IntroductionNigeria has a high burden of children living with HIV and tuberculosis (TB). This article examines the magnitude of TB among children receiving antiretroviral treatment (ART), compares their ART outcomes with their non-TB counterparts and argues that addressing TB among children on ART is critical for achieving the 90–90–90 targets.MethodsThis was a facility-based, retrospective analysis of medical records of children aged <15 years who were newly initiated on ART between 2011 and 2012. Structured tools were used to collect data. STATA software was used to perform descriptive, survival and multivariate analyses.ResultsA total of 1142 children with a median age of 3.5 years from 20 selected facilities were followed for 24 months. Of these, 95.8% were assessed for TB at ART initiation and 14.7% had TB. Children on ART were more likely to have TB if they were aged 5 years or older (p<0.01) and had delayed ART initiation (p<0.05). The cotrimoxazole and isoniazid prophylaxes were provided to 87.9 and 0.8% of children, respectively. The rate of new TB cases was 3 (2.2–4.0) per 100 person-years at six months and declined to 0.2 (0.06–1.4) per 100 person-years at 24 months. TB infection [adjusted hazard ratio (aHR): 4.3; 2.3–7.9], malnutrition (aHR: 5.1; 2.6–9.8), delayed ART initiation (aHR: 3.2; 1.5–6.7) and age less than 1 year at ART initiation (aHR: 4.0; 1.4–12.0) were associated with death. Additionally, patients with TB (aHR: 1.3; 1.1–1.6) and children below the age of 1 at ART initiation (aHR: 2.9; 1.7–5.2) were more likely to be lost to follow-up (LFU).ConclusionsChildren on ART with TB are less likely to survive and more likely to be LFU. These risks, along with low isoniazid uptake and delayed ART initiation, present a serious challenge to achieving the 90–90–90 targets and underscore an urgent need for inclusion of childhood TB/HIV in global plans and reporting mechanisms.

Maternal syphilis screening and treatment in Nigeria are inadequate to meet the elimination aspirations. A rapid scale-up of antenatal care syphilis screening and treatment are crucial to averting an epidemic in Nigeria by 2020.

BackgroundIn Nigeria, maternal, newborn, and child health (MNCH) weeks are campaign-like events designed to accelerate progress toward Millennium Development Goals. The authors examined whether integrating HIV testing into MNCH weeks was feasible and could lead to increased case finding and linkage to prevention of mother-to-child transmission (PMTCT) services.MethodsPregnant women attending MNCH week during the first week of December 2014 in 13 local government areas in Benue State were provided with HIV tests and referrals to PMTCT services. Demographic, past antenatal care (ANC), and HIV testing information were collected using a structured questionnaire. We used routine ANC/PMTCT data from national electronic system (DHIS-2) to compare with the results obtained from MNCH week.ResultsA total of 50,271 pregnant women with a median age of 25 years (IQR: 21–29) were offered HIV testing. About 50,253 (99.96%) agreed to get HIV testing, with 1,063 (2.1%) testing positive. Six hundred forty-four (60.6%) of those with positive results were linked to PMTCT. In multivariate analysis, marital status, gestation age, and those with no ANC visit during this pregnancy were associated with a positive HIV test. Approximately 30% (50,253 versus 39,080) more pregnant women received HIV testing in MNCH week compared to those who received HIV testing in routine ANC services in 2013. Of the 50,253 who accepted testing, 15,611 (31.1%) did not attend ANC during this pregnancy, of which 9,615 (61.6%) had not had any previous HIV tests. Four hundred forty-two (4.6%) of these 9,615 tested HIV-positive.ConclusionIntegration of HIV testing into MNCH weeks is feasible and improved uptake of HIV testing and linkage to care. However, the rate of HIV positivity was lower than that reported by previous studies. The findings indicate that MNCH weeks provides opportunity to reach those who do not attend ANC services for HIV care.

Caregiver satisfaction has the potential to promote equity for children living with HIV, by influencing health-seeking behaviour. We measured dimensions of caregiver satisfaction with paediatric HIV treatment in Nigeria, and discuss its implications for equity by conducting facility-based exit interviews for caregivers of children receiving antiretroviral therapy in 20 purposively selected facilities within 5 geopolitical zones. Descriptive analysis and factor analysis were performed. Due to the hierarchical nature of the data, multilevel regression modelling was performed to investigate relationships between satisfaction factors and socio-demographic variables. Of 1550 caregivers interviewed, 63% (95% CI: 60.6–65.4) reported being very satisfied overall; however, satisfaction varied in some dimensions: only 55.6% (53.1–58.1) of caregivers could talk privately with health workers, 56.9% (54.4–59.3) reported that queues to see health workers were too long, and 89.9% (88.4–91.4) said that some health workers did not treat patients living with HIV with sufficient respect. Based on factor analysis, two underlying factors, labelled Availability and Attitude, were identified. In multilevel regression, the satisfaction with availability of services correlated with formal employment status (p < .01), whereas caregivers receiving care in private facilities were less likely satisfied with both availability (p < .01) and attitude of health workers (p < .05). State and facility levels influenced attitudes of the health workers (p < .01), but not availability of services. We conclude that high levels of overall satisfaction among caregivers masked dissatisfaction with some aspects of services. The two underlying satisfaction factors are part of access typology critical for closing equity gaps in access to HIV treatment between adults and children, and across socio-economic groups.

OBJECTIVE To assess outcomes and barriers of Disclosure of HIV serostatus among infected women in Kilifi District. METHODS This was a qualitative study conducted at Comprehensive Care and Research Centre of Kilifi District Hospital in Kenya. The study recruited and interviewed 20 women who were selected by mixed purposeful sampling among all clients attending the clinic. Data transcription, coding, categorization and lastly theme formation were done in the process of data analysis. RESULTS Mixtures of positive and negative outcomes were reported from individual clients. The different outcomes of disclosure were grouped into two categories. These were Patient's relationship with different social groups and Community care and support for HIV positive patients. The positive outcomes were strengthened partner relationship, social care, financial support, and encouragement to ARV drug adherence. The negative outcomes were family separation, abandonment, refusal of the husbands to get tested for HIV and suicidal attempts. The reported barriers to disclosure were stigma, religion, and fear of family violence, fear of loosing jobs, gossiping and fear of accusation of infidelity. CONCLUSION Disclosure of HIV serostatus is a complex process; it is not a single night event but a process that can take weeks, months, even years with a lot of positive and negative outcomes and some of the negative outcomes being very devastating to the client. Also the Concept of "Anticipated outcomes Vs Real outcomes" of disclosure was found to be valid to the majority of clients. Lastly, the issue of concern to many clients was the question; "Should I disclose or disappear?" If this question could be well addressed, it will positively influence the disclosure of HIV serostatus and thus open doors for easy accessibility to the available free medical care for HIV patients and encourage ARV drug adherence especially in the developing countries.