Loss of HIV-infected patients on potent antiretroviral therapy programs in Togo: risk factors and the fate of these patients

Introduction: National programs are facing challenges of loss to follow-up of people living with HIV/AIDS (PLWHA) on antiretroviral therapy (ART). We sought to identify risk factors associated with early loss to follow-up among HIV-infected patients on ART in Togo and the outcome of such patients. Methods: This was a retrospective cross-sectional study using medical records of all patients older than age 15 years enrolled at 28 treatment centers who were on ART programs and who were lost to follow-up from 2008 to 2011. Results: Of the 16,617 patients on ART, 1,216 (7.3%) were lost to follow-up. Most (94.1%) were infected with HIV-1 and 32.6% were in WHO stage III or IV. The median CD4 count was 118/mm3 (IQR: 58-178 cells/mm3). No telephone number was mentioned in the medical records of 212 patients. Of the 1004 patients whose phone number was listed, 802 patients (79.9%) were not reachable on the recorded number, 114 patients (11.4%) were alive and 88 patients (8.8%) had died. In multivariate analysis, factors associated with loss to follow-up during the first 6 months of ART were: age below 35 years (OR=1.6; 95%CI: 1.2-2.2), female sex (OR=1.8; 95%CI: 1.3-2.5), WHO stage III or IV (OR=1.7; 95%CI: 1.3-2.2), existence of an opportunistic infection (OR=2.3; 95%CI: 1.5-3.1), and follow-up in a public centre (OR=1.9; 95%CI: 1.2-3.3). Conclusion: This study identified several factors associated with lost to follow-up during the first 6 months of ART, and confirmed high mortality among these patients. The National AIDS Program should strengthen medical support of PLWHA in Togo including active case follow-up.Key words: Africa, HIV, human immunodeficiency virus, lost to follow-up, people living with HIV, Tog

Session 1 - Vocational Education and Training: basics for teaching and research in Vocational Education and Training at universities

This session highlights the basics of Vocational Education and Training (VET). Each university has its own characteristics. The contributions seek to encourage various forms of VET. Challenges for universities and other institutions are emphasised. The contributions help draw conclusions for the Further structuring of VET in Sub-Saharan Africa. Other country-specific articles from the session concentrate on the characteristics and orientation of VET systems, thereby helping create an overall picture of the status of VET in all participating countries. The participants endeavored to analyze the current situation of VET in Sub-Saharan Africa by exploring the character and individual design of the current VET systems in the participating countries

Microbial cell immobilization in biohydrogen production: a short overview

The high dependence on fossil fuels has escalated the challenges of greenhouse gas emissions and energy security. Biohydrogen is projected as a future alternative energy as a result of its non-polluting characteristics, high energy content (122 kJ/g), and economic feasibility. However, its industrial production has been hampered by several constraints such as low process yields and the formation of biohydrogen-competing reactions. This necessitates the search for other novel strategies to overcome this problem. Cell immobilization technology has been in existence for many decades and is widely used in various processes such as wastewater treatment, food technology, and pharmaceutical industry. In recent years, this technology has caught the attention of many researchers within the biohydrogen production field owing to its merits such as enhanced process yields, reduced microbial contamination, and improved homogeneity. In addition, the use of immobilization in biohydrogen production prevents washout of microbes, stabilizes the pH of the medium, and extends microbial activity during continuous processes. In this short review, an insight into the potential of cell immobilization is presented. A few immobilization techniques such as entrapment, adsorption, encapsulation, and synthetic polymers are discussed. In addition, the effects of process conditions on the performance of immobilized microbial cells during biohydrogen production are discussed. Finally, the review concludes with suggestions on improvement of cell immobilization technologies in biohydrogen production

Study of Condensed Phases, of Vaporization Temperatures of Aluminum Oxide and Aluminum, of Sublimation Temperature of Aluminum Nitride and Composition in an Air Aluminum Plasma

International audienceWith the Gibbs free energy method, we determine the molar fraction in a plasma at and out of thermal equilibrium consisting of air and aluminum for several percentages in the temperature range of 500–6000 K. We take three temperatures into account (Trot = Th; Tvib; Tex = Te). We indicate the formulae and the numerical method used to perform the calculation taking three condensed phases AlN, Al, Al2O3 into account. We show that the air percentage plays a major role to create these phases. We clarify the role plays on the vaporization temperatures and on the sublimation temperatureby the non-thermal equilibrium of the plasma. This kind of plasma is found in arc roots, near a wall, in plasmas with a high value of electrical field,… The influence of the pressures until 30 9 105 Pa. is shown on molar fraction of the chemical species, on the vaporization temperatures and on the sublimation temperature. The vaporization temperatures are given versus the thermal non equilibrium versus various mixtures (air, aluminum) and versus the pressures (10^5 Pa–30 10^5 Pa)

Alarming rates of virological failure and drug resistance in patients on long-term antiretroviral treatment in routine HIV clinics in Togo

Information on efficacy of long-term antiretroviral treatment (ART) exposure in resource-limited countries is still scarce. In 767 patients attending routine HIV centers in Togo and receiving first-line ART for more than four years, 42% had viral load greater than 1000copies/ml and either were on a completely ineffective ART regime or were with only a single drug active. The actual conditions to ensure lifelong ART in resource-limited countries can have dramatic long-term outcomes

Vertical transmission of microcystins to Nile crocodile (Crocodylus niloticus) eggs

Cyanobacteria or blue green algae are known for their extensive and highly visible blooms in eutrophic, stagnant freshwater bodies. Climate change and global warming have also contributed to a rise in toxic cyanobacterial blooms. One of the most important cyanobacteria is Microcystis aeruginosa, which can synthesize various microcystins that can affect the health of terrestrial and aquatic animals. Commercial Nile crocodile (Crocodylus niloticus) farming in South Africa is based on keeping breeders (adult males and females) in big dams on farms (captive-bred approach). Unfortunately, cyanobacterial blooms in the breeder dams are a concern to farm owners, managers and veterinarians. The main objectives of this research project were to determine if microcystins were present in the contents of crocodile eggs and the liver and yolk of dead hatchlings, and to determine if the reduced hatchability on commercial farms might be caused by these toxins. Furthermore, the concentration of microcystins in the breeder dam was monitored on a monthly basis spanning the ovulation and egg laying period. During the hatching season microcystin concentrations in unfertilised eggs, egg shell membranes and in the yolk and liver of dead hatchlings were determined using liquid chromatography-high resolution mass spectrometry (LC-HRMS). Microcystins were detected in Nile crocodile egg and hatchling samples. Microcystin (MC-LR, MC-RR, MC-YR) concentrations in the crocodile egg and hatchling samples collected from clutches with a good hatching rate (≥90%) ranged between 0 and 1.76 ng g−1, with the highest concentration in the egg shell membranes. Microcystin concentrations in samples collected from clutches with a bad hatching rate (≤10%) ranged from 0 – 1.63 ng g−1 with the highest concentration detected in the hatchling yolk. However, the concentrations were probably underestimated as the percentage recovery from spiked samples was very low with the extraction method employed. Bayesian analysis suggests that the liver, yolk and unfertilised egg all have similar microcystin concentrations, while the membranes have (with moderate to high certainty) higher microcystin concentrations. There appears to be no difference in microcystin concentrations among good and bad clutches across all tissue types or within a specific tissue type, but due to the small sample size, it was not possible to determine whether microcystin affected the hatchability of Nile crocodile eggs. However, vertical transmission of microcystin variants to the Nile crocodile egg does occur and the possible implications for the survival of wild Nile crocodile populations should be ascertained.The National Research Foundation of South Africa [86820].http://www.elsevier.com/locate/toxicon2018-08-01hj2018Anatomy and PhysiologyParaclinical Science

High prevalence of HIV-1 drug resistance among patients on first-line antiretroviral treatment in Lome, Togo

Background: With widespread use of antiretroviral (ARV) drugs in Africa, one of the major potential challenges is the risk of emergence of ARV drug-resistant HIV strains. Our objective is to evaluate the virological failure and genotypic drug-resistance mutations in patients receiving first-line highly active antiretroviral therapy (HAART) in routine clinics that use the World Health Organization public health approach to monitor antiretroviral treatment (ART) in Togo. Methods: Patients on HAART for one year (10-14 months) were enrolled between April and October 2008 at three sites in Lome, the capital city of Togo. Plasma viral load was measured with the NucliSENS EasyQ HIV-1 assay (Biomerieux, Lyon, France) and/or a Generic viral load assay (Biocentric, Bandol, France). Genotypic drug-resistance testing was performed with an inhouse assay on plasma samples from patients with viral loads of more than 1000 copies/ml. CD4 cell counts and demographic data were also obtained from medical records. Results: A total of 188 patients receiving first-line antiretroviral treatment were enrolled, and 58 (30.8%) of them experienced virologic failure. Drug-resistance mutations were present in 46 patients, corresponding to 24.5% of all patients enrolled in the study. All 46 patients were resistant to non-nucleoside reverse-transcriptase inhibitors (NNRTIs): of these, 12 were resistant only to NNRTIs, 25 to NNRTIs and lamivudine/emtricitabine, and eight to all three drugs of their ARV regimes. Importantly, eight patients were already predicted to be resistant to etravirine, the new NNRTI, and three patients harboured the K65R mutation, inducing major resistance to tenofovir. Conclusions: In Togo, efforts to provide access to ARV therapy for infected persons have increased since 2003, and scaling up of ART started in 2007. The high number of resistant strains observed in Togo shows clearly that the emergence of HIV drug resistance is of increasing concern in countries where ART is now widely used, and can compromise the long-term success of first-and second-line ART