Togo: Thorny transition and misguided aid at the roots of economic misery

The parliamentary elections of October 2007, the first free Togolese elections since decades, were meant to correct at least partially the rigged presidential elections of 2005. Western donors considered it as a litmus test of despotic African regimes’ propensity to change towards democratization and economic prosperity. They took Togo as model to test their approach of political conditionality of aid, which had been emphasised also as corner stone of the joint EU-Africa strategy. Empirical findings on the linkage between democratization and economic performance are challenged in this paper because of its basic data deficiencies. It is open to question, whether Togo’s expected economic consolidation and growth will be due to democratization of its institutions or to the improved external environment, notably the growing competition between global players for African natural resources

Incidence and risk factors of C. trachomatis and N. gonorrhoeae among young women from the Western Cape, South Africa: The EVRI study

Objective Young women in South Africa are highly affected by sexually transmitted infections (STI), like C. trachomatis (CT) and N. gonorrhoeae (NG). We aimed to estimate the incidence of CT and NG, and its determinants, among young women from the Western Cape, South Africa, participating in an HPV vaccine trial (the EVRI study). Methods HIV-negative women aged 16-24 years were enrolled between October 2012 and July 2013. At enrolment and month 6 participants were screened for CT and NG (Anyplex CT/ NG real-time detection method). A questionnaire on demographic and sexual history characteristics was completed at enrolment and month 7. Treatment for CT and/or NG was offered to infected participants. Incidence rates (IR) of CT and NG were estimated. Determinants of incident CT and NG infections were assessed using Poisson regression. Results 365 women were tested for CT and/or NG at least twice. Prevalence of CT and NG at baseline was 33.7% and 10.4%, respectively. Prevalence of co-infection with CT and NG was 7.1%. During 113.3 person-years (py), 48 incident CT infections were diagnosed (IR = 42.4 per 100 py, 95% confidence interval (CI) 31.9-56.2). Twenty-nine incident NG were diagnosed during 139.3 py (IR = 20.8 per 100 py, 95%CI 14.5-29.9). Prevalent CT infection at baseline was associated with incident CT (adjusted incidence rate ratio (aIRR) 5.8, 95%CI 3.0-11.23. More than three lifetime sex partners increased the risk for incident NG (3-4 partners aIRR = 7.3, 95%CI 2.1-26.0; > 5 partners aIRR = 4.3, 95%CI 1.1-17.5). Conclusions The IR of bacterial STIs among young women in the Western Cape is very high. Besides being previously infected and a higher lifetime number of sex partners, no other risk factors were found for CT and NG, suggesting that the majority of these women were at risk. This indicates the need for intensified prevention of STIs as well as screening and treatment programs to increase sexual health in this region

Natural history of cutaneous human papillomavirus (HPV) infection in men: the HIM study.

Accumulating evidence suggests that cutaneous human papillomavirus (HPV) infection is associated with non-melanoma skin cancer (NMSC). Little is known about the natural history of cutaneous HPV. A sub-cohort of 209 men with no NMSC history, initially enrolled in the HPV infection in men (HIM) study, were followed for a median of 12.6 months. Epidemiological data were collected through self-administered questionnaires. Cutaneous HPV DNA was measured in normal skin swabs (SS) and eyebrow hairs (EB) for 25 and 16 HPV types in genera β and γ, respectively. Any β HPV infection was more prevalent in SS (67.3%) compared to EB (56.5%, p = 0.04). Incidence in SS was higher than 20 per 1,000 person-months for HPV types 4, 5, 23, 38 and 76. Median duration of persistence of β and γ HPV infection was 8.6 and 6.1 months in EB, respectively, and 11.3 months and 6.3 months, in SS, respectively. Older age (>44 years vs. 18-30 years) was significantly associated with prevalent (SS OR = 3.0, 95% CI = 1.2-7.0) and persistent β HPV infection (EB OR = 6.1, 95% CI = 2.6-14.1). History of blistering sunburn was associated with prevalent (OR = 2.8, 95% CI = 1.3-5.8) and persistent (OR = 2.3, 95% CI = 1.2-4.6) β HPV infection in SS. Cutaneous HPV is highly prevalent in men, with age and blistering sunburn being significant risk factors for cutaneous β HPV infection

HPV serostatus pre- and post-vaccination in a randomized phase II preparedness trial among young Western Cape, South African women: The evri trial

Background: HPV antibodies are a marker of past exposure to the virus. Our objective was to assess HPV serostatus pre- and post-vaccination among HIV-negative women. Methods: Women aged 16â24 years old were randomized in a placebo controlled trial utilizing the 4-valent HPV (4vHPV) vaccine (NCT01489527, clinicaltrials.gov). Participants (n=389) received the 4vHPV vaccine or placebo following a three dose schedule. Sera were collected at Day 1 and Month 7 for assessment of HPV 6, 11, 16, and 18 neutralizing antibody levels using a multiplex competitive Luminex immunoassay (Merck) based on detecting the L1 capsid antigen for each HPV type. Results: Seroprevalence was 73% for HPV6, 47% for HPV11, 33% for HPV16, and 44% for HPV18. Seroprevalence for any HPV type did not significantly differ by age or lifetime number of partners. The majority of participants (64%) had two or more 4vHPV antibodies present at enrollment and 12% had antibodies to all four. Among women in the vaccine arm, those that were seropositive for HPV16 at enrollment had higher titers at month 7 compared to women that were seronegative for HPV16 at enrollment; this trend holds for the other HPV types as well. Seroconversion among baseline seronegative participants in the placebo group ranged from 5% for HPV16 to 23% for HPV6. Conclusion: HPV seroprevalence was high in this population, emphasizing the need to vaccinate prior to sexual debut. Keywords: HPV vaccine, EVRI, Seroprevalence, cLI

An analysis of HPV infection incidence and clearance by genotype and age in men: The HPV Infection in Men (HIM) Study

Objectives: Genital HPV infection in men causes benign and cancerous lesions, the incidence of which differs by age. The goal of this work was to comprehensively evaluate incidence and clearance of individual HPV genotypes among men by age group. Methods: HIV-negative men ages 18–70 with no history of anogenital cancer were recruited for the HPV Infection in Men (HIM) Study. Participants completed clinical exams and questionnaires every six months for up to ~4 years. Genital specimens underwent HPV genotyping, with associations between age and HPV assessed using Cox analyses. Results: 4085 men were followed for a median of 48.6 months (range: 0.3–94.0). Significantly lower HPV incidence rates were observed among the oldest age group (55–70 years) for grouped high-risk (incidence rate ratio [IRR]=0.71), HPV16 (IRR=0.54), grouped low-risk (IRR=0.74), and HPV6 (IRR=0.57) infections compared to men ages 18–24. However, incidence of the grouped 9-valent HPV vaccine types remained constant across the lifespan. Likelihood of HPV6 and HPV16 clearance remained constant until age 54, then increased significantly for men ages 55–70 (adjusted hazard ratio [AHR]=1.92 and 1.65, respectively). Conclusions: Men remain susceptible to HPV infections throughout their lifespan, highlighting the need for prevention efforts with long-lasting duration. Keywords: Human papillomavirus, Natural history, Incidence, Clearance, Age-specific, HIM Stud

Associations of baseline characteristics with incidence and persistence for any type of β HPV infection in men residing in Tampa, Florida.

<p>OR = odds ratio, CI = confidence interval.</p><p>*Unadjusted logistic regression. All analyses, except for ‘age’ are adjusted for age.</p><p>Associations of baseline characteristics with incidence and persistence for any type of β HPV infection in men residing in Tampa, Florida.</p

Time to incidence of β-HPV infection in normal skin swabs and eyebrow hairs of men.

<p>Kaplan Meier estimate for time to incidence of any β HPV infection in a sample of 209 men. Participants who were negative for all HPV types at baseline were included. Time was counted until their first visit with a HPV positive sample or until censored. The 'last observation carried forward' approach was taken when counting time to incidence (e.g. 0 NA 1 pattern of HPV positivity at consecutive visits, the NA was treated as '0' and the time was counted in the time to incidence.). This only affected skin swab samples since most people were β globin or HPV positive for eyebrows and thus their samples were not removed.</p