Background Mentor mothers provide psychosocial and other support to pregnant and post-partum women living with HIV (WLHIV), which has been shown to enhance maternal-infant outcomes in the prevention of mother-to-child transmission of HIV (PMTCT). Our objective was to assess the acceptability of mentor mothers as a PMTCT intervention, and to explore opinions on mentor mother program composition and delivery among stakeholders in North-Central Nigeria. Methods We conducted nine focus group discussions and 31 in-depth interviews with 118 participants, including WLHIV, pregnant women, male partners, health workers, traditional birth attendants, community leaders, PMTCT program implementers, and policymakers. Participants were purposively recruited from health facilities and surrounding communities in the Federal Capital Territory and Nasarawa State. Transcripts were manually analysed using a Grounded Theory approach, where theory was derived from the data collected. Results Most participants were female (n = 78, 67%), and married (n = 110, 94%). All participant groups found  mentor mothers acceptable as women providing care to pregnant and postpartum women, and as WLHIV supporting other WLHIV. Mentor mothers were uniquely relatable as role models for WLHIV because they were women, living with HIV, and had achieved an HIV-negative status for their HIV-exposed infants. Mentor mothers were recognized as playing major roles in maternal health education, HIV treatment initiation, adherence, and retention, HIV prevention for male partners and infants, and couple HIV disclosure. Most WLHIV preferred to receive mentor mothers’ services at health facilities rather than at home, due to concerns about HIV-related stigma and discrimination through association with mentor mothers. Key mentor mother needs were identified as training, remuneration, and validation as lay health workers. Conclusions Mentor mothers are an acceptable PMTCT intervention among stakeholders in North-Central Nigeria. However, stigma and discrimination for both mentor mothers and their clients remain a critical challenge, and mentor mother needs such as training, pay, and a sustainably supported niche in health systems require focused attention. Trial registration Clinicaltrials.gov registration number (NCT 01936753), registered on September 3, 2013 (retrospectively registered).

Background Nigeria has the second highest burden of HIV in children younger than 15 years (220 000) and adolescents 10-19 years (230 000) in the world. Unfortunately, fewer than a quarter of these children and adolescents are identified and given access to treatment. Decentralisation of HIV testing services to high-yield service delivery points can facilitate identification of undiagnosed HIV-positive children and adolescents. However, decentralisation of testing services is still uncommon, partly due to existing health-care professional boundaries. We evaluated the effectiveness of task-shifting HIV testing services from specialised laboratory personnel to nurses to improve HIV case identification in paediatric and adolescent clients. Methods We established a testing point for patients aged 0-19 years in the inpatient ward at a secondary health-care facility in a rural district with high prevalence of HIV in north-central Nigeria. Paediatric nurses were trained by laboratory personnel to provide HIV testing to children and adolescents admitted to the ward. We reviewed the hospital ward admission records and laboratory HIV testing records for patients aged 0-19 years to establish a pre-intervention baseline. Findings In the 3 months before the intervention when HIV testing services were provided only by laboratory personnel, 276 children and adolescents were admitted (mean 92•0 admissions/month), of whom only 22 patients (8%) underwent HIV testing and no positive cases were identified. However, in the 4-month intervention period between April and July, 2018, 179 paediatric or adolescent clients were admitted (44•8 admissions/month), of whom 169 (94%) were tested for HIV by nurses and four HIV-positive children were newly identified (a 2•4% yield). Linkage to care and antiretroviral therapy initiation was achieved for all newly identified children within 24 h of diagnosis. Interpretation Task-shifting of paediatric and adolescent inpatient HIV-testing services to nurses was more effective in HIV case identification than was testing by laboratory personnel. In settings where limited human resources remains a major challenge, implementation and scale-up of task shifting for testing services can significantly improve HIV case identification and, therefore, treatment coverage in children and adolescents. Funding CDC-PEPFAR.

Background: COVID-19’s sudden uprising and proliferation causes fear and psychological distress in the general public. Its pandemic nature is associated with psychological distress and symptoms of mental illness. Hence, it becomes imperative to pay attention to the mental health of nurses who are caring for patients during the outbreak. Methodology: A cross-sectional study among 161 nurses in southwest Nigeria. An Online questionnaires were sent to nurses through social media applications. In addition to socio-demographic and work-related variables, psychological trauma was measured using Kessler-10 psychological distress scale. Descriptive statistics, Chi square test, and binary logistic regression were used in the analysis. All analysis were done using Stata MP 16. Results: COVID-19 related psychological trauma was 27.4% among nurses. Majority of the respondents were females (82.6 %), Christians (85.7%), and urban residents (88.2%).About 85.7% of the nurses were Yoruba by tribe. About a half of the nurses (48.4%) had less than 10 years work experience. Muslims (AOR: 4.17, CI: 1.27- 13.76) were 4.17 times more likely to have COVID-19 related psychological trauma compared to Christians. Also, nurses who had no contact with COVID-19 patients (AOR: 0.09, CI: 0.02- 0.49) were less likely to have COVID-19 related psychological trauma. Conclusion: COVID-19-related psychological trauma was notably high among the nurses, and associated risk factors were religion and contact with COVID-19 patient. Nurses should be given adequate attention in terms of programmes or training that is capable of improving their competence in handling COVID-19 patients and boost their psychological health during the pandemic.

Background Isoniazid preventive therapy (IPT) significantly reduces the incidence of active tuberculosis in people living with HIV. However, despite high tuberculosis morbidity and mortality in people living with HIV, uptake of IPT remains grossly suboptimal, with implementation impeded by several barriers related to health workers and patients. We evaluated the use of a quality improvement approach to improve IPT in a tertiary hospital in north central Nigeria with a high HIV burden. Methods In July, 2018, a 4-week quality improvement pilot project was undertaken at the Federal Medical Centre in Keffi, Nigeria. The facility-based continuous quality-improvement committee, comprised of different cadres of staff working in the hospital's antiretroviral therapy clinic, reviewed their HIV quality-of-care indicators and noted that only 3% of eligible HIV clients received IPT between September, 2017, and March, 2018. The committee did a root cause analysis and identified poor knowledge of clinicians on the importance of IPT, fear of drug resistance, frequent stock-outs of isoniazid, and poor medication adherence as the key reasons for low rates of IPT. In response to these findings, the following key change ideas were implemented: IPT orientation for clinicians, incorporation of IPT education into routine health education for people living with HIV, display of IPT information education and communication materials in consulting and patient waiting rooms, and auditing of clients' folders prior to consultation to identify and tag eligible folders with IPT sticky notes.

Background HIV-exposed infants (HEI) who die before diagnosis or treatment initiation, or who die in spite of being HIV-free constitute missed opportunities for reducing infant mortality. Verbal autopsy (VA) has been successfully applied in the collection of data to determine symptoms and circumstances surrounding death among infants, children and adults among populations that lack vital registration systems. There is little available data on rates and causes of death among HIV-exposed infants (HEI) in Nigeria. We used VA to characterize attributable causes and predictors of mortality among HEI in rural North-Central Nigeria.Methods Pregnant women living with HIV and HEI were enrolled at rural primary healthcare facilities and followed-up for 12 months, post-delivery. A simple 21-item VA instrument was used to collect infant mortality information from mothers, other family members, mentor mothers, and/or healthcare workers. Attributable causes of death were determined by physician coding. Multivariate logistic regression was performed to determine independent predictors of mortality.Results Data from 455 HIV-exposed infected and uninfected fetus/infant-mother pairs were analyzed. All mothers received anti-retroviral therapy. Seventy-five (16.5%) fetuses/infants died during gestation and within 12 months post-delivery. Forty (53.3%) deaths occurred in utero . The 12-month infant mortality risk among HEI in our study was 88.7/1,000. Among the 35 live-born infants, birth asphyxia (6/17, 35.3%) and sepsis (7/18, 38.9%) were the most common causes of death in the neonatal and post-neonatal periods, respectively. Unadjusted estimates showed that a greater proportion of deceased infants had mothers who did not deliver at a health facility (53.3 vs 31.8%, p=0.003), and who were newly HIV-diagnosed during pregnancy (69.3 vs 50.8%, p=0.029). Infants receiving nevirapine prophylaxis within 72 hours were less likely to have died (aOR = 0.40, 95% CI: 0.2-0.9).Conclusions Early HIV diagnosis and treatment among women of child-bearing age, maternal access to facility delivery and timely infant antiretroviral prophylaxis should be programmatically strengthened to reduce HEI mortality. Additionally, robust monitoring and evaluation systems are needed to track and record deaths among HEI.