A Systematic Review of Mobile Phone Interventions (SMS/IVR/Calls) to Improve Adherence and Retention to Antiretroviral Treatment in Low-and Mid

The use of mobile health technologies (mHealth) to ameliorate HIV care has considerably risen in low- and middle-income countries (LMICs) since 2010. Yet, the discrepancies in the results of accompanying studies warrant an updated and systematic consolidation of all available evidence. We report a systematic review of studies testing whether text/image messages, interactive voice response reminders, or calls promote adherence and retention to antiretroviral therapy (ART) in LMICs. We systematically compiled studies published in English until June 2018 from PubMed/Medline, Web of Science, WHO database, ProQuest Dissertations and Theses, and manual search. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 and used frequency analysis to assess reported findings. In total, we compiled 35 published articles: 27 completed studies and 8 protocols. Among the main 27 studies, 17 examine adherence, 5 retention, and 5 both measures. Results indicate that 56% report positive and statistically significantly impacts of mHealth on primary outcomes, the remaining 44% report insignificant results. While 41% of studies found a positive and significant effect for adherence, only 12% improved retention. The evidence shows ambiguous results (with high variability) about the effectiveness of mobile phone-assisted mHealth interventions to boost adherence and retention to ART. The literature also points to short follow-up periods, small samples, and limited geographical coverage. Hence, future research should focus on evaluating longer interventions with more patients spread across wider areas to address whether mHealth can be effectively used in LMICs

Etiology and risk factors for meningitis during an outbreak in Batié Health District, Burkina Faso, January-March 2016

Introduction: On 16 March 2016, Batié Health District notified the Burkina Faso Ministry of Health Surveillance unit of 12 suspected cases of meningitis. During the same period, Batié´s neighboring districts in Côte d'Ivoire and Ghana were experiencing a meningitis epidemic. We investigated to establish the etiology and risk factors for the disease and to recommend prevention and control measures. Methods: We conducted unmatched case control study. A case was any person living in Batié with fever (temp. ≥ 38.5°C) and any of the following: neck stiffness, neurological disorder, bulging fontanelle, convulsion during January to April 2016 with cerebrospinal fluid (CSF) positive to PCR. Controls were non sick household members, neighbors or friends to the cases. We analyzed the investigation and laboratory records. We included all confirmed cases and two neighborhood controls per case. We used a standard questionnaire to collect data. We analyzed data by Epi info 7 and calculated odds ratio (ORs),adjusted odds ratios (AOR) and 95% confidence interval. We proceeded to univariate, bivariate, multivariate and logistic regression analysis. Results: We interviewed 93 participants including 31 meningitis cases and 62 controls. The median age of cases was 8 years old [2 months-55 years] and 6.5 years old [5 months-51 years] for controls. Streptococcus pneumoniae 16(51.61%), Neisseria meningitidis W 14(45.16%) and Haemophilus influenzae b 1(3.23%) were the identified germs. The independent risk factors identified were travel to meningitis affected areas (Adjusted odd ratio(AOR)=12[2.3-60],p=0.0029); >5 persons sharing bedroom (AOR=5.7[1.5-22],p=0.012) and rhinopharyngitis (AOR=26[1.8-380],p=0.017). Conclusion: Streptococcus pneumoniae and Neisseria meningitidis W caused the outbreak in Batié. The risk factors were overcrowding, travel to affected areas, and rhinopharyngitis. We recommended reactive vaccination against Neisseria meningitidis W, limited travel to affected areas and ventilation of rooms

Ampleur de la dengue dans la ville de Ouagadougou, Burkina-Faso, 2016: Magnitude of dengue fever in the city of Ouagadougou, Burkina-Faso, 2016

Introduction: En Octobre 2016, le Burkina Faso a connu une flambée de cas de dengue dont l’ampleur est peu connue. Aussi aucune étude n’a été réalisée durant les dix dernières années, donnant lieu à un manque d’information actualisée sur sa prévalence et son incidence. Cette étude avait pour objectif de déterminer l’ampleur de la dengue à Ouagadougou et le type de virus circulant. Méthodes: Nous avons mené une étude transversale sur les cas de dengue enregistrés dans les formations sanitaires (FS) de la ville de Ouagadougou du 1er août au 31 décembre 2016. Un cas de dengue était défini comme toute personne résident dans la ville de Ouagadougou présentant une maladie fébrile aiguë (2-7 jours), avec au moins deux des symptômes suivants : céphalées, douleur rétro-orbitale, myalgie, arthralgie, éruption cutanée, manifestations hémorragiques, syndrome de choc et un test biologique positif à la PCR ou avec TDR-Dengue positif ayant un lien épidémiologique avec un cas confirmé. Nous avons réalisé une recherche active des cas à travers une revue documentaire des registres de laboratoire, consultation et/ou d’hospitalisation des FS, Une fiche de collecte a été utilisée pour recueillir les caractéristiques sociodémographiques, cliniques, biologiques des cas. Résultats: Au total, 5094 cas de dengue ont été enregistrés dans les FS. L’âge médian était de 27 ans avec un intervalle interquartile de 16 à 37 ans. Quinze cas (51,72%) ont été testés positifs à la PCR dont 10 (66,67%) au DENV2 et 5 (33,33%) au DENV3. Parmi les cas, 2569 (50,76%) étaient de sexe féminin et 1494 (28,16%) cas avaient été hospitalisés. Sur les cas recensés, 73% avaient été notifiés par les structures privées et 3174 (88,88%) étaient des éleves/étudiants ou fonctionnaires ou commerçants. Le taux d’attaque global était de 201 cas (5094/2532311) pour 100000 habitants. Le taux de létalité était de 35/5094 (0,69%). Conclusion: Le taux d’attaque global de la dengue en 2016 était de 201 cas pour 100000 habitants. La dengue touchait plus les adultes jeunes surtout les élèves/étudiants et les fonctionnaires et était causée par les types 2 et 3. Les cas étaient plus notifiés par les structures privées. Une surveillance hebdomadaire associée à une surveil-lance sentinelle et la sensibilisation de la population sur la dengue contribueraient à endiguer ce fléau au Burki-na Faso. Background: In October 2016, Burkina Faso experienced an outbreak of dengue fever that the magnitude is little known. Also, no studies have been performed in the past ten years, giving rise to a lack of updated information on its prevalence and incidence. We conducted an investigation to determine the magnitude of dengue fever in Ouagadougou’s city and the type of virus circulating. Methods: We conducted a cross-sectional study on the cases of dengue recorded in health facilities (HF) in Ouagadougou’s city from August 1st to December 31st, 2016. We defined a case of dengue as any person resident in the city of Ouagadougou with acute febrile illness (2-7days), with at least two of the following symptoms (headache, retro-orbital pain, myalgia, arthralgia, rash, hemorrhagic manifestations, shock syndrome) and a positive PCR test or with dengue-RDT positive, having an epidemiological link with a confirmed case. We carried out an active search for cases through a documentary review of laboratory, consultation and/or hospitalization registers of HF, used a file to collect the socio-demographic, clinical and biological characteristics of the cases. Results: A total of 5094 cases of dengue fever were recorded in the HF. The median age was 27 years with an interquartile range of 16 to 37 years old. Fifteen (51.72%) cases tested positive with PCR including 10(66.67%) for DENV2 and 5(33.33%) for DENV3. Among the cases, 2,569(50.76%) were female and 1,494(28.16%) cases were hospitalized. Of the cases listed, 73% were notified by private’s hospitals and 3,174 (88.88%) were pupils/students or civil servants or traders. The overall attack rate was 201 cases (5094/2532311) per 100,000 populations. The case fatality rate was 35/5094 (0.69%). Conclusion: The overall dengue attack rate in 2016 was 201 cases per 100,000 populations. Dengue more affected young adults especially the pupils/students or civil servants and was caused by types 2 and 3. The cases were more notified by the private hospitals. We recommend weekly surveillance, sentinel surveillance and public awareness of dengue fever

Cross-Clade Recognition of HIV-1 CAp24 by CD4+ T Cells in HIV-1-Infected Individuals in Burkina Faso and Germany

The presence of antigen-specific cellular immune responses may be an indicator of long-term asymptomatic HIV-1-disease. The detection of cellular immune responses to infection with different subtypes of HIV-1 may be hampered by genetic differences of immunodominant antigens such as the capsid protein CAp24. In Nouna, Burkina Faso, HIV-1 circulating recombinant forms CRF02_AG and CRF06_cpx are the 2 major strains detectable in HIV-1-infected individuals, while subtype B strains prevail in Europe and North America. Amino acid sequences of CAp24 were assessed in blood samples from 10 HIV-1-infected patients in Nouna, Burkina Faso. Production of interferon-gamma (IFN-γ) in peripheral blood CD4+ lymphocytes in response to recombinant HIV-1 proteins derived from clade B (including CAp24NL4-3) was measured using a modified flow-cytometry-based whole blood short term activation assay (FASTimmune, BDBiosciences). IFN-γ production following stimulation with a whole length CAp24 protein derived from clade B (CAp24NL4-3) was additionally quantified in comparison to a CAp24 protein derived from CRF02_AG (CAp24BD6-15) in 16 HIV-1-infected patients in Heidelberg, Germany. Amino acid sequence identity of CAp24 obtained from patients in Nouna ranged between 86 and 89% when compared to the clade B CAp24NL4-3 consensus sequence, between 90 and 95% when compared to the circulating recombinant form CRF06_CPX consensus sequence, and between 92 and 96% when compared to the CAp24BD6-15 consensus sequence. Significant numbers of HIV-1-specific CD4+ lymphocytes producing IFN-γ were detected in 4 of 10 HIV-1-infected patients. In 7 of 16 patients in Heidelberg, recombinant CAp24BD6-15 stimulated IFN-γ-production in CD4+ lymphocytes to a similar extent as the clade B-derived CAp24NL4-3. Thus, antigen-specific CD4+ lymphocytes from both West African and European patients infected with different strains of HIV-1 show relevant cross-clade recognition of HIV-1 CAp24 in a flow-cytometry-based whole blood short term activation assay

Rhinitis associated with asthma is distinct from rhinitis alone: TARIA‐MeDALL hypothesis

Asthma, rhinitis, and atopic dermatitis (AD) are interrelated clinical phenotypes that partly overlap in the human interactome. The concept of “one-airway-one-disease,” coined over 20 years ago, is a simplistic approach of the links between upper- and lower-airway allergic diseases. With new data, it is time to reassess the concept. This article reviews (i) the clinical observations that led to Allergic Rhinitis and its Impact on Asthma (ARIA), (ii) new insights into polysensitization and multimorbidity, (iii) advances in mHealth for novel phenotype definitions, (iv) confirmation in canonical epidemiologic studies, (v) genomic findings, (vi) treatment approaches, and (vii) novel concepts on the onset of rhinitis and multimorbidity. One recent concept, bringing together upper- and lower-airway allergic diseases with skin, gut, and neuropsychiatric multimorbidities, is the “Epithelial Barrier Hypothesis.” This review determined that the “one-airway-one-disease” concept does not always hold true and that several phenotypes of disease can be defined. These phenotypes include an extreme “allergic” (asthma) phenotype combining asthma, rhinitis, and conjunctivitis.info:eu-repo/semantics/publishedVersio

Evidence for models of diagnostic service provision in the community: literature mapping exercise and focused rapid reviews

Background Current NHS policy favours the expansion of diagnostic testing services in community and primary care settings. Objectives Our objectives were to identify current models of community diagnostic services in the UK and internationally and to assess the evidence for quality, safety and clinical effectiveness of such services. We were also interested in whether or not there is any evidence to support a broader range of diagnostic tests being provided in the community. Review methods We performed an initial broad literature mapping exercise to assess the quantity and nature of the published research evidence. The results were used to inform selection of three areas for investigation in more detail. We chose to perform focused reviews on logistics of diagnostic modalities in primary care (because the relevant issues differ widely between different types of test); diagnostic ultrasound (a key diagnostic technology affected by developments in equipment); and a diagnostic pathway (assessment of breathlessness) typically delivered wholly or partly in primary care/community settings. Databases and other sources searched, and search dates, were decided individually for each review. Quantitative and qualitative systematic reviews and primary studies of any design were eligible for inclusion. Results We identified seven main models of service that are delivered in primary care/community settings and in most cases with the possible involvement of community/primary care staff. Not all of these models are relevant to all types of diagnostic test. Overall, the evidence base for community- and primary care-based diagnostic services was limited, with very few controlled studies comparing different models of service. We found evidence from different settings that these services can reduce referrals to secondary care and allow more patients to be managed in primary care, but the quality of the research was generally poor. Evidence on the quality (including diagnostic accuracy and appropriateness of test ordering) and safety of such services was mixed. Conclusions In the absence of clear evidence of superior clinical effectiveness and cost-effectiveness, the expansion of community-based services appears to be driven by other factors. These include policies to encourage moving services out of hospitals; the promise of reduced waiting times for diagnosis; the availability of a wider range of suitable tests and/or cheaper, more user-friendly equipment; and the ability of commercial providers to bid for NHS contracts. However, service development also faces a number of barriers, including issues related to staffing, training, governance and quality control. Limitations We have not attempted to cover all types of diagnostic technology in equal depth. Time and staff resources constrained our ability to carry out review processes in duplicate. Research in this field is limited by the difficulty of obtaining, from publicly available sources, up-to-date information about what models of service are commissioned, where and from which providers. Future work There is a need for research to compare the outcomes of different service models using robust study designs. Comparisons of ‘true’ community-based services with secondary care-based open-access services and rapid access clinics would be particularly valuable. There are specific needs for economic evaluations and for studies that incorporate effects on the wider health system. There appears to be no easy way of identifying what services are being commissioned from whom and keeping up with local evaluations of new services, suggesting a need to improve the availability of information in this area. Funding The National Institute for Health Research Health Services and Delivery Research programme

An open dataset of Plasmodium falciparum genome variation in 7,000 worldwide samples.

MalariaGEN is a data-sharing network that enables groups around the world to work together on the genomic epidemiology of malaria. Here we describe a new release of curated genome variation data on 7,000 Plasmodium falciparum samples from MalariaGEN partner studies in 28 malaria-endemic countries. High-quality genotype calls on 3 million single nucleotide polymorphisms (SNPs) and short indels were produced using a standardised analysis pipeline. Copy number variants associated with drug resistance and structural variants that cause failure of rapid diagnostic tests were also analysed.  Almost all samples showed genetic evidence of resistance to at least one antimalarial drug, and some samples from Southeast Asia carried markers of resistance to six commonly-used drugs. Genes expressed during the mosquito stage of the parasite life-cycle are prominent among loci that show strong geographic differentiation. By continuing to enlarge this open data resource we aim to facilitate research into the evolutionary processes affecting malaria control and to accelerate development of the surveillance toolkit required for malaria elimination