Determinants of COVID-19 vaccine uptake: evidence from a vulnerable global South setting

OBJECTIVE

Studies are paying increasing attention to complex social determinants in explaining the variation in the rates COVID-19 vaccine uptake. This study examines the influence of various individual, contextual, and vaccine-related factors on COVID-19 vaccine uptake behaviour in a resource-scarce and vulnerable setting using a quantitative research approach. Using a multi-staged cluster sampling approach, 408 individuals from 204 households in Cape Coast, Ghana's tourism hub, were surveyed. Probit and logistic regression models were estimated to test the vaccine-related factors.

RESULTS

A significant difference is observed between wait time and vaccination status (χ2 = 21.17; p = 0.000). Moreover, age and religion, as controlled variables, equally played significant roles in influencing the adoption of the vaccine. Other factors encompass the perceived risk of contracting COVID-19, the perceived benefits of the vaccine in relation to its side effects, and the level of trust individuals have in the concern of vaccine producers for their health. These findings call for targeted campaigns by the Ministry of Health, health facilities and other institutions promoting the COVID-19 vaccine. These actors should emphasize the benefits of vaccination, prioritize trust-building initiatives, and provide clear guidance on vaccination schedules, and manage waiting time.

HIV status and knowledge of cervical cancer among women in Ghana

BACKGROUND

Cervical cancer remains a disease of significant concern to women's health. The aim of this study was to identify predictors of knowledge of cervical cancer among women living with HIV and those with negative or unknown HIV status at the Cape Coast Teaching Hospital (CCTH).

METHODS

This study was based on a larger hospital-based analytical cross-sectional study conducted at the antiretroviral therapy (ART) and gynaecology clinics of the Cape Coast Teaching Hospital in Ghana. Participants were women living with HIV (WLHIV) and women without HIV or whose status was unknown, aged 25 to 65 years, seeking healthcare. Data were collected with a questionnaire and analysed using frequencies, percentages, Chi-square test, binary logistic regression and multivariate analysis.

RESULTS

The mean age was 39.5 years (± 9.8) and 47.2 years (± 10.7) for women without or unknown HIV and WLHIV, respectively. HIV-negative/unknown women were mostly nulligravida (76%) and nullipara (69%), while WLHIV mostly had pregnancies (76%) and children (84%) in excess of seven. Knowledge of cervical cancer was statistically significantly associated with HIV status (X2 = 75.65; P-value = 0.001). The odds of having knowledge of cervical cancer for women considered to be negative/unknown for HIV were about three times (AOR = 3.07; 95% CI = 1.47, 6.41) higher than their compatriots with HIV. Women with post-secondary/tertiary (AOR = 4.45; 95% CI = 2.11, 9.35) education had significantly higher odds of having knowledge of cervical cancer than those with no education or those with just primary education.

CONCLUSIONS

To improve knowledge of cervical cancer among women, an intentionally structured health education programme is needed, particularly for WLHIV, those with lower levels of education and the unemployed.

Human immunodeficiency virus care and management in incarcerated populations in Sub-Saharan Africa between 2010 and 2022: A narrative review

BACKGROUND

Different countries in sub-Saharan Africa (SSA) have established guidelines to reduce HIV transmission and improve its management in prisons. This narrative review aimed to examine established literature on HIV care and management among incarcerated persons in SSA to identify successful interventions that could inform improved guidelines, policies, and practices related to the clinical care of this population.

METHODS

We searched PubMed, Scopus, Web of Science, Embase, and TRIP Medical Databases in August 2022 for articles published between 1st January 2010 and 30th June 2022. We identified 27 eligible articles based on the Population/Concept/Context framework.

RESULTS

HIV screening primarily involved mass campaigns rather than formal prison programmes, with limited implementation of universal testing and treatment. Although a few studies reported on access to antiretrovirals (ARVs), prisoners in urban areas and females had disproportionate access. Barriers identified include poor living conditions, high levels of stigma, and resource constraints. Inter-prison transfers, release from prison, and lack of established programmes hindered follow-up and linkage to care.

CONCLUSIONS

The implementation of strategies such as universal testing and treatment, human resource strengthening, financing plans for testing, ARV care, and frequent assessment of risk could improve HIV care and management in prisons in SSA.

Challenges and knowledge gaps in the management of non-tuberculous mycobacterial pulmonary disease in sub-Saharan African countries with a high tuberculosis burden: a scoping review

INTRODUCTION

In sub-Saharan African (SSA) countries endemic for tuberculosis (TB), previous TB is a significant risk factor for non-tuberculous mycobacterial pulmonary disease (NTM-PD). The deployment of GeneXpert MTB/RIF in pulmonary TB diagnostic work-up regularly identifies symptomatic patients with a positive smear microscopy but negative GeneXpert, indicative of NTM presence. This scoping review outlines recent evidence for NTM-PD diagnosis and management in SSA.

OBJECTIVE

The review's objective was to outline the risk factors, available diagnostics, management options and outcomes of NTM-PD in high-burden TB settings in SSA using the population-concept-context framework.

DESIGN AND DATA SOURCES

We searched existing literature from PubMed, Web of Science, African Journals Online, Google Scholar and grey literature. Studies published between January 2005 and December 2022 were retained. Data were extracted into Rayyan software and Mendeley and summarised using Excel.

RESULTS

We identified 785 potential articles, of which 105 were included in the full-text review, with 7 papers retained. Included articles used international criteria for diagnosing NTM-PD. Multiple papers were excluded due to non-application of the criteria, suggesting challenging application in the SSA setting. Identified risk factors include previous TB, smoking and mining. Most commonly, chest radiography and not CT was used for the radiological diagnosis of PD, which may miss early changes related to NTM-PD. Molecular methods for NTM species identification were employed in research settings, usually at referral centres, but were unavailable for routine care. Most studies did not report a standardised approach to treatment and they were not offered treatment for the specific disease, marking a lack of guidance in treatment decision-making. When treatment was provided, the outcome was often not reported due to the lack of implementation of standardised outcome definitions.

CONCLUSIONS

These outlined challenges present a unique opportunity for researchers to undertake further studies in NTM-PD and proffer solutions more applicable to SSA.

An intervention to increase cervical cancer screening among women living with HIV: A mixed methods study

OBJECTIVE

We examined the effectiveness of a behavioral intervention in promoting cervical cancer screening among women living with HIV (WLWH) in Ghana.

METHODS

A Mixed-methods study was conducted involving 83 WLWH, who were randomly assigned to an intervention group (n = 42) to receive voice-recorded messages based on the 3 R model (Reframing, Reprioritizing, and Reforming) or a control group (n = 41) to receive standard care. The primary outcomes were screening uptake and HPV prevalence. Other outcomes were the acceptability, appropriateness, and feasibility of the intervention.

RESULTS

The intervention group had a 100% screening rate, and the control group had a 14.63% screening rate. The prevalent rate of high-risk (hr)-HPV genotypes among the women was 67.5% (95%C.I: 0.56-0.77). Over 48% of the participants had multiple hr-HPV genotypes, 64.29% had HPV16/18/45%, and 73.21% had HPV 31/33/45/52/58. Of the women (89.30%) who screened positive, 60% of them were diagnosed and treated for pre-cancer lesions. The intervention messages were acceptable (encourage proactive behavior), feasible (simple, easy to understand), and appropriate (helpful, informative). Facilitators and barriers to self-sampling were identified.

CONCLUSION

Combining the 3 R model with self-sampling increases cervical cancer screening among WLWH.

PRACTICE IMPLICATION

Healthcare professionals and policymakers can use this model to increase cervical cancer screening.

Health service factors affecting the COVID-19 vaccination campaign in a Ghanaian metropolis: A qualitative exploratory study

OBJECTIVE

The study sought to explore the perspectives of vaccinators on the health system factors that impacted the COVID-19 vaccination campaign.

DESIGN

The study employed an exploratory-descriptive qualitative design. Key-informants' interviews were conducted using semi-structured guide to gather the data. Thematic analysis following the steps of Braun and Clark was conducted using ATLAS.ti software.

SETTING

The study setting was the Cape Coast Metropolis where the Central Regional Health Directorate is located. The Directorate initiates and implements policy decisions across the region. It is also the only metropolis in the region that recorded about 5970 of the total COVID-19 cases recorded in Ghana.

PARTICIPANTS

Eleven vaccinators who had been trained for the COVID-19 vaccination and had participated in the campaign for at least 6 months were purposively sampled through the Regional Public Health Unit.

RESULTS

Four themes were derived from the data after analysis; 'vaccine-related issues'; 'staffing issues'; 'organising and planning the campaign' and 'surveillance and response systems'. Subthemes were generated under each major theme. Our results revealed the health service promoted the COVID-19 vaccination campaign through public education and ensured access to COVID-19 vaccines through the use of community outreaches. Also, the health service ensured adequate logistics supply for carrying out the campaign as well as ensured vaccinators were adequately equipped for adverse incidence reporting and management. Dissatisfaction among COVID-19 vaccinators attributed to low remuneration and delays in receiving allowances as well as shortfalls in efforts at securing transportation and a conducive venue for the vaccination exercise also emerged. Other challenges in the vaccination campaign were attributed to poor data entry platforms and limited access to internet facilities.

CONCLUSION

This study highlights the health system's strategies and challenges during the COVID-19 vaccination campaign, emphasising the need for critical interventions to prevent low vaccination rates.

An exploratory qualitative study of the psychological effects of HIV diagnosis; the need for early involvement of mental health professionals to improve linkage to care

BACKGROUND

Diagnosing a life-threatening disease like the human immunodeficiency virus (HIV) can be unbearable to the individual, which has implications for their subsequent care-seeking decision-making. However, an essential element of HIV testing is identifying infected individuals and linking them with adequate care services, thus contributing to the UNAIDS 95-95-95 targets. The attainment of these targets has been particularly challenging for lower and middle-income countries (LMIC). This study explored the psychological reactions to a positive HIV status in a hospital treatment centre to provide insight into mental health interventions' role in improving HIV screening and early antiretroviral therapy (ART) initiation to enhance the quality of life.

METHODS

An exploratory qualitative study was investigated among adults who were diagnosed as HIV positive. Participants were purposively recruited from an HIV Treatment Centre. Data were collected with semi-structured interviews that explored the interpretations and psychological reactions to their positive HIV status. Overall, 18 participants were interviewed to reach saturation. Data were transcribed verbatim and analysed thematically to produce findings that address the study's objective.

RESULTS

Following analysis of participants' interpretations, understanding and implications of their HIV-positive diagnosis, two major themes emerged: (1) anxiety regarding the impact of the disease on self, family and society was overwhelming. Participants were anxious because of the stigma, fear, worry, shock, and shame they faced. (2) Participants expressed hopelessness and could not see meaning or purpose in life. Suicidal ideation, suicide plans and self-harm characterised hopelessness.

CONCLUSIONS

The initial reaction to the diagnosis of HIV in this LMIC context has the potential to impact linkage to care negatively and, thus, the attainment of the global 95-95-95 targets. It is, therefore, essential that mental health and psychological support services are integrated with testing services to manage the initial reactions and support individuals to improve early linkage to care and thus improve overall outcomes for the infected individual and society.

Computational Screening of Neuropilin-1 Unveils Novel Potential Anti-SARS-CoV-2 Therapeutics

Neuropilin 1 (NRP-1) inhibition has shown promise in reducing the infectivity of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) and preventing the virus entry into nerve tissues, thereby mitigating neurological symptoms in COVID-19 patients. In this study, we employed virtual screening, including molecular docking, Molecular Dynamics (MD) simulation, and Molecular Mechanics-Poisson Boltzmann Surface Area (MM-PBSA) calculations, to identify potential NRP-1 inhibitors. From a compendium of 1930 drug-like natural compounds, we identified five potential leads: CNP0435132, CNP0435311, CNP0424372, CNP0429647, and CNP0427474, displaying robust binding energies of -8.2, -8.1, -10.7, -8.2, and -8.2 kcal/mol, respectively. These compounds demonstrated interactions with critical residues Tyr297, Trp301, Thr316, Asp320, Ser346, Thr349, and Tyr353 located within the b1 subdomain of NRP-1. Furthermore, MD simulations and MM-PBSA calculations affirmed the stability of the complexes formed, with average root mean square deviation, radius of gyration, and solvent accessible surface area values of 0.118 nm, 1.516 nm, and 88.667 nm2 , respectively. Notably, these lead compounds were estimated to penetrate the blood-brain barrier and displayed antiviral properties, with Pa values ranging from 0.414 to 0.779. The antagonistic effects of these lead compounds merit further investigation, as they hold the potential to serve as foundational scaffolds for the development of innovative therapeutics aimed at reducing the neuroinfectivity of SARS-CoV-2.

Hepatitis C virus seroprevalence, testing, and treatment capacity in public health facilities in Ghana, 2016-2021; A multi-centre cross-sectional study

The current burden of Hepatitis C virus infection and the availability of HCV-related services in Ghana are not well described. Previous estimates on HCV seroprevalence in the country are outdated. This study investigated the HCV seroprevalence and testing and treatment capacity in Ghana. A multi-centre cross-sectional study was conducted in which laboratory and blood bank registers from 17 public healthcare institutions in Ghana were reviewed. A survey on cost and availability of HCV-related testing and treatment was also performed. Crude and pooled estimates of HCV seroprevalence, frequency and median cost of available diagnostic tests and medicines were described. The crude HCV seroprevalence was 2.62% (95% CI 2.53-2.72) and the pooled estimate was 4.58% (95% CI 4.06-5.11) among 103,609 persons tested in laboratories. Age (OR 1.02 95% CI 1.01-1.02) and male sex (OR 1.26 95% CI 1.08-1.48) were predictors of a positive anti-HCV RDT test. Northern administrative regions in Ghana had the highest HCV seroprevalence ranging from 8.3-14.4%. Among 55, 458 potential blood donors, crude HCV seroprevalence was 3.57% (95% CI 3.42-3.72). Testing was through Rapid Diagnostic Test (RDT) kits in most facilities, and only 2 of 17 centres were performing HCV RNA testing. The median cost of an anti-HCV RDT test was $0.97 (0-1.61) and $3.23 (1.61-7.58) for persons with and without government health insurance respectively. The median cost of a 12-week course of the pan-genotypic direct-acting antiviral therapy sofosbuvir-daclatasvir was $887.70. In conclusion, there are significant regional differences in HCV burden across Ghana. Limited access to and cost of HCV RNA and DAA therapy hinders testing and treatment capability, and consequently HCV elimination efforts. A national HCV program supported with a sustainable financing plan is required to accelerate HCV elimination in Ghana.

High-risk human papillomavirus genotype distribution among women living with HIV; implication for cervical cancer prevention in a resource limited setting

BACKGROUND

For women living with HIV (WLHIV), the burden of persistent HPV infection, cervical pre-cancerous lesions and cancer have been demonstrated to be higher than among HIV-negative women. As Ghana and other lower-middle-income countries (LMIC) work toward developing national cervical cancer programmes, it is essential that local scientific evidence be provided to guide policy decisions, especially for such special populations. The objective of this study was to determine the distribution of high-risk HPV genotype and related factors among WLHIV and its implication for the prevention of cervical cancer prevention efforts.

METHODS

A cross-sectional study was conducted at the Cape Coast Teaching Hospital in Ghana. WLHIV, aged 25-65 years, who met the eligibility criteria were recruited through a simple random sampling method. An interviewer-administered questionnaire was used to gather socio-demographic, behavioural, clinical and other pertinent information. The AmpFire HPV detection system (Atila BioSystem, Mointain View, CA was used to detect 15 high-risk HPV genotypes from self-collected cervico-vaginal samples. The data collected were exported to STATA 16.0 for statistical analysis.

RESULTS

In all, 330 study participants, with mean age of 47.2 years (SD ± 10.7), were involved. Most (69.1%, n = 188/272) had HIV viral loads < 1000 copies/ml and 41.2% (n = 136) had ever heard of cervical screening. The overall hr-HPV prevalence was 42.7% (n = 141, 95% CI 37.4-48.1) and the five commonest hr-HPV types among screen positives were HPV59 (50.4%), HPV18 (30.5%), HPV35 (26.2%), HPV58 (17%) and HPV45 (14.9%). Most infected women (60.3%, n = 85) had multiple hr-HPV infections, with about 57.4% (n = 81) having 2-5 h-HPV types, while 2.8% (n = 4) had more than five hr-HPV types. A total of 37.6% (n = 53) had HPV16 and/or18, while 66.0% (n = 93) had the hr-HPV genotypes covered by the nonavalent vaccine. Women with HIV viral load ≥ 1000copies/ml (AOR = 5.58, 95% CI 2.89-10.78, p < 0.001) had a higher likelihood of being co-infected.

CONCLUSION

This study found out that the prevalence of hr-HPV still remains high in women with HIV, with a notable occurrence of multiple infections and infection with genotypes 16 and/or18. Additionally, an association was established between hr-HPV and infection HIV viral load.. Therefore, comprehensive HIV care for these women should include awareness of cervical cancer, consideration of vaccination and implementation of screening and follow-up protocols. National programmes in LMIC, such as Ghana, should consider using HPV-based screen-triage-treat approach with partial genotyping.

Culture and pandemic control at cross-roads: navigating the burial guidelines for COVID-19-related deaths in a Ghanaian setting

BACKGROUND

Despite the large volume of scientific evidence on the rapid spread of the COVID-19 pandemic and associated high morbidity and mortality, little is known about the sociocultural disruptions which ensued. The current study explored the nuanced navigation of the COVID-19-related death and burial protocols and its impact on traditional burial and funeral rites in Ghana.

METHODS

This qualitative study was based on the 'focused' ethnographic design. Data were collected using key informant interviews from nineteen COVID-19-related bereaved family members and public health officials involved in enforcing adherence to COVID-19-related death and burial protocols in the Cape Coast Metropolis of Central region of Ghana. Recursive analysis was conducted to generate the themes and sub-themes from the data.

RESULTS

The overarching theme was "Uncultural" connotations ascribed to the COVID-19-related death and burial protocols. The COVID-19-related death and burial protocols were ubiquitously deemed by participants to be 'uncultural' as they inhibited deep-rooted indigenous and eschatological rites of separation between the living and the dead. This was fueled by limited awareness and knowledge about the COVID-19 burial protocols, resulting in fierce resistance by bereaved family members who demanded that public health officials release the bodies of their deceased relatives. Such resistance in the midst of resource limitation led to negotiated compromises of the COVID-19-related death and burial protocols between family members and public health officials.

CONCLUSIONS

Insensitivity to socio-cultural practices compromised the implementation of the COVID-19 pandemic control interventions, particularly, the COVID-19-related death and burial protocols. Some compromises that were not sanctioned by the protocols were reached to allow health officials and families respectfully bury their dead. These findings call for the need to prioritize the incorporation of sociocultural practices in future pandemic prevention and management strategies.

Association of DRB1*11 and DRB1*12 alleles of the HLA system with the evolution of the Hepatitis B virus infection in Burkina Faso

BACKGROUND

Hepatitis B Virus (HBV) infection affect all social strata of humanity and in the absence of any management, this infection has a different outcome from one infected person to another. This suggests that there are specific individual factors that influence the outcome of the pathology. Sex, immunogenetics and age of contraction of the virus have been cited as factors that influence the evolution of the pathology. In this study, we looked at two alleles of the Human Leucocyte Antigen (HLA) system to measure their possible involvement in the evolution of HBV infection.

METHOD AND RESULTS

We conducted a cohort study involving 144 individuals spread over 04 distinct stages of infection and then compared allelic frequencies in these populations. A multiplex PCR was conducted and the data obtained was analyzed using R and SPSS software. Our study revealed a predominance of HLA-DRB1*12 in our study population without, however, showing a significant difference between HLA-DRB1*11 and HLA-DRB1*12. The HLA-DRB1*12 proportion was significantly higher in chronic hepatitis B (CHB) and resolved hepatitis B (RHB) compared to cirrhosis and hepatocellular carcinoma (HCC) (p-value = 0,002). Carrying HLA-DRB1*12 has been associated with a low risk of complication of infection (CHB → cirrhosis; OR 0,33 p-value 0,017; RHB → HCC OR 0,13; p-value = 0,00,045) whereas the presence of HLA-DRB1*11 in the absence of HLA-DRB1*12 increased the risk of developing severe liver disease. However, a strong interaction of these alleles with the environment could modulate the infection.

CONCLUSION

Our study shown that HLA-DRB1*12 is the most frequent and it's carriage may be protective in the development of infection.

Coping with loneliness and stigma associated with HIV in a resource-limited setting, making a case for mental health interventions; a sequential mixed methods study

BACKGROUND

Challenges such as stigma and loneliness may increase vulnerability to Human Immunodeficiency Virus (HIV) infection and negatively affect the quality of life of people living with HIV (PLHIV) despite the massive investment in access to antiretroviral therapy. This study aims to determine the level of loneliness and stigma and explore the coping resources employed by PLHIV in a resource-constrained setting.

METHODS

This was a sequential mixed methods study conducted at the Cape Coast Teaching Hospital (CCTH) in Ghana between May and December 2021. A total of 395 adults were selected using a simple random sampling technique. HIV Stigma Scale and UCLA Loneliness Scale were used to collect quantitative data. A purposive sampling technique was applied to recruit 18 participants to saturation using a semi-structured interview guide. SPSS version 21 was used for the statistical analysis of the quantitative data. HIV-related loneliness and stigma levels were estimated, and bivariate and multivariable logistic regression were used to evaluate associated factors using a statistical significance of p-value (p < .05). In general, the thematic analysis approach by Braun and Clark was employed to analyse the qualitative data. Findings were then triangulated.

RESULTS

The mean age was 46.79 years (± 12.53), 75.4% of the participants were female, with a prevalence of stigma of 99.0% (95%CI = 97.4-99.7) and loneliness of 30.1% (95%CI = 25.6-34.9). Tertiary-level education and instrumental support were associated with lower levels of loneliness. In contrast, comorbidity, personalised stigma, negative self-image, and self-blame were positively related to loneliness. Thematic analyses of the qualitative data produced a range of themes that showed that people living with HIV rely on personal resources, social support networks, and behaviour modification strategies to manage their condition. In particular, some of these strategies include; religiosity and spirituality, family and friends, medication and professional support systems.

CONCLUSION

The results suggest that PLHIV in the developing world face enormous challenges, socially, psychologically and financially. Although there have been global efforts to make HIV services accessible, the findings suggest a need for integrating mental health services contextually to reduce loneliness and HIV-related stigma to improve quality of life.

The Influence of COVID-19 Pandemic on the Health Seeking Behaviors of Adults Living With Chronic Conditions: A View Through the Health Belief Model

The COVID-19 pandemic resulted in disruption in every facet of life including health service delivery. This has threatened the attainment of global targets to improve health and wellbeing of all persons. In particular, for persons living with chronic diseases, who require consistent monitoring by health professionals and medication to enhance their health, understanding how the pandemic has disruption their access to health care delivery is critical for interventions aimed at improving health service delivery for all as well as preparedness for future pandemic. This study applied the constructs of the Health Belief Model, to explore the influences of the COVID-19 pandemic on the health seeking behaviors of persons living with chronic diseases. The design was exploratory descriptive. Semi-structured interviews were conducted to collect data among persons living with chronic diseases in the Cape Coast Metropolis of Ghana. Thematic analysis, both inductive and deductive, was conducted to unearth the findings. Awareness of increased susceptibility and risk of a more severe episode if they contracted COVID-19 as a result of the existing chronic diseases was identified. Lack of access to health professionals during the peak of the pandemic as well as the fear of contracting the virus while accessing their regular chronic disease clinic was the main barriers identified. Information in the media served as cues to action for adopting preventive health strategies. Behavior modifications; dietary and lifestyle, self-medication and adoption of COVID-19 related precautions were practiced. Susceptibility to contracting COVID-19 contributed to missed adherence to treatment appointment. The health belief model was a useful framework in exploring the health seeking behavior of the adults living with chronic conditions during the COVID-19 in this study setting. Intensifying targeted education for persons living with chronic diseases will contribute to the adoption of positive health seeking behaviors during future pandemic.

Regional and country-level trends in cervical cancer screening coverage in sub-Saharan Africa: A systematic analysis of population-based surveys (2000-2020)

BACKGROUND

Sub-Saharan Africa (SSA) has the highest cervical cancer (CC) burden globally-worsened by its HIV epidemics. In 2020, the World Health Organization (WHO) introduced a CC elimination strategy with goals for vaccination, screening, and treatment. To benchmark progress, we examined temporal trends in screening coverage, percent screened at least twice by the age of 45, screening coverage among women living with HIV (WLHIV), and pre-cancer treatment coverage in SSA.

METHODS AND FINDINGS

We conducted a systematic analysis of cross-sectional population-based surveys. It included 52 surveys from 28 countries (2000 to 2020) with information on CC screening among women aged 25 to 49 years (N = 151,338 women). We estimated lifetime and past 3-year screening coverage by age, year, country, and HIV serostatus using a Bayesian multilevel model. Post-stratification and imputations were done to obtain aggregate national, regional, and SSA-level estimates. To measure re-screening by age 45, a life table model was developed. Finally, self-reported pre-cancer treatment coverage was pooled across surveys using a Bayesian meta-analysis. Overall, an estimated 14% (95% credible intervals [95% CrI]: 11% to 21%) of women aged 30 to 49 years had ever been screened for CC in 2020, with important regional and country-level differences. In Eastern and Western/Central Africa, regional screening coverages remained constant from 2000 to 2020 and WLHIV had greater odds of being screened compared to women without HIV. In Southern Africa, however, screening coverages increased and WLHIV had equal odds of screening. Notably this region was found to have higher screening coverage in comparison to other African regions. Rescreening rates were high among women who have already been screened; however, it was estimated that only 12% (95% CrI: 10% to 18%) of women had been screened twice or more by age 45 in 2020. Finally, treatment coverage among 4 countries with data was 84% (95% CrI: 70% to 95%). Limitations of our analyses include the paucity of data on screening modality and the few countries that had multiple surveys.

CONCLUSION

Overall, CC screening coverage remains sub-optimal and did not improve much over the last 2 decades, outside of Southern Africa. Action is needed to increase screening coverage if CC elimination is to be achieved.

A nationwide cross-sectional review of in-hospital hepatitis B virus testing and disease burden estimation in Ghana, 2016 - 2021

BACKGROUND AND AIMS

Data are needed to inform hepatitis B virus (HBV) testing and treatment policies in Ghana to make progress towards achieving the 2030 WHO elimination targets. This study investigated testing patterns for HBV and described the age, sex, and region-specific prevalence of HBV infection in Ghana using hospital data.

METHODS

A nationwide multi-centre cross-sectional study was performed where hospital-based registers were reviewed. These included review of 139,966 laboratory, 169,048 blood bank, and 83,920 delivery register entries from 22 healthcare institutions in Ghana. Frequencies and proportions, and crude and pooled estimates reported. Chi squared test was used for tests of independence. Logistic regression was used to identify factors associated with a positive test result.

RESULTS

The crude HBsAg seroprevalence was 8.48% (95%CI 8.25-8.57%) with pooled estimate of 11.40% (95%CI 10.44-12.35). HBsAg seroprevalence among children under 5 years was 1.87% (95%CI 1.07-3.27) and highest age-specific seroprevalence was in those 40-49 years. The highest region-specific seroprevalences was in the Savannah (22.7%). Predictors of a positive HBsAg RDT test included female sex (OR 0.81 95% CI 0.74-0.88), and age (OR 1.005 95%CI 1.002-1.007). The proportion of parturient women receiving HBsAg testing increased between 2017 (87.2%) and 2020 (94.3%) (p < 0.001). The crude HBsAg seroprevalence in parturient women was 6.14% (95% CI 5.97-6.31). Among blood donors the crude HBsAg seroprevalence was 5.69% (95%CI 5.58-5.80). Data from 2 teaching hospitals indicated that in 2020, although 1500 HBsAg positive tests were recorded only 746 serological profile and 804 HBV DNA tests were performed. HBV e antigen seroprevalence was 6.28% (95%CI 4.73-7.84).

CONCLUSION AND RECOMMENDATIONS

Ghana remains a country with high HBV burden. There is an unequal distribution, with higher HBsAg seroprevalence in the north of the country. Furthermore, PCR testing is not widely available outside of large teaching hospitals, which limits diagnostic work-up. Hepatitis reporting systems and registers should be improved to facilitate data capture of indicators and standardised across the country to allow for comparability. Furthermore, where gains have been made in testing among pregnant women, there is a need for linkage to appropriate care.

Preponderance of vaccine-preventable diseases hotspots in northern Ghana: a spatial and space-time clustering analysis from 2010 to 2014

BACKGROUND

Vaccine-preventable diseases (VPDs) persist globally with a disproportionately high burden in Low and Middle-Income Countries (LMICs). Although this might be partly due to the failure to sustain vaccination coverage above 90% in some WHO regions, a more nuanced understanding of VPD transmission beyond vaccination coverage may unveil other important factors in VPD transmission and control. This study identified VPDs hotspots and explored their relationships with ecology, urbanicity and land-use variations (Artisanal and Small-scale Gold Mining (ASGM) activities) in Ghana.

METHODS

District-level disease count data from 2010 to 2014 from the Ghana Health Service (GHS) and population data from the Ghana Population and Housing Census (PHC) were used to determine clustering patterns of six VPDs (Measles, Meningitis, Mumps, Otitis media, Pneumonia and Tetanus). Spatial and space-time cluster analyses were implemented in SaTScan using the discrete Poisson model. P-values were estimated using a combination of sequential Monte Carlo, standard Monte Carlo, and Gumbel approximations.

RESULTS

The study found a preponderance for VPD hotspots in the northern parts of Ghana and northernmost ecological zones (Sudan Savannah and Guinea Savannah). Incidence of meningitis was higher in the Sudan Savannah ecological zone relative to: Tropical Rain Forest (p = 0.001); Semi Deciduous Forest (p < 0.0001); Transitional Zone (p < 0.0001); Coastal Savannah (p < 0.0001) and Guinea Savannah (p = 0.033). Except for mumps, which recorded a higher incidence in urban districts (p = 0.045), incidence of the other five VPDs did not differ across the urban-rural divide. Whereas spatial analysis suggested that some VPD hotspots (tetanus and otitis media) occur more frequently in mining districts in the southern part of the country, a Mann-Whitney U test revealed a higher incidence of meningitis in non-mining districts (p = 0.019). Pneumonia and meningitis recorded the highest (722.8 per 100,000) and least (0.8 per 100,000) incidence rates respectively during the study period.

CONCLUSION

This study shows a preponderance of VPD hotspots in the northern parts of Ghana and in semi-arid ecoclimates. The relationship between ASGM activities and VPD transmission in Ghana remains blurred and requires further studies with better spatial resolution to clarify.

First detection of mutated ERG11 gene in vulvovaginal Candida albicans isolates at Ouagadougou/Burkina Faso

Background

Vulvovaginal candidiasis is an important cause of morbidity among women due to Candida species. In the last decades, resistance to azoles, first-line antifungals has increased. One molecular mechanism of azole resistance by Candida involves mutations in the ERG11 gene encoding lanosterol 14-α-demethylase, the target enzyme. This study was conducted to identify the clinical Candida species associated in vulvovaginal candidiasis; to determine the rate of antifungal resistance among Candida albicans isolates and to determine mutated ERG11 gene at Saint Camille Hospital in Ouagadougou, Burkina Faso.

Methods

Antifungals susceptibility were performed using Kirby–Bauer disk diffusion method. ERG11 gene was detected using conventional PCR in C. albicans isolates resistant to at least one azole.

Results

Out of 262 clinical strains isolated, C. albicans accounted for 59.90%, followed by Candida glabrata 27.86%, Candida famata 7.25%, Candida tropicalis 3.05% and Saccharomyces cerevisiae 1.91%. Resistance rate of fluconazole to C. albicans was 59.54%. ERG11 gene was found in 9.79% of 92 C. albicans strains resistant to azoles.

Conclusions

This detection of mutated ERG11 gene in C. albicans is the first in Burkina Faso and may be a cause of azole resistance in recurrent Candida vulvovaginitis.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12879-022-07619-5.

Parenting practices and family relationships during the COVID-19 lockdown in Ghana

The effects of the COVID-19 pandemic have been far reaching across almost every sphere of life. Families, which are the basic units of society, have not been spared the ravages of the pandemic. Changes in family daily routines as a result of COVID-19 can affect spousal relationships, parenting and childcare practices. However, the extent to which the pandemic has affected parenting practices and family relationships in Ghana is not known.

The goal of this study was to assess how parenting practices and family relationships have been influenced during the COVID-19 pandemic in Ghana. Data for this paper was drawn from an online questionnaire response from 463 participants in Ghana as a subset analysis from a multi-country study on personal and family coping system with COVID-19 pandemic in the global south.

The mean score for pre-COVID-19 relationship with partner (36.86) was higher (p<0.0001) than the mean score for during COVID-19 relationship with partner (35.32) indicating that COVID-19 has had negative influence on relationships. The mean score for pre-COVID-19 parenting (32.78) was higher (p<0.0001) compared to the mean score for during COVID-19 parenting (31.40) indicating negative influence on parenting. We have predicted that participants whose coping levels were “Well” on the average, are likely to be doing well in relationship with partners and parenting practices during the COVID-19 period

The challenging public health containment measures of the COVID-19 pandemic have negatively influenced the relationship between partners and parenting practices in Ghana.

HPV Self-Sampling for Cervical Cancer Screening among Women Living with HIV in Low- and Middle-Income Countries: What Do We Know and What Can Be Done?

Introduction. Self-sampling has the potential to increase cervical cancer (CC) screening among women with HIV in low- and middle-income countries (LMICs). However, our understanding of how HPV self-collection studies have been conducted in women with HIV is limited. The purpose of this scoping review was to examine the extent to which the HPV self-sampling has been applied among women with HIV in LMICs. Method: We conducted multiple searches in several databases for articles published between 2000 and January 2022. With the combination of keywords relating to HPV self-sampling, LMICs, and women with HIV, we retrieved over 9000 articles. We used pre-defined inclusion and exclusion criteria to select relevant studies for this review. Once a study met the inclusion criteria, we created a table to extract each study’s characteristics and classified them under common themes. We used a qualitative descriptive approach to summarize the scoping results. Results: A total of 12 articles were included in the final review. Overall, 3178 women were enrolled in those studies and 2105 (66%) of them were women with HIV. The self-sampling participation rate was 92.6%. The findings of our study show that 43% of the women with HIV in 8 of the studies reviewed tested positive for high-risk HPV (hr-HPV) genotypes, indicating 4 out of 10 women with HIV in the studies are at risk of cervical cancer. The prevalence of the hr-HPV in women with HIV was 18% higher than that of HIV-negative women. Most women in the study found the self-sampling experience acceptable, easy to use, convenient, and comfortable. Self-sampling performance in detecting hr-HPV genotypes is comparable to clinician-performed sampling. However, limited access (i.e., affordability, availability, transportation), limited knowledge about self-screening, doubts about the credibility of self-sampling results, and stigma remain barriers to the wide acceptance and implementation of self-sampling. In conclusion, the findings of this review highlight that (a) the prevalence of hr-HPV is higher among women with HIV than HIV-negative women, (b) self-sampling laboratory performance is similar to clinician-performed sampling, (c) the majority of the women participated in self-sampling, which could likely increase the cervical cancer screening uptake, and (d) women with HIV reported a positive experience with self-sampling. However, personal, environmental, and structural barriers challenge the application of self-sampling in LMICs, and these need to be addressed.

Molecular Epidemiology of Human Herpes Virus Type 8 Among Patients with Compromised Immune System in Ouagadougou, Burkina Faso

Introduction

Human herpesvirus type 8 (HHV-8) is the main etiological agent of Kaposi's sarcoma. This virus is frequently associated with immunocompromision. This study aimed to detect HHV-8 in people with compromised immune system.

Patients and Methods

This is a cross-sectional study that included 180 subjects: 179 HIV-infected patients and 1 patient with bullous pemphigoid. Blood samples were taken from all subjects, and swabs of lesions were then taken from individuals with symptoms of Kaposi's sarcoma. Viral load and CD4+ T lymphocytes count were performed for persons living with HIV and real-time PCR detection of HHV-8 DNA was performed in all subjects in the study.

Results

Among HIV-infected persons, 13.41% had a viral load of more than 10,000 copies/mL, and 22.91% had a CD4+ T lymphocytes count of fewer than 350 cells/µL. A total of four (three HIV-1 infected patients and one patient with bullous pemphigoid) patients (2.22%) had apparent lesions of Kaposi's sarcoma. In the plasmas and swabs from associated lesions, HHV-8 DNA was found in only two individuals, with an HHV-8 prevalence of 1.11% (2/180) with 0.55% (1/179) in an HIV-infected patient on antiretroviral therapy.

Conclusion

These results exposing low prevalence levels of HHV-8 in HIV-infected patients could be due to the beneficial effect of antiretroviral drugs.

Screening of BRCA1 (c.5177_5180delGAAA rs80357867 and c.4986+6T>C rs80358086) and the BRCA2 (c.6445_6446delAT rs80359592) Genes for Breast Cancer Prevention in Burkina Faso

Background

The objective of this study is to search for mutations in the BRCA1 (c.5177_5180delGAAA and c.4986+6T>C) and BRCA2 genes (c.6445_6446delAT) in a population of women diagnosed with breast cancer.

Methods

This is a case-control study that involved 140 participants, including 70 patients with histologically diagnosed breast cancer and 70 healthy women without breast cancer. Mutations in the BRCA1 (rs80357867, rs80358086) and BRCA2 (rs80359592) genes were tested by real-time PCR. The 95% confidence interval Odds Ratio (OR) was used to estimate the associations between specific genotypes and breast cancer.

Results

The study revealed that no mutations were detected for rs80359592. Similarly, no reference allele (TTTC/TTTC) of rs80357867 was found in this study. However, the homozygous double mutant (-/) genotype of this rs80357867 was observed in 11.43% and 1.43% of patients and controls respectively, while 88.57% of patients and 98.57% of controls had a heterozygous deletion (TTTC/-). Concerning rs80358086, 8.57% of the patients had a heterozygous mutation (A/G) with no significantly risk association with occurrence of breast cancer (OR = 6.46; 95% CI: 0.75-55.21; p = 0.11). In addition, this heterozygous mutation was significantly associated with a family history of breast cancer (OR=128; 95% CI: 9.46-1730.93) and breast cancer risk in nonmultiparous women (OR=6; 95% CI: 1-35.90; p= 0.05) but no association with overweight/obesity (OR=1.66; 95% CI: 0.18-15.35; p=1).

Conclusion

This study shows high frequencies of heterozygous mutation of rs80357867 and rs80358086 from patients. In Burkina Faso, these results could help with early diagnosis of breast cancer in patients.

Correlates of cervical cancer screening participation, intention and self-efficacy among Muslim women in southern Ghana

Background

The World Health Organisation’s efforts to eliminate cervical cancer by 2030 with a target of 70% screening coverage using a high-performance test demand that women increase participation in screening. Factors that impact uptake of screening must therefore be identified and bottlenecks addressed, especially in lower- and middle-income countries where cervical cancer incidence remains high. This study investigated Muslim women, participation in, intention to engage in and self-efficacy about cervical cancer screening.

Methods

An analytical cross-sectional study was conducted among Muslim women aged 18 years and above in the Cape Coast Metropolis of Ghana using an interviewer-administered questionnaire. Data were analysed using appropriate descriptive statistics, Chi-square test, point biserial correlation and binary logistic regression analysis.

Results

The mean age of participants was approximately 31 years (M = 30.9, SD = 10.4). Out of the 431 women, 21 (4.9%) had ever participated in cervical cancer screening. Participants demonstrated very low knowledge about cervical cancer and screening, with a mean knowledge score of 3.68 out of 15. Knowledge about cervical cancer was associated with increased odds of participating in cervical cancer screening (aOR = 1.32, 95%CI 1.11, 1.56). Concerns about similarity with health provider in terms of gender and faith was associated with decreased odds of cervical cancer screening self-efficacy (aOR = 0.81, 95% CI 0.67). Islamic modesty (aOR = 0.88, 95%CI 0.81, 0.96) was associated with decreased self-efficacy about seeking cervical cancer screening, whereas attitude (aOR = 1.32, 95%CI 1.14, 1.53) was significantly associated with increased self-efficacy about seeking cervical cancer screening. Again, Islamic modesty (aOR = 0.88, 95%CI 0.80, 0.97) was associated with decreased intention to participate in screening, whereas attitude (aOR = 1.42, 95%CI 1.20, 1.68) was associated with increased intention to participate in screening.

Conclusions

There are gaps in knowledge of cervical cancer among Muslim women in this study as less than 5% had participated in screening. A positive attitude was found to influence intention to screen and actual participation in screening programmes. Islamic modesty and commitment to the Islamic faith decreased intention and self-efficacy regarding screening. Therefore, comprehensive and appropriate socio-cultural and religion-specific interventions aimed at addressing the barriers to screening are important in improving uptake among Muslim women.

Mutations in exon 11 (11.1 and 11.2) of the <em>BRCA1</em> gene and risk factors for breast cancer in Burkina Faso

Breast cancer is the leading cause of death among women in both developed and developing countries. It is multifactorial, including genetic predispositions such as oncogenic mutations on BRCA1 and 2 genes. The objectives of the present study were to identify oncogenic mutations in exon 11 of the BRCA1 gene and to determine the risk factors for breast cancer among women population in Burkina Faso.

This study involved 100 women, including 50 cases of breast cancer and 50 controls (no clinical signs and no family history of breast cancer or other cancers). Mutations in the BRCA1 gene were detected by PCR using sequence primers specific for exon 11 fragments (11.1 and 11.2).

In our study population, age (OR=22.40; CI: 4.33-115.82; p<0.001) and obesity (OR=4.23; CI: 1.64-10.92; p=0.003) were risk factors while multiparity was a protective factor for breast cancer (OR=0.35; CI: 0.15-0.81; p=0.02). A mutation was found on both fragments 11.1 and 11.2 of the BRCA1 gene exon 11 in 04/50 (8.0 %) of patients. No mutations were observed in controls.

The present study revealed high frequency of oncogenic mutations in exon 11 fragments (11.1 and 11.2) of the BRCA1 gene. These mutations on exon 11 are and involved in the occurrence of breast cancer in our population. Age and obesity were also risk factors for breast cancer among women population in Burkina Faso.

Enigma of the high prevalence of anti-SARS-CoV-2 antibodies in HIV-positive people with no symptoms of COVID-19 in Burkina Faso

The severe acute respiratory syndrome due to the new coronavirus (SARS-CoV-2), responsible for coronavirus disease (COVID-19), has severely tested the global health response capacity, with predictions of a fatality for developing countries. To evaluate the prevalence of anti-SARS-CoV- 2 antibodies in People Living with HIV (PLHIV) with no COVID-19 symptoms in Burkina Faso. Seroprevalence was estimated by performing a qualitative screening test for SARS-CoV-2-specific immunoglobulins. The STANDARDTM Q COVID-19 IgM/IgG Combo Test kit from SD BIOSENSOR was used. Parameters like HIV plasma viral load, CD4 T cell count and C-Reactive Protein (CRP) expression were estimated. This study enrolled a total of 200 PLHIV aged 4-87 years who are asymptomatic for COVID-19. There were 36 (18%) positive for SARS-CoV-2 IgM and/or IgG of which three (1.50%) were positive for SARS-CoV-2 IgM and 33 (16.50%) for IgG. Among participants diagnosed as IgM positive, 66.67% (2/3) had the highest HIV viral loads with the lowest CD4 T cell counts (p<0.0001). The expression of CRP was relatively higher in COVID-19 IgG positive individuals (7.95±12.5 mg/L) than negative individuals (6.26±6.92 mg/L; p=0.37). The rate of IgG and IgM SARS-CoV-2 immunoglobulin carriage (18%), accompanied by a relatively high CRP levels, was revealed in this study among PLHIV. This serologic evidence and mild inflammation suggest that Burkina Faso escaped the worst, not necessarily because there were not many SARS-CoV-2 infections in its population, but because factors including genetic and environmental, might have resulted in many asymptomatic carriers.

Explorative-descriptive study on the effects of COVID-19 on access to antiretroviral therapy services: the case of a teaching hospital in Ghana

OBJECTIVE

To explore how the COVID-19 pandemic affected access to antiretroviral therapy (ART) services from the perspective of the persons living with HIV (PLWH).

DESIGN

The study adopted an exploratory-descriptive qualitative design that used in-depth interviews as the technique for the data collection. Data analysis was done using conceptual content analysis, following the traditions of Elo and Kyngäs on deductive and Hsieh on inductive content analysis.

SETTING

ART clinic, Cape Coast Teaching Hospital, Ghana.

PARTICIPANTS

Twelve participants who had at least 1 year history of accessing ART care before the COVID-19 pandemic and at least one clinic visit during the pandemic were purposively sampled from the ART clinic.

RESULTS

Five concepts of accessing healthcare proposed by Penchansky and Thomas were explored: accessibility, availability, affordability, accommodation and acceptability. The ART unit in the study setting remained open for service delivery throughout the pandemic. However, fear of contracting the virus while patronising services affected the participants' decision to use the facility. Although all the participants in this study reportedly honoured their refill appointments, they indicated knowledge of other PLWH defaulting. With reference to the availability of resources, a shortage of antiretrovirals was reported, affecting the refill appointment intervals. In spite of the challenges, several strategies were implemented to accommodate the patients' needs while protecting them from contracting the virus by instituting the stipulated COVID-19 protocols. The study found that some of the strategies impacted the acceptability and affordability of the services as transportation costs increased. Varying levels of accessibility to health workers providing ART services in the study setting was also recorded.

CONCLUSION

Strategies were implemented to accommodate the effects of the pandemic on ART provision. However, these had deficiencies that must be addressed using appropriate Differentiated Service Delivery (DSD) interventions that will ensure continuous access to service delivery in the ongoing and any similar future occurrences.

Nationwide Surveillance of Pfhrp2 Exon 2 Diversity in Plasmodium falciparum Circulating in Symptomatic Malaria Patients Living in Ghana

Reports of increasing false-negative HRP2-based rapid diagnostic test results across Africa require constant monitoring of factors associated with these false-negative outcomes, as failure of this diagnostic tool will have severe consequences on malaria treatment and control programs. This study characterized the extent of genetic diversity in the Plasmodium falciparum histidine-rich protein 2 (Pfhrp2) gene in P. falciparum isolates from symptomatic malaria patients across the regions of Ghana. Exon 2 of Pfhrp2 was amplified from gDNA using polymerase chain reaction. All Pfhrp2-negative samples were subjected to Pf18S rRNA and Pfmsp2 gene amplifications. The amplified Pfhrp2 exon 2 fragments from clonal samples were sent for commercial Sanger sequencing. The type and number of PfHRP2 repeats, classified based on repeat types previously reported, were estimated from the sequence data and compared among geographical regions. About 81% (2,333/2,890) of the original microscopy positive DBS were available and used in this study. The Pfhrp2 exon 2 amplification was successful in 98.5% (2,297/2,333) of the tested samples, with band size ranging from 400 bp to 1,050 bp. A total of 13 out of the 24 previously reported repeat types were identified among the samples, with three samples lacking both type 2 and type 7 repeat motifs. This study suggested that the genetic diversity of Pfhrp2 exon 2 identified in P. falciparum circulating in symptomatic malaria patients in Ghana is unlikely to influence the sensitivity and specificity of HRP2 RDT-based diagnosis.

KIR2DL5B and HLA DRB1*12 alleles seems to be associated with protection against HIV-1 in serodiscordant couples in Burkina Faso

INTRODUCTION

The Human Immunodeficiency Virus (HIV) belongs to the Retroviridae family and remains a public health problem in sub-Saharan Africa. Recent reports from WHO have shown that 33 million people died from HIV infections. HIV is one of the most serious fatal human diseases of the 20^th and 21^st centuries. However, variations in genetic and immunological factors are associated with protection against HIV infection in uninfected people exposed to HIV. This is the case with Naturals Killers which play an important role in the progression or regression of HIV infection. The objective of this study is to characterize certain HLA (Human Leukocyte Antigen) class II genes and KIR genes in HIV-1 serodiscordant couples in Burkina Faso.

METHODS

This study was carried out at Burkina Faso among nineteen (19) HIV-1 serodiscordant couples. Classical multiplex PCR (SSP-PCR) was used to characterize the presence or absence of the KIR genes and certain class II HLAs (DRB1*11 and DRB1*12).

RESULTS

The characterization of the KIR and HLA genes DRB1*11, DRB1*12 in this study demonstrated that the inhibitor KIR2DL5B, would confer protection against HIV-1 infection in seronegative partners [OR = 0.13 (0.02-0.72) and p = 0.029)], and the HLA DRB1*12 allele was associated with protection against HIV-1 infection in seronegative partners [OR = 0.16 (0.03-0.77) and p = 0.038]. AA and Bx haplotypes were not found to be associated with HIV-1 infection in serodiscordant couples.

CONCLUSION

This study confirms the involvement of the KIR genes in viral pathologies such as HIV-1 infection. Future larger-scale studies may provide a better understanding of the molecular mechanism by which the KIR Haplotype and combination of KIR/HLA are associated with protection against HIV infection. This article is protected by copyright. All rights reserved.

Clinical preceptorship in Ghana in the era of COVID-19 pandemic: an interventional study

BACKGROUND

Innovations in clinical nursing education are critical in enhancing the experiences of students, especially in the era of coronavirus pandemic. This study aimed at investigating nurse preceptors' perceptions of use, intention to use and self-efficacy towards digital technology in preceptorship in the Cape Coast Metropolis of Ghana.

METHODS

A concurrent type of mixed-methods design with a non-randomised interventional study using three-phase multi-methods technique was conducted among nurse preceptors in the Cape Coast Metropolis in the Central Region of Ghana. Forty-five nurse preceptors participated in a pre and post training intervention while seven were purposively selected for the qualitative interview. Complimentarity method of triangulation was used in the analysis. The quantitative data were analysed with STATA version 16 and presented using frequencies, percentages, means with standard deviations and McNemar's test while qualitative data were analysed using the six steps approach to qualitative data analysis by Braun and Clarke.

RESULTS

Perceived usefulness statement "using technology will improve clinical teaching" increased from 19 (42.22%) at baseline to 44 (97.78%) post intervention. Perceived ease of using technology statement "I would find it easy to get this technology to do what I want it to do" also increased from 36 (80.00%) to 41 (91.11%) post intervention. Self-efficacy increased from 40 (88.89%) to 43 (95.56%) after the intervention. There was a statistically significant difference between pre-training and post-training scores regarding tablet (p = 0.016) and experience with online library resources (p = 0.039). The qualitative results yielded three themes, namely: strengths of using technology; constraints in the learning environment; and future of technological approach to clinical teaching.

CONCLUSIONS

The training intervention improved participants intentions, self-efficacy, perceived use and perceived ease of use of technology. However, there are constraints in the clinical learning environment including students and preceptor-related factors, and institutional factors that needs to be addressed as part of efforts to implement technology in clinical teaching in this era of COVID-19 pandemic and beyond.

Molecular epidemiology of human papillomavirus in pregnant women in Burkina Faso

INTRODUCTION

Genital human papillomavirus (HPV) infection is widespread among sexually active individuals. Several factors may contribute to increased risk of infection in pregnant women. The objective of this study was to determine the high-risk (HR-HPV) and low-risk (LR-HPV) oncogenic HPV genotypes among pregnant women in Ouagadougou.

METHODOLOGY

In this study, 100 endocervical samples were collected using a sterile swab on the sterile examination glove used during vaginal examination in pregnant women. DNA from each sample was amplified by PCR followed by hybridization using the HPV Direct Flow Chips kit detecting 36 HPV genotypes.

RESULTS

Twenty-three percent (23%) of pregnant women had HPV infection. Of the 36 genotypes tested, 29 genotypes had been identified with a predominance of HPV 52 (10.34%), HPV 35 (6.89%), and HPV 82 (6.89%) for high risk and HPV 43 (10.34%), HPV 44/55 (6.90%), and HPV 62/81 (6.89%) for low risk.

CONCLUSION

HPV is common among pregnant women in Burkina Faso. However, the available vaccines do not cover the frequent genotypes found in this study. HPV could therefore constitute a threat for pregnant women and a risk of infection for the newborn.

Effects of COVID-19 pandemic on ART Service delivery: perspectives of healthcare workers in a Teaching Hospital in Ghana

BACKGROUND

Ghana has a generalized HIV epidemic and efforts have been made to curb the spread and reverse its effects on the general population. In the wake of COVID-19 pandemic, the health system was unsettled and antiretroviral therapy (ART) care has been impacted in diverse ways. The study sought to explore the effects of COVID-19 on ART service provision in Ghana from the perspectives of the healthcare workers.

METHODS

An exploratory-descriptive qualitative approach was employed in this study. Using maximum variation sampling method, fifteen healthcare workers; nurses, data managers and pharmacists were recruited from an ART clinic in a Teaching Hospital in Ghana. In-depth interviews were conducted and analysed using Braun and Clarke thematic approach.

RESULTS

Three themes emerged from the data; "… And the pandemic struck", "Impact of the pandemic on ART service delivery"; "Effecting the needed change". The healthcare workers' initial reactions to the pandemic and their show of commitment in ensuring continued ART service was evident. COVID-19 impacted service delivery in three main ways; (1) clients' clinic attendance was erratic at various stages of the pandemic, (2) irregular resource availability as shortage was reported due to affected last mile delivery as a result of the lockdown in Accra, and (3) the health worker-patient interaction became less engaging because of established COVID-19 protocols. The healthcare workers however instituted strategies such as adjusting the patient appointment schedule, health professionals' work schedule, establishing several work stations, task-shifting, and ensuring the implementation of all the COVID-19 protocols within the ART unit to ensure consistent service delivery as well as patient and staff safety. The study also found a decline in the implementation of several strategies established in the ART clinic during the initial phases of the pandemic such as a decline in the supply of Personal Protective Equipment (PPEs) by hospital management.

CONCLUSIONS

Although several strategies were implemented to manage the effects of the pandemic on ART care, there is a need to establish pathways of support for healthcare workers within the ART clinic and to consolidate as well as institutionalise the changes that ensured continuous but safe service delivery.

Profiling the Quality and Quantity of Naturally Induced Antibody Responses Against Pfs230 and Pfs48/45 Among Non-Febrile Children Living in Southern Ghana: A Longitudinal Study

A clear understanding of the properties of naturally induced antibody responses against transmission-blocking vaccine candidates can accelerate the understanding of the development of transmission-blocking immunity. This study characterized the naturally induced IgG responses against two leading transmission-blocking vaccine antigens, Pfs230 and Pfs48/45, in non-febrile children living in Simiw, Ghana. Consecutive sampling was used to recruit 84 non-febrile children aged from 6 to 12 years old into the 6-month (November 2017 until May 2018) longitudinal study. Venous blood (1 ml) was collected once every 2 months and used to determine hemoglobin levels, P. falciparum prevalence using microscopy and polymerase chain reaction, and the levels and relative avidity of IgG responses against Pfs230 and Pfs48/45 using indirect ELISA. IgG levels against Pfs230 and Pfs48/45 decreased from the start (November) to the middle (January) and end (March) of the dry season respectively, then they began to increase. Participants, especially older children (10-12 years old) with active infections generally had lower antibody levels against both antigens. The relative avidities of IgG against both antigens followed the trend of IgG levels until the middle of the dry season, after which the relative avidities of both antigens correlated inversely with the antibody levels. In conclusion, although IgG antibody levels against both Pfs48/45 and Pfs230 began to increase by the early rainy season, they were inversely correlated to their respective relative avidities.

Prevalence of Methicillin-Resistant Staphylococcus Species Among Filarial Lymphedema Patients in Ahanta West District of Ghana

Background

Filarial pathologies such as lymphedema may be associated with complications such as chronic non-healing wounds. Nonetheless, the role of bacterial population colonizing the lymphedematous legs has been posited to worsen the conditions of those living with the infection. These bacteria are usually composed of staphylococcal species partly because they are commensals. Thus, this present study sought to type the methicillin-resistant Staphylococcus aureus (MRSA) prevalence among individuals presenting with filarial lymphedema, particularly as MRSA tends to affect treatments options.

Methods

We recruited individuals (n = 321) with stages I–VII of lymphedema in a cross-sectional study in the Ahanta West district of the Western Region of Ghana. Swabs from lymphedematous limb ulcers, pus, and cutaneous surfaces were cultured using standard culture-based techniques. The culture isolates were later identified using Matrix-assisted Laser Desorption/Ionization Time of Flight (MALDI-TOF) mass spectrometry.

Results

A total of 192 Staphylococci species were isolated, with an overall prevalence of 39.7% (95% CI: 35%–44%; N = 483). S. hominis was the most prevalent species (23.95%), followed by S. haemolyticus (20.83%), S. epidermidis (15.10%), S. aureus (10.41%), and S. saprophyticus (9.32%). The remaining 20.34% were distributed among S. wanneri, S. sciuri, S. pasteuri, S. xylosus, S. simulans, S. cohnii, S. caprae, S. lugdunensis, and S. capitis. MRSA, containing mecA gene, was detected in 21 out of 31 Staphylococci isolates tested, with an overall prevalence of 68% (95% CI: 51%–84%). In addition, a virulent gene, Panton–Valentine leukocidin (PVL), which is usually associated with S. aureus, was detected in 20/31 (64.5%) S. aureus in the study.

Conclusion

These results suggest that MRSA species may pose a challenge to the treatment of filarial lymphedema with antibiotics particularly, as doxycycline is currently being piloted in some endemic areas to treat the infection. Thus, intensive antimicrobial resistance surveillance should be conducted in endemic areas by health authorities to forestall the dilemma of multidrug resistance not only against lymphatic filariasis (LF) infection but other diseases.

A systematic review and meta-analysis of the prevalence of hepatitis B virus infection among pregnant women in Nigeria

Background

Nigeria has a high burden of hepatitis B virus (HBV) infection, commonly acquired through vertical transmission. However, there is a lack of an efficient surveillance system for monitoring and understanding the epidemiology of HBV among pregnant women. Building on a previous review on the prevalence of HBV in Nigeria (2000–2013), we conducted a systematic review and meta-analysis of HBV prevalence among pregnant women in Nigeria.

Methods

Four electronic databases PubMed, Embase, Global Health, and Scopus were systematically searched from January 2014 to February 2021. We also searched the African Journal Online and manually scanned the reference lists of the identified studies for potentially eligible articles. Observational studies that reported the prevalence of HBsAg and/or HBeAg among pregnant women in peer-reviewed journals were included in the study. We performed a meta-analysis using a random-effects model. We defined HBV infection as a positive test to HBsAg.

Results

From the 158 studies identified, 20 studies with a total sample size of 26, 548 were included in the meta-analysis. The pooled prevalence of HBV infection among pregnant women across the studies was 6.49% (95% confidence interval [CI] = 4.75–8.46%; I² = 96.7%, p = 0.001; n = 20). The prevalence of HBV was significantly lower among pregnant women with at least secondary education compared with those with no education or primary education (prevalence ratio = 0.7, 95% CI = 0.58–0.87; n = 10). However, the prevalence of HBV was not significantly different by age, religion, marital status, or tribe. The prevalence of HBV was not significantly different among pregnant women with previous surgery, blood transfusion, multiple lifetime sex partners, tribal marks, tattoos, scarification, or sexually transmitted infections, compared with those without these risk factors. From a total sample size of 128 (n = 7), the pooled prevalence of HBeAg among HBV-infected pregnant women was 14.59% (95% CI = 4.58–27.99%; I² = 65.5%, p = 0.01). Subgroup analyses of HBV infection by study region and screening method, and meta-regression analysis of the study year, sample size, and quality rating were not statistically significant.

Conclusions

There is an intermediate endemicity of HBV infection among pregnant women in Nigeria. Interventions, such as routine antenatal HBV screening, antiviral prophylaxis for eligible pregnant women, and infant HBV vaccination should be scaled up for the prevention of perinatal transmission of HBV infection in Nigeria.

Seroprevalence, Genotyping, and Monitoring of Hepatitis C Viral Loads in Patients on Antivirals in Burkina Faso

Introduction

Hepatitis C virus (HCV) infection remains a major public health problem worldwide. In Burkina Faso, nearly 720,000 people are living with HCV, and each year about 900 people die from complications of cirrhosis or hepatocellular carcinoma. This study was planned to determine the HCV seroprevalence, characterize circulating genotypes, and monitor HCV viral loads in patients under treatment with antivirals.

Methods

A total of 4,124 individuals and 167 patients in the pre-therapy program were recruited. The “SD Bioline HCV” kit was used for rapid screening of anti-HCV antibodies. Viral load and genotyping were performed in 167 HCV patients on antivirals using the “Iontek HCV Quant” and “Iontek genotyping” kits.

Results

Prevalence of HCV was 1.65% (68/4,124), and the median viral load of participants was 5.37 log10/mL (1.32–7.67 log10/mL). Genotype 2 was predominant with a frequency of 86.23% (144/167) and appeared to be more active with higher viral load compared to 13.77% (23/167) for genotype 1 (p < 0.001). After 24 weeks of pan-genotypic direct-acting antivirals, such as sofosbuvir/daclatasvir and sofosbuvir/velpatasvir, the viral loads of all patients became undetectable.

Conclusion

The responses to antivirals by the circulating genotypes indicate that the results are very satisfactory. Therefore, the prevalence of HCV in the population can be reduced through identification of cases and treatment.

Family-Based Index testing for HIV; a qualitative study of acceptance, barriers/challenges and facilitators among clients in Cape Coast, Ghana

ABSTRACTFamily-based Index HIV Testing, (FBIT) approach is known to be associated with a relatively higher testing yield compared to Provider-Initiated Testing and Counselling. The implementation of this strategy in several countries has exposed some barriers to optimal FBIT outcomes. With the scale up of FBIT in Ghana, stakeholder engagement is key in identifying and addressing barriers to implementation. This study explored acceptance, barriers/challenges and facilitators of FBIT. Seventeen in-depth qualitative interviews were conducted among clients who had been offered FBIT at the Cape Coast Teaching Hospital using a semi-structured interview guide. Data were analysed using Braun and Clarke's [(2006)] thematic analysis framework and found that (1) participants accepted the strategy and were willing to use it; (2) lack of awareness of the strategy among the general public, fear of disclosure/stigmatization, issues with confidentiality and privacy are barriers/challenges associated with the FBIT approach, and (3) increasing public education on HIV in general and FBIT in particular, ensuring confidentiality and privacy regarding testing are facilitators for increasing uptake of FBIT. It is concluded that despite acceptance of FBIT as a good strategy among index clients, general HIV education to reduce stigma and addressing confidentiality can optimize uptake.

Coping strategies adapted by Ghanaians during the COVID-19 crisis and lockdown: A population-based study

BACKGROUND

The COVID-19 pandemic and control measures adopted by countries globally can lead to stress and anxiety. Investigating the coping strategies to this unprecedented crisis is essential to guide mental health intervention and public health policy. This study examined how people are coping with the COVID-19 crisis in Ghana and identify factors influencing it.

METHODS

This study was part of a multinational online cross-sectional survey on Personal and Family Coping with COVID-19 in the Global South. The study population included adults, ≥18 years and residents in Ghana. Respondents were recruited through different platforms, including social media and phone calls. The questionnaire was composed of different psychometrically validated instruments with coping as the outcome variable measured on the ordinal scale with 3 levels, namely, Not well or worse, Neutral, and Well or better. An ordinal logistic regression model using proportional odds assumption was then applied.

RESULTS

A total of 811 responses were included in the analysis with 45.2% describing their coping level as well/better, 42.4% as neither worse nor better and 12.4% as worse/not well. Many respondents (46.9%) were between 25-34 years, 50.1% were males while 79.2% lived in urban Ghana. Having pre-existing conditions increased the chances of not coping well (aOR = 1.86, 95%CI: 1.15-3.01). Not being concerned about supporting the family financially (aOR = 1.67, 95%CI: 1.06-2.68) or having the feeling that life is better during the pandemic (aOR = 2.37, 95%CI: 1.26-4.62) increased chances of coping well. Praying (aOR: 0.62, 95%CI: 0.43-0.90) or sleeping (aOR: 0.55, 95%CI: 0.34-0.89) more during the pandemic than before reduces coping.

CONCLUSION

In Ghana, during the COVID-19 pandemic, financial security and optimism about the disease increase one's chances of coping well while having pre-existing medical conditions, praying and sleeping more during the pandemic than before reduces one's chances of coping well. These findings should be considered in planning mental health and public health intervention/policy.

Prevalence and changes in boredom, anxiety and well-being among Ghanaians during the COVID-19 pandemic: a population-based study

BACKGROUND

The outbreak of the COVID-19 pandemic has been associated with several adverse health outcomes. However, few studies in sub-Saharan Africa have examined its deleterious consequences on mental health. Therefore, we investigated the prevalence and changes in boredom, anxiety and psychological well-being before and during the COVID-19 pandemic in Ghana.

METHODS

Data for this study were drawn from an online survey of 811 participants that collected retrospective information on mental health measures including symptoms of generalized anxiety disorder, boredom, and well-being. Additional data were collected on COVID-19 related measures, biosocial (e.g. age and sex) and sociocultural factors (e.g., education, occupation, marital status). Following descriptive and psychometric evaluation of measures used, multiple linear regression was used to assess the relationships between predictor variables and boredom, anxiety and psychological well-being scores during the pandemic. Second, we assessed the effect of anxiety on psychological well-being. Next, we assessed predictors of the changes in boredom, anxiety, and well-being.

RESULTS

Before the COVID-19 pandemic, 63.5% reported better well-being, 11.6% symptoms of anxiety, and 29.6% symptoms of boredom. Comparing experiences before and during the pandemic, there was an increase in boredom and anxiety symptomatology, and a decrease in well-being mean scores. The adjusted model shows participants with existing medical conditions had higher scores on boredom (ß = 1.76, p < .001) and anxiety (ß = 1.83, p < .01). In a separate model, anxiety scores before the pandemic (ß = -0.25, p < .01) and having prior medical conditions (ß = -1.53, p < .001) were associated with decreased psychological well-being scores during the pandemic. In the change model, having a prior medical condition was associated with an increasing change in boredom, anxiety, and well-being. Older age was associated with decreasing changes in boredom and well-being scores.

CONCLUSIONS

This study is the first in Ghana to provide evidence of the changes in boredom, anxiety and psychological well-being during the COVID-19 pandemic. The findings underscore the need for the inclusion of mental health interventions as part of the current pandemic control protocol and public health preparedness towards infectious disease outbreaks.

Living with hepatitis B virus infection; media messaging matters

Hepatitis B Virus (HBV) infection is of public health importance due to its high prevalence and infectivity. A positive test for HBV has psychological, emotional, and socio-economic implications that may affect the quality of life of the clients. The media is a major source of information and awareness creation on many health related issues including HBV. This study explored how media messaging on HBV influenced coping among persons infected with HBV. Twelve in-depth interviews were conducted among clients who reported at the STI clinic for routine care at the Cape Coast Teaching Hospital, Ghana. Descriptive content analysis involving deductive and inductive approaches were applied. The findings show that radio was the main source of HBV related information. Misinformation on the transmission, chronicity and prognoses of HBV infection was mostly conveyed by traditional medicine practitioners on the media. These resulted in adverse emotional, social, and physical reactions such as fear and panic, isolation and loneliness, sleeplessness and unsafe health seeking behaviours. However, access to scientific information from health professionals resulted in empowerment and positive coping. More need to be done to regulate the content of HBV-related messages aired so as to avoid misinformation and its consequent negative impact on coping.

Prevalence and attitude towards hepatitis B vaccination among healthcare workers in a tertiary hospital in Ghana

Introduction

adequate knowledge on hepatitis B virus (HBV) infection is important among healthcare workers (HCWs) as this impacts the vaccination seeking behaviour. This study sought to assess the knowledge, vaccination status and related factors amongst HCWs in a tertiary facility in Ghana.

Methods

an analytical cross-sectional study was conducted amongst full-time HCWs of different categories at the Cape Coast Teaching Hospital, Ghana. Stratified sampling was used to arrive at the number needed for each category of HCW and then simple random sampling to recruit participants. A structured self-administered questionnaire was used. Descriptive statistics and logistics regression were carried out on the data.

Results

a total of 303 HCWs participated with 78.07% (n=235) being between 20-30 years, and majority being females (62.38%, n=189). A total of 186 (61.39%) participants had adequate knowledge, mean knowledge score was 4.73/7 (±0.97). About 80% (n=218) had received the 3 doses of HBV vaccine. Among the unvaccinated, cost was the major barrier (62.07%, n=18). Participants who did not know that HBV was more infectious than HIV (aOR=5.31, 95%CI: 1.91-14.77), p<0.001) and those who did not have knowledge that HBV vaccine was effective were more likely to be unvaccinated (aOR=8.63, 95%CI: 2.99–24.94), p<0.0001). The gender and cadre of staff did not show statistical evidence of an association with vaccination status.

Conclusion

knowledge on HBV is paramount for all HCWs as well as the importance of receiving the full doses of the hepatitis B vaccines. Barriers to vaccination must be removed to ensure protection of HCWs.

Experiences and training needs of healthcare providers involved in the care of Ghanaian adolescents living with HIV: an interventional study

Background

Caring for adolescents living with HIV/AIDS (ALHIV) can be overwhelming due to their unique needs. Ghana is currently among nine countries in West and Central Africa contributing to 90% of new paediatric infections in the sub-region with a growing population of ALHIV. Regardless, gaps in paediatric related care including healthcare providers (HCPs) capacity issues have been identified. This study sought to assess the competencies of adolescent-oriented healthcare providers before, and after interventionist training to inform recommendation that would guide the psychosocial care they give to ALHIV.

Methods

The study adopted a mixed methods approach with a non-randomized interventional study involving three-phase multi-methods. The sample consisted of 28 adolescent-oriented and multi-disciplinary healthcare providers at the Cape Coast Teaching Hospital (CCTH) in Ghana. Data were obtained in three phases, namely, a baseline survey, interventionist training, and post-training in-depth interviews. Quantitative data were analyzed using Stata version 13 for descriptive analysis while the qualitative data were analyzed thematically using NVivo version 11.

Results

Although the majority of the HCPs claim to be knowledgeable about adolescent health issues (n = 21, 75.0%), only about a third (n = 10, 35.7%) could correctly define who an adolescent is. The majority (n = 18, 64.3%) had not received any training on how to work with the adolescent client. The main areas identified for improvement in the ALHIV care in phase 1 included issues with psychosocial assessment, communication and treatment adherence strategies, creating an adolescent-friendly work environment, and availability of job aids/protocols. During the post-training interviews, participants reported an improved understanding of the characteristics of an adolescent-friendly site and basic principles for ALHIV care. They were also able to correctly describe the widely used adolescent health assessment tool; the HEEADSSS. Post intervention interviews also revealed HCPs perception on increased practice related confidence levels and readiness to implement new knowledge and skills gained.

Conclusion

This study has shown that targeted training on routine ALHIV care is effective in increasing HCPs knowledge, skills and confidence. Addressing the healthcare system/facility related gaps serves as an impetus for improved ALHIV care among HCPs.

Polymorphism of MMP1 and MMP3 promoter regions and HR-HPV infection in women from Burkina Faso and Côte d'Ivoire

The single nucleotide polymorphism (SNP) of the promoter region of MMP-1 (at 1607 bp) and MMP-3 (at 1171 bp) create Ets binding sites. Correlations between these SNPs and sensitivity to several biological processes such as metastasis and recurrence of cancer have been reported in several studies. In this case-control study, we looked for these SNPs in women infected with or not with high-risk human papillomaviruses (HR-HPV). The frequency, distribution and correlation of these SNPs with the presence or absence of HR-HPV infection were evaluated. Genotypes 1G1G, 1G2G and 2G2G for MMP1 and genotypes 5A5A, 5A6A, 6A6A for MMP3 were found in our study population. In general, we noted that the 1G (40.8%) and 2G (64.8%) alleles were more frequent in non-infected women and infected women, respectively, and more specifically this difference was significant in women from Côte d'Ivoire. These results, although yet to be reaffirmed with assays for quantifying the mRNA of these genes, suggest that the SNP of the MMP-1 promoter could promote infection with HR-HPV.

Genotypic distribution of human oncogenic papillomaviruses in sexually active women in Burkina Faso: Central, Central-Eastern and Hauts-Bassins regions

Objective this study was conducted to determine the distribution of high-risk human papillomavirus (HR-HPV) genotypes in women in the general population of three regions of Burkina Faso. Method This multicenter, descriptive cross-sectional study involved 1321 sexually active women in five cities in three regions of Burkina Faso: Central, Central-Eastern and Hauts-Bassins regions. After collection of endocervical specimens, pre-cervical lesions were screened by visual inspection with acetic acid and lugol (VIA / VILI). HR-HPV genotypes were characterized by multiplex real-time PCR after extraction of viral DNA. Results The mean age of women was 31.98 ± 10.09 years. The HR-HPV infection in the three regions ranged from 26.16% to 43.26% with 35.42% as overall prevalence in women. The most common HR-HPV genotypes in descending order were: HPV 56, 52, 66, 59, 39, 51, 18, 35. The prevalence of bivalent vaccine genotypes (HPV16 / 18) was 7.83% against 63.78% of genotypes not covered by HPV vaccine; 36.32% (170/468) of women had multiple concomitant HR-HPV infections. Conclusion this study showed significant regional variation and high prevalence of HR-HPV infection in women. The predominant genotypes differ from those covered by available vaccines in Burkina Faso. These results will help guide our health policies towards better prevention of cervical cancer. The diversity of oncogenic genotypes is sparking a large-scale study in the West African sub-region, particularly in cases of cancer and the introduction of the nonavalent vaccine which includes HPV 52 found among the predominant genotypes in this study.

No correlation between the variants of exostosin 2 gene and type 2 diabetes in Burkina Faso population

Recent genome-wide association studies and replication analyses have reported the association of variants of the exostosin- 2 gene (EXT2) and risk of type 2 diabetes (T2D) in some populations, but not in others. This study aimed to characterize the variants rs1113132, rs3740878 and rs11037909 of EXT2 and to determine the existence of a possible correlation with T2D in Burkina Faso. It is a case-control study undertaken in Burkina Faso in the city of Ouagadougou at the Hospital of Saint Camille of Ouagadougou from December 2014 to June 2015. It relates to 121 type 2 diabetes cases and 134 controls. The genotyping of these polymorphisms was done by real-time PCR using the allelic exclusion method with TaqMan probes. The minor allele frequencies (MAFs) was almost identical in diabetic and control subjects for the all three Single Nucleotide Polymorphisms (SNPs) with no statistical significance, p>0.05: rs1113132 (OR=0.89; p=0.82); rs11037909 (OR=0.89; p=0.74) and rs3740878 (OR=1.52; p=0.42). None of the three polymorphisms studied was associated with the risk of DT2. However, an association between the BMI, age and type 2 diabetes was noted. The variants of EXT2 would not be associated to the risk of T2D in the African black population of Burkina Faso.

Predictors of HIV stigma among health workers in the Cape Coast metropolis, Ghana

Stigma against people living with HIV (PLHIV) among health workers remains a barrier to the provision of needed care to HIV patients worldwide. We sought to investigate predictors of HIV stigma among health workers in Cape Coast, Ghana. This was a cross sectional study conducted in three hospitals from November 2016 to February 2017. The study made use of a pre-existing self-administered questionnaire. Multiple regression analysis and Pearson’s coefficient tests were performed to determine the relationship between the dependent variable, i.e. the stigmatized attitudes of health workers, and some independent variables, and to determine which of the independent variables predict stigma amongst health care workers. A total of 331 health workers of different categories participated. Respondents’ personal opinions on HIV, fears/worries of getting infected and category of staff {F(3,327)= 23.934 P<0.00}, R² = 0.180) significantly predicted their stigmatizing behaviour. Compared to other health workers, nurses had higher scores for stigmatizing behaviour. The study found evidence of discriminatory and stigmatizing behaviour towards PLHIV by health workers. Stigma reduction programmes aimed at health workers should be strengthened at all health facilities that provide care to PLHIV.

Identification of Plasmodium falciparum circumsporozoite protein-specific CD8+ T cell epitopes in a malaria exposed population

BACKGROUND

Sterile protection against malaria, most likely mediated by parasite-specific CD8+ T cells, has been achieved by attenuated sporozoite vaccination of animals as well as malaria-naïve and malaria-exposed subjects. The circumsporozoite protein (CSP)-based vaccine, RTS,S, shows low efficacy partly due to limited CD8+ T cell induction, and inclusion of such epitopes could improve RTS,S. This study assessed 8-10mer CSP peptide epitopes, present in predicted or previously positive P. falciparum 3D7 CSP 15mer overlapping peptide pools, for their ability to induce CD8+ T cell IFN-γ responses in natural malaria-exposed subjects.

METHODS

Cryopreserved PBMCs from nine HLA-typed subjects were stimulated with 23 8-10mer CSP peptides from the 3D7 parasite in IFN-ɣ ELISpot assays. The CD8+ T cell specificity of IFN-γ responses was confirmed in ELISpot assays using CD8+ T cell-enriched PBMC fractions after CD4+ cell depletion.

RESULTS

Ten of 23 peptide epitopes elicited responses in whole PBMCs from five of the nine subjects. Four peptides tested positive in CD8+ T cell-enriched PBMCs from two previously positive responders and one new subject. All four immunodominant peptides are restricted by globally common HLA supertypes (A02, A03, B07) and mapped to regions of the CSP antigen with limited or no reported polymorphism. Association of these peptide-specific responses with anti-malarial protection remains to be confirmed.

CONCLUSIONS

The relatively conserved nature of the four identified epitopes and their binding to globally common HLA supertypes makes them good candidates for inclusion in potential multi-epitope malaria vaccines.

Haematological Changes among HIV-Positive Persons on Antiretroviral Therapy at a Tertiary Hospital in Ghana

BACKGROUND

Haematological abnormalities such as anaemia, leucopenia, and thrombocytopenia are common complications of Human Immunodeficiency Virus (HIV) infection. Few researchers have studied the changes in HIV positive patients before and during antiretroviral therapy (ART) in Ghana. This study is aimed at determining the haematological profile of people living with HIV (PLHIV) at baseline and whilst on ART in a tertiary facility in Cape Coast, Ghana.

METHODS

This was an analytical cross-sectional study with a retrospective component among PLHIV assessing ART services at the Cape Coast Teaching Hospital, Ghana. Full blood count (FBC) test was performed on blood samples and the results were analyzed and categorized based on WHO definitions.

RESULTS

A total of 440 participants were included. The mean haemoglobin level (g/dL) for females at baseline, 6 months after ART and during this study were 9.6 (±1.8), 10.9 (±1.4) and 11.6 (±1.4); and 10.2 (±2.1), 11.6 (±1.7) and 11.8 (±1.6) for males. At baseline, the commonest type of anaemia for both females and males was microcytic hypochromic anaemia. The mean platelet count was 382 x 109/l at baseline but reduced to 298 x 109/L after 6 months on ART. Among male participants in this study, the main factor associated with being anaemic after 6 months on ART was the ART regimen with non-Zidovudine based regimen, having reduced odds of anaemia of OR 0.3 (95%CI 0.1 - 0.9), p-value of 0.04. Among females, having plasma viral load >1000 copies per ml was found to have increased odds of being anaemic (OR 1.4, 95%CI 0.7 - 2.6), though not statistically significant (P-value of 0.32).

CONCLUSION

The prevalence of anaemia, though improved on ART, was high among PLHIV. It is essential to ensure that full blood count of PLHIV in Ghana are done regularly, at all levels of service provision, with appropriate referral systems in place. The change to the current TDF based preferred first line ART regimen must also be enforced to reduce the potential risks associated with AZT use. This will improve outcome for PLHIV.