Explore the vast range of titles available.

Objectives. To characterize the proportion of Medicaid-eligible infants experiencing gaps in Medicaid coverage during early infancy and to determine whether infants without Medicaid coverage were covered by other plans or not at all. Study design. Infants with Medicaid-financed births from three states participating in the 2016–2020 Pregnancy Risk Assessment Monitoring System (PRAMS) were included (N=3,658). Infant insurance coverage (Medicaid, non-Medicaid, none) was assessed at the time of the PRAMS survey, typically around four months of age. Results. Fifteen percent of infants had non-Medicaid insurance coverage, two percent were uninsured, and 83% had Medicaid coverage after Medicaid-financed birth. The strongest predictor of infant uninsurance was maternal uninsurance or non-Medicaid coverage before pregnancy. Conclusion. Some presumably eligible infants are not enrolled in Medicaid or experience lapses in Medicaid coverage. Informing families about infants’ coverage eligibility and supporting families during the enrollment process would especially benefit families with no pre-pregnancy experience with Medicaid.

This paper employs two-stage input-output structural decomposition analysis (SDA) to identify the factors responsible for changes in Japan's ... emissions for two periods: 1995-2000 and 2000-2005. First, the study decomposes the total change in ... emissions for each period to obtain the contribution of change in ... emissions per unit output ... emissions coefficient), change in technology (technology effect), and change in final demand. The study observed from the first-stage decomposition that emissions coefficient and final demand drive the change in the first period (1995-2000) while the technology effect drives the change in the second period (2000-2005). The high contribution of the technology effect is driven by activities of iron and steel; coke, refined petroleum and gas; road transportation; and electricity sectors. Having observed the trend of the technology effect across the two periods, the study carried out a second-stage decomposition on technology effect in the second period to examine the contribution of each sector and observed that chemical and pharmaceuticals; iron and steel; road transportation; and construction sectors are mainly responsible. In conclusion, improvement in technical efficiency especially at the industrial process level of each industry will help Japan achieve greater level of ... emissions reduction.

In October 2019, a peer-based transition preparedness model was introduced as part of peer club activities to prepare young persons living with HIV (YLHIV) for adult care. This study compared the 12 and 24 months treatment outcomes of YLHIV who transitioned to adult care in primary, secondary and tertiary health facilities in Southern Nigeria, following the introduction of this model. This was a retrospective cohort study using data extracted from the medical records of YLHIV who transitioned to adult care at 25 years in 2018 and in 2021 across 155 healthcare facilities in southern Nigeria. Baseline data at transition, as well as 12 and 24 months post-transition data were extracted for comparison between those who were transitioned before (2018 cohort) and after (2021 cohort) the transition preparedness model was introduced. Logistics regression analysis was used to compare client continuity on treatment and undetectable viral load between the two groups at 12 and 24 months after transitioning to adult care. Most of the1,555 YLHIV who transitioned to adult care in 2018 (n = 343, 22.1%) and 2021 (n = 1,212, 77.9%) were females (91.0% in 2018 v.82.6% in 2021) and initiated ART at 20 years or older (92.7% v. 95.7%). A higher proportion of those in the 2021 cohort were continuously retained both at 12 months and 24 months post-transitioning compared to those in the 2018 cohort (12 months: 96.7% vs 80.2%, p < 0.001; 24 months: 92.7% vs 77.6% p < 0.001). Similarly, the proportion of YLHIV with undetectable viral load in the 2021 cohort was significantly higher than those in the 2018 cohort at both 12 months (96.1% vs 60.1%, p < 0.001) and 24 months (93.3% vs 80.6%, p < 0.001), respectively. Peer-based transition preparedness model improved treatment outcomes of YLHIV who transition to adult care. Programs should implement tailored, peer-based interventions to address gaps in service delivery.

Background HIV prevention, treatment, and care across the globe have been heavily dependent on donor funding and international aid, particularly across the Global South, with the highest contribution from the United States Government (USG) through PEPFAR. PEPFAR’s shift towards HIV care sustainability involves transitioning HIV/AIDS treatment programs from international to local partners. Despite the increasing focus on these transitions, there is limited evidence of effective models and the outcome of such transitions, particularly in low- and middle-income countries like Nigeria. This study evaluates the transition of a large-scale HIV/AIDS program from an international implementing partner (FHI 360) to a local partner, Excellence Community Education Welfare Scheme (ECEWS) in Nigeria, highlighting the processes and early outcomes. Methods The study used a before–after design to analyse programme data from Akwa Ibom and Cross River States, comparing indicators before, during and after the transition of HIV services from FHI 360 to the local partner ECEWS. A transition model was developed with stakeholder engagement. De-identified client data were abstracted from the Electronic Medical Records and District Health Information System (DHIS2) database for the pre-transition period (January–June 2022) and post-transition period (July–December 2022) and compared. Outcomes compared included HIV testing services, on-schedule refill appointments, and viral load testing uptake. Statistical analyses were performed using STATA version 14, with significance at p  < 0.05. Results A total of 405,702 individuals were tested for HIV between January 2022 and December 2022, with 116,138 (29%) tested before and 289,564 (71%) tested after the transition period. The average number of monthly tests increased by 149%, from 19,356 to 48,260 ( p  = 0.001), between the two periods. Additionally, on-schedule refill appointments improved significantly post-transition, increasing from 97.8 to 98.2% ( p  < 0.001), while viral load testing uptake improved from 96 to 99%. Success was attributed to comprehensive planning, strong stakeholder engagement, flexible communication strategies, and a robust monitoring and evaluation (M&E) system, which were outcomes of the transition model. Conclusion HIV/AIDS treatment program transitions to indigenous partners can be successfully achieved without compromising service accessibility, care quality, or treatment outcomes. Our study findings highlight the importance of collaborative planning in sustaining program outcomes during transitions with the aim of sustaining service delivery during this period. A systematic approach, utilising a well-structured transition model, facilitates a seamless transfer and provides a strategic framework for Nigerian programs.

ObjectiveDecrease the incidence of inadequate diuresis (ID, loss of <6% of birth weight) in extremely preterm neonates (EPT, <28 weeks of gestation at birth) during the first week of life by 50% in 1 year.Study designQuality improvement project in a level IV neonatal intensive care unit. A fluid management protocol was implemented, including the use of a fluid guide sheet and closer monitoring of hydration parameters. Seventy-nine baseline EPT neonates were compared to 83 post intervention. The incidence of ID was tracked monthly, along with prespecified morbidities and complications. Statistical data analyses also compared the pre- and post-intervention periods.ResultsFluid volumes in the first week were decreased (p < 0.001). ID decreased from 43 to 29% (p = 0.061). Tracked morbidities and complications were not statistically different.ConclusionIntentional and individualized adjustment of fluids led to decreased ID without increased hypernatremia and dehydration, or a change in tracked morbidities.

This study examines the lessons learnt from the implementation of a surge program in Akwa Ibom State, Nigeria as part of the Strengthening Integrated Delivery of HIV/AIDS Services (SIDHAS) Project. In this analysis, we included all clients who received HIV counseling and testing services, tested HIV positive, and initiated ART in SIDHAS-supported local government areas (LGAs) from April 2017 to March 2021. We employed descriptive and inferential statistics to analyze our results. A total of 2,018,082 persons were tested for HIV. Out of those tested, 102,165 (5.1%) tested HIV-positive. Comparing the pre-surge and post-surge periods, we observed an increase in HIV testing from 490,450 to 2,018,082 (p≤0.031) and in HIV-positive individuals identified from 21,234 to 102,165 (p≤0.001) respectively. Of those newly identified positives during the surge, 98.26% (100,393/102,165) were linked to antiretroviral therapy compared to 99.24% (21,073/21,234) pre-surge. Retention improved from 83.3% to 92.3% (p<0.001), and viral suppression improved from 73.5% to 96.2% (p<0.001). A combination of community and facility-based interventions implemented during the surge was associated with the rapid increase in case finding, retention, and viral suppression; propelling the State towards HIV epidemic control. HIV programs should consider a combination of community and facility-based interventions in their programming.

Background A good understanding of the demand for malaria rapid diagnostic test (MRDT), malaria health care-seeking behavior, and drug use among community members is crucial to malaria control efforts. The aim of this study was to assess the demand (use and/or request) for MRDT, health care-seeking behavior, and drug use, as well as associated factors, among rural community members (both children and adults) with fever or malaria-like illness in Ebonyi state, Nigeria. Methods A cross-sectional household survey was conducted between October 1st and November 7th, 2018, in 18 rural geographical clusters. Data was collected using a structured interviewer-administered questionnaire. Descriptive analysis was done using summary statistics. Associated factors (socio-demographic, knowledge and opinion level) were assessed using bivariate and multivariate binomial logistic regressions while the overall effects of these factors were assessed using the “postestimation test” command in Stata. Results A total of 1310 children under 5 years of age and 2329 children ages 5 years and above and adults (excluding pregnant women) (3639 overall) participated in the study. Among the 1310 children under 5 years of age: 521 (39.8%) received MRDT of which the caregivers of 82 (15.7%) requested for the MRDT; 931 (71.1%) sought care with public/private sector providers (excluding traditional practitioners/drug hawkers) the same/next day; 495 (37.8%) sought care at government primary health centres, 744 (56.8%) sought care with the patent medicine vendors (PMVs); 136 (10.4%) sought care with traditional practitioners; 1020 (77.9%) took ACTs (=88.2%, 1020/1156 of those who took anti-malarial drugs). Generally, lower values were respectively recorded among the 2329 children ages 5 years and above and adults (excluding pregnant women). The most important overarching predictor of the demand for MRDT and care-seeking behaviour was the knowledge and opinion level of respondent female heads of households about malaria and malaria diagnosis. Conclusions Among the rural community members with fever or malaria-like illness in Ebonyi state, Nigeria, while majority did not receive MRDT or diagnostic testing, and sought care with the PMVs, most took anti-malaria drugs, and mostly ACTs. Interventions are needed to improve the knowledge and opinion of the female heads of households about malaria and malaria diagnosis.

Background Globally, two out of five children living with HIV (CLHIV) are unaware of their HIV status, and a little more than 50% are receiving antiretroviral therapy (ART). This paper describes case-finding strategies and their contribution to identifying CLHIV and linking them to ART in Nigeria. Methods This before-after study used program data abstracted during the implementation of different paediatric-focused strategies (provider-initiated testing and counselling, orphans and vulnerable children testing, family-based index testing, early infant diagnosis (EID), community-driven EID, and community-based testing) delivered in health facilities and in communities to improve HIV case identification. Data were abstracted for children (0 to 14 years) who received HIV testing services and were initiated on ART in Akwa Ibom State, Nigeria during the pre-implementation period (April–June 2021) and during the implementation period (July–September 2021). Descriptive statistics were used to describe the testing coverage, positivity rate (proportion of tests that were positive for HIV), linkage to ART, and ART coverage, by age, sex, and testing modality. Interrupted time series analysis (ITSA) on STATA 14 was used to estimate the effect of the implementation of these strategies on HIV testing uptake and positivity rate at a 0.05 significance level. Results A total of 70,210 children were tested for HIV within the six-month period, and 1,012 CLHIV were identified. A total of 78% (n = 54,821) of the tests and 83.4% (n = 844) CLHIV were diagnosed during the implementation period. During implementation, the HIV positivity rate increased from 1.09% (168/15,389) to 1.54% (844/54,821), while linkage to ART increased from 99.4% (167/168) to 99.8% (842/844). The contribution from community-based modalities to CLHIV identified increased from 63% (106/168) to 84% (709/844) during the implementation, with the majority, 60.8% (431/709), from community-based index testing. Overall, ART coverage increased from 39.7 to 55.6% at the end of the intervention period. Conclusion The findings show that expanding differentiated HIV testing approaches provided mostly in the community significantly increased pediatric case identification. However, ART coverage remains low, especially for younger age groups, and requires further efforts.

Background: Persistent low-level viraemia (PLLV) is a risk factor for virologic failure among people receiving antiretroviral therapy (ART). Objectives: We assessed the prevalence and predictors of PLLV among individuals receiving Dolutegravir-based ART in southern Nigeria. Design: This retrospective cohort study used routine program data from electronic medical records of persons receiving Dolutegravir-based first-line ART in 154 PEPFAR/USAID-supported health facilities in Akwa Ibom and Cross Rivers states, Nigeria. Methods: Clients on first-line Dolutegravir-based ART ⩾6 months, who had a viral load result in the 12 months preceding October 2021 (baseline), and a second viral load result by September 2022 were included. Persons with low-level viraemia (LLV) (viral load 51–999 copies/ml) received additional adherence support. The outcome analysed was PLLV (two consecutive LLV results). Indices were summarized using descriptive statistics, and predictors of PLLV were determined using multivariate logistic regression. Results: In total, 141,208 persons on ART were included, of which 63.3% (n = 89,944) were females. The median age was 36 [29–44] years, median ART duration was 19 [11–42] months. At the end of the study, 10.5% (14,759/141,208) had initial LLV, 90.1% (13,304/14,759) of which attained undetectable viral load (⩽50 copies/ml), and 1.1% (163/14,759) transitioned to virologic failure (⩾1000 copies/ml) by the end of the study. PLLV prevalence was 0.9% (1292/141,208). Increasing ART duration [adjusted odds ratio (aOR) = 1.9; 95% confidence interval (CI): 1.54–2.44; p < 0.001] and viral suppression (<1000 copies/ml) before initial LLV (aOR = 1.7; 95% CI: 1.50–2.00; p < 0.001) were positively associated with PLLV, while receipt of tuberculosis preventive therapy reduced the likelihood of PLLV (aOR = 0.3; 95% CI: 0.10–0.94; p = 0.039). Conclusion: PLLV was uncommon among individuals receiving dolutegravir-based ART and was associated with longer ART duration, prior viral suppression, and non-receipt of tuberculosis preventive therapy. This strengthens recommendations for continuous adherence support and comprehensive health services with ART, to prevent treatment failure.