Opportunistic Infections and Associated Factors among HIV-Infected Adult Persons on Antiretroviral Therapy at Ruhengeri Referral Hospital, Rwanda: A cross-sectional study

Background Human Immunodeficiency Virus (HIV) is among the highest health crises that humanity ever confronted and it causes progressive weakening of the immune system leading to opportunistic infections (OIs) or malignancies during the natural course of the disease. This study aimed at assessing the prevalence and factors associated with the occurrence of OIs among adult PLWHIV on antiretroviral therapy (ART) at Ruhengeri referral hospital. Methodology A cross-sectional study was performed by reviewing records of HIV-positive adult (≥ 15 years) on ART enrolled at Ruhengeri referral hospital from 1st January 2007 to 31st December 2017. Opportunistic infections were reported based on clinical diagnosis and the prevalence of OIs was determined. Results The study reviewed records from 423 PLWHIV. Thirty-nine (9.2%) PLWHIV had been diagnosed with OIs; and frequent OIs were tuberculosis (20%), oral candidiasis, pneumonia and STI (15.6% each). The independent risk factors for developing OIs were being jobless (AOR = 5.03, 95% CI = 2.13, 32.99), spending more than five years on ART (AOR = 4.34, 95% CI = 1.12-16.78) and starting ART at WHO clinical stage III (AOR = 4.88, 95% CI = 1.65-16.78). Conclusion There is a need to strengthen the management of opportunistic infections despite the use of ART at Ruhengeri referral hospital. Rwanda J Med Health Sci 2022;5(3):323-33

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Effects of using the Informed Health Choices digital secondary school resources on the ability of Rwandan students to think critically about health: protocol for a cluster-randomised trial

<p><strong>Background</strong>: Young people are exposed to many claims about the effects of things they can do to protect or improve health. To make good health choices, they need the ability to assess the reliability of those claims critically. Critical thinking is a core competence in the Rwandan secondary school curriculum and in many countries. However, critical thinking about health is rarely taught in Rwanda. Digital secondary school resources for critical thinking about health can potentially address this gap and if published be widely disseminated at low cost. The objective of the planned study is to evaluate the effects of using digital secondary school resources to help students learn to think critically about health.</p> <p><strong>Methods:</strong> We will conduct a two-arm cluster-randomized trial. We will randomly select 84 lower secondary schools from 10 districts representing all five provinces of Rwanda. Using stratified random allocation, we will assign 84 schools to the intervention or control arm. Schools in the intervention arm will teach 10-lessons after teacher training on the content of the secondary school resources. Schools in the control arm will not receive any training and resources. They will carry on with teaching the national curriculum. The primary outcome will be the proportion of students with a predetermined passing score on a test with multiple-choice questions from the Claim Evaluation Tools item bank. The questions measure the ability to apply key concepts related to assessing health claims and making informed health choices. The test will include two questions addressing each of the nine concepts covered by the secondary school resources.</p> <p><strong>Discussion</strong>: This is one of three randomized trials to assess the effects of the Informed Health Choices secondary school resources in Rwanda, Kenya, and Uganda.  The findings will inform decisions about how to promote critical thinking about health. <strong>Trial registration: </strong>Pan African Clinical Trial Registry, trial identifier: PACTR202203880375077, Registered on 15th February 2022.</p><p>An amendment to the protocol describing plans for sensitivity analyses to address missing outcome data for the one-year follow-up has been uploaded (Protocol amendment 1-year follow-up sensitivity analyses.pdf).</p&gt