Evaluation of five commercial assays for detecting HIV 1 & 2 antibodies, Addis Ababa

Abstract: The major operational characteristics of five commercially available assays for the detection of antibodies to Human Immunodeficiency Virus (HIV1 & 2) were evaluated. Four Enzyme Linked Immuno-sorbent assays (ELISAs) and one simple immuno-dot assay with visual reading, were assessed using a panel of 265 sera (18.8% hospital suspected patients, 18.8% commercial sex-workers (CSW), 31.5% blood donor sample (BDS), and 30.9% of them were scholarship winners (SSW)). Sensitivity, specificity, positive predictive value, test efficiency, delta (δ) values (for the four ELISAs) were determined. All the assays had higher sensitivities (98.7100%), specificities (97.2-99.1%), and test efficiencies (98.1-99.6%). Higher positive and negative delta (δ+,δ -) values, +1.17 and –0.99, were observed for ICE*HIV 1-0-2 and Vironostika Uniform II PLUS O, respectively. HIV-SPOT HIV 1 & 2 showed highest value of ease of performance and suitability for small blood bank collection centers. Results of this study showed that the test efficiency, sensitivity, and specificity of the test kits were excellent as compared to the reference test. Further studies on cost-effectiveness and evaluation of newly arrived test kits before use at different levels are recommended. [Ethiop. J. Health Dev. 1999;13(3):175-180

Seroprevalence Of Syphilis and HIV-1 Among Pregnant Women Attending Antenatal Clinic in Jimma Hospital, Southwestern Ethiopia

No abstract - Available on PD

Sero-prevalence of latent <it>Toxoplasma gondii </it>infection among HIV-infected and HIV-uninfected people in Addis Ababa, Ethiopia: A comparative cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Toxoplasmosis in immuno-compromised hosts manifests primarily as a life threatening condition, toxoplasmic encephalitis. However, there is scarce information about the magnitude of <it>Toxoplasma gondii </it>infection among HIV-infected people in Ethiopia. This study was, therefore, conducted to determine the sero-prevalence of <it>T. gondii </it>infection among HIV-infected and HIV-uninfected subjects.</p> <p>Findings</p> <p>Sera were collected from people with and without HIV infection for the purpose of studying hepatitis B virus (HBV) at St. Paul Hospital, Addis Ababa, Ethiopia from 24 January 2007 to 15 February 2007. Among these sera, the first 330 consecutive sera, 165 from each HIV sero-group, were selected and tested for anti-<it>T. gondii </it>IgG antibodies using Enzyme Linked Immunosorbent Assay. The seroprevalence of <it>Toxoplasma </it>infection was assessed against socio-demographic characteristics, HIV and HBV serostatus and HBV-related risk factors. The overall sero-prevalence of latent <it>T. gondii </it>infection among the study subjects was 90.0%. <it>Toxoplasma </it>infection was observed with respective prevalence of 93.3% and 86.7% among HIV-infected and HIV-uninfected people. Though <it>Toxoplasma </it>infection seems to be influenced by age, gender and HIV serostatus, only HBV serostatus was significantly associated (OR 2.71, CI 1.12 to 6.57) in multivariate logistic regression analysis.</p> <p>Conclusion</p> <p>The seroprevalence of latent <it>T. gondii </it>infection is high and similar by HIV status. Educating people to prevent acquisition of new <it>Toxoplasma </it>infection and minimizing the risk of disease manifestations among HIV-<it>Toxoplasma </it>co-infected individuals is important.</p

Tuberculin Skin Test Conversion and Reactivity Rates among Adults with and without Human Immunodeficiency Virus in Urban Settings in Ethiopia

To investigate whether low CD4(+) T-cell counts in healthy and human immunodeficiency virus (HIV)-infected Ethiopians influence tuberculosis (TB) immunological memory, tuberculin skin test (TST) conversion and reactivity rates were investigated among adults with and without HIV infection in urban settings in Ethiopia. Reaction to the TST was analyzed with purified protein derivative by the Mantoux technique. A total of 1,286 individuals with TST results of ≥5-mm (n = 851) and ≤4-mm (n = 435) induration diameters were included. Individuals with ≤4-mm induration sizes were followed up for 21.4 ± 9.5 months (mean ± standard deviation) to observe skin test conversion. The overall TST reactivity (≥5-mm induration diameter) was 66.2% (n = 851). Reactivity was significantly lower among HIV-positive persons (40.5%) than among HIV-negative persons (68.7%) (P < 0.001). Of the above persons, 32 incident TB patients were checked for their TST status 13.05 ± 11.1 months before diagnosis and reactivity was found among 22 (68.7%) of them. Of the TST-negative persons with 0- to 4-mm indurations who were followed up for 3 years, the conversion rate to positivity was 17.9/100 person-years of observation (PYO) (14.4/100 PYO and 18.3/100 PYO in HIV-positive and -negative persons, respectively). Despite lower absolute CD4(+) T-cell numbers in Ethiopians, higher TST conversion and reactivity rates show the presence of a higher rate of latent TB infection and/or transmission. The lower TST positivity rate before a diagnosis of TB disease showed the lower sensitivity of the test. This indicates the need for other sensitive and specific diagnostic and screening methods to detect TB infection, particularly among HIV-positive persons, so that they can be given prophylactic isoniazid therapy

Behavioural survey for HIV/AIDS infection in Asosa, among the general population and commercial sex workers

Background: Assessment of high-risk behavior for HIV/AIDS transmission is rare in emerging regions of Ethiopia. Objective: To assess high-risk behaviors and factors for voluntary counseling and testing. Examination of the situation has been undertaken. Methods: A cross-sectional behavioral survey was done in Asosa Town on randomly selected adults and all female sex workers. Results: From 631 sexually active adults, 527 (84.6%) had sexual intercourse in last the 12months, 67(12.7%) sex in exchange with money and 88(16.7%) with their non-regular non-commercial partner. Ever use of condom among the general population and female sex workers was found in 168(26.6%) and 185(88.5%) respectively. More than one third of the respondents among the general population knew a person who died of HIV /AIDS and 47.6 % of the respondents lost a close relative due to the same cause. Among the general population, 421(47.6%) were aware of being engaged in high-risk practices, which expose them to HIV/AIDS. Multi variate analysis revealed female [OR= 1.5, 95%CI=1.02-2.10] and individuals who had a positive attitude to take VCT test [OR=1.60: 95% CI=1.2-2.2] felt themselves more at risk. Conclusion: High-risk behavior, low levels of condom use and knowledge about the epidemic have been found in Asosa. Behavioral change communication has to be implemented to reduce those risky behavior and scale up condom use. [Ethiop.J.Health Dev. 2004;18(2):75-81

The status of HIV screening laboratories in Ethiopia: achievements, problems encountered and possible solutions

Objectives: To know the status of HIV screening laboratories in different parts of the country, to identify the major problems encountered and to suggest and recommend possible solutions to the policy makers at different levels. Materials and methods: Forty-two out of 74 government and non-government owned HIV screening laboratories were supervised in December 2001. A cross sectional study using a detailed questionnaire and an on-site observation /supervision to assess the technical issues, safety procedures, laboratory management and other related issues to quality assurance was conducted. These laboratories were selected randomly and at least one laboratory from each region has been included. Results: Most laboratories, 27(64.3%) were capable of performing ELISA and Rapid tests. Majority of them (62%) do not follow a specific testing algorithm, only in 50% were confirmatory tests performed, while 21% send their specimen to the regional laboratories and the remaining 29% do not confirm their results at all. In only 29% of them were safety guidelines practiced. In 58.4% and 54.7% of them, there was a shortage of reagents and protective materials, respectively. Problems related to maintenance, weak referral system, poor laboratory management, lack of follow-up resulting in delay of issuing results to clients were identified. Recommendations: It is suggested that the problems of regional laboratories should be alleviated through collaborative approach among different stakeholders and there is a need to encourage them to fully participate in NEQUAS. Strengthening in equipment and trained human resource, and close follow-up of Regional Laboratories, timely ordering of supplies and reagents, continuous training programs on HIV screening methods, quality assurance and maintenance were recommended. [Ethiop.J.Health Dev. 2002;16(2):209-215

Laboratory services in hospitals and regional laboratories in Ethiopia

Background: Laboratory service facility in health institutions in Ethiopia of is very weak and limited. This can be explained by lack of properly designed laboratory rooms, shortage of equipment and supplies, poor maintenance system and lack of close follow-up and supervision. Objective: To assess the laboratory service at a Hospital and Regional levels, and to come up with some recommendations that may help for the improvement of the service in the country. Methods: Thirty-four health institutions with laboratory service (28 Hospitals and 6 Regional Referral laboratories) were assessed from 9 Regional and 2 Administrative states of the country. A pre-tested well-structured questionnaire was administered. Site supervision on the general conditions of the laboratories was also made. Results: Almost all the health institutions reported shortage of common supplies and reagents. Common and simple tests were not even done due to severe reagent shortages. Majority of the health institutions reported problems related to maintenance. Weak referral system and absence of quality assurance network were also observed. Recommendations: Planning together with laboratory professionals and/or budgeting the laboratory service separately and close follow-up for the proper utilization were suggested to alleviate the problems related to shortage of supplies and reagents. Establishing national quality assurance network, addressing problems related to maintenance, equipping the laboratories would help the laboratories to meet the need of the service users in the sector. [Ethiop.J.Health Dev. 2004;18(1):43-47

Overall HIV-1 prevalence in pregnant women over-estimates HIV-1 in the predominantly rural population of Afar Region

The appropriateness of sentinel sero-surveillance based upon ante-natal clinic (ANC) attendees to estimate HIV-1 prevalence in the general population has been questioned. In Ethiopia, where the population is heterogeneous and where economic and practical barriers to ANC attendance exist, problems of extrapolation may be exacerbated. We planned an unlinked anonymous sero-survey which included data on basic population characteristics to investigate whether sero-surveillance data from ANCs in Afar Region might be taken to represent the situation among the general population of the Region. 371 pregnant women attending Dubti Hospital and Assayta Health Centre were tested for HIV-1 (using a single ELISA test) and active syphilis (RPR test). Socio-demographic characteristics were collected for each woman. Of the women tested, 278 (75%) were 28 years of age or younger. Two hundred eighty (76%) were urban residents and 237 (64%) described themselves as being of Amhara ethnicity. Overall, 73 (19.7%) were HIV-1 positive, but prevalence was three times higher among the 237 women of Amhara ethnicity compared to the 112 of Afar ethnicity (24.9% vs 8.0%, p < 0.001), and almost three times higher for urban compared to rural residents (23.2% vs 8.8%, p < 0.001). Positive RPR results were strongly associated with HIV-1 infection (OR 3.37, 95% CI 1.47-7.71). According to the Demographic and Health Survey (DHS) 2000, only 4.5% of the population of Afar Region is of Amhara ethnicity, and 7.8% urban residents. We have demonstrated that basing ANC sero-surveillance in urban areas of Afar Region over-samples urban residents of Amhara ethnicity and yields a major over-estimation of overall HIV-1 prevalence for the Region. Reliable estimation of HIV-1 prevalence in Afar Region will require more flexible strategies that permit sampling of rural Afar resident

Clinical and laboratory parameters of 874 HIV-infected patients at antiretroviral therapy initiation.

<p>Clinical and laboratory parameters of 874 HIV-infected patients at antiretroviral therapy initiation.</p

The effect of HIV coinfection, HAART and TB treatment on cytokine/chemokine responses to Mycobacterium tuberculosis (Mtb) antigens in active TB patients and latently Mtb infected individuals

Identification of Mtb specific induced cytokine/chemokine host biomarkers could assist in developing novel diagnostic, prognostic and therapeutic tools for TB. Levels of IFN-γ, IL-2, IL-17, IL-10, IP-10 and MIP-1α were measured in supernatants of whole blood stimulated with Mtb specific fusion protein ESAT-6/CFP-10 using xMAP technology. The study groups were HIV positive TB patients (HIV+TB+), HIV negative TB patients (HIV-TB+), HIV positive tuberculin skin test positive (TST+) (HIV+TST+), HIV negative TST+ (HIV-TST+), and HIV-TST- individuals. Compared to HIV-TST-, latent TB infection led to increased levels of IP-10, IFN-γ and IL-17, while levels of IL-2 and IP-10 were increased with active TB. Levels of IFN-γ, IL-17, MIP-1α, and IL-10 were increased in HIV-TST+ individuals compared to HIV-TB+ patients. HIV coinfection decreased the level of IFN-γ, IL-17, IP-10 and IL-2. After six months (M6) of anti-TB treatment (ATT) in HIV-TB+ patients, IFN-γ, IL-10, and MIP-1α levels normalized. After M6 and M18 of ATT plus HAART in HIV+TB+ patients, levels of MIP-1α and IL-10 normalized, while this was not the case for IFN-γ, IL-2, IL-17, and IP-10 levels. In HIV+TST+ patients on HAART, levels of IFN-γ, IL-17, IL-10 and MIP-1α normalized, while no change in the levels of IL-2 and IP-10 were observed. In conclusion, the simultaneous measurement of IFN-γ, IL-17 and IP-10 may assist in diagnosing LTBI; IL-2 and IP-10 may assist in diagnosing active TB; while IFN-γ, IL-17, MIP-1α, and IL-10 levels could help to discriminate LTBI and active TB. In addition, IL-10 and MIP-1α levels could help to monitor responses to TB treatment and HAART