Feasibility of Early Infant Diagnosis of HIV in Resource-Limited Settings: The ANRS 12140-PEDIACAM Study in Cameroon

BACKGROUND: Early infant diagnosis (EID) of HIV is a key-point for the implementation of early HAART, associated with lower mortality in HIV-infected infants. We evaluated the EID process of HIV according to national recommendations, in urban areas of Cameroon. METHODS/FINDINGS: The ANRS12140-PEDIACAM study is a multisite cohort in which infants born to HIV-infected mothers were included before the 8(th) day of life and followed. Collection of samples for HIV DNA/RNA-PCR was planned at 6 weeks together with routine vaccination. The HIV test result was expected to be available at 10 weeks. A positive or indeterminate test result was confirmed by a second test on a different sample. Systematic HAART was offered to HIV-infected infants identified. The EID process was considered complete if infants were tested and HIV results provided to mothers/family before 7 months of age. During 2007-2009, 1587 mother-infant pairs were included in three referral hospitals; most infants (n = 1423, 89.7%) were tested for HIV, at a median age of 1.5 months (IQR, 1.4-1.6). Among them, 51 (3.6%) were HIV-infected. Overall, 1331 (83.9%) completed the process by returning for the result before 7 months (median age: 2.5 months (IQR, 2.4-3.0)). Incomplete process, that is test not performed, or result of test not provided or provided late to the family, was independently associated with late HIV diagnosis during pregnancy (adjusted odds ratio (aOR) = 1.8, 95%CI: 1.1 to 2.9, p = 0.01), absence of PMTCT prophylaxis (aOR = 2.4, 95%CI: 1.4 to 4.3, p = 0.002), and emergency caesarean section (aOR = 2.5, 95%CI: 1.5 to 4.3, p = 0.001). CONCLUSIONS: In urban areas of Cameroon, HIV-infected women diagnosed sufficiently early during pregnancy opt to benefit from EID whatever their socio-economic, marital or disclosure status. Reduction of non optimal diagnosis process should focus on women with late HIV diagnosis during pregnancy especially if they did not receive any PMTCT, or if complications occurred at delivery

Predictors of poor retention on antiretroviral therapy as a major HIV drug resistance early warning indicator in Cameroon: results from a nationwide systematic random sampling

Retention on lifelong antiretroviral therapy (ART) is essential in sustaining treatment success while preventing HIV drug resistance (HIVDR), especially in resource-limited settings (RLS). In an era of rising numbers of patients on ART, mastering patients in care is becoming more strategic for programmatic interventions. Due to lapses and uncertainty with the current WHO sampling approach in Cameroon, we thus aimed to ascertain the national performance of, and determinants in, retention on ART at 12 months

Independent and combined effects of improved water, sanitation, and hygiene, and improved complementary feeding, on child stunting and anaemia in rural Zimbabwe: a cluster-randomised trial.

BACKGROUND: Child stunting reduces survival and impairs neurodevelopment. We tested the independent and combined effects of improved water, sanitation, and hygiene (WASH), and improved infant and young child feeding (IYCF) on stunting and anaemia in in Zimbabwe. METHODS: We did a cluster-randomised, community-based, 2 × 2 factorial trial in two rural districts in Zimbabwe. Clusters were defined as the catchment area of between one and four village health workers employed by the Zimbabwe Ministry of Health and Child Care. Women were eligible for inclusion if they permanently lived in clusters and were confirmed pregnant. Clusters were randomly assigned (1:1:1:1) to standard of care (52 clusters), IYCF (20 g of a small-quantity lipid-based nutrient supplement per day from age 6 to 18 months plus complementary feeding counselling; 53 clusters), WASH (construction of a ventilated improved pit latrine, provision of two handwashing stations, liquid soap, chlorine, and play space plus hygiene counselling; 53 clusters), or IYCF plus WASH (53 clusters). A constrained randomisation technique was used to achieve balance across the groups for 14 variables related to geography, demography, water access, and community-level sanitation coverage. Masking of participants and fieldworkers was not possible. The primary outcomes were infant length-for-age Z score and haemoglobin concentrations at 18 months of age among children born to mothers who were HIV negative during pregnancy. These outcomes were analysed in the intention-to-treat population. We estimated the effects of the interventions by comparing the two IYCF groups with the two non-IYCF groups and the two WASH groups with the two non-WASH groups, except for outcomes that had an important statistical interaction between the interventions. This trial is registered with ClinicalTrials.gov, number NCT01824940. FINDINGS: Between Nov 22, 2012, and March 27, 2015, 5280 pregnant women were enrolled from 211 clusters. 3686 children born to HIV-negative mothers were assessed at age 18 months (884 in the standard of care group from 52 clusters, 893 in the IYCF group from 53 clusters, 918 in the WASH group from 53 clusters, and 991 in the IYCF plus WASH group from 51 clusters). In the IYCF intervention groups, the mean length-for-age Z score was 0·16 (95% CI 0·08-0·23) higher and the mean haemoglobin concentration was 2·03 g/L (1·28-2·79) higher than those in the non-IYCF intervention groups. The IYCF intervention reduced the number of stunted children from 620 (35%) of 1792 to 514 (27%) of 1879, and the number of children with anaemia from 245 (13·9%) of 1759 to 193 (10·5%) of 1845. The WASH intervention had no effect on either primary outcome. Neither intervention reduced the prevalence of diarrhoea at 12 or 18 months. No trial-related serious adverse events, and only three trial-related adverse events, were reported. INTERPRETATION: Household-level elementary WASH interventions implemented in rural areas in low-income countries are unlikely to reduce stunting or anaemia and might not reduce diarrhoea. Implementation of these WASH interventions in combination with IYCF interventions is unlikely to reduce stunting or anaemia more than implementation of IYCF alone. FUNDING: Bill & Melinda Gates Foundation, UK Department for International Development, Wellcome Trust, Swiss Development Cooperation, UNICEF, and US National Institutes of Health.The SHINE trial is funded by the Bill & Melinda Gates Foundation (OPP1021542 and OPP113707); UK Department for International Development; Wellcome Trust, UK (093768/Z/10/Z, 108065/Z/15/Z and 203905/Z/16/Z); Swiss Agency for Development and Cooperation; US National Institutes of Health (2R01HD060338-06); and UNICEF (PCA-2017-0002)

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Morbidité et mortalité néonatale dans un hôpital de district urbain à ressources limités à Douala, Cameroun

In countries with limited health-care resources, achieving the fourth Millennium Development Goal recommended by the WHO requires the reduction of neonatal mortality. Interventions at different levels of the community and the health-care system are needed, including in district hospitals

Photoperiodic effects on the male gonads of the Namibian gerbil, Gerbilliscus cf. leucogaster from central Namibia

Photoperiodism has been shown to be an important synchronizer of seasonal reproduction in many rodent species in the wild; it is a reliable cue as in the southern hemisphere it coincides with the onset of rainfall and hence the availability of food resources for maximal reproductive success. The photoperiodic effect on the reproductive status of the Namibian gerbil, Gerbilliscus cf. leucogaster from central Namibia was investigated. Twenty adult males were exposed to a long-day length (16L:8D), while further 20 adult males were subjected to a short-day length (SD:8L:16D); all for a period of 3 months. Testicular mass per gram body mass, testicular volume and seminiferous tubule diameters were used to assess the effect of photoperiod on gonadal development. Body mass did not significantly differ between the two photoperiodic regimes. The testicular mass per gram of body mass was significantly heavier for the males maintained on a long photoperiod compared to those on a short photoperiod. Similarly, testicular volume and seminiferous tubule diameter were greater in males maintained on a long-day cycle compared to those on the short-day cycle. These findings suggest that G. cf. leucogaster is photoresponsive to day length changes. Photoperiodic changes in the semi-arid habitats can be used to herald the onset of reproduction as it often acts in concert with other proximate cues in desert rodents, but is a constant environmental cue that does not change from year to year, unlike rainfall patterns.https://www.springer.com/journal/429912021-03-04hj2020Mammal Research InstituteZoology and Entomolog

The reproductive pattern of the Gerbilliscus cf. leucogaster (Rodentia: Muridae) from Namibia

Very little is known about the reproductive biology of the Gerbilliscus cf. leucogaster (Peters, 1852) despite its wide distribution throughout the southern African subregion. Body mass, reproductive tract morphometrics, and gonadal histology were studied over 12 months in wild caught Gerbilliscus cf. leucogaster from the central part of Namibia to gain insights into the reproductive pattern of this species. The number of Graafian follicles and corpora lutea in 93 females increased at the end of the dry period (September) and throughout the wet months of the year (October–May) relative to that of the dry season (June–August). Pregnant and lactating females were recorded during the wet months of the year, with a peak observed during February. Testicular mass relative to body mass, testicular volume, and seminiferous tubule diameter in 64% of males increased significantly during the rainfall period (October–June). In addition, 8% of males exhibited little spermatogenesis and 28% showed no spermatogenesis or presence of sperm in the epididymis during the dry period (June–August). These findings suggest that the Gerbilliscus cf. leucogaster breeds predominantly during the rainfall period in Namibia when the food resources are more abundant.The University of Namibia to S.P.M. and by the University of Pretoria and the South African National Research Foundation to N.C.B. and C.T.C.http://www.nrcresearchpress.com/journal/cjzhj2019Mammal Research InstituteZoology and Entomolog

Bartonella diversity and zoonotic potential in indigenous Tete Veld rats (Aethomys ineptus) from South Africa

Bartonellosis is a vector-borne disease that is often misdiagnosed due to a broad range of clinical symptoms, compounded by a lack of awareness regarding the prevalence, diversity and public health impacts of regional strains. Despite recent PCR-based confirmation of Bartonella in 9.7% of non-malarial, acute febrile patients in South Africa, data regarding reservoirs of infection are limited. As the majority of Bartonella species described to date are associated with rodent species globally, including zoonotic species such as B. elizabethae, and as rodent biodiversity is high in southern Africa, we evaluated Bartonella in the Tete Veld rat (Aethomys ineptus), a highly adaptable murid rodent that thrives in both natural and commensal settings. These rodents are infested with a broad range of ectoparasite species, and often occur in sympatry with Micaelamys namaquensis, an indigenous rodent previously shown to host B. elizabethae. DNA extracts from heart samples of 75 A. ineptus trapped over an eight-month period, from the Roodeplaat Nature Reserve (RNR), were evaluated using a multi-locus sequence analysis (MLSA) approach. Nucleotide sequencing and phylogenetic analyses of individual (gltA, ribC, rpoB and nuoG) and concatenated gene datasets confirmed the presence of three discrete Bartonella lineages (I-III). Lineages I and II, are genetically distinct from all currently recognised Bartonella species but cluster with strains present in other indigenous rodents from South and East Africa, whereas lineage III contained B. elizabethae, a zoonotic species associated with Rattus species globally. Records confirming R. tanezumi presence in this nature reserve, which is situated in close proximity to Pretoria, the administrative capital of South Africa, suggests the likelihood of spill-over from invasive to indigenous species. These results together with the high levels of infection (86.7%) and co-infection (33.8%), indicate that A. ineptus is a natural reservoir for multiple Bartonella species in South Africa, including one with zoonotic potential.LMH was supported by Centers for Disease Control and Prevention (CDC) Cooperative Agreement (Co-Ag) 5 NU2GGH001874-02-00 postgraduate bursary. HB was supported by a University of Pretoria Post-Doctoral Bursary. Financial support was provided by the National Research Foundation (NRF), South Africa through individual (ADSB), Research Chair (NCB) and facility (No: UID78566) grants and through the CDC CoAg 5 NU2GGH001874-02-00.http://www.elsevier.com/locate/meegid2020-09-01hj2020Mammal Research InstituteZoology and Entomolog

Rev Epidemiol Sante Publique

Position du problème Au Cameroun, la couverture des enfants éligibles au traitement antirétroviral (TARV) (15 %) était l’une des plus faibles des 21 pays prioritaires du Fonds Mondial en 2012. Le but de cette étude était de faire une analyse situationnelle de l’offre des soins pour améliorer la prise en charge du VIH pédiatrique (PECP) au Cameroun. Méthodes Une étude transversale descriptive a été menée pendant quatre mois (avril à août 2014) dans 12 formations sanitaires de sept régions du Cameroun sélectionnées par un sondage systématique. Les données ont été recueillies à l’aide d’un auto-questionnaire administré aux personnels soignants et aux responsables administratifs inclus dans l’étude. Résultats Au total 142 personnels en charge du VIH pédiatrique ont été inclus dans cette étude : 115 du niveau opérationnel parmi lesquels 59 (51,2 %) personnels de santé, 44 (38,3 %) agents communautaires, 12 (10,4 %) chefs de services, 19 responsables du niveau régional et 8 du niveau central. La grande majorité des personnels soignants impliqués dans la PECP étaient des infirmiers, nécessitant ainsi la délégation effective des tâches médicales institutionnalisée au Cameroun. Très peu de documents normatifs nationaux prenaient en compte la PECP. La faible vulgarisation de ces documents normatifs à tous les niveaux de la pyramide sanitaire pourrait justifier le non-respect des protocoles de prise en charge observé dans les formations sanitaires offrant la PECP. Conclusion La mise à jour et la diffusion à large échelle des documents nationaux normatifs, prenant en compte des spécificités de l’enfant infecté par le VIH, sont nécessaires pour améliorer l’application des directives de la PECP au niveau opérationnel.Background In Cameroon in 2012, the proportion (15%) of children eligible for antiretroviral treatment (ART) was one of the lowest among the 21 Global Fund priority countries. The objective of this study was to carry out a situational analysis of the existing care offer for pediatric HIV in Cameroon. Methods A descriptive cross-sectional study was conducted over a 4-month period (April to August 2014) in 12 healthcare facilities in 7 regions of Cameroon selected by systematic sampling. The data were collected in a self-administered questionnaire filled out by the caregiving and administrative personnel included in the study. Results All in all, 142 persons in charge of pediatric HIV treatment were included in the study, of whom 115 were working at the operational level: 59 (51.2%) health personnel, 44 (38.3%) community agents and 12 (10.4%) department heads; the other 27 exercised responsibilities at the regional (19) and the local (8) levels. An overwhelming majority of the caregivers involved in pediatric VIH treatment were nurses, a factor necessitating the delegation of medical tasks institutionalized in Cameroon. Few standardized nationwide documents take into account these treatment modalities. Inadequate dissemination of the documents at all levels of the healthcare pyramid may justify the non-compliance with the care protocols that has been observed in the training programs dedicated to the subject. Conclusion The updating and large-scale dissemination of standardized nationwide documents taking into account the specificities of HIV-infected children are required to improve implementation at the operational level of the Cameroonian healthcare system of the existing guidelines for pediatric HIV treatment