FACULTY OF CLINICAL SCIENCES
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Item Appraisal of the Geriatric Centre University College Hospital Ibadan.(West African College of Physicians and the West African College of Surgeons, 2021) Adebusoye, L. A.; Olowookere, O.; Ajayi, S.; Cadmus, E.O.; Labaeka, EGeriatric medicine is an emerging subspecialty in Nigeria. The interest in the care of older Nigerians followed the Madrid International Plan of Action on Ageing in April 2002. This led to an increase in research, publications and advocacy culminating in the establishment of the pioneer geriatric centre in Nigeria in 2012. Since then, there has been an increase in capacity building, manpower development and institutionalization of geriatric care in Nigeria. This is an account of the evolution of the Chief Tony Anenih Geriatric Centre, University College Hospital, Ibadan (UCH). METHODS: We undertook the review of the history, structure and key service elements in the Geriatric Centre, UCH from January 1, 2013, to December 31, 2020. RESULTS: The number of patients rose from 2,559 in the first year to 19,300 by the end of 2020. The initial four multidisciplinary units increased to 12 over the review period. Likewise, the in-patient admission increased between the first year (122 patients) and 2020 (141 patients). The overall mortality rate was 11.4% over the review period. Internship opportunities were provided to students including resident doctors, undergraduates (medical) and postgraduate students (Masters and PhD). Besides, 139 medical doctors have undergone the annual basic certificate training in geriatric medicine organised by the Centre. Also, 7 fellowship dissertations and 11 peer-reviewed papers have been published. CONCLUSION: The centre has demonstrated the possibility of caring for older patients in a low-resource setting. The employment of the multidisciplinary approach yielded a low mortality rate, higher attendance and manpower development.Item Blueprint for health security in Nigeria by 2050: Ageing and ageing- related diseases(University of Ibadan, Nigeria, 2019) Akinyemi, R. O.; Cadmus, E. O.; Adeniji, O.; Ajayi, S.; Farombi, T.; Omobowale, O. C.; Olowookere, O. O.; Adebusoye, L. A.; Alonge, T. O.; Ogunniyi, ABackground: Nigeria is currently populated by about 200 million people of diverse ethnic, cultural and religious inclinations. Projections estimate that the proportion and absolute number of older persons aged 60 years and above (currently about 5% of the total population) will increase to 25 million by the year 2050. Ageing of the Nigerian population has far reaching multifaceted economic, psychosocial, educational and health implications. Situation analysis: In this paper, a scenario-based analysis is presented on the likely trajectory of health security for older Nigerians by the year 2050. Ageing – associated diseases are predominantly non - communicable (NCD) and their burden is likely to increase over the next 30 years. The combined burden of NCDs and infectious diseases (malaria, tuberculosis, HIV/AIDS, emerging and re – emerging diseases) suggest that the demand on health services (preventive, diagnostic, curative, rehabilitative and palliative care) from older persons and the elderly will increase in tandem with the growth of this segment of the population. Conclusion: A blueprint for achieving healthy ageing for older persons by the year 2050 is presented. This encompasses set targets, strategic plans and a monitoring and evaluation scheme. Improved funding and coverage of the National Health Insurance Scheme, better pensions and retirement benefit coverage, other social schemes and policy interventions and rigorous implementation schemes are all required for achieving health security by the year 2050 with respect to ageing and ageing – related disorders.Item HIV Viremia Is associated With APOL1 Variants and Reduced JC-Viruria(Frontiers Media SA, 2021) Kruzel-Davila, E.; Sankofi, B. M.; Amos-Abanyie, E. K.; Ghansah, A.; Nyarko, A.; Agyemang, S.; Awandare, G. A.; Szwarcwort-Cohen, M.; Reiner-Benaim, A.; Hijazi, B.; Ulasi, I.; Raji, Y. R.; Boima, V.; Osafo, C.; Adabayeri, V. M.; Matekole, M.; Olanrewaju, T. O.; Ajayi, S.; Mamven, M.; Antwi, S. |; Ademola, A. D.; Plange-Rhule, J.; Arogundade, F. A.; Akyaw, P. A.; Winkler, C. A.; Salako, B. L.; Ojo, A.; Skorecki, K.; Adu, D.Variants in the Apolipoprotein L1 (APOL1) gene (G1-rs60910145, rs73885319, G2-rs71785313) are common in Africans and in individuals of recent African ancestry and are associated with an increased risk of non-diabetic chronic kidney disease (CKD) and in particular of HIV associated nephropathy (HIVAN). In light of the significantly increased risk of HIVAN in carriers of two APOL1 risk alleles, a role in HIV infectivity has been postulated in the mechanism of APOL1 associated kidney disease. Herein, we aim to explore the association between HIV viremia and APOL1 genotype. In addition, we investigated interaction between BK and JC viruria, CKD and HIV viremia. A total of 199 persons living with HIV/AIDS (comprising 82 CKD cases and 117 controls) from among the participants in the ongoing Human Heredity and Health in Africa (H3Africa) Kidney Disease Research Network case control study have been recruited. The two APOL1 renal risk alleles (RRA) genotypes were associated with a higher risk of CKD (OR 12.6, 95% CI 3.89–40.8, p < 0.0001). Even a single APOL1 RRA was associated with CKD risk (OR 4.42, 95% CI 1.49–13.15, p = 0.007). The 2 APOL1 RRA genotypes were associated with an increased probability of having HIV viremia (OR 2.37 95% CI 1.0–5.63, p = 0.05). HIV viremia was associated with increased CKD risk (OR 7.45, 95% CI 1.66–33.35, P = 0.009) and with a significant reduction of JC virus urine shedding (OR 0.35, 95% CI 0.12–0.98, p = 0.046). In contrast to prior studies, JC viruria was not associated with CKD but was restricted in patients with HIV viremia, regardless of CKD status. These findings suggest a role of APOL1 variants in HIV infectivity and emphasize that JC viruria can serve as biomarker for innate immune system activation.Item Genomic approaches to the burden of kidney disease in Sub-Saharan Africa: the Human Heredity and Health in Africa (H3Africa) kidney disease research network(International Society of Nephrology., 2016) Osafo, C.; Raji, Y. R.; 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.; Ademola, A. D.Item 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 moreItem 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 needsItem 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.Item 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.Item 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.Item 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.