University Students Dealing with Sexually Transmitted Infections and HIV/AIDS: Knowledge and Practice, a Cross-sectional study Conducted in Fianarantsoa, Madagascar

This study aimed to evaluate the Knowledge and attitude of the academic students about sexually transmitted infections and HIV at the university of Fianarantsoa in 2018. Materials and methods: This was an analytical cross-sectional study conducted among undergraduate students at the University Andrainjato-Fianarantsoa. Knowledge was assessed using a score where each correct answer was given one point. Results: 1035 students were included, 67.7% (n=701) had good knowledge about STIs, and HIV/AIDS. Sexual transmission (83.9%; n=868) was the most known. On multivariate analysis, being a student at the faculty of medicine (p<0.001, aOR 137.3 [19.1-988]), faculty of Letters (p<0.001, aOR 4.5 [2.8-7.2)]), or the Normal Graduate School (NGS) (p<0.001, aOR 6.7 [3.3-13.7]), being tested for HIV before (p= 0.002, aOR 1.6 [1.2-2.2]) constitute the major factor of good knowledge about the sexual infections. The majority (71.8%, n=743) have had sexual intercourse before, and the median age of first sexual activities was 18 years (17-20). The use of Condoms (44.4%, n=460) was the most practiced in the STIs prevention method, followed by fidelity (19.8%; n=205) and abstinence (11.4%, n=118). Among the students, 29.3% (302) had high-risk sexual behavior in the last 3 months. Conclusion: The proportion of academic students with good knowledge of STIs and HIV is not satisfactory. There was a discordance between the knowledge of STI prevention and the daily university practice of the students

University Students Dealing with Sexually Transmitted Infections and HIV/AIDS: Knowledge and Practice, a Cross-sectional study Conducted in Fianarantsoa, Madagascar

This study aimed to evaluate the Knowledge and attitude of the academic students about sexually transmitted infections and HIV at the university of Fianarantsoa in 2018. Materials and methods: This was an analytical cross-sectional study conducted among undergraduate students at the University Andrainjato-Fianarantsoa. Knowledge was assessed using a score where each correct answer was given one point. Results: 1035 students were included, 67.7% (n=701) had good knowledge about STIs, and HIV/AIDS. Sexual transmission (83.9%; n=868) was the most known. On multivariate analysis, being a student at the faculty of medicine (p<0.001, aOR 137.3 [19.1-988]), faculty of Letters (p<0.001, aOR 4.5 [2.8-7.2)]), or the Normal Graduate School (NGS) (p<0.001, aOR 6.7 [3.3-13.7]), being tested for HIV before (p= 0.002, aOR 1.6 [1.2-2.2]) constitute the major factor of good knowledge about the sexual infections. The majority (71.8%, n=743) have had sexual intercourse before, and the median age of first sexual activities was 18 years (17-20). The use of Condoms (44.4%, n=460) was the most practiced in the STIs prevention method, followed by fidelity (19.8%; n=205) and abstinence (11.4%, n=118). Among the students, 29.3% (302) had high-risk sexual behavior in the last 3 months. Conclusion: The proportion of academic students with good knowledge of STIs and HIV is not satisfactory. There was a discordance between the knowledge of STI prevention and the daily university practice of the students

Knowledge, Attitude, and Practice of Academic Students about STIs and HIV/AIDS at the University of Fianarantsoa: A Cross-Sectional Study

Introduction: Sexually transmitted infections (STIs) facilitate and increase the risk of HIV transmission. This paper focuses on evaluating the knowledge, attitude, and practice of academic students about sexually transmitted infections and HIV at the university of Fianarantsoa. Materials: An analytical cross-sectional study was conducted among the students at the Andrainjato University. Knowledge was assessed using a score of one point for each correct answer. Results: 1035 students were included and 67.7% (n=701) had good  knowledge about STIs and HIV/AIDS. The sexual transmission (83.9%; n=868) was the most commonly known. On multivariate analysis, being a student at the faculty of medicine (p<0.001, aOR 137.3 [19.1-988]), faculty of Letters (p<0.001, aOR 4.5 [2.8-7.2)]), or the Normal Graduate School  (NGS) (p<0.001, aOR 6.7 [3.3-13.7]), being tested for HIV before (p= 0.002, aOR 1.6 [1.2-2.2]), constituted the major factor of good knowledge about sexual infections. Majority (71.8%, n=743) have had sexual intercourse before, and the median age of their first sexual activities was  18 years (17-20). The use of Condom (44.4%, n=460) was the most practiced STIs prevention method. This is followed by fidelity (19.8%; n=205) and abstinence (11.4%, n=118). Among the students, 29.3% (302) had high-risk sexual behavior during the last three months. Conclusion: The proportion of academic students with good knowledge of STIs and HIV was not satisfying. There was also discordance between the knowledge of STIs prevention and the daily university practice of the students

Epidemiological characteristics of cryptococcal meningoencephalitis associated with Cryptococcus neoformans var. grubii from HIV-infected patients in Madagascar : a cross-sectional study

Cryptococcal meningoencephalitis (CM) remains the most prevalent invasive fungal infection worldwide. The main objective of this study was to describe the prevalence of CM and cryptococcal infection in HIV-infected patients in Madagascar. The secondary objectives were to assess the adjusted prevalence of CM according to clinical presentation and patient characteristics, to determine crude 90-day survival according to cryptococcal antigen (CrAg) status and CM, and to identify the genotypes of Cryptococcus clinical isolates. This cross-sectional study was carried out at two urban hospitals in Antananarivo (central highlands) and Toamasina (east coast) between November 2014 and December 2016. Consecutive HIV-infected adults presenting with CD4 cell counts 64200/\u3bcl were enrolled. Lateral flow immunoassays of CrAg were performed on serum for all patients, and on cerebrospinal fluid for patients with CM symptoms. MALDI-ToF MS, ITS sequencing, and determinations of the molecular and mating types of the isolates were performed. Fluconazole is the only drug for CM treatment available in Madagascar. Patients were treated orally, with high doses (1200 mg/day) for 10-12 weeks and then with 200 mg/day. Minimum inhibitory concentrations were determined for amphotericin B, flucytosine, voriconazole and fluconazole in E-tests. Overall prevalence was 13.2% (95% CI 7.9-20.3) for cryptococcal infection and 10.9% (95% CI 6.1-17.5) for CM, among the 129 HIV-infected patients studied. The 90-day mortality rate was 58.8% (10/17) in CrAg-positive patients and 17.9% (20/112) in CrAg-negative patients (p<0.001). The 13 Cryptococcus strains obtained at baseline were all Cryptococcus neoformans var. grubii, genotypes VNI-\u3b1A (3 isolates), VNII-\u3b1A (4 isolates) or hybrid VNI/VNII-\u3b1AA\u3b1 (6 isolates), suggesting high diversity. Two strains acquired fluconazole resistance after four and five months of exposure, respectively. The prevalence of cryptococcosis is high in Madagascar and this serious condition is life-threatening in HIV-infected patients. These findings will be used to raise the awareness of national authorities to strengthen the national HIV/AIDS control program

An open-label, randomized, non-inferiority trial of the efficacy and safety of ciprofloxacin versus an aminoglycoside + ciprofloxacin in the treatment of bubonic plague (IMASOY): study protocol for a randomized control trial—an update to the published protocol

This article reports an update to the protocol of the IMASOY trial, which was prospectively registered on clinicaltrials.gov (NCT04110340) in October 2019

Prevalence of pulmonary tuberculosis and HIV infections and risk factors associated to tuberculosis in detained persons in Antananarivo, Madagascar

The incidence rate of tuberculosis in prisons is estimated to be 8 times greater than that in the general population in Madagascar. Our objectives were to estimate the prevalence of pulmonary tuberculosis and HIV infection among prisoners and to identify risk factors associated with tuberculosis. We conducted a cross-sectional study at the central prison of Antananarivo from March to July 2021. Individual male and female inmates aged ≥ 13 years who had lived in the prison for at least three months prior to the study period were included as participants. Acid-fast bacilli detection by microscopy and/or culture, an intradermal tuberculin test, a chest X-ray, and a rapid diagnostic orientation test for HIV were performed. Among 748 participants, 4 (0.5%) were confirmed to have pulmonary tuberculosis. Overall, 14 (1.9%) patients had “confirmed” or “probable” tuberculosis [0.90–2.84, 95% CI]. The proportion of participants with latent tuberculosis infection was 69.6% (517/743) based on a positive tuberculin test without clinical symptoms or radiography images indicating tuberculosis. Out of 745 HIV screening tests, three showed reactive results (0.4%). Age (OR = 4.4, 95% CI [1.4–14.0]) and prior tuberculosis treatment (or episodes) were found to be associated with confirmed and probable tuberculosis

Implementation of an antibiotic resistance surveillance tool in Madagascar, the TSARA project: a prospective, observational, multicentre, hospital-based study protocol.

INTRODUCTION: Antimicrobial resistance (AMR) has become a significant public health threat. Without any interventions, it has been modelled that AMR will account for an estimated 10 million deaths annually by 2050, this mainly affects low/middle-income countries. AMR has a systemic negative perspective affecting the overall healthcare system down to the patient's personal outcome. In response to this issue, the WHO urged countries to provide antimicrobial stewardship programmes (ASPs). ASPs in hospitals are a vital component of national action plans for AMR, and have been shown to significantly reduce AMR, in particular in low-income countries such as Madagascar.As part of an ASP, AMR surveillance provides essential information needed to guide medical practice. We developed an AMR surveillance tool-Technique de Surveillance Actualisée de la Résistance aux Antimicrobiens (TSARA)-with the support of the Mérieux Foundation. TSARA combines bacteriological and clinical information to provide a better understanding of the scope and the effects of AMR in Madagascar, where no such surveillance tool exists. METHODS AND ANALYSIS: A prospective, observational, hospital-based study was carried out for data collection using a standardised data collection tool, called TSARA deployed in 2023 in 10 hospitals in Madagascar participating in the national Malagasy laboratory network (Réseau des Laboratoires à Madagascar (RESAMAD)). Any hospitalised patient where the clinician decided to take a bacterial sample is included. As a prospective study, individual isolate-level data and antimicrobial susceptibility information on pathogens were collected routinely from the bacteriology laboratory and compiled with clinical information retrieved from face-to-face interviews with the patient and completed using medical records where necessary. Analysis of the local ecology, resistance rates and antibiotic prescription patterns were collected. ETHICS AND DISSEMINATION: This protocol obtained ethical approval from the Malagasy Ethical Committee n°07-MSANP/SG/AGMED/CNPV/CERBM on 24 January 2023. Findings generated were shared with national health stakeholders, microbiologists, members of the RESAMAD network and the Malagasy academic society of infectious diseases

The impact of COVID-19 on clinical research for Neglected Tropical Diseases (NTDs): A case study of bubonic plague.

BACKGROUND: Among the many collaterals of the COVID-19 pandemic is the disruption of health services and vital clinical research. COVID-19 has magnified the challenges faced in research and threatens to slow research for urgently needed therapeutics for Neglected Tropical Diseases (NTDs) and diseases affecting the most vulnerable populations. Here we explore the impact of the pandemic on a clinical trial for plague therapeutics and strategies that have been considered to ensure research efforts continue. METHODS: To understand the impact of the COVID-19 pandemic on the trial accrual rate, we documented changes in patterns of all-cause consultations that took place before and during the pandemic at health centres in two districts of the Amoron'I Mania region of Madagascar where the trial is underway. We also considered trends in plague reporting and other external factors that may have contributed to slow recruitment. RESULTS: During the pandemic, we found a 27% decrease in consultations at the referral hospital, compared to an 11% increase at peripheral health centres, as well as an overall drop during the months of lockdown. We also found a nation-wide trend towards reduced number of reported plague cases. DISCUSSION: COVID-19 outbreaks are unlikely to dissipate in the near future. Declining NTD case numbers recorded during the pandemic period should not be viewed in isolation or taken as a marker of things to come. It is vitally important that researchers are prepared for a rebound in cases and, most importantly, that research continues to avoid NTDs becoming even more neglected

An open-label, randomized, non-inferiority trial of the efficacy and safety of ciprofloxacin versus streptomycin + ciprofloxacin in the treatment of bubonic plague (IMASOY): study protocol for a randomized control trial.

BACKGROUND: Bubonic plague is the primary manifestation of infection with Yersinia pestis, accounting for 90% of all plague cases and with 75% of global cases reported in Madagascar. All drugs in use for treating plague are registered based on experimental data and anecdotal evidence, and no regimen currently recommended is supported by a randomized clinical trial. The IMASOY trial intends to fill this knowledge gap by comparing two 10-day regimens included in the national guidelines in Madagascar. The primary objective of the trial is to test the hypothesis that ciprofloxacin monotherapy is non-inferior to streptomycin followed by ciprofloxacin for the treatment of bubonic plague, thus avoiding the need for injectable, potentially toxic, aminoglycosides. METHODS: A two-arm parallel-group randomized control trial will be conducted across peripheral health centres in Madagascar in five districts. Males and non-pregnant females of all ages with suspected bubonic or pneumonic plague will be recruited over the course of three plague 'seasons'. The primary endpoint of the trial is to assess the proportion of patients with bubonic plague who have a therapeutic response to treatment (defined as alive, resolution of fever, 25% reduction in the size of measurable buboes, has not received an alternative treatment and no clinical decision to continue antibiotics) as assessed on day 11. DISCUSSION: If successful, the trial has the potential to inform the standard of care guidelines not just in Madagascar but in other countries afflicted by plague. The trial is currently ongoing and expected to complete recruitment in 2022. TRIAL REGISTRATION: ClinicalTrials.gov NCT04110340 . Registered on 1 October 2019

The global spread of misinformation on spiders

Non peer reviewe