Abstract
Background:Against a background of security challenges, Nigeria conducted recently the largest population-based HIV survey in the world to ascertain the burden of the HIV disease in the country.Objective:We evaluated the main outcomes of the survey and the level of success using participation/response indicators.Methods:The survey was conducted from July–December 2018 by over 6,000 field staff across Nigeria in six consecutive webs, using two-stage cluster sampling. We estimated the prevalence of HIV, hepatitis B and hepatitis C in the entire country and by conflict zone status. Adjusted odds ratios (OR) and 95% confidence intervals (CI) from survey logistic regression models were used to compare the likelihood of test positivity for the three infections between zones.Findings:A total of 186,405 adults were interviewed from 97,250 households in 3,848 census enumeration areas. The overall HIV, hepatitis B and hepatitis C positivity rates were 1.55%, 7.63% and 1.73%, respectively. The prevalence of HIV, hepatitis B and C infection was significantly greater in conflict than non-conflict zones (HIV: 1.75% versus 1.0%; hepatitis B: 9.9% versus 7.3%; and hepatitis C: 3.2% versus 0.3%; p < 0.01 in all cases). Individuals living in conflict zones were about three times as likely to test positive for HIV (OR = 2.80, 95% CI = 2.08, 3.60) and nearly six times as likely to test positive for hepatitis C (OR = 5.90, 95% CI = 2.17, 16.67).Conclusion:Large population-based surveys are feasible, even in armed conflict settings. The burden of HIV, hepatitis B and hepatitis C was significantly higher in areas of conflict in Nigeria, highlighting the need for reinforced public health control measures in these settings in order to attain UNAIDS’ 95-95-95 targets of controlling the HIV epidemic in sub-Saharan Africa by 2030.
Highlights
The burden of HIV, hepatitis B and hepatitis C was significantly higher in areas of conflict in Nigeria, highlighting the need for reinforced public health control measures in these settings in order to attain UNAIDS’ 95-95-95 targets of controlling the HIV epidemic in sub-Saharan Africa by 2030
Interview response rates rose from 87.03% in web 1 to 91.89% in web 6 corresponding to a 5.58% improvement (p < 0.01)
Individuals living in conflict zones were about three times as likely to test positive for HIV (OR = 2.80, 95%confidence intervals (CI): 2.08, 3.60), and six times as likely to test positive for hepatitis C (OR = 5.90, 95%CI: 2.17, 16.67)
Summary
Population-based HIV Impact Assessment (PHIA) Surveys are national cross-sectional studies that. PHIA surveys are often conducted in settings lacking strong HIV case-base surveillance systems, and their results can be used to guide HIV policy development and resource allocation in survey countries. The conduct of research studies in armed conflict settings is associated with considerable strategic, methodological, applied, ethical, and policy challenges [2,3,4,5,6,7,8,9,10,11]. Against a background of security challenges, Nigeria conducted recently the largest population-based HIV survey in the world to ascertain the burden of the HIV disease in the country
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