Nationwide HIV prevalence survey in general population in Niger

A systematic review and meta-analysis of gender difference in epidemiology of HIV, hepatitis B, and hepatitis C infections in people with severe mental illness

BACKGROUND

People with severe mental disorders (SMDs) are associated with increased risk of infectious disease including human immunodeficiency virus infection (HIV) and hepatitis viruses, such as hepatitis B virus (HBV), hepatitis C virus (HCV), and other types of hepatitis viruses because of high-risk behaviors compared to the general population. The prevalence of HIV in people with SMDs is higher in females than in males. Unlike HIV, the prevalence of HBV and HCV is higher in males than in females. This study aimed to carry out a systematic review and meta-analysis to determine the prevalence and estimated gender difference in the risk of HIV, HBV, and HCV in people with SMD.

METHODS

Literature search was performed using the electronic databases PubMed, EMBASE, and Scopus. Publications were screened according to predefined inclusion criteria. A qualitative and quantitative analysis was undertaken for this systematic review. Eighteen materials published from 1993 to 2017 were included in the qualitative and quantitative analysis. Random-effect model was used to calculate weighted prevalence, odds ratio (OR), and corresponding 95% confidence interval (CI).

RESULTS

12,290 citations were identified and 18 articles including 11,175 participants were included. The results of our meta-analysis show that the prevalence of HIV, HBV, and HCV in people with SMD was 7.59% (95% CI 4.82-11.75), 15.63% (95% CI 7.19-30.69), and 7.21% (95% CI 4.44-11.50), respectively. The prevalence of HIV was higher in women (8.25%) than men (7.04%), but the prevalence of HBV and HCV was higher in men than women (18.91% versus 12.02% and 9.16% versus 5.43% for HBV and HCV in men versus women, respectively). A meta-analysis of included studies demonstrated a significantly increased risk of HBV (OR 1.72; 95% CI 1.17-2.53) and HCV (OR 2.01; 95% CI 1.16-3.20) infections in men compared to women in people with SMD. However, no significant association was observed between gender and HIV. The funnel plot and Egger's regression tests provided no evidence of substantial publication bias in the prevalence and gender difference in association for HIV, HBV, and HCV in people with SMD.

CONCLUSIONS

In our review, the prevalence of HIV, HBV, and HCV was high. The prevalence of HBV is significantly higher than HIV and HCV. There was a significantly increased risk of HBV and HCV infections in men compared to women. No significant association was observed between gender and HIV. People with SMDs warrant greater emphasis in efforts to identify and treat HIV, HBV and HCV.

HIV infection and hepatitis B seroprevalence among antenatal clinic attendees in Niger, West Africa

This transversal study was suggested in order to estimate the nationwide seroprevalences of HIV infection and hepatitis B among 495 pregnant women in Niger in 2008. The study detected anti-HIV antibodies with Genscreen^® Plus HIV Ag/Ab Ultra Kit (Bio-Rad; Hercules, CA), Vironostika^® HIV Uni-Form II Ag/Ab (bioMérieux; Marcy-l’Etoile, France), and ImmunoComb^® II HIV 1 and 2 BiSpot (Orgenics; Yavne, Israel). HBsAg was detected by Monolisa^® HBsAg Ultra (Bio-Rad) and ImmunoComb^® II HBsAg (Orgenics). The rates obtained were 2.02% (95% confidence intervals (CI): 1.03%–3.81%) and 16.16% (95% CI: 13.09%–19.77%), respectively. There were no significant variations according to environment, region, age, marital status, educational level, antecedent of surgery and transfusion. But these data need a large sample, and periodic updates for a better planning of activities in the framework of a national reproductive health program, including prevention of mother-to-child HIV transmission.

Systematic review exploring time trends in the association between educational attainment and risk of HIV infection in sub-Saharan Africa

OBJECTIVE

To assess the evidence that the association between educational attainment and risk of HIV infection is changing over time in sub-Saharan Africa.

DESIGN AND METHODS

Systematic review of published peer-reviewed articles. Articles were identified that reported original data comparing individually measured educational attainment and HIV status among at least 300 individuals representative of the general population of countries or regions of sub-Saharan Africa. Statistical analyses were required to adjust for potential confounders but not over-adjust for variables on the causal pathway.

RESULTS

Approximately 4000 abstracts and 1200 full papers were reviewed. Thirty-six articles were included in the study, containing data on 72 discrete populations from 11 countries between 1987 and 2003, representing over 200,000 individuals. Studies on data collected prior to 1996 generally found either no association or the highest risk of HIV infection among the most educated. Studies conducted from 1996 onwards were more likely to find a lower risk of HIV infection among the most educated. Where data over time were available, HIV prevalence fell more consistently among highly educated groups than among less educated groups, in whom HIV prevalence sometimes rose while overall population prevalence was falling. In several populations, associations suggesting greater HIV risk in the more educated at earlier time points were replaced by weaker associations later.

DISCUSSION

HIV infections appear to be shifting towards higher prevalence among the least educated in sub-Saharan Africa, reversing previous patterns. Policy responses that ensure HIV-prevention measures reach all strata of society and increase education levels are urgently needed.

HIV seroprevalence surveys in Nigerien pregnant women: a comparison between 2002 and 2006

In the framework of HIV serosurveillance, serosurveys in pregnant women are a good alternative to population-based surveys, which are more difficult to implement. In 2002 and 2006, surveys were conducted in Niger to assess the HIV seroprevalence in pregnant women and to evaluate the trend of the HIV epidemic. The overall seroprevalence was 0.96% (95% CI 0.5-1.7%) and 1.3% (95% CI 0.9-1.8%) in 2002 and 2006, respectively, showing no significant change. In the 2006 overall sample, women living in urban areas were significantly more infected than those in rural environments, with prevalences of 1.9% and 0.7%, respectively (P=0.006). Women with higher school attainment were more often HIV-positive than other women (4.6% vs. 1.7%; P<0.001). The 2006 prevalence, which is among the lowest of the sub-Saharan region, was not significantly different from the national seroprevalence measured in adults in 2002 (0.87%, 95% CI 0.5-1.3%). Close monitoring of the epidemic must be continued.

[Prevalence of tuberculous meningitis in Niamey's Hospital, Niger]

Tuberculosis is hyperendemic in Niger. In Niamey between June 2002 and May 2004, 996 cerebro-spinal fluids (CSF) collected from meningitis suspected patients have been analysed by PCR for the detection of Neisseria meningitidis, Haemophilus influenzae and Streptococcus pneumoniae: the aetiologic diagnosis was obtained for 208 cases (20.9%). The Mycobacterium tuberculosis PCR assay performed on the negative samples was positive for 4 CSF: 0.4% prevalence among suspected cases of meningitis or 1.9% among confirmed bacterial meningitis.

[Behaviour and HIV seroprevalence investigation in sex workers of Dirkou, Niger, 2002]

In the framework of the Human Immunodeficiency Virus (HIV) surveillance, seroprevalence and behavioural survey was conducted in 2002 in Dirkou, a place of concentration of female sex workers (FSW) in Niger The global HIV seroprevalence found was 50% (CI at 95%: 40.6-59.36%). The behavioural survey revealed that 98% of FSW had heard about HIV whereas 78.7% know at least one HIV transmission way and 76.9% know at least one HIV prevention means. Only 33.3% declared using condom, what show that sensitisation efforts are needed to induce a behaviour change in FSW and their clients.

Human immunodeficiency virus type 1 among bar and hotel workers in northern Tanzania: the role of alcohol, sexual behavior, and herpes simplex virus type 2

GOALS

We assessed baseline prevalence of human immunodeficiency virus type 1 (HIV-1) and other STDs, as well as behavioral and biologic risk factors for HIV-1 in a population of female bar/hotel workers in Moshi, Tanzania.

STUDY DESIGN

Between 2002 and 2003, we enrolled 1042 female bar/hotel workers in an ongoing prospective cohort study. We analyzed data collected at baseline to assess the associations between alcohol, sexual behavior, STDs, and HIV-1 infection.

RESULTS

The prevalence of HIV-1 infection was 19.0% (95% confidence interval [CI] = 16.6%-21.4%). Consistent condom use was low (11.1%). HIV-1 was associated with genital ulcers on examination (adjusted odds ratio [AOR] = 2.08, 95% CI = 1.16-3.74), herpes simplex virus type 2 (HSV-2) (AOR = 3.80, 95% CI = 2.42-5.97), and problem drinking (AOR = 1.92, 95% CI = 1.06-3.47). Other independent predictors of HIV-1 were increasing age, number of sex partners, cohabitating, formerly married, location of employment, and having a husband with another wife.

CONCLUSIONS

These findings suggest that programs designed to control HSV-2, reduce the number of sexual partners and alcohol use, and promote condom use could be effective in reducing transmission of HIV-1 in this population.