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

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

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

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.Objective. 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/mLwere 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

L’utilisation de l’approche CTC: quel impact sur la couverture vaccinale lors de la campagne préventive de vaccination contre la méningite A avec le MenAfriVac au Togo en 2014?

Introduction: Une campagne de vaccination contre la méningite A avec le vaccin MenAfriVac a été organisée dans les quatre régions septentrionales du Togo du 28 novembre au 07 décembre 2014. L'approche CTC a été utilisée pour la première fois à une grande échelle pour la campagne de vaccination dans dix districts sanitaires du Togo. L'objectif de cette étude était d'estimer la couverture vaccinale et, de déterminer l'effet de l'utilisation de la Chaîne à Température Contrôlée (CTC) sur ces couvertures vaccinales.Méthodes: L'enquête s'est déroulée du 9 au 14 mars 2015, soit environ 3 mois après la fin de la campagne de vaccination dans ces quatre régions. Le sondage en grappe à deux degrés stratifiés selon les régions a été utilisé. Dans 10 districts, le Togo a fait le choix d'utiliser le vaccin MenAfriVac en CTC.Résultats: Au total, 2707 ménages ont été enquêtés et 9082 personnes âgées de 1 à 29 ans ont été interviewées. L'âge moyen des personnes enquêtées était de 11,8±7,7 ans et le sex-ratio (H/F) de 1,01. Le nombre moyen de personnes par ménage était de 5,7 et celui des personnes de 1 à 29 ans ciblées par la campagne était de 3,4. Sur les 9082 personnes enquêtées, 8889 (98%) étaient vaccinées. En analyse multivariée, les facteurs associés à la couverture vaccinale avec le MenAfrivac étaient la résidence dans la zone au moment de la campagne (aOR = 4,52 ; 95%IC = [4.07 - 4.97]) et le fait d'être informé de la campagne avant son démarrage (aOR=2,42 ; 95%IC = [2.05 - 2.80]). Par contre, la couverture vaccinale n'était pas différente selon la zone ayant utilisé l'approche CTC ou non (aOR=0,09 ; 95%IC = [-0,27-0,45]). Deux cent sept personnes interrogées (2,3%) ont déclaré avoir eu une Manifestation Adverse Post Immunisation (MAPI) après l'administration du vaccin. Il s'agissait surtout de MAPI mineures à type de fièvre,  d'abcès et de gonflement au point d'injection.Conclusion: Les résultats de cette enquête montrent que l'utilisation de la CTC dans un pays à ressources limitées comme le Togo n'a pas eu un effet négatif sur les couvertures vaccinales. En effet, il n'y avait pas de différence entre la couverture vaccinale dans les zones CTC et celles non CTC. Il importe de capitaliser l'expérience acquise pour l'utilisation des vaccins du Programme Elargi de Vaccination avec l'approche CTC surtout dans les pays à ressources limitées confrontés à la disponibilité de la chaîne de froid.Mots clés: Meningitis A, MenAfriVac vaccine, CTC, immunization coverage, TogoEnglish Title: Impact of Controlled Temperature Chain (CTC) approach on immunization coverage achieved during the preventive vaccination campaign against meningitis A using MenAfriVac in Togo in 2014English AbstractBackground: a vaccination campaign against meningitis A using MenAfriVac vaccine was implemented in the four regions of northern Togo from 28 November to 7 December 2014. CTC approach was first used on a large scale in a vaccination campaign in ten health districts in Togo. This study aims to estimate the immunization coverage and to determine the effect of Controlled Temperature Chain (CTC) approach on these immunization coverages.Method: we conducted a survey from 9 to 14 March 2015 (for approximately 3 months) after the end of the vaccination campaign in these four regions. Interviewees were selected using two stages cluster sampling stratified according to the regions. MenAfriVac vaccine in Controlled Temperature Chain (CTC) was used in 10 districts, in Togo.Results: a total of 2707 households were surveyed and 9082 people aged 1-29 years were interviewed. The average age of the individuals surveyed was 11.8±7.7 years and sex-ratio (H/F) was 1.01. The average number of individuals per household was 5.7 and that of persons aged 1-29 years targeted in the campaign was 3.4. Out of 9082 people surveyed 8889 (98%) were vaccinated. Multivariate analysis showed that the factors associated with immunization coverage using MenAfrivac vaccine were: habitual residence in the area at the time of the campaign (AOR = 4.52; 95%CI = [4.07 - 4.97]) and level of information about the campaign before it starts (AOR=2.42; 95%CI = [2.05 - 2.80]). By contrast, there were no differences in vaccination coverage between the areas based on whether the CTC approach was used or not (AOR=0.09; 95%CI = [-0.27 - 0.45]). Two hundred and seven respondents (2.3%) reported that they had Adverse Event Following Immunisation (AEFI) after the administration of the vaccine. These were usually minor AEFI involving fever, abscesses and swelling at the injection site.Conclusion: survey results show that the use of CTC in a country with limited resources such as Togo doesn't have a negative impact on immunization coverage. Indeed, there was no difference between immunization coverage in CTC and non-CTC areas. It is important to capitalize on the experience gained in order to use vaccines by Expanded Program of Immunization in CTC approach especially in countries with limited resources in terms of cold chain availability.Keywords: Meningitis A, MenAfriVac vaccine, CTC, vaccine coverage, Tog

Prevalence of syphilis among female sex workers and their clients in Togo in 2011

Abstract Background During the last ten years, a resurgence of syphilis has occurred in many countries worldwide, including Togo. Previous studies have shown a wide range of syphilis infection among the female sex workers (FSWs), from 1.5 to 42.1%. In Togo, Key populations, including FSWs, are rarely involved in the sentinel surveillance programs to determine the prevalence of HIV and syphilis. The aim of this study was to determine the prevalence of syphilis among female sex workers (FSWs) and their clients in Togo. Methods We conducted a cross-sectional study in December 2011 targeting FSWs and their clients in Togo. Among participant who consented, we collected blood samples for syphilis and HIV testing. Results In total, 1,836 participants (1,106 FSWs and 730 clients) were included in the survey. Their mean age was 28.6 ± 9 years. The prevalence of syphilis was 2.2% (2.2% among FSWs compare to 2.3% among their clients, p = 0.82). This prevalence was higher among FSWs over 30 years old compare to those less than 30 years old (Odd Ratio (OR) =5.03; 95% CI [1.95-13.49]). Single FSWs were three times less likely to have syphilis than those living in couple or married (OR = 3.11; CI 95% [1.16-8.83]). Brothel based or declared FSWs were 4 times more likely to be infected by syphilis than secret ones (OR = 3.89; CI 95% [1.60-9.54]). Out of the 1,836 participants of the survey, 165 (8.9%) were HIV positive. Having syphilis was associated with HIV infection (OR = 3.41; IC 95% [1.53-7.41]). Conclusion This study showed that: i) the prevalence of syphilis among FSWs and their clients was high; ii) syphilis was significantly associated with HIV infection. It is necessary to increase awareness campaigns and emphasize on condom use among this key population group