Search

Introduction: The retention in care of patients undergoing antiretroviral therapy (ART) is a cornerstone for preventing AIDS-associated morbidity and mortality, as well as further transmission of HIV. Adherence to ART poses particular challenges in conflict-affected settings like the Central African Republic (CAR). The study objective was to estimate the rate of lost-to-follow-up (LTFU) and determine factors associated with LTFU among patients living with HIV under ART in CAR., Methods: A retrospective cohort analysis was conducted using data from patients being managed at 42 representative ART dispensing sites (i.e. management of ≥200 patients) in the seven health regions of CAR which started ART between January 2019 to September 2021 and followed up to December 2021. The outcome of LTFU was defined as a failure of a patient to attend a scheduled ART refill appointment for at least 90 days from the last appointment. Patients were censored at the first LTFU event., Results: A total of 6844 patients enrolled in ART care were included in the analysis, of whom 67.5% were females. The mean age (standard deviation) was 35.3 years (10.5). Forty-two per cent (n = 2874/6844) had an LTFU event during the follow-up period. However, 23.2% (n = 666/2874) returned to care after LTFU. Overall retention in antiretroviral care at 12 months was 64.2% (CI 63.0-65.5), which ranged from 76.1% in the capital to 48.2% in the inner country region. Risk factors related to LTFU were being male (adjusted hazard ratio [aHR] 1.33; CI 1.1-1.5), age < 25 (aHR 1.46; CI 1.1-1.9), living in regions outside the capital (aHR 1.83; CI 1.6-2.3) and undernutrition (aHR 1.13; CI 1.0-1.3)., Conclusions: Retention to care in CAR is suboptimal, especially in the inner country. Our results underline the difficulties involved in retaining patients in ART in complex settings, the interplay between poor retention, social unrest, stigma, food insecurity and HIV epidemic control, and the need for tailored programming and interventions like differentiated treatment strategies and complementary food provision., (© 2024 The Author(s). Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of International AIDS Society.)

Human Papillomavirus (HPV)-35 accounts for up 10% of cervical cancers in Sub-Saharan Africa. We herein assessed the genetic diversity of HPV35 in HIV-negative women from Chad (identified as #CHAD) and HIV-infected men having sex with men (MSM) in the Central African Republic (CAR), identified as #CAR. Ten HPV35 DNA from self-collected genital secretions (n = 5) and anal margin samples (n = 5) obtained from women and MSM, respectively, were sequenced using the ABI PRISM® BigDye Sequencing technology. All but one HPV35 strains belonged to the A2 sublineage, and only #CAR5 belonged to A1. HPV35 from #CAR had higher L1 variability compared to #CHAD (mean number of mutations: 16 versus 6). L1 of #CAR5 showed a significant variability (2.29%), suggesting a possible intra-type divergence from HPV35H. Three (BC, DE, and EF) out of the 5 capsid loops domains remained totally conserved, while FG- and HI- loops of #CAR exhibited amino acid variations. #CAR5 also showed the highest LCR variability with a 16bp insertion at binding sites of the YY1. HPV35 from #CHAD exhibited the highest variability in E2 gene (P<0.05). E6 and E7 oncoproteins remained well conserved. There is a relative maintenance of a well conserved HPV35 A2 sublineage within heterosexual women in Chad and MSM with HIV in the Central African Republic., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Mboumba Bouassa et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

To determine the rate of attrition of patients in the antiretroviral treatment program in Bangui and factors associated with this loss to follow-up. This was a retrospective descriptive, analytical cohort study from January 1, 2014 to March 31, 2017 in two large outpatient treatment centers in Bangui. Data were entered in and analyzed with Epi info version 3.5.4 software. Survival probability was calculated by a Kaplan Meier curve. The Cox model and logistic regression were used to determine the association between attrition and risk factors. A total of 292 patients were registered. Attrition rates at 6, 12, and 24 months were 14%, 20% and 31%, respectively. Factors associated with attrition were patients' age (young), living alone (compared to living with a partner), distance between place of residence and treatment center, presence of opportunistic infections, low hemoglobin levels, and lack of therapeutic education. This study identified the main risk factors for patients leaving the care system. Innovative strategies including differentiated approaches must be implemented to improve quality of screening, early start of treatment, and geographical access to care. Particular emphasis should be placed on therapeutic education to train and educate patients about their illness and how to manage it.

Objective: To describe the epidemiological and clinical profile of intestinal parasites in children in rural Central African Republic., Patients and Methods: We conducted a multicenter cross-sectional study in Central African Republic rural areas. Children seen as outpatients regardless of the reason for consultation were included in the study after parental consent. Each stool sample sent to the laboratory in a plastic pot was subjected to a direct co-examination with physiological water., Results: A total of 102 children were included in the study, of whom 53 were boys (51.96%), the median age was 4 years (3 months; 15 years old). They had a primary level of education in 31.37% of cases, 76.47% came from Health Region 1. Drilling was the source of drinking water in 61.76% of cases and the backwater was used for bathing by 26.47% of children. Abdominal pain was observed in 55 children (53.92%). The prevalence of intestinal parasitosis was 88.23%. Of 122 identified parasites, 96 were helminths (78.69%) and 26 were protozoa (21.31%). Of the three protozoan species isolated, Entamoeba histolytica was found in 15 cases (14.70%). The most common helminthiasis was Ascaris lumbricoides (40.19%). The frequency of parasitic infection was 92% in children aged from 5 to 9 years. Mono-parasitism was observed in 52.94% versus 33.33% for poly-parasitism., Conclusion: Intestinal parasitosis is a public health problem in Central African Republic rural areas. Improving access to drinking water for populations could reduce the magnitude of these diseases., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

to understand the attitude of men who have sex with men (MSM) towards the use of condoms, to identify potential barriers to their use, environmental factors that facilitate or on the contrary, prevent this use, beliefs about contracting HIV, and priority needs of MSM for general prevention of sexually transmitted infections (STI). Individual interviews conducted in private with 20 MSM. In general, MSM recognize that condoms protect against STI as well as preventing unwanted pregnancies (although this is not our purpose here). The disadvantages of condom use that they reported included the potential for them to break and their reduction of pleasure. Barriers to their use include the belief that the partner is not HIV-positive, the shame of buying condoms, inability to wear them, and lack of financial resources, as well as social norms and false beliefs. MSM are aware of the positive role of condoms against STIs, including HIV. They perceive the dangerousness of the HIV, but do not feel vulnerable to this disease. They have identified obstacles to condom use, and their lists of perceived needs suggest solutions to them. Implementing these solutions in interventions should improve the frequency of condom use.

Hepatocellular carcinoma (HCC) is still a major killing malignancy in sub-Saharan Africa. Lifelong intoxication with aflatoxin B1 is considered as one of the primary causes of this situation. The role of aflatoxin in HCC from a given population is commonly estimated through the prevalence of R249S mutation of TP53, a hallmark for previous exposure to the mycotoxin. However, the role of AFB1 is barely known in large part of Africa. We conducted a survey on circulating cell-free DNA from 149 patients with HCC and 213 control subjects with and without liver diseases from Cameroon and Central African Republic using droplet digital PCR technique. We observed a mutation prevalence of 24.8% (n = 37/149) in patients with tumor and 5.6% (n = 12/213) in controls (P = 2.2E-07). Patients with mutations usually displayed significantly increased circulating alpha-fetoprotein (AFP) values, high hepatitis B virus (HBV) DNA loads as well as worsened values of blood cells count. Interestingly, the fraction of droplets positive for R249S was significantly larger in patients with liver cancer (15.3 ± 3.7%) than in controls (0.5 ± 0.3%, P = 7.1E-04). Our survey indicates that AFB1 is instrumental for HCC development in Middle Africa and that droplet digital PCR might be used in the region both to diagnose HCC and to conduct public health surveys on populations at risk of chronic aflatoxin intoxication.

Background: High-risk (HR) human papillomavirus (HPV) infection remains a great concern in relation to African men who have sex with men (MSM), especially those infected with HIV. The prevalence of HR-HPV and associated risk factors was estimated in a cross-sectional observational study covering MSM living in Bangui, Central African Republic., Methods: MSM receiving care at the Centre National de Référence des Infections Sexuellement Transmissibles et de la Thérapie Antirétrovirale, Bangui, were included. HIV serostatus and socio-demographic and behavioral characteristics were collected. HPV DNA was detected and genotyped on anal swabs using Anyplex™ II HPV28 test (Seegene, South Korea), and HSV DNA by in-house real-time PCR. Logistic regression analyses were used to determine risk factors associated with HPV outcomes., Results: 42 MSM (mean age, 23.2 years; range, 14-39) including 69.1% HIV-1-positive and 30.9% HIV-negative were prospectively enrolled. The prevalence of anal HPV was 69.1%, including 82.7% of HR-HPV which were multiple in 52.0%. The most prevalent genotypes were HPV-35, HPV-58, HPV-59 and HPV-31. While, HPV-16 and HPV-18 were present in a minority of samples. Multiple HR-HPV infection was more frequent in HIV-positive MSM (41.4%) with 2.7 genotypes per anal samples than in HIV-negative (7.7%) with 1.5 genotypes per anal samples. HPV types included in the prophylactic Gardasil-9® vaccine were detected in 68.9% of specimens and HPV-58 was the most frequently detected. MSM infected by HPV-16 and HPV-18 were all infected by HIV-1. Few anal swabs (11.9%) contained HSV-2 DNA without relationship with HPV detection. Condomless receptive anal intercourse was the main risk factor to being infected with any type of HPV and condomless insertive anal intercourse was significantly less associated with HPV contamination than receptive anal intercourse (Odd ratio = 0.02)., Conclusion: MSM in Bangui are at-risk of HIV and HR-HPV anal infections. The unusual distribution of HPV-35 as predominant HPV suggests possible geographic specificities in the molecular epidemiology of HR-HPV in sub-Saharan Africa. Scaling up prevention strategies against HPV infection and related cancers adapted for MSM in Africa should be prioritized. Innovative interventions should be conceived for the MSM population living in Bangui., Competing Interests: The authors have declared that no competing interests exist.

Introduction: HIV in sub-Saharan Africa remains a great concern in men who have sex with men (MSM). Intervention on MSM is a key strategy to control the burden of HIV among this population. Herein we assessed the effect of 2 years of HIV testing and counseling on risk-tacking and HIV and STI incidences among MSM living in Bangui in the Central African Republic., Methods: The incidences of HIV, syphilis and hepatitis B and the sexual behavior characteristics were assessed at inclusion and after 2 years of follow up in the prospective MSM cohort., Results: 99 MSM were included and followed up during 2 years. The mean age of study MSM was 24 years (range, 14-39); among those, the majority was single (84.8%) and unemployed (33.3%) or students (23.9%). The majority (up to 80%) were living in only 4 (out of 10) neighboring district of Bangui. Insertive anal intercourse showed significant decrease from 54% at inclusion to 46% after 2 years of follow up (P < 0.001). In contrast, we observed slight increase in receptive anal intercourse (60% versus 66%) and oral sex (70% versus 74%), but the difference did not reach statistical significance. Finally, the prevalences of HIV, syphilis and hepatitis B increased significantly from 29% to 41%, 12% to 21% and 14% to 23%, respectively., Conclusion: These observations indicate that medical care and counseling on MSM does not provide significant changes in risk-taking, whereas the incidences of HIV, syphilis and hepatitis B remained high. Innovative interventions should be conceived for the MSM population living in Bangui., Competing Interests: The authors declare no competing interests.

An outbreak of monkeypox occurred in the district of Bangassou in 2015. The monkeypox is a re-emerging zoonosis of viral origin highly contagious. It is an eruptive fever which evolves in an epidemic manner. An investigation was held December 10, 2015, to February 10, 2016 in the focus of the epidemic. Its objective was to describe the epidemic according to the time, places and people and to determine the incidence and lethality of the disease. This was a descriptive study. The data collection was made by interview and using a linear plug composed of several sections. All suspected cases were taken into account. The interview was done with patients or the parents of sick children. The blood and the contents of the lesions were collected and sent to the laboratory of the Institut Pasteur in Bangui for confirmation. Our data were analyzed with Epi info7. In total 12 patients had been registered including 9 secondary cases. Patients aged 31 to 40 years and less than 10 years were most affected. In addition, adults were most affected by the disease (8/12). The average age was 25 years with extremes at 15 months and 41 years. The sex male/female ratio was 1. The overall attack rate of disease and lethality were 0.2 per 1000 inhabitants and 25% respectively. The fatality was 67% among children less than 10 years. Fever and rash were the main symptoms of the disease. Lymphadenopathy was present in 54.5%. Ten of the 12 patients were hospitalized (83%). The average duration of hospitalization was 13 days with the extremes 6 and 28 days. The monkeypox like smallpox remains a serious and fatal disease in children. A survey of animal reservoirs complained to identify strains of the virus is essential. During an outbreak, good communication and isolation of patients may break the chain of transmission. Other measures to limit their contact with the forest or virus reservoirs are to be encouraged.

Depression is a complication occurring frequently after a stroke. It negatively affects the physical, cognitive and social recovery. Authors report the results of a casecontrol study section was performed in neurology of the friendship hospital and psychiatry of the general hospital in Bangui, from January to August 2012 to ascertain the existence of a link between stroke and depression in hospitalized patients and to identify factors limiting taken into efficient load. On one hundred five subjects included, thirty five were stroke victims matched with seventy witnesses. The prevalence of post stroke depression was 88.6% (31/35) versus (20/70) 28.5% in controls (p <0.001). This post stroke depression occurred in 58% of men with a sex ratio of 1.4. The mean age of subjects with post stroke depression was 49.1 years, with extremes ranging from 33 to 76 years of age. Most (64.5%) subjects with post stroke depression was no occupation; 71.5% of them had a stroke dating back more than six weeks, and 92% had a motor deficit with a Barthel Index <100. Subjects with stroke suffered mostly moderate depression (48.1%) whereas the controls usually had mild depression (80.4%). This depression was not correlated with motor deficit, or the laterality of the lesion, or cognitive disorder. But, some Central African specificities could explain this phenomenon. These results demonstrate the reality of post stroke depression in Africa, hence the need to think in support of any subject with stroke topic. Moreover, questions about the tools used to evaluate the post stroke depression and the time interval between stroke onset and the onset of depressive symptoms remain and require further consideration.

Given the gradual improvement of living conditions and aging, dementia and related syndromes are becoming serious problems in the developing countries. A cross-sectional door to door type study in neighbourhood, was conducted from October 2008 to January 2009, in the general population in Bangui, order to help get a better understanding of the prevalence and risk factors of dementia among people over 65 living in the Central African capital. Of the 496 elderly respondents, 188 had cognitive disorders. After a neuropsychological examination, 40 of these subjects were diagnosed with dementia. The prevalence of dementia was 8.1% (IC 95% = [5.7-10.5]). The average age of subjects with dementia, ranging from 65 to 90 years, was 76.0 ± 7.1 years. There was a significant risk of developing dementia for an increase of ten years old (OR = 2.6, 95% CI [1.5 to 4.5]). The sex-ratio was 6/34. 82.5% of the demented had never attended school. 70.0% showed a state of malnutrition (BMI ≤ 18,5 kg/m(2)), significantly associated with dementia (OR = 3.3; IC 95% = [1.5-7.3]). The blood pressure was high in 67.5% of demented which is significantly associated with dementia (OR = 2.4; IC 95% = [1.1-5.4]). A recent change in financial status was a factor significantly associated with dementia (OR = 6.4; IC 95% = [1.8-22.5]). These results support the existence of dementia in urban Africa. The observed prevalence is close to those found in high-income countries. Further studies should be conducted which includes both the rural and urban Africa, to better understand the problem and solutions consider to comprehensive care and prevention axes adapted to our context.

Introduction: Konzo is a neuromyelopathy characterized by permanent spastic paraparesis, linked to a subacute poisoning by cyanide found in cassava. The purpose of the study is to describe the epidemiological aspects of konzo in health region No. 2 in the Central African Republic., Method: A descriptive cross-sectional study was conducted among patients collected during a one-month period (July 16 to August 16, 2007) of active surveillance for acute flaccid paralysis., Results: Eighty-one cases of konzo were identified during the study period, representing a prevalence of 10 per 100,000. Mean age of patients was 10.7+/-7.7 years. Children and women were most affected. The main warning signs were fatigability (97.6%), tremor (88.9%), walking difficulty (100.0%), dysarthria (67.9%) and a loss of visual acuity (65.4%). The predominant neurological signs were lower limb paresis (90.0%) and hyperesthesia (66.7%)., Conclusion: Konzo is a serious public health problem in this region of the Central African Republic. A prevention program should be set-up.