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The characterization of human behavior in real-world contexts is critical for developing a comprehensive model of human health. Recent technological advancements have enabled wearables and sensors to passively and unobtrusively record and presumably quantify human behavior. Better understanding human activities in unobtrusive and passive ways is an indispensable tool in understanding the relationship between behavioral determinants of health and diseases. Adult individuals (N = 60) emulated the behaviors of smoking, exercising, eating, and medication (pill) taking in a laboratory setting while equipped with smartwatches that captured accelerometer data. The collected data underwent expert annotation and was used to train a deep neural network integrating convolutional and long short-term memory architectures to effectively segment time series into discrete activities. An average macro-F1 score of at least 85.1 resulted from a rigorous leave-one-subject-out cross-validation procedure conducted across participants. The score indicates the method’s high performance and potential for real-world applications, such as identifying health behaviors and informing strategies to influence health. Collectively, we demonstrated the potential of AI and its contributing role to healthcare during the early phases of diagnosis, prognosis, and/or intervention. From predictive analytics to personalized treatment plans, AI has the potential to assist healthcare professionals in making informed decisions, leading to more efficient and tailored patient care.

Abstract Syed Abdul Mannan Hamdani Objective To evaluate the clinicopathological features and survival outcomes of mucinous ovarian cancer (MOC) patients in an Asian population. Study Design Descriptive observational study. Place and Duration of Study Shaukat Khanum Memorial Cancer Hospital, Lahore, Pakistan, from January 2001 to December 2016. Methods Data of MOC were evaluated for demographics, tumor stage, clinical characteristics, tumor markers, treatment modalities, and outcomes from electronic Hospital Information System. Results Nine-hundred patients with primary ovarian cancer were reviewed, out of which 94 patients (10.4%) had MOC. The median age was 36 ± 12.4 years. The most common presentation was abdominal distension 51 (54.3%), while the rest presented with abdominal pain and irregular menstruation. Using FIGO (The International Federation of Gynecology and Obstetrics) staging, 72 (76.6%) had stage I, 3 (3.2%) stage II, stage III in 12 (12.8%), and 7 (7.4%) had stage IV disease. The majority of patients 75 (79.8%) had early-stage (stage I/II), while 19 (20.2%) presented with advanced-stage (III & IV). The median follow-up duration was 52 months (range 1–199 months). Among patients with early-stage (I&II), 3- and 5-year progression-free survival (PFS) was 95%, while for advanced stage (III&IV), PFS was 16% and 8%, respectively. The overall survival (OS) in early-stage I&II was 97%, while for advanced stages III & IV, the OS was 26%. Conclusion MOC is a challenging and rare subtype of ovarian cancer requiring special attention and recognition. Most patients treated at our center presented with early stages and had excellent outcomes, while advanced-stage disease had dismal results.

Field studies were conducted between 2018 and 2019 in Antalya province in order to reveal the parasitoid wasps associated with cynipid galls (Hymenoptera: Cynipidae). As a result of these studies, a total of 13 parasitoid wasp species were identified belonging to four families; Eupelmidae, Eurytomidae, Torymidae, and Ormyridae. Among them, Torymus scutellaris (Walker, 1833) is a new record for Turkey. Data are given on the distribution of the species, their associated galls, and host plants.

Objective: To assess the outcomes of fertility-sparing surgery in patients with ovarian epithelial carcinoma treated at our centre. Study Design: Retrospective longitudinal study. Place and Duration of Study: Shaukat Khanum Memorial Cancer Hospital & Research Center, Lahore Pakistan, from Jul 2001 to Aug 2015. Methodology: We studied 31 patients with ovarian epithelial carcinoma who underwent fertility-sparing surgery at Shaukat Khanum Memorial Hospital. The detail regarding patients and tumour characteristics, along with outcomes of the intervention, was obtained from secondary data kept in the electronic hospital information system. Results: A total of 132 patients with ovarian epithelial carcinoma were identified; 31 patients underwent fertility-sparing surgery (Stage-IA, n=19; Stage-IC, n=12). By histopathology, 14(45.0%) had mucinous cystadenocarcinoma, 7(22.6%) serous adenocarcinoma, 6(19.4%) endometroid, and 4(12.9%) with clear cell pathology. The mean duration of follow-up was 52.6±2.3 months (18-118 months) after fertility-sparing surgery. Five-year recurrence-free survival was 81.0%. (Three-year=89.0%), using the Kaplan-Meier graph. Three patients had successful pregnancies, with one having a twin pregnancy. Conclusion: Fertility-sparing surgery should be considered for children of early-stage epithelial ovarian carcinoma patients as it preserves fertility and endocrine function while avoiding recurrence.

Abstract Objective: To evaluate the effect of response to first-line chemotherapy on renal functions in multiple myeloma (MM) patients. Study Design: Cross-sectional study. Place and Duration of Study: Shaukat Khanum Memorial Cancer Hospital, Lahore, from Jan 2013 to Dec 2017. Methodology: Multiple myeloma patients with renal impairment (RI) at baseline were included. Data was collected from the hospital registry.The variables assessed pre and post first-line chemotherapywere age, gender, initial estimated glomerular filteration rate and serum creatinine levels. Progression-free survivaland overall survival (OS) was calculated for both groups of patients i.e those who had improvement in renal funtions and those who did not show improvement. Kaplan-Meier curves were drawn, and SPSS-20 was used for data analysis. Results: Mean age was 48 ± 7 years. Out of 139 myeloma patients, 35 (25.1%) had RI at baseline. Males were 23 (65.7%), while females were 12 (34.3%). Cyclophosphamide, thalidomide and deamethsone (CTD)were used in the majority 30 (85.7%) followed by boretzomib, thalidomide and dexamethasone (VTD) in 2 (5.7%) patients. Boretezomib and dexamethasone (BorDex), lenalidomide and dexamethasone (Len Dex), lenalidomde, cyclophosphamide and dexamethasone (LCD) were given to 1 (2.8%) patient each. Serum creatinine levels normalized in 19 (54.3%). Dialysis was required in 11 (31.4%) patients out of which 3 (8.6%) got dialysis-independent while 8 (22.9%) patients remained dialysis-dependent. The medianoverall survival in whom creatinine levels normalized was 35 months while it was 15 months in those in whom it did not normalize. Conclusion: Prompt administration of chemotherapy regimens can lead to an improvement in renal function.

In recent years, new cynipid species have been described and new records were provided in Turkey where is the most species-rich region in the Western Palearctic region. In this study, some cynipid galls were collected from roots (close to the surface) or branches below the soil surface of the host oak (Andricus csokai, A. quercusradicis, A. rhyzomae, A. schoenroggei, A. stonei). A. rhyzomae and A. schoenroggei among these species are new records for the cynipid (Hymenoptera: Cynipidae) fauna of Turkey. In addition, a new host oak was recorded for A. quercusradicis and A. rhyzomae. Also, the first location record of A. stonei was provided with this study although the species previously is known from Turkey. With this study, these five species were reported for the first time for the study area (Afyonkarahisar).

Teratomas are a common form of germ cell tumor. Teratomas are commonly found in the gonadal organs, such as the ovaries and testes. Treatment of choice for ovarian teratomas is complete surgical excision, which exhibits a good prognosis in benign teratomas; however, chemotherapy treatment is needed for malignant components. Neurological paraneoplastic presentation of gynecological tumors is rare; however, ovarian tumors account for 10% of this presentation. In literature, paraneoplastic limbic encephalitis, anti-N-methyl-D-aspartate receptor encephalitis, and paraneoplastic cerebellar degeneration have been reported in ovarian teratomas and tumors; however, myasthenia gravis has been reported only twice. In both of those cases, manifestation of myasthenia gravis was preceding the diagnosis of ovarian cancer. We describe the first case of a 21-year-old female who presented with new-onset myasthenia gravis after finishing chemotherapy for ovarian teratoma. Another unusual aspect of our case is the rare co-occurrence of gliomatosis peritonei with mature teratoma.

Three new species of herb gall wasps (Cynipidae: Aulacideini and Phanacidini) are described from Turkey. Aulacidea turguti sp. nov. induces galls on Hieracium patentissimum Freyn & Sint. ex Freyn, 1895 (Asteraceae) and was collected in Gümüşhane province, Phanacis ciceki sp. nov. and Phanacis urhani sp. nov. were collected in Gümüşhane and Ordu Provinces, the former inducing galls on Picris sp. and the latter on Cirsium vulgare (Savi) Ten., 1835–36 (Asteraceae). SEM images, gall photos, distribution, biology, and diagnostic morphological characteristics of the three new species are provided.

In recent decades, research has grown increasingly in Iran and consequently, the country has risen dramatically in world rankings based on the number of scientific documents. However, there are many evidences that show these researches were ineffective. Therefore, their efficacy should be evaluated which is the main purpose of this study. In this regard, using the descriptive-analytical method and valid secondary data and statistics, the most recent situation or the trend of impact pathway components (from investment to development) were compared with other countries. The required data were extracted from valid databases including UNESCO, World Bank, OECD, Thomson Reuters, SCImago, Islamic Parliament Research Center, National Iranian Productivity Organization, Harvard University, Massachusetts Institute of Technology (MIT), and Enerdata. The necessary calculations and rankings were done using Excel 2007. The results showed that, first, compared with other countries, Iran hasn’t given high priority to research and isn’t in a serious way to address this matter because in 2010 it ranked 66 (among 89 countries) based on share of R&D expenditure in GDP, 54 (among 88 countries) based on R&D expenditure per capita, 57 (among 72 countries) based on R&D expenditure per researcher, 79 (among 89 countries) based on average investment per research, and in 2000 it ranked 19 (among 21 countries) based on share of basic research in total R&D expenditure. Second, apart from the period leading to 2006, despite an impressive growth in research quantity, Iran share of High Technology products in industrial export shows deterioration. Third, during 1980-2014 Iran Economy Complexity Index has always been negative and placed among third weakest countries. Forth, despite a unique growth in science production, Iran couldn’t increase its total factor productivity and has fallen dramatically in world rankings based on energy intensity and GDP per unit of energy used. Therefore, according to the results of current and preceding studies, it is clear that even if there is no external deterrent, these researches cannot still play a tangible role in Iran development.

In recent decades, research has growth Increasingly in Iran and, consequently, the country has risen dramatically in world rankings, based on the number of scientific documents. The impressive growth of the number of Iran researches, research experts increasingly focus on "research impact", and repeated emphasize on the issue of "use of research to improve society" in Iran superior governmental documents, leaded some researchers to investigate "how much Iran researches are effective?" They showed that these researches have in general been ineffective. Therefore, their efficacy should be evaluated which is the main purpose of this study. In this regard, using the Descriptive-Analytical method and valid secondary data and statistics, the results of Citation Analysis of Iran research outcomes were compared with other countries. Central questions of this study were respectively about «the quality of Iran whole researches (1996-2014)», «the quality of top researches (2005-2014)», «comparing the quality of whole researches with quality of top researches», and «the quality of Iran's Persian (2011-2012) and English (2014) scientific journals». For this purpose, based on the reliable data from valid databases (Thomson Reuters, Scopus and ISC), the value and rank of Iran at different citation related indices were extracted or calculated. The results, including «few citations per paper (5/7) which is about half of the global average (10/3) and declining trend of Iran rank based on this index», «poor country rank based on the share of top papers in all documents (128)», «small share of global citations (47.0%), despite a significant share in the world Scientific document (1/1%)», «low h-index despite the large number of articles», «inappropriate position in the basis of self-citation (more than 50% in 2014) in addition to a declining trend», «few citations per paper (76/7) which is about half of the global average (144/9)», «small share of global citations to top papers (0/18%) compared with the share of Iran in top papers(0/41%)», and the fact that «the average of 0/91% of Persian scientific journals' IF was 0/037 and just 1% of them had more than 0/5 IFs» imply that the quality of Iran researches has been both poor and decreasing. Therefore, during recent decades, despite an impressive growth in the number of Iran researches, these researches have had a poor and regressive «efficacy».

Background: Youth (ages 14-24) in Nigeria have disproportionately high rates of new HIV infection. Pre-exposure prophylaxis could substantially reduce new infections among youth but has not been scaled up. This cross-sectional study aimed to assess Pre-exposure prophylaxis awareness, willingness to use, and prior use of Pre-exposure prophylaxis among youth in Nigeria., Methods: This is a secondary analysis of cross-sectional data from a quasi-experimental pilot study (clinical trial NCT04070287). The analysis focused on Pre-exposure prophylaxis awareness, willingness to use, and prior use among 324 youth recruited between September 2019 to March 2020. Descriptive statistics were calculated as frequencies and percentages for categorical variables and means and standard deviations for continuous variables., Results: Of the 324 participants, the mean age and standard deviation were 21.17 (± 2.20) years. The majority were 20-24 years old (75.9%) and male (57.7%). Only 30.7% used condoms consistently over three months. Regarding Pre-exposure prophylaxis awareness and willingness, 62.6% had never heard of Pre-exposure prophylaxis, and 158 (50.1%) reported willingness to use Pre-exposure prophylaxis. Only 10 (3.2%) reported having used Pre-exposure prophylaxis., Conclusion: Nigerian youth have low awareness of and prior use of Pre-exposure prophylaxis. Given the gap between prior use and willingness to use Pre-exposure prophylaxis, our findings suggest missed opportunities to prevent new HIV infections among youth in Nigeria. Efforts to increase awareness and uptake of Pre-exposure prophylaxis among this population should consider youth-led Pre-exposure prophylaxis outreach efforts and effectively communicate the benefits of Pre-exposure prophylaxis to this population., Trial Registration: NCT04070287, the Date of registration of the trial is 20-07-2019., (© 2024. The Author(s).)

Background: Noncommunicable diseases continue to pose a substantial health challenge globally, with hyperglycemia serving as a prominent indicator of diabetes., Objective: This study employed machine learning algorithms to predict hyperglycemia in a cohort of individuals who were asymptomatic and unraveled crucial predictors contributing to early risk identification., Methods: This dataset included an extensive array of clinical and demographic data obtained from 195 adults who were asymptomatic and residing in a suburban community in Nigeria. The study conducted a thorough comparison of multiple machine learning algorithms to ascertain the most effective model for predicting hyperglycemia. Moreover, we explored feature importance to pinpoint correlates of high blood glucose levels within the cohort., Results: Elevated blood pressure and prehypertension were recorded in 8 (4.1%) and 18 (9.2%) of the 195 participants, respectively. A total of 41 (21%) participants presented with hypertension, of which 34 (83%) were female. However, sex adjustment showed that 34 of 118 (28.8%) female participants and 7 of 77 (9%) male participants had hypertension. Age-based analysis revealed an inverse relationship between normotension and age (r=-0.88; P=.02). Conversely, hypertension increased with age (r=0.53; P=.27), peaking between 50-59 years. Of the 195 participants, isolated systolic hypertension and isolated diastolic hypertension were recorded in 16 (8.2%) and 15 (7.7%) participants, respectively, with female participants recording a higher prevalence of isolated systolic hypertension (11/16, 69%) and male participants reporting a higher prevalence of isolated diastolic hypertension (11/15, 73%). Following class rebalancing, the random forest classifier gave the best performance (accuracy score 0.89; receiver operating characteristic-area under the curve score 0.89; F1-score 0.89) of the 26 model classifiers. The feature selection model identified uric acid and age as important variables associated with hyperglycemia., Conclusions: The random forest classifier identified significant clinical correlates associated with hyperglycemia, offering valuable insights for the early detection of diabetes and informing the design and deployment of therapeutic interventions. However, to achieve a more comprehensive understanding of each feature's contribution to blood glucose levels, modeling additional relevant clinical features in larger datasets could be beneficial., (© Kolapo Oyebola, Funmilayo Ligali, Afolabi Owoloye, Blessing Erinwusi, Yetunde Alo, Adesola Z Musa, Oluwagbemiga Aina, Babatunde Salako. Originally published in JMIRx Med (https://med.jmirx.org).)

Background: Chronic kidney disease (CKD) affects almost 10% of the global populace including people living with HIV (PLWH). PLWH acquire CKD from both traditional and HIV-specific CKD risk factors. This study aimed to determine the prevalence of CKD and associated factors among antiretroviral therapy (ART) naïve PLWH in Lagos, Nigeria.  METHODS: This is a secondary data analysis among adult (≥ 18 years) ART-naïve PLWH enrolled at a large ART clinic in Lagos over 6 years. CKD was defined as estimated glomerular filtration rates (eGFR) below 60ml/min/1.73m 2 over 3 months. Three estimators [Body surface area corrected Cockcroft Gault (BSA-CG), Modification of Diet in Renal Disease (MDRD), Chronic kidney disease Epidemiology Collaboration (CKD-EPI)] were used to determine the burden of CKD with no race correction factor. Age- and sex-standardised prevalence rates were determined. Cohen Kappa and Spearman correlations were used to compare the estimators. Logistic regressions were applied to identify variables associated with prevalent CKD., Results: Among 2 772 PLWH, the mean age was 38 years with males older than females (p < 0.001). The majority of participants were females (62.1%), married (54.8%), employed (85.7%), had underweight or normal body mass index (BMI) (62.2%), and were diagnosed with World Health Organization (WHO) clinical stages 1 and 2 (55.5%). The age- and sex-standardised prevalence of CKD ranged from 10.0 - 17.6% with the highest Spearman's correlation (0.928) observed with MDRD and CKD-EPI equations. Increasing age [AOR (95% CI), equation] was significantly associated with CKD across all equations [1.09 (1.06 - 1.13), BSA-CG; 1.07 (1.05 - 1.10), MDRD; 1.09 (1.06 -1.12), CKD-EPI]. Other variables associated with CKD [AOR (95% CI), equation] were anaemia [2.50 (1.34 - 4.68), BSA-CG; 1.73 (1.04 - 2.86), MDRD], BMI <25 kg/m 2 [3.35 (1.55 - 7.26), BSA-CG; 2.02 (1.18 - 3.46), CKD-EPI], and CD4 counts ≤ 200 cells/µL [2.02 (1.06 - 3.87), BSA-CG]., Conclusion: There was a high prevalence of CKD among ART-naïve PLWH at enrollment, which highlights the need to evaluate this population for CKD. Aside increasing age and low CD4 counts, none of the traditional or HIV-specific risk factors were related to CKD diagnosis., (© 2024. The Author(s).)

Background: Under-five children mortality rate (U5MR) remains a crucial indicator of a nation's child healthcare and socioeconomic development. This study aims to identify and quantify significant maternal, child, family, and environmental risk factors contributing to under-five mortalities in the Northeast geopolitical zone of Nigeria., Methods: Retrospective analysis of secondary data from the 2018 National Demographic and Health Survey (NDHS) in six northeastern Nigerian states. Maternal factors (age, education, health-seeking behavior), child variables (weight, sex, vaccination status), family factors, and environmental factors (water source, residence, wealth index) were analyzed to determine their association with the under-five mortality rate (U5MR). Logistic regression models and population-attributable risk estimates were used to identify key contributors to U5MR in the region., Results: A total of 26,293 mothers were surveyed, of which the majority (93.6%) were married, employed (70.7%), and had no insurance (99%). Most of the mothers were above 35 years of age, uneducated and with first birth between ages 15-19. Adjusted odds ratios show unmarried mothers 1.67 (P=0.015), small birth size 1.37 (P=0.022), never breastfeeding 1.83 (P=0.000), short birth intervals 1.50 (0.005), higher parity 1.5 (P=0.005), lack of any family planning method 1.43(P=0.040), twin siblings 3.95 (P=0.000) and place of residence 1.21 (P=0.000) were associated with higher U5MR odds ratios. Maternal age 21-25 years showed a protective effect AOR 0.59 (95% CI: 0.36-0.98, P=0.040) and age > 31 years AOR 0.44 (95% CI: 0.24-0.81, P=0.009)., Conclusion: This study provides crucial insights into the multifaceted determinants of under-5 mortality in Northeast Nigeria. The findings underscore the importance of tailored interventions addressing maternal, child, and family factors to improve child health outcomes in the region., Competing Interests: The Authors declare that no competing interest exists, (Copyright © 2024 by West African Journal of Medicine.)

Background: HIV self-testing (HIVST) among young people is an effective approach to enhance the uptake of HIV testing recommended by the World Health Organization. However, the COVID-19 pandemic disrupted conventional facility-based HIV testing services, necessitating the exploration of innovative strategies for the effective delivery of HIVST., Objective: This study analyzed the outcomes of a digital World AIDS Day crowdsourcing open call, designed to elicit youth responses on innovative approaches to promote HIVST among young people (14-24 years) in Nigeria during COVID-19 restrictions., Methods: From November 2 to 22, 2020, a World AIDS Day 2020 crowdsourcing open call was held digitally due to COVID-19 restrictions. The crowdsourcing open call followed World Health Organization standardized steps, providing a structured framework for participant engagement. Young people in Nigeria, aged 10-24 years, participated by submitting ideas digitally through Google Forms or email in response to this crowdsourcing open call prompt: "How will you promote HIV self-testing among young people during COVID-19 pandemic?" Data and responses from each submission were analyzed, and proposed ideas were closely examined to identify common themes. Four independent reviewers (AE, SM, AZM, and TG) judged each submission based on the desirability, feasibility, and impact on a 9-point scale (3-9, with 3 being the lowest and 9 being the highest)., Results: The crowdsourcing open call received 125 eligible entries, 44 from women and 65 from men. The median age of participants was 20 (IQR 24-20) years, with the majority having completed their highest level of education at the senior secondary school level. The majority of participants lived in the South-West region (n=61) and Lagos state (n=36). Of the 125 eligible entries, the top 20 submissions received an average total score of 7.5 (SD 2.73) or above. The panel of judges ultimately selected 3 finalists to receive a monetary award. Three prominent themes were identified from the 125 crowdsourcing open call submissions as specific ways that HIVST can adapt during the COVID-19 pandemic: (1) digital approaches (such as gamification, photoverification system, and digital media) to generate demand for HIVST and avoid risks associated with attending clinics, (2) awareness and sensitization through existing infrastructures (such as churches, schools, and health facilities), and (3) partnerships with influencers, role models, and leaders (such as religious and youth leaders and social influencers in businesses, churches, organizations, and schools) to build trust in HIVST services., Conclusions: The crowdsourcing open call effectively engaged a diverse number of young people who proposed a variety of ways to improve the uptake of HIVST during the COVID-19 pandemic. Findings contribute to the need for innovative HIVST strategies that close critical knowledge and practice gaps on ways to reach young people with HIVST during and beyond the pandemic., Trial Registration: ClinicalTrials.gov NCT04710784; https://clinicaltrials.gov/study/NCT04710784., (©Onyekachukwu Anikamadu, Oliver Ezechi, Alexis Engelhart, Ucheoma Nwaozuru, Chisom Obiezu-Umeh, Ponmile Ogunjemite, Babatunde Ismail Bale, Daniel Nwachukwu, Titilola Gbaja-biamila, David Oladele, Adesola Z Musa, Stacey Mason, Temitope Ojo, Joseph Tucker, Juliet Iwelunmor. Originally published in JMIR Formative Research (https://formative.jmir.org), 30.04.2024.)

Introduction: Sexual dysfunction in women with HIV is a necessary but understudied aspect of HIV complications in women living with HIV. This study reports the prevalence, pattern, and risk factors for sexual dysfunction in women living with HIV in southwest Nigeria., Methods: A validated Female Sexual Function Index was used to determine sexual dysfunction in a cross-sectional study design involving 2926 adult women living with HIV in a large, publicly funded tertiary HIV treatment centre in Lagos, Nigeria. A score of less than 26.5 indicated sexual dysfunction. Multivariate logistic regression analysis was performed to identify risk factors for sexual dysfunction. P<0.05 was considered statistically significant at a 95% confidence interval (CI)., Results: The prevalence of sexual dysfunction was 71.4%. The types of dysfunctions detected included disorder of desire (76.8%), sexual arousal (66.0%), orgasm (50.0%), pain (47.2%), lubrication (47.2%), and satisfaction (38.8%). Multivariate analysis showed that menopause (aOR: 2.0; 1.4-4.1), PHQ score of 10 and above (aOR: 2.3; 1.7-3.2), co-morbid medical conditions (aOR: 1.8; 1.4-2.7), use of protease inhibitor-based antiretroviral therapy (aOR: 1.3; 1.2-2.1) and non-disclosure of HIV status (aOR: 0.7; 0.6-0.8) were factors associated with sexual dysfunction., Conclusions: Sexual dysfunction is common among Nigerian women living with HIV. Menopause, use of protease inhibitor-based regimens, PHQ score of at least 10, co-morbid medical condition, and non-disclosure of HIV status were associated with sexual dysfunction. National HIV programmes, in addition to incorporating screening and management of sexual dysfunction in the guidelines, should sensitise and train health workers on the detection and treatment of sexual dysfunction., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Ezechi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Population-based study is known to be a very essential type of study during and after a pandemic or epidemic, as it provides crucial information on the incidence, prevalence, and risk factors of the disease in question. There has been limited information about the challenges faced in conducting such surveys in Nigeria. In this paper, we will share our experience, and describe the challenges faced in conducting a population-based seroepidemiological study of COVID-19 in Lagos, Nigeria. Some challenges were peculiar to specific Local Government Areas (LGAs) while others were general. The challenges include general misconceptions of community members about health research, difficulties in mapping houses, planning for data collection, standardizing data collection, working in hard-to-reach communities when resources were limited as well as difficulty in collection of blood and naso-oropharyngeal swabs. Ways of overcoming these problems, lessons learnt, and recommendations are hereby discussed., (© 2023. The Author(s).)

Background: The gains from successful antiretroviral therapy (ART) roll-out could be compromised by the increasing burden of non-communicable diseases, particularly cardiovascular diseases among people living with HIV (PLWH). Hypertension remains a significant contributor to cardiovascular diseases. This study aims to determine the prevalence and determinants of hypertension among ART-naïve PLWH in a large ART clinic in Lagos, Nigeria., Materials and Methods: This study uses data collected from adult ART-naïve PLWH enrolled at an ART clinic over ten years. Participants aged 18 years and older, not pregnant, and not accessing care for post-exposure prophylaxis were included in the study. Hypertension was defined as systolic and diastolic blood pressure greater than or equal to 140 mmHg and 90 mmHg, respectively. Logistic regressions were used to investigate the factors associated with hypertension., Results: Among the 10 426 participants included in the study, the majority were females (66%) and aged 25-49 years (84%). The crude prevalence of hypertension was 16.8% (95%CI 16.4 - 17.2) while the age and sex standardised prevalence rate was 21.9% (95%CI 20.7 - 23.2), with males (25.8%, 95%CI 23.5 - 28.0) having a higher burden compared with females (18.3%, 95%CI 17.0 - 19.6). Increasing age, male gender, overweight or obesity, co-morbid diabetes mellitus or renal disease, and CD4 count ≥ 201 cells/μL were significantly associated with prevalent hypertension., Conclusion: There was a substantial burden of hypertension among ART-naïve PLWH, which was associated with the traditional risk factors of the condition. This highlights the need to integrate screening and care of hypertension into routine HIV management for optimal care of PLWH., (© 2023. The Korean Society of Hypertension.)

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a causative agent of COVID-19 is a leading cause of ill-health and deaths worldwide. Currently, COVID-19 has no known widely approved therapeutics. Thus, the need for effective treatment., Objectives: We investigated the safety and efficacy of two (2) therapeutic agents; chloroquine phosphate (CQ), 2- hydroxychloroquine (HCQ) and a control (standard supportive therapy) among hospitalized adults with COVID-19., Methods: The clinical trial was done in accordance to the World Health Organization master protocol for investigational therapeutics for COVID-19. Atotal of 40 participants with laboratory-confirmed positive COVID-19 were enrolled. Blood samples and oropharyngeal (OP) swabs were obtained on days 1,3,15 and 29 for safety and efficacy assessments., Results: The baseline demographics showed that the median ages in years (range) were 45 (31-57) in CQ, 45 (36.5-60.5) in HCQ, 43 (39.5-67.0) and 44.5 (25.3-51.3) in the control (P<0.042).At randomization, seven (7) participants were asymptomatic, thirty-three (33) had mild symptoms, eight (8) had moderate symptoms while three (3) had severe symptoms. The average day of conversion to negative COVID-19 was 15.5 days for CQ, 16 days for HCQ and 18 days for the control(P=0.036)., Conclusion: The safety assessment revealed no adverse effect of the drugs in COVID-19 patients after treatment. These findings proved that chloroquine and hydroxychloroquine are effective for the treatment of COVID-19 among hospitalized adults. It also confirmed that they are safe., Competing Interests: The Authors declare that no competing interest exists, (Copyright © 2023 by West African Journal of Medicine.)

Background: Poor medication adherence is a major barrier to HIV control among youth living with HIV (Y-PLWH). The PEERNaija application (app) is an adapted smartphone app grounded in social cognitive and contigency management theories and designed to harness peer-based social incentives and conditional financial incentives to promote medication adherence. The app delivers a multifaceted medication adherence intervention including (1) peer-based social incentives, (2) financial incentives, (3) virtual peer social support, and (4) early clinic-based outreach for non-adherent Y-PLWH. A pilot trial of the app will be conducted in Nigeria, Africa's most populous country with the 4th largest HIV epidemic, and home to 10% of the world's four million Y-PLWH., Methods: In this randomized controlled trial, we will compare implementation outcomes (feasibility, acceptability, appropriateness measured via validated scales, enrollment and application installation rates, feedback surveys and focus group discussions with participants, and back-end application data), and preliminary efficacy (in improving medication adherence and viral suppression) of the PEERNaija app at 6 months. Participants in Arm 1 (PEERNaija) will receive daily medication reminders, peer-based social incentives, and virtual peer social support. Participants in Arm 2 (PEERNaija +) will additionally receive a conditional financial incentive based on their adherence performance. Eligibility for Y-PLWH includes (1) being aged 14-29 years, (2) being on ART, (3) owning a smartphone, (4) being willing to download an app, and (5) being able to read simple text in English., Discussion: This study will serve as the basis for a larger intervention trial evaluating the PEERNaija app (and the integration of mHealth, incentive, and peer-support-based strategies) to improve HIV outcomes in a critically important region of the world for Y-PLWH., Trial Registration: ClinicalTrials.gov. NCT04930198. First submitted date: May 25, 2021. Study start: August 1, 2021, https://clinicaltrials.gov/ ., Protocol Version: January 21, 2022., (© 2023. The Author(s).)

Background: Mobile health (mHealth) interventions among adolescents and young adults (AYAs) are increasingly available in African low- and middle-income countries (LMICs). For example, the unstructured supplementary service data (USSD) could be used to verify HIV self-testing (HIVST) among AYAs with poor bandwidth., Objective: The aim of this study is to describe the creation of an USSD platform and determine its feasibility and usability to promote the verification of HIVST results among AYAs in Nigeria., Methods: We developed and evaluated a USSD platform to verify HIVST results using a user-centered approach. The USSD platform guided AYAs in performing HIVST, interpreting the result, and providing linkage to care after the test. Following the usability assessment, the USSD platform was piloted. We used a mixed methods study to assess the platform's usability through a process of quantitative heuristic assessment, a qualitative think-aloud method, and an exit interview. Descriptive statistics of quantitative data and inductive thematic analysis of qualitative variables were organized., Results: A total of 19 AYAs participated in the usability test, with a median age of 19 (IQR 16-23) years. There were 11 females, 8 males, and 0 nonbinary individuals. All individuals were out-of-school AYAs. Seven of the 10 Nielsen usability heuristics assessed yielded positive results. The participants found the USSD platform easy to use, preferred the simplicity of the system, felt no need for a major improvement in the design of the platform, and were happy the system provided linkage to care following the interpretation of the HIVST results. The pilot field test of the platform enrolled 164 out-of-school AYAs, mostly young girls and women (101, 61.6%). The mean age was 17.5 (SD 3.18) years, and 92.1% (151/164) of the participants reported that they were heterosexual, while 7.9% (13/164) reported that they were gay. All the participants in the pilot study were able to conduct HIVST, interpret their results, and use the linkage to care feature of the USSD platform without any challenge. A total of 7.9% (13/164) of the AYAs had positive HIV results (reactive to the OraQuick kit)., Conclusions: This study demonstrated the usability and feasibility of using a USSD system as an alternative to mobile phone apps to verify HIVST results among Nigerian youth without smartphone access. Therefore, the use of a USSD platform has implications for the verification of HIVST in areas with low internet bandwidth. Further pragmatic trials are needed to scale up this approach., (©David Ayoola Oladele, Juliet Iwelunmor, Titilola Gbajabiamila, Chisom Obiezu-Umeh, Jane Ogoamaka Okwuzu, Ucheoma Nwaozuru, Adesola Zaidat Musa, Kadija Tahlil, Ifeoma Idigbe, Jason Ong, Weiming Tang, Joseph Tucker, Oliver Ezechi. Originally published in JMIR Formative Research (https://formative.jmir.org), 25.09.2023.)

Background: UNAIDS (Joint United Nations Programme on HIV and AIDS) and the Nigeria National HIV/AIDS Strategic Framework recommend HIV self-testing and youth-friendly services to enhance HIV testing, linkage to health services, and prevention. However, the voices of youths are seldom incorporated into interventions. We examined qualitative data generated from a series of participatory events in partnership with Nigerian youths focused on enhancing linkage to care., Objective: The aim of this study was to assess youth-initiated interventions developed during a designathon to improve linkage to care and sexually transmitted infection services., Methods: This study conducted a designathon informed by crowdsourcing principles and the participatory research action framework. A designathon is a multistage process including an open call, a sprint event, and follow-up activities. The open call solicited Nigerian youths (14-24 years old) to develop intervention strategies for linkage to care and youth-friendly health services. A total of 79 entries were received; from this, a subset of 13 teams responded to the open call and was invited to participate in a sprint event over 72 hours. Narratives from the open-call proposals were analyzed using grounded theory to identify emergent themes focused on youth-proposed interventions for linkage to care and youth-friendly services., Results: A total of 79 entries (through the web=26; offline=53) were submitted. Women or girls submitted 40 of the 79 (51%) submissions. The average age of participants was 17 (SD 2.7) years, and 64 of 79 (81%) participants had secondary education or less. Two main themes highlighted strategies for enhancing youths' HIV linkage to care: digital interventions and collaboration with youth influencers. A total of 76 participants suggested digital interventions that would facilitate anonymous web-based counseling, text prompt referrals, and related services. In addition, 16 participants noted that collaboration with youth influencers would be useful. This could involve working in partnership with celebrities, gatekeepers, or others who have a large youth audience to enhance the promotion of messages on HIV self-testing and linkage. The facilitators of youths' linkage included health facility restructuring, dedicated space for youths, youth-trained staff, youth-friendly amenities, and subsidized fees. Barriers to HIV linkage to care among youths included a lack of privacy at clinics and concerns about the potential for breaching confidentiality., Conclusions: Our data suggest specific strategies that may be useful for enhancing HIV linkage to care for Nigerian youths, but further research is needed to assess the feasibility and implementation of these strategies. Designathons are an effective way to generate ideas from youths., (©Ifeoma Idigbe, Titilola Gbaja-Biamila, Sarah Asuquo, Ucheoma Nwaozuru, Chisom Obiezu-Umeh, Kadija M Tahlil, Adesola Zaidat Musa, David Oladele, Bill Kapogiannis, Joseph Tucker, Juliet Iwelunmor, Oliver Ezechi. Originally published in JMIR Formative Research (https://formative.jmir.org), 29.06.2023.)

Background: Prediabetes and diabetes are important metabolic public health problems, especially among adolescents. However, they are being given little or no attention, especially in Sub-Saharan Africa (SSA). Prediabetes increases the risk of developing type 2 diabetes mellitus (T2DM) and cardiovascular diseases., Objective: To determine the prevalence of prediabetes and its associated factors among adolescents in Kano, northwest, Nigeria., Methods: This was a cross-sectional study of 650 secondary school students aged 10-19 years in Tarauni LGA of Kano state. A self-administered questionnaire was used to obtain the socio-demographic data and family history of diabetes of the participants. Each participant had his/her FBS and OGTT measured. Prediabetes was defined using the ISPAD criteria (FBS of 5.6-6.9mmol/L and 2HPP glucose level of 7.8-11.0mm). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were determined for the FBG test against the OGTT test. Bivariate and multivariate logistic regressions were done to ascertain the associated factors of prediabetes., Results: There were 372 females and 278 males. The age range was 10-19 years with a mean 14.9±1.8 years. The prevalence of prediabetes using FBG was 5.5% while using OGTT was 8.9%, while 0.6% of students had combined IFG/IGT. FBG had a sensitivity of 7%, specificity of 95%, PPV of 11% and a NPV of 91%. Male gender (AOR=2.56, C.I= 1.25 - 5.23) and socioeconomic class (AOR= 3.36, C.I = 1.32 - 8.54) were found to be associated with IFG while positive family history of diabetes (AOR= 0.39, C.I = 0.18 - 0.84) was associated with IGT., Conclusion: Prediabetes is common among the study population and the sex-specific prevalence rate was higher among males. Higher socioeconomic class and a positive family history of diabetes were significant associations., (Copyright © 2023 Nigerian Medical Association.)

Background: Although many behavioral interventions are adapted, little is known about the reasons for adaptations and the process and outcomes influencing adaptations. To address this gap, we explored the adaptations made to promote HIV prevention services, including HIV self-testing (HIVST), among Nigerian youth., Methods: The main objective of this qualitative case study design was to document the adaptations made over time using the Framework for Reporting Adaptations and Modifications - Expanded (FRAME). Between 2018 and 2020, we organized four participatory activities as part of the 4 Youth by Youth project to increase the uptake of HIVST services in Nigeria-an open call, a designathon, a capacity-building bootcamp and a pilot feasibility trial. We also began the process of implementing a final intervention using a pragmatic randomized control trial (RCT). The open call solicited creative strategies to promote HIVST among Nigerian youth and then had experts evaluate them. The designathon brought together youth teams to further develop their HIVST service strategies into implementation protocols. Teams determined to be exceptional were invited to a four-week capacity-building bootcamp. The five teams that emerged from the bootcamp were supported to pilot their HIVST service strategies over a 6-month period. The adapted intervention is currently being evaluated in a pragmatic RCT. We transcribed meeting reports and conducted document reviews of study protocols and training manuals., Results: Sixteen adaptations were identified and categorized into three domains: (1) modifications to the content of the intervention (i.e. photo verification system and/or Unstructured Supplementary Service Data (USSD) system to verify HIVST); (2) modifications to the delivery the intervention (i.e. implement participatory learning community sessions to provide supportive supervision and technical support); (3) modifications to the evaluation processes (i.e. economic evaluation to estimate the cost of implementing intervention on a larger scale). Frequent reasons for adaptation included increasing intervention reach, modifying interventions to enhance their appropriateness and fit with the recipient, and increasing the intervention's feasibility and acceptability. Most adaptations were planned and reactive, and the need for modifications was determined by the youths, 4YBY program staff, and advisory group., Conclusions: Findings suggest that the nature of adaptations made throughout the implementation process reflects the necessity of evaluating services in context while adjusting to specific challenges as they are identified. Further research is needed to understand the effect of these adaptations on the overall intervention effect as well as the quality of youth engagement., (© 2023. The Author(s).)

Prior to 2018, malaria therapeutic efficacy studies (TESs) in Nigeria were implemented separately at different sites, as assigned by the National Malaria Elimination Program (NMEP). In 2018, however, the NMEP engaged the Nigerian Institute of Medical Research to coordinate the 2018 TESs in 3 of 14 sentinel sites with the objective of standardizing their conduct across all three sites: Enugu, Kano, and Plateau states in three of six geopolitical zones. Artemether-lumefantrine and artesunate-amodiaquine, the two first-line drugs for treatment of acute uncomplicated malaria in Nigeria, were tested in both Kano and Plateau states. In Enugu State, however, artemether-lumefantrine and dihydroartemisinin-piperaquine were the test drugs, with dihydroartemisinin-piperaquine being tested for potential inclusion in Nigerian treatment policy. The TES was conducted in 6-month to 8-year-old children and was funded by the Global Fund with additional support from the WHO. A multipartite core team comprised of the NMEP, the WHO, the U.S. Presidential Malaria Initiative, academia, and the Nigerian Institute of Medical Research was set up to oversee the execution of the 2018 TES. This communication reports best practices adopted to guide its coordination, and lessons learned during in the process, including applying developed standard operating procedures, powering the sample size adequately for each site to report independently, training the investigating team for fieldwork, facilitating stratification of decisions, determining efficiencies derived from monitoring and quality assessment, and optimizing logistics. The planning and coordination of the 2018 TES activities is a model of a consultative process for the sustainability of antimalarial resistance surveillance in Nigeria.

Purpose of Review: Sustaining evidence-based interventions in resource-limited settings is a perennial challenge. Despite growing research on the significance of sustainability, few frameworks describe why and how to plan for sustainability in settings limited with resources. Drawing on a synthesis of the literature on sustainability, including the Dynamic Sustainability Framework, we review lessons learned from research to date, to point out a path forward for sustaining evidence-based interventions in resource-limited settings., Recent Findings: We describe PLAN or why people learning, adapting, and nurturing the core values of an intervention can enhance its sustainability over time. PLAN is a dynamic framework that simplifies the process of planning for sustainability of evidence-based interventions throughout the lifecyle of an intervention, taking into consideration the people that matter as well as the learning, adaptation, and nurturing involved with understanding and studying the interactions between interventions/innovations, practice settings, intervention fit, and the broader ecological contexts in which implementation occurs. We use case-study data from our ongoing pragmatic HIV implementation trial, the 4 Youth by Youth project, to detail the value and implications of why people learning, adapting, and nurturing HIV interventions implemented in resource-limited settings matter. PLAN is designed to further the dialogue on ways research and practice teams can critically work to ensure the sustainability of their evidence-based interventions from the onset, particularly in settings and with populations limited with resources. It also illustrates how attention to sustainability from the beginning may foster actions necessary for sustained program → sustained benefits → sustained capacity → sustained value, but in the absence of early and active planning, none of this will occur. Ultimately, we hope to accelerate the sustainability of evidence-based HIV interventions, and making a PLAN at the bare minimum may ensure that the goals of continuing and maintaining desirable features of any evidence-based interventions can be realized., (© 2023. The Author(s).)

Background: Several studies have shown that the impact of maternal mental health disorders on newborns' well-being in low and middle-income countries (LMIC) are underreported, multi-dimensional and varies over time and differs from what is reported in high-income countries. We present the prevalence and risk factors associated with common mental disorders (CMDs) among breastfeeding mothers whose infants were admitted to Nigerian tertiary care facilities., Methods: This was a national cross-sectional study involving mothers of hospitalised babies from eleven Nigerian tertiary hospitals. We used the WHO self-reporting Questionnaire 20 and an adapted WHO/UNICEF ten-step breastfeeding support package to assess mothers' mental health and breastfeeding support., Results: Only 895 of the 1,120 mothers recruited from eleven tertiary healthcare nurseries in six geopolitical zones of Nigeria had complete datasets for analysis. The participants' mean age was 29.9 ± 6.2 years. One in four had CMDs; 24.0% (95% CI: 21.235, 26.937%). The ages of mothers, parity, gestational age at delivery, and length of hospital stay were comparable between mothers with and those without CMDs. Antenatal care at primary healthcare facilities (adjusted odds ratio [aOR:13], primary education [aOR:3.255] living in the south-southern region of the country [aOR 2.207], poor breastfeeding support [aOR:1.467], polygamous family settings [aOR:2.182], and a previous history of mental health disorders [aOR:4.684] were significantly associated with CMDs. In contrast, those from the middle and lower socioeconomic classes were less likely to develop CMDs, with [aOR:0.532] and [aOR:0.493], respectively., Conclusion: In Nigeria, the prevalence of CMDs is relatively high among breastfeeding mothers with infants admitted to a tertiary care facility. Prior history of mental illness, polygamous households, mothers living in the southern region and low or no educational attainment have a greater risk of developing CMDs. This study provides evidence for assessing and tailoring interventions to CMDs among breastfeeding mothers in neonatal nurseries in LMIC., Competing Interests: The author(s) declared no potential conflicts of interest concerning the research, authorship, and/or publication of this article., (Copyright: © 2023 Alao et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Rampant chloroquine/hydroxychloroquine poisoning in Nigerian hospitals following suggestions of its possible efficacy in the treatment and prevention of the newly emerged COVID-19 disease informed this survey., Objectives: The aim of this study was to assess the knowledge, attitude and perception of the Nigerian populace on the use of chloroquine in the COVID-19 pandemic., Methods: This cross-sectional study was done by administering an electronic questionnaire created using Google Docs, through social media cascade methods including the WhatsApp application software to capture data on chloroquine use between April 20 and June 20, 2020., Results: Six hundred and twenty-eight people responded to the questionnaire (response rate 99.2%, mean age 41.05 ± 12.3) from the six geopolitical zones in Nigeria with 556 (88.5%) having tertiary level education. Only 21 (3.3%) of the respondents took chloroquine for treatment or prevention. Respondents from the North-west geopolitical zones used chloroquine 5.8 (95% CI: 1.55, 21.52, p=0.02) more times than other zones while the age group 20-29 were 8.8 times more likely to use chloroquine than any other age group (95% CI: 3.53, 21.70, p = 0.00). Female respondents were 2.3 times more likely to use chloroquine than the males (OR 2.26 95% CI: 0.90-5.68; p=0.08) and those in the income bracket of N75,000-99,000, 2.5 times more than other income groups., Conclusion: Young adults, North-western geopolitical zone, and female gender should be target groups for education on rational chloroquine use. The danger of chloroquine overdose should be communicated to the general population in Nigeria., (© 2023 Olukosi AY et al.)

The emergence of coronavirus disease has impacted human lives, one of which is economic disruption. Many Malaysian organisations have devised various crisis-response techniques, such as downsizing, laying off, retrenching, and combining. As a result, the number of Malaysians working in precarious jobs, which are defined by unpredictable and uncertain situations, has indirectly increased, hence increasing job insecurity. Therefore, maintaining psychological health is essential to safeguarding the mental health of employees. In the current working landscape, job security and work-life balance have commonly been deemed necessary in contributing to well-being among employees. As a result, the purpose of this study was to examine how work-life balance influences the relationship between job insecurity and psychological well-being among Malaysian precarious workers. It also fills a gap in the research by explaining the causal association between job insecurity and psychological well-being among precarious workers, as previous well-being studies have largely focused on employees with secure jobs. There were 442 responders collected using purposive and snowball sampling methods, and they were requested to complete the Job Insecurity Scale (JIS), Work-Life Balance, and Well-Being Index Scale (WHO-5). Job instability was negatively connected with work-life balance and psychological well-being. On the other hand, work-life balance was found to be positively related to psychological well-being. This supports the notion that work-life balance is a significant mediator in the relationship between job insecurity and psychological well-being. These findings emphasise that Malaysian precarious workers with job security could enhance their psychological well-being by achieving work-life balance.

Antimalarial drug resistance has thrown a spanner in the works of malaria elimination. New drugs are required for ancillary support of existing malaria control efforts. Plasmodium falciparum requires host glucose for survival and proliferation. On this basis, P. falciparum hexose transporter 1 (PfHT1) protein involved in hexose permeation is considered a potential drug target. In this study, we tested the antimalarial activity of some compounds against PfHT1 using computational techniques. We performed high throughput virtual screening of 21,352 small-molecule compounds against PfHT1. The stability of the lead compound complexes was evaluated via molecular dynamics (MD) simulation for 100 nanoseconds. We also investigated the pharmacodynamic, pharmacokinetic and physiological characteristics of the compounds in accordance with Lipinksi rules for drug-likeness to bind and inhibit PfHT1. Molecular docking and free binding energy analyses were carried out using Molecular Mechanics with Generalized Born and Surface Area (MMGBSA) solvation to determine the selectivity of the hit compounds for PfHT1 over the human glucose transporter (hGLUT1) orthologue. Five important PfHT1 inhibitors were identified: Hyperoside (CID5281643); avicularin (CID5490064); sylibin (CID5213); harpagoside (CID5481542) and quercetagetin (CID5281680). The compounds formed intermolecular interaction with the binding pocket of the PfHT1 target via conserved amino acid residues (Val314, Gly183, Thr49, Asn52, Gly183, Ser315, Ser317, and Asn48). The MMGBSA analysis of the complexes yielded high free binding energies. Four (CID5281643, CID5490064, CID5213, and CID5481542) of the identified compounds were found to be stable within the PfHT1 binding pocket throughout the 100 nanoseconds simulation run time. The four compounds demonstrated higher affinity for PfHT1 than the human major glucose transporter (hGLUT1). This investigation demonstrates the inhibition potential of sylibin, hyperoside, harpagoside, and avicularin against PfHT1 receptor. Robust preclinical investigations are required to validate the chemotherapeutic properties of the identified compounds., Competing Interests: The authors have declared that no competing interests exist.

It is important to understand how to frame the formats for promoting HIV self-testing to increase uptake among young people. In this study, we used a culture-centered model to understand the narratives of HIV self-testing preferences among young people in Nigeria. We conducted a crowdsourcing contest to solicit ideas surrounding HIV self-testing promotion among young people (10-24 years) in Nigeria from October to November 2018 as part of the 2018 World AIDS Day event. We received 903 submissions and employed thematic content analysis to evaluate 769 eligible youth narratives. Thematic content analysis of the statements from the youth narratives was guided by the PEN-3 cultural model to examine the positive, existential, and negative perceptions (beliefs and values), enablers (resources), and nurturers (roles of friends and family) of HIV self-testing promotion among young people in Nigeria. Several themes emerged as factors that influence the uptake of HIV self-testing among young people in Nigeria. Specifically, seven themes emerged as perceptions: HIV testing accessibility, stigma reduction, and autonomy (positive); HIV self-testing kit packaging and advertisements (existential); lack of knowledge and increased stigma (negative). Seven themes emerged as enablers: social media, school, and government promotion (positive); gamification and animation (existential); high cost and access to linkage to care services (negative); And seven themes emerged as nurturers: peer, families, and faith-based communities (positive); parents and family-centered approach (existential); and partners and family (negative). Our data suggests that increased awareness around HIV self-testing on current youth-friendly platforms, de-stigmatization of HIV and HIV self-testing, decreased prices for HIV self-testing kits, reliability of testing kits, increased linkage to care services, and promotion of self-testing among family members and the community will be beneficial for HIV self-testing scale-up measures among young people in Nigeria., Competing Interests: The authors have declared that no competing interests exist.

Background: Evidence-based task-strengthening strategies for hypertension (HTN) control (TASSH) are not readily available for patients living with HIV in sub-Saharan Africa where the dual burden of HTN and HIV remains high. We are conducting a cluster randomized controlled trial comparing the effectiveness of practice facilitation versus a self-directed control (i.e., receipt of TASSH with no practice facilitation) in reducing blood pressure and increasing the adoption of task-strengthening strategies for HTN control within HIV clinics in Nigeria. Prior to implementing the trial, we conducted formative research to identify factors that may influence the integration of TASSH within HIV clinics in Nigeria., Methods: This mixed-methods study was conducted with purposively selected healthcare providers at 29 HIV clinics, followed by a 1-day stakeholder meeting with 19 representatives of HIV clinics. We collected quantitative practice assessment data using two instruments: (a) an adapted Service Availability and Readiness Assessment (SARA) tool to assess the capacity of the clinic to manage NCDs and (b) Implementation Climate Scale to assess the degree to which there is a strategic organizational climate supportive of the evidence-based practice implementation. The quantitative data were analyzed using descriptive statistics and measures of scale reliability. We also used the Consolidated Framework for Implementation Research (CFIR), to thematically analyze qualitative data generated and relevant to the aims of this study., Results: Across the 29 clinics surveyed, the focus on TASSH (mean=1.77 (SD=0.59)) and educational support (mean=1.32 (SD=0.68)) subscales demonstrated the highest mean score, with good-excellent internal consistency reliability (Cronbach's alphas ranging from 0.84 to 0.96). Within the five CFIR domains explored, the major facilitators of the intervention included relative advantage of TASSH compared to current practice, compatibility with clinic organizational structures, support of patients' needs, and intervention alignment with national guidelines. Barriers included the perceived complexity of TASSH, weak referral network and patient tracking mechanism within the clinics, and limited resources and diagnostic equipment for HTN., Conclusion: Optimizing healthcare workers' implementation of evidence-based TASSH within HIV clinics requires attention to both the implementation climate and contextual factors likely to influence adoption and long-term sustainability. These findings have implications for the development of effective practice facilitation strategies to further improve the delivery and integration of TASSH within HIV clinics in Nigeria., Trial Registration: ClinicalTrials.gov , NCT04704336., (© 2022. The Author(s).)

Background: The World Health Organization recommends HIV self-testing (HIVST) as an additional approach to HIV testing and the Nigerian government is supportive of this policy recommendation. However, effectively increasing uptake and sustainability among Nigerian youth is unknown. The goal of this study is to conduct a full-powered type I hybrid effectiveness-implementation trial to test the effectiveness of youth-friendly implementation science strategies in increasing uptake and sustainability of HIVST led by and for Nigerian youth., Methods: Our 4 Youth by Youth (4YBY) strategy combines four core elements: 1) HIVST bundle consisting of HIVST kits and photo verification system; 2) a participatory learning community; 3) peer to peer support and technical assistance; and 4) on-site supervision and performance feedback to improve uptake and sustainability of HIVST and enhance linkage to youth-friendly health clinics for confirmatory HIV testing where needed, sexually transmitted infection (STI) testing (i.e. syphilis, gonorrhea, chlamydia, and hepatitis, STI treatment, and PrEP referral. Utilizing a stepped-wedge, cluster-randomized controlled trial, a national cohort of youth aged 14-24 recruited from 32 local government areas across 14 states and four geo-political zones in Nigeria will receive the 4YBY implementation strategy. In addition, an economic evaluation will explore the incremental cost per quality adjusted life year gained., Discussion: This study will add to the limited "how-to-do it literature" on implementation science strategies in a resource-limited setting targeting youth population traditionally underrepresented in implementation science literature. Study findings will also optimize uptake and sustainability of HIVST led by and for young people themselves., Trial Registration: This study is registered in ClinicalTrials.govNCT04710784 (on January 15, 2021)., (Copyright © 2021. Published by Elsevier Inc.)

Although HIV self-testing (HIVST) has expanded in many regions, a few HIVST services have been tailored for and organized by youth. Innovative HIVST models are needed to differentiate testing services and generate local demand for HIVST among youth. The current pilot study aimed at examining the feasibility and efficacy of crowdsourced youth-led strategies to enhance HIVST as well as sexually transmitted infection (STI) testing. Teams of youth iteratively developed HIVST interventions using crowdsourcing approaches and apprenticeship training. Five interventions were selected and then evaluated among youth (ages 14-24) from September 2019 to March 2020. Given the similar outcomes and approaches, we present cumulative data from the completed interventions. We assessed HIVST uptake (self-report), STI uptake (facility reports for gonorrhea, syphilis, hepatitis B, and chlamydia testing), and quality of youth participation. Mixed-effect logistic regression models estimated intervention effects at baseline and 6 months. Of the 388 youths enrolled, 25.3% were aged 14-19, 58.0% were male, and 54.1% had completed secondary education. We observed a significant increase in HIVST from 3 months compared with 6 months (20% vs. 90%; p  < 0.001). Among those who received an HIVST at 3 months, 324 out of 388 were re-tested at 6 months. We also observed significant increases in testing for all four STIs: syphilis (5-48%), gonorrhea (5-43%), chlamydia (1-45%), and hepatitis B testing (14-55%) from baseline to the 6-month follow-up. Youth participation in the intervention was robust. Youth-led HIVST intervention approaches were feasible and resulted in increased HIV/STI test uptake. Further research on the effectiveness of these HIVST services is needed.

Background: Human immunodeficiency virus risk-reduction interventions that include income-generating activities are garnering attention as effective strategies to engage adolescent girls and young women (AGYW) toward HIV risk reduction. To sustain and promote the uptake of these interventions, researchers must understand factors that may encourage or present barriers to AGYW participation in such interventions. This study explores AGYW perceived barriers and facilitators to participation in a school-based combination income-generating HIV prevention intervention in Nigeria. Methods: A convenience sample of AGYW who participated in a school-based combination income-generating HIV prevention intervention were recruited for the study. Data generated from focus group discussions (FGDs) (eight discussion groups comprising 10-12 participants) were analyzed by inductive thematic analysis. Results: A total of 93 participants with a mean age of 15.04 years (SD = 0.89) participated in the FGDs. The study participants identified several facilitators and barriers to participation in the intervention. Three main themes that emerged as facilitators were: (1) involvement of young female facilitators in the delivery of intervention components, (2) opportunity for social interaction with peers during the intervention period, and (3) support and approval from school authorities. Two main themes were also identified as barriers: (1) sexual conservatism from society and parents and (2) challenges in sustaining a microenterprise. Conclusions: Despite the perceived benefits and interest in participation in the intervention, the study participants outlined some challenges that may hinder participation in the intervention components. Addressing barriers, such as stigma associated with the discussion of sexual health-related topics, coupled with the promotion of facilitating factors, such as leveraging context-appropriate intervention delivery modalities, is important for enhancing the engagement of AGYW in HIV risk-reduction intervention. Our findings can guide future research and design of combination income-generating HIV prevention interventions for in-school AGYW in low-resource settings such as Nigeria., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Nwaozuru, Tijani, Gbajabiamila, Obiezu-Umeh, Uzoaru, Ezechi, Musa, Curley, BeLue and Iwelunmor.)

Background: Despite the global expansion of HIV self-testing (HIVST), many research studies still rely on self-reported outcomes. New HIVST verification methods are needed, especially in resource-limited settings., Objective: This study aims to evaluate the user experience of a mobile health (mHealth) app to enhance HIVST result reporting and verification., Methods: Semistructured, in-depth interviews were used to evaluate the user experience of the 4 Youth By Youth mHealth photo verification app for HIVST. We used a think-aloud approach, and participants performed usability tasks and completed a qualitative exit interview. The app included HIV educational resources, step-by-step video instructions for performing HIVST, a 20-minute timer, a guide on interpreting results with linkages to care, an offline version, and a photo verification system. Demographic characteristics were reported by using descriptive statistics. Qualitative data were analyzed by using thematic analysis., Results: A total of 19 users-12 women and 7 men-with a mean age of 22 years, participated in the study. The users completed the usability tasks and successfully uploaded a photo of their test results by using the app without assistance. Four main themes were identified in the data. First, in terms of user-friendly design, the participants noted the user-friendly features of the offline version and the app's low data use. However, some wanted the app to work in the background when using their mobile phone, and the font used should be more youth friendly. Second, in terms of ease of use, participants remarked that the app's self-explanatory nature and instructions that guided them on how to use the app enhanced its use. Third, in terms of a user's privacy, many participants reinforced the importance of privacy settings and tools that protect confidentiality among users. Finally, in terms of linkage to care, participants noted that the app's linkage to care features were useful, particularly in relation to referrals to trained counselors upon the completion of the test. All the participants noted that the app provided a convenient and private means of verifying the HIV test results., Conclusions: Our findings demonstrated the importance of engaging end users in the development phase of health technology innovations that serve youth. Clinical trials are needed to determine the efficacy of using an mHealth app to verify HIVST results among young people., (©David Oladele, Juliet Iwelunmor, Titilola Gbajabiamila, Chisom Obiezu-Umeh, Jane Ogoamaka Okwuzu, Ucheoma Nwaozuru, Adesola Zaidat Musa, Ifeoma Idigbe, Kadija Tahlil, Weiming Tang, Donaldson F Conserve, Nora E Rosenberg, Agatha N David, Joseph Tucker, Oliver Ezechi. Originally published in JMIR Formative Research (https://formative.jmir.org), 17.11.2021.)

Background: In regions with weak healthcare systems, critical shortages of the healthcare workforce, and increasing prevalence of dual disease burdens, there is an urgent need for the implementation of proven effective interventions and strategies to address these challenges. Our mixed-methods hybrid type II effectiveness-implementation study is designed to fill this evidence-to-practice gap. This study protocol describes a cluster randomized controlled trial which evaluates the effectiveness of an implementation strategy, practice facilitation (PF), on the integration, adoption, and sustainability of a task-strengthening strategy for hypertension control (TASSH) intervention within primary healthcare centers (PHCs) in Lagos State, Nigeria., Design: Guided by the Consolidated Framework for Implementation Research (CFIR) and the Reach Effectiveness Adoption Implementation and Maintenance (RE-AIM), this study tests the impact of a proven effective implementation strategy to integrate hypertension management into the HIV care cascade, across 30 PHCs. The study will be conducted in three phases: (1) a pre-implementation phase that will use CFIR to develop a tailored PF intervention for integrating TASSH into HIV clinics; (2) an implementation phase that will use RE-AIM to compare the clinical effectiveness of PF vs. a self-directed condition (receipt of information on TASSH without PF) on BP reduction; and (3) a post-implementation phase that will use RE-AIM to evaluate the effect of PF vs. self-directed condition on adoption and sustainability of TASSH. The PF intervention components comprise (a) an advisory board to provide leadership support for implementing TASSH in PHCs; (b) training of the HIV nurses on TASSH protocol; and (c) training of practice facilitators, who will serve as coaches, provide support, and performance feedback to the HIV nurses., Discussion: This study is one of few, if any trials, to evaluate the impact of an implementation strategy for integrating hypertension management into HIV care, on clinical and implementation outcomes. Findings from this study will advance implementation science research on the effectiveness of tailoring an implementation strategy for the integration of an evidence-based, system-level hypertension control intervention into HIV care and treatment., Trial Registration: ClinicalTrials.gov ( NCT04704336 ). Registered on 11 January 2021., (© 2021. The Author(s).)

Background and Objective: A third of new human immunodeficiency virus (HIV) infections occur among young people and the majority of young people living with HIV are in sub-Saharan Africa. We examined the strength of Nigerian youth preferences related to HIV testing and HIV self-testing (HIVST)., Methods: Discrete choice experiments were conducted among Nigerian youth (age 14-24 years). Participants completed one of two discrete choice experiments: (1) preferred qualities of HIV testing (cost, location of test, type of test, person who conducts the test, and availability of HIV medicine at the testing site) and (2) preferred qualities of HIVST kits (cost, test quality, type of test, extra items, and support if tested positive). A random parameter logit model measured the strength of preferences., Results: A total of 504 youth participated: mean age 21 years (standard deviation 2 years), 38% male, and 35% had a higher than secondary school education. There was a strong preference overall to test given the scenarios presented, although male individuals were less likely to test for HIV or use HIVST kits. Youth preferred HIV testing services (with attributes in order of importance) that are free, blood-based testing, available in private/public hospitals or home, for HIV medications to be available in the same location as testing, and a doctor conducts the test. Participants preferred HIVST kits (with attributes in order of importance) that are available from community health centers, free, approved by the World Health Organization, include other sexually transmitted infection testing, have the option of an online chat, and oral-based HIVST., Conclusions: The HIV home testing was equally preferred to testing in a hospital, suggesting a viable market for HIVST if kits account for youth preferences. Male youth were less likely to choose to test for HIV or use HIVST kits, underscoring the need for further efforts to encourage HIV testing among young male individuals., (© 2021. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Background: Acute respiratory failure, a major cause of death in COVID-19, is managed with high-flow oxygen therapy via invasive mechanical ventilation. In resource-limited settings like Nigeria, the shortage of ventilators and oxygen supply makes this option challenging. Evidence-based non-invasive alternatives to mechanical ventilation such as the use of continuous positive airway pressure (CPAP) devices exist, but there have been concerns that non-invasive ventilation may expose healthcare workers to infection from aerosolized dispersion of SARS-CoV-2. We propose to evaluate the feasibility, adaptability and acceptability of a CPAP/O 2 helmet solution for non-invasive ventilation among patients with COVID-19 and health workers in eight COVID-19 treatment and isolation centers in Nigeria., Methods: The study will occur in 4 stages: (1) convene a Steering Committee of key stakeholders and recruit implementation sites; (2) use the integrated Promoting Action on Research Implementation in Health Services (i-PARiHS) framework to guide a needs assessment of treatment centers' capacity to use high-flow oxygen therapy to treat COVID-19 patients and utilize the findings to develop an implementation strategy for the use of a CPAP/O 2 helmet solution; (3) build infrastructure to support training and data monitoring processes and to develop implementation protocols to evaluate the adaptability of the strategy for the use of the CPAP/O 2 helmet; and (4) train health workers, distribute a CPAP/O 2 helmet solution for non-invasive ventilation, pilot test the implementation strategy, and assess feasibility of its use and acceptability that includes monitoring altered risk of SARS-CoV-2 infection among healthcare workers., Discussion: The CPAP/O 2 helmet solution for non-invasive ventilation in Nigeria can serve as a scalable model for resource-poor countries, and beyond the COVID-19 pandemic, has the potential to be deployed for the treatment of pneumonia and other respiratory diseases., Trial Registration: NCT04929691. Registered June 18, 2021-retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04929691., (© 2021. The Author(s).)