Last data update: Dec 02, 2024. (Total: 48272 publications since 2009)
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Query Trace: Okunoye O[original query] |
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SARS-CoV-2 serologic surveillance among people living with HIV in Nigeria, April 2022-January 2023
Chun HM , Osawe S , Adams-Dabban S , Favaloro J , Iriemenam NC , Dirlikov E , Martin D , Milligan K , Abutu A , Okunoye O , Okoli M , Akanbi O , Akinmulero O , Okonkwo R , Oyedele O , Greby S , Abimiku A , Okoye MIJ , Shiraishi RW , Adegoke D , Bello M , Villeng F , Item II , Gabo S , Abubakar A , Thomas A , Olaleye T , Awala S , Nwatu F , Ugboaja B , Udoh I , Akayi L , Dattijo J , Adenekan T , Aminu-Alhaji A , Ezeuko I . Int J Infect Dis 2024 107309 OBJECTIVES: Evidence indicates that people living with HIV (PLHIV) are more impacted by COVID-19. The burden of SARS-CoV-2 infection among PLHIV is unknown in Nigeria. METHODS: We conducted repeated cross-sectional SARS-CoV-2 serosurveys in 14 states and the Federal Capital Territory in Nigeria among PLHIV who had an HIV viral load (VL) test during April 2022-January 2023. Evidence of SARS-CoV-2 immunoglobulin G (IgG) antibodies was assessed using a multiplex bead assay (MBA) to measure IgG to spike (S), receptor binding domain (RBD), and nucleocapsid (N) proteins to identify potential infection and/or vaccination status. RESULTS: Between April 2022 and January 2023, 47,614 remnant VL samples were included and tested for SARS-CoV-2 antibodies. Seroprevalence of SARS-CoV-2 infection, defined as IgG antibodies to spike and RBD591 [S+] and nucleocapsid [N+], (S+N+), ranged between 21·1% (95% CI: 11·4-31·8) in Ekiti State in January 2023 to 71·4% (95% CI 71·9-81·9) in Gombe State in November 2022, with overall steady trends within and between states over time, across age and sex. CONCLUSIONS: High rates of SARS-CoV-2 antibody seroprevalence among PLHIV in Nigeria were observed. This underscores the need to understand the association between HIV and SARS-CoV-2 to inform strategies to reduce the threat posed by COVID-19. |
Lessons learnt from assessing and improving accuracy and positive predictive value of the national HIV testing algorithm in Nigeria
Mpamugo AO , Iriemenam NC , Bashorun A , Okunoye OO , Bassey OO , Onokevbagbe E , Jelpe T , Alagi MA , Meribe C , Aguolu RE , Nzelu CE , Bello S , Ezra B , Obioha CA , Ibrahim BS , Adedokun O , Ikpeazu A , Ihekweazu C , Croxton T , Adebajo SB , Okoye MIJ , Abimiku A . Afr J Lab Med 2024 13 (1) 2339 BACKGROUND: HIV testing remains an entry point into HIV care and treatment services. In 2007, Nigeria adopted and implemented a two-test rapid HIV testing algorithm of three HIV rapid test kits, following the sequence: Alere Determine (first test), Unigold(TM) (second test), and STAT-PAK(®) as the tie-breaker. Sub-analysis of the 2018 Nigeria HIV/AIDS Indicator and Impact Survey data showed significant discordance between the first and second tests, necessitating an evaluation of the algorithm. This manuscript highlights lessons learnt from that evaluation. INTERVENTION: A two-phased evaluation method was employed, including abstraction and analysis of retrospective HIV testing data from January 2017 to December 2019 from 24 selected sites supported by the United States President's Emergency Plan for AIDS Relief programme. A prospective evaluation of HIV testing was done among 2895 consecutively enrolled and consented adults, aged 15-64 years, accessing HIV testing services from three selected sites per state across the six geopolitical zones of Nigeria between July 2020 and September 2020. The prospective evaluation was performed both in the field and at the National Reference Laboratory under controlled laboratory conditions. Stakeholder engagements, strategic selection and training of study personnel, and integrated supportive supervision were employed to assure the quality of evaluation procedures and outcomes. LESSONS LEARNT: The algorithm showed higher sensitivity and specificity in the National Reference Laboratory compared with the field. The approaches to quality assurance were integral to the high-quality study outcomes. RECOMMENDATIONS: We recommend comparison of testing algorithms under evaluation against a gold standard. WHAT THIS STUDY ADDS: This study provides context-specific considerations in using World Health Organization recommendations to evaluate the Nigerian national HIV rapid testing algorithm. |
Evaluation of the Nigeria national HIV rapid testing algorithm
Iriemenam NC , Mpamugo A , Ikpeazu A , Okunoye OO , Onokevbagbe E , Bassey OO , Tapdiyel J , Alagi MA , Meribe C , Ahmed ML , Ikwulono G , Aguolu R , Ashefor G , Nzelu C , Ehoche A , Ezra B , Obioha C , Baffa Sule I , Adedokun O , Mba N , Ihekweazu C , Charurat M , Lindsay B , Stafford KA , Ibrahim D , Swaminathan M , Yufenyuy EL , Parekh BS , Adebajo S , Abimiku A , Okoye MI . PLOS Glob Public Health 2022 2 (11) e0001077 Human Immunodeficiency Virus (HIV) diagnosis remains the gateway to HIV care and treatment. However, due to changes in HIV prevalence and testing coverage across different geopolitical zones, it is crucial to evaluate the national HIV testing algorithm as false positivity due to low prevalence could be detrimental to both the client and the service delivery. Therefore, we evaluated the performance of the national HIV rapid testing algorithm using specimens collected from multiple HIV testing services (HTS) sites and compared the results from different HIV prevalence levels across the six geopolitical zones of Nigeria. The evaluation employed a dual approach, retrospective, and prospective. The retrospective evaluation focused on a desktop review of program data (n = 492,880) collated from patients attending routine HTS from six geopolitical zones of Nigeria between January 2017 and December 2019. The prospective component utilized samples (n = 2,895) collected from the field at the HTS and tested using the current national serial HIV rapid testing algorithm. These samples were transported to the National Reference Laboratory (NRL), Abuja, and were re-tested using the national HIV rapid testing algorithm and HIV-1/2 supplementary assays (Geenius to confirm positives and resolve discordance and multiplex assay). The retrospective component of the study revealed that the overall proportion of HIV positives, based on the selected areas, was 5.7% (28,319/492,880) within the study period, and the discordant rate between tests 1 and 2 was 1.1%. The prospective component of the study indicated no significant differences between the test performed at the field using the national HIV rapid testing algorithm and the re-testing performed at the NRL. The comparison between the test performed at the field using the national HIV rapid testing algorithm and Geenius HIV-1/2 supplementary assay showed an agreement rate of 95.2%, while that of the NRL was 99.3%. In addition, the comparison of the field results with HIV multiplex assay indicated a sensitivity of 96.6%, the specificity of 98.2%, PPV of 97.0%, and Kappa Statistic of 0.95, and that of the NRL with HIV multiplex assay was 99.2%, 99.4%, 99.0%, and 0.99, respectively. Results show that the Nigeria national serial HIV rapid testing algorithm performed very well across the target settings. However, the algorithm's performance in the field was lower than the performance outcomes under a controlled environment in the NRL. There is a need to target testers in the field for routine continuous quality improvement implementation, including refresher trainings as necessary. |
Comparison of one single-antigen assay and three multi-antigen SARS-CoV-2 IgG assays in Nigeria
Iriemenam NC , Ige FA , Greby SM , Okunoye OO , Uwandu M , Aniedobe M , Nwaiwu SO , Mba N , Okoli M , William NE , Ehoche A , Mpamugo A , Mitchell A , Stafford KA , Thomas AN , Olaleye T , Akinmulero OO , Agala NP , Abubakar AG , Owens A , Gwyn SE , Rogier E , Udhayakumar V , Steinhardt LC , Martin DL , Okoye MI , Audu R . J Clin Virol Plus 2023 3 (1) 100139 OBJECTIVES: Determining an accurate estimate of SARS-CoV-2 seroprevalence has been challenging in African countries where malaria and other pathogens are endemic. We compared the performance of one single-antigen assay and three multi-antigen SARS-CoV-2 IgG assays in a Nigerian population endemic for malaria. METHODS: De-identified plasma specimens from SARS-CoV-2 RT-PCR positive, dried blood spot (DBS) SARS-CoV-2 RT-PCR positive, and pre-pandemic negatives were used to evaluate the performance of the four SARS-CoV-2 assays (Tetracore, SARS2MBA, RightSign, xMAP). RESULTS: Results showed higher sensitivity with the multi-antigen (81% (Tetracore), 96% (SARS2MBA), 85% (xMAP)) versus the single-antigen (RightSign (64%)) SARS-CoV-2 assay. The overall specificities were 98% (Tetracore), 100% (SARS2MBA and RightSign), and 99% (xMAP). When stratified based on <15 days to ≥15 days post-RT-PCR confirmation, the sensitivities increased from 75% to 88.2% for Tetracore; from 93% to 100% for the SARS2MBA; from 58% to 73% for RightSign; and from 83% to 88% for xMAP. With DBS, there was no positive increase after 15-28 days for the three assays (Tetracore, SARS2MBA, and xMAP). CONCLUSION: Multi-antigen assays performed well in Nigeria, even with samples with known malaria reactivity, and might provide more accurate measures of COVID-19 seroprevalence and vaccine efficacy. |
Seroprevalence of SARS-CoV-2 in four states of Nigeria in October 2020: a population-based household survey
Audu RA , Stafford KA , Steinhardt L , Musa ZA , Iriemenam N , Ilori E , Blanco N , Mitchell A , Hamada Y , Moloney M , Iwara E , Abimiku A , Ige FA , William NE , Igumbor E , Ochu C , Omoare AA , Okunoye O , Greby SM , Rangaka MX , Copas A , Dalhatu I , Abubakar I , McCracken S , Alagi M , Mba N , Anthony A , Okoye M , Okoi C , Ezechi OC , Salako BL , Ihekweazu C . PLoS Glob Public Health 2022 2 (6) e0000363 The observed epidemiology of SARS-CoV-2 in sub-Saharan Africa has varied greatly from that in Europe and the United States, with much lower reported incidence. Population-based studies are needed to estimate true cumulative incidence of SARS-CoV-2 to inform public health interventions. This study estimated SARS-CoV-2 seroprevalence in four selected states in Nigeria in October 2020. We implemented a two-stage cluster sample household survey in four Nigerian states (Enugu, Gombe, Lagos, and Nasarawa) to estimate age-stratified prevalence of SARS-CoV-2 antibodies. All individuals in sampled households were eligible for interview, blood draw, and nasal/oropharyngeal swab collection. We additionally tested participants for current/recent malaria infection. Seroprevalence estimates were calculated accounting for the complex survey design. Across all four states, 10,629 (96.5%) of 11,015 interviewed individuals provided blood samples. The seroprevalence of SARS-CoV- 2 antibodies was 25.2% (95% CI 21.8-28.6) in Enugu State, 9.3% (95% CI 7.0-11.5) in Gombe State, 23.3% (95% CI 20.5-26.4) in Lagos State, and 18.0% (95% CI 14.4-21.6) in Nasarawa State. Prevalence of current/recent malaria infection ranged from 2.8% in Lagos to 45.8% in Gombe and was not significantly related to SARS-CoV-2 seroprevalence. The prevalence of active SARS-CoV-2 infection in the four states during the survey period was 0.2% (95% CI 0.1-0.4). Approximately eight months after the first reported COVID-19 case in Nigeria, seroprevalence indicated infection levels 194 times higher than the 24,198 officially reported COVID-19 cases across the four states; however, most of the population remained susceptible to COVID-19 in October 2020. |
Validation of xMAP SARS-CoV-2 Multi-Antigen IgG assay in Nigeria.
Iriemenam NC , Ige FA , Greby SM , Mpamugo A , Abubakar AG , Dawurung AB , Esiekpe MK , Thomas AN , Okoli MU , Awala SS , Ugboaja BN , Achugbu CC , Odoh I , Nwatu FD , Olaleye T , Akayi L , Akinmulero OO , Dattijo J , Onokevbagbe E , Okunoye O , Mba N , Agala NP , Uwandu M , Aniedobe M , Stafford KA , Abimiku A , Hamada Y , Swaminathan M , Okoye MI , Steinhardt LC , Audu R . PLoS One 2022 17 (4) e0266184 OBJECTIVE: There is a need for reliable serological assays to determine accurate estimates of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seroprevalence. Most single target antigen assays have shown some limitations in Africa. To assess the performance of a multi-antigen assay, we evaluated a commercially available SARS-CoV-2 Multi-Antigen IgG assay for human coronavirus disease 2019 (COVID-19) in Nigeria. METHODS: Validation of the xMAP SARS-CoV-2 Multi-Antigen IgG assay was carried out using well-characterized SARS-CoV-2 reverse transcription polymerase chain reactive positive (97) and pre-COVID-19 pandemic (86) plasma panels. Cross-reactivity was assessed using pre-COVID-19 pandemic plasma specimens (213) from the 2018 Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS). RESULTS: The overall sensitivity of the xMAP SARS-CoV-2 Multi-Antigen IgG assay was 75.3% [95% CI: 65.8%- 82.8%] and specificity was 99.0% [95% CI: 96.8%- 99.7%]. The sensitivity estimate increased to 83.3% [95% CI: 70.4%- 91.3%] for specimens >14 days post-confirmation of diagnosis. However, using the NAIIS pre-pandemic specimens, the false positivity rate was 1.4% (3/213). CONCLUSIONS: Our results showed overall lower sensitivity and a comparable specificity with the manufacturer's validation. There appears to be less cross-reactivity with NAIIS pre-pandemic COVID-19 specimens using the xMAP SARS-CoV-2 Multi-Antigen IgG assay. In-country SARS-CoV-2 serology assay validation can help guide the best choice of assays in Africa. |
Cross-reactivity of two SARS-CoV-2 serological assays in a malaria-endemic setting.
Steinhardt LC , Ige F , Iriemenam NC , Greby SM , Hamada Y , Uwandu M , Aniedobe M , Stafford KA , Abimiku A , Mba N , Agala N , Okunoye O , Mpamugo A , Swaminathan M , Onokevbagbe E , Olaleye T , Odoh I , Marston BJ , Okoye M , Abubakar I , Rangaka MX , Rogier E , Audu R . J Clin Microbiol 2021 59 (7) e0051421 Background: Accurate SARS-CoV-2 serological assays are critical for COVID-19 serosurveillance. However, previous studies have indicated possible cross-reactivity of these assays, including in malaria-endemic areas.Methods: We tested 213 well-characterized pre-pandemic samples from Nigeria using two SARS-CoV-2 serological assays: Abbott Architect IgG and Euroimmun NCP IgG assay, both targeting SARS-CoV-2 nucleocapsid protein. To assess antibody binding strength, an avidity assay was performed on these samples and on plasma from SARS-CoV-2 PCR-positive persons.Results: Thirteen (6.1%) of 212 samples run on the Abbott assay and 38 (17.8%) of 213 run on the Euroimmun assay were positive. Anti-Plasmodium IgG levels were significantly higher among false-positives for both Abbott and Euroimmun; no association was found with active P. falciparum infection. An avidity assay using various concentratIons of urea wash in the Euroimmun assay reduced loosely-bound IgG: of 37 positive/borderline pre-pandemic samples, 46%, 86%, 89%, and 97% became negative using 2M, 4M, 5M, and 8M urea washes, respectively. The wash slightly reduced avidity of antibodies from SARS-CoV-2 patients within 28 days of PCR confirmation; thereafter avidity increased for all urea concentrations except 8M.Conclusions: This validation found moderate to substantial cross-reactivity on two SARS-CoV-2 serological assays using samples from a malaria-endemic setting. A simple urea wash appeared to alleviate issues of cross-reactivity. |
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