Prevalence of hepatitis A virus in patients attending a referral hospital in Bubanza Province, Northwest Burundi

Background: Viral hepatitis is a public health problem wide world. Hepatitis A, transmitted by fecal-oral route, is an infectious viral disease caused by hepatitis A virus and mainly due to poor sanitation. This study aimed to determine the prevalence of hepatitis A virus and associated factors in patients attending Mpanda referral hospital in Northwest Burundi.Methods: A cross-sectional study was done from November 2017 to January 2018 on 385 participants aged 2 years and above. Participants were recruited using a systematic random sampling technique. Data were collected using questionnaire from consented/assented participants. Five millilitres of venous blood was collected and analyzed. Anti-hepatitis A virus antibodies were screened using Enzyme Immuno Assay. Data were analyzed using Statistical Package for the Social Sciences version 16.0 software. A descriptive analysis was followed by bivariate analysis using a Chi-square test for comparison of various sub-groups with 5% statistical significance level. Odds ratio and 95% Confidence Intervals were calculated and presented.Results: The median age of the participants was 23 years and the range 72 years. The overall prevalence of Hepatitis A virus was 60.3%. There was a significant association between age [OR=7.22 (4.04-12.93), P <0.001], lack of clean water [OR=10.07 (5.63-18.01), P <0.001], traditional latrines [OR=1.86 (1.02-3.40), P=0.04] and Hepatitis A Virus seroprevalence.Conclusions: Present study shows high prevalence of HAV infection in patients attending Mpanda Referral Hospital. Younger age, lack of clean water and traditional latrines play roles in increasing prevalence of HAV infection in both rural and urban areas

An in vitro evaluation of drugs used in the Kenyan ART program

The majority of anti-HIV drug susceptibility tests have been performed on subtype B HIV-1 strains, since these are the most prevalent in countries designing, testing, and manufacturing the current anti-HIV agents. The increasing global spread of HIV subtype highlights the need to determine the activity of anti-HIV drugs against subtypes of HIV other than subtype B. Furthermore an increasing number of individuals infected with many of the non subtype B virus strains now receive antiretroviral therapy because of rollout programs in developing countries as well as increasing migration to the developed world. The phenotypic susceptibility of two laboratory strains HIV-1JFRL and HIV-1IIIB (representing subtype B) and two clinical isolates HIV-104RTA and HIV-1025RTA (representing subtypes A and D respectively) was determined. The in vitro drug susceptibility testing of the isolates was carried out in C8166 cell line and in peripheral blood mononuclear cells (PBMCs). The study revealed that the drugs used in the Kenyan national ART program inhibited HIV-1 replication in-vitro as their inhibitory concentrations (IC50) compared well with the standard Inhibitory concentration values. The results also suggest a biochemical similarity of the reverse transcriptase (RT) and protease enzymes from these subtypes despite the divergence at the genetic level. The findings suggest that similar clinical benefits of antiviral therapy obtain in persons infected with other subtypes of HIV-1other than subtype B and that the generic drugs used in the national ART program in Kenya are as efficacious as branded drugs in inhibiting HIV replication in vitro despite the limited number of the viruses studied.Pan African Medical Journal 2016; 2

Characterization of HIV-1 Integrase Gene and Resistance Associated Mutations Prior to Roll out of Integrase Inhibitors by Kenyan National HIV-Treatment Program in Kenya

BACKGROUND: Antiretroviral therapy containing an integrase strand transfer inhibitor plus two Nucleoside Reverse Transcriptase inhibitors has now been recommended for treatment of HIV-1-infected patients. This thus determined possible pre-existing integrase resistance associated mutations in the integrase gene prior to introduction of integrase inhibitors combination therapy in Kenya.METHODS: Drug experienced HIV patients were enrolled at Kisii Teaching and Referral in Kenya. Blood specimens from (33) patients were collected for direct sequencing of HIV-1 polintegrase genes. Drug resistance mutations were interpreted according to the Stanford algorithm and phylogenetically analysed using insilico tools.RESULTS: From pooled 188 Kenyan HIV integrase sequences that were analysed for drug resistance, no major mutations conferring resistance to integrase inhibitors were detected. However, polymorphic accessory mutations associated with reduced susceptibility of integrase inhibitors were observed in low frequency; M50I (12.2%), T97A (3.7%), S153YG, E92G (1.6%), G140S/A/C (1.1%) and E157Q (0.5%). Phylogenetic analysis (330 sequences revealed that HIV-1 subtype A1 accounted for majority of the infections, 26 (78.8%), followed by D, 5 (15.2%) and C, 2 (6%).CONCLUSION: The integrase inhibitors will be effective in Kenya where HIV-1 subtype A1 is still the most predominant. However, occurring polymorphisms may warrant further investigation among drug experienced individuals on dolutegravir combination or integrase inhibitor treatment.&nbsp

Molecular Characterization of HIV-1 And Drug Resistance Among HIV-1 Infected Patients Attending Kayanza District Hospital, Burundi

This study was funded by the East Africa Public health Laboratory Network Project (EAPHLNP)/Burundi. Abstract Virological failure in management of HIV-1 infection has been reported to be between 11 to 24% after 12 months of treatment. Out of these, acquired or transmitted drug resistance mutations have been reported at 71% to 90% in Sub-Sahara Africa. In this cross-sectional study we aimed to determine virological failure and drug resistance mutations in HIV-1 infected patients on ART attending Kayanza district hospital, Burundi. Patients were recruited using a purposive sampling technique. After informed consent, 4mL of venous blood was collected from each patient. The blood was separated into plasma and cells for various laboratory assays. Plasma viral loads were quantified using the Abbott m2000rt system. Polymerase chain reaction using gene specific primers was done after extraction of nucleic acids from plasma with &gt;1000 copies/ mL, followed by sequencing of all amplified samples. Drug resistance was determined using the IAS and Stanford University database, with phylogenetic analyses done using the neighbor joining method.Two hundred patients were recruited; 13% of the respondents had virological failure associated with multiple sex partners (adjusted odds ratio (aOR, 0.154 , p =0.016) and irregularity in taking medications (aOR: 0.4 , p=0.014). Fifteen samples were successfully sequenced; 80% (12/15) were HIV-1 subtype C, 7% (1/15) subtype A, and 13% (2/15) were HIV-1 subtype A1. Of these, 87.5% had at least one mutation (NRTI or NNRTI), while 12.5 % did not carry any Drug Resistance Mutations. The most common drug resistance mutations were M183V, T215V M41L, E44D, L74I, L210W and K65R, K103N, Y188H. The prevalence of virological failure was established at 13%.Our findings showed possible gaps in the last 90% of the 90-90-90 WHO target by 2020. The results highlight the need for intense viral load and resistance testing for patients to improve overall treatment outcome. Some strategies are needed to improve adherence counselling and drug resistance mutation testing should be implemented to monitor HIV-1 patients on ART in Burundi. Keywords: HIV-1, antiretroviral therapy, Virological failure, DRMs, Burundi. DOI: 10.7176/JBAH/9-10-05 Publication date:May 31st 201

Prevalence and Genetic Characterization of Rotavirus Infections Among Children Under Five Years in Mutaho Health District, Gitega Province and Bujumbura Municipality, Burundi

Rotavirus is the leading cause of severe diarrhea in children under five years worldwide. It is ranked as a priority for vaccine. In Burundi, vaccine against rotavirus was implemented in 2013. The impact of recent rotavirus vaccination on morbidities in Burundi is not well established. Moreover, no study has been carried out to document the genetic diversity of rotavirus strains circulating in Burundi. This cross-sectional health facility-based study aimed at determining the prevalence and molecular characteristics of rotavirus infections among children under five years of age in Mutaho Health District and the Municipality of Bujumbura, in Burundi. Stool specimens were collected from children presenting with acute diarrhea. These specimens were tested for rotavirus antigen using Diagnostar® rapid test kit.  Positive stool samples were confirmed at the Kenya Medical Research Institute (KEMRI) by ELISA. Positive confirmed samples underwent RT-PCR, G and P genotyping by multiplex semi-nested PCR using a cocktail of type specific primers or by sequencing. A total of 646 participants were enrolled in this study. The overall prevalence of rotavirus was 6.2% (40/646) with 4.0% (16/400) in Mutaho health district and 9.7% (24/246) in the Municipality of Bujumbura. Rotavirus detection rate tended to increase as the level of precipitation went down, showing a significant negative association between the two variables. (OR = 15.2; P = 0.0001). In addition, rotavirus detection rate was higher in Bujumbura Municipality than in Mutaho health district (OR = 2.6; P = 0.005). Two G genotypes were identified, G1 the predominating G genotype accounted for 53.8% (14/26) followed by G12 (46.2%, 12/26). The prevalence of the genotype G1 of Group A rotavirus was significantly higher in Bujumbura Municipality than in Mutaho health district while G12 predominated in Mutaho health district (OR = 7.33; P = 0.026). Rotavirus strains from pigs might have contributed to the high prevalence of human G12 rotavirus in that area. Three different P types were identified P[8] the most common, followed by P[6] and P[4]. The most common G/P combination genotype was G1P[8] which accounted for 45.5% of all rotavirus genotypes identified, followed by G12 P [8] (41.0%), G1P [6] (4.5%), G12 P [6] (4.5%) and G12 P [4] (4.5%). The emergence of G12 rotavirus strains which share neither G nor P genotypes with currently used rotavirus vaccines raises public health concerns as they have the potential to challenge their efficacy. Therefore, we recommend to initiate and maintain a continuous rotavirus strain surveillance in Burundi so as to monitor trends in the occurrence of these prevailing and potentially emerging new strains. Keywords: Rotavirus, diarrhea, genetic diversity, prevalence, Mutaho, Bujumbura, children DOI: 10.7176/JBAH/9-10-04 Publication date:May 31st 201

Mutations in the “a” Determinant Region of Hepatitis B Virus Genotype A among Voluntary Kenyan Blood Donors

Background: Occurrence of mutations within the major antigenic alpha determinant region of hepatitis B surface antigen (HBsAg can alter HBV antigenicity resulting in   failures in diagnosis, vaccine and hepatitis B immunoglobulin therapy. Objective: This study aimed at detection of mutations in the “a” determinant region of HBV surface antigen among voluntary blood donors in Kenya. Design: A cross sectional study involving serology and molecular techniques Settings: This study involved analysis of samples from blood transfusion centers Subjects: A total of 301 blood samples from donor blood were collected for the study. Methods: Sero-status for HBsAg was determined using Enzyme-Linked Immunosorbent Assay (ELISA). A fragment of the S gene including the "a" determinant was amplified by PCR from the HBsAg positive samples and sequenced for mutation analysis. Mutations and phylogenetic analyses were performed using Mega 6 software, Bioedit software and GENETYX® software version 9.1.0. Results: Out of the 301 samples tested 69/301 (22.9%) were Polymerase Chain Reaction (PCR) positive including 2/69(2.9%) were sero-negative for HBsAg. All isolates were genotype A, sub-genotype A1. A total of 29 mutations were observed of which 37.9% were located within the “a” determinant. Mutations T143M and K122R were the most frequent in this study. Escape mutations associated with diagnostic failure, vaccine and immunoglobulin therapy escape were also identified. Conclusions: These findings are important for policies related to vaccine implementation and therapeutic and diagnostic guidelines. Keywords: Escape mutants, genotype, hepatitis B virus, antigenic determinant, surface antigen

Human Immunodeficiency Virus -1 and Hepatitis B Virus Co-Infections among Injecting Drug Users in Malindi, Kenya

Currently no published data addressing the burden of Human Immunodeficiency Virus (HIV) and Hepatitis B Virus (HBV) co-infection among injecting drug users (IDUs) in Kenya exists. These two viruses share similar routes of transmission, with illicit drug use by injection being the major route of infection. Injecting drug use is a rapidly growing problem in coastal towns of Kenya and the problem is aggravated by sex tourism.This study aimed at determining the prevalence of HBV in HIV positive IDUs and correlating the findings with socio-demographic factors of the study population.A cross-sectional study was conducted using structured questionnaires and laboratory testing of blood samples. Surface antigens for HBV (HBsAg) and anti-HIV antibodies were screened using rapid kits followed by Enzyme Linked Immunosorbent assay tests on positive samples using Hepanostika and Vironostika test kits, for HIV and HBV, respectively. The CD4+ T-cell count was determined by flow cytometry.The prevalence of HIV/HBV co-infection was 14.3% (13/91) with a mean age of 33.2 (SD ± 8.1) years. The mean CD4+ cell count in the HIV/HBV co-infected individuals was significantly lower than HIV mono-infection. Needle sharing and duration of active injection of drugs were significantly associated with HIV/HBV co-infections.This study concludes a potentially high prevalence of HBV/ HIV co-infection in injecting drug users in Malindi, Kenya. With limited evidence on IDU prevalence and its consequences in sub-Saharan Africa, the results of this study highlight the need for a more refined policy on HIV treatment strategy among IDUs. There is a further need for triple testing for HIV, HBV and HCV among suspected IDUs and other associated risk groups like the commercial sex workers before commencement of treatment. Keywords: Injecting drug users, HIV-1, HBV, viral co-infection, Malindi, Keny

Mutations in the “a” Determinant Region of Hepatitis B Virus Genotype A among Voluntary Kenyan Blood Donors

Occurrence of mutations within the major antigenic alpha determinant region of hepatitis B surface antigen (HBsAg can alter HBV antigenicity resulting in   failures in diagnosis, vaccine and hepatitis B immunoglobulin therapy. This study aimed at detection of mutations in the “a” determinant region of HBV surface antigen among voluntary blood donors in Kenya. This was a cross sectional study involving serology and molecular techniques. This study involved analysis of samples from blood transfusion centers. A total of 301 blood samples from donor blood were collected for the study.  Sero-status for HBsAg was determined using Enzyme-Linked Immunosorbent Assay (ELISA). A fragment of the S gene including the "a" determinant was amplified by PCR from the HBsAg positive samples and sequenced for mutation analysis. Mutations and phylogenetic analyses were performed using Mega 6 software, Bioedit software and GENETYX® software version 9.1.0. Out of the 301 samples tested 69/301 (22.9%) were Polymerase Chain Reaction (PCR) positive including 2/69(2.9%) were sero-negative for HBsAg. All isolates were genotype A, sub-genotype A1. A total of 29 mutations were observed of which 37.9% were located within the “a” determinant. Mutations T143M and K122R were the most frequent in this study. Escape mutations associated with diagnostic failure, vaccine and immunoglobulin therapy escape were also identified. These findings are important for policies related to vaccine implementation and therapeutic and diagnostic guidelines. Keywords: Escape mutants, genotype, hepatitis B virus, antigenic determinant, surface antige

Factors Associated with Choice of Infant Feeding Practices among HIV-1 Positive Post-natal Clinic Attendees in Tharaka Nithi County

Background: Feeding practices for HIV-exposed infants plays a key role in determining the risk of morbidity and mortality. Infected mothers’ choice of infant feeding is influenced by many factors within the community hence challenging their decisions. We sought to determine factors associated with choice of HIV exposed infant feeding practices in the region. Methods: Two hundred and forty nine HIV infected mothers were systematically recruited.  Data on infant HIV status was obtained from facility records. Respondents were interviewed using a semi-structured questionnaire. Focus group discussions and key informant interviews were carried out to support primary data. Analysis was done using SPSS version 16.0. Logistic regression was used to determine association of factors that influenced choice of infant feeding practice. Results: Of the 249 respondents, 98% chose exclusively breastfeeding during prenatal counseling but majority did not sustain beyond 2 months, while replacement feeding was least practiced (2%) postnatal. Major factors that influenced feeding practices were mother’s education (OR 2.637; CI: 1.088-6.388), non-health care workers advise (OR 3.053; CI: 1.706-5.463), not belonging to support groups (OR 2.804; CI: 1.620-4.854) rejection of health care workers support (OR 3.386; CI: 1.937-5.919). Conclusion: Although exclusive breastfeeding was the preferred feeding choice among the respondents immediately after birth, it was not sustained beyond the second month of the infant’s life. Increased contact of HIV positive women with health care workers and professionals through promotion of trust in community health workers, attendance of ANC and delivery in hospital should be promoted.  Education efforts should also target non health care persons who influence feeding practices to reduce stigma among HIV positive mothers. Keywords:  Infant feeding practices; Stigm

High Parity and Low Education are Predictors of Late Antenatal Care initiation among Women in Maternal and Child Health Clinics in Kwale County, Kenya

Background: Timely initiation of antenatal care (ANC) clinic attendance during pregnancy helps identify and reduce risk factors in pregnancy.  The World Health Organization (WHO) recommends at least four ANC visits during pregnancy with the first being in the first trimester. In most developing countries including Kenya, the first visit occurs late in some mothers. Aim: This study describes ANC attendance by mothers at clinics in Kwale County. It was conducted with the aim of determining factors affecting ANC attendance in two dispensaries in Kwale County. Design: A cross-sectional study using quantitative research methods was adopted. Results: Two hundred and eighty pregnant women at a gestational age of 20 weeks and above were recruited and interviewed. All the mothers made at least one ANC visit with 19.6% starting in the first trimester. About a quarter of the mothers (24.0 %) came for the first time at nine months gestational age.  There was a significant relationship between late ANC initiation and low or no formal education (p = 0.001) as well as higher parity (p = 0.0001). Mothers with no formal education were four times more likely to initiate ANC clinics late  compared to those with secondary or tertiary education (OR = 4.687; CI 1.765 – 12.447). The likelihood of mothers whose husbands had no formal education initiating ANC later was almost three times more likely as compared to those who had secondary or tertiary education (OR = 2.775; CI 1.107 – 6.960).  Multiparous women were more likely to initiate ANC clinics earlier compared to grand multiparous women (OR = 0.513; CI 0.223 – 1.183). Conclusion: Timely initiation and appropriate ANC attendance was low in Kwale. Low education level and high parity had a significant negative association with timely ANC initiation. There is need for community mobilization and enlightening on the importance of timely ANC attendance for mothers to reap the full benefits of maternal and child health care. Keywords: Maternal, Antenatal, Child, Health, Parity, Multiparous, Grand multiparous.