HIV diagnosis disclosure to infected children and adolescents; challenges of family caregivers in the Central Region of Ghana

Background Disclosure of Human Immunodeficiency Virus (HIV) to infected older children and adolescents is essential for both personal health maintenance and HIV prevention within the larger population. Non-disclosure of HIV status has been identified as one of the potential barriers to optimum adherence especially in children and adolescents. Like many other countries in the SSA region, Ghana has significant number of children and adolescents infected by HIV, who have increased survival times, due to increased access to ART. However, both family caregivers and healthcare workers face an array of challenges with the disclosure process, including the timing, what information about the child’s HIV status should be shared with him/her and how to go about it. The aim of the study was to identify family caregiver factors associated with non-disclosure of HIV status to infected children and adolescents accessing Antiretroviral Therapy (ART) at the three main ART sites within the Central Region of Ghana. Methods A quantitative analytical survey was conducted among 103 family caregivers of HIV infected children (aged 6–17 years) assessing ART services in the Central Region of Ghana. Data were analyzed using SSPS version 21. Results The age range of caregivers was 20–69 years. The study found a low disclosure rate (23.3%) among caregivers. Majority of the caregivers (80.6%) lacked knowledge on the process of disclosure (how and what to tell child), and majority (64%) also had never received guidance about the disclosure process from their healthcare providers. The main barriers to disclosure were caregiver lack of knowledge regarding the disclosure process and when to disclose, the fear of child’s reaction, and fear of stigmatization and associated negative social consequences. Conclusion These findings suggest a lesser involvement of health care providers in preparing caregivers for the disclosure process. This therefore highlight the need for the National HIV/AIDS/STI Control Program to strengthen the involvement and training of healthcare providers in HIV diagnosis disclosure to infected children, based on context-specific policy guidelines informed by the WHO recommendations

Knowledge and experience of a cohort of HIV-positive and HIV-negative Ghanaian women after undergoing human papillomavirus and cervical cancer screening.

BACKGROUND: Cervical cancer is the most common cancer in women in Ghana, but knowledge and experience of women who have had cervical screening is under-evaluated. This study examined knowledge and understanding of HPV and cervical cancer and evaluated experiences of screening in a cohort of women of mixed HIV status. METHODS: This was a mixed methods study using questionnaires and focus group discussions, with a knowledge score constructed from the questionnaire. HIV-positive and HIV-negative women were recruited from a larger cervical screening study in Ghana and were interviewed 6 months after receiving screening. Quantitative data was analyzed and triangulated with qualitative data following thematic analysis using the framework approach. RESULTS: A total of 131 women were included (HIV-positive, n = 60). Over 80% of participants had a knowledge score deemed adequate. There was no difference between HIV-status groups in overall knowledge scores (p = 0.1), but variation was seen in individual knowledge items. HIV-positive women were more likely to correctly identify HPV as being sexually-transmitted (p = 0.05), and HIV negative women to correctly identify the stages in developing cervical cancer (p = < 0.0001). HIV-positive women mostly described acquisition of HPV in stigmatising terms. The early asymptomatic phase of cervical cancer made it difficult for women to define "what" cancer was versus "what" HPV infection was. All women expressed that they found it difficult waiting for their screening results but that receiving information and counselling from health workers alleviated anxiety. CONCLUSIONS: Knowledge of women who had participated in a cervical screening study was good, but specific misconceptions existed. HIV-positive women had similar levels of knowledge to HIV-negative, but different misconceptions. Women expressed generally positive views about screening, but did experience distress. A standardized education tool explaining cervical screening and relevance specifically of HPV-DNA results in Ghana should be developed, taking into consideration the different needs of HIV-positive women

Sero-prevalence of Hepatitis B and C viral co-infections among HIV-1 infected ART-naïve individuals in Kumasi, Ghana

Background The study assessed the hepatitis B virus (HBV) and hepatitis C virus (HCV) co-infection paradigm among the human immunodeficiency virus (HIV) infected patients attending a tertiary hospital in Ghana. Also, the immunological and virological characterisation of these viruses, prior to antiretroviral therapy (ART) initiation was investigated. Method A total of 400 HIV infected (HIV type-1) treatment naïve subjects ≥18 years were enrolled and tested for HBsAg and anti-HCV. Hepatitis B virus serological profile was performed on samples that were HBV positive. CD4+ T-cell count and HIV-1 RNA viral loads were determined using BD FacsCalibur analyzer (USA) and COBAS AmpliPrep/COBAS TaqMan Analyzer (USA) respectively. Results The overall prevalence of HBV/HCV co-infection among the HIV-1 patients was 18.0%. The prevalence of HIV-HBV and HIV-HCV co-infections were 12.5% and 5.5% respectively. The prevalence of active viral hepatitis (HBeAg-positive) among HIV-HBV co-infected patients was 40%. None of the patients had anti-HBc IgM. HIV-HBV co-infection was associated with lower CD4+ T-cell count as well as higher HIV-1 viral load compared to both HIV mono- infection and HIV-HCV co- infection (pp = 0.035], male gender [aOR = 2.74(1.15–6.51); p = 0.023], primary education [aOR = 9.60(1.21–76.08); p = 0.032], secondary education [aOR = 14.67(1.82–118.08); p = 0.012] and being single [aOR = 2.88(1.12–7.39); p = 0.028] were independent risk factors of HIV-HBV co-infections but not HIV-HCV co-infections. Conclusion The present study highlights the predominance of HBV exposure among the HIV infected patients in Ghana. HBV coinfection was associated with severe immunosuppression and higher HIV-1 viral load

Self-collected vaginal sampling for the detection of genital human papillomavirus (HPV) using careHPV among Ghanaian women.

BACKGROUND: Detection of genital HPV DNA is recommended as an important strategy for modern cervical cancer screening. Challenges include access to services, the reliance on cervical samples taken by clinicians, and patient's preference regarding provider gender. The objective of this research was to determine the acceptability, feasibility and performance of alternative self-collected vaginal samples for HPV detection among Ghanaian women. METHODS: A comparative frequency-matched study was conducted in a systematic (1:5) sample of women attending HIV and outpatient clinics in the Cape Coast Teaching Hospital, Ghana. Participants were instructed on self-collection (SC) of vaginal samples using the careHPV brush and a clinician-collected (CC) cervical sample was obtained using a similar brush. Paired specimens were tested for HPV DNA (14 high-risk types) by careHPV assay (Qiagen) and by HPV genotyping (Anyplex II, Seegene). RESULTS: Overall, 194 women of mean age 44.1 years (SD ± 11.3) were enrolled and 191 paired SC and CC results were analysed. The overall HPV detection concordance was 94.2% (95%CI: 89.9-97.1), Kappa value of 0.88 (p < 0.0001), showing excellent agreement. This agreement was similar between HIV positive (93.8%) and negative (94.7%) women. Sensitivity and specificity of SC compared to CC were 92.6% (95%CI: 85.3-97.0) and 95.9% (95%CI: 89.8-98.8) respectively. The highest sensitivity was among HIV positive women (95.7%, 95%CI: 88.0-99.1) and highest specificity among HIV negative women (98.6%, 95%CI: 92.4-100). Overall, 76.3% women found SC very easy/easy to obtain, 57.7% preferred SC to CC and 61.9% felt SC would increase their likelihood to access cervical cancer screening. CONCLUSIONS: The feasibility, acceptability and performance of SC using careHPV support the use of this alternative form of HPV screening among Ghanaian women. This could be a potential new affordable strategy to improve uptake of the national cervical cancer screening program

Options in human papillomavirus (HPV) detection for cervical cancer screening: comparison between full genotyping and a rapid qualitative HPV-DNA assay in Ghana.

BACKGROUND: Modern cervical cancer screening increasingly relies on the use of molecular techniques detecting high-risk oncogenic human papillomavirus (hr-HPV). A major challenge for developing countries like Ghana has been the unavailability and costs of HPV DNA-based testing. This study compares the performance of careHPV, a semi-rapid and affordable qualitative detection assay for 14 hr-HPV genotypes, with HPV genotyping, for the detection of cytological cervical squamous intraepithelial lesions (SIL). METHODS: A study comparing between frequency matched HIV-1 seropositive and HIV-seronegative women was conducted in the Cape Coast Teaching Hospital, Ghana. A systematic sampling method was used to select women attending clinics in the hospital. Cervical samples were tested for HPV by careHPV and Anyplex-II HPV28 genotyping assay, and by conventional cytology. RESULTS: A total of 175 paired results (94 from HIV-1 seropositive and 81 from HIV-seronegative women) were analyzed based on the ability of both tests to detect the 14 hr-HPV types included in the careHPV assay. The inter-assay concordance was 94.3% (95%CI: 89.7-97.2%, kappa = 0.88), similar by HIV serostatus. The careHPV assay was equally sensitive among HIV-1 seropositive and seronegative women (97.3% vs. 95.7%, p = 0.50) and slightly more specific among HIV-seronegative women (85.0% vs. 93.1%, p = 0.10). careHPV had good sensitivity (87.5%) but low specificity (52.1%) for the detection of low SIL or greater lesions, but its performance was superior to genotyping (87.5 and 38.8%, respectively). Reproducibility of careHPV, tested on 97 samples by the same individual was 82.5% (95%CI: 73.4-89.4%). CONCLUSIONS: The performance characteristics of careHPV compared to genotyping suggest that this simpler and cheaper HPV detection assay could offer a suitable alternative for HPV screening in Ghana

Evaluation of urinalysis parameters and antimicrobial susceptibility of uropathogens among out-patients at University of Cape Coast hospi

Background: Urinary tract infection (UTI) is a major global public health issue. The gold standard for diagnosing UTI is urine culture. This is however labour intensive and time consuming. Many prescribers therefore rely on urinalysis in diagnosing UTI. This study sought to evaluate the performance of some parameters of urinalysis as predictors of urine culture positivity. The common causative agents and their antibiotic susceptibility patterns were also determined. Methods: A cross sectional study was carried out at the University of Cape Coast Hospital from July 2017 – December 2017 among out-patients. The performance characteristics of leukocyte esterase (3+) and nitrite reactions were estimated and compared with urine culture. Antimicrobial susceptibility tests were done using disc diffusion technique described by Kirby-Bauer. Results: Prevalence of UTI in this study was 30.0% (64/213). The most prevalent pathogen was E. coli (20, 31.2%), followed by S. saprophyticus (9, 14.1%). Most of the bacteria (52, 94.5%) were sensitive to amikacin, followed by ciprofloxacin (42, 76.3%). The most sensitive (94.4%) of the parameters was pus cells [>5 white blood cells (WBC) per high power field (HPF)] and the least sensitive was the nitrite test (21.0%). The leukocyte esterase test showed the highest accuracy of 91.1%. Conclusion: The study supports the recommendation of the use of oral ciprofloxacin as the first line treatment of uncomplicated UTI by the Ghana Standard Treatment Guidelines (2017). Funding: No funding was provided for this study. Keywords: urine tract infection, urinalysis, uropathogens, Cape Coas

Epidemiology of cervical human papillomavirus (HPV) infection and squamous intraepithelial lesions (SIL) among a cohort of HIV-infected and uninfected Ghanaian women.

BACKGROUND: There is limited data in Ghana on the epidemiology of HPV and cervical neoplasia and their associations with HIV. This study aimed to compare among HIV-1 seropositive and HIV-seronegative Ghanaian women: (1) the prevalence, genotype distribution and risk factors associated with cervical HPV infection; and (2) the prevalence and risk factors associated with abnormal cervical cytology. METHODS: A comparative frequency-matched study was conducted in a systematic sample of women aged ≥18 years attending HIV and general outpatient clinics in Cape Coast Teaching Hospital, Ghana. Participants were interviewed and cervical samples collected for HPV genotyping (Seegene Anyplex-II HPV28) and cytological testing. RESULTS: Overall, 333 women were recruited, 163 HIV-1 seropositive and 170 HIV-seronegative women of mean age 43.8 years (SD ±9.4)) and 44.3 years (SD ±12.8), respectively. The prevalence of 14 high-risk (hr) HPV genotypes was higher among HIV-1 seropositive women (65.6% vs. 30.2%, P < 0.0001), as was proportion with multiple hr.-HPV infections (60.6% vs. 21.3%, P < 0.0001). HPV35 was the most prevalent hr.-HPV genotype in both groups (11.9% and 5.3%). The main factors associated with hr.-HPV infection were age for HIV-positive women and circumcision status of main sexual partner for both HIV-negative and positive women. Abnormal cervical cytology prevalence was higher among HIV-1 seropositive women (any SIL: 14.1% vs. 1.2%, P < 0.0001; low-grade SIL [LSIL]: 4.9% vs. 0.6%, P = 0.02; high-grade SIL: 1.8% vs. 0%, P = 0.07). Among HIV-1 seropositive women, number of pregnancies and CD4+ cell count were associated with LSIL+ cytology. There was strong association between LSIL+ abnormalities and HPV35 (aOR = 4.7, 95%CI: 1.3-17.7, P = 0.02). CONCLUSIONS: HIV-1 infected women bear significant burden of HPV infection and related disease. Prevention and screening programmes should be specifically deployed for this population in Ghana

Impact of universal childhood vaccination against hepatitis B in Ghana: A pilot study

Hepatitis B virus (HBV) infection is of public health importance worldwide. Vaccination against the infection, especially in early childhood has significantly reduced the public health impact. This pilot study was undertaken in Cape Coast Metropolitan area to assess the impact of the introduction of HBV vaccination in children. A cross-sectional multi-stage cluster sampling of 501 pupils from 30 public and private primary and junior high schools within the Cape Coast metropolis. A questionnaire covering basic demographic details and immunisation history were administered to the participants after consent and assent had been sought. Hepatitis B serological test for HBsAg, HBcAb, HBsAb, HBeAg and HbeAb was undertaken using Hepatitis B test kit and capillary blood from the participants. The general prevalence of HBcAb, HBsAg and HBsAb was found to be 3.6, 2.6 and 19.8% respectively. The prevalence of HBcAb was 2.6 and 6.1% among pupils delivered after and before the vaccine programme introduction respectively. Introduction of the vaccination programme in Ghana has had a positive impact on the HBV infection in Ghana

Retinal Microvasculopathy Is Common in HIV/AIDS Patients: A Cross-Sectional Study at the Cape Coast Teaching Hospital, Ghana

properly cited. Purpose. The purpose of this study was to evaluate the ocular disorders in HIV positive patients attending the Cape Coast Teaching Hospital, Ghana. Methods. A cross-sectional study using systematic random sampling was conducted on 295 HIV positive patients. Data collection consisted of semistructured questionnaires, laboratory investigation, medical profile, and ophthalmic examination. Statistical association tests including 2 , independent -test, and ANOVA were done. A value ≤ 0.05 was considered statistically significant. Results. Of the 295 participants, 205 (69.5%) were on antiretroviral therapy while 90 (30.3%) were not on therapy. Majority of the participants (162, 54.9%) were in clinical stage two, followed by stages three (68, 23.1%), one (62, 21%), and four (3, 1%), respectively. The overall prevalence of ocular disorders was 5.8%. The most common HIV related ocular disorder was HIV retinal microvasculopathy (58.8%), followed by herpes zoster ophthalmicus and Toxoplasma retinochoroiditis, both representing 11.8% of ocular disorders seen. Cytomegalovirus retinitis, Bell&apos;s palsy, and optic neuritis were the least common (5.9%). CMV retinitis recorded the highest viral load of 1,474,676 copies/mL and mean CD4 count of 136 cells/mm 3 . The mean CD4 count for participants with HIV related ocular disorders was significantly lower compared to participants without disorders ( = 2.5, = 0.012). Participants with ocular disorders also recorded significantly higher mean viral loads than those who did not have ocular disorders ( = 2.8, = 0.006). Conclusion. Lower CD4 counts and high viral load copies were associated with the manifestation of HIV related ocular disorders. Background Acquired immunodeficiency syndrome (AIDS) is caused by the human immunodeficiency virus (HIV) which affects all body organs either directly or by opportunistic infections, and the eye is not spared. AIDS indicates advanced HIV disease in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive There is a huge dearth of information in Ghana on ocular related findings in HIV patients. Reports from other societies have always considered the associations between HIV related ocular manifestations and CD4 counts but not viral loads. The purpose of this study was to evaluate the associations between presenting ocular disorders and CD4 counts/viral load copies in HIV positive patients attending the Cape Coast Teaching Hospital, Ghana. Methods Study Site. The study was carried out at the Antiretroviral Therapy (ART) Specialist Clinic of the Cape Coast Teaching Hospital in Ghana. The Cape Coast Teaching Hospital, one of the five teaching hospitals in Ghana, provides health services to people in the central and western regions and parts of Ashanti and eastern regions. It also has the mandate of training doctors and other medical staff. Study Design and Participants. The study employed a descriptive cross-sectional design. Sample size was determined based on the expression , where is the minimum sample size, is the standard normal deviation, usually set at 1.96 which corresponds to the 95% confidence interval, is the proportion in the target population estimated to have the infection (1.4% for the central region), and is the degree of accuracy desired, usually set at 5%. Consequently, a sample size of 30 was calculated. This was adjusted to 200 participants to account for attrition rate and inefficiencies associated with the sampling method. A systematic sampling method was used to recruit clinically diagnosed HIV patients, who attended the ART Specialist Clinic between January and May 2016. Based on the average daily attendance at the clinic and a determined sampling interval of three (3), the first participant was chosen by randomly selecting a number between one and three. Every third patient from the first participant was then recruited into the study. In all, 320 patients were examined within the period. Out of them, 295 patients had complete medical data and they were included in the analysis. Patients who had comorbidities such as diabetes, hypertension, and sickle cell disease were excluded from the study. Ethical Considerations. The study was conducted in accordance with the Helsinki Declaration on Research Regarding Human Subjects. Ethical clearance (ID number UCCIRB/CHAS/2015/090) was obtained from the Institutional Review Board of the University of Cape Coast. The rationale of the study was comprehensively explained to all participants after which consent forms were issued to them to sign, including local language versions which were read out to illiterate subjects who consented with a thumbprint prior to investigation. For participants below 18 years of age whose assent was sought, their parents/guardians signed the consent forms on their behalf. The participants were assured of confidentiality and safety at all times. They were also reminded of the voluntary nature of the study which granted them the right to withdraw at any point. Data Collection. The method of data collection consisted of semistructured questionnaires, laboratory investigation, medical profiles, and ophthalmic examination. Every consenting patient was assigned a specific study code. A trained investigator interviewed and filled the questionnaires for all the participants. Information obtained from the questionnaires included age, gender, occupation, religion, marital status, level of education, and duration of infection from the time of diagnosis. The patient&apos;s HIV related medical information such as the World Health Organization (WHO) clinical stage of the disease, whether the participant was on ART or not, and duration of ART usage was recorded. Blood Sample Collection and Analysis . About 3 mL of venous blood was collected from each participant and HIV biomarkers CD4 counts and viral loads were determined. Two CD4 counts were obtained for this study: nadir CD4 counts (the lowest CD4 count ever recorded) and the current CD4 counts (CD4 counts at the time of the study). It was important to evaluate both the nadir and the current CD4 counts in this study to appreciate the effect of antiretroviral therapy on CD4 and to ascertain the stage at which some HIV related ocular disorders actually occurred. Ophthalmic Examination. Ophthalmic examination was conducted by experienced eye care personnel. Presenting Distance Visual Acuity (PDVA) measurements followed by slit lamp biomicroscopy and dilated funduscopy were performed on all participants. Pinhole acuity was performed to rule out refractive error as the cause of reduced vision. Dilated fundus examination was performed with 2.5% phenylephrine ophthalmic solution. Two drops of the phenylephrine were administered at an interval of 5 minutes followed by one hour of waiting to ensure maximum papillary dilation. Journal of Ophthalmology 3 Ophthalmoscopy was then performed on each participant. Ophthalmic examination forms were correspondingly labeled for each participant. Categories of visual impairment (VI) were determined based on the International Classification of Diseases, where &quot;low vision&quot; is defined as presenting visual acuity &lt; 6/18 in the better eye Statistical Analysis. The data collected were entered into SPSS for Windows, version 21.0.1. The analysis involved the use of frequency distribution tables. Chi-square ( 2 ) test was used to determine the associations between categorical variables. Fisher&apos;s exact test was used where counts were less than 5. Independent -test and analysis of variance (ANOVA) were performed to compare the mean values of HIV biomarkers (CD4 counts and viral loads) between participants who had HIV related visual disorders and those who did not. A value ≤ 0.05 was considered statistically significant. Results A total of 320 patients were examined within the period, out of whom 295 had complete medical data and were included in the analysis. They comprised 78 (26.4%) males and 217 (73.6%) females. Their ages ranged from 10 to 83 years with mean age of 45.3 years (SD: ±11.6). According to the WHO criteria on HIV classification, majority of the participants (162, 54.9%) were in clinical stage two, followed by stages three, one, and four that had 68 (23.1%), 62 (21%), and 3 (1%) participants, respectively. Two hundred and five (69.5%) of the participants were on antiretroviral therapy while the remaining 90 (30.5%) were not on therapy. The mean age of participants on ART was 45.9 (SD: ±11.64) years while those not on ART had a mean age of 43.8 (SD: ±11.46) years. There was no statistically significant difference between the mean ages of participants on ART and those without therapy ( = 1.4, = 0.14). The mean current CD4 count of participants on ART was lower (786.5 cells/mm 3 ) than of participants not on ART (863.8 cells/mm 3 ). This difference was, however, not significant ( = 1.3, = 0.20). Similarly, there was no significant difference between the mean viral load counts for participants on ART and those not on ART ( = 1.1, = 0.28). Majority of the participants (150, 50.8%) had normal vision of VA 6/6. One hundred and sixteen (39.3%) had mild visual impairment (VA 6/9-6/18). Twenty-nine (9.8%) of the participants had low vision (VA &lt; 6/18) out of whom 19 (65.5%) were on antiretroviral therapy. Five (17.2%) of the 29 participants were in the first clinical stage of the disease whereas 19 (65.5%) and 5 (17.2%) were in stages two and three, respectively. Low vision occurrence was lower in the ART group (9.8%) than in the non-ART group (11.1%). However, there was no significant association between low vision and ART status ( 2 = 0.24, = 0.62). Out of the 295 participants who took part in the study, 17 (5.8%) had HIV related ocular disorders of whom three were bilateral cases (making 20 eyes in all). Of these 17 participants, 4 (23.5%) were males and the remaining 13 (76.5%) were females. There was no significant association between manifestation of ocular disorders and sociodemographic factors such as gender ( = 1.00), age ( = 0.60), occupation ( = 0.38), and duration of infection from the time of diagnosis ( = 0.81). There was also no significant difference between the mean ages of patients who manifested ocular disorders and those who did not ( = 0.2, = 0.80). The most prevalent HIV related ocular disorder in this study was retinal microvasculopathy (10, 58.8%). The mean CD4 count for participants with this disorder was 142 cells/mm 3 with a mean viral load of 20,308 copies/mL. Herpes zoster ophthalmicus and Toxoplasma retinochoroiditis each accounted for 2 (11.8%) of the ocular disorders found. Participants who had HZO recorded a mean CD4 count of 269 cells/mm 3 and mean viral load of 38,090 copies/mL. Cytomegalovirus retinitis was responsible for only 1 (5.9%) case and it occurred in a participant with a CD4 count of 136 cells/mm 3 and the highest viral load count of 1,474,676 copies/mL. Neuroophthalmic disorders found were Bell&apos;s (hemifacial) palsy and optic neuritis, each accounting for (1, 5.9%) of the cases. Participants who had HIV related ocular disorders had significantly lower mean values of nadir CD4 counts (172 cells/mm 3 ) when compared to those who did not have ocular disorders (309 cells/mm 3 ) ( = 0.012). This mean CD4 count (172 cells/mm 3 ) indicates that the patients who manifested HIV related ocular disorders had severe immune suppression (i.e., CD4 &lt; 250 cells/mm 3 ). Also, patients who manifested HIV related ocular disorders recorded significantly higher mean values of viral load copies as compared to their counterparts who did not manifest ocular disorders ( = 0.006). However, no significant association was found between ocular disorders and current CD4 counts ( = 0.10). Non-HIV related ocular conditions such as nonneurological blepharoptosis, pingueculae, pterygia, conjunctivitis, cataract, and glaucoma suspects were also found in the study population. Majority (11, 64.7%) of the participants who had 4 Journal of Ophthalmology HIV related ocular disorders were at stage two of the disease while 4 and 2 were at stages one and three, respectively. There was, however, no association between ocular manifestation and clinical stage of the disease ( 2 = 1.213, = 0.724). Again, no association was found between ART usage and ocular manifestation ( 2 = 0.110, = 1.000). Discussion Previous studies have always considered the associations between HIV related ocular manifestations and CD4 counts but not viral loads. The current study sought to evaluate the associations between presenting ocular disorders and CD4 counts/viral load copies in HIV positive patients attending the Cape Coast Teaching Hospital, Ghana. The 5.8% prevalence of HIV related ocular disorders in the present study was lower than in a recently published study from the Ashanti region of Ghana where the authors reported ocular complications in 48% The finding of 9.8% low vision in this study was higher than the 3.1% reported by Abokyi et al. [20] also in the Cape Coast Metropolis in Ghana. HIV retinal microvasculopathy being the most common HIV related ocular manifestation is consistent with the recent report from the Ashanti region, Ghana Herpes zoster ophthalmicus as the second most common ocular disorder was comparable with reported cases from Nigeria and Cameroon The finding on CMV retinitis is consistent with that in Ethiopia Conclusion Consistent with other findings, our study suggests that ocular manifestations in HIV patients are heightened by reduced CD4 counts and corresponding higher viral load copies. Particularly, CMV retinitis was associated with extremely high viral load copies though it was very rare. Ethical Approval Ethical clearance with certificate ID UCCIRB/CHAS/2015/ 090 was obtained from the Institutional Review Board of the University of Cape Coast. Consent Participants and guardians provided informed consent by thumbprinting or signatures after freely agreeing to participate. Competing Interests The authors declare that they have no competing interests. Authors&apos; Contributions Emmanuel Kwasi Abu, Samuel Abokyi, Richard Kobina Dadzie Ephraim, and Daniel Afedo conceived the study idea and participated in its design and data analysis and in the manuscript preparation. Emmanuel Kwasi Abu, Samuel Abokyi, Dorcas Obiri-Yeboah, Daniel Afedo, and Samuel Bert Boadi-Kusi participated in the clinical examination of patients and in the data analysis and were also involved in reviewing the manuscript. Richard Kobina Dadzie Ephraim and Lawrence Duah Agyeman conducted the laboratory analysis of the samples. All authors read and approved the final manuscript

A systematic review and meta-analysis of the prevalence of hepatitis B virus infection among pregnant women in Nigeria

Background: Nigeria has a high burden of hepatitis B virus (HBV) infection, commonly acquired through vertical transmission. However, there is a lack of an efficient surveillance system for monitoring and understanding the epidemiology of HBV among pregnant women. Building on a previous review on the prevalence of HBV in Nigeria (2000–2013), we conducted a systematic review and meta-analysis of HBV prevalence among pregnant women in Nigeria. Methods: Four electronic databases PubMed, Embase, Global Health, and Scopus were systematically searched from January 2014 to February 2021. We also searched the African Journal Online and manually scanned the reference lists of the identified studies for potentially eligible articles. Observational studies that reported the prevalence of HBsAg and/or HBeAg among pregnant women in peer-reviewed journals were included in the study. We performed a meta-analysis using a random-effects model. We defined HBV infection as a positive test to HBsAg. Results: From the 158 studies identified, 20 studies with a total sample size of 26, 548 were included in the meta-analysis. The pooled prevalence of HBV infection among pregnant women across the studies was 6.49% (95% confidence interval [CI] = 4.75–8.46%; I2 = 96.7%, p = 0.001; n = 20). The prevalence of HBV was significantly lower among pregnant women with at least secondary education compared with those with no education or primary education (prevalence ratio = 0.7, 95% CI = 0.58–0.87; n = 10). However, the prevalence of HBV was not significantly different by age, religion, marital status, or tribe. The prevalence of HBV was not significantly different among pregnant women with previous surgery, blood transfusion, multiple lifetime sex partners, tribal marks, tattoos, scarification, or sexually transmitted infections, compared with those without these risk factors. From a total sample size of 128 (n = 7), the pooled prevalence of HBeAg among HBV-infected pregnant women was 14.59% (95% CI = 4.58–27.99%; I2 = 65.5%, p = 0.01). Subgroup analyses of HBV infection by study region and screening method, and meta-regression analysis of the study year, sample size, and quality rating were not statistically significant. Conclusions: There is an intermediate endemicity of HBV infection among pregnant women in Nigeria. Interventions, such as routine antenatal HBV screening, antiviral prophylaxis for eligible pregnant women, and infant HBV vaccination should be scaled up for the prevention of perinatal transmission of HBV infection in Nigeria