BackgroundThe Nigerian Antiretroviral therapy (ART) program started in 2004 and now ranks among the largest in Africa. However, nationally representative data on outcomes have not been reported.MethodsWe evaluated retrospective cohort data from a nationally representative sample of adults aged ≥15 years who initiated ART during 2004 to 2012. Data were abstracted from 3,496 patient records at 35 sites selected using probability-proportional-to-size (PPS) sampling. Analyses were weighted and controlled for the complex survey design. The main outcome measures were mortality, loss to follow-up (LTFU), and retention (the proportion alive and on ART). Potential predictors of attrition were assessed using competing risk regression models.ResultsAt ART initiation, 66.4 percent (%) were females, median age was 33 years, median weight 56 kg, median CD4 count 161 cells/mm3, and 47.1% had stage III/IV disease. The percentage of patients retained at 12, 24, 36 and 48 months was 81.2%, 74.4%, 67.2%, and 61.7%, respectively. Over 10,088 person-years of ART, mortality, LTFU, and overall attrition (mortality, LTFU, and treatment stop) rates were 1.1 (95% confidence interval (CI): 0.7–1.8), 12.3 (95%CI: 8.9–17.0), and 13.9 (95% CI: 10.4–18.5) per 100 person-years (py) respectively. Highest attrition rates of 55.4/100py were witnessed in the first 3 months on ART. Predictors of LTFU included: lower-than-secondary level education (reference: Tertiary), care in North-East and South-South regions (reference: North-Central), presence of moderate/severe anemia, symptomatic functional status, and baseline weight <45kg. Predictor of mortality was WHO stage higher than stage I. Male sex, severe anemia, and care in a small clinic were associated with both mortality and LTFU.ConclusionModerate/Advanced HIV disease was predictive of attrition; earlier ART initiation could improve program outcomes. Retention interventions targeting men and those with lower levels of education are needed. Further research to understand geographic and clinic size variations with outcome is warranted.

Arbovirus transmission by Aedes mosquitoes has long been a significant problem in Africa. In West Africa, Aedes vector management faces significant challenges; lack of recent Aedes distributional data and potential distributional modeling hinder effective vector control and pose serious public health issues. In this study, larval and adult mosquitoes were collected from four study sites in Enugu State, Nigeria every other month between November 2017 and September 2018. A total number of 2997 Aedes mosquitoes were collected and identified, and 59 positive field occurrence points for both Aedes adult and larvae were recorded. A total of 18 positive occurrence points were used for modeling. Ecological Niche Models (ENMs) were used to estimate the current geographic distribution of Aedes species ( spp. ) in Enugu State, south-east Nigeria, and mosquito presence was used as a proxy for predicting risk of disease transmission. Maximum Entropy distribution modeling or “MaxEnt” was used for predicting the potential suitable habitats, using a portion of the occurrence records. A total of 23 environmental variables (19 bioclimatic and four topographic) were used to model the potential geographical distribution area under current climatic conditions. The most suitable habitat for Aedes spp. was predicted in the northern, central, and southeastern parts of Enugu State with some extensions in Anambra, Delta, and Edo States in the west, and Ebonyi State in the east. Seasonal temperature, precipitation of the wettest month, mean monthly temperature range, elevation, and precipitation of the driest months were the highest estimated main variable contributions associated with the distribution of Aedes spp. We found that Aedes spp. prefer to be situated in environmental conditions where precipitation of wettest month ranged from 265 to 330 mm, precipitation of driest quarter ranged from 25 to 75 mm while precipitation of wettest quarter ranged from 650 to 950 mm. Aedes mosquitoes, such as Ae. aegypti and Ae. albopictus, pose a significant threat to human health, hence, the results of this study will help decision makers to monitor the distribution of these species and establish a management plan for future national mosquito surveillance and control programs in Nigeria.

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.

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This dataset reveals differences among SDRMs by subtype; in particular, between the GWA-II and GCA subclades, compared with CRF02_AG and GWA-I.