Elimination of Viral Hepatitis in Low and Middle-Income Countries: Epidemiological Research Gaps

PURPOSE OF REVIEW: The purpose of our review was to summarize current recommendations on testing strategies, antiviral therapy eligibility and monitoring, and prevention of mother-to-child transmission of chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infections, and to highlight major research gaps in low and middle-income countries (LMIC), with a particular focus on sub-Saharan Africa (SSA). RECENT FINDINGS: While data on the prevalence of HBV and HCV infections in LMIC are increasing, current knowledge on liver-related complications as well as on treatment outcomes remains limited. Furthermore, very little information is available on the feasibility and cost-effectiveness of large-scale testing and management strategies in high-prevalence settings. The availability of policy-relevant data is particularly scarce in SSA, which accounts for a significant part of the global burden of chronic viral hepatitis. SUMMARY: Current recommendations on the management and monitoring of chronic viral hepatitis rely mainly on data from high-income settings. The global elimination of viral hepatitis will only be achieved if prevention, testing, and treatment strategies tailored to specific LMIC are implemented. In order to inform scalable and cost-effective interventions, dedicated research initiatives have to be undertaken. Future studies will have to include the evaluation of innovative testing strategies, the validation of simplified methods to diagnose liver cirrhosis and hepatocellular carcinoma, and the monitoring of long-term treatment outcomes and toxicity. In addition, national plans to achieve the elimination of HBV mother-to-child transmission are urgently needed, including effective ways to test pregnant women, treat those who are eligible, and ensure birth dose vaccination is given to all newborns

Assessment of Knowledge and Consumption Patterns of Soybean, Moringa Oleifera, Aloe Vera and Other Agro-Resources: The Case of the Elderly and Pregnant/Nursing Women in Lome, Togo

Purpose: To assess how soybean products and other agro-resources are known and consumed by some vulnerable populations in Lome (Togo). Methods: A cross sectional study was conducted from March to April 2015 among people aged 50 years and over attending two Pension Fund departments and pregnant and nursing women attending Bè Hospital in Lome. Data were collected using a pre-tested face-to-face questionnaire. Participants were surveyed about their knowledge and consumption habits of soybean, Moringa oleifera, Aloe vera products and other agro-resources. Results: A total of 847 respondents were included in the study with 426 pregnant/nursing women and 421 people aged 50 years and over. The majority of respondents were married (39.5%) and 45.3% of the elderly people were widowed. At least nine over ten respondents (96%) knew soybean products and 76.8% of them reported a lifetime consumption of soybean products. The available and most consumed agro-resources included tofu (82.7%), moringa leaves (87.2%) and soy flour (29.7%). The least consumed products were soymilk, soy yogurt and moringa juice. Respondents also reported using moringa tea and soap, as well as Aloe vera juice and toothpaste. Conclusion: Soybean products and other agricultural resources are well known and consumed by people living in Lome. Data on actual food intake is useful to public health professionals and food safety risk assessors. It is important to inform the public at large of the recognized benefits of some foods that will provide solutions to their health problems

Regional heterogeneity of malaria prevalence and associated risk factors among children under five in Togo: evidence from a national malaria indicators survey.

BACKGROUND: Malaria remains a major cause of morbidity and death among children less than 5 years of age. In Togo, despite intensification of malaria control interventions, malaria remained highly prevalent, with significant heterogeneity from one region to another. The aim of this study is to explore further such regional differences in malaria prevalence and to determine associated risk factors. METHODS: Data from a 2017 cross-sectional nationally representative malaria indicator survey was used. Children aged 6–59 months in selected households were tested for malaria using a rapid diagnostic test (RDT), confirmed by microscopy. Univariate and multivariate logistic regression analysis were performed using Generalized Linear Models. RESULTS: A total of 2131 children aged 6–59 months (1983 in rural areas, 989 in urban areas) were enrolled. Overall 28% of children tested positive for malaria, ranging from 7.0% in the Lomé Commune region to 4% 7.1 in the Plateaux region. In multivariate analysis, statistically significant differences between regions persisted. Independent risk factors identified were higher children aged (aOR = 1.46, 95% CI [1.13–1.88]) for those above 24 months compared to those below; households wealth quintile (aOR = 0.22, 95% CI [0.11–0.41]) for those richest compared to those poorest quintiles; residence in rural areas (aOR = 2.02, 95% CI [1.32–3.13]). CONCLUSION: Interventions that target use of combined prevention measures should prioritise on older children living in poorest households in rural areas, particularly in the regions of high malaria prevalence

Condom use and associated factors among men who have sex with men in Togo, West Africa

Introduction: in 2011, the prevalence of HIV among men who have sex with men (MSM) in Togo was estimated at 19.6% compared to 3.4% in the general population. This study aimed to describe condom use and associated factors among MSM in Togo. Methods: in 2011, a crosssectional survey was conducted using the snowball sampling method among MSM in Togo. This study enrolled MSM aged 18 years and above who reported having sexual contact with other men within the last 30 days. A standardized survey form was used for data collection, and multivariate analyses were performed. Results: A total of 724 MSM were included in this study. The median age was 25 years [22-28], 90.3% had at least a secondary school level. The sexual practices during the last sexual encounter with another man included: insertive anal sex (62.2%), receptive anal sex (56.6%), oral sex (33.8%) and oral-anal sex (8.6%). A condom was used during the last insertive and receptive anal encounters in 78.4% and 81.2% of the time, respectively. In multivariate analysis, condom use was positively associated with previous participation in HIV/STD prevention activities (aOR=1.72; 95% CI=[1.09-2.71]), with the consideration of the last sexual partner as a casual one (aOR=1.87; 95% CI=[1.24-2.82]) and with having at least a secondary school level (aOR=2.40; 95% CI=[1.22-4.69]). Conclusion: One out of five MSM did not use a condom during the last anal encounter with another man. HIV prevention programs in Africa should develop specific interventions targeting MSM to reduce the incidence of HIV in this hidden population.Pan African Medical Journal 2016; 2

Barriers and facilitators in cervical cancer screening uptake in Abidjan, Cote d'Ivoire in 2018: a cross-sectional study

BACKGROUNDS: Cervical cancer (CC) incidence remains unacceptably high in Côte d'Ivoire. In an effort to prevent this malignant condition, a national CC screening program has been scaled up in the country. This study aimed at assessing CC screening uptake and its associated factors in Abidjan in 2018. METHODS: A cross-sectional survey was conducted from July to September 2018 in the main healthcare facilities of three randomly selected out of the eight health districts of Abidjan. During the study period, a standardized questionnaire was administrated by research assistants to all women aged 25 to 55 years old, attending the three participating facilities. Demographics, knowledge on CC, personal history of CC screening and reasons for not attending CC screening were collected. A logistic regression model was computed to document factors associated with reported CC screening uptake. RESULTS: A total of 1158 women with a median age of 32 years (IQR [27-36]), including 364 (31.4%) with no formal education were included. Of those participants, 786 (67.9%) had ever heard about CC. CC screening uptake at least once was reported by 7.5% [95% CI: 6.0-9.0] participants. In multivariable analysis, being ≥45 years (aOR: 6.2 [2.3-17.2]), having a university level (aOR: 2.8 [1.2-6.6]) (versus non formal education) and access to mass campaign information (aOR: 18.2 [8.5-39.1]) were associated with a reported CC screening uptake. The main reported barriers to CC screening were unawareness towards CC screening (75.5%), negligence (20.5%), fear of CC detection (3.9%) and fear of additional costs (3.3%). CONCLUSION: CC screening uptake remains low despite current initiatives to support awareness and prevention in Abidjan. Awareness campaigns need to be massively increased with the adjunction of tailored messages based on the level of women's education to enhance the CC screening coverage and reach the WHO goal of CC elimination by 2030

PLoS One

BACKGROUND: In Cote d'Ivoire, people living with HIV (PLHIV) have free access to antiretroviral therapy (ART) and cotrimoxazole. Yet, they may use other medications to treat non-HIV diseases. Scarce data are available regarding the use of non-HIV medications in Africa. This study describes the use of non-HIV medications and identifies the factors associated with their use by PLHIV on ART in Cote d'Ivoire. METHODS: A cross-sectional study was conducted in six HIV clinics in 2016. HIV-1-infected adults receiving ART for at least one year were eligible. A standardized questionnaire was used to collect demographics, HIV characteristics and medication use data. Associated factors were identified using a multivariate adjusted Poisson regression. RESULTS: A total of 1,458 participants (74% women) were enrolled. The median age was 44 years, and the median duration of ART was 81 months. A total of 696 (48%) participants reported having used at least one non-HIV medication. Among the 1,519 non-HIV medications used, 550 (36%) had not been prescribed and 397 (26%) were from the nervous system class. Individuals who were more likely to report the use of at least one non-HIV medication included those who had been treated in an Abidjan HIV clinic, had a high school education level, had a monthly income between 152 and 304 euros, had a poor perceived health status, had WHO advanced clinical stage, had used traditional medicine products and had not used cotrimoxazole. CONCLUSION: Almost half PLHIV on ART reported using non-HIV medication. Further research is needed to assess whether the use of non-HIV medication is appropriate given about a third of those medications are not being prescribed

Evaluation du système de surveillance épidémiologique de la méningite bactérienne dans la région des Savanes au Togo, 2016 – 2019: Evaluation of the epidemiological surveillance system for bacterial meningitis in the Savanes region of Togo, 2016 – 2019

Introduction: La surveillance cas par cas de la Méningite Bactérienne Aiguë (MBA) a démarré depuis 2014 dans la ré-gion des Savanes mais le niveau de sa performance est méconnu. L’objectif de cette étude était d’évaluer ce système de surveillance de 2016 à 2019. Méthodes: Il s’est agi d’une étude transversale qui a inclus tous les cas de MBA notifiés dans la région des Savanes entre la semaine 1 (S1) 2016 et S19 2019, 34 Formations Sanitaires (FS) périphériques, sept hôpitaux de districts (HD) et l’hôpital régional (CHR). Les données ont été collectées par interview, observation et examen de registres. Les directives éditées dans le guide « CDC-Atlanta 2001 », ont été utilisées pour dé-crire l’organisation, le fonctionnement et les attributs : utilité, simplicité, acceptabilité, flexibilité, représen-tativité, réactivité, qualité des données et Valeur Prédictive Positive (VPP). Résultats: Le système opérait avec trois mécanismes de transmission des données suivant le circuit : FS-Direction préfectorale-Direction régionale-Niveau central. Trois épidémies causées par Nm W en 2016 et 2017 et Nm C en 2019 ont été détectées. Le délai moyen de vaccination réactive était de cinq semaines. La promp-titude des rapports hebdomadaires, initialement à 100%, a régressé à moins de 60% après introduction de « Argus » et « District Health Information System, deuxième version (DHIS-2) ». Les prestataires avaient prélevé le LCR et rempli la fiche d’investigation dans 92,2% (141/153), IC 95% (86,7% - 95,9%) des cas. Dans la base de données, respectivement 24,6% (252/1024), IC 95% (22,2% - 27,3%) et 20,7% (212/1024), IC 95% (18,3% - 23,3%] des données manquaient pour les variables « Résultat final » et « Classification finale ». Les cas provenaient de tous les districts et représentaient toutes les tranches d’âge. La Valeur Pré-dictive Positive globale a varié de 42,1% (122/290), IC 95% (36,3% - 48,0%) en 2016 à 64,0% (48/75), IC 95% (52,1% - 74,8%) en 2019. Conclusion: Le système de surveillance de la MBA dans la région des Savanes était utile, acceptable et représentatif malgré certaines données manquantes. Il était complexe, non flexible et peu prompt pour la riposte vacci-nale. Il faudrait un mécanisme unique de transmission des données, pouvoir confirmer les cas dans les HD et auditer les données. Introduction: Case-by-case surveillance of Acute Bacterial Meningitis (ABM) started since 2014 in the Savannah region but the level of its performance is unknown. The objective of this study was to evaluate this surveillance system from 2016 to 2019. Methods: This was a cross-sectional study that included all cases of (ABM) notified in the Savanes region between week 1 (W1) 2016 and week19 2019, 34 peri-urban Health Formations (SFs), seven district hospitals (DHs) and the regional hospital (RHC). Data were collected by interview, observation and review of records. The guidelines published in the CDC-Atlanta 2001 guide were used to describe the organisation, functioning and attributes: utility, simplicity, acceptability, flexibility, representativeness, responsiveness, data quality and Positive Predictive Value (PPV). Results: The system operated with three data transmission mechanisms following the circuit: FS-Prefectural Directorate-Regional Directorate-Central level. Three epidemics caused by Nm W in 2016 and 2017 and Nm C in 2019 were detected. The average time for reactive vaccination was five weeks. The promptness of weekly reporting, initially 100%, decreased to less than 60% after the introduction of Argus and District Health Information System, version 2 (DHIS-2). Providers had collected CSF and completed the investigation form in 92.2% (141/153), 95% CI (86.7% - 95.9%) of cases. In the database, 24.6% (252/1024), 95% CI (22.2% - 27.3%) and 20.7% (212/1024), 95% CI (18.3% - 23.3%) of the data were missing for the variables "Final outcome" and "Final classification" respectively. The cases came from all districts and represented all age groups. The overall Positive Predictive Value ranged from 42.1% (122/290), 95% CI (36.3% - 48.0%) in 2016 to 64.0% (48/75), 95% CI (52.1% - 74.8%) in 2019. Conclusion: The surveillance system for MVA in the Savanes region was useful, acceptable and representative despite some missing data. It was complex, inflexible and not very prompt for the vaccine response. A single data transmission mechanism is needed, as well as the ability to confirm cases in HDs and audit data

HIV prevalence and risk behaviors among female sex workers in Togo in 2017: a cross-sectional national study

BACKGROUND: The HIV epidemic remains an important public health challenge for the sub-Saharan region. Female Sex Workers (FSW) in this region are among the most vulnerable of the key population groups with HIV prevalence as high as twice that of the general population. The aim of this study was to estimate HIV prevalence and explore sexual risk behaviors among FSW in Togo. METHODS: A cross-sectional study using a Respondent Driven Sampling method was conducted across the six regions of country among FSW in 2017. A comprehensive questionnaire was used to explore socio-demographic characteristics, sexual history, HIV knowledge, and sexual behaviors. HIV rapid tests were used to assess HIV infection. RESULTS: A total of 1,036 FSW, with a median age of 26 years old [interquartile range (IQR): 22-33], participated in the study, with 49.2% (n = 510) of them having reached secondary school. Median age at first sexual intercourse was 20 years old [IQR: 17-25] and estimated number of clients per week was of 5 [IQR: 3-10]. A total of 936 (95.6%) reported the use of a condom during last sexual intercourse with a client and 493 (47.6%) reported the use of a condom during their last sexual intercourse with a partner or husband. HIV prevalence was 13.2% [95% CI: 11.2 - 15.4], and was associated with age (being between 26 and 32 years old; aOR = 4.5; 95% CI: [2.4 - 9.1], p < 0.0001) and ≥ 33 years old; aOR = 6.4; 95% CI [3.5 - 12.7], p < 0.0001), education level (being in primary school or less; aOR = 1.7; 95% CI: [1.1-2.6]; p = 0.012) and the number of partners per week (more than 2 and 3 partners; aOR = 2.5; 95% CI [1.2-5.2]; p = 0.014). CONCLUSIONS: HIV prevalence and sexual risk behaviors remain high among FSW in Togo, despite prevention efforts aimed at curbing this trend. Other factors, such as access and availability of condoms, the social and legal environment in which FSW operate, should be considered for HIV prevention strategies in this population

Unmet needs for modern contraceptive methods among sexually active adolescents and young women in Togo: a nationwide cross-sectional study

BackgroundThe unmet need for modern contraceptives among sexually active adolescent and young women (AYW) in Africa contributes to high morbidity and mortality. To investigate the prevalence of unmet need for modern contraceptives and its associated factors among AYW in Togo, we performed a secondary analysis of data from the MICS-62017 survey.MethodWe extracted data from sexually active AYW aged 15–24  years for the analysis and used multi-level logistic regression models to identify factors associated with unmet need for modern contraceptives.ResultsAmong the AYW, the median age was 20  years. The prevalence of unmet need for modern contraceptives was 27.02%. Factors that increased the likelihood of having unmet need for contraceptives included being in the “Poor” or “Middle” quintile of household wealth, aged 20–24  years, and completing primary or secondary education. Living in a household headed by a woman and having a household head aged 19–38, 39–58, or greater than 78  years decreased the likelihood of unmet need for modern contraceptives.ConclusionThe study highlights the high-unmet need for modern contraceptives among sexually active AYW in Togo and emphasizes the importance of addressing individual and household/community factors to improve their sexual and reproductive health. Interventions such as increasing AYW awareness, providing social marketing campaigns in schools, and targeting men-headed households could help promote modern contraceptive use and improve the sexual and reproductive health of AYW in Togo

PLoS One

OBJECTIVES: This study aimed to describe HIV testing uptake, as well as HIV prevalence and its associated factors among older adults aged ≥50 years in health facilities in Togo. METHODS: A cross-sectional study was carried out from February 2018 to June 2019 among hospitalized older adults aged ≥50 years in tertiary and secondary hospitals in Togo. HIV testing was performed according to the national algorithm. Socio-demographic data and HIV testing history were collected using a standardized questionnaire. RESULTS: A total of 619 patients (43.9% female) of median age 61 years, (IQR: 55-70) were recruited and offered HIV testing. Among them, 25.7% had never previously tested for HIV. In total, 91.6% (567/619) accepted HIV testing while 8.4% (52/619) refused to be tested. Of those who tested, forty patients were HIV positive, yielding a prevalence of 7.1%. Twenty-three patients (57.5%) were newly diagnosed with HIV infection. In multivariable analysis, two factors were associated with HIV infection: living alone (aOR = 5.83; 95%CI = [2.26-14.53]) and being \textbackslashtextless60 years (aOR = 3.12; 95%CI = [1.51-6.66]). CONCLUSION: The majority of older adults in this study accepted testing for HIV and almost three in five HIV positive older adults were newly diagnosed with HIV as a result of this testing. There is an urgent need to integrate older adults into responses to the HIV epidemic and to strengthen targeted prevention care and treatment in this population