Browsing by Author "Ajayi, S."

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A predominance of hypertensive heart failure in the Abuja heart study cohort of urban Nigerians: a prospective clinical registry of 1515 de novo cases.
(2012) Ojji D.; Stewart, S.; Ajayi, S.; Manmak, M.; Sliwa K.
Aims: Even though cardiovascular disease is gradually becoming the major cause of morbidity and mortality in sub-Saharan Africa, there are very few data on the pattern of heart disease in this part of the world. We therefore decided to determine the pattern of heart disease in Abuja, which is one of the fastest growing and most westernized cities in Nigeria, and compare our findings with those of the Heart of Soweto Study in South Africa. Methods and results: Detailed clinical data were consecutively captured from 1515 subjects of African descent, residing in Abuja, and equivalent Soweto data from 4626 subjects were available for comparison. In Abuja, male subjects were on average, 2 years older than female subjects. Hypertension was the primary diagnosis in 45.8% of the cohort, comprising more women than men [odds ratio (OR) 1.96, 95% confidence interval (CI) 1.26– 2.65], and hypertensive heart failure (HF) was the most common form of HF in 61% of cases. On an age- and sex-adjusted basis, compared with the Soweto cohort, the Abuja cohort were more likely to present with a primary diagnosis of hypertension (adjusted OR 2.10, 95% CI 1.85– 2.42) or hypertensive heart disease/failure (OR 2.48, 95% CI 2.18–2.83); P , 0.001 for both. They were, however, far less likely to present with CAD (OR 0.04, 95% CI 0.02 –0.11) and right heart failure (2.5% vs. 27%). Conclusion: As in Soweto, but more so, hypertension is the most common cause of de novo HF presentations in Abuja, Nigeria.
Challenges and possible solutions to peritoneal dialysis use in Nigeria.
(2020) Ajayi, S.; Raji, Y.; Bello, T.; Arije, A.
Introduction: peritoneal dialysis is a form of renal replacement therapy that is both effective and relatively affordable. Peritoneal dialysis (PD) was first used in Nigeria as a treatment option for renal failure. Its use was first reported in Nigeria in 1969 and became more widespread in the 80s and 90s. Haemodialysis, which is capital intensive to set up and requires infrastructures and facilities such as electricity, intense water consumption and buildings, seems to have upstaged peritoneal dialysis both in demand and supply. Methods: this cross-sectional study is a convenient survey of nephrologists, renal technicians and nurses in Nigeria. We used a structured, self-administered questionnaire on a cross-section of members and associate members attending a national nephrology association meeting. Results: there were 68(54.4%) doctors, 43(27.2%) nurses, and 14(11.2%) renal technicians, all from medical institutions with renal treatment programs who participated in the study. The most common problems encountered with PD use are financial constraints (51.7%), inadequate fluid supply (50%), frequent line blockage (22.4%) and frequent infections (17.2%). Reasons attributed to the stoppage of PD in the centres included lack of PD fluids (50.8%), unavailability of PD catheters (22.8%), lack of expert personnel to train (15.8%). Conclusion: main challenges to peritoneal dialysis use in Nigeria include limited experience and training and availability and cost of consumables. Effort to overcome the factors militating against its use should be positively pursued so that peritoneal dialysis will be reintegrated into the mainstream of renal replacement therapy once more
Genomic approaches to the burden of kidney disease in sub-saharan africa: the human heredity and health in africa
(2016) Osafo, C.; Raji, Y.; Olanrewaju, T.; Mamven, M.; Arogundade, F.; Ajayi, S.; Ulasi, I.; Salako, B.; Plange-Rhule, J.; Mengistu, Y.; Mc’Ligeyo, S.O.; Moturi, G.; Winkler, C.A.; Moxey-Mims, M.M.; Rasooly, R.S.; Kimmel, P.; Adu, D.; Ojo, A.; Parekh, R.S.
H3Africa partnerships to empower clinical research sites to generate high-quality biological samples
(2020) Croxton, T.; Agala, N.; Jonathan, E.; Balogun, O.; Ozumba, P.J.; Onyemata, E.; Onyemata, E.; Lawal, S.; Mamven, M.; Ajayi, S.; Melikam, S.E.; Owolabi, M.; Ovbiagele, B.; Adu, D.; Ojo, A.; Beiswanger, C.M.; Abimiku, A.
Background: The Institute of Human Virology Nigeria (IHVN) – Human Heredity and Health in Africa (H3Africa) Biorepository (I-HAB) seeks to provide high-quality biospecimens for research. This depends on the ability of clinical research sites (CRS) – who provide biospecimens – to operate according to well-established industry standards. Yet, standards are often neglected at CRSs located in Africa. Here, I-HAB reports on its four-pronged approach to empower CRSs to prepare high-quality biospecimens for research. Objectives: I-HAB sought (1) to assess a four-pronged approach to improve biobanking practices and sample quality among CRSs, and (2) to build human capacity. Methods: I-HAB partnered with two H3Africa principal investigators located in Nigeria and Ghana from August 2013 through to May 2017 to debut its four-pronged approach (needs assessment, training and mentorship, pilot, and continuous quality improvement) to empower CRSs to attain high-quality biospecimens. Results: Close collaborations were instrumental in establishing mutually beneficial and lasting relationships. Improvements during the 12 months of engagement with CRSs involved personnel, procedural, and supply upgrades. In total, 51 staff were trained in over 20 topics. During the pilot, CRSs extracted 50 DNA biospecimens from whole blood and performed quality control. The CRSs shipped extracted DNA to I-HAB and I-HAB that comparatively analysed the DNA. Remediation was achieved via recommendations, training, and mentorship. Preanalytical, analytical and post-analytical processes, standard operating procedures, and workflows were systematically developed. Conclusion: Partnerships between I-HAB and H3Africa CRSs enabled research sites to produce high-quality biospecimens through needs
Long-term outcome of second-line antiretroviral therapy in resource limited settings.
(2014) Osinusi-Adekanbi, O.; Stafford, K.; Ukpaka, A.; Salami, D.; Ajayi, S.; Ndembi, N.; Abimiku, A.; Nwizu, C.; Gilliam, B.; Reddfield, R.; Amoroso, A.
There is limited information on efficacy and durability of second-line antiretroviral therapy (2NL) beyond 12 months in resource limited settings. A total of 73 patients were enrolled into a prospective 2NL observational cohort in Nigeria. Second-line antire troviral therapy consisted of lopinavir/ritonavir plus nucleoside reverse transcriptase inhibitors. Time on 2NL ranged from 15 to 31 months. Genotypes were retrospectively done and not available to guide second-line regimen choice. At enrollment, median CD4 count was 121 cells/mm3 , and median time on first-line antiretroviral therapy (1SL) was 24 months. At 6 to 9 months on 2NL, 72.6% (intention to treat [ITT]) and 88.3% (on treatment [OT]) had an undetectable viral load (UDVL). At 12 months, 65.8% (ITT) and 90.57% (OT) had UDVL. At >12 to 24 months and at >24 months, 57.5% (ITT) and 91.3% (OT) had UDVL. No statistically significant association was observed between CD4 at 2NL start, sex, genotypic sensitivity score of 2NL, or teno fovir (TDF) use in 1SL and viral suppression. Two patients developed major protease inhibitor mutations while on 2NL. We observed a high degree of viral suppression at 12 months and little loss of viral suppression thereafter.
Patient retention and adherence to antiretrovirals in a large antiretroviral therapy program in Nigeria: a longitudinal analysis for risk factors.
(2010) Charurat M.; Oyegunle M.; Benjamin R.; Habib A.; Eze E.; Ele P.; Ibanga I.; Ajayi, S.; Eng M.; Monda P.; Dakum P.; Farley P.; Blattner W.
Background: Substantial resources and patient commitment are required to successfully scale-up antiretroviral therapy (ART) and provide appropriate HIV management in resource-limited settings. We used pharmacy refill records to evaluate risk factors for loss to follow-up (LTFU) and non-adherence to ART in a large treatment cohort in Nigeria. Methods and Findings: We reviewed clinic records of adult patients initiating ART between March 2005 and July 2006 at five health facilities. Patients were classified as LTFU if they did not return .60 days from their expected visit. Pharmacy refill rates were calculated and used to assess non-adherence. We identified risk factors associated with LTFU and non-adherence using Cox and Generalized Estimating Equation (GEE) regressions, respectively. Of 5,760 patients initiating ART, 26% were LTFU. Female gender (p,0.001), post-secondary education (p = 0.03), and initiating treatment with zidovudine-containing (p = 0.004) or tenofovir-containing (p = 0.05) regimens were associated with decreased risk of LTFU, while patients with only primary education (p = 0.02) and those with baseline CD4 counts (cell/ml3 ) .350 and ,100 were at a higher risk of LTFU compared to patients with baseline CD4 counts of 100–200. The adjusted GEE analysis showed that patients aged ,35 years (p = 0.005), who traveled for .2 hours to the clinic (p = 0.03), had total ART duration of .6 months (p,0.001), and CD4 counts .200 at ART initiation were at a higher risk of non-adherence. Patients who disclosed their HIV status to spouse/ family (p = 0.01) and were treated with tenofovir-containing regimens (p#0.001) were more likely to be adherent Conclusions: These findings formed the basis for implementing multiple pre-treatment visit preparation that promote disclosure and active community outreaching to support retention and adherence. Expansion of treatment access points of care to communities to diminish travel time may have a positive impact on adherence.