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Ugwu CA, Alao O, John OG, Akinnawo B, Ajayi I, Odebode O, Bejide I, Campbell A, Campbell J, Adole JA, B. Olawoye I, Akano K, Okolie J, Eromon P, Olaitan P, Olagunoye A, Adebayo I, Adebayo V, Babalola E, Abioye O, Ajayi N, Ogah E, Ukwaja K, Okoro S, Oje O, Kingsley OC, Eke M, Onyia V, Achonduh-Atijegbe O, Ewah FE, Obasi M, Igwe V, Ayodeji O, Chukwuyem A, Owhin S, Oyejide N, Abah S, Ingbian W, Osoba M, Alebiosu A, Nadesalingam A, Aguinam ET, Carnell G, Krause N, Chan A, George C, Kinsley R, Tonks P, Temperton N, Heeney J, Happi C. Immunological insights into COVID-19 in Southern Nigeria. Front Immunol 2024; 15:1305586. [PMID: 38322252 PMCID: PMC10844438 DOI: 10.3389/fimmu.2024.1305586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 01/04/2024] [Indexed: 02/08/2024] Open
Abstract
Introduction One of the unexpected outcomes of the COVID-19 pandemic was the relatively low levels of morbidity and mortality in Africa compared to the rest of the world. Nigeria, Africa's most populous nation, accounted for less than 0.01% of the global COVID-19 fatalities. The factors responsible for Nigeria's relatively low loss of life due to COVID-19 are unknown. Also, the correlates of protective immunity to SARS-CoV-2 and the impact of pre-existing immunity on the outcome of the COVID-19 pandemic in Africa are yet to be elucidated. Here, we evaluated the natural and vaccine-induced immune responses from vaccinated, non-vaccinated and convalescent individuals in Southern Nigeria throughout the three waves of the COVID-19 pandemic in Nigeria. We also examined the pre-existing immune responses to SARS-CoV-2 from samples collected prior to the COVID-19 pandemic. Methods We used spike RBD and N- IgG antibody ELISA to measure binding antibody responses, SARS-CoV-2 pseudotype assay protocol expressing the spike protein of different variants (D614G, Delta, Beta, Omicron BA1) to measure neutralizing antibody responses and nucleoprotein (N) and spike (S1, S2) direct ex vivo interferon gamma (IFNγ) T cell ELISpot to measure T cell responses. Result Our study demonstrated a similar magnitude of both binding (N-IgG (74% and 62%), S-RBD IgG (70% and 53%) and neutralizing (D614G (49% and 29%), Delta (56% and 47%), Beta (48% and 24%), Omicron BA1 (41% and 21%)) antibody responses from symptomatic and asymptomatic survivors in Nigeria. A similar magnitude was also seen among vaccinated participants. Interestingly, we revealed the presence of preexisting binding antibodies (N-IgG (60%) and S-RBD IgG (44%)) but no neutralizing antibodies from samples collected prior to the pandemic. Discussion These findings revealed that both vaccinated, non-vaccinated and convalescent individuals in Southern Nigeria make similar magnitude of both binding and cross-reactive neutralizing antibody responses. It supported the presence of preexisting binding antibody responses among some Nigerians prior to the COVID-19 pandemic. Lastly, hybrid immunity and heterologous vaccine boosting induced the strongest binding and broadly neutralizing antibody responses compared to vaccine or infection-acquired immunity alone.
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Affiliation(s)
- Chinedu A. Ugwu
- The Africa Centre of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer’s University, Ede, Osun, Nigeria
- Department of Biological Sciences, Faculty of Natural Sciences, Redeemer’s University, Ede, Osun, Nigeria
| | - Oluwasina Alao
- The Africa Centre of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer’s University, Ede, Osun, Nigeria
- Department of Biological Sciences, Faculty of Natural Sciences, Redeemer’s University, Ede, Osun, Nigeria
| | - Oluwagboadurami G. John
- The Africa Centre of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer’s University, Ede, Osun, Nigeria
- Department of Biological Sciences, Faculty of Natural Sciences, Redeemer’s University, Ede, Osun, Nigeria
| | - Blossom Akinnawo
- The Africa Centre of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer’s University, Ede, Osun, Nigeria
- Department of Biological Sciences, Faculty of Natural Sciences, Redeemer’s University, Ede, Osun, Nigeria
| | - Israel Ajayi
- The Africa Centre of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer’s University, Ede, Osun, Nigeria
- Department of Biological Sciences, Faculty of Natural Sciences, Redeemer’s University, Ede, Osun, Nigeria
| | - Ooreofe Odebode
- The Africa Centre of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer’s University, Ede, Osun, Nigeria
- Department of Biological Sciences, Faculty of Natural Sciences, Redeemer’s University, Ede, Osun, Nigeria
| | - Ifeoluwa Bejide
- Department of Biological Sciences, Faculty of Natural Sciences, Redeemer’s University, Ede, Osun, Nigeria
| | - Allan Campbell
- The Africa Centre of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer’s University, Ede, Osun, Nigeria
- Department of Biological Sciences, Faculty of Natural Sciences, Redeemer’s University, Ede, Osun, Nigeria
| | - Julian Campbell
- The Africa Centre of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer’s University, Ede, Osun, Nigeria
- Department of Biological Sciences, Faculty of Natural Sciences, Redeemer’s University, Ede, Osun, Nigeria
| | - Jolly A. Adole
- The Africa Centre of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer’s University, Ede, Osun, Nigeria
- Department of Biological Sciences, Faculty of Natural Sciences, Redeemer’s University, Ede, Osun, Nigeria
| | - Idowu B. Olawoye
- The Africa Centre of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer’s University, Ede, Osun, Nigeria
- Department of Biological Sciences, Faculty of Natural Sciences, Redeemer’s University, Ede, Osun, Nigeria
| | - Kazeem Akano
- The Africa Centre of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer’s University, Ede, Osun, Nigeria
- Department of Biological Sciences, Faculty of Natural Sciences, Redeemer’s University, Ede, Osun, Nigeria
| | - Johnson Okolie
- The Africa Centre of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer’s University, Ede, Osun, Nigeria
| | - Philomena Eromon
- The Africa Centre of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer’s University, Ede, Osun, Nigeria
| | - Peter Olaitan
- Osun State University Teaching Hospital (UNIOSUNTH), Osogbo, Nigeria
| | - Ajibola Olagunoye
- Osun State University Teaching Hospital (UNIOSUNTH), Osogbo, Nigeria
| | - Ibukun Adebayo
- Osun State University Teaching Hospital (UNIOSUNTH), Osogbo, Nigeria
| | - Victor Adebayo
- Osun State University Teaching Hospital (UNIOSUNTH), Osogbo, Nigeria
| | | | - Omowumi Abioye
- Osun State University Teaching Hospital (UNIOSUNTH), Osogbo, Nigeria
| | - Nnennaya Ajayi
- Alex Ekwueme Federal University Teaching Hospital Abakaliki (AEFUTHA), Abakaliki, Nigeria
| | - Emeka Ogah
- Alex Ekwueme Federal University Teaching Hospital Abakaliki (AEFUTHA), Abakaliki, Nigeria
| | - Kingsley Ukwaja
- Alex Ekwueme Federal University Teaching Hospital Abakaliki (AEFUTHA), Abakaliki, Nigeria
| | - Sylvanus Okoro
- Alex Ekwueme Federal University Teaching Hospital Abakaliki (AEFUTHA), Abakaliki, Nigeria
| | - Ogbonnaya Oje
- Alex Ekwueme Federal University Teaching Hospital Abakaliki (AEFUTHA), Abakaliki, Nigeria
| | | | - Matthew Eke
- Alex Ekwueme Federal University Teaching Hospital Abakaliki (AEFUTHA), Abakaliki, Nigeria
| | - Venatius Onyia
- Alex Ekwueme Federal University Teaching Hospital Abakaliki (AEFUTHA), Abakaliki, Nigeria
| | - Olivia Achonduh-Atijegbe
- The Africa Centre of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer’s University, Ede, Osun, Nigeria
| | - Friday Elechi Ewah
- Alex Ekwueme Federal University Teaching Hospital Abakaliki (AEFUTHA), Abakaliki, Nigeria
| | - Mary Obasi
- Alex Ekwueme Federal University Teaching Hospital Abakaliki (AEFUTHA), Abakaliki, Nigeria
| | - Violet Igwe
- Alex Ekwueme Federal University Teaching Hospital Abakaliki (AEFUTHA), Abakaliki, Nigeria
| | | | | | | | - Nicholas Oyejide
- The Africa Centre of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer’s University, Ede, Osun, Nigeria
| | | | - Winifred Ingbian
- The Africa Centre of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer’s University, Ede, Osun, Nigeria
| | - Moyosoore Osoba
- The Africa Centre of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer’s University, Ede, Osun, Nigeria
| | - Ahmed Alebiosu
- The Africa Centre of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer’s University, Ede, Osun, Nigeria
| | - Angalee Nadesalingam
- Laboratory of Viral Zoonotics, Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Ernest T. Aguinam
- Laboratory of Viral Zoonotics, Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
| | - George Carnell
- Laboratory of Viral Zoonotics, Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Nina Krause
- Laboratory of Viral Zoonotics, Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Andrew Chan
- Laboratory of Viral Zoonotics, Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Charlotte George
- Laboratory of Viral Zoonotics, Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Rebecca Kinsley
- Laboratory of Viral Zoonotics, Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Paul Tonks
- Laboratory of Viral Zoonotics, Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Nigel Temperton
- Viral Pseudotype Unit, Medway School of Pharmacy, The Universities of Greenwich and Kent, Kent, United Kingdom
| | - Jonathan Heeney
- Laboratory of Viral Zoonotics, Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Christian Happi
- The Africa Centre of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer’s University, Ede, Osun, Nigeria
- Department of Biological Sciences, Faculty of Natural Sciences, Redeemer’s University, Ede, Osun, Nigeria
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Fowotade A, Bamidele F, Egbetola B, Fagbamigbe AF, Adeagbo BA, Adefuye BO, Olagunoye A, Ojo TO, Adebiyi AO, Olagunju OI, Ladipo OT, Akinloye A, Onayade A, Bolaji OO, Rannard S, Happi C, Owen A, Olagunju A. A randomized, open-label trial of combined nitazoxanide and atazanavir/ritonavir for mild to moderate COVID-19. Front Med (Lausanne) 2022; 9:956123. [PMID: 36160134 PMCID: PMC9493023 DOI: 10.3389/fmed.2022.956123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/11/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe nitazoxanide plus atazanavir/ritonavir for COVID-19 (NACOVID) trial investigated the efficacy and safety of repurposed nitazoxanide combined with atazanavir/ritonavir for COVID-19.MethodsThis is a pilot, randomized, open-label multicenter trial conducted in Nigeria. Mild to moderate COVID-19 patients were randomly assigned to receive standard of care (SoC) or SoC plus a 14-day course of nitazoxanide (1,000 mg b.i.d.) and atazanavir/ritonavir (300/100 mg od) and followed through day 28. Study endpoints included time to clinical improvement, SARS-CoV-2 viral load change, and time to complete symptom resolution. Safety and pharmacokinetics were also evaluated (ClinicalTrials.gov ID: NCT04459286).ResultsThere was no difference in time to clinical improvement between the SoC (n = 26) and SoC plus intervention arms (n = 31; Cox proportional hazards regression analysis adjusted hazard ratio, aHR = 0.898, 95% CI: 0.492–1.638, p = 0.725). No difference was observed in the pattern of saliva SARS-CoV-2 viral load changes from days 2–28 in the 35% of patients with detectable virus at baseline (20/57) (aHR = 0.948, 95% CI: 0.341–2.636, p = 0.919). There was no significant difference in time to complete symptom resolution (aHR = 0.535, 95% CI: 0.251–1.140, p = 0.105). Atazanavir/ritonavir increased tizoxanide plasma exposure by 68% and median trough plasma concentration was 1,546 ng/ml (95% CI: 797–2,557), above its putative EC90 in 54% of patients. Tizoxanide was undetectable in saliva.ConclusionNitazoxanide co-administered with atazanavir/ritonavir was safe but not better than standard of care in treating COVID-19. These findings should be interpreted in the context of incomplete enrollment (64%) and the limited number of patients with detectable SARS-CoV-2 in saliva at baseline in this trial.Clinical trial registration[https://clinicaltrials.gov/ct2/show/NCT04459286], identifier [NCT04459286].
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Affiliation(s)
- Adeola Fowotade
- Department of Medical Microbiology and Parasitology, University of Ibadan, Ibadan, Nigeria
| | - Folasade Bamidele
- Department of Medical Microbiology and Parasitology, University of Ibadan, Ibadan, Nigeria
| | | | - Adeniyi F. Fagbamigbe
- Department of Epidemiology and Medical Statistics, University of Ibadan, Ibadan, Nigeria
| | - Babatunde A. Adeagbo
- Department of Pharmaceutical Chemistry, Obafemi Awolowo University, Ile-Ife, Nigeria
| | | | | | - Temitope O. Ojo
- Department of Community Health, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | | | - Omobolanle I. Olagunju
- Department of Surveillance and Epidemiology, Nigeria Centre for Disease Control, Abuja, Nigeria
| | | | - Abdulafeez Akinloye
- Department of Pharmaceutical Chemistry, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Adedeji Onayade
- Department of Community Health, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | - Oluseye O. Bolaji
- Department of Pharmaceutical Chemistry, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Steve Rannard
- Department of Chemistry, University of Liverpool, Liverpool, United Kingdom
| | - Christian Happi
- African Centre of Excellence for Genomics of Infectious Diseases, Redeemer’s University, Ede, Nigeria
| | - Andrew Owen
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, United Kingdom
| | - Adeniyi Olagunju
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, United Kingdom
- *Correspondence: Adeniyi Olagunju,
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Olagunju A, Fowotade A, Olagunoye A, Ojo TO, Adefuye BO, Fagbamigbe AF, Adebiyi AO, Olagunju OI, Ladipo OT, Akinloye A, Adeagbo BA, Onayade A, Bolaji OO, Happi C, Rannard S, Owen A. Efficacy and safety of nitazoxanide plus atazanavir/ritonavir for the treatment of moderate to severe COVID-19 (NACOVID): A structured summary of a study protocol for a randomised controlled trial. Trials 2021; 22:3. [PMID: 33397457 PMCID: PMC7780204 DOI: 10.1186/s13063-020-04987-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 12/18/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES To investigate the efficacy and safety of repurposed antiprotozoal and antiretroviral drugs, nitazoxanide and atazanavir/ritonavir, in shortening the time to clinical improvement and achievement of SARS-CoV-2 polymerase chain reaction (PCR) negativity in patients diagnosed with moderate to severe COVID-19. TRIAL DESIGN This is a pilot phase 2, multicentre 2-arm (1:1 ratio) open-label randomised controlled trial. PARTICIPANTS Patients with confirmed COVID-19 diagnosis (defined as SARS-CoV-2 PCR positive nasopharyngeal swab) will be recruited from four participating isolation and treatment centres in Nigeria: two secondary care facilities (Infectious Diseases Hospital, Olodo, Ibadan, Oyo State and Specialist State Hospital, Asubiaro, Osogbo, Osun State) and two tertiary care facilities (Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State and Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State). These facilities have a combined capacity of 146-bed COVID-19 isolation and treatment ward. INCLUSION CRITERIA Confirmation of SARS-CoV-2 infection by PCR test within two days before randomisation and initiation of treatment, age bracket of 18 and 75 years, symptomatic, able to understand study information and willingness to participate. Exclusion criteria include the inability to take orally administered medication or food, known hypersensitivity to any of the study drugs, pregnant or lactating, current or recent (within 24 hours of enrolment) treatment with agents with actual or likely antiviral activity against SARS-CoV-2, concurrent use of agents with known or suspected interaction with study drugs, and requiring mechanical ventilation at screening. INTERVENTION AND COMPARATOR Participants in the intervention group will receive 1000 mg of nitazoxanide twice daily orally and 300/100 mg of atazanvir/ritonavir once daily orally in addition to standard of care while participants in the control group will receive only standard of care. Standard of care will be determined by the physician at the treatment centre in line with the current guidelines for clinical management of COVID-19 in Nigeria. MAIN OUTCOME MEASURES Main outcome measures are: (1) Time to clinical improvement (defined as time from randomisation to either an improvement of two points on a 10-category ordinal scale (developed by the WHO Working Group on the Clinical Characterisation and Management of COVID-19 infection) or discharge from the hospital, whichever came first); (2) Proportion of participants with SARS-CoV-2 polymerase chain reaction (PCR) negative result at days 2, 4, 6, 7, 14 and 28; (3) Temporal patterns of SARS-CoV-2 viral load on days 2, 4, 6, 7, 14 and 28 quantified by RT-PCR from saliva of patients receiving standard of care alone versus standard of care plus study drugs. RANDOMISATION Allocation of participants to study arm is randomised within each site with a ratio 1:1 based on randomisation sequences generated centrally at Obafemi Awolowo University. The model was implemented in REDCap and includes stratification by age, gender, viral load at diagnosis and presence of relevant comorbidities. BLINDING None, this is an open-label trial. NUMBER TO BE RANDOMISED (SAMPLE SIZE) 98 patients (49 per arm). TRIAL STATUS Regulatory approval was issued by the National Agency for Food and Drug Administration and Control on 06 October 2020 (protocol version number is 2.1 dated 06 August 2020). Recruitment started on 9 October 2020 and is anticipated to end before April 2021. TRIAL REGISTRATION The trial has been registered on ClinicalTrials.gov (July 7, 2020), with identifier number NCT04459286 and on Pan African Clinical Trials Registry (August 13, 2020), with identifier number PACTR202008855701534 . FULL PROTOCOL The full protocol is attached as an additional file which will be made available on the trial website. In the interest of expediting dissemination of this material, the traditional formatting has been eliminated, and this letter serves as a summary of the key elements in the full protocol. The study protocol has been reported in accordance with the Standard Protocol Items: Recommendations for Clinical Interventional Trials (SPIRIT) guidelines (Additional file 2).
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Affiliation(s)
- Adeniyi Olagunju
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Obafemi Awolowo University, Ile-Ife, Nigeria. .,Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, United Kingdom.
| | - Adeola Fowotade
- Department of Medical Microbiology and Parasitology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - Temitope Olumuyiwa Ojo
- Department of Community Health, Faculty of Clinical Sciences, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | | | - Adeniyi Francis Fagbamigbe
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
| | | | | | | | - Abdulafeez Akinloye
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Babatunde Ayodeji Adeagbo
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Adedeji Onayade
- Department of Community Health, Faculty of Clinical Sciences, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | - Oluseye Oladotun Bolaji
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Christian Happi
- African Centre of Excellence for Genomics of Infectious Diseases, Redeemer's University, Ede, Nigeria
| | - Steve Rannard
- Department of Chemistry, School of Physical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Andrew Owen
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, United Kingdom
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Adejimi AA, Olagunoye A, Akinkumi G, Agbeleye O, Alawale O, Adeola-Musa O, Adenekan A, Oyebade A, Bello M, Olugbile M, Adeoye O, Olatunji G. Evaluation of HIV prevention programme among out-of-school youths: achievements and implications of HIV/AIDS funded project in Osun State, Nigeria. International Journal of Adolescence and Youth 2017. [DOI: 10.1080/02673843.2017.1318769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Adebola A. Adejimi
- Department of Community Medicine, Ladoke Akintola University of Technology (LAUTECH) Teaching Hospital, Osogbo, Nigeria
- Department of Community Medicine, University of Ibadan, Ibadan, Nigeria
| | - Ajibola Olagunoye
- Department of Community Medicine, Ladoke Akintola University of Technology (LAUTECH) Teaching Hospital, Osogbo, Nigeria
| | - Grace Akinkumi
- Department of Community Medicine, Ladoke Akintola University of Technology (LAUTECH) Teaching Hospital, Osogbo, Nigeria
| | - Opeyemi Agbeleye
- Department of Community Medicine, Ladoke Akintola University of Technology (LAUTECH) Teaching Hospital, Osogbo, Nigeria
| | - Olubukola Alawale
- Department of Community Medicine, Ladoke Akintola University of Technology (LAUTECH) Teaching Hospital, Osogbo, Nigeria
| | - Oluwatoyin Adeola-Musa
- Department of Community Medicine, Ladoke Akintola University of Technology (LAUTECH) Teaching Hospital, Osogbo, Nigeria
- Department of Epidemiology and Disease Control, Osun State Ministry of Health, Osogbo, Nigeria
| | | | - Akin Oyebade
- Osun State Agency for the Control of AIDS, Osogbo, Nigeria
| | - Mosur Bello
- Osun State Agency for the Control of AIDS, Osogbo, Nigeria
| | - Michael Olugbile
- Second HIV Programme Development Project (HPDP2), World Bank, Abuja, Nigeria
| | - Olusegun Adeoye
- Second HIV Programme Development Project (HPDP2), World Bank, Abuja, Nigeria
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