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Building sustainable clinical trial sites in Sub-Saharan Africa through networking, infrastructure improvement, training and conducting clinical studies: The PanACEA approach. Acta Trop 2023; 238:106776. [PMID: 36502888 DOI: 10.1016/j.actatropica.2022.106776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/16/2022] [Accepted: 11/21/2022] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The Pan-African Consortium for the Evaluation of Anti-Tuberculosis Antibiotics (PanACEA) was designed to build tuberculosis (TB) trial capacity whilst conducting clinical trials on novel and existing agents to shorten and simplify TB treatment. PanACEA has now established a dynamic network of 11 sub-Saharan clinical trial sites and four European research institutions. OBJECTIVES In 2011, a capacity development program, funded by the European & Developing Countries Clinical Trials Partnership (EDCTP), was launched with four objectives, aiming at strengthening collaborating TB research sites to reach the ultimate goal of becoming self-sustainable institutions: networking; training; conducting clinical trials; and infrastructure scaling-up of sites. METHODS Assessment in six sub-Saharan TB-endemic countries (Gabon, Kenya, South Africa, Tanzania, Uganda and Zambia) were performed through a structured questionnaire, site visits, discussion with the PanACEA consortium, setting of milestones and identification of priorities and followed-up with evaluations of each site. The results of this needs-based assessment was then translated into capacity development measures. RESULTS In the initial phase, over a four-year period (March 2011 - June 2014), the programme scaled-up six sites; conducted a monitoring training program for 11 participants; funded five MSc and four PhD students, fostering gender balance; conducted four epidemiological studies; supported sites to conduct five Phase II studies and formed a sustainable platform for TB research (panacea-tb.net). CONCLUSION Our experience of conducting TB clinical trials within the PanACEA programme environment of mentoring, networking and training has provided a sound platform for establishing future sustainable research centres. Our goal of facilitating emergent clinical TB trial sites to better initiate and lead research activities has been mostly successful.
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Martial NT, Mubarik S, Yu C. Long-term trends of tuberculosis incidence and mortality in four central African countries. Sci Rep 2021; 11:16624. [PMID: 34404835 PMCID: PMC8371097 DOI: 10.1038/s41598-021-95967-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 07/20/2021] [Indexed: 12/28/2022] Open
Abstract
Tuberculosis (TB) incidence and mortality rates are still high in Sub-Saharan Africa, and the knowledge about the current patterns is valuable for policymaking to decrease the TB burden. Based on the Global Burden of Disease (GBD) study 2019, we used a Joinpoint regression analysis to examine the variations in the trends of TB incidence and mortality, and the age-period-cohort statistical model to evaluate their risks associated with age, period, and cohort in males and females from Cameroon (CAM), Central African Republic (CAR), Chad, and the Democratic Republic of the Congo (DRC). In the four countries, TB incidence and mortality rates displayed decreasing trends in men and women; except for the males from DRC that recorded an almost steady pattern in the trend of TB incidence between 1990 and 2019. TB incidence and mortality rates decreased according to the overall annual percentage changes over the adjusted age category in men and women of the four countries, and CAM registered the highest decrease. Although TB incidence and mortality rates increased with age between 1990 and 2019, the male gender was mainly associated with the upward behaviors of TB incidence rates, and the female gender association was with the upward behaviors of TB mortality rates. Males and females aged between 15–54 and 15–49 years old were evaluated as the population at high risks of TB incidence and mortality respectively in CAM, CAR, Chad, and DRC. The period and cohort relative risks (RRs) both declined in men and women of the four countries although there were some upward behaviors in their trends. Relatively to the period and cohort RRs, females and males from CAM recorded the most significant decrease compared to the rest of the countries. New public health approaches and policies towards young adults and adults, and a particular focus on elderlies’ health and life conditions should be adopted in CAM, CAR, DRC, and Chad to rapidly decrease TB incidence and mortality in both genders of the four countries.
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Affiliation(s)
| | - Sumaira Mubarik
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, Wuhan, 430071, China
| | - Chuanhua Yu
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, Wuhan, 430071, China.
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3
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Development of sustainable research excellence with a global perspective on infectious diseases: Centre de Recherches Médicales de Lambaréné (CERMEL), Gabon. Wien Klin Wochenschr 2021; 133:500-508. [PMID: 33398458 PMCID: PMC7781170 DOI: 10.1007/s00508-020-01794-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 11/30/2020] [Indexed: 11/17/2022]
Abstract
Medical research in sub-Saharan Africa is of high priority for societies to respond adequately to local health needs. Often enough it remains a challenge to build up capacity in infrastructure and human resources to highest international standards and to sustain this over mid-term to long-term periods due to difficulties in obtaining long-term institutional core funding, attracting highly qualified scientists for medical research and coping with ever changing structural and political environments. The Centre de Recherches Médicales de Lambaréné (CERMEL) serves as model for how to overcome such challenges and to continuously increase its impact on medical care in Central Africa and beyond. Starting off as a research annex to the Albert Schweitzer Hospital in Lambaréné, Gabon, it has since then expanded its activities to academic and regulatory clinical trials for drugs, vaccines and diagnostics in the field of malaria, tuberculosis, and a wide range of poverty related and neglected tropical infectious diseases. Advancing bioethics in medical research in Africa and steadily improving its global networks and infrastructures, CERMEL serves as a reference centre for several international consortia. In close collaboration with national authorities, CERMEL has become one of the main training hubs for medical research in Central Africa. It is hoped that CERMEL and its leitmotiv “to improve medical care for local populations” will serve as an inspiration to other institutions in sub-Saharan Africa to further increase African capacity to advance medicine.
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Janssen S, Osbak K, Holman R, Hermans S, Moekotte A, Knap M, Rossatanga E, Massinga-Loembe M, Alabi A, Adegnika A, Meenken C, van Vugt M, Kremsner PG, Meintjes G, van der Poll T, Grobusch MP. Low incidence of the immune reconstitution inflammatory syndrome among HIV-infected patients starting antiretroviral therapy in Gabon: a prospective cohort study. Infection 2017; 45:669-676. [PMID: 28349491 PMCID: PMC5630650 DOI: 10.1007/s15010-017-1000-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 02/21/2017] [Indexed: 11/30/2022]
Abstract
There is a paucity of data on the immune reconstitution inflammatory syndrome (IRIS) in the Central African region. We followed ART-naive HIV-infected patients initiating antiretroviral therapy in an HIV clinic in Gabon, for 6 months. Among 101 patients, IRIS was diagnosed in five. All IRIS cases were mucocutaneous manifestations. There were no cases of tuberculosis (TB) IRIS, but active TB (n = 20) was associated with developing other forms of IRIS (p = 0.02). Six patients died. The incidence of IRIS is low in Gabon, with mild, mucocutaneous manifestations.
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Affiliation(s)
- S Janssen
- Division of Internal Medicine, Department of Infectious Diseases, Center of Tropical Medicine and Travel Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1100 DD, Amsterdam, The Netherlands. .,Centre de Recherches Médicales en Lambaréné, Lambaréné, Gabon. .,Centre de Traitement Ambulatoire Lambaréné, Lambaréné, Gabon. .,Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany. .,Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa. .,Division of Internal Medicine, Department of Infectious Diseases, Center for Experimental and Molecular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.
| | - K Osbak
- Division of Internal Medicine, Department of Infectious Diseases, Center of Tropical Medicine and Travel Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1100 DD, Amsterdam, The Netherlands.,Centre de Recherches Médicales en Lambaréné, Lambaréné, Gabon.,Centre de Traitement Ambulatoire Lambaréné, Lambaréné, Gabon
| | - R Holman
- Clinical Research Unit, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - S Hermans
- Department of Global Health, Academic Medical Center, Amsterdam Institute for Global Health and Development, University of Amsterdam, Amsterdam, The Netherlands.,Faculty of Health Sciences, Desmond Tutu HIV Centre, Institute for Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.,Department of Internal Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - A Moekotte
- Division of Internal Medicine, Department of Infectious Diseases, Center of Tropical Medicine and Travel Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1100 DD, Amsterdam, The Netherlands.,Centre de Recherches Médicales en Lambaréné, Lambaréné, Gabon
| | - M Knap
- Division of Internal Medicine, Department of Infectious Diseases, Center of Tropical Medicine and Travel Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1100 DD, Amsterdam, The Netherlands.,Centre de Recherches Médicales en Lambaréné, Lambaréné, Gabon
| | - E Rossatanga
- Centre de Traitement Ambulatoire Lambaréné, Lambaréné, Gabon
| | - M Massinga-Loembe
- Centre de Recherches Médicales en Lambaréné, Lambaréné, Gabon.,Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - A Alabi
- Centre de Recherches Médicales en Lambaréné, Lambaréné, Gabon.,Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - A Adegnika
- Centre de Traitement Ambulatoire Lambaréné, Lambaréné, Gabon.,Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - C Meenken
- Department of Ophthalmology, VU Medical Center, Vrije Universiteit, Amsterdam, The Netherlands
| | - M van Vugt
- Division of Internal Medicine, Department of Infectious Diseases, Center of Tropical Medicine and Travel Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1100 DD, Amsterdam, The Netherlands
| | - P G Kremsner
- Centre de Recherches Médicales en Lambaréné, Lambaréné, Gabon.,Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - G Meintjes
- Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - T van der Poll
- Division of Internal Medicine, Department of Infectious Diseases, Center for Experimental and Molecular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - M P Grobusch
- Division of Internal Medicine, Department of Infectious Diseases, Center of Tropical Medicine and Travel Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1100 DD, Amsterdam, The Netherlands.,Centre de Recherches Médicales en Lambaréné, Lambaréné, Gabon.,Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany.,Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
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Burchard GD, Grobusch MP. Central Africa. Infect Dis (Lond) 2017. [DOI: 10.1002/9781119085751.ch7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
| | - Martin P. Grobusch
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center; University of Amsterdam; Amsterdam The Netherlands
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Janssen S, Huson MA, Osbak KK, Rossatanga EG, Alabi A, Lutter R, Grobusch MP, van der Poll T. HIV infection rather than concurrent opportunistic infections drives most systemic procoagulant, vascular and damage responses - a prospective cohort study in central Africa. Antivir Ther 2017; 22:153-161. [PMID: 28054932 DOI: 10.3851/imp3100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND HIV infection is accompanied by various systemic host responses, including activation of coagulation and the vascular endothelium. We sought to determine the impact of opportunistic coinfections in a central African setting. METHODS This prospective study included 98 HIV-infected individuals in Gabon initiating combination antiretroviral therapy (cART) and followed them up for 6 months. Patients were stratified according to the presence of active tuberculosis (TB; n=19), mucocutaneous opportunistic infection (n=9) or no opportunistic infection (n=70). HIV-uninfected subjects were included as controls (n=32). Plasma concentrations of 14 markers of coagulation, endothelial activation, extracellular matrix formation and tissue damage were measured with a multiplex assay at baseline and months 3 and 6 after cART initiation. RESULTS HIV-infected patients showed elevated plasma levels of all biomarkers measured with exception of protein C, which was reduced. Concurrent TB was only associated with elevated concentrations of D-dimer, metallopeptidase inhibitor 1 and Tenascin-C. Mucocutaneous coinfection did not alter HIV-associated responses. Most markers measured declined but remained elevated despite response to cART. CONCLUSIONS HIV infection is associated with systemic pro-coagulant, vascular and damage responses. In an ambulatory setting, concurrent opportunistic infections have little if any influence on these responses and normalization is incomplete after response to cART. This suggests that these responses are mainly driven by HIV-associated immune activation and less so by opportunistic infections.
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Affiliation(s)
- Saskia Janssen
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.,Center for Experimental and Molecular Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.,Centre de Recherches Médicales de Lambaréné, Albert Schweitzer Hospital, Lambaréné, Gabon.,Centre de Traitement Ambulatoire, Lambaréné, Gabon.,Clinical Infectious Diseases Research Initiative, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Michaela Am Huson
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.,Center for Experimental and Molecular Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.,Centre de Recherches Médicales de Lambaréné, Albert Schweitzer Hospital, Lambaréné, Gabon
| | - Kara K Osbak
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.,Centre de Recherches Médicales de Lambaréné, Albert Schweitzer Hospital, Lambaréné, Gabon.,Centre de Traitement Ambulatoire, Lambaréné, Gabon
| | | | - Abraham Alabi
- Centre de Recherches Médicales de Lambaréné, Albert Schweitzer Hospital, Lambaréné, Gabon
| | - René Lutter
- Departments of Respiratory Medicine and Experimental Immunology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Martin P Grobusch
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.,Centre de Recherches Médicales de Lambaréné, Albert Schweitzer Hospital, Lambaréné, Gabon.,Centre de Traitement Ambulatoire, Lambaréné, Gabon
| | - Tom van der Poll
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.,Center for Experimental and Molecular Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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7
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Alabi AS, Traoré AN, Loembe MM, Ateba-Ngoa U, Frank M, Adegnika AA, Lell B, Mahoumbou J, Köhler C, Kremsner PG, Grobusch MP. Enhanced laboratory capacity development: a boost for effective tuberculosis control in resource-limited settings. Int J Infect Dis 2016; 56:81-84. [PMID: 27888000 DOI: 10.1016/j.ijid.2016.11.404] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Revised: 11/14/2016] [Accepted: 11/15/2016] [Indexed: 12/31/2022] Open
Abstract
Both routine and research tuberculosis (TB) laboratory capacity urgently need to be expanded in large parts of Sub-Saharan Africa. In 2009, the Centre de Recherches Médicales de Lambaréné (CERMEL) took a strategic decision to expand its activities by building TB laboratory capacity to address research questions and to improve routine diagnostic and treatment capacity. Over the past 7 years, a standard laboratory has been developed that is contributing significantly to TB diagnosis, treatment, and control in Gabon; training has also been provided for TB research staff in Central Africa. CERMEL has a cordial relationship with the Gabon National TB Control Programme (PNLT), which has culminated in a successful Global Fund joint application. This endeavour is considered a model for similar developments needed in areas of high TB prevalence and where TB control remains poor to date.
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Affiliation(s)
- Abraham Sunday Alabi
- Centre des Recherches Médicales de Lambaréné (CERMEL), PB 118, Lambaréné, Gabon; Eberhard Karls Universität, Institut für Tropenmedizin, Tübingen, Germany.
| | - Afsatou Ndama Traoré
- Centre des Recherches Médicales de Lambaréné (CERMEL), PB 118, Lambaréné, Gabon; Microbiology Department, University of Venda, Thohoyandou, South Africa
| | - Marguerite Massinga Loembe
- Centre des Recherches Médicales de Lambaréné (CERMEL), PB 118, Lambaréné, Gabon; Eberhard Karls Universität, Institut für Tropenmedizin, Tübingen, Germany; Departement de Bacteriologie Virologie, Faculte de medicine, Universite des Sciences de la Sante, Libreville, Gabon
| | - Ulysse Ateba-Ngoa
- Centre des Recherches Médicales de Lambaréné (CERMEL), PB 118, Lambaréné, Gabon; Eberhard Karls Universität, Institut für Tropenmedizin, Tübingen, Germany
| | - Matthias Frank
- Eberhard Karls Universität, Institut für Tropenmedizin, Tübingen, Germany
| | - Ayola Akim Adegnika
- Centre des Recherches Médicales de Lambaréné (CERMEL), PB 118, Lambaréné, Gabon; Eberhard Karls Universität, Institut für Tropenmedizin, Tübingen, Germany
| | - Bertrand Lell
- Centre des Recherches Médicales de Lambaréné (CERMEL), PB 118, Lambaréné, Gabon; Eberhard Karls Universität, Institut für Tropenmedizin, Tübingen, Germany
| | - Jocelyn Mahoumbou
- Programme National de Lutte Contre la Tuberculose (PNLT), Ministry of Health, Libreville, Gabon
| | - Carsten Köhler
- Eberhard Karls Universität, Institut für Tropenmedizin, Tübingen, Germany; German Centre for Infection Research (DZIF), Partner Site Tübingen, Tübingen, Germany
| | - Peter Gottfried Kremsner
- Centre des Recherches Médicales de Lambaréné (CERMEL), PB 118, Lambaréné, Gabon; Eberhard Karls Universität, Institut für Tropenmedizin, Tübingen, Germany; German Centre for Infection Research (DZIF), Partner Site Tübingen, Tübingen, Germany
| | - Martin Peter Grobusch
- Centre des Recherches Médicales de Lambaréné (CERMEL), PB 118, Lambaréné, Gabon; Eberhard Karls Universität, Institut für Tropenmedizin, Tübingen, Germany; German Centre for Infection Research (DZIF), Partner Site Tübingen, Tübingen, Germany; Centre of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam Medical Centre, University of Amsterdam, The Netherlands
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8
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Bélard S, Remppis J, Bootsma S, Janssen S, Kombila DU, Beyeme JO, Rossatanga EG, Kokou C, Osbak KK, Obiang Mba RM, Kaba HM, Traoré AN, Ehrhardt J, Bache EB, Flamen A, Rüsch-Gerdes S, Frank M, Adegnika AA, Lell B, Niemann S, Kremsner PG, Loembé MM, Alabi AS, Grobusch MP. Tuberculosis Treatment Outcome and Drug Resistance in Lambaréné, Gabon: A Prospective Cohort Study. Am J Trop Med Hyg 2016; 95:472-80. [PMID: 27352879 DOI: 10.4269/ajtmh.15-0668] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 04/11/2016] [Indexed: 12/16/2022] Open
Abstract
Despite overall global progress in tuberculosis (TB) control, TB remains one of the deadliest communicable diseases. This study prospectively assessed TB epidemiology in Lambaréné, Gabon, a Central African country ranking 10th in terms of TB incidence rate in the 2014 World Health Organization TB report. In Lambaréné, between 2012 and 2014, 201 adult and pediatric TB patients were enrolled and followed up; 66% had bacteriologically confirmed TB and 95% had pulmonary TB. The human immunodeficiency virus (HIV) coinfection rate was 42% in adults and 16% in children. Mycobacterium tuberculosis and Mycobacterium africanum were identified in 82% and 16% of 108 culture-confirmed TB cases, respectively. Isoniazid (INH) and streptomycin yielded the highest resistance rates (13% and 12%, respectively). The multidrug resistant TB (MDR-TB) rate was 4/91 (4%) and 4/13 (31%) in new and retreatment TB cases, respectively. Treatment success was achieved in 53% of patients. In TB/HIV coinfected patients, mortality rate was 25%. In this setting, TB epidemiology is characterized by a high rate of TB/HIV coinfection and low treatment success rates. MDR-TB is a major public health concern; the need to step-up in-country diagnostic capacity for culture and drug susceptibility testing as well as access to second-line TB drugs urgently requires action.
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Affiliation(s)
- Sabine Bélard
- Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon. Institut für Tropenmedizin, Universitätsklinikum Tübingen, Eberhard Karls Universität, Tübingen, Germany. Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Department of Pediatric Pneumology and Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Jonathan Remppis
- Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon. Institut für Tropenmedizin, Universitätsklinikum Tübingen, Eberhard Karls Universität, Tübingen, Germany
| | - Sanne Bootsma
- Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon. Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Saskia Janssen
- Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon. Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Davy U Kombila
- Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon
| | | | | | - Cosme Kokou
- Hôpital Albert Schweitzer de Lambaréné, Lambaréné, Gabon
| | - Kara K Osbak
- Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon. Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Régis M Obiang Mba
- Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon
| | - Harry M Kaba
- Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon
| | - Afsatou N Traoré
- Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon. Microbiology Department, University of Venda, Thohoyandou, South Africa
| | - Jonas Ehrhardt
- Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon. Institut für Tropenmedizin, Universitätsklinikum Tübingen, Eberhard Karls Universität, Tübingen, Germany
| | - Emmanuel B Bache
- Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon
| | - Arnaud Flamen
- Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon
| | - Sabine Rüsch-Gerdes
- National Reference Center for Mycobacteria, Forschungszentrum Borstel, Borstel, Germany
| | - Matthias Frank
- Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon. Institut für Tropenmedizin, Universitätsklinikum Tübingen, Eberhard Karls Universität, Tübingen, Germany. German Centre for Infection Research (DZIF), Partner Site Tübingen, Germany
| | - Ayôla A Adegnika
- Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon. Institut für Tropenmedizin, Universitätsklinikum Tübingen, Eberhard Karls Universität, Tübingen, Germany. German Centre for Infection Research (DZIF), Partner Site Tübingen, Germany
| | - Bertrand Lell
- Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon. Institut für Tropenmedizin, Universitätsklinikum Tübingen, Eberhard Karls Universität, Tübingen, Germany. German Centre for Infection Research (DZIF), Partner Site Tübingen, Germany
| | - Stefan Niemann
- National Reference Center for Mycobacteria, Forschungszentrum Borstel, Borstel, Germany
| | - Peter G Kremsner
- Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon. Institut für Tropenmedizin, Universitätsklinikum Tübingen, Eberhard Karls Universität, Tübingen, Germany. German Centre for Infection Research (DZIF), Partner Site Tübingen, Germany
| | - Marguerite M Loembé
- Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon. Institut für Tropenmedizin, Universitätsklinikum Tübingen, Eberhard Karls Universität, Tübingen, Germany. German Centre for Infection Research (DZIF), Partner Site Tübingen, Germany. Bacteriology and Virology Department, Université des Sciences de la Santé, Libreville, Gabon
| | - Abraham S Alabi
- Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon. Institut für Tropenmedizin, Universitätsklinikum Tübingen, Eberhard Karls Universität, Tübingen, Germany
| | - Martin P Grobusch
- Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon. Institut für Tropenmedizin, Universitätsklinikum Tübingen, Eberhard Karls Universität, Tübingen, Germany. Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa. German Centre for Infection Research (DZIF), Partner Site Tübingen, Germany.
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9
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Linguissi LSG, Vouvoungui CJ, Poulain P, Essassa GB, Kwedi S, Ntoumi F. Diagnosis of smear-negative pulmonary tuberculosis based on clinical signs in the Republic of Congo. BMC Res Notes 2015; 8:804. [PMID: 26683052 PMCID: PMC4684611 DOI: 10.1186/s13104-015-1774-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 11/30/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The diagnosis of pulmonary tuberculosis (PTB) and smear-negative pulmonary tuberculosis (SNPT) in resource-limited countries is often solely based on clinical signs, chest X-ray radiography and sputum smear microscopy. We investigated currently used methods for the routine diagnosis of SNPT in the Republic of Congo (RoC) among TB suspected patients. The specific case of HIV positive patients was also studied. METHODS A cross-sectional study was conducted at the anti-tuberculosis center (CAT) of Brazzaville, RoC. Tuberculosis suspects were examined for physical signs of TB. Clinical signs, results from sputum smear microscopy, tuberculin skin test (TST) and chest X-ray were recorded. RESULTS Of the 772 enrolled participants, 372 were diagnosed PTB. Cough was a common symptom for PTB and no PTB patients. Pale skin, positive TST, weight loss and chest X-ray with abnormalities compatible with PTB (PTB-CXR) were significant indicators of PTB. Thirty-six percent of PTB patients were diagnosed SNPT. This category of patients presented less persistent cough and less PTB-CXR. Anorexia and asthenia were significant indicators of SNPT. In the case of HIV+ patients, 57% were SNPT with anorexia, asthenia and shorter cough being strong indicators of SNPT. CONCLUSION Chest X-ray abnormalities, weight loss, pale skin and positive TST were significant indicators of PTB. Anorexia and asthenia showed good diagnostic performance for SNPT, which deserve to be recommended as index indicators of SNPT diagnosis. Duration of cough is also a relevant indicator, especially for HIV+ patients.
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Affiliation(s)
- Laure Stella Ghoma Linguissi
- Fondation Congolaise pour la Recherche Médicale, Cité OMS, villa D6, Djoué, Brazzaville, Republic of Congo. .,Centre de Recherche Biomoleculaire Pietro Annigoni (CERBA), Labiogene, Université de Ouagadougou, 01 BP 364, Ouaga 01, Burkina Faso.
| | | | - Pierre Poulain
- Fondation Congolaise pour la Recherche Médicale, Cité OMS, villa D6, Djoué, Brazzaville, Republic of Congo. .,Institut National de la Santé et de la Recherche Médicale U 1134, Paris, France. .,UMR_S 1134, DSIMB, Université Paris Diderot, Sorbonne Paris Cite, Paris, France. .,Institut National de la Transfusion Sanguine, DSIMB, Paris, France. .,UMR_S 1134, Laboratory of Excellence GR-Ex, DSIMB, Paris, France.
| | - Gaston Bango Essassa
- Centre Antituberculeux de Brazzaville, Programme de Lutte contre la Tuberculose, Brazzaville, Republic of Congo.
| | - Sylvie Kwedi
- Capacity for Leadership Excellence and Research, CLEAR, INC, Yaoundé, Cameroon. .,Faculty of Médecine and Biomedical Sciences, University of Yaoundé I, Yaounde, Cameroon.
| | - Francine Ntoumi
- Fondation Congolaise pour la Recherche Médicale, Cité OMS, villa D6, Djoué, Brazzaville, Republic of Congo. .,Faculty of Sciences and Techniques, University Marien Ngouabi, BP 2672, Brazzaville, Republic of Congo. .,Institute for Tropical Medicine, University of Tübingen, Tübingen, Germany.
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Bain LE, Clovis NC. Winning the battle and losing the war? Where public health is getting it wrong in the current fight against HIV-AIDS and tuberculosis in Sub-Saharan Africa. Pan Afr Med J 2015; 21:75. [PMID: 26491518 PMCID: PMC4594979 DOI: 10.11604/pamj.2015.21.75.7057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 05/26/2015] [Indexed: 11/25/2022] Open
Abstract
Despite the enormous victory that has been recorded in decreasing significantly HIV-TB related mortality and morbidity in Sub-Saharan Africa, enormous challenges continue to obstruct proper and enviable control of these conditions. These range from prioritization, ethics, funding, drug resistance and research gaps. Resistance to these diseases could constitute key treatment and prevention challenges to health care systems and the international community if not handled appropriately and promptly. This paper presents key shortcomings of the current funding, management and research policies and highlights possible action areas to remedy this situation.
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Affiliation(s)
- Luchuo Engelbert Bain
- Department of Military Health, Ministry of Defense, Cameroon ; Centre for Population Studies and Health Promotion, CPSHP, Yaoundé, Cameroon
| | - Nkeh Charles Clovis
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Cameroon
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11
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Huson MAM, Kalkman R, Stolp SM, Janssen S, Alabi AS, Beyeme JO, van der Poll T, Grobusch MP. The impact of HIV on presentation and outcome of bacterial sepsis and other causes of acute febrile illness in Gabon. Infection 2015; 43:443-51. [PMID: 25758583 PMCID: PMC4521089 DOI: 10.1007/s15010-015-0753-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 02/16/2015] [Indexed: 12/27/2022]
Abstract
Purpose HIV, bacterial sepsis, malaria, and tuberculosis are important causes of disease in Africa. We aimed to determine the impact of HIV on the presentation, causes and outcome of bacterial sepsis and other acute febrile illnesses in Gabon, Central Africa. Methods We performed a prospective observational study in new adult admissions with fever or hypothermia (≥38 or <36 °C). Blood cultures, as well as HIV and malaria testing were performed in all patients. Results We enrolled 382 patients, including 77 (20.2 %) with HIV infection. Malaria was the most frequent diagnosis (n = 130, 34 %), and was associated with a more severe presentation in HIV patients. Sepsis was also common (n = 107, 28 %), including 29 (7.6 %) patients with culture confirmed bacterial bloodstream infection. Bacterial bloodstream infections were more frequent in HIV patients, in particular with S. pneumoniae. Tuberculosis was observed in 29 (7.6 %) patients, and was also more common in HIV patients. The majority of HIV patients was newly diagnosed, and only 15 (19.5 %) were using combination antiretroviral therapy. Conclusions Our findings illustrate the impact of HIV co-infection on the burden of sepsis, malaria and tuberculosis in Gabon, as well as the need to scale up HIV counseling, testing and treatment. Electronic supplementary material The online version of this article (doi:10.1007/s15010-015-0753-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michaëla A M Huson
- Division of Infectious Diseases, Center of Experimental and Molecular Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, Room G2-105, 1105 AZ, Amsterdam, The Netherlands,
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