FACULTY OF CLINICAL SCIENCES
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Item External Genital warts in HIV-infected patients with sexually transmitted infections in Ibadan, Nigeria(College of Medicine, University of Ibadan, and University College Hospital, Ibadan, Nigeria, 2017) Fayemiwo, S. A.; Adesina, O. A.; Akinyemi, J. O.; Michael, O. S.; Adekanmbi, O. A.; Awolude, O. A.; Kuti, M. A.; Odaibo, G. N.; Adewole, I. F.Background: Human Papilloma Virus (HPV) infection in the genital area is usually asymptomatic, and when symptomatic, manifests in either benign or malignant forms. This study aims at providing information on the prevalence of external genital warts (EGWs) among people living with HIV (PLWHIVS) attending Antiretroviral Treatment (ART) clinic at the University College Hospital, Ibadan, Nigeria. Methods: This is a descriptive cross-sectional survey of PLWHIVS attending ART clinic between January 2006 and December 2007. Diagnosis of genital warts was based on the findings of typical lesions on the external genitalia, vaginal, cervix or perianal region after clinical examination and informed consent from cach participant. Antibodies against Herpes and HPV were measured using, Enzyme-linked immunosorbent Assay (ELISA). Results: A total of 5,207 patients, 3519 female and 1688 males attended the ART clinic during the period. The mean age of the patients was 34.67 yrs (9.16). Five hundred and forty-two (10.0%) had various sexually transmitted infections (STIs). The prevalence of anogenital warts was 3.65% among the HIV-infected patients and 35.0 % among the subset of HIV-infected patients with STIs. The prevalence of genital warts was 1.5 times higher in treatment experienced patients (OR=1.46; 95%CI: 1.02, 2.10). Genital wart was found to be associated with low CD4 count, high viral load, treatment- experience and non-use of condom during sexual intercourse. (P=0.002). Conclusions: External genital warts are common among people living with HIV infection. According to the appropriate guidelines, HPV vaccine should also be offered to HIV-infected adolescents that are non-reactive to the virus.Item Oral Melanotic Hyperpigmentation (OMH) among HIV Seropositive Patients: A Clinical Study at the University College Hospital, Ibadan(Nigerian Association of Oral and Maxillofacial Pathology and Medicine, 2017) Abe, E. O.; Adeyemi, B. F.; Adisa, A. O.; Okoje-Adesomoju, V. N.; Awolude, O. A.BACKGROUND: Oral melanin hyperpigmentation (OMH) has been classified as a HIV associated condition which may present as a brown-black macule or patch of the oral mucosa in HIV seropositive patients. HIV-OMH may be idiopathic, drug- induced or due to adrenal insufficiency. This cross-sectional study was conducted to determine the prevalence of HIV- OMH among HIV seropositive patients attending the Infectious Disease Institute centre, UCH Ibadan. METHODOLOGY: Consecutive, consenting HIV seropositive patients attending PEPFAR clinic, UCH, Ibadan were enrolled. Data collected included age, gender, duration since diagnosis of HIV and commencement of HAART, history of smoking, any systemic disease, WHO staging of HIV, CD4 count, presence of OMH and site affected. Data analysis was done using SPSS version 15. RESULTS: The study group of 150 HIV sero-positive patients comprised 24 males (16%) and 126 females (84%). Out of all the patients seen, OMH was seen in 97 of them, majority reported not being aware of the condition, some noted it before being diagnosed of HIV, while only 14(14.4%) reported the presence of OMH after being diagnosed with HIV and commencement of HAART (p= 0.032). Concerning the OMH sites, gingiva was most noted followed by tongue, palate, buccal and labial mucosa. CONCLUSION: The prevalence of HIV-OMH in this study was 14.4%. Gingiva was the most common site affected.Item Effect of Hepatitis C virus infection on selected laboratory values in pregnant women with Human Immunodeficiency virus infection(Society for Gastroenterology and Hepatology in Nigeria (SOGHIN), 2016) Adesina, O. A.; Akinyemi, J. O.; Michael, O. S.; Fayemiwo, S. A.; Awolude, O. A.; Ogunbosi, B. O.; Kuti, M. A.; Adewole, I. F.Background and Objectives: Both hepatitis C and Human Immunodeficiency viruses affect laboratory indices. The objective of this study was to describe the impact of both viruses on laboratory indices among 1,821 HIV-positive pregnant women. Methods: This was a cross-sectional retrospective study at the University College Hospital, Ibadan Results: Twenty-six (1.7%) women were HCV positive, 139 (8.8%) were HBsAg positive and 1, 407 (89.3%) were negative for both viruses. Three patients (0.19%) were positive for both viruses. These patients, the HBsAg positive women and 246 with no result for either virus were excluded from analysis. The HCV positive women had lower hematocrit (27.3% + 4.5 vs. 28.4% + 4.6, p=0.29), lower WBC (5, 200 vs. 5, 500 cells/ml, p =0.766) but higher platelet count (209, 000 vs. 199, 000 cells / ml, p = 0.019). The coinfected group had higher CD4 (380 vs. 326 cells/ml, p = 0.319), higher urea (16.0vs.ll.0mg/ml, p =0.013) but comparable ALT (16.0 vs.15.0 iu/ml, p = 0.95), log viral load (4.08+1.22 vs. 4.08+1.11, p=0.97) and creatinine levels (0.6vs.0.6, p=0.329). Only the difference in urea level was statistically significant. Conclusion: While values were comparable between both groups, the synergistic effect of both viruses makes it necessary for health-care providers to closely monitor patients.Item Integration of VIA Into Staff Medical Exercise as Prevention Strategy(Society of Gynaecology& Obstetrics of Nigeria (SOGON), 2011) Akinwunmi, B. O.; Awolude, O. A.; Adesina, O. A.; Akingbola, O. O.; Adewole, I. F.Item Human Immunodeficiency Virus Infection in Obstetrics and Gynaecology(HEBN Publishers Plc, 2021) Awolude, O. A.; Fawole, O. A.Item Effect of intervention delivered by lay maternal care providers to improve outcome and parenting skills among adolescents with perinatal depression in Nigeria (the RAPiD study): a cluster randomized controlled trial(Elsevier, 2022) Gureje, O.; Oladeji, B. D.; Kola, L.; Bello, T.; Ayinde, O.; Faregh, N.; Bennett, I.; Zelkowitz, P.Background: Perinatal depression is more common and is associated with greater negative consequences among adolescents than adults. Psychosocial interventions designed for adults may be inadequate at addressing the unique features of adolescent perinatal depression. Methods: In a two-arm parallel cluster randomized trial conducted in thirty primary maternal care clinics in Ibadan, Nigeria (15-intervention and 15-control) we compared age-appropriate intervention consisting of problem-solving therapy, behavioral activation, parenting skills training, and parenting support from a self- identified adult to care as usual. Pregnant adolescents (aged <20 years) at fetal gestational age16–36 weeks with moderate to severe depression were recruited. Primary outcomes were depression symptoms (Edinburgh Postnatal Depression Scale, EPDS) and parenting practices (Infant-Toddler version of the Home Inventory for Measurement of the Environment, HOME-IT) at six-months postnatal. Results: There were 242 participants (intervention arm: 141; Control arm: 101), with a mean age of 18∙0 (SD- 1∙2). Baseline mean EPDS score was 14∙2 (SD-2.1); 80∙1 % completed the six-month postnatal follow-up. The intervention group had lower level of depressive symptoms than the control group, mean EPDS scores: 5∙5 (SD- 3∙6) versus 7∙2 (SD-4∙0) (adjusted mean difference -1∙84 (95%CI- 3∙06 to 0∙62; p =0∙003) and better parenting practices, mean total HOME-IT scores: 29∙8 (SD-4∙4) versus 26∙4 (SD-4∙2) (adjusted mean difference 3∙4 (95%Cl- 2∙12 to 4∙69, p =0∙001). Limitations: This study explored the effect of complex interventions making it difficult to know precisely what aspects produced the outcomes. Conclusions: An age-appropriate psychosocial intervention package holds promise for scaling up care for adolescents with perinatal depression especially in resource-constrained settings.Item Evaluation of the iCARE Nigeria pilot intervention using social media and peer navigation to promote HIV testing and linkage to care among high-risk young men: a nonrandomized controlled trial(2022-02) Garofalo, R.; Adetunji, A.; Kuhns, L. M.; Omigbodun, O.; Johnson, A. K.; Kuti, K. M.; Awolude, O. A.; Berzins, B.; Janulis, P.; Okonkwor, O.; Oladeji, B.; Muldoon, A. L.; Amoo, O. P.; Atunde, H.; Kapogiannis, B.; Taiwo, B. O.IMPORTANCE Nigeria has the fourth-largest HIV epidemic globally, yet high levels of social stigma inhibit HIV testing among Nigerian youths and young men who have sex with men (MSM). OBJECTIVE To report pilot data from iCARE Nigeria (Intensive Combination Approach to Roll Back the Epidemic in Nigerian Adolescents), a combination intervention using social media and peer navigation to promote HIV testing and linkage to care among high-risk youths and young men (hereinafter referred to as young men), including predominantly young MSM. DESIGN, SETTING, AND PARTICIPANTS This nonrandomized controlled study assessed an organizational and community-level 12-month, preintervention-postintervention pilot trial of a combination intervention designed to increase HIV testing uptake, increase the rate of identified seropositive cases, and improve linkage to care among young men, including MSM, using social media outreach and peer navigation. Data were collected from June 1, 2019, to May 30, 2020. Participants were young men aged 15 to 24 years in the city of Ibadan, Nigeria, and surrounding areas. Frequencies and percentages were examined, and a Fisher exact test was used to evaluate outcomes compared with historical surveillance data. Linkage to care was defined as 2 clinic visits, including HIV confirmation, within 2 months of a positive rapid test result. INTERVENTION Four peer navigators conducted social media outreach promoting sexual health and guiding individuals to HIV counseling and rapid testing in clinical, community, or home-based settings. MAIN OUTCOMES AND MEASURES Primary outcomes included the number of young men tested for HIV at university-based iCARE catchment clinics or by iCARE peer navigators in the community, the postintervention HIV seroprevalence of these groups, and linkage to care of participants diagnosed with HIV infection. RESULTS A total of 339 participants underwent testing for HIV (mean [SD] age, 21.7 [1.9] years), with 283 (83.5%) referred through social media. The main referral sources for social media were WhatsApp (124 [43.8%]), Facebook (101 [35.7%]), and Grindr (57 [20.1%]). Regarding testing location, participants chose home (134 [39.5%]), community-based (202 [59.6%]), or clinic (3 [0.9%]) settings. Eighty-six participants reported no prior HIV testing. Thirty-six participants (10.6%) were confirmed as HIV seropositive; among those, 18 (50.0%) reported negative test results within the past year, and 31 (86.1%) were linked to care. In two 6-month follow-up periods, the intervention increased HIV testing by 42%and 31%, respectively, and seroprevalence increased compared with historical trends with odds ratios of 3.37 (95%CI, 1.43-8.02; P = .002) and 2.74 (95%CI, 1.10-7.11; P = .02), respectively. CONCLUSIONS AND RELEVANCE These findings suggest that use of iCARE Nigeria was associated with increased HIV testing and linkage to care in a high-risk, difficult-to-reach population, making it a promising combination intervention for young MSM.Item Prevalence and correlates of depression among pregnant adolescents in primary maternal care in Nigeria(Springer, 2022) Oladeji, B. D.; Bello, T.; Ayinde, O.; Idowu, P.; Gureje, O.To examine the prevalence as well as the clinical and psychosocial factors associated with depression and depression severity in pregnant adolescents. Participants were consecutively registered pregnant adolescents presenting to 30 selected primary maternal and child healthcare centers in Ibadan, Nigeria, who were screened for enrolment into an intervention trial for perinatal depression (depression defined as a score of ≥ 12 on the Edinburg Postnatal Depression Scale [EPDS] and met the DSM-IV diagnostic criteria for depression). Of the 1359 pregnant adolescents screened, 246 (18.1%) had depression. Mean age was 18.4 (sd 1.00), 58.9% were either married or cohabiting, 91.4% were primipara, and the mean gestational age was 23.8 weeks (sd 5.4 weeks). Food insecurity (going to bed hungry at least once in the previous week because there was no food to eat) was reported by 13.3%. In bivariate analysis, younger age, not living with a partner, unemployment, and food insecurity were associated with depression. In bivariate analysis, younger age, not living with a partner, unemployment and food insecurity were associated with depression, while younger age, being single and food insecurity were independently associated with being depressed in multivariate analysis. Severity of depression was related to age, higher anxiety and disability scores, lower quality of life scores across all domains and poorer attitudes towards pregnancy. Depression was associated with indices of higher social disadvantage among adolescents. Delaying childbearing and measures aimed at alleviating poverty may be important in preventing depression in this vulnerable group.Item Theory-driven development of a mobile phone supported intervention for adolescents with perinatal depression(Springer, 2021-11) Kola, L.; Abiona, D.; Oladeji, B. D.; Ayinde, O.; Bello, T.; Gureje, O.Purpose This paper describes the design of a theory-informed pragmatic intervention for adolescent perinatal depression in primary care in Nigeria. Methods We conducted Focus Group Discussions (FGDs) among 17 adolescent mothers and 25 maternal health care providers with experience in the receipt and provision of care for perinatal depression. The Consolidated Framework for Implementation Research (CFIR) was used to systematically examine the barriers and facilitators affecting adolescent mothers' use of an existing intervention package for depression. The Theoretical Domain Framework (TDF) and the Capability, Opportunity, Motivation, Behaviour (COM-B) model were used to analyze the results of the data across the five CFIR domains. Results FGD analysis revealed that care providers lacked knowledge on approaches to engage young mothers in treatment. Young mothers had poor treatment engagement, low social support, and little interest in parenting. A main characteristic of the newly designed intervention is the inclusion of age-appropriate psychoeducation supported with weekly mobile phone calls, to address treatment engagement and parenting behaviours of young mothers. Also in the outer setting, low social support from relatives was addressed with education, “as need arises” phone calls, and the involvement of "neighborhood mothers”. In the inner settings, care providers’ behaviour is addressed with training to increase their capacity to engage young mothers in treatment. Conclusion A theory-based approach helped develop an age-appropriate intervention package targeting depression and parenting skills deficit among perinatal adolescents in primary maternal care and in which a pragmatic use of mobile phone was key.Item Patterns and correlates of patient-reported helpfulness of treatment for common mental and substance use disorders in the WHO World Mental Health Surveys(Elsevier Srl, 2022) Kessler, R. C.; Kazdin, A. E.; Aguilar-Gaxiola, S.; Al-Hamzawi, A.; Alonso, J.; Altwaijri, Y. A.; Andrade, L. H.; Benjet, C.; Bharat, C.; Borges, G.; Bruffaerts, R.; Bunting, B.; Caldas de Almeida, J. M.; Cardoso, G.; Chiu, W. T.; Cía, A.; Ciutan, M.; Degenhardt, L.; de Girolamo, G.; de Jonge, P.; de Vries, Y. A.; Florescu, S.; Gureje, O.; Haro, J. M.; Harris, M. G.,; Hu, C.; Karam, A. N.; Karam, E. G.; Karam, G.; Kawakami, N.; Kiejna, A.; Kovess-Masfety, V.; Lee, S.; Makanjuola, V.; McGrath, J. J.; Medina-Mora, M. E.; Moskalewicz, J.; Navarro-Mateu, F.; Nierenberg, A. A.; Nishi, D.; Ojagbemi, A.; Oladeji, B. D.; O’Neill, S.; Posada-Villa, J.; Puac-Polanco, V.; Rapsey, C.; Ruscio, A. M.; Sampson, N. A.; Scott, K. M.; Slade, T.; Stagnaro, J. C.; Stein, D. J.; Tachimori, H.; ten Have, M.; Torres, Y.; Viana, M. C.; Vigo, D. V.; Williams, D. R.; Wojtyniak, B.; Xavier, M.; Zarkov, Z.; Ziobrowski, H. N.; WHO WMH survey collaboratorsPatient-reported helpfulness of treatment is an important indicator of quality in patient-centered care. We examined its pathways and predictors among respondents to household surveys who reported ever receiving treatment for major depression, generalized anxiety disorder, social phobia, specific phobia, post-traumatic stress disorder, bipolar disorder, or alcohol use disorder. Data came from 30 community epidemiological surveys –17 in high-income countries (HICs) and 13 in low- and middle-income countries (LMICs) – carried out as part of the World Health Organization (WHO)’s World Mental Health (WMH) Surveys. Respondents were asked whether treatment of each disorder was ever helpful and, if so, the number of professionals seen before receiving helpful treatment. Across all surveys and diagnostic categories, 26.1% of patients (N=10,035) reported being helped by the very first professional they saw. Persisting to a second professional after a first unhelpful treatment brought the cumulative probability of receiving helpful treatment to 51.2%. If patients persisted with up through eight professionals, the cumulative probability rose to 90.6%. However, only an estimated 22.8% of patients would have persisted in seeing these many professionals after repeatedly receiving treatments they considered not helpful. Although the proportion of individuals with disorders who sought treatment was higher and they were more persistent in HICs than LMICs, proportional helpfulness among treated cases was no different between HICs and LMICs. A wide range of predictors of perceived treatment helpfulness were found, some of them consistent across diagnostic categories and others unique to specific disorders. These results provide novel information about patient evaluations of treatment across diagnoses and countries varying in income level, and suggest that a critical issue in improving the quality of care for mental disorders should be fostering persistence in professional help-seeking if earlier treatments are not helpful.