RRs) and 95% confidence intervals (CIs). Results: Of 12,452 patients followed, a total of 5928 initiated ART with at least 6 months of follow-up and one CD4 measurement. The entry point for 3924 (66.2%) was through the program's own voluntary counseling and testing (VCT) center, while 1310 (22.1%) were referred from an outside clinic/program, 332 (5.6%) in-patients, and 373 (6.3%) through other entry points including prevention of mother to child transmission (PMTCT) and transferred from other programs. The mean CD4 at enrollment in care was 268 ± 23.7 cells per mm 3 , and the mean HIV-1 RNA was 3.3 ± 1.3.log 10 copies/mL. A total of 3468 (80.5%) received nevirapine (NVP) and 2260 (19.5%) received efavirenz (EFV)-based regimens. A total of 2140 (36.1%) received tenofovir (TDF); 2662 (44.9%) zidovudine (AZT); and 1126 (19.0%) stavudine (d4T). Among those receiving TDF, 45.0% also received emtricitabine (FTC). In a multivariate model, immunologic failure was more common among PLWH with female gender as compared to male [RR (95% CI) 1.22
Background: The Nigerian HIV Geriatric Cohort (NHGC) is a longitudinal cohort setup to learn how ... more Background: The Nigerian HIV Geriatric Cohort (NHGC) is a longitudinal cohort setup to learn how elderly people living with HIV (EPLHIV) in Nigeria fare, despite not being prioritized by the national treatment program, and to deepen knowledge for their differentiated care and achieve better outcomes. In this paper, we describe data collected on sociodemographic and clinical data from EPLHIV from the inception of Nigeria's national HIV program to 2018. Methods: Patient-level data spanning the period 2004 to 2018, obtained from comprehensive HIV treatment hospitals, that are supported by four major PEPFAR-implementing partners in Nigeria were used. These 4 entities collaborated as member organizations of the Nigeria Implementation Science Alliance. We de ned elderly as those aged 50 years and above. From deidenti ed treatment records, demographic and clinical data of EPLHIV ≥50-year-old at ART initiation during the review period was extracted, merged into a single REDcap® database, and described using STATA 13. Results: A total of 101,652 unique EPLHIV entries were analysed. This cohort's data was of 53,608(52.7%)
Journal of Advances in Medicine and Medical Research
Background: The Clinical Mentorship Programme (CMP) is an organized form of PHM programme, which ... more Background: The Clinical Mentorship Programme (CMP) is an organized form of PHM programme, which was deployed as a pioneer public health intervention and modelled to support existing interventions and other ongoing strategies to catalyze better outcomes in the HIV Control Programme in Rivers State, Nigeria. CMP as a form of PHM is untested mainly in Nigeria. It is a structured intervention to complement the effort at bridging the gap of huge unmet needs in HIV service delivery in a low-resource setting, marked by a difficult terrain and security challenges. The rationale was to catalyze quality improvement in targeted indicators using locally tested initiatives, build the capacity of local teams, promote a culture of problem-solving attitude at the site level and strengthen team effort between the Institute of Human Virology, Nigeria, Government Agencies and beneficiary community. Methodology: The CMP was implemented in the State HIV control Programme from about July 2019. The SCMs ...
Background: Rivers State had a huge burden of PLHIV, and the UNAIDS Spectrum 2019 model projected... more Background: Rivers State had a huge burden of PLHIV, and the UNAIDS Spectrum 2019 model projected the total number of PLHIV in the State in 2020 to be 184,551. The semblance of HIV treatment care and support program, commencing after the diagnosis of the first reported case of HIV, dates as far back as 1989 when HIV was first diagnosed in the State. However, thirty years later, the treatment coverage had remained poor, despite the support of development partners. So, there was a strong need to strengthen the capacity of all critical actors in the program to achieve the objectives around the three-95s of the End AIDS Strategy, using strategic yet novel interventions such as the CMP. This research aims to determine how much of an effect a clinical mentorship program has had on enhancing Rivers State's HIV control efforts. Methodology: The clinical mentorship framework was implemented and amortized to strengthen all layers of ongoing interventions to catalyze better quality improve...
Prevalence and risk factors for obesity among elderly patients living with HIV/AIDS in a low-resource setting
Medicine
Obesity is associated with detrimental changes in cardiovascular and metabolic parameters, includ... more Obesity is associated with detrimental changes in cardiovascular and metabolic parameters, including blood pressure, dyslipidemia, markers of systemic inflammation, and insulin resistance. In the elderly living with the human immunodeficiency virus (EPLHIV), and being treated with antiretroviral medications, the obesity complications escalate and expose the elderly to the risk of noncommunicable diseases. Given that over 3 million EPLHIV in sub-Sahara Africa, we assessed the prevalence of obesity and its associated factors among EPLHIV in a low-resource setting. This was a cross sectional study of EPLHIV aged 50 years and older, being treated with antiretroviral medications from 2004 to 2018. HIV treatment data collected from multiple treatment sites were analyzed. Baseline characteristics of the participants were described, and multivariable relative risk model was applied to assess the associations between obesity (body mass index [BMI] ≥30 kg/m2) and the prespecified potential ri...
Background In Nigeria, private for-profit health facilities present an opportunity to achieve the... more Background In Nigeria, private for-profit health facilities present an opportunity to achieve the UNAIDS 95-95-95 HIV targets because of their reach and patronage. However, little is known about determinants of outcomes in these facilities. This study describes patient outcomes and the patient and health facility characteristics associated with these outcomes in adults receiving HIV treatment in private facilities in the Federal Capital Territory (FCT), Benue and Nasarawa states in north-central Nigeria. Methods A retrospective longitudinal analysis of program data collected between 2013 and 2019 was done. Patient attributes and outcomes were compared across the two states and FCT. Incidence rates were determined for all cause exit, mortality and loss to follow up (LTFU). Cox proportional hazard models were used to identify associations between patient and facility attributes and these outcomes. Bivariate and multivariate logistic regression models were used to determine the factors...
Background Ineffective linkage to care (LTC) is a known challenge for community HIV testing. To o... more Background Ineffective linkage to care (LTC) is a known challenge for community HIV testing. To overcome this challenge, a robust linkage to care strategy was adopted by the 2018 Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS). The NAIIS linkage to care strategy was further adapted to improve Nigeria’s programmatic efforts to achieve the 1st 90 as part of the Nigeria Antiretroviral Therapy (ART) Surge initiative, which also included targeted community testing. In this paper we provide an overview of the NAIIS LTC strategy and describe the impact of this strategy on both the NAIIS and the Surge initiatives. Methods The NAIIS collaborated with community-based organizations (CBOs) and deployed mobile health (mHealth) technology with real-time dashboards to manage and optimize community LTC for people living with HIV (PLHIV) diagnosed during the survey. In NAIIS, CBOs’ role was to facilitate linkage of identified PLHIV in community to facility of their choice. For the ART Surge, we...
Background For nearly three decades, hospitals have been the only source of antiretroviral therap... more Background For nearly three decades, hospitals have been the only source of antiretroviral therapy (ART) for many people living with HIV. Yet, developing countries with the largest burden of HIV commonly lack the hospitals and health-care workers to care for these patients. In 2013, WHO recommended the use of structures outside hospitals for management of HIV. We piloted a community pharmacy ART model in communities with high HIV prevalence in Nigeria. The purpose was to develop a treatment model that could be expanded into an overarching comprehensive response to HIV management, especially in resource-limited settings with weak health systems. Methods Registered community pharmacies linked to participating hospitals were recruited between February 2016 and May 2017. Patients with stable viral loads (≤20 copies/mL) who were willing to have their care devolved to a community pharmacy were referred by trained contact persons at the hospitals. Registered pharmacists at the community pharmacies counselled referred patients and refilled their prescriptions. Biodemographic and clinical data were collected from Feb 25, 2016, to May 31, 2017. The outcome measures were percentage of patients retained in care and adherence to therapy. Mean difference in the viral load at the baseline (≤20 copies/mL) and after 6 months was assessed using a paired sample t-test. Findings 26 community pharmacies and 14 hospitals were included in the pilot. 375 patients (median baseline viral load 19 copies/mL [IQR 19-32]; median CD4 count 460 cells/mL [277-648]) had their care devolved to the community pharmacies. After 12 months, almost all the patients (374 [99•7%] of 375) were retained in care and adherence to medication (measured by prescription refill) was 100%. After 6 months of follow-up, 19 patients received results of their second viral load test, showing no significant difference in the mean viral load between baseline and after 6 months (p<0•46). Interpretation We show that patients can conveniently access ART in community pharmacies linked to hospitals, with no adverse effects on adherence or viral load. The model will be rolled-out to other regions in Nigeria, and could potentially be applied elsewhere.
ObjectivesThis study evaluates the effect of Community Anti-retroviral Groups on Immunologic, Vir... more ObjectivesThis study evaluates the effect of Community Anti-retroviral Groups on Immunologic, Virologic and clinical outcomes of stable Antiretroviral Therapy patients in Nigeria.MethodA cohort of 251 eligible adults (≥18 years) on first-line ART for at least 6 months with CD4 counts >200 cells/mm3 and viral load <1000 c/ml were devolved from 10 healthcare facilities to 51 community antiretroviral therapy groups. Baseline immunologic, virologic and clinical parameters were collected and community antiretroviral therapy group patients were followed up for a year after which Human Immunodeficiency Virus treatment outcomes at the baseline and a year after follow-up were compared using paired sample t-test. All the analyses were performed in STATA version 14.ResultOut of the 251 stable antiretroviral therapy adults enrolled, 186 (75.3%) were female, 52 (22.7%) had attained post-secondary education and the mean age of participants was 38 years (SD: 9.5). Also, 66 (27.9%) were emplo...
Background Adverse events (AEs) of second line anti-tuberculosis drugs (SLDs) are relatively well... more Background Adverse events (AEs) of second line anti-tuberculosis drugs (SLDs) are relatively well documented. However, the actual burden has rarely been described in detail in programmatic settings. We investigated the occurrence of these events in the national cohort of multidrugresistant tuberculosis (MDR-TB) patients in Nigeria. Method This was a retrospective, observational cohort study, using pharmacovigilance data systematically collected at all MDR-TB treatment centers in Nigeria. Characteristics of AEs during the intensive phase treatment were documented, and risk factors for development of AEs were assessed. Results Four hundred and sixty patients were included in the analysis: 62% were male; median age was 33 years [Interquartile Range (IQR):28-42] and median weight was 51 kg (IQR: 45-59). Two hundred and three (44%) patients experienced AEs; four died of conditions associated with SLD AEs. Gastro-intestinal (n = 100), neurological (n = 75), ototoxic (n = 72) and psychiatric (n = 60) AEs were the most commonly reported, whereas ototoxic and psychiatric AEs were the most debilitating. Majority of AEs developed after 1-2 months of therapy, and resolved in less than a month after treatment. Some treatment centers were twice as likely to report AEs compared with others, highlighting significant inconsistencies in
Background To accelerate progress toward the UNAIDS 90-90-90 targets, US Centers for Disease Cont... more Background To accelerate progress toward the UNAIDS 90-90-90 targets, US Centers for Disease Control and Prevention Nigeria country office (CDC Nigeria) initiated an Antiretroviral Treatment (ART) Surge in 2019 to identify and link 340,000 people living with HIV/AIDS (PLHIV) to ART. Coronavirus disease 2019 (COVID-19) threatened to interrupt ART Surge progress following the detection of the first case in Nigeria in February 2020. To overcome this disruption, CDC Nigeria designed and implemented adapted ART Surge strategies during February–September 2020. Methods Adapted ART Surge strategies focused on continuing expansion of HIV services while mitigating COVID-19 transmission. Key strategies included an intensified focus on community-based, rather than facility-based, HIV case-finding; immediate initiation of newly-diagnosed PLHIV on 3-month ART starter packs (first ART dispense of 3 months of ART); expansion of ART distribution through community refill sites; and broadened access t...
What patient and health facility attributes predict retention and virologic suppression in private for-profit health centers? A retrospective cohort analysis of data from a large private sector antiretroviral treatment program in Nigeria
Background In Nigeria, private for-profit health facilities present an opportunity to achieve the... more Background In Nigeria, private for-profit health facilities present an opportunity to achieve the 95-95-95 HIV targets because of their reach and patronage. However, little is known about determinants of outcomes in these facilities. This study describes patient outcomes and their determinants in adults receiving HIV treatment in private facilities in 3 states in north-central Nigeria. Methods A retrospective longitudinal analysis of program data collected between 2013 and 2019 was done. Patient attributes and outcomes were compared across states. Incidence rates were determined for all outcomes. Cox proportional hazard models and multivariate logistic regression models were used to identify associations with and predictors of study outcomes respectively. Results 42.7%, 22.2% and 35.1% of the 22,010 study subjects were in Benue, FCT and Nasarawa respectively. 31.8% had been on ART for less than a year at censoring. Incidence rates for all-cause exit, mortality and LTFU were 17.2, 2....
Background A substantial number of persons living with HIV (PLWH) in Nigeria do not experience du... more Background A substantial number of persons living with HIV (PLWH) in Nigeria do not experience durable viral suppression on first-line antiretroviral therapy (ART). Understanding risk factors for first-line treatment failure informs patient monitoring practices and distribution of limited resources for second-line regimens. We determined predictors of immunologic and virologic failures in a large ART delivery program in Abuja, Nigeria. Methods A retrospective cohort study was conducted at the University of Abuja Teaching Hospital, a tertiary health care facility, using data from February 2005 to December 2014 in Abuja, Nigeria. All PLWH aged ≥ 15 years who initiated ART with at least 6-month follow-up and one CD4 measurement were included. Immunologic failure was defined as a CD4 decrease to or below pre-ART level or persistent CD4 1000 copies/mL after at least 6 months of ART and enhanced adherence counselling. HIV drug resistance (Sanger sequences) was analyzed using the Stanford...
Background: An estimated 280,000 adults aged 50 years and above live with HIV in Nigeria, a popul... more Background: An estimated 280,000 adults aged 50 years and above live with HIV in Nigeria, a population set to increase with ART efficacy and expanding coverage. To learn how elderly people living with HIV (EPLHIV) in Nigeria fare, despite not being prioritized by the national treatment program, and to deepen knowledge for their differentiated care and achieve better outcomes, the Nigerian HIV Geriatric Cohort (NHGC) was setup. Methods: Patient-level data spanning the period 2004 to 2018, obtained from comprehensive HIV treatment hospitals, that are supported by four major PEPFAR-implementing partners in Nigeria was used. These 4 entities collaborated as member organizations of the Nigeria Implementation Science Alliance. We defined geriatric/elderly as those aged 50 years and above. From de-identified treatment records, demographic and clinical data of EPLHIV ≥50-year-old at ART initiation during the review period was extracted, merged into a single REDcap® database, and described u...
Background Expanded access to antiretroviral therapy (ART) leads to improved HIV/AIDS treatment o... more Background Expanded access to antiretroviral therapy (ART) leads to improved HIV/AIDS treatment outcomes in Nigeria, however, increasing rates of loss to follow-up among those on ART is threatening optimal standard achievement. Therefore, this retrospective cross-sectional study is aimed at identifying correlates and predictors of loss to follow-up in patients commencing ART in a large HIV program in Nigeria. Methods Records of all patients from 432 US CDC Presidents Emergency Plan for AIDS Relief (PEPFAR) supported facilities across 10 States and FCT who started ART from 2004 to 2017 were used for this study. Bivariate and multivariate analysis of the demographic and clinical parameters of all patients was conducted using STATA version 14 to determine correlates and predictors of loss to follow-up. Results Within the review period, 245,257 patients were ever enrolled on anti-retroviral therapy. 150,191 (61.2%) remained on treatment, 10,960 (4.5%) were transferred out to other facil...
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Papers by Charles Mensah