Open Access Original Research Article

Accelerated Scale up of Voluntary Medical Male Circumcision within the Military Health Services in Uganda: The Race towards 2020 HIV Epidemic Control

E. Lugada, G. Seruwagi, A. Nyanzi, S. Lawoko, D. Bwayo, V. Kasujja, B. Lutimba, T. Rwegyema, J. Akao, C. Wamundu, A. Musinguzi, E. Asiimwe, F. K. Kinuthia, B. Kikaire

International STD Research & Reviews, Page 1-15
DOI: 10.9734/ISRR/2021/v10i230127

Background: Scaling up Voluntary Medical Male Circumcision (VMMC) is a critical intervention in achieving HIV epidemic control by 2020. However, documentation of programmatic interventions to improve VMMC uptake among military populations, a population that is at high risk of HIV, is lacking. URC-Department of Defense HIV/AIDS Prevention Program (DHAPP) implemented a novel approach to accelerate VMMC uptake in the Ugandan military.  We describe trends in VMMC uptake and associated operational costs following the intervention. We also contrast between military and civilian facilities.

Program Description: We implemented monthly mobile VMMC services throughout the country targeting soldiers, their families and surrounding communities. Records gathered during implementation were used to describe the intervention. Quantitative methods were applied to compare VMMC post intervention rates with set targets and monthly VMMC trends country-wide between military and civilian facilities over a five months period. An operational VMMC service cost analysis was applied to determine per male circumcision unit cost, excluding cost of consumables.

Lessons Learnt: Command-driven mobilization, multiple stakeholder engagement, use of mobile VMMC teams and data-driven planning increased demand for and uptake of VMMC services among the military. By the first month of intervention, VMMC performance had surpassed set monthly targets of 1,474 by 1457 circumcisions, accounting for a 99% increase (n=2,931 circumcisions) from 31% to 62% uptake. Overall VMMC performance achieved within the military was 132% in excess of set targets (n=7,408) at six months. The scaled-up operational VMMC cost per circumcision performed dropped from $15 to $7, a 47% unit cost saving within six months. While a positive trend in VMMC uptake was observed in the military facilities, the opposite was exhibited in civilian facilities over the observation period.

Conclusion: It is feasible to rapidly scale up circumcision coverage in populations served by military health facilities through mobile short term episodic VMMC services which optimize volume and efficiency. Invoking command-led mobilization and multiple stakeholder involvement is critical in demand creation and overcoming the mobile nature of the military.

Open Access Original Research Article

Seroprevalence and Risk Factors Associated with Human Immunodeficiency Virus Infection Type 1 in Donors of the National Blood Transfusion Center of Libreville (Gabon)

Christian Mangala, Therese Nkoa, Denis Maulot-Bangola, Franck Vivien Vigan Codjo, Joseph Fokam

International STD Research & Reviews, Page 16-24
DOI: 10.9734/ISRR/2021/v10i230128

Background: Transmission of HIV through blood transfusion remains a public health problem, particularly in countries in Sub-Saharan Africa. However, no study has determined the epidemiological data regarding HIV-1 infection in Gabonese blood donors. The objective of this study is to assess the seroprevalence of HIV-1 and the risk factors associated with infection in donors from the National Blood Transfusion Center in Libreville (Gabon).

Methods: A cross-sectional study carried out from June to August 2020 in 3669 persons donating blood at the National Blood Transfusion Center (NBTC). The ELISA technique (Evolis®, BioRad), the chemiluminescence technique (Cobas® e601, Roche), and the SD Bioline® HIV 1/2 test (Standard Diagnostics. Inc) were used for the detection of anti-HIV-1/2 antibodies and P24 antigen in donor plasma. Data were analyzed using SPSS software version 21.0, with p˂.05 considered statistically significant. 

Results: The seropositivity rate HIV-1 was 0.8% (30/3669) (95% CI: 0.5; 1.1). The study was composed of 79.4% men and 20.6% women. The most representative age group was of 25-34 years with 54.5%. The seropositivity of men, women, and unrelated voluntary donors was 0.7%, 1.2%, and 1.0%, respectively. The risk factors such as the first blood donation (Adjusted Odds Ratio (AOR) = 0.1 [0.0 ;0.4], P= .002), multiple sexual partners (AOR = 6.2 [2.2;17.2], P= .001), primary educational level (AOR = 10.1 [1.4;75], P = .024), and dental care (AOR = 3.6 [1.2;11], P = .024) were significantly associated with HIV infection. About 0.14% of the patients had co-infection.

Conclusion: In the Gabonese context, about one out of a hundred blood donors are HIV-infected. These carriers of HIV infection in the blood banks are mainly new donors with multiple sexual partners, limited education, and poor dental care.

Open Access Original Research Article

Awareness and Knowledge of HIV Transmission and Prevention among Military Personnel in Abuja, Nigeria

Olajide A. Adekunle, David A. Adeyemi

International STD Research & Reviews, Page 37-48
DOI: 10.9734/ISRR/2021/v10i230130

Aims: To assess the level of knowledge of HIV transmission and prevention and identify factors influencing the awareness of HIV transmission and prevention among military personnel in Nigeria.

Study design: A cross-sectional study.

Place and duration of study: The Nigerian Defense Headquarters, Abuja, Nigeria.

Methodology: Using the stratified probability sampling technique, military personnel between the age of 18 and 55 years, were recruited based on arm of service with a percentage distribution of 60:20:20 (Army, Navy, and Air Force respectively). The sample size(n) was 384 and the adjusted sample size was 427 respondents. The tool for data collection was a semi-structured self-administered questionnaire. This instrument, divided into 3 sections, was designed to obtain information on socio-demographics (sex, age, ethnic background, education level as the highest level of education attainment, experience in the military; the arm of service, rank, length of service, gender and number of sexual partners, knowledge of HIV prevention, and perception of risk of HIV transmission. Data were analyzed using descriptive statistics, Chi-square tests, and logistic regression at p<0.05.

Results: While 98.5% of respondents have ever heard of HIV, 80.3% claimed to have seen or heard information about HIV, with media (85.9%) been the major source of this information. Out of the 391 respondents, 174 (44.5%) and 217 (55.5%) military personnel had inadequate and adequate knowledge of HIV transmission respectively while 80.8% and 19.2% of these respondents had inadequate and adequate knowledge of HIV prevention, respectively.

Conclusions: While there was no significant difference in the proportion of those military men that had adequate and inadequate knowledge of HIV transmission, there was a clear and significant difference in the proportion of military men with adequate and inadequate prevention knowledge. Age, education, marital status, and service arm are predictive factors that could influence knowledge of HIV transmission and prevention.

Open Access Original Research Article

Seroprevalence of Chlamydia trachomatis IgA, IgM and IgG Antibodies and Associated Risk Factors among Sexually Active Individuals at Saint Vincent de Paul Hospital in Dschang, West Cameroon

Thomas Djifack Tadongfack, Irina Lydia Sudeu Nitcheu, Rodrigue Ngoune, Vanessa Rosine Nkouayep, Aline Camerl Nzeffouo Selabi, Viany Nankeng Manhafo, Blanche Lydie Bebe Moussango Enangue, Romeo Hervis Tedjieu, Carine Tsoplifak Kenfack, François Roger Nguepy Keubo, Monique Odette Kamtchueng, Michael Junior Piameu Chadou

International STD Research & Reviews, Page 72-80
DOI: 10.9734/ISRR/2021/v10i330133

Background: Chlamydia trachomatis is the most common cause of sexually transmitted infections worldwide. Infections caused by this pathogen are usually symptomatic in men and asymptomatic in about 2/3 of women resulting in a variety of clinical complications.

Aim: To determine the seroprevalence of immunological markers and the risk factors associated with the seropositivity to C. trachomatis infection in sexually active individuals visiting the Saint Vincent de Paul Hospital in Dschang, West region Cameroon

Study Design: This was an analytical cross-sectional study conducted between July and September 2020 at Saint Vincent de Paul Hospital in Dschang, Cameroon.

Methods: A total of 154 participants were recruited during the data collection period. An indirect ELISA method was used to analyse participant’s serum samples. Risk factors were assessed through univariate and multivariate logistic regression using SPSS 25.

Results: The seroprevalence of C. trachomatis infection was 38.3% (95%CI: 30.6 - 46.0). Only 39.6% (95%CI: 31.6 - 47.3) of the study population had never been in contact with the bacterium. The reinfection rate among participants was 8.4% (95%CI: 4.0 - 12.8). Results revealed that being Male is a protective factor against the infection [aOR: 0.12; 95% CI: 0.03 - 0.56; P .007]. The non-use of condom [aOR: 21.58; 95% CI: 3.53 – 132.06; P .001] and having encountered three or more sexual partners [aOR: 9.90; 95%CI: 1.07 – 91.60; P .043] were the significant predictors of Chlamydia seropositivity.

Conclusion: The implementation of proactive strategies to curb down the spread of the infection is necessary in this locality. This can be done by providing NAATs to as many health facilities as possible, educating the population and standardizing treatment protocols.

Open Access Review Article

Genetic Diversity of HIV-1 and Transfusion Safety : Systematic Review and Concepts Analysis

Christian Mangala, Joseph Fokam, Denis Maulot Bangola, Thérèse Nkoa

International STD Research & Reviews, Page 60-71
DOI: 10.9734/ISRR/2021/v10i330132

Background: The genetic diversity of human immunodeficiency virus type 1 (HIV-1) is a real problem facing blood banks. This genetic diversity has a negative impact on diagnostic strategies within the transfusion chain by weakening the security of the donation. The objective of this study is to clarify the concepts emanating from the research project entitled : «Genetic diversity of HIV-1 and its effect on the residual risk in blood transfusion in Gabon».

Methods: This study was the result of a systematic review and a conceptual analysis of several studies that were systematically searched for in databases (PubMed, Google Scholar, and Medline), and whose object was focused on the genetic diversity of HIV -1 and its impact on transfusion safety. Indeed, the information relating to the concepts coming from the full articles was used. These were obtained by reading the most relevant articles. All relevant studies reporting data on HIV-1 genetic diversity and blood safety published in English between January 2012 and December 2020 have been identified for context. The method of conceptual analysis of « Walker and Avant (2005) » was used to clarify the different concepts of our study. The correlation test was used to show the relationship between the concepts.

Results: This systematic review and conceptual analysis study made it possible to determine the variables and to clarify the different concepts (HIV-1, Genetic diversity, Blood transfusion, Residual risk) essential for carrying out our research project entitled: "Genetic diversity of HIV-1 and its effect on the residual risk in blood transfusion". This model made it possible to show the effect of the genetic diversity of HIV-1 on the residual risk in blood transfusion using as model variables : viral load and serological markers (Antibodies and P24 Antigen). Knowledge of molecular strains (URF, CRF, subtypes) during this study made it possible to better identify the molecular strains most involved in the residual risk. Despite its complexity, this conceptual analysis contributed enormously to the understanding of the activities and the quantifiable and non-quantifiable components that participated in our study. Statistical analysis showed that the HIV-1 concept was significantly related to the other three concepts with P = 0.001. Likewise for the concept of genetic diversity was also significantly linked to the two other concepts with P = 0.003.

Conclusion: The genetic diversity of HIV-1 in the blood transfusion environment contributes significantly to the transmission of HIV from donor to recipient. The mastery of these molecular strains is essential for the various blood banks to ensure a safe blood supply.

Open Access Systematic Review Article

Residual Risk of HIV in African Transfusional Setting: Systematic Review and Meta-Analysis

Christian Mangala, Joseph Fokam, Denis Maulot Bangola, Mireille Moundanga, Thérèse Nkoa

International STD Research & Reviews, Page 25-36
DOI: 10.9734/ISRR/2021/v10i230129

Context: The residual risk of HIV transmission is still a real problem into the transfusional settings of limited resources countries. Blood banks of African countries confront the risk of transmitting HIV to recipients. The objective of this study is to estimate the residual risk of HIV in African transfusion settings and to compare this residual risk with that of other countries in the South (developping countries).

Methods: This study resulted of a systematic review with meta-analysis of data from several comprehensive studies carried out between 2011 and 2017 whose purpose was focused on the residual risk of HIV transmission through blood transfusion. The studies on the residual risk were systematically searched in the different databases (PubMed, Medline and Google Scholar). The eligibility criteria were based on published studies which had blood donors as participants, looking at the residual risk of HIV in developing countries and the technique was based on the search for antibodies-P24 Antigen of the HIV or on nucleic acid (RNA) testing. Studies carried out before 2011 and after 2017 were excluded. Studies in rich countries were also excluded. The Cochrane tool was used to assess the risk of bias.

Results: A total of 327,278 seronegative donors (for 12 eligible studies) were admitted for this study, i.e. 75.5% of men and 24.5% of women. The median age of all donors was 30.4 years. For studies carried out in the Africa zone (Burkina Faso, Ivory Coast, Nigeria, Democratic Republic of Congo, Tanzania and Zimbabwe), 327,278 donors were initially seronegative, of which 626 were found to be positive. Indeed, out of 742 incident cases in this study from African countries and other countries of the South, 84.4% of positive donors came from African studies and 15.6% of positive donors came from other countries of the South in this study. The residual risk (RR) of HIV in Africa has been estimated at 13 per 1,000,000 donations, with an incidence rate (IR) of 21.5 per 100,000 person-years. And in the other countries of the South (Brazil, Croatia, India, Iran, Malaysia and Pakistan), the RR of HIV has been estimated at 0.6 per 1,000,000 donations, or an incidence rate of 1.1 per 100,000 person-years.

Conclusion: The residual risk of HIV in the transfusion environment is still high and still persists in blood banks in southern countries in general and in Africa in particular.

Open Access Systematic Review Article

Residual Risk of HBV in African Blood Banks: Systematic Review and Meta-Analysis

D. Maulot-Bangola, C. Mangala, J. Fokam, T. Nkoa

International STD Research & Reviews, Page 49-59
DOI: 10.9734/ISRR/2021/v10i230131

Background: Blood transfusions carry the risk of transmitting blood-borne infections. A precise estimate of the transfusion risk of viral infection will help to determine the effect of new and current safety measures in sub-Saharan Africa. This study proposes to estimate the residual risk of HBV in blood banks in African countries and to compare them to other countries in the South.

Methods: The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. PubMed, Medline, Google Scholar and Zotero were accessed. The eligibility criteria were based on published studies that had blood donors as participants, looking at the residual risk of HBV in developing countries and the technique was based on the search for HBsAg or Hepatitis B Core Antibodies or Nucleic Acid (DNA) testing. The Cochrane tool was used to assess the risk of bias.

Results: Twelve articles comprising 71,207 allogeneic and hepatitis B surface antigen (HBsAg)-negative blood donations were included in the meta-analysis. A total of 4912 HBsAg negative African donation including (51.0%) new donors and (49.0%) from regular donors. 80.8% of them were male and the median age was 28 years. Of 1225 HBV strains (47% and 53.4% incident cases) were frequencies in sub-Saharan Africa and in other Southern countries respectively. Considering the twelve participating blood centres as a whole, the incidence rate of new infections was high (4905.1) in sub-Saharan Africa than (869.7) in other Southern countries per 100,000 person-years. In contrast, the estimated residual risk in sub-Saharan Africa (5913 in 1 million donations) was five times higher than estimated in other Southern countries (1048.4 in 1 million donations).

Conclusion: Blood donations with HBsAg undetectable by routine testing and low levels of HBV DNA are extremely common in sub-Saharan Africa, at a rate of 5913 per 1 million donations. Given that at least several of these samples could reflect contamination or a false negative result, elimination of infection by a test limited to HBsAg does not prevent transmission.