A survey of RNA viruses in mosquitoes from Mozambique reveals novel genetic lineages of flaviviruses and phenuiviruses, as well as frequent flavivirus-like viral DNA forms in Mansonia

Background: Mosquito-borne diseases involving arboviruses represent expanding threats to sub-Saharan Africa imposing as considerable burden to human and veterinary public health. In Mozambique over one hundred species of potential arbovirus mosquito vectors have been identified, although their precise role in maintaining such viruses in circulation in the country remains to be elucidated. The aim of this study was to screen for the presence of flaviviruses, alphaviruses and bunyaviruses in mosquitoes from different regions of Mozambique. Results: Our survey analyzed 14,519 mosquitoes, and the results obtained revealed genetically distinct insect-specific flaviviruses, detected in multiple species of mosquitoes from different genera. In addition, smaller flavivirus-like NS5 sequences, frequently detected in Mansonia seemed to correspond to defective viral sequences, present as viral DNA forms. Furthermore, three lineages of putative members of the Phenuiviridae family were also detected, two of which apparently corresponding to novel viral genetic lineages. Conclusion: This study reports for the first-time novel insect-specific flaviviruses and novel phenuiviruses, as well as frequent flavivirus-like viral DNA forms in several widely known vector species. This unique work represents recent investigation of virus screening conducted in mosquitoes from Mozambique and an important contribution to inform the establishment of a vector control program for arbovirus in the country and in the region.publishersversionpublishe

implication for assessing the risk of arbovirus outbreaks

Funding Information: This work was also supported by the U.S. Centers for Disease Control and Prevention through a cooperative agreement number 5NU14GH001237-03-00. The views expressed in this written publication do not necessarily reflect the official policies of the U.S. Department of Health and Human Services. European Foundation Initiative into Neglected Tropical Disease also supported this study. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. We thank all community leaders, household heads staff from the provincial health directorates, staff from the Medical Entomology Laboratory from the National Institute of Health, staff from National Malaria Control Programme, and staff from the Laboratório de Transmissores de Hematozoários of the Oswaldo Cruz Institute for their support during field work, laboratory testing and identification of Aedes spp. We also thank José Feriano Américo who produced the maps of this work. Ours special thanks goes to Professor J. Dereck Charlwood who revised the English grammar and typos of the entire manuscript. Consent for publication Our manuscript does not present any individual person's data. Publisher Copyright: © 2018 Abílio et al. http://creativecommons.org/licenses/by/4.0/.Background: Aedes-borne arboviruses have emerged as an important public health problem worldwide and, in Mozambique, the number of cases and its geographical spread have been growing. However, information on the occurrence, distribution and ecology of Aedes aegypti and Ae. albopictus mosquitoes remain poorly known in the country. Methods: Between March and April 2016, a cross-sectional study was conducted in 32 districts in Mozambique to determine the distribution and breeding sites of Ae. aegypti and Ae. albopictus. Larvae and pupae were collected from a total of 2,807 water-holding containers using pipette, dipper, funnel and sweeping procedures, depending on the container type and location. Both outdoor and indoor water-holding containers were inspected. The immature forms were reared to adults and the identifications of the mosquito species was carried out with a stereomicroscope using a taxonomic key. Results: Aedes aegypti was found in every district sampled, while Ae. albopictus was only found in Moatize district, situated in Tete Province in the central part of the country. Six hundred and twenty-eight of 2,807 (22.4%) containers were positive for Ae. aegypti but only one (0.03%) was positive for Ae. albopictus. The Container Index (CI) of Aedes was highest in densely populated suburban areas of the central region (260/604; 43.0%), followed by suburban areas in northern areas (228/617; 36.9%) whilst the lowest proportion was found in urbanized southern areas (140/1586; 8.8%). The highest CI of Aedes was found in used tires (448/1268; 35.3%), cement tanks (20/62; 32.3%) and drums (21/95; 22.1%). Conclusion: Data from our study showed that Ae. aegypti is present nation-wide, since it occurred in every sampled district, whilst Ae. albopictus had a limited distribution. Therefore, the risk of transmission of dengue and chikungunya is likely to have been underestimated in Mozambique. This study highlights the need for the establishment of a national entomological surveillance program for Aedes spp. in Mozambique in order to gain a better understanding about vector bionomics and to support the development of informed effective vector control strategies.publishersversionpublishe

Are routine tuberculosis programme data suitable to report on antiretroviral therapy use of HIV-infected tuberculosis patients?

<p>Abstract</p> <p>Background</p> <p>Antiretroviral therapy (ART) is lifesaving for HIV-infected tuberculosis (TB) patients. ART-use by these patients lag behind compared to HIV-testing and co-trimoxazole preventive therapy. TB programmes provide the data on ART-use by HIV-infected TB patients, however often the HIV services provide the ART. We evaluated whether the data on ART-use in the TB register were complete and correct. The timing of ART initiation was evaluated to assess whether reporting on ART-use could have happened with the TB case finding reporting. We collected data on TB treatment, HIV testing and ART for adult TB cases in 2007 from three TB clinics in Manica Province, Mozambique. These data on use of ART from TB registers were compared with those from the HIV services.</p> <p>Findings</p> <p>Of 628 patients included, 504 (81%) were tested and of these 356 (71%) were HIV-infected. Of the co-infected patients, 81% registered with the HIV services in the same facility. The TB register was correct on ART-use in 73% of co-infected cases and complete in 74%. Information on ART-use could have been reported with the TB case finding reports in 56% of co-infected patients.</p> <p>Conclusion</p> <p>The TB register is reasonably correct and complete on ART-use. However, the HIV patient record seems a much better source to provide this information. Reporting on ART-use at the end of the quarter in which TB treatment starts provides the programme with timely but incomplete information. A more complete but less timely picture is available after a year.</p

Abundant Aedes (Stegomyia) aegypti aegypti mosquitoes in the 2014 dengue outbreak area of Mozambique

In early 2014, dengue cases were reported from northern Mozambique, 30 years after the last outbreak. We identified potential dengue vector species in three northern towns, Pemba, Nampula and Nacala, and one southern town, Maputo, during the outbreak in April 2014. A major dengue vector species, Aedes (Stegomyia) aegypti, was found in all these towns. The dominant vector subspecies in the northern towns was Aedes aegypti aegypti, while Ae. aegypti formosus was dominant in Maputo. Considering the high proportion of Ae. aegypti aegypti and its high vector competence, the findings from this study suggest that Ae. aegypti aegypti was responsible for the outbreak in northern Mozambique

Correction: Community ART Support Groups in Mozambique: The Potential of Patients as Partners in Care.

[This corrects the article DOI: 10.1371/journal.pone.0166444.]

Community ART Support Groups in Mozambique: The Potential of Patients as Partners in Care.

High rates of attrition are stymying Mozambique's national HIV Program's efforts to achieve 80% treatment coverage. In response, Mozambique implemented a national pilot of Community Adherence and Support Groups (CASG). CASG is a model in which antiretroviral therapy (ART) patients form groups of up to six patients. On a rotating basis one CASG group member collects ART medications at the health facility for all group members, and distributes those medications to the other members in the community. Patients also visit their health facility bi-annually to receive clinical services.A matched retrospective cohort study was implemented using routinely collected patient-level data in 68 health facilities with electronic data systems and CASG programs. A total of 129,938 adult ART patients were registered in those facilities. Of the 129,938 patients on ART, 6,760 were CASG members. A propensity score matched analysis was performed to assess differences in mortality and loss to follow-up (LTFU) between matched CASG and non-CASG members. Propensity scores were estimated using a random-effects logistic regression model. The following covariates where included in the model: sex, educational status, WHO stage, year of ART initiation, age, CASG eligibility, CD4 cell count category, weight, and employment status.Non-CASG participants had higher LTFU rates (HR 2.356; p = 0.04) than matched CASG participants; however, there were no significant mortality differences between CASG and non-CASG participants. Compared with the full cohort of non-CASG members, CASG members were more likely to be female (74% vs. 68%), tended to have a lower median CD4 counts at ART initiation (183 cells/m3 vs. 200cells/m3) and be less likely to have a secondary school education (15% vs. 23%).ART patients enrolled in CASG were significantly less likely to be LTFU compared to matched patients who did not join CASG. CASG appears to be an effective strategy to decrease LTFU in Mozambique's national ART program

A survey of RNA viruses in mosquitoes from Mozambique reveals novel genetic lineages of flaviviruses and phenuiviruses, as well as frequent flavivirus-like viral DNA forms in Mansonia

BACKGROUND: Mosquito-borne diseases involving arboviruses represent expanding threats to sub-Saharan Africa imposing as considerable burden to human and veterinary public health. In Mozambique over one hundred species of potential arbovirus mosquito vectors have been identified, although their precise role in maintaining such viruses in circulation in the country remains to be elucidated. The aim of this study was to screen for the presence of flaviviruses, alphaviruses and bunyaviruses in mosquitoes from different regions of Mozambique. RESULTS: Our survey analyzed 14,519 mosquitoes, and the results obtained revealed genetically distinct insectspecific flaviviruses, detected in multiple species of mosquitoes from different genera. In addition, smaller flaviviruslike NS5 sequences, frequently detected in Mansonia seemed to correspond to defective viral sequences, present as viral DNA forms. Furthermore, three lineages of putative members of the Phenuiviridae family were also detected, two of which apparently corresponding to novel viral genetic lineages. CONCLUSION: This study reports for the first-time novel insect-specific flaviviruses and novel phenuiviruses, as well as frequent flavivirus-like viral DNA forms in several widely known vector species. This unique work represents recent investigation of virus screening conducted in mosquitoes from Mozambique and an important contribution to inform the establishment of a vector control program for arbovirus in the country and in the region.Additional file 1: Supplementary Figure 1. Microscopic observation of C6/36 cells mock-infected cells (A; 300×), or after infection (day 3) with viruses present in three independent pools of Ma. uniformis, An. ziemani, and An. pretoriensis mosquitoes collected in Mozambique.Additional file 2.Additional file 3: Supplementary Table 1. PCR primers and thermal profiles used in this work.Wellcome Trust and the National Institute of Health of Mozambique.http://www.biomedcentral.com/bmcmicrobiolpm2020Veterinary Tropical Disease

Predictors of CASG membership (N = 129,938 at 68 facilities providing CASG Services).

<p>Predictors of CASG membership (N = 129,938 at 68 facilities providing CASG Services).</p

Cumulative incidence of LTFU and Death among matched CASG and non-CASG participants.

<p>Cumulative incidence of LTFU and Death among matched CASG and non-CASG participants.</p