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1. High prevalence and poor linkage to care of transfusion‐transmitted infections among blood donors in Dar‐es‐Salaam, Tanzania

Author

Mohamed, Zameer, Kim, Jin, Magesa, Alex, Kasubi, Mabula, Feldman, Sarah, Chevaliez, Stéphane, Mwakale, Promise, Taylor-Robinson, Simon, Thursz, Mark, Shimakawa, Yusuke, Rwegasha, John, Lemoine, Maud, Imperial College London, Muhimbili National Hospital [Dar es Salaam, Tanzanie] (MNH), Epidémiologie des Maladies Emergentes - Emerging Diseases Epidemiology, Pasteur-Cnam Risques infectieux et émergents (PACRI), Institut Pasteur [Paris]-Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-Institut Pasteur [Paris]-Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM), Hôpital Henri Mondor, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Muhimbili University of Health and Allied Sciences, This work was supported by the Wellcome Trust Institutional Strategic Support Fund (ISSF)., Institut Pasteur [Paris] (IP)-Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-Institut Pasteur [Paris] (IP)-Conservatoire National des Arts et Métiers [CNAM] (CNAM), and Institut Pasteur [Paris]-Conservatoire National des Arts et Métiers [CNAM] (CNAM)-Institut Pasteur [Paris]-Conservatoire National des Arts et Métiers [CNAM] (CNAM)

Subjects
Adult, Male, sub-Saharan Africa, Adolescent, Blood Donors, HIV Infections, Tanzania, Young Adult, transfusion‐transmitted infections (TTIs), Risk Factors, Prevalence, Humans, Mass Screening, Blood Transfusion, Family, Disease Notification, Retrospective Studies, linkage to care, Transfusion Reaction, Original Articles, Middle Aged, transfusion-transmitted infections (TTIs), Hepatitis B, Hepatitis C, blood donation, Female, Original Article, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, sub‐Saharan Africa
Abstract

International audience; Blood transfusion is one of the most commonly relied upon therapies in sub-Saharan Africa. Existing safeguards recommended include systematic screening for transfusion-transmitted infections and restricted voluntary nonremunerated blood donor selection. We report the transfusion-transmitted infection screening and notification practice at a large urban blood transfusion centre in Dar-es-Salaam, Tanzania. Between October 2016 and March 2017 anonymized records of all donors registered at the blood transfusion unit were accessed to retrospectively note demographic information, donor status, first-time status, transfusion-transmitted infection result and notification. 6402 consecutive donors were screened for transfusion-transmitted infections; the majority were family/replacement blood donors (88.0%) and male (83.8%). Overall transfusion-transmitted infections prevalence was 8.4% (95% CI 7.8-9.1), with hepatitis B being the most prevalent infection (4.1% (95% CI 3.6-4.6)). Transfusion-transmitted infections were more common in family/replacement blood donors (9.0% (95% CI 8.3-9.8)) as compared to voluntary nonremunerated blood donor (4.1% (95% CI 2.8-5.7)). A minority of infected-donors were notified of a positive result (8.5% (95% CI 6.3-11.2)). Although transfusion-transmitted infections are more prevalent among family/replacement blood donors, overall risk of transfusion-transmitted infections across all groups is considerable. In addition, existing efforts to notify donors of a positive transfusion-transmitted infection are poor. Future policies must focus on improving linkage to care for newly diagnosed patients with transfusion-transmitted infections.

Published
2019

2. The hepatitis C cascade of care in people who inject drugs in Dar es Salaam, Tanzania

Author

Mohamed, Zameer, Rwegasha, John, Kim, Jin, Shimakawa, Yusuke, Poiteau, Lila, Chevaliez, Stéphane, Bhagani, Sanjay, Taylor-Robinson, Simon, Thursz, Mark, Mbwambo, Jessie, Lemoine, Maud, Wellcome Trust, Imperial College London, Muhimbili National Hospital [Dar es Salaam, Tanzanie] (MNH), Epidémiologie des Maladies Emergentes - Emerging Diseases Epidemiology, Pasteur-Cnam Risques infectieux et émergents (PACRI), Institut Pasteur [Paris]-Conservatoire National des Arts et Métiers [CNAM] (CNAM)-Institut Pasteur [Paris]-Conservatoire National des Arts et Métiers [CNAM] (CNAM), Hôpital Henri Mondor, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Royal Free Hospital [London, UK], This study was supported by the Wellcome Trust Global Centre and the United Kingdom National Institute for Health Research (NIHR) Biomedical Facility at Imperial College London (G606101)., Institut Pasteur [Paris] (IP)-Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-Institut Pasteur [Paris] (IP)-Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM), Institut Pasteur [Paris]-Conservatoire National des Arts et Métiers [CNAM] (CNAM), and HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-Institut Pasteur [Paris]-Conservatoire National des Arts et Métiers [CNAM] (CNAM)

Subjects
Male, hepatitis C virus, people who inject drugs, Hepacivirus, Tanzania, DISEASE, MESH: Genotype, Sub‐Saharan Africa, 1108 Medical Microbiology, Mass Screening, MESH: Hepacivirus, PLATELET RATIO, Substance Abuse, Intravenous, Sub-Saharan Africa, TRANSIENT ELASTOGRAPHY, Disease Management, Continuity of Patient Care, Viral Load, MESH: Hepatitis C, Chronic, PREVALENCE, Infectious Diseases, INFECTIONS, HCV, Female, Original Article, MESH: Viral Load, Life Sciences & Biomedicine, USERS, Adult, Genotype, MESH: Disease Management, HARM REDUCTION, MESH: Tanzania, Virology, parasitic diseases, cascade of care, Humans, MESH: Mass Screening, MESH: Humans, Science & Technology, Gastroenterology & Hepatology, fungi, fibrosis, HIV, MESH: Adult, 1103 Clinical Sciences, Original Articles, LIVER FIBROSIS ASSESSMENT, Hepatitis C, Chronic, MESH: Male, MESH: Continuity of Patient Care, MESH: Substance Abuse, Intravenous, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Female
Abstract

International audience; The World Health Organisation has recently called for hepatitis C virus (HCV) elimination and has identified people who inject drugs (PWID) as a key population to scale-up screening and linkage to care. This study reports the cascade of care for HCV in PWID attending the largest opioid substitution treatment (OST) clinic in Dar-es-Salaam, Tanzania. Between February 2011 and March 2016, HCV serology for all PWID registered at the Muhimbili National Hospital OST clinic, Dar-es-Salaam were obtained from records. In 2015, consecutive HCV-seropositive PWID were invited to undergo a clinical evaluation including epidemiological questionnaire, liver stiffness measurement (Fibroscan) and virological analysis (HCV RNA viral load and genotyping). During the study period, 1350 persons registered at the OST clinic: all had a HCV serology including 409 (30%) positive results. Among the HCV-seropositive individuals, 207 (51%) were active attenders and 153 (37%) were enrolled for clinical assessment: 141 (92%) were male, median age: 38 years (IQR 34-41), and 65 (44%) were co-infected with HIV; 116 patients (76%) had detectable HCV RNA, with genotypes 1a (68%) and 4a (32%); 21 (17%) had clinically significant fibrosis (≥F2) and 6 (5%) had cirrhosis (F4). None were offered HCV treatment. Chronic hepatitis C among PWID enrolled in the OST centre in Dar-es-Salaam is frequent, but its continuum of care is insufficient; integration of HCV diagnosis and treatment should form a part of OST intervention in PWID in Tanzania.

Published
2018

3. Clinical utility of HCV core antigen detection and quantification using serum samples and dried blood spots in people who inject drugs in Dar-es-Salaam, Tanzania

Author

Mohamed, Zameer, Mbwambo, Jessie, Shimakawa, Yusuke, Poiteau, Lila, Chevaliez, Stéphane, Pawlotsky, Jean-Michel, Rwegasha, John, Bhagani, Sanjay, Taylor-Robinson, Simon, Makani, Julie, Thursz, Mark, Lemoine, Maud, Imperial College London, Muhimbili National Hospital [Dar es Salaam, Tanzanie] (MNH), Muhimbili University of Health and Allied Sciences, Epidémiologie des Maladies Emergentes - Emerging Diseases Epidemiology, Pasteur-Cnam Risques infectieux et émergents (PACRI), Institut Pasteur [Paris]-Conservatoire National des Arts et Métiers [CNAM] (CNAM)-Institut Pasteur [Paris]-Conservatoire National des Arts et Métiers [CNAM] (CNAM), Service d'hépato-gastro-entérologie [APHP Henri Mondor], Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Hôpital Henri Mondor-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre National de Référence Virus des hépatites B, C et Delta, Institut National de la Transfusion Sanguine [Paris] (INTS)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Royal Free Hospital [London, UK], This study formed part of a Wellcome Trust Institutional Strategic Support Fund Global Health Fellow grant awarded to ZM. All authors are grateful to the Wellcome Trust Global Centre and the UK National Institute for Health Research (NIHR) Biomedical Facility at Imperial College London for funding and infrastructure support., The authors thank the participants and the team working at the Methadone clinic at Muhimbili National Hospital, Wellcome Trust, Institut Pasteur [Paris]-Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-Institut Pasteur [Paris]-Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Institut Pasteur [Paris] (IP)-Conservatoire National des Arts et Métiers [CNAM] (CNAM), and HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-Institut Pasteur [Paris] (IP)-Conservatoire National des Arts et Métiers [CNAM] (CNAM)

Subjects
Male, MESH: Hepatitis C / blood, people who inject drugs, HEPATITIS-C, Hepacivirus, Tanzania, MESH: Genotype, MESH: Phylogeny, HCV core antigen, MESH: Hepatitis C Antigens / analysis, Phylogeny, MESH: Hepatitis C Antigens / metabolism, Viral Core Proteins, virus diseases, Viral Load, Hepatitis C, dried blood spot, PREVALENCE, Infectious Diseases, MESH: Hepatitis C / diagnosis, RNA, Viral, Female, MESH: Viral Load, Life Sciences & Biomedicine, USERS, MESH: Dried Blood Spot Testing / methods, MESH: Viral Core Proteins / metabolism, MESH: Hepacivirus / genetics, Research Article, Adult, Genotype, Immunology, Sensitivity and Specificity, Article, MESH: Hepacivirus / physiology, MESH: Tanzania, Humans, MESH: Viral Core Proteins / genetics, Science & Technology, MESH: Humans, BARRIERS, MESH: Hepatitis C Antigens / genetics, screening, HIV, MESH: Adult, MESH: Hepacivirus / isolation & purification, 1199 Other Medical And Health Sciences, MESH: Male, MESH: Sensitivity and Specificity, MESH: Hepatitis C / virology, Africa, MESH: Viral Core Proteins / analysis, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Dried Blood Spot Testing, MESH: RNA, Viral / genetics, Hepatitis C Antigens, C VIRUS-INFECTION, POINT-OF-CARE, MESH: Female, hepatitis C virus (HCV)
Abstract

International audience; Introduction: A lack of access to hepatitis C virus (HCV) diagnostics is a significant barrier to achieving the World Health Organization 2030 global elimination goal. HCV core antigen (HCVcAg) quantification and dried blood spot (DBS) are appealing alternatives to conventional HCV serology and nucleic acid testing (NAT) for resource-constraint settings, particularly in difficult-to-reach populations. We assessed the accuracy of serum and DBS HCVcAg testing in people who inject drugs in Tanzania using HCV NAT as a reference.Method: Between May and July 2015, consecutive HCV-seropositive patients enrolled in the local opioid substitution treatment centre were invited to participate in the study. All had HCV RNA detection (Roche Molecular Systems, Pleasanton, CA, USA), genotyping (NS5B gene phylogenetic analysis) and HCVcAg on blood samples and DBS (Architect assay; Abbott Diagnostics, Chicago, IL, USA).Results: Out of 153 HCV-seropositive individuals, 65 (42.5%) and 15 (9.8%) were co-infected with HIV (41 (63%) were on anti-retroviral therapy (ARVs)) and hepatitis B respectively. In total, 116 were viraemic, median viral load of 5.7 (Interquartile range (IQR); 4.0-6.3) log iU/ml (75 (68.2%) were genotype 1a, 35 (31.8%) genotype 4a). The median alanine transaminase (ALT) (iU/l), aspartate transaminase (AST) (iU/l) and gamma-glutamyl transferase (GGT) (iU/l) were 35 (IQR; 23-51), 46 (32-57) and 69 (35-151) respectively. For the quantification of HCV RNA, serum HCVcAg had a sensitivity at 99.1% and a specificity at 94.1%, with an area under the receiver operating curve (AUROC) at 0.99 (95% CI 0.98-1.00). DBS HCVcAg had a sensitivity of 76.1% and a specificity of 97.3%, with an AUROC of 0.87 (95% CI 0.83-0.92). HCVcAg performance did not differ by HIV co-infection or HCV genotype. Conclusions Our study suggests that HCVcAg testing in serum is an excellent alternative to HCV polymerase chain reaction in Africa. Although HCVcAg detection and quantification in DBS has a reduced sensitivity, its specificity and accuracy are good and it could therefore be used for scaling up HCV testing and care in resource-limited African settings.

Published
2017

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