Risk factors associated with multidrug resistant tuberculosis among patients referred to Kibong’oto Infectious Disease Hospital in northern Tanzania

Background: Multidrug resistant tuberculosis (MDR-TB) remains is an important public health problem in developing world. We conducted this study to determine risk factors associated with MDR-TB and drug susceptibility pattern to second line drug among MDR TB patients in Tanzania.Methods: Unmatched case control study was conducted at Kibong’oto Infectious Diseases Hospital in Tanzania in 2014. A case was defined as any patient whose sputum yielded Mycobacterium tuberculosis that were resistance to at least rifampin (RFP) and isoniazid (INH) whereas control was defined as those sensitive to rifampin (RFP) + isoniazid (INH).  One morning sputum sample was collected from each study subject and cultured on Löwenstein-Jensen (LJ) media for M. tuberculosis. Drug susceptibility testing of isolated M. tuberculosis was done for rifampicin, isoniazid, kanamycin and ofloxacin. A semi-structured questionnaire was used to collect socio-demographic and risk factors information for MDR-TB. Results: A total of 102 cases and 102 controls were enrolled. The predominant age group was 31- 40 years, of whom cases and controls accounted for 38 (37.3%) and 35 (34.3%) of the study subjects, respectively. Majority of participants (69% cases and 71% control) were males and self-employed (62.7% cases and 84.4% controls). More than half (52%) and approximately a quarter (24.5%) of cases and control had HIV infection, respectively. About two-thirds of cases (62.7%) were cigarette smokers compared to controls (42.2%). Previous history of TB treatment accounted for approximately three folds in cases (72.5%) and only 24.5% in controls. Risk factors independently associated with MDR-TB were previous history of treatment with first line anti-TB (OR= 3.3, 95% CI 1.7-6.3), smoking (OR=1.9, 95% CI 1.0-3.5), contact with TB case (OR=2.7, 95% CI 1.4-5.1) and history of TB. All MDR TB isolates were sensitive to kanamycin and ofloxacin.Conclusion: MDR-TB among patients referred to Kibong’oto Infectious Diseases Hospital is associated with previous history of TB contact, smoking habit, and contact with TB case. All MDR TB isolates were sensitive to the tested second line drugs, Kanamycin and Ofloxacin

Reduction of HIV transmission rates from mother to child in the era of antiretroviral therapy in the Lake Victoria zone, Tanzania

Background: Since the introduction of prevention of mother to child transmission (PMTCT) in Tanzania, HIV infection rates have been reduced in different regions across the country. However, there is limited published data from the Lake Victoria zone of Tanzania regarding the effectiveness of various regimens used for PMTCT. This study was done to assess the effectiveness of antiretroviral therapy in preventing mother to child transmission of HIVMethods: Infants aged ≤18 months born to HIV positive mothers undertaking PMTCT programme and those with no intervention program from Mara, Kagera, Mwanza and Shinyanga were tested for HIV-1 DNA polymerase chain reaction (PCR). Data were analysed using STATA version 10.0 to assess factors associated with outcome.Results: A total of 1,005 study subjects were enrolled in the study. Of these 55% (554/1005) were females. Majority (82.6%; 830/1005) of the infants studied were aged 1-6 months. The median age of the infant studied was 3 months (IQR 2-4). Out of 1005 non-repetitive samples; 61(6.1%) were HIV-1 DNA PCR positive. Positive dried blood spots (DBS) rates by region were 6.4%, 5.9%, 5.6% and 5.1% in Mwanza, Mara, Kagera and Shinyanga, respectively. During pregnancy interventions, the positive rate for women with no therapy was 12.6% and for zidovudine alone was 5.4% while for triple antiretroviral therapy was 0.5%. Women who were in highly active antiretroviral therapy (HAART) during pregnancy had significantly lower positive rate than those without HAART treatment (p=0.001). Of 755 infants who received nevirapine, 3.9% were DBS positive compared to 12.8% of those who didn’t receive nevirapine (p=0.001).Conclusion: The use of antiretroviral therapy in the PMTCT programme is effective in reducing HIV transmission from mother to child

Prevalence of Hepatitis B surface antigen among pregnant women attending antenatal clinic at Nyamagana District Hospital Mwanza, Tanzania

In developing countries there is no routine screening of hepatitis B virus (HBV) infection among pregnant women resulting into limited data on its magnitude. The objective of this study was to determine the prevalence and risk factors associated with active HBV infection among pregnant women attending antenatal clinic (ANC) in Mwanza City, Tanzania. A total of 211 pregnant women were serially enrolled between May and July 2014. Hepatitis B surface antigen (HBsAg) was determined using a rapid Immuno-chromatographic assay. The median age of the study population was 23 years (IQR 20-29 years).  Of 211 pregnant women, 61.6% (130/211) were multigravidae. Eight (3.8%) of the pregnant women were positive with HBsAg. There was a significant difference in prevalence between primigravidae and multigravidae (0.8% vs. 8.6%, p=0.017). Active hepatitis B infection among pregnant women in Mwanza city is low and associated with multigravidity. Despite low prevalence of acute hepatitis B infection routine screening of HBsAg and anti HBsAg antibodies, coupled with the vaccination of those at risk should be introduced to prevent hepatitis B infection complications.

High seroprevalence of specific Toxoplasma gondii IgG antibodies among HIV/AIDS patients with immunological failure attending a tertiary hospital in northwestern Tanzania

 Toxoplasmosis is a major cause of morbidity and mortality among patients with advanced HIV disease. However, there is limited data on the magnitude of toxoplasmosis among HIV patients with immunological treatment failure. Therefore, this study was designed to determine the seroprevalence of specific Toxoplasma gondii IgG antibodies among HIV/AIDS patients attending Bugando Medical Centre in Mwanza, Tanzania. Immunological treatment failure was defined using the World Health Organization (WHO) criteria and specific T.gondii IgG antibodies were determined using indirect enzyme linked immunosorbent (ELISA). A total of 178 non-repetitive sera from HIV/AIDS patients were analyzed. The mean age of study participants was 38.5±11.3 years. Majority of study participants were males 120 (67.42%). Out of 178 patients, 38 (21.34%) were diagnosed to have immunological failure. T.gondii specific IgG antibodies were found in 26 (68.4%) of the patients with immunological failure compared to 46 (32.86%) of those without immunological failure (OR: 4.42, CI: 2.05-9.55; p<0.001). The seroprevalence of T.gondii infection is high among patients with immunological treatment failure and place them at a high risk of T. gondii encephalitis necessitating sustained trimethoprim-sulfamethaxazole prophylaxis to prevent reactivation.  

Variability of High risk HPV Genotypes among HIV Infected Women in Mwanza, Tanzania- The Need for Evaluation of Current Vaccine Effectiveness in Developing Countries.

High risk (HR) human papilloma Virus (HPV) genotypes have been associated with cervical cancer. In Tanzania there is a limited data on the epidemiology of HPV and genotypes distribution among HIV infected women. Here we document varieties of HPV genotypes associated with cervical squamous intraepithelial lesions (SIL) among HIV- infected women at Bugando Medical Centre, Mwanza-Tanzania. A cross sectional hospital based study involving HIV infected women was conducted between August and October, 2014. Exfoliated cells from ectocervix and endocervix were collected using cytobrush. HPV genotypes were detected using polymerase chain reaction (PCR) followed by sequencing using specific primers targeting broad range of HPV types. Cytology was done to establish squamous intraepithelial lesions. Log binomial regression analysis was done to establish risk ratios (RR) associated with HPV infection using STATA version 11. A total of 255 HIV infected women with mean age 39.2 ± 9.1 years were enrolled in the study. HPV DNA was detected in 138/255 (54.1 %, 95 % CI: 47-60) of HIV infected women. Twenty six genotypes were detected in various combinations; of these 17(65.3 %) were of HR genotypes. HR genotypes were detected in 124(48.6 %) of HIV infected women. Common HR genotypes detected were HPV-52(26), HPV-58(21), HPV-35(20) and HPV-16(14). The risk of being HPV positive was significantly higher among women with CD4 counts <100 (RR: 1.20, 95 % CI: 1.05-1.35, P = 0.006) and women with SIL (RR: 1.37, 95 % CI: 1.11-1.68, P = 0.005). Significant proportion of HIV infected women with low CD4 counts have various grades of cervical SIL associated with varieties of uncommon HR genotypes. There is a need to evaluate the effectiveness of the current vaccine in preventing cervical cancer in developing countries where HIV is endemic

Pediatric HIV care and treatment services in Tanzania: implications for survival.

BACKGROUND: Improving child survival for HIV-infected children remains an important health agenda. We present progress regarding care and treatment services to HIV infected children in Tanzania. METHODS: The National AIDS Control Programme Care and Treatment (CTC 2) database was used to obtain information of all children aged 0-14yearsenrolled in the HIV Care and Treatment Program between January 2011 and December 2014. We assessed eligibility for ART, time from enrolment to ART initiation, nutritional status, and mortality using Kaplan-Meier methods. RESULTS: A total of 29,531 (14,304 boys and 15,227 girls) ART-naive children aged 0-14 years were enrolled during the period, approximately 6700 to 8000 children per year. The male to female ratio was 48:50. At enrolment 72% were eligible for ART, 2-3% of children were positive for TB, and 2-4% were severely malnourished. Between 2011 and 2014, 2368 (8%) died, 9243 (31%) were Lost to Follow-up and 17,920 (61%) were on care or ART. The probability of death was 31% (95% CI 26-35), 43% (40-47), 52% (49-55) and 61% (58-64) by 1,2, 5 and 10 years of age, respectively. The hazard of death was greatest at very young ages (<2 years old), and decreased sharply by 4 years old. Children who were on ART had around 10-15% higher survival over time. CONCLUSIONS: Significant progress has been made regarding provision of paediatric HIV care and treatment in Tanzania. On average 7000 children are enrolled annually, and that approximately two thirds of children diagnosed under the age of 2 years were initiated on ART within a month. Provision of ART as soon as the child is diagnosed is the biggest factor in improving survival. However we noted that i) most children had advanced disease at the time of enrolment ii) approximately two-thirds of children were missing a baseline CD4 measurement and only 35% of children had either a CD4 count or percentage recorded, indicating limited access to CD4 testing services, and iii) 31% were lost to follow-up (LTFU). These challenges need to be addressed to improve early detection, enrolment and retention of HIV-infected children into care and improve documentation of services offered

The use of 0.01M phosphate buffered saline as detection buffer for Alere Determine® HIV rapid test in resource limited settings

Insufficient supply of manufacture’s buffers/diluents in relation to the number of strips per kit has been found to have negative impact on patients’ results. Some laboratories personnel tend to use diluents from other rapid tests manufacturers such as Bioline, Unigold as well as malaria rapid diagnostic test (MRDT). This study aimed at evaluating the use of 0.01M phosphate buffered saline (PBS) as detection buffer for Alere Determine® HIV rapid test. This study was carried out at Bugando School of Medicine in Mwanza, Tanzania. A total of 300 whole blood specimens; 150 HIV positive specimens from patients attending Care and Treatment Centreand 150 HIV negative specimens were retested for HIV status using Alere Determine® HIV rapid test employing normal Alere buffer and 0.01M PBS as buffer.Of the total specimens tested; 150 (100%) of HIV positive were positive by using both Alere buffer and 0.01M PBS while 150(100%) of HIV negative samples were negative by both Alere Determine® and 0.01M PBS. The agreement between 0.01M PBS and Alere Determine® buffer was 100%. The value of kappa indicates perfect agreement between 0.01M PBS and Alere Determine® buffer (100%). A 0.01M PBS is recommended as alternative detection buffer for Alere Determine® in cases of insufficient supply. Further investigation to evaluate the suitable buffer for other rapid tests for HIV and other diseases is recommended especially in resource limited settings.

Sero-prevalence and associated factors of Helicobacter pylori infection among adult patients with dyspepsia attending the gastroenterology unit in a tertiary hospital in Mwanza, Tanzania.

Background: Prevalence of H. pylori infection varies greatly between populations in different countries. This study was conducted to determine the magnitude of H.pylori among adult patients with dyspepsia attending the gastroenterology unit at Bugando medical centre. Methods: A cross sectional study involving 202 dyspeptic patients was conducted between June and July 2014. A Standardized data collection tool was used to collect socio-demographic characteristics. H.pylori antibodies were detected using rapid immunochromatographic tests according to manufacturer\u2019s instructions. Results: The median age of study population was 42 (IQR: 33-54). Females 105 (51.9%) formed majority of the population studied. Of 202 participants; 119 (58.9%) were from rural areas. Seroprevalence of H.pylori infection was found to be 79/202 (39.1%, 95% CI: 32.3 -45.7). As the age increased the risk of having H.pylori infection also increased (OR: 1.02 95% CI: 1-1.04, P=0.02). On multivariate logistic regression analysis untreated drinking water was found to predict H.pylori seropositivity (OR: 2.33, CI: 1.09-4.96, p=0.028). Conclusion: The seroprevalence of H.pylori among dyspeptic patients is high in this setting. Therefore the community in Mwanza should be educated on the use of safe drinking water in order to minimize H. pylori infections

Whole genome sequencing of Mycobacterium tuberculosis isolates and clinical outcomes of patients treated for multidrug-resistant tuberculosis in Tanzania.

BACKGROUND: Tuberculosis (TB), particularly multi- and or extensive drug resistant TB, is still a global medical emergency. Whole genome sequencing (WGS) is a current alternative to the WHO-approved probe-based methods for TB diagnosis and detection of drug resistance, genetic diversity and transmission dynamics of Mycobacterium tuberculosis complex (MTBC). This study compared WGS and clinical data in participants with TB. RESULTS: This cohort study performed WGS on 87 from MTBC DNA isolates, 57 (66%) and 30 (34%) patients with drug resistant and susceptible TB, respectively. Drug resistance was determined by Xpert® MTB/RIF assay and phenotypic culture-based drug-susceptibility-testing (DST). WGS and bioinformatics data that predict phenotypic resistance to anti-TB drugs were compared with participant's clinical outcomes. They were 47 female participants (54%) and the median age was 35 years (IQR): 29-44). Twenty (23%) and 26 (30%) of participants had TB/HIV co-infection BMI < 18 kg/m2 respectively. MDR-TB participants had MTBC with multiple mutant genes, compared to those with mono or polyresistant TB, and the majority belonged to lineage 3 Central Asian Strain (CAS). Also, MDR-TB was associated with delayed culture-conversion (median: IQR (83: 60-180 vs. 51:30-66) days). WGS had high concordance with both culture-based DST and Xpert® MTB/RIF assay in detecting drug resistance (kappa = 1.00). CONCLUSION: This study offers comparison of mutations detected by Xpert and WGS with phenotypic DST of M. tuberculosis isolates in Tanzania. The high concordance between the different methods and further insights provided by WGS such as PZA-DST, which is not routinely performed in most resource-limited-settings, provides an avenue for inclusion of WGS into diagnostic matrix of TB including drug-resistant TB

Prevalence and incidence rate of tuberculosis among HIV-infected patients enrolled in HIV care, treatment, and support program in mainland Tanzania.

BACKGROUND: Despite improvements in access to antiretroviral therapy (ART), mortality in people living with human immunodeficiency virus (PLHIV) is still high and primarily attributed to tuberculosis (TB) infection. In Sub-Saharan Africa, approximately 80% of HIV-related mortality cases are associated with TB. Relatively little is known about the incidence of TB among PLHIV in Tanzania and the determinant factors. We report the prevalence and incidence rate of confirmed TB and determine association with selected demographic and program-related factors based on data in the national HIV care and treatment program from 2011 to 2014. METHODS: We used the Tanzania National AIDS Control Programme database to obtain information on all HIV clients enrolled in the HIV care and treatment program between January 2011 and December 2014. We analyzed retrospective cohort data to assess the prevalence and TB incidence rate per 1000 person-years. A multivariable Cox proportional hazards regression model was used to estimate hazard ratios and 95% confidence intervals for putatively associated factors. RESULTS: Over 4 years, there were 22,071 confirmed cases of pulmonary TB in 1,323,600 person-years. The overall TB incidence was around 16.7 (95% CI 16.4-16.9) cases per 1000 person-years. The annual incidence rate decreased by 12.4 % from 17.0 (95% CI 16.5-17.4) in 2011 to 14.9 (95% CI 14.5-15.4) in 2014. The TB incidence rate was higher in persons not using ART and in males than in females. The incidence of TB was higher in patients with advanced HIV disease and decreased with increasing age. The overall prevalence of TB was 2.2%, with a peak prevalence of 2.5% in 2013 and was higher among children < 15 years (3.2%) in the same year. CONCLUSION: The study found an overall decrease in the incidence of TB in PLHIV. Our results emphasize the need for early initiation of ART and the provision of TB preventive therapy for those PLHIV without active TB after intensified TB case-finding