Distribution of new HIV infections among key risk population groups in Togo

Introduction: good data on the epidemiology of modes of transmission of HIV among population at risk are important for development of prevention strategies, and resource allocation for the implementation of the interventions. We sought to estimate new HIV infections among key risk groups in Togo. Methods: we conducted a systematic review of epidemiological data on HIV and AIDS as part of the HIV control strategies in Togo from 2001 to 2012 following the PRISMA guidelines. We used the Mode of Transmission (MoT) modelling tool to estimate the incidence of new HIV infections in high risk groups. The MoT tool was developed and validated by UNAIDS and implemented by several countries using data on the HIV epidemic to estimate new HIV infections that will appear in the core groups. We used Epi-MoT tool to assess the availability and the quality of data. A score of availability of data over 50% and the quality over 1.5 were required to proceed to the MoT analysis. Uncertainty analysis to assess the reliability of the results was performed. Results: incidence of new HIV infections was estimated at 6,643 (95% CI = 5274, 9005) with an incidence rate of 203 per 1,000,000 inhabitants. The proportion of new HIV infections was 61.9% (95% CI = 46.2 to 71.7) in stable heterosexual couples compare to 14.01% (95% CI = 7.2 to 23.3) in people having casual sex. In high-risk groups new HIV infections accounted for 2.4% among sex workers (SWs) (95% CI = 1.2 - 4.1), 7.9% among clients of SWs (95% CI = 3.9-14.1) and 6.9% among men who have sex with men (MSM) (95% CI = 3.1 to 13.1). Conclusion: we describe the prediction of the HIV epidemic with a large contribution of stable heterosexual couples in the occurrence of new infections. But HIV incidence remains high in key risk populations. Innovative strategies for risk reduction should be strengthened to reduce the transmission especially in stable heterosexual couples

Loss of HIV-infected patients on potent antiretroviral therapy programs in Togo: risk factors and the fate of these patients

Introduction: National programs are facing challenges of loss to follow-up of people living with HIV/AIDS (PLWHA) on antiretroviral therapy (ART). We sought to identify risk factors associated with early loss to follow-up among HIV-infected patients on ART in Togo and the outcome of such patients. Methods: This was a retrospective cross-sectional study using medical records of all patients older than age 15 years enrolled at 28 treatment centers who were on ART programs and who were lost to follow-up from 2008 to 2011. Results: Of the 16,617 patients on ART, 1,216 (7.3%) were lost to follow-up. Most (94.1%) were infected with HIV-1 and 32.6% were in WHO stage III or IV. The median CD4 count was 118/mm3 (IQR: 58-178 cells/mm3). No telephone number was mentioned in the medical records of 212 patients. Of the 1004 patients whose phone number was listed, 802 patients (79.9%) were not reachable on the recorded number, 114 patients (11.4%) were alive and 88 patients (8.8%) had died. In multivariate analysis, factors associated with loss to follow-up during the first 6 months of ART were: age below 35 years (OR=1.6; 95%CI: 1.2-2.2), female sex (OR=1.8; 95%CI: 1.3-2.5), WHO stage III or IV (OR=1.7; 95%CI: 1.3-2.2), existence of an opportunistic infection (OR=2.3; 95%CI: 1.5-3.1), and follow-up in a public centre (OR=1.9; 95%CI: 1.2-3.3). Conclusion: This study identified several factors associated with lost to follow-up during the first 6 months of ART, and confirmed high mortality among these patients. The National AIDS Program should strengthen medical support of PLWHA in Togo including active case follow-up.Key words: Africa, HIV, human immunodeficiency virus, lost to follow-up, people living with HIV, Tog

HIV prevalence and behavioral studies in female sex workers in Togo: a decline in the prevalence between 2005 and 2011

Introduction: We determined the sero-prevalence of HIV among female sex workers (FSWs) in Togo identified their sexual risk behaviors.Methods: We conducted a cross-sectional study from 17 to 27 December, 2011 on 1106 FSWs in Togo. Venous sample were collected to estimate HIV prevalence as per national algorithms. Behavior data were collected by interviewer-administered questionnaires. Results: Of the 1106 FSWs (mean age = 27.6 years) surveyed, 17% and 63% had their first sexual intercourse before the age of 15 and 18 years respectively. Overall, 43.4% of the FSWs had more than seven clients per week. Most FSWs (95%) said they had sex using a condom in their lifetime while 8.8% had used a condom during their last sexual intercourse. About 79% of FSWs used a condom during their sexual encounters the previous week and 11.6% had used a condom during each of their sexual encounters the previous day. Most FSWs (62.2%) reported to have been tested for HIV. Of these, 145 (13.1%) were HIV positive. HIV sero-prevalence decreased from 19.4% in the south to 7.5% in the north of the country. Behaviors associated with FSW being HIV positive included: FSW having more than 7 clients per week (p<0.001), not using condoms at every intercourse act (p=0.003) or during the last sexual encounter (p=0.006) and trading sex in brothels (p<0.001). Conclusion: We estimate HIV sero-prevalence among FSWs in 2011 to be 13.1% in Togo, significantly lower than a prevalence of 29.5% estimated previously in 2005. Inconsistent use of condoms was identified as associated with high risk factor for acquiring HIV.Key words: Sex workers, HIV, sexual behavior, Tog

Métastases cutanées vues au laboratoire d’anatomie pathologique à Lomé, Togo entre 2005 et 2014

Introduction: L'objectif de cette étude était de documenter le profil épidémiologique et histologique des métastases cutanées vues au laboratoire d'anatomie pathologique (LAP) de Lomé. Méthodes: Il s'agissait d'une étude descriptive et transversale portant sur des cas de métastases cutanées observées au LAP du CHU Sylvanus Olympio entre 2005 et 2014.Résultats: Au cours de cette période d'étude, nous avons recensé 32 cas de métastases cutanées représentant 3,2% (1005 cas) de l'ensemble des cas de métastases enregistrées au LAP. L'âge moyen des patients atteints de ces métastases cutanées était de 42,6 ans et le sex-ratio (F/H) de 2,2. Sur le plan macroscopique, ces métastases étaient nodulaires dans 15 cas, bourgeonnantes dans 12 cas, ulcéré dans 3 cas et ulcéro-bourgeonnant dans 2 cas. Les types histologiques étaient représentés par les adénocarcinomes (19 cas, 59,4%), les carcinomes épidermoïdes (8 cas, 25 %), la maladie de Paget (3 cas, 9,4%), le carcinome à petites cellules du type neuroendocrine (un cas, 3,1%) et le mélanome (un cas, 3,1%). Selon le degré de différenciation, les métastases cutanées étaient bien différenciées dans 14 cas (56%). Les principales localisations de ces métastases cutanées étaient le thorax (11 cas, 34,4%) suivi de l'abdomen (10 cas, 31,3%). Les cancers primitifs étaient surtout d'origine mammaire (14 cas, 43,7%).Conclusion: Cette étude montre que les métastases cutanées sont relativement rares et les tumeurs malignes d'origine mammaire sont les tumeurs primitives prédominantes. Avec un pourcentage élevé des formes peu différenciées et celles indifférenciées, l'amélioration du plateau technique du LAP (immunohistochimie) permettra d'accroitre ses capacités diagnostiques

Polio Eradication Initiative contribution in strengthening immunization and integrated disease surveillance data management in WHO African region, 2014

AbstractIntroductionThe PEI Programme in the WHO African region invested in recruitment of qualified staff in data management, developing data management system and standards operating systems since the revamp of the Polio Eradication Initiative in 1997 to cater for data management support needs in the Region. This support went beyond polio and was expanded to routine immunization and integrated surveillance of priority diseases. But the impact of the polio data management support to other programmes such as routine immunization and disease surveillance has not yet been fully documented. This is what this article seeks to demonstrate.MethodsWe reviewed how Polio data management area of work evolved progressively along with the expansion of the data management team capacity and the evolution of the data management systems from initiation of the AFP case-based to routine immunization, other case based disease surveillance and Supplementary immunization activities.ResultsIDSR has improved the data availability with support from IST Polio funded data managers who were collecting them from countries. The data management system developed by the polio team was used by countries to record information related to not only polio SIAs but also for other interventions. From the time when routine immunization data started to be part of polio data management team responsibility, the number of reports received went from around 4000 the first year (2005) to >30,000 the second year and to >47,000 in 2014.ConclusionPolio data management has helped to improve the overall VPD, IDSR and routine data management as well as emergency response in the Region. As we approach the polio end game, the African Region would benefit in using the already set infrastructure for other public health initiative in the Region

Syndrome Keratitis-Ichtyosis-Deafness (KID) chez un enfant togolais issu d’un mariage consanguin

Le syndrome KID est une affection génétique rare associant kératite, ichtyose et surdité. Nous rapportons un cas dont la surdité s'est compliquée de mutisme chez un enfant togolais issu d'un mariage consanguin.Il s'agissait d'une fillette de 9 ans admise en dermatologie pour une peau sèche et une kératodermie palmoplantaire évoluant depuis l'enfance, une surdité sévère et un mutisme total évoluant depuis la naissance. Il n'y avait pas d'histoire familiale connue de syndrome KID. Les parents de cet enfant sont des cousins germains. A l'examen, on notait une kératodermie palmoplantaire typique en cuir grossier, une peau sèche ichtyosiforme finement squameuse avec un aspect pachydermique aux genoux et un aspect arlequin aux jambes. L'examen ophtalmologique avait noté une blépharo-conjonctivite, une xérophtalmie, une photophobie et une absence de sourcils. L'examen ORL avait objectivé une hypotrophie des pavillons des oreilles, une surdité sévère et un mutisme total. La particularité de cette observation réside dans la sévérité de l'atteinte auditive qui s'est compliquée de mutisme. Notre enfant étant née de parents consanguins sains, sans histoire familiale de KID, nous pensons que le mode de transmission est probablement sporadique. Une étude moléculaire du cas index et de ses parents, non réalisée à cause de notre plateau technique limité aurait pu le confirmer

Hepatitis B infection in HIV-1-infected patients receiving highly active antiretroviral therapy in Lomé, Togo: Prevalence and molecular consequences

Background. No data are available on HIV/hepatitis B virus (HBV) or hepatitis C virus coinfection in Togo, and patients are not routinely tested for HBV infection.Objectives. To determine the prevalence of HBV and the risk of HBV drug resistance during antiretroviral treatment in HIV-coinfected patients in Togo.Method. This cross-sectional study was carried out in Lomé, Togo, from January 2010 to December 2011 among HIV-infected patients who had been on antiretroviral therapy (ART) for at least 6 months.Results. In total, 1 212 patients (74.9% female) living with HIV/AIDS and treated with ART were included in the study. The seroprevalence of hepatitis B surface antigen (HBsAg) was 9.7% (117/1 212; 95% confidence interval (CI) 8.04 - 11.45). Of these 117 HBsAg-positive patients, 16 (13.7%) were hepatitis B e antigen (HBeAg)-positive, and 115 (98.3%) were on lamivudine. The HBV DNA load was >10 IU/ mL in 33/117 patients overall (38%), and in 87.5% of 16 HBeAg positive patients (p<0.0001). In multivariate analysis, factors associated with HBV DNA load >10 IU/mL were HBeAg positivity (adjusted odds ratio (aOR) 6.4; p=0.001) and a higher level of education (aOR 6.5; p=0.026). The prevalence of HBV resistance to lamivudine was 13.0% (15/115; 95% CI 7.0 - 19.0). The detected resistance mutations were rtL180M (14/15 patients) and rtM204V/I (15/15).Conclusion. The seroprevalence of HBV among ART-treated HIV-infected patients in Togo was 9.7%. The prevalence of HBV lamivudine resistance mutations after 2 years of ART was 13.0%. These results suggest that HBV screening before ART initiation can be based on HBsAg testing

Profil Des Infections Ostéoarticulaires En Consultation Rhumatologique Au CHU- Kara (Togo)

Introduction: Osteoarticular infections remain public health problems in Africa. We aim at determining the clinical forms, topographic and etiological osteoarticular infections in a rheumatology unit of northern Togo. Methods: We conducted a cross-sectional study from April 2012 to March 2015 on inpatient records having suffered from musculoskeletal infection. Results: Of the 1813 patients admitted to the department in three years, 86 (4.74%) suffered from musculoskeletal infection. Of them, 36 (41.86%) were men and 50 (58.1% 4) were women, with a sex ratio (M/F) of 0.72. The mean age of the patients was 45 years. The mean duration of disease progression was 3.5 months. The different clinical forms observed were: spondylitis (47 patients, 54.65%), infectious arthritis (31 cases, 36.05%) and osteomyelitis (eight cases; 9.30%). The infection was likely tuberculous in 53 patients (61.63%), including 44 cases of Pott's disease. A banal germ was mentioned in the 33 others patients (38.37%). In four cases, the germ was isolated: Staphylococcus aureus (three cases) and Staphylococcus epidermidis (one case). The joints most affected by the infection were the hip (nine patients) and the knee (eight patients). Infection was multifocal in 14 cases (16.27%). The main risk factors for the infection identified were: promiscuity and poor hygiene (59.30%), alcoholism (26.74%) and retroviral infection (12.79%). Conclusion: This study and joint infections are a common reason for rheumatology consultation in northern Togo with a significant share of multifocal forms

Pathologies cutanées vues au laboratoire d’anatomie pathologique à Lomé, Togo

Introduction: Les affections cutanées restent encore un problème de santé publique dans la majorité des pays en développement. Notre étude s'est fixée comme objectif de déterminer les aspects épidémiologiques et histologiques des dermatoses au Togo. Méthodes: Il s'agissait d'une étude descriptive et transversale portant sur les cas de dermatoses diagnostiquées de 2002 à 2013 (10 ans) au laboratoire d'anatomie pathologique (LAP) du CHU- Sylvanus Olympio. Tous les cas d'examen portant sur un prélèvement de peau (biopsie, exérèse, pièces opératoires) ont été colligés de 2002 à 2013 à partir des données des registres dudit laboratoire. Résultats: Au cours de la période d'étude, 1119 (7,6 %) des 14720 prélèvements reçus au LAP étaient des prélèvements de peau, ce qui correspond à une fréquence annuelle de 111,9 prélèvements. L'âge moyen des patients dont les prélèvements de peau appartenaient était de 35,4 ans et le sex-ratio (H/F) de 1,39. Au plan histologique, les lésions cutanées étaient reparties en dermatoses non tumorales (390 cas, 34,8%), dermatoses tumorales et pseudo tumorales (607 cas, 54,2%) et des dermatoses de diagnostic incertain (122 cas, 10,9%). La lèpre (95 cas, 8,5%) et le carcinome épidermoïde (134 cas, 11,9%) étaient les types histologiques les plus fréquents. Conclusion: Les dermatoses tumorales et pseudo tumorales font plus l'objet de demande d'examen anatomopathologique au Togo, ce qui s'explique par la hantise de tumeurs malignes devant toute dermatose tumorale. L'amélioration du plateau technique du LAP (immunohistochimie, immunofluorescence directe) permettra d'accroitre ses capacités diagnostiques.Keywords: Pathologie cutanée, histopathologie, Tog

Morbidity and mortality due to malaria in Est Mono district, Togo, from 2005 to 2010 : a times series analysis

BACKGROUND: In 2004, Togo adopted a regional strategy for malaria control that made use of insecticide-treated nets (ITNs), followed by the use of rapid diagnostic tests (RDTs), artemisinin-based combination therapy (ACT). Community health workers (CHWs) became involved in 2007. In 2010, the impact of the implementation of these new malaria control strategies had not yet been evaluated. This study sought to assess the trends of malaria incidence and mortality due to malaria in Est Mono district from 2005 to 2010. METHODS: Secondary data on confirmed and suspected malaria cases reported by health facilities from 2005 to 2010 were obtained from the district health information system. Rainfall and temperature data were provided by the national Department of Meteorology. Chi square test or independent student’s t-test were used to compare trends of variables at a 95% confidence interval. An interrupted time series analysis was performed to assess the effect of meteorological factors and the use of ACT and CHWs on morbidity and mortality due to malaria. RESULTS: From January 2005 to December 2010, 114,654 malaria cases (annual mean 19,109 ± 6,622) were reported with an increase of all malaria cases from 10,299 in 2005 to 26,678 cases in 2010 (p<0.001). Of the 114,654 malaria cases 52,539 (45.8%) were confirmed cases. The prevalence of confirmed malaria cases increased from 23.1 per 1,000 in 2005 to 257.5 per 1,000 population in 2010 (p <0.001). The mortality rate decreased from 7.2 per 10,000 in 2005 to 3.6 per 10,000 in 2010 (p <0.001), with a significant reduction of 43.9% of annual number of death due to malaria. Rainfall (β-coefficient = 1.6; p = 0.05) and number of CHWs trained (β-coefficient = 6.8; p = 0.002) were found to be positively correlated with malaria prevalence. CONCLUSION: This study showed an increase of malaria prevalence despite the implementation of the use of ACT and CHW strategies. Multicentre data analysis over longer periods should be carried out in similar settings to assess the impact of malaria control strategies on the burden of the disease. Integrated malaria vector control management should be implemented in Togo to reduce malaria transmission.AFENET and SAFELTPhttp://www.malariajournal.com/content/11/1/389am2013ay201