Background In sub-Saharan Africa, there is increasing mortality and morbidity of adolescents due to poor linkage, retention in HIV care and adherence to antiretroviral therapy (ART). This is a result of limited adolescent-centred service delivery interventions. This cost-effectiveness and feasibility study were piggybacked on a cluster-randomized trial that assessed the impact of an adolescent-centred service delivery intervention. The service delivery intervention examined the impact of an incentive scheme consisting of conditional economic incentives and motivational interviewing on the health outcomes of adolescents living with HIV in Nigeria. Method A cost-effectiveness analysis from the healthcare provider’s perspective was performed to assess the cost per additional patient achieving undetected viral load through the proposed intervention. The cost-effectiveness of the incentive scheme over routine care was estimated using the incremental cost-effectiveness ratio (ICER), expressed as cost/patient who achieved an undetectable viral load. We performed a univariate sensitivity analysis to examine the effect of key parameters on the ICER. An in-depth interview was conducted on the healthcare personnel in the intervention arm to explore the feasibility of implementing the service delivery intervention in HIV treatment hospitals in Nigeria. Result The ICER of the Incentive Scheme intervention compared to routine care was US$1419 per additional patient with undetectable viral load. Going by the cost-effectiveness threshold of US$1137 per quality-adjusted life-years suggested by Woods et al., 2016, the intervention was not cost-effective. The sensitivity test showed that the intervention will be cost-effective if the frequency of CD4 count and viral load tests are reduced from quarterly to triannually. Healthcare professionals reported that patients’ acceptance of the intervention was very high. Conclusion The conditional economic incentives and motivational interviewing was not cost-effective, but can become cost-effective if the frequency of HIV quality of life indicator tests are performed 1–3 times per annum. Patients’ acceptance of the intervention was very high. However, healthcare professionals believed that sustaining the intervention may be difficult unless factors such as government commitment and healthcare provider diligence are duly addressed. Trial registration This trial is registered in the WHO International Clinical Trials Registry through the WHO International Registry Network (PACTR201806003040425).

Background This study investigated the determinants of coronavirus disease 2019 (COVID-19) vaccine hesitancy among healthcare workers (HCWs) in Cameroon and Nigeria. Methods This analytic cross-sectional study was conducted from May to June 2021, including consenting HCWs aged ≥18 y identified using snowball sampling. Vaccine hesitancy was defined as indecisiveness or unwillingness to receive the COVID-19 vaccine. Multilevel logistic regression yielded adjusted ORs (aORs) for vaccine hesitancy. Results We included a total of 598 (about 60% women) participants. Little or no trust in the approved COVID-19 vaccines (aOR=2.28, 95% CI 1.24 to 4.20), lower perception of the importance of the vaccine on their personal health (5.26, 2.38 to 11.6), greater concerns about vaccine-related adverse effects (3.45, 1.83 to 6.47) and uncertainty about colleagues’ acceptability of the vaccine (2.98, 1.62 to 5.48) were associated with higher odds of vaccine hesitancy. In addition, participants with chronic disease (aOR=0.34, 95% CI 0.12 to 0.97) and higher levels of concerns about getting COVID-19 (0.40, 0.18 to 0.87) were less likely to be hesitant to receive the COVID-19 vaccine. Conclusions COVID-19 vaccine hesitancy among HCWs in this study was high and broadly determined by the perceived risk of COVID-19 and COVID-19 vaccines on personal health, mistrust in COVID-19 vaccines and uncertainty about colleagues’ vaccine acceptability.

Background: In sub-Saharan Africa, there is increasing mortality and morbidity of adolescents due to poor linkage, retention in HIV care and adherence to antiretroviral therapy (ART). This is a result of limited adolescent-centred service delivery interventions. This cost-effectiveness and feasibility study were piggybacked on a cluster-randomized trial that assessed the impact of an adolescent-centred service delivery intervention. The service delivery intervention examined the impact of an incentive scheme consisting of conditional economic incentives and motivational interviewing on the health outcomes of adolescents living with HIV in Nigeria. Method: A cost-effectiveness analysis from the healthcare provider’s perspective was performed to assess the cost per additional patient achieving undetected viral load through the proposed intervention. The cost-effectiveness of the incentive scheme over routine care was estimated using the incremental cost-effectiveness ratio (ICER), expressed as cost/patient who achieved an undetectable viral load. A one-way sensitivity analysis examined the effect of the regimen change to Dolutegravir-based combination (which occurred during the trial) on the ICER. An in-depth interview was conducted on the healthcare personnel in the intervention arm to explore the feasibility of implementing the service delivery intervention in HIV treatment hospitals in Nigeria.Result: The ICER of the intervention compared to routine care was US$1,593.2 per additional patient with undetectable viral load. Going by the cost-effectiveness threshold suggested by the World Health Organization (WHO) Commission on Macroeconomics and Health, the intervention was very cost-effective as it costs less than one Nigerian GDP/capita of US$2028.2. The effect of regimen change increased the ICER to US$2,094.38. Healthcare professionals reported that patients’ acceptance of the intervention was very high.Conclusion: The conditional economic incentives and motivational interviewing were very cost-effective. Patients’ acceptance of the intervention was very high. However, healthcare professionals believed that sustaining the intervention may be difficult unless factors such as government commitment and healthcare provider diligence are duly addressed.Trial registration This trial is registered in the WHO International Clinical Trials Registry through the WHO International Registry Network (https://pactr.samrc.ac.za/: PACTR201806003040425).

Introduction: Vaccination against COVID-19 is an effective strategy to curb the burden of COVID-19, but vaccine acceptance and uptake among African healthcare workers (HCWs) remain low. This study investigated the determinants of COVID-19 vaccine hesitancy among HCWs in Cameroon and Nigeria. Methods: We conducted an analytic cross-sectional study from May to June 2021, including consenting HCWs > 18 years identified using snowball sampling. Vaccine hesitancy was defined as indecisiveness or unwillingness to receive the COVID-19 vaccine. Multilevel logistic regression yielded adjusted odds ratios (aOR) for vaccine hesitancy. Results: We included a total of 598 (~60% women) participants. Vaccine hesitancy was estimated at 56.9% and 42.4% in Cameroon and Nigeria. Little or no trust in the approved COVID-19 vaccines (aOR= 2.28, 95% CI=1.24-4.20), lower perception of the importance of the vaccine on their personal health (5.26, 2.38-11.6), greater concerns about vaccine-related adverse effects (3.45, 1.83-6.47), and uncertainty about colleagues’ acceptability of the vaccine (2.98, 1.62-5.48) were associated with higher odds of vaccine hesitancy. In addition, participants with chronic disease (aOR= 0.34, 95% CI=0.12-0.97) and higher levels of concerns about getting COVID-19 (0.40, 0.18-0.87) were less likely to be hesitant to receive the COVID-19 vaccine. Conclusion: COVID-19 vaccine hesitancy among HCWs in this study was high and was determined, broadly, by the perceived risk of COVID-19 and COVID-19 vaccines on personal health, mistrust in COVID-19 vaccines, and uncertainty about colleagues’ vaccine acceptability. Targeted interventions addressing these concerns are warranted to improve COVID-19 uptake among HCWs in these settings.