Experimental infections of baboons (Papio spp.) and vervet monkeys (Cercopithecus aethiops) with Trichinella zimbabwensis and successful treatment with ivermectin.

Experimental Trichinella zimbabwensis infections were established in three baboons (Papios p.)and four vervet monkeys (Cercopithecuase thiops) and the clinical-pathological manifestations assessed. The infected animals showed clinical signs ranging from fever, diarrhoea, periorbitaol edema and muscular pain in varying degrees. One baboon became blind due to the infection. Levels of creatinine phosphokinase and lactated ehydrogenase increased to reach a peak on Day 42 post-infection(pi)for both baboons and monkeys. Blood parameters such as packed cell volume, levels of red blood cells and white blood cells did not change significantly from the normal ranges except for the levels of eosinophils which peaked above the normal ranges at Day 28 and 56 pi in baboons and at Day 56 pi in monkeys

Transmission studies on Trichinella species isolated from Crocodylus niloticus and efficacy of fenbendazole and levamisole against muscle L1 stages in Balb C mice

Forty four Balb C mice, aged 18 weeks were infected with crocodile ( Crocodylus niloticus)-derived Trichinella species. Of the infected mice, 32 were randomly divided into two groups each containing equal numbers of males and females; levamisole treated group and fenbendazole treated group. Each group was randomly subdivided into two subgroups as follows: levamisole group (subgroup 1: treated with levamisole on day 35 post infection and subgroup 2: treated with levamisole on days 35 and 42 post infection) and fenbendazole group (subgroup 1: treated with fenbendazole on day 35 post infection and subgroup 2: treated with fenbendazole on days 35 and 42 post infection). The first sub-groups treated on day 35 post infection were slaughtered on day 42 post infection and the second subgroups were treated on days 35 and 42 post infection and slaughtered on day 49 post infection. Two female mice were infected a day after mating and were slaughtered together with the offspring on day 64 post-infection. Ten infected control mice were given 1 ml distilled water orally as placebo, and five of these were slaughtered on day 42 post infection. The results showed that the mean reproductive capacity index of this strain (RCI) in Balb C mice was 110. There was a significant reduction ( P<0.01) in larval counts in the single treatment groups (day 35) and in the double treatment groups (days 35 and 42) for both anthelmintics when compared the number of parasites in the control groups. After a single treatment, levamisole reduced the infection by 79.9% and fenbendazole by 76.7%. Following double treatments, levamisole reduced the infection by 95.5% and fenbendazole by 99.1%. There was evidence that the infected pregnant mice transmitted the parasite to their offspring. It is not certain whether the parasite was transmitted congenitally or transmammary. Alternative ways of controlling the parasite in crocodile farms in Zimbabwe are discussed.The articles have been scanned in colour with a HP Scanjet 5590; 600dpi. Adobe Acrobat v.9 was used to OCR the text and also for the merging and conversion to the final presentation PDF-format.Research Board of the University of Zimbabwe.mn201

Taenia solium cysticercosis in Eastern and Southern Africa: an emerging problem in agriculture and public health

Pig production has increased tremendously in Eastern and Southern Africa (ESA), particularly in smallholder rural communities. The increase in pig production has mainly been due to land scarcity, increase in pork consumption in many areas including urban centers, and the recognition by many communities of the fast and greater return of the pig industry, compared with other domesticated livestock industries. Concurrent with the increase in smallholder pig keeping and pork consumption, there have been increasing reports of Taenia solium cysticercosis in pigs and humans in the ESA region, although the problems are under-recognized by all levels in many ESA countries. Having recognizing this, scientists researching T. solium in ESA formed a regional cysticercosis working group (CWGESA) to increase awareness of the problem and enable effective and sustainable control of T. solium. This article summarizes the status of T. solium infections in humans and pigs in the ESA countries and highlights the formation and progress of the CWGESA

The landscape for HIV pre-exposure prophylaxis during pregnancy and breastfeeding in Malawi and Zambia: A qualitative study.

High HIV incidence rates have been observed among pregnant and breastfeeding women in sub-Saharan Africa. Oral pre-exposure prophylaxis (PrEP) can effectively reduce HIV acquisition in women during these periods; however, understanding of its acceptability and feasibility in antenatal and postpartum populations remains limited. To address this gap, we conducted in-depth interviews with 90 study participants in Malawi and Zambia: 39 HIV-negative pregnant/breastfeeding women, 14 male partners, 19 healthcare workers, and 18 policymakers. Inductive and deductive approaches were used to identify themes related to PrEP. As a public health intervention, PrEP was not well-known among patients and healthcare workers; however, when it was described to participants, most expressed positive views. Concerns about safety and adherence were raised, highlighting two critical areas for community outreach. The feasibility of introducing PrEP into antenatal services was also a concern, especially if introduced within already strained health systems. Support for PrEP varied among policymakers in Malawi and Zambia, reflecting the ongoing policy discussions in their respective countries. Implementing PrEP during the pregnancy and breastfeeding periods will require addressing barriers at the individual, facility, and policy levels. Multi- level approaches should be considered in the design of new PrEP programs for antenatal and postpartum populations

Mapping the medical outcomes study HIV health survey (MOS-HIV) to the EuroQoL 5 Dimension (EQ-5D-3L) utility index

10.1186/s12955-019-1135-8Health and Quality of Life Outcomes1718

The cost‐effectiveness of prophylaxis strategies for individuals with advanced HIV starting treatment in Africa

Introduction Many HIV‐positive individuals in Africa have advanced disease when initiating antiretroviral therapy (ART) so have high risks of opportunistic infections and death. The REALITY trial found that an enhanced‐prophylaxis package including fluconazole reduced mortality by 27% in individuals starting ART with CD4 <100 cells/mm3. We investigated the cost‐effectiveness of this enhanced‐prophylaxis package versus other strategies, including using cryptococcal antigen (CrAg) testing, in individuals with CD4 <200 cells/mm3 or <100 cells/mm3 at ART initiation and all individuals regardless of CD4 count. Methods The REALITY trial enrolled from June 2013 to April 2015. A decision‐analytic model was developed to estimate the cost‐effectiveness of six management strategies in individuals initiating ART in the REALITY trial countries. Strategies included standard‐prophylaxis, enhanced‐prophylaxis, standard‐prophylaxis with fluconazole; and three CrAg testing strategies, the first stratifying individuals to enhanced‐prophylaxis (CrAg‐positive) or standard‐prophylaxis (CrAg‐negative), the second to enhanced‐prophylaxis (CrAg‐positive) or enhanced‐prophylaxis without fluconazole (CrAg‐negative) and the third to standard‐prophylaxis with fluconazole (CrAg‐positive) or without fluconazole (CrAg‐negative). The model estimated costs, life‐years and quality‐adjusted life‐years (QALY) over 48 weeks using three competing mortality risks: cryptococcal meningitis; tuberculosis, serious bacterial infection or other known cause; and unknown cause. Results Enhanced‐prophylaxis was cost‐effective at cost‐effectiveness thresholds of US$300 and US$500 per QALY with an incremental cost‐effectiveness ratio (ICER) of US$157 per QALY in the CD4 <200 cells/mm3 population providing enhanced‐prophylaxis components are sourced at lowest available prices. The ICER reduced in more severely immunosuppressed individuals (US$113 per QALY in the CD4 <100 cells/mm3 population) and increased in all individuals regardless of CD4 count (US$722 per QALY). Results were sensitive to prices of the enhanced‐prophylaxis components. Enhanced‐prophylaxis was more effective and less costly than all CrAg testing strategies as enhanced‐prophylaxis still conveyed health gains in CrAg‐negative patients and savings from targeting prophylaxis based on CrAg status did not compensate for costs of CrAg testing. CrAg testing strategies did not become cost‐effective unless the price of CrAg testing fell below US$2.30. Conclusions The REALITY enhanced‐prophylaxis package in individuals with advanced HIV starting ART reduces morbidity and mortality, is practical to administer and is cost‐effective. Efforts should continue to ensure that components are accessed at lowest available prices

Late Presentation With HIV in Africa: Phenotypes, Risk, and Risk Stratification in the REALITY Trial.

This article has been accepted for publication in Clinical Infectious Diseases Published by Oxford University PressBackground: Severely immunocompromised human immunodeficiency virus (HIV)-infected individuals have high mortality shortly after starting antiretroviral therapy (ART). We investigated predictors of early mortality and "late presenter" phenotypes. Methods: The Reduction of EArly MortaLITY (REALITY) trial enrolled ART-naive adults and children ≥5 years of age with CD4 counts .1). Results: Among 1711 included participants, 203 (12%) died. Mortality was independently higher with older age; lower CD4 count, albumin, hemoglobin, and grip strength; presence of World Health Organization stage 3/4 weight loss, fever, or vomiting; and problems with mobility or self-care at baseline (all P < .04). Receiving enhanced antimicrobial prophylaxis independently reduced mortality (P = .02). Of five late-presenter phenotypes, Group 1 (n = 355) had highest mortality (25%; median CD4 count, 28 cells/µL), with high symptom burden, weight loss, poor mobility, and low albumin and hemoglobin. Group 2 (n = 394; 11% mortality; 43 cells/µL) also had weight loss, with high white cell, platelet, and neutrophil counts suggesting underlying inflammation/infection. Group 3 (n = 218; 10% mortality) had low CD4 counts (27 cells/µL), but low symptom burden and maintained fat mass. The remaining groups had 4%-6% mortality. Conclusions: Clinical and laboratory features identified groups with highest mortality following ART initiation. A screening tool could identify patients with low CD4 counts for prioritizing same-day ART initiation, enhanced prophylaxis, and intensive follow-up. Clinical Trials Registration: ISRCTN43622374.REALITY was funded by the Joint Global Health Trials Scheme (JGHTS) of the UK Department for International Development, the Wellcome Trust, and Medical Research Council (MRC) (grant number G1100693). Additional funding support was provided by the PENTA Foundation and core support to the MRC Clinical Trials Unit at University College London (grant numbers MC_UU_12023/23 and MC_UU_12023/26). Cipla Ltd, Gilead Sciences, ViiV Healthcare/GlaxoSmithKline, and Merck Sharp & Dohme donated drugs for REALITY, and ready-to-use supplementary food was purchased from Valid International. A. J. P. is funded by the Wellcome Trust (grant number 108065/Z/15/Z). J. A. B. is funded by the JGHTS (grant number MR/M007367/1). The Malawi-Liverpool–Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine (grant number 101113/Z/13/Z) and the Kenya Medical Research Institute (KEMRI)/Wellcome Trust Research Programme, Kilifi (grant number 203077/Z/16/Z) are supported by strategic awards from the Wellcome Trust, United Kingdom. Permission to publish was granted by the Director of KEMRI. This supplement was supported by funds from the Bill & Melinda Gates Foundation

Effect of host age in the distribution of adult Trichinella zimbabwensis in the small intestines of golden hamsters (Mesocricetus auratus) and Balb C mice

Golden hamsters (Mesocricetus auratus) and Balb C mice were experimentally infected with Trichinella zimbabwensis to determine the effect of host age in the distribution of adult stages in the small intestines. The hamsters and mice were divided into two groups of young and old animals. Hamsters aged 90 days were designated as young and those aged 360 days were designated as old while mice of 30 days of age were designated as young and those aged 90 days as old. To recover the adult parasites of T. zimbabwensis, the small intestines of each animal were separated and divided into four equal parts and each part was slit open Iongitudinally. The contents were incubated in 0.85 % saline for 4 h at 37 °C before the adult worms were recovered from the saline. They were fixed in 70 % alcohol and counted under a dissecting microscope. In both young and old hamsters and mice, T. zimbabwensis adult worm counts were significantly higher (P < 0.05) in the second segment of the intestines thus invariably reflecting a significantly high count (P< 0.05) in the first (anterior) hall of the small intestines. From this study it was demonstrated that host-age had no effect on the distribution of T. zimbabwensis adult worms in the different segments of the small intestines of golden hamsters and Balb C mice.The articles have been scanned with a HP Scanjet 8300; 600dpi, saved in TIFF format. Adobe Acrobat v.9 was used to OCR the text and also for the merging and conversion to the final presentation PDF-format