-
[show abstract]
[hide abstract]
ABSTRACT: OBJECTIVES: Diagnosis of the neurological stage of human African trypanosomiasis is performed by examination of cerebrospinal fluid (CSF) for the presence of trypanosomes and numbers of white blood cells (WBC). Both CSF parameters are also used to assess treatment outcome during follow-up. In view of the importance of CSF examination, and the practical problems encountered with it, we compared the sensitivity of two trypanosome concentration techniques and the repeatability of two cell counting methods, as well as occurrence of systematic differences between them. METHODS: Patients were recruited at Dipumba hospital, in Mbuji-Mayi in the Democratic Republic of the Congo. In 94 CSF samples, trypanosome detection was performed with modified single centrifugation (MSC) and double centrifugation (DC). On 189 CSF samples with ≤30 cells/μl, cell counting was performed in duplicate in a Fuchs-Rosenthal counting chamber and in a disposable Uriglass counting chamber. RESULTS: Modified single centrifugation detected trypanosomes in significantly (P < 0.0001) more patients (85) than DC (46). Cell counts did not differ systematically in the two methods. Variability in the differences between duplicate cell counts was significantly higher (P = 0.002) in Uriglass (SD of differences 2.03) than in Fuchs-Rosenthal (SD of differences 1.62). CONCLUSIONS: For analysis of CSF in the context of sleeping sickness stage determination and follow-up after treatment, we strongly recommend the MSC for parasite detection and the application of disposable counting chambers. When the first cell count is ≤20 cells/μl, we recommend repeating the counting procedure on the same CSF specimen and taking the average of both countings.
Tropical Medicine & International Health 03/2013; · 2.80 Impact Factor
-
Epco Hasker,
Sangeeta Kansal,
Paritosh Malaviya,
Kamlesh Gidwani,
Albert Picado,
Rudra Pratap Singh,
Ankita Chourasia,
Abhishek Kumar Singh,
Ravi Shankar, Joris Menten,
Mary Elizabeth Wilson,
Marleen Boelaert,
Shyam Sundar
[show abstract]
[hide abstract]
ABSTRACT: Asymptomatic persons infected with the parasites causing visceral leishmaniasis (VL) usually outnumber clinically apparent cases by a ratio of 4-10 to 1. We describe patterns of markers of infection and clinical VL in relation to age in Bihar, India.
We selected eleven villages highly endemic for . During a 1-year interval we conducted two house to house surveys during which we collected blood samples on filter paper from all consenting individuals aged 2 years and above. Samples were tested for anti-leishmania serology by Direct Agglutination Test (DAT) and rK39 ELISA. Data collected during the surveys included information on episodes of clinical VL among study participants.
We enrolled 13,163 persons; 6.2% were reactive to DAT and 5.9% to rK39. Agreement between the tests was weak (kappa = 0.30). Among those who were negative on both tests at baseline, 3.6% had converted to sero-positive on either of the two tests one year later. Proportions of sero-positives and sero-converters increased steadily with age. Clinical VL occurred mainly among children and young adults (median age 19 years).
Although infection with L. is assumed to be permanent, serological markers revert to negative. Most VL cases occur at younger ages, yet we observed a steady increase with age in the frequency of sero-positivity and sero-conversion. Our findings can be explained by a boosting effect upon repeated exposure to the parasite or by intermittent release of parasites in infected subjects from safe target cells. A certain proportion of sero-negative subjects could have been infected but below the threshold of antibody abundance for our serologic testing.
PLoS Neglected Tropical Diseases 02/2013; 7(2):e2053. · 4.69 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: BACKGROUND:: Whereas routine viral load (VL) monitoring currently is too costly for poor countries, clinical failure criteria perform poorly. We previously developed an algorithm combining a clinical predictor score (CPS) with targeted VL testing in a Cambodian patient population (derivation population). We now prospectively validate the algorithm in the same clinical setting (validation population), assess its operational performance and explore its cost-saving potential. METHODS:: We performed a cross-sectional study in a tertiary hospital in Phnom Penh, Cambodia applying the CPS in adults on first-line antiretroviral treatment (ART) for at least 1 year. Treatment failure was defined as a VL > 1000 copies/ml. The area under the receiver-operating characteristic (AUROC) curve of the CPS to detect treatment failure in the current study population (validation population) was compared with the AUROC of the CPS obtained in the patient population where the CPS was derived from in 2008 in the same study setting (derivation population). Costs related to VL testing and second line regimens with the different testing strategies were compared. RESULTS:: 1490 individuals (56.6% female, median age 38 years (IQR 33-44)) were included, with a median baseline CD4 cell count of 94 cells/μL (IQR 28-205). Median time on ART was 3.6 years (IQR 2.1-5.1), 45 (3.0%) individuals had treatment failure. The AUROC of the CPS in validation was 0.75 (95% 0.67-0.83), relative to an AUROC of 0.70 in the derivation population. At the CPS cut-off ≥ 2, VL was indicated for 164 (11%) individuals, preventing inappropriate switching to second line in 143 cases. Twenty-four cases of treatment failure would be missed. When applied in routine care, the AUROC was 0.69 (95% CI 0.60-0.77). Overall one-year program costs with targeted VL testing were four-fold reduced. CONCLUSIONS:: The algorithm performed well in validation and has cost-saving potential. Further studies to assess its performance, feasibility and impact in different settings are warranted.
JAIDS Journal of Acquired Immune Deficiency Syndromes 01/2013; · 4.43 Impact Factor
-
Hilde M Vandenhoudt,
Lilian Langat, Joris Menten,
Fredrick Odongo,
Simon Oswago,
Geoffrey Luttah,
Clement Zeh,
Tania Crucitti,
Kayla Laserson,
John Vulule,
Anne Buve
[show abstract]
[hide abstract]
ABSTRACT: BACKGROUND: In 1997, a survey in Kisumu found a prevalence of HIV infection among female sex workers (FSW) of 75%. Only 50% reported using a condom with the last client. In 2008, we conducted another survey to collect data to inform an intervention targeting FSW in Kisumu. METHODS: In 2008 FSW were recruited by respondent-driven sampling. Women completed a questionnaire and were tested for HIV and other sexually transmitted infections (STIs). Multiple logistic regression analysis was done to explore factors associated with HIV-infection, and with condom use. Prevalence of HIV infection was compared in the two surveys from 1997 and 2008. Multivariate analysis was used to assess whether a change in HIV prevalence between the two surveys could be explained by changes in socio-demographic characteristics and/or behavioral factors. RESULTS: 481 FSW participated in the 2008 study. HIV prevalence was 56.5% (95% CI 52.0-61.6). Factors independently associated with HIV were age older than 29 years; being a widow; STI treatment in the past year; herpes simplex virus Type-2 infection; bacterial vaginosis; and trichomoniasis. Condom use with last client was reported by 75.0% (95% CI 70.9-78.9). Predictors of condom use with the last client were age older than 29 years; higher price paid by last client; ever having been tested for HIV. Predictors of unprotected sex were being drunk during last sex act; usually having sex during menses; and STI treatment in the past year. The odds ratio of HIV infection associated with year of survey was 0.49 (95% CI 0.33-0.75) after adjusting for socio-demographic and behavioral factors. CONCLUSIONS: The prevalence of HIV among FSW in Kisumu was found to be lower in 2008 than in 1997, while reported condom use was higher. However, access to HIV/STI prevention and care services needs to improve to further decrease HIV transmission between FSW and their clients.
PLoS ONE 01/2013; 8(1):e54953. · 4.09 Impact Factor
-
Raffaella M Ravinetto,
Ambrose Talisuna,
Maaike De Crop,
Harry van Loen, Joris Menten,
Chantal Van Overmeir,
Halidou Tinto,
Raquel Gonzalez,
Martin Meremikwu,
Carolyn Nabasuma,
Ghyslain M Ngoma,
Corine Karema,
Yeka Adoke,
Mike Chaponda,
Jean-Pierre Van Geertruyden,
Umberto D'Alessandro
[show abstract]
[hide abstract]
ABSTRACT: The last decade has witnessed a substantial increase of multi-centre, public health-oriented clinical trials in poor countries. However, non-commercial research groups have less staff and financial resources than traditional commercial sponsors, so the trial teams have to be creative to comply with Good Clinical Practices (GCP) requirements. According to the recent experience of a large multicentre trial on antimalarials, major challenges result from the complexity of multiple ethical review, the costs of in-depth monitoring at several sites, setting up an adequate Good Clinical Laboratory Practices (GCLP) framework, lack of insurers in host countries, and lack of adequate non-commercial data management software. Public research funding agencies need to consider these challenges in their funding policies. They also could support common spaces where North-South collaborative research groups may share critical information, such as on research insurance and open-source, GCP-compliant software. WHO should update its GCP guidelines, which date back to 1995, to incorporate the perspectives and needs of non-commercial clinical research.
Tropical Medicine & International Health 12/2012; · 2.80 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To identify factors associated with incidence of visceral leishmaniasis (VL), we surveyed 13,416 households in Bihar State, India. VL was associated with socioeconomic status, type of housing, and belonging to the Musahar caste. Annual coverage of indoor residual insecticide spraying was 12%. Increasing such spraying can greatly contribute to VL control.
Emerging Infectious Diseases 10/2012; 18(10):1662-4. · 6.79 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Abstract Mood disorders are more frequent among people with HIV infection than among non-HIV-infected individuals of the same age, socioeconomic status, and HIV risks. They have been associated with worse adherence and clinical outcomes, yet remain underdiagnosed and undertreated in sub-Saharan Africa. We explored the relationship between mood disorders using the 10-item depression scale of the Centers for Epidemiological Studies (CES-D10) and the 22-item Impact of Events Scale-Revised (IES-R) for posttraumatic stress disorder, and a range of demographic and HIV-related variables among 252 consecutive subjects on antiretroviral therapy (ART). The study was conducted in the Genito-Urinary Medicine Clinic of the Medical Research Council's Gambia Unit. These screening tests were positive in 7% and 30%, respectively, of the patients, with higher scores (more depression or more post-traumatic stress) associated with female gender, more advanced WHO clinical stage, and lower Karnofsky Perfomance Scale rating. Higher CES-D10 scores were also seen among those on their second ART regimen. No relationship was seen with age, time on ART, viral load, or CD4 cell count. Compared to an earlier study at the same site in subjects prior to starting ART, the prevalence of depression in those stabilized on ART was dramatically reduced (by 34%, from 41%) while that of PTSD dropped less (by 13%, from 43%). Integrating the CES-D10 or a similar instrument into patient preparation for ART is recommended in order to identify those who may benefit from further mental health investigations, specific therapy, or closer follow-up during early ART.
AIDS patient care and STDs 09/2012; 26(10):589-96. · 2.68 Impact Factor
-
Jane Cunningham,
Epco Hasker,
Pradeep Das,
Sayda El Safi,
Hiro Goto,
Dinesh Mondal,
Margaret Mbuchi,
Maowia Mukhtar,
Ana Rabello,
Suman Rijal,
Shyam Sundar,
Monique Wasunna,
Emily Adams, Joris Menten,
Rosanna Peeling,
Marleen Boelaert
[show abstract]
[hide abstract]
ABSTRACT: Background. Poor access to diagnosis stymies control of visceral leishmaniasis (VL). Antibody-detecting rapid diagnostic tests (RDTs) can be performed in peripheral health settings. However, there are many brands available and published reports of variable accuracy. Methods. Commercial VL RDTs containing bound rK39 or rKE16 antigen were evaluated using archived human sera from confirmed VL cases (n = 750) and endemic non-VL controls (n = 754) in the Indian subcontinent (ISC), Brazil, and East Africa to assess sensitivity and specificity with 95% confidence intervals. A subset of RDTs were also evaluated after 60 days' heat incubation (37°C, 45°C). Interlot and interobserver variability was assessed. Results. All test brands performed well against ISC panels (sensitivity range, 92.8%-100%; specificity range, 96%-100%); however, sensitivity was lower against Brazil and East African panels (61.5%-91% and 36.8%-87.2%, respectively). Specificity was consistently > 95% in Brazil and ranged between 90.8% and 98% in East Africa. Performance of some products was adversely affected by high temperatures. Agreement between lots and readers was good to excellent (κ > 0.73-0.99). Conclusions. Diagnostic accuracy of VL RDTs varies between the major endemic regions. Many tests performed well and showed good heat stability in the ISC; however, reduced sensitivity against Brazilian and East African panels suggests that in these regions, used alone, several RDTs are inadequate for excluding a VL diagnosis. More research is needed to assess ease of use and to compare performance using whole blood instead of serum and in patients coinfected with human immunodeficiency virus.
Clinical Infectious Diseases 08/2012; 55(10):1312-1319. · 9.15 Impact Factor
-
William Worodria, Joris Menten,
Marguerite Massinga-Loembe,
Doreen Mazakpwe,
Danstan Bagenda,
Olivier Koole,
Harriet Mayanja-Kizza,
Luc Kestens,
Roy Mugerwa,
Peter Reiss,
Robert Colebunders
[show abstract]
[hide abstract]
ABSTRACT: Here, we aimed to determine the clinical spectrum, predictors and outcomes of paradoxical tuberculosis-immune reconstitution inflammatory syndrome (TB-IRIS) in a resource-limited setting.
In a prospective cohort, we studied 254 patients with tuberculosis and HIV coinfection commencing antiretroviral therapy (ART). We identified patients with TB-IRIS using the International Network for Studies Against HIV-Associated IRIS (INSHI) case definition. Risk factors and clinical outcomes of TB-IRIS were determined and reported.
A total of 53 (21%) patients developed TB-IRIS a median of 2 weeks (IQR 12-22 days) after starting ART. The majority of the patients (70%) with TB-IRIS had extrapulmonary manifestations of TB-IRIS. In a multiple logistic regression model, baseline haemoglobin <100 g/l (OR 2.23 [95% CI 1.08-4.60]; P=0.031) and baseline CD4(+) T-cell count <50 cells/μl (OR 4.13 [95% CI 1.80-9.51]; P=0.001) were significant predictors of IRIS. Seven additional patients fulfilled all INSHI criteria of TB-IRIS but had the episode of TB-IRIS later than 3 months after ART start.
TB-IRIS was a frequent reason for clinical deterioration among patients with TB commencing ART but was not a primary contributor to mortality. Patients with advanced CD4 depletion and anaemia were at increased risk of TB-IRIS. Some patients developed late-onset TB-IRIS and/or a recurrent TB-IRIS episode.
Antiviral therapy 04/2012; 17(5):841-8. · 3.16 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Retention of patients in ART care is a major challenge in sub-Saharan programs. Retention is also one of the key indicators to evaluate the success of ART programs.
A retrospective review of 1500 randomly selected medical charts of adult ART patients from a local non-governmental (NGO) supported ART program in the Democratic Republic of Congo (DRC). Retention was defined as any visit to the clinic in the 4 months prior to the abstraction date. Retention over time and across different sites was described. The relationship between patient characteristics and retention rates at 1 year was also examined. 1450 patients were included in the analysis. The overall retention rates were 81.4% (95% CI: 79.3-83.4), 75.2% (95% CI: 72.8-77.3), 65.0% (95% CI: 62.3-67.6) and 57.2% (95% CI: 54.0-60.3) at 6 months, 1 year, 2 years and 3 years respectively. The retention rates between sites varied between 62.1% and 90.6% at 6 months and between 55.5% and 86.2% at 1 year. During multivariable analysis weight below 50 kg (aHR: 1.33, 95%CI: 1.05-1.69), higher WHO stage at initiation (aHR: 1.22, 95%CI 0.85-1.76 for stage 3 and aHR: 2.98, 95%CI: 1.93-4.59 for stage 4), and male sex (aHR: 1.32, 95%CI: 1.05-1.65) remained as significant risk factors for attrition during the first year after ART initiation. Other independent risk factors were year of initiation (aHR: 1.73, 95%CI: 1.26-2.38 for the year 2007 and aHR: 3.06, 95%CI: 2.26-4.14 for the period 2008-2009), and site.
Retention is a major problem in DRC, while coverage of patients on ART is still very low. With the flattening of funding for HIV care and treatment in sub-Saharan Africa, and with decreasing funding worldwide, maximizing retention during the much needed scaling-up will even be more important.
PLoS ONE 01/2012; 7(7):e40971. · 4.09 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Post-kala-azar dermal leishmaniasis (PKDL) is a cutaneous complication appearing after treatment of visceral leishmaniasis, and PKDL patients are considered infectious to sand flies and may therefore play a role in the transmission of VL. We estimated the risk and risk factors of PKDL in patients with past VL treatment in south-eastern Nepal.
Between February and May 2010 we traced all patients who had received VL treatment during 2000-2009 in five high-endemic districts and screened them for PKDL-like skin lesions. Suspected cases were referred to a tertiary care hospital for confirmation by parasitology (slit skin smear (SSS)) and/or histopathology. We calculated the risk of PKDL using Kaplan-Meier survival curves and exact logistic regression for risk factors.
Out of 680 past-treated VL patients, 37(5.4%) presented active skin lesions suspect of PKDL during the survey. Thirty-three of them underwent dermatological assessment, and 16 (2.4%) were ascertained as probable (2) or confirmed (14) PKDL. Survival analysis showed a 1.4% risk of PKDL within 2 years of VL treatment. All 16 had been previously treated with sodium stibogluconate (SSG) for their VL. In 5, treatment had not been completed (≤ 21 injections). Skin lesions developed after a median time interval of 23 months [interquartile range (IQR) 16-40]. We found a higher PKDL rate (29.4%) in those inadequately treated compared to those who received a full SSG course (2.0%). In the logistic regression model, unsupervised treatment [odds ratio (OR) = 8.58, 95% CI 1.21-374.77], and inadequate SSG treatment for VL in the past (OR = 11.68, 95% CI 2.71-45.47) were significantly associated with PKDL.
The occurrence of PKDL after VL treatment in Nepal is low compared to neighboring countries. Supervised and adequate treatment of VL seems essential to reduce the risk of PKDL development and active surveillance for PKDL is needed.
PLoS Neglected Tropical Diseases 12/2011; 5(12):e1433. · 4.69 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: World Health Organization (WHO) immunological and clinical criteria for monitoring first-line antiretroviral treatment (ART) offer low accuracy for predicting viral failure. Targeting viral load assays to those at high risk has been recommended and a system to do this has been developed in Cambodia. Systems for use in sub-Saharan African populations were evaluated.
A new Ugandan-based scoring system for targeting viral load assays was developed from data from the first 4 years of a Ugandan cohort (N = 559) receiving first-line ART. The accuracy of this, the Cambodian system and the WHO criteria to predict viral failure, through targeting viral load assays, were compared in a separate population of 496 Ugandans.
The new Ugandan scoring system included CD4 cell count, mean cell volume, adherence, and HIV-associated clinical events as predictors of viral failure. In the validation population, the Ugandan system undertook viral load assays in 61 (12.3%) cases offering 20.5% sensitivity and 100% positive predictive value (PPV) to predict viral failure. The Cambodian system undertook viral load assays in 33 (6.7%) cases producing 23.1% sensitivity and 90.0% PPV. WHO criteria recommended viral load assays in 72 (14.5%) cases offering 30.8% sensitivity and 100% PPV.
Locally developed algorithms based on clinical and immunological criteria may offer little additional accuracy over WHO criteria for targeting viral load assays. When possible, confirming viral load before switching therapy is recommended. Scoring systems are more flexible than WHO criteria in allowing ART providers to choose the proportion of the population that undergo targeted viral load testing.
AIDS (London, England) 06/2011; 25(13):1627-35. · 4.91 Impact Factor
-
William Worodria,
Marguerite Massinga-Loembe,
Doreen Mazakpwe,
Kenneth Luzinda, Joris Menten,
Frank Van Leth,
Harriet Mayanja-Kizza,
Luc Kestens,
Roy D Mugerwa,
Peter Reiss,
Robert Colebunders
[show abstract]
[hide abstract]
ABSTRACT: Tuberculosis-HIV (TB-HIV) coinfection remains an important cause of mortality in antiretroviral therapy (ART) programs. In a cohort of TB-HIV-coinfected patients starting ART, we examined the incidence and predictors of early mortality.
Consecutive TB-HIV-coinfected patients eligible for ART were enrolled in a cohort study at the Mulago National Tuberculosis and Leprosy Program clinic in Kampala, Uganda. Predictors of mortality were assessed using Cox proportional hazards analysis.
Three hundred and two patients [median CD4 count 53 cells/μL (interquartile range, 20-134)] were enrolled. Fifty-three patients died, 36 (68%) of these died within the first 6 months of TB diagnosis. Male sex [hazard (HR): 2.19; 95% confidence interval (CI): 1.19 to 4.03; P = 0.011], anergy to tuberculin skin test [HR: 2.59 (1.10 to 6.12); P = 0.030], a positive serum cryptococcal antigen result at enrollment (HR: 4.27; 95% CI: 1.50 to 12.13; P = 0.006) and no ART use (HR: 4.63; 95% CI: 2. 37 to 9.03; P < 0.001) were independent predictors of mortality by multivariate analysis. Six (10%) patients with TB immune reconstitution inflammatory syndrome died, and in most, an alternative contributing cause of death was identified.
Mortality among these TB-HIV-coinfected patients was high particularly when presenting with advanced HIV disease and not starting ART, reinforcing the need for timely and joint treatment for both infections. Screening for a concomitant cryptococcal infection and antifungal treatment for patients with cryptococcal antigenemia may further improve clinical outcome.
JAIDS Journal of Acquired Immune Deficiency Syndromes 06/2011; 58(1):32-7. · 4.43 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Natural killer (NK) cells are regulated by interactions between polymorphic killer immunoglobulin-like receptors (KIR) and human leukocyte antigens (HLA). Genotypic combinations of KIR3DS1/L1 and HLA Bw4-80I were previously shown to influence HIV-1 disease progression, however other KIR genes have not been well studied. In this study, we analyzed the influence of all activating and inhibitory KIR, in association with the known HLA inhibitory KIR ligands, on markers of disease progression in a West African population of therapy-naïve HIV-1 infected subjects. We observed a significant association between carriage of a group B KIR haplotype and lower CD4+ T cell counts, with an additional effect for KIR3DS1 within the frame of this haplotype. In contrast, we found that individuals carrying genes for the inhibitory KIR ligands HLA-Bw4 as well as HLA-C1 showed significantly higher CD4+ T cell counts. These associations were independent from the viral load and from individual HIV-1 protective HLA alleles. Our data suggest that group B KIR haplotypes and lack of specific inhibitory KIR ligand genes, genotypes considered to favor NK cell activation, are predictive of HIV-1 disease progression.
PLoS ONE 01/2011; 6(2):e17043. · 4.09 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Objective To estimate the female sex worker population size in three cities in Côte d’Ivoire and in Kisumu, Kenya.Methods Capture–recapture was used, calculating size estimates by first ‘tagging’ a number of individuals and, through an independent recapture, calculating the proportion of overlap. The same procedures were used in all four cities. In the first phase, members of the target population were ‘captured’ and ‘marked’ by giving them a capture card. Six days later, in the same places and at the same time, a second sample was ‘captured’, which comprised a certain number of people who were captured in the first round. During the exercise, questions were asked to estimate the coverage of the sex worker clinics.Results Using capture–recapture, the estimated number of female sex workers was 1160 in Yamoussoukro (95% CI 1053–1287), 1202 in Bouaké (95% CI 1128–1279), 1916 in San Pedro (95% CI 1809–2030) and 1350 in Kisumu (95% CI 1261–1443). The proportion of female sex workers in Côte d’Ivoire who had visited the clinic ranged from 15% in Yamoussoukro to 30% in San Pedro and was 34% in Kisumu.Conclusions Capture–recapture was successfully applied to estimate the population size of female sex workers. These estimations were urgently needed to help mobilize an increased response to HIV, to assess programme coverage and to estimate potential impact of the targeted intervention.La méthode de capture-recapture pour estimer la taille de la population des professionnelles du sexe dans trois villes de la Côte d’Ivoire et à Kisumu dans l’ouest du KenyaObjectif: Estimer la taille de la population des professionnelles du sexe dans trois villes de la Côte d’Ivoire et à Kisumu au Kenya.Méthodes: La méthode de capture-recapture a été utilisée, le calcul des estimations de taille a d’abord été effectué par le ‘marquage’ d’un certain nombre d’individus et par une recapture indépendante, le calcul de la proportion de chevauchement. Les mêmes procédures ont été utilisées dans les quatre villes. Dans la première phase, les membres de la population cible ont été“capturés” et “marqués” en leur octroyant une carte de capture. Six jours plus tard, dans les mêmes endroits et au même moment, un second échantillon a été“capturé”, qui comprenait un certain nombre des personnes capturés lors du premier tour. Au cours de l’exercice, des questions ont été posées pour estimer l’étendue de la couverture en cliniques pour les professionnelles du sexe.Résultats: Sur base de la méthode de capture-recapture, le nombre estimé de professionnelles du sexe était de 1160 à Yamoussoukro (IC95%: 1053-1287), 1202 à Bouaké (IC95%: 1128-1279), 1916 à San Pedro (IC95%: 1809-2030) et 1357 à Kisumu (IC95%: 1261-1443). La proportion de professionnelles du sexe en Côte d’Ivoire qui avaient visité une clinique variait de 15%à Yamoussoukro à 30%à San Pedro et de 34%à Kisumu.Conclusions: La méthode de capture-recapture a été appliquée avec succès pour estimer la taille de la population des professionnelles du sexe. Ces estimations étaient urgemment nécessaires pour aider à mobiliser et à accroître la réponse au VIH, évaluer la couverture du programme et estimer l’impact potentiel des interventions ciblées.Mots-clés: professionnelles du sexe, estimation de la taille, capture-recapture, cartographie, prévention du sida, Afrique.Captura y recaptura para estimar el tamaño de la población de trabajadoras sexuales en tres ciudades de la Costa de Marfil y en Kisumu, Kenia occidentalObjetivo: Estimar el tamaño de la población de trabajadoras sexuales en tres ciudades de lCosta de Marfil y en Kisumu, Kenia.Métodos: Se utilizó el método de captura y recaptura: calculando el tamaño estimado haciendo primero un “marcaje” de un número de individuos y, posteriormente, mediante una recaptura independiente, calculando la proporción de solapamiento. Se utilizó el mismo procedimiento en las cuatro ciudades. En la primera fase, los miembros de la población diana fueron “capturados” y luego “marcados” dándoles una tarjeta de captura. Seis días más tarde, en los mismos lugares y a la misma hora, se “capturó” una segunda muestra, que incluía a un cierto número de mujeres que habían sido “capturadas” durante la primera ronda. Durante este ejercicio, se realizaron preguntas para estimar la cobertura de las clínicas para trabajadoras sexuales.Resultados: Utilizando el método de captura-recaptura, el número estimado de trabajadoras sexuales era de 1160 en Yamoussoukro (95%IC 1053-1287), 1202 en Bouaké (95%IC 1128-1279), 1916 en San Pedro (95%IC 1809-2030) y 1357 en Kisumu (95%IC 1261-1443.) La proporción de trabajadoras sexuales en Costa de Marfil que había visitado una clínica estaba entre un 15% en Yamoussoukro y el 30% en San Pedro y era del 34% en Kisumu.Conclusiones: El método de captura-recaptura fue exitoso cuando al aplicarse para estimar el tamaño poblacional de las trabajadoras sexuales. Estas estimaciones se necesitaban de forma urgente para ayudar a movilizar una mayor respuesta frente al VIH, para evaluar la cobertura del programa y para estimar el posible impacto de una intervención dirigida.Palabras clave: trabajadoras sexuales, estimación de tamaño, caputura-recaptura, mapeado, prevención del SIDA, África.
Tropical Medicine & International Health 11/2010; 15(12):1537 - 1543. · 2.80 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Visceral leishmaniasis (VL) is an important vector-borne disease caused by Leishmania donovani in the Indian subcontinent. The actual incidence and role of asymptomatic infections in the region are not wellknown. We used the direct agglutination test (DAT) and the rK39 ELISA as L. donovani infection markers in 10 VL endemic villages in Nepal. DAT titre distribution showed two subgroups in the population (infected and non-infected individuals), while rK39 did not. The agreement between both tests was moderate (j = 0.53; 95% CI 0.49–0.57). More research is needed to develop validated markers for Leishmania infection.
Tropical Medicine & International Health 11/2010; 15(11):1390-4. · 2.80 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To estimate the female sex worker population size in three cities in Côte d'Ivoire and in Kisumu, Kenya.
Capture-recapture was used, calculating size estimates by first 'tagging' a number of individuals and, through an independent recapture, calculating the proportion of overlap. The same procedures were used in all four cities. In the first phase, members of the target population were 'captured' and 'marked' by giving them a capture card. Six days later, in the same places and at the same time, a second sample was 'captured', which comprised a certain number of people who were captured in the first round. During the exercise, questions were asked to estimate the coverage of the sex worker clinics.
Using capture-recapture, the estimated number of female sex workers was 1160 in Yamoussoukro (95% CI 1053-1287), 1202 in Bouaké (95% CI 1128-1279), 1916 in San Pedro (95% CI 1809-2030) and 1350 in Kisumu (95% CI 1261-1443). The proportion of female sex workers in Côte d'Ivoire who had visited the clinic ranged from 15% in Yamoussoukro to 30% in San Pedro and was 34% in Kisumu.
Capture-recapture was successfully applied to estimate the population size of female sex workers. These estimations were urgently needed to help mobilize an increased response to HIV, to assess programme coverage and to estimate potential impact of the targeted intervention.
Tropical Medicine & International Health 11/2010; 15(12):1537-43. · 2.80 Impact Factor
-
Alain Nahum,
Annette Erhart,
Ambroisine Mayé,
Daniel Ahounou,
Chantal van Overmeir, Joris Menten,
Harry van Loen,
Martin Akogbeto,
Marc Coosemans,
Achille Massougbodji,
Umberto D'Alessandro
[show abstract]
[hide abstract]
ABSTRACT: Clinical malaria incidence was determined over 18 months in a cohort of 553 children living in a peri-urban area near Cotonou. Three cross-sectional surveys were also carried out. Malaria incidence showed a marked seasonal distribution with two peaks: the first corresponding to the long rainy season, and the second corresponding to the overflowing of Lake Nokoue. The overall Plasmodium falciparum incidence rate was estimated at 84/1,000 person-months, and its prevalence was estimated at over 40% in the two first surveys and 68.9% in the third survey. Multivariate analysis showed that girls and people living in closed houses had a lower risk of clinical malaria. Bed net use was associated with a lower risk of malaria infection. Conversely, children of families owing a pirogue were at higher risk of clinical malaria. Considering the high pyrethroids resistance, indoor residual spraying with either a carbamate or an organophospate insecticide may have a major impact on the malaria burden.
The American journal of tropical medicine and hygiene 09/2010; 83(3):465-73. · 2.59 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Control of human African trypanosomiasis (HAT) in the Democratic Republic of Congo is based on mass population screening by mobile teams; a costly and labor-intensive approach. We hypothesized that blood samples collected on filter paper by village health workers and processed in a central laboratory might be a cost-effective alternative. We estimated sensitivity and specificity of micro-card agglutination test for trypanosomiasis (micro-CATT) and enzyme-linked immunosorbent assay (ELISA)/T.b. gambiense on filter paper samples compared with parasitology-based case classification and used the results in a Monte Carlo simulation of a lot quality assurance sampling (LQAS) approach. Micro-CATT and ELISA/T.b. gambiense showed acceptable sensitivity (92.7% [95% CI 87.4-98.0%] and 82.2% [95% CI 75.3-90.4%]) and very high specificity (99.4% [95% CI 99.0-99.9%] and 99.8% [95% CI 99.5-100%]), respectively. Conditional on high sample size per lot (> or = 60%), both tests could reliably distinguish a 2% from a zero prevalence at village level. Alternatively, these tests could be used to identify individual HAT suspects for subsequent confirmation.
The American journal of tropical medicine and hygiene 08/2010; 83(2):374-9. · 2.59 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: We evaluated Families Matter! Program (FMP), an intervention designed to improve parent-child communication about sexual risk reduction and parenting skills. Parents of 10- to 12-year-olds were recruited in western Kenya. We aimed to assess community acceptability and FMP's effect on parenting practices and effective parent-child communication. Data were collected from parents and their children at baseline and 1 year postintervention. The intervention's effect was measured on six parenting and parent-child communication composite scores reported separately for parents and children. Of 375 parents, 351 (94%) attended all five intervention sessions. Parents' attitudes regarding sexuality education changed positively. Five of the six composite parenting scores reported by parents, and six of six reported by children, increased significantly at 1 year postintervention. Through careful adaptation of this U.S. intervention, FMP was well accepted in rural Kenya and enhanced parenting skills and parent-child sexuality communication. Parents are in a unique position to deliver primary prevention to youth before their sexual debut as shown in this Kenyan program.
AIDS education and prevention: official publication of the International Society for AIDS Education 08/2010; 22(4):328-43. · 1.51 Impact Factor
