Design and challenges of a large HIV prevention clinical study on mother-to-child transmission: ANRS 12397 PROMISE-EPI study in Zambia and Burkina Faso

Under embargo until: 2022-04-23Post-natal HIV infection through breastfeeding remains a challenge in many low and middle-income countries, particularly due to non-availability of alternative infant feeding options and the suboptimal Prevention of Mother to Child Transmission of HIV-1 (PMTCT) cascade implementation and monitoring. The PROMISE-EPI study aims to address the latter by identifying HIV infected mothers during an almost never-missed visit for their infant, the second extended program on immunization visit at 6–8 weeks of age (EPI-2). The study is divided into 3 components inclusive of an open-label randomized controlled trial aiming to assess the efficacy of a responsive preventive intervention compared to routine intervention based on the national PMTCT guidelines for HIV-1 uninfected exposed breastfeeding infants. The preventive intervention includes: a) Point of care testing for early infant HIV diagnosis and maternal viral load; b) infant, single-drug Pre-Exposure Prophylaxis (PrEP) (lamivudine) if mothers are virally unsuppressed. The primary outcome is HIV-transmission rate from EPI-2 to 12 months. The study targets to screen 37,000 mother/infant pairs in Zambia and Burkina Faso to identify 2000 mother/infant pairs for the clinical trial. The study design and challenges faced during study implementation are described, including the COVID-19 pandemic and the amended HIV guidelines in Zambia in 2020 (triple-drug PrEP in HIV exposed infants guided by quarterly maternal viral load). The changes in the Zambian guidelines raised several questions including the equipoise of PrEP options, the standard of care-triple-drug (control arm in Zambia) versus the study-single-drug (intervention arm).acceptedVersio

Changing trends in mastitis

<p>Abstract</p> <p>The global dairy industry, the predominant pathogens causing mastitis, our understanding of mastitis pathogens and the host response to intramammary infection are changing rapidly. This paper aims to discuss changes in each of these aspects. Globalisation, energy demands, human population growth and climate change all affect the dairy industry. In many western countries, control programs for contagious mastitis have been in place for decades, resulting in a decrease in occurrence of <it>Streptococcus agalactiae </it>and <it>Staphylococcus aureus </it>mastitis and an increase in the relative impact of <it>Streptococcus uberis </it>and <it>Escherichia coli </it>mastitis. In some countries, <it>Klebsiella </it>spp. or <it>Streptococcus dysgalactiae </it>are appearing as important causes of mastitis. Differences between countries in legislation, veterinary and laboratory services and farmers' management practices affect the distribution and impact of mastitis pathogens. For pathogens that have traditionally been categorised as contagious, strain adaptation to human and bovine hosts has been recognised. For pathogens that are often categorised as environmental, strains causing transient and chronic infections are distinguished. The genetic basis underlying host adaptation and mechanisms of infection is being unravelled. Genomic information on pathogens and their hosts and improved knowledge of the host's innate and acquired immune responses to intramammary infections provide opportunities to expand our understanding of bovine mastitis. These developments will undoubtedly contribute to novel approaches to mastitis diagnostics and control.</p

Are healthcare workers at higher risk of HIV infection than the general population in Burkina Faso?

In order to assess the HIV prevalence in healthcare workers (HCWs) in Burkina Faso, we conducted a national survey in 97 health facilities from urban and rural areas. Of 1570 HCWs who agreed to participate, 1013 (64·5%) provided a urine sample for HIV testing. The crude prevalence of HIV in HCWs was 3·5% (95% CI 2·3-4·6). HIV prevalence was 0·7% in students and trainees, 3·8% in nurses and midwives, 4·5% in administrative workers, and 4·6% in laboratory workers. After age and area standardization, men from the Demographic Health Survey (DHS) had a similar HIV prevalence (2·3%, 95% CI 1·4-2·9) as male HCWs (2·5%, 95% CI 1·1-4·0), while female HCWs were more infected (4·5%, 95% CI 2·5-6·0) than women from the DHS (2·1%, 95% CI 1·3-2·4). A voluntary counselling and testing (VCT) programme should be specifically implemented and adapted for female HCWs.info:eu-repo/semantics/publishe

Voluntary HIV testing and risky sexual behaviours among health care workers: a survey in rural and urban Burkina Faso

BACKGROUND: Voluntary counselling and testing (VCT) together with a safe sexual behaviour is an important preventive strategy in the control of HIV. Although Health care workers (HCWs) are critical in the response to HIV, little is known about VCT and high risk behaviours (HRB) among this group in West Africa. This study aims to assess the prevalence of VCT and HRB among HCWs in Burkina Faso. METHODS: We collected data through a questionnaire in urban areas (Ouagadougou and Bobo-Dioulasso) and rural areas (Poni and Yatenga) among HCWs from 97 health care facilities. Urine samples were collected, screened for HIV using a Calypte(R) test kit and confirmed by Western Blot. Multiple logistic regression analysis was performed to identify factors associated with the use of VCT services and with high-risk sex behaviour. RESULTS: About 92.5% of eligible HCWs participated (1570 out of 1697). Overall, 38.2% of them (34.6% of women and 42.6% of men) had ever used VCT services. About 40% of HCWs reported that fear of knowing the test result was the main reason for not doing the HIV test. Male HCWs (p = 0.001), laboratory workers (p < 0.001), those having two years or more experience (p = 0.03), and those who had multiple partners (p = 0.001) were more likely to have tested for HIV. One fifth of HCWs reported multiple partners. Of these, thirteen percent did not use condoms. HCWs who had multiple partners were significantly more likely to be men, single, living in rural areas, and under the age of 29 years. CONCLUSION: VCT was still very low among HCWs in Burkina Faso, while HRB was high.These findings suggest that 'HCW-friendly' VCT centres should be implemented, securing confidentiality among colleagues. In addition, refreshment courses on HIV risk reduction, counselling and testing are certainly required during the professional career of HCWs

Who Is Going for VCT? A Case Study in Urban Burkina Faso.

Introduction. Voluntary HIV counselling and testing (VCT) is a key element of treatment and is essential for prevention of vertical HIV transmission. Little information is available on the uptake of VCT in Burkina Faso. This study aims to assess the prevalence of VCT in urban Burkina Faso, where the epidemic is still highly concentrated. Methods. We conducted a two-stage clustered population-based survey among 1,694 subjects living in Ouagadougou, Burkina Faso. After informed consent was obtained, a behavioural questionnaire was administered to participants. Results. Overall, 10.2% of individuals had used VCT, while 9% were women. Among women who had a child after the launch of the programme to prevent mother-to-child transmission (PMTCT), only 10.4% have been tested for HIV. Almost all participants (99.3%) were aware of HIV/AIDS, and 65% knew the main methods of prevention. In multivariate analysis, older age and being married and better educated were independent factors associated with VCT. Conclusions. Despite high public knowledge and awareness about HIV, VCT uptake was still very low and PMTCT coverage was poor. New strategies are required to increase VCT uptake in urban areas, in particular among the youngest age.info:eu-repo/semantics/publishe

Are teachers at higher risk of HIV infection than the general population in Burkina Faso?

In order to assess the human immunodeficiency virus (HIV) prevalence among teachers in Burkina Faso, we carried out a national survey in 336 primary and secondary schools from urban and rural areas. Among 2088 teachers who agreed to participate, 1498 (71.7%) provided urine for HIV testing. The crude prevalence of HIV among teachers was 2.8% (95% confidence interval [CI]: 2.0-3.6), with no difference between teachers from primary schools (2.9%, 95%CI: 2.1-4.0) and those from secondary schools (2.5%, 95%CI: 0.5-4.5). Age- and area-standardized HIV prevalence was 1.0% (95%CI: 0.4-1.2) in male teachers, 2.5 times lower than among men in the general population (as assessed from a concomitant Demographic Health Survey), and it was 3.5% (95%CI: 2.5-5.2) in female teachers, 1.7 times higher than in Demographic Health Survey women.This finding calls for the implementation of specific HIV prevention programmes in the education sector targeting women more specifically. © The Author(s) 2013

Who Is Going for VCT? A Case Study in Urban Burkina Faso

Introduction. Voluntary HIV counselling and testing (VCT) is a key element of treatment and is essential for prevention of vertical HIV transmission. Little information is available on the uptake of VCT in Burkina Faso. This study aims to assess the prevalence of VCT in urban Burkina Faso, where the epidemic is still highly concentrated. Methods. We conducted a two-stage clustered population-based survey among 1,694 subjects living in Ouagadougou, Burkina Faso. After informed consent was obtained, a behavioural questionnaire was administered to participants. Results. Overall, 10.2% of individuals had used VCT, while 9% were women. Among women who had a child after the launch of the programme to prevent mother-to-child transmission (PMTCT), only 10.4% have been tested for HIV. Almost all participants (99.3%) were aware of HIV/AIDS, and 65% knew the main methods of prevention. In multivariate analysis, older age and being married and better educated were independent factors associated with VCT. Conclusions. Despite high public knowledge and awareness about HIV, VCT uptake was still very low and PMTCT coverage was poor. New strategies are required to increase VCT uptake in urban areas, in particular among the youngest age

Epidemiology of herpes simplex virus type 2 infection in rural and urban Burkina Faso.

Herpes simplex virus type 2 (HSV-2) infection enhances human immunodeficiency virus (HIV) susceptibility and may increase sexual transmission, but few data on HSV-2 prevalence are available from West Africa. The main objective of this study was to describe the prevalence and determinants of HSV-2 among adults in urban and rural Burkina Faso

Low seroprevalence of syphilis in Burkina Faso.

Little information is available on the epidemiology of syphilis in West Africa, where this infection is routinely screened in antenatal clinics to prevent congenital infection. In order to inform control programmes, the burden of active syphilis was estimated among pregnant women and adults in Burkina Faso