EDCTP Alumni Network

Background: In Republic of Chad, the seroprevalence of HIV among antenatal pregnant women is known as decreasing over years meanwhile the epidemiological data among pregnant women for hepatitis B virus are scarce. The co-infection HIV/HBV increases the risk of mother to child transmission of both viruses. This study aimed to determine the rate of HIV, HBV co-infection and to identify the associated risk factors among pregnant women attending Guelendeng health district (GHD). Methods: A cross-sectional and descriptive study was conducted from March to May 2019 among pregnant women attending GHD. The questionnaire included demographics, AIDS and HBV knowledge, behavior factors and history of blood transfusion. Blood samples were obtained and tested serologically for HIV and HBV. The study of associations between exposure and outcome variables was sought with the odds ratio (OR), expressed with 95% confidence interval. Tests were performed using Epi info 7.0 with p<0.05 considered as significant. Results: Out of 200 enrolled pregnant women, the median age was 25years old with interquartile range from 20.5 to 30 years old. The seroprevalence of HIV, HBV and the co-infection HIV/HBV were 4.5% (95% CI: 2.1%-8.4%; 9/200), 13% (95% CI: 8.7%-18.5%; 26/200) and 2% (95 % IC: 0.6%-5%; 4/200) respectively. The antenatal age was associated to HBV infection (p=0.04) unlike HIV infection (p=0.4) and HIV/HBV co-infection (p=0.52). Women aged more than 29 years were most affected. Bivariate analysis identified that the non-use of condom (OR 7.79, 95% CI: 1.9-32.6, p=0.004) and blood transfusion history (OR 17.9, 95% CI: 2.6-124.8, p=0.01) were associated risk factors of contracting HIV. Conclusion: The seroprevalence of HIV and HBV remains high among pregnant women attending antenatal ward in Guelendeng Health District with associated risk factors such as age, blood transfusion and the non-use of condom with new sexual partners.

In an increasingly interconnected world, with the devastating effects of climate changes and humanitarian crises, pandemics and emerging infectious diseases are more likely to become our daily reality. When it comes to health care, sub-Saharan Africa faces more challenges than most other regions of the world, including lack of funds, precarity and poor infrastructures. Yet, these areas are most often on the front lines of infectious threats.

To attain the HIV 95-95-95 goals by 2030 in Cameroon, high quality research to inform policy and patient care is of utmost importance. In the context of limited workforce and resources, collaborations, sharing of locally-adapted strategies and other field experience, leveraging on existing and innovative platforms would facilitate a coordinated and optimal AIDS response at country level. The second edition of the Cameroon HIV Research Forum (CAM-HERO) conference took place both physically and virtually on November 18 and 19, 2021 in Kribi, on the theme "Research for Policy and Care". This scientific event brought together Cameroonian HIV/AIDS researchers, experienced clinicians and regulatory authorities to foster i) the dissemination of research findings and facilitate translation into policy, ii) operational research collaboration, iii) identification of new research areas, and iv) capacity building. To achieve the set objectives during this event, a consensus on research priorities for accelerating the achievement of three 95 HIV goals in Cameroon were summarized; meeting sessions included 31 abstract presentations, 13 discussions, and presentations on various aspects of HIV research including ethics, administrative procedures and needs for capacity building; training of young scientists on guidelines for research proposal development toward ethical clearance was done; and a platform for discussion between researchers and regulatory authorities was conducted around the design and setting-up of a national HIV/AIDS research agenda. CAM-HERO 2021 brought together HIV researchers, experts and junior scientists around major programmatic challenges, evidence to translate into practice, research priorities on HIV/AIDS. Collaborations were reinforced, capacities were strengthened, and footprints were established towards a consensus on a national HIV/AIDS research agenda.

The extent of SARS-CoV-2 circulation in many African countries remains unclear, underlining the need for antibody sero-surveys to assess the cumulative attack rate. Here, we present the results of a cross-sectional sero-survey of a random sample of residents of a health district in Yaounde, Cameroon, conducted from October 14 to November 26, 2020. Among the 971 participants, the test-adjusted seroprevalence of anti-SARS-CoV-2 IgG antibodies was 29·2% (95% CI 24·3-34·1). This is about 322 times greater than the 0.09% nationwide attack rate implied by COVID-19 case counts at the time. Men, obese individuals and those living in large households were significantly more likely to be seropositive, and the majority (64·2% [58·7-69·4]) of seropositive individuals reported no symptoms. Despite the high seroprevalence, most of the population had not been infected with SARS-CoV-2, highlighting the importance of continued measures to control viral spread and quick vaccine deployment to protect the vulnerable.

Molecular diagnosis of COVID-19 is critical to the control of the pandemic, which is a major threat to global health. Several molecular tests have been validated by WHO, but would require operational evaluation in the field to ensure their interoperability in diagnosis. In order to ensure field interoperability in molecular assays for detection of SARS-CoV-2 RNA, we evaluated the diagnostic concordance of SARS-CoV-2 between an automated (Abbott) and a manual (DaAn gene) realtime PCR (rRT-PCR), two commonly used assays in Africa. A comparative study was conducted on 287 nasopharyngeal specimens at the Chantal BIYA International Reference Centre (CIRCB) in Yaounde- Cameroon. Samples were tested in parallel with Abbott and DaAn gene rRT-PCR, and performance characteristics were evaluated by Cohen's coefficient and Spearman's correlation. A total of 273 participants [median age (IQR) 36 (26-46) years] and 14 EQA specimens were included in the study. Positivity was on 30.0% (86/287) Abbott and 37.6% (108/287) DaAn gene. Overall agreement was 82.6% (237/287), with k=0.82 (95%CI 0.777-0.863), indicating an excellent diagnostic agreement. The positive and negative agreement was 66.67% (72/108) and 92.18 % (165/179) respectively. Regarding Viral Load (VL), positive agreement was 100% for samples with high VLs (CT<20). Among positive SARS-CoV- 2 cases, the mean difference in Cycle Threshold (CT) for the manual and Cycle Number (CN) for the automated was 6.75±0.3. The excellent agreement (>80%) between the Abbott and DaAn gene rRTPCR platforms supports interoperability between the two assays. Discordance occurs at low-VL, thus underscoring these tools as efficient weapons in limiting SARS-CoV-2 community transmission.

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).&#x0D; 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.&#x0D; 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.&#x0D; 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.

Background: Decreased antioxidant ability is one of the worsening conditions in AIDS. We aimed
to evaluate total antioxidant ability among others, and their variation in HIV infected patients
following their CD4+ T cells count and viral load, in a context of new ART scarcity in most LMICs.
Material and Methods: We conducted a cross sectional study on 167 individuals (76 controls, 33
treatments naïve and 58 HIV-1 infected patients on ART). We assessed their plasma total antioxidant
ability (FRAP), Malondialdehyde (MDA) and thiol (SH) groups using standard spectrophotometric
methods, then we calculated Lipid Peroxidation Index (LPI). Statistical analysis was performed using
GraphPad Prism 6. Data were analyzed by two-tailed unpaired t-test for two groups’ comparison
and ANOVA for more than two groups. Pearson correlation between CD4+ T cells count, viral load
and the above markers was determined; P ≤ 0.05 was considered statistically significant.
Results: The following controls/naïve/treated subjects’ values for FRAP (mM) (1.907 ± 0.074/1.77
± 0.05/1.695 ± 0.03); MDA (μΜ) (0.781 ± 0.081/1.115 ± 0.118/1.342 ± 0.109); SH (μΜ) (2.747 ±
0.130/1.582 ± 0.197/1.498 ± 0.140) and LPI (0.43 ± 0.61/ 0.61 ± 0.7/2.59 ± 0.83) were all obtained
with P ≤ 0.05. The FRAP increased only with 3TC+TDF+EFV and 3TC+ABC+NVP cART while
MDA decrease significantly with the later (p=0.027). MDA and LPI significantly increased in heavily
treated patients with p<0.0014 and p=0.0001 respectively. Overall, the patients showed an increase
of viral loads following a decrease of CD4+ T cells (r= -0.803, p=0.016) but 3TC+TDF+EFV seem
to better manage the both. The only significant correlation was established between SH groups and
CD4+Tcells count (r=0.447; p=0.0006).
Conclusion: Our study showed that thiol groups may be protective against CD4+Tcells count
depletion and that the cART 3TC+TDF+EFV, 3TC+ABC+NVP may be helpful in fighting against
free radical generation and particularly 3TC+TDF+EFV as controlling CD4+ T cells count and
viral load in long term treated patients. The study particularly showed the implication of cART in
increasing lipid peroxidation index following the treatment duration in heavily treated patients,
which aggravated their conditions in an area where drug options are limited, calling for new drugs
availability and personalized medicine.

Response to ritonavir-boosted-protease inhibitors (PI/r)-based regimen is associated with some Gag mutations among HIV-1 B-clade. There is limited data on Gag mutations and their covariation with mutations in protease among HIV-1 non-B-clades at PI/r-based treatment failure. Thus, we characterized Gag mutations present in isolates from HIV-1 infected individuals treated with a PI/r-regimen (n = 143) and compared them with those obtained from individuals not treated with PI/r (ART-naïve [n = 101] or reverse transcriptase inhibitors (RTI) treated [n = 118]). The most frequent HIV-1 subtypes were CRF02_AG (54.69%), A (13.53%), D (6.35%) and G (4.69%). Eighteen Gag mutations showed a significantly higher prevalence in PI/r-treated isolates compared to ART-naïve (p < 0.05): Group 1 (prevalence < 1% in drug-naïve): L449F, D480N, L483Q, Y484P, T487V; group 2 (prevalence 1-5% in drug-naïve): S462L, I479G, I479K, D480E; group 3 (prevalence ≥ 5% in drug-naïve): P453L, E460A, R464G, S465F, V467E, Q474P, I479R, E482G, T487A. Five Gag mutations (L449F, P453L, D480E, S465F, Y484P) positively correlated (Phi ≥ 0.2, p < 0.05) with protease-resistance mutations. At PI/r-failure, no significant difference was observed between patients with and without these associated Gag mutations in term of viremia or CD4 count. This analysis suggests that some Gag mutations show an increased frequency in patients failing PIs among HIV-1 non-B clades.

During the early month of the Coronavirus disease 2019 (COVID-19) pandemic, ignited in Wuhan China, the most reported cases and deaths have been reported in high-income countries (HIC) by the middle of 2021. On the other hand, the challenges of lack of and limited access to testing facilities contributed to an underestimation of infections in many low middle-income countries (LMIC), most especially in sub-Saharan Africa. With the increase of global testing and confirmed infection cases, the impact of the pandemic on individuals and communities in LMIC became very evident. This negative impact of COVID-19 in its forms has motivated research in diversified domains to address potential response for the management of the pandemic within the framework of LMIC strategic health plan. with particular references to the transmission patterns of SARS-CoV-2, the clinical characteristics of the disease, and the impact of pandemic prevention and response measures. Sub-Saharan Africa is faced with many setbacks from the pandemic due to the unpreparedness for disasters epidemiology of global magnitude, as created by COVID-19. This paper has been motivated by the COVID-19 pandemic global effect that has permitted us make a review using a multidisciplinary approach. We have taken into consideration the socio, pharmacoeconomic and anthropological impact potential burden of COVID-19 in LMIC countries, faced with limited human resources, funding, or medical supplies from response activities.

Background: Sub-Saharan Africa carries the greatest burden of HIV-infection with increasing drug resistance burden, which requires improved patient management and monitoring. Current WHO recommendations suggest transitioning to dolutegravir-based (adults) or raltegravir-based-regimens (neonates) for initial antiretroviral therapy (ART) and as a suitable alternative in cases of multi-resistance in resource-limited settings. This review aims at synthesizing the current knowledge on dolutegravir use and integrase resistance-associated mutations found before the wide use of dolutegravir-based regimens.

Methods: This systematic review will include randomized and non-randomized trials, cohort, and cross-sectional studies published on dolutegravir use or integrase resistance-associated mutations in Sub-Saharan Africa. Searches will be conducted (from 2007 onwards) in PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Latin American and Caribbean Health Sciences Literature (LILAC), Web of Science, African Journals Online, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. Hand searching of the reference lists of relevant reviews and trials will be conducted and we will also look for conference abstracts. We will include studies of adults and/or children exposed to integrase inhibitors-based therapies; especially dolutegravir or raltegravir (which is our intervention of interest as compared to other antiretroviral regimens). We will exclude studies of patients with specific co-morbidities such as tuberculosis or opportunistic infections. Primary outcomes will be "the rate of viral suppression" and "the level of drug resistance" on integrase inhibitor-based regimens among patients in Sub-Saharan Africa. Secondary outcomes will be "the effect of baseline viremia on viral suppression," "the effect of treatment duration on viral suppression," "the proportion of patients with immune recovery," "the rate of non-adherence," "rate of adverse events;" "drug resistance according to different integrase inhibitor-based regimens," and "drug resistance according to viral subtypes/recombinants." Two reviewers will independently screen titles and abstracts, assess the full texts for eligibility, and extract data. If data permits, random effects models will be used where appropriate. Subgroup and additional analyses will be conducted to explore the potential sources of heterogeneity (e.g., age, sex, baseline viremia, CD4 following treatment, treatment duration, and adherence level).

Discussion: This review will help to strengthen evidence on the effectiveness of integrase strand transfer inhibitors by contributing to current knowledge on the use of dolutegravir and/or raltegravir (especially for neonates) in Sub-Saharan Africa. Results will therefore help in setting-up baseline data for an optimal management of people living with HIV as Sub-Saharan African countries are transitioning to dolutegravir-based regimens. Evidence will also support HIV/AIDS programs in identifying gaps and actions to be undertaken for improved long-term care and treatment of people living with HIV in Sub-Saharan Africa.

Background: The lower burden of COVID-19 in tropical settings may be due to preexisting cross-immunity, which might vary according to geographical locations and potential exposure to other pathogens. We sought to assess the overall prevalence of SARS-CoV-2 antibodies and determine SARS-CoV-2 seropositivity according to HIV-status before the COVID-19 pandemic era.

Methods: A cross-sectional and comparative study was conducted at the Chantal BIYA International Reference Centre (CIRCB) on 288 stored plasma samples (163 HIV-positive versus 125 HIV-negative); all collected in 2017-2018, before the COVID-19 pandemic era. Abbott Panbio™ COVID-19 IgG/IgM assay was used for detecting SARS-CoV-2 immunoglobulin G (IgG) and M (IgM). Among people living with HIV (PLHIV), HIV-1 viral load and TCD4 cell count (LTCD4) were measured using Abbott Real Time PCR and BD FACSCalibur respectively. Statistical analyses were performed, with p<0.05 considered statistically significant.

Results: The median [IQR] age was 25 [15-38] years. Overall seropositivity to SARS-CoV-2 antibodies was 13.5% (39/288) of which 7.3% (21) was IgG, 7.3% (21) IgM and 1.0% (3) IgG/IgM. According to HIV-status in the study population, SARS-CoV-2 seropositivity was 11.0% (18/163) among HIV-positive versus 16.8% (21/125) among HIV-negative respectively, p=0.21. Specifically, IgG was 6.1% (10/163) versus 8.8% (11/125), p=0.26; IgM was 5.5% (9/163) versus 9.6%, (12/125), p=0.13 and IgG/IgM was 0.6% (1/163) versus 1.6% (2/125) respectively. Among PLHIV, SARS-CoV-2 seropositivity according to CD4 count was 9.2% (≥500 cells/µL) versus 1.8% (200-499 cells/µL), (OR=3.5; p=0.04) and 0.6% (<200 cells/µL), (OR=17.7; p<0.01). According to viral load, SARS-CoV-2 seropositivity was 6.7% (≥40 copies/mL) versus 4.9% (<40 copies/mL), (OR= 3.8; p<0.01).

Conclusion: Before COVID-19 in Cameroon, cross-reactive antibodies to SARS-CoV-2 were in circulation, indicating COVID-19 preexisting immunity. This preexisting immunity may contribute in attenuating disease severity in tropical settings like Cameroon. Of relevance, COVID-19 preexisting immunity is lower with HIV-infection, specifically with viral replication and poor CD4-cell count. As poor CD4-count leads to lower cross-reactive antibodies (regardless of viral load), people living with HIV appear more vulnerable to COVID-19 and should be prioritized for vaccination.

Once a drug is approved in phase III of clinical trials, pharmacovigilance (PV) becomes very important for the surveillance of drug, vaccine or medical devices. PV constitutes part of the phase IV approval, which involves a study for collecting, detecting, and monitoring adverse events in any population that the drug is used. The adverse events that are reported must be assessed to ascertain the causal effects and prevent or avoid unanticipated side effects on the population. With the advent of the coronavirus disease 2019 (COVID-19) pandemic, vaccination has been the motor for the management of the pandemic, and through intensive health sensitization, more people are vaccinated in a short period leading to greater challenges to the PV taskforce and the PV operating centrers. Global partnerships including the international society of pharmacovigilance (ISOP), the French national agency for medicines and health products safety (ANSM), and a multitude of others are working in synergy towards putting in place a continuous collaboration work package with many sensitization, education, capacity building, and research initiatives. This is within the framework of identifying the safety and efficacy of vaccines in order to provide solutions to emerging challenging ethical questions.

Through PV, signal detection is in progress for the identification of adverse events. The unanticipated emergence and negative impact of COVID-19, caused by the severe acute respiratory syndrome virus 2 (SARS-CoV-2) has significantly compelled global pharmacists and drug actors to collectively play an important role in the management of COVID-19. This has to be done within the framework of therapeutic strategies and guaranteed safety, efficacy and quality of new and old xenobiotics. In the current treatment COVID-19 has created health-related challenges and a shift in paradigm in drug discovery and development of new chemical entities (NCE), for vaccine or drug repurposing for different levels of treatment interventions. The accelerated interest in dynamic research and innovation have led to different approaches of treatment and this has come with potential side effects, which has led to the call for post marketing surveillance and monitory. PV is therefore a key component for phase IV study for the drugs and vaccines approved for global use. This paper gives an insight into the global PV monitoring and surveillance of new chemical entities (drugs and vaccines) and new technologies targeting the management of COVID-19.

Introduction: depuis le lancement en 2015 de la stratégie « Traitement pour tous » au Cameroun, un plan d´accélération du traitement antirétroviral (TARV) est mis en œuvre avec des progrès remarquables. Ces efforts s´accompagnent d´un risque d´émergence de la pharma-corésistance du VIH. L´Organisation Mondiale de la Santé (OMS) propose ainsi la surveillance des indicateurs d´alerte précoce (IAP) de la pharma-corésistance du VIH. L'objectif de cette étude était d'évaluer sur le plan national les IAP de la pharma-corésistance du VIH au Cameroun.

Méthodes: une étude rétrospective a été menée en décembre 2017 dans les 10 régions du Cameroun; elle a évalué les six IAPs recommandés par l´OMS sur 68 sites de prise en charge du VIH sélectionnés de façon aléatoire. La période de rapportage s´étendait de Juillet 2016 à Juin 2017.

Résultats: les scores à l´échelle nationale étaient: retrait des médicaments dans les délais (IAP1): 66%; rétention sous TARV 12 mois après l´initiation (IAP2): 66%; rupture de stocks d´ARVs sur une période de 12 mois (IAP3): 53%; couverture en réalisation des tests de charge virale (CV) (IAP4): 10%; suppression de la CV à 12 mois de TARV (IAP5): 73% et pratiques de dispensation du TARV (IAP6): 100%. Les scores régionaux étaient similaires.

Conclusion: la performance des IAP au Cameroun est faible et nécessite des interventions urgentes, prioritairement la couverture des tests de CV, la gestion optimale des ARV et l´adhérence des patients.

Molecular diagnosis of COVID-19 is critical to the control of the pandemic, which is a major threat to global health. Several molecular tests have been validated by WHO, but would require operational evaluation in the field to ensure their interoperability in diagnosis. In order to ensure field interoperability in molecular assays for detection of SARS-CoV-2 RNA, we evaluated the diagnostic concordance of SARS-CoV-2 between an automated (Abbott) and a manual (DaAn gene) realtime PCR (rRT-PCR), two commonly used assays in Africa. A comparative study was conducted on 287 nasopharyngeal specimens at the Chantal BIYA International Reference Centre (CIRCB) in Yaounde- Cameroon. Samples were tested in parallel with Abbott and DaAn gene rRT-PCR, and performance characteristics were evaluated by Cohen's coefficient and Spearman's correlation. A total of 273 participants [median age (IQR) 36 (26-46) years] and 14 EQA specimens were included in the study. Positivity was on 30.0% (86/287) Abbott and 37.6% (108/287) DaAn gene. Overall agreement was 82.6% (237/287), with k=0.82 (95%CI 0.777-0.863), indicating an excellent diagnostic agreement. The positive and negative agreement was 66.67% (72/108) and 92.18 % (165/179) respectively. Regarding Viral Load (VL), positive agreement was 100% for samples with high VLs (CT<20). Among positive SARS-CoV- 2 cases, the mean difference in Cycle Threshold (CT) for the manual and Cycle Number (CN) for the automated was 6.75±0.3. The excellent agreement (>80%) between the Abbott and DaAn gene rRTPCR platforms supports interoperability between the two assays. Discordance occurs at low-VL, thus underscoring these tools as efficient weapons in limiting SARS-CoV-2 community transmission.

Introduction: the Treat-All remains the globally endorsed approach to attain the 95-95-95 targets and end the AIDS pandemic by 2030, but requires some country-level contextualization. In Cameroon, the specific research agenda to inform strategies for improving HIV policy was yet to be defined.

Methods: under the patronage of the Cameroon Ministry of health, researchers, policy makers, implementing partners, and clinicians from 13 institutions, used the Delphi method to arrive at a consensus of HIV research priorities. The process had five steps: 1) independent literature scan by 5 working groups; 2) review of the initial priority list; 3) appraisal of priorities list in a larger group; 4) refinement and consolidation by a consensus group; 5) rating of top research priorities.

Results: five research priorities and corresponding research approaches, resulted from the process. These include: 1) effectiveness, safety and active toxicity monitoring of new and old antiretrovirals; 2) outcomes of Antiretroviral Therapy (ART) with focus in children and adolescents; 3) impact of HIV and ART on aging and major chronic diseases; 4) ART dispensation models and impact on adherence and retention; 5) evaluations of HIV treatment and prevention programs.

Conclusion: the research priorities resulted from a consensus amongst a multidisciplinary team and were based on current data about the pandemic and science to prevent, treat, and ultimately cure HIV. These priorities highlighted critical areas of investigation with potential relevance for the country, funders, and regulatory bodies.

Background: Rapid Diagnostic Tests have been wildly reported for HBsAg screening in Cameroon. Aims and Objectives: The present study aimed at assessing the diagnostic performance and the limit of detection of three Rapid Diagnostic Tests used for HBsAg screening for blood donation in Cameroon. Study Design: A hospital-based cross-sectional study involving blood donors who met blood banks requirements was done. Setting: The study was carried out at Douala Laquintinie Hospital and Bamenda Regional Hospital. Materials and Methods: Ten mL of blood specimen was collected among blood donors who accepted to partake in the study by signing the inform consent. Laboratory processing was performed at the University of Buea. The limit of detection of the assays under evaluation was checked and the diagnostic performance assessed. The automated Architect HBsAg assay and the ELISA Biorex HBsAg were used as the reference standard. Statistics: Sensitivity, specificity was obtained by comparing the results of each of the assay to those of the reference standard. The limit of detection (LOD) of the three RDTs compared to the ELISA Biorex was assessed by preparing 14-fold Dilution of known positive control samples. Results: The limit of detection of the tests under evaluation was 0.18IU/mL whereas the one of the ELISA Biorex was 0.05IU/mL. Diaspot and Fastep obtained a sensitivity of 88.24% when compared to Architect and respectively 60.53% and 57.89% when compared to Biorex. Abon showed a lower sensitivity of 50.0% as compared to Biorex and 58.82% compare to Architect. Diaspot and Fastep had a specificity > 99% independent on the standard while Fastep had 98.62% using Biorex and 97.54% using Architect. Conclusion: Diaspot and Fastep feature the World Health Organization required specificity independent of the standard used while none of the tests reached the expected sensitivity and limit of detection.

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.

A successful transition to dolutegravir-based regimens in low and middle-income countries (LMICs) requires an integrase genotyping assay effective on diverse HIV-1 clades. We herein developed and validated an in-house integrase genotyping protocol on plasma samples from 195 HIV-infected patients in Cameroon. Median [IQR] viremia was 23,574 (518-109,235) copies/mL; 128/195 participants had ≥1000copies/mL (i.e., WHO-threshold for genotypic resistance testing in LMICs). A total of 18 viral clades were detected: 72(51.1%) CRF02_AG, 38(26.9%) pure subtypes and 31(22.0%) other recombinants. Following WHO-threshold (≥1000copies/ml), sequencing performance was 82.81%(106/128). Regarding viremia, performance was 85.00%(68/80) with ≥100,000copies/mL versus 76.67%(23/30) with 10,000 to 99,999copies/mL (P = 0.22); 83.33%(15/18) with 1,000 to 99,999copies/mL (P = 0.55); 73.68%(14/19) with 500 to 999copies/mL (P = 0.19); 50%(13/26) for 200 to 499copies/mL (P = 0.0005) and 36.36%(8/22) for <200copies/mL (P < 0.0001). The developed in-house integrase-genotyping is highly effective on both pure and recombinant viral clades, even at low-level viremia. This performance underscores its usefulness in monitoring integrase-resistance mutations and supporting the scale-up of dolutegravir-based regimens in LMICs.

Hepatitis viral infections are one of major threat to public health worldwide. The vast majority of people infected with viral hepatitis are found in resources limited countries of Africa and Asia. There is a lack of accurate data to better determine the burden of this disease in Cameroon, moreover among vulnerable people. The aim of this study was to estimate the seroprevalence of HBV and HCV viruses among persons with disabilities (PwD) with or without HIV status.

Multiple factors, such as immune disruption, prophylactic co-trimoxazole, and antiretroviral therapy, may influence the structure and function of the gut microbiome of children infected with HIV from birth. In order to understand whether HIV infection altered gut microbiome and to relate changes in microbiome structure and function to immune status, virological response and pediatric ART regimens, we characterized the gut microbiome of 87 HIV-infected and 82 non-exposed HIV-negative children from Yaounde, a cosmopolitan city in Cameroon. We found that children living with HIV had significantly lower alpha diversity in their gut microbiome and altered beta diversity that may not be related to CD4+ T cell count or viral load. There was an increased level of Akkermansia and Faecalibacterium genera and decreased level of Escherichia and other Gamma proteobacteria in children infected with HIV, among other differences. We noted an effect of ethnicity/geography on observed gut microbiome composition and that children on ritonavir-boosted protease inhibitor (PI/r)-based ART had gut microbiome composition that diverged more from HIV-negative controls compared to those on non-nucleoside reverse-transcriptase inhibitors-based ART. Further studies investigating the role of this altered gut microbiome in increased disease susceptibility are warranted for individuals who acquired HIV via mother-to-child transmission.

Keywords: CD4; CD8; HIV; Periodontitis; Viral load.

In Cameroon, COVID-19 infection spread rapidly and nationwide, with up to 721 deaths reported. To the best of our knowledge, no study reported the on-theground data using a large patients' dataset to give a comprehensive knowledge on COVID-19 pandemic in Cameroon. The objective of this study was to shade lights on the epidemiological, virological and clinical features of COVID-19 in the Cameroonian context. An observational study was conducted among symptomatic and asymptomatic individuals tested for SARS-CoV-2 by PCR on nasopharyngeal samples from April 22^nd, 2020 to January 5^th, 2021. Out of 14119 individuals (59.8% male), overall SARS-CoV-2 positivity was 12.7% (from 7.9% in <10 years to 17.3% in >60 years, p<0.001). The positivity rate of symptomatic individuals was 36.1% versus 9.8% among asymptomatic ones, p<0.001. Age group ≤10 [aOR (95%CI): 0.515 (0.338-0.784), p=0.002] and being symptomatic [aOR (95% CI): 5.108 (4.521-5.771), p<0.001] were predictors of SARS-CoV-2 positivity. Regarding PCR Cycle Threshold (CT), 53.8% of positive individuals had a CT <30. According to age, compared to older individuals, those aged 21-40 years showed a higher proportion with high viraemia (CT<20; 21.3% versus 12.5% respectively, p=0.003). Similarly, symptomatic individuals showed a higher proportion with high viraemia (22.4%), when compared to asymptomatic (13.9%); p<0.001. During this first wave of the pandemic, overall SARS-CoV-2 positivity remained high (>10%) and was associated with the presence of symptoms and older age. Most of the infection is among young and asymptomatic individuals, suggesting the "track-and-test" strategy should target these potential transmitters.

The objective of this study was to determine the rates of virological failure (VF) and HIV drug resistance (HIVDR) amongst adolescents on antiretroviral Therapy (ART). A retrospectively designed study was conducted in 10 healthcare centers for adolescents living with HIV (ALHIV) in the two main cities of Cameroon (Yaoundé and Douala), from November 2018 to May 2019. Sociodemographic, clinical, therapeutic and laboratory parameters were collected from medical records. All enrolled ALHIV had viral load (VL) measurements following the national guidelines. All patients with a VL ≥ 1000 copies/ml were called to perform genotyping tests. The chi-square test was used to determine the factors associated with VF. Out of the 1316 medical records of ALHIV, we included 1083 ALHIV having a VL result. Among them, 276 (25.5%) were experiencing VF, and VF was significantly higher in ALHIV with suboptimal adherence (p<0.001), older adolescents (p<0.05), those who lived outside the city where they were receiving ART (p<0.006), severely immunocompromised (p<0.01) and started ART at infancy (p<0.02). Among the 45/276 (16.3%) participants with an available genotyping resistance testing (GRT) result, the overall rate of HIVDR was 93.3% (42/45). The most common mutations were K103N (n = 21/42, 52.3%) resulting in high-level resistance to Efavirenz and Nevirapine, followed by M184V (n = 20/42, 47.6%) and thymidine analog mutations (n = 15/42, 35.7%) associated with high-level resistance to Lamivudine and Zidovudine respectively. The high rate of VF and HIVDR among ALHIV regularly followed in health facilities in Cameroon highlights the need to develop interventions adapted to an adolescent-centered approach to preserve future ART options.

Background: The withdrawal of stavudine from the first line Antiretroviral Therapy (ART) and the introduction of tenofovir (TDF) since 2010 in sub-Saharan Africa had a direct repercussion on the initiation of many patients on this new molecule. Despite its therapeutic efficiency already proved, TDF seems to induce some side effects such as renal failures. So, it is important to study the variation of early renal marker and immunological response (CD4 cells) of patients on regimen with TDF in order to have an optimal therapeutic follow up.

Methods: A historic-prospective and longitudinal survey was carried out from September 2011 to April 2012 at the Yaounde Central Hospital including adult participants in their first 6 months of ART in compliance with ethical standards. Dosage of serum creatinine estimated Glomerular Filtration Rate and CD4 T-lymphocytes count were systematically performed at baseline and at endpoint. Besides, a urinary dipstick test was only done at endpoint. Data analysis were performed with EPI INFO 7.0 and the comparison of categorical variables were done by chi-square test. A p-value <0.05 was considered as statistically significant.

Results: Out of the 132 naïve and eligible patients to ART with TDF, 68.2% were females and the mean age of the study population was 41 years old. There was an abnormal increase of creatinine from 6.1% (D0) to 19.7% (M6) (p <0.01) with men being more affected (21.4%). Thirty six percent (36%) of patients presented proteinuria at M6 and the incidence of kidney impairment was 7.6%. A quick recovery of immune response was also observed moving from 4.8% at D0 to 25.6% at M6 (p <0.01).

Conclusion: Even though ART with TDF improves the immune response, a strict monitoring of the creatinine is recommended. We also suggested the systematical dosage of serum creatinine and other markers of renal failure among patients on TDF regimens.

To attain the HIV 95-95-95 goals by 2030 in Cameroon, high quality research to inform policy and patient care is of utmost importance. In the context of limited workforce and resources, collaborations, sharing of locally-adapted strategies and other field experience, leveraging on existing and innovative platforms would facilitate a coordinated and optimal AIDS response at country level. The second edition of the Cameroon HIV Research Forum (CAM-HERO) conference took place both physically and virtually on November 18 and 19, 2021 in Kribi, on the theme "Research for Policy and Care". This scientific event brought together Cameroonian HIV/AIDS researchers, experienced clinicians and regulatory authorities to foster i) the dissemination of research findings and facilitate translation into policy, ii) operational research collaboration, iii) identification of new research areas, and iv) capacity building. To achieve the set objectives during this event, a consensus on research priorities for accelerating the achievement of three 95 HIV goals in Cameroon were summarized; meeting sessions included 31 abstract presentations, 13 discussions, and presentations on various aspects of HIV research including ethics, administrative procedures and needs for capacity building; training of young scientists on guidelines for research proposal development toward ethical clearance was done; and a platform for discussion between researchers and regulatory authorities was conducted around the design and setting-up of a national HIV/AIDS research agenda. CAM-HERO 2021 brought together HIV researchers, experts and junior scientists around major programmatic challenges, evidence to translate into practice, research priorities on HIV/AIDS. Collaborations were reinforced, capacities were strengthened, and footprints were established towards a consensus on a national HIV/AIDS research agenda.

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.

Hepatitis B virus (HBV) infection is prevalent in Gabon and poses a potential risk of transmission by blood transfusion. However, few studies have examined epidemiological data regarding HBV infection of Gabonese blood donors. This article reports on research conducted to estimate the seroprevalence of HBV and associated risk factors in the urban population of Gabon. A cross-sectional and analytic study survey of blood donors attending at the Gabonese National Blood Transfusion Center, was carried out between June and August 2020. The ELISA technique (Evolis®, BioRad) and the chemiluminescence technique (Cobas® e601, Roche) had been used for the detection of hepatitis B surface antigens in the plasma of donors. Repeatedly reactive hepatitis B surface antigen levels among first-time and repeat donors were used to assess prevalence and risk factors using multivariable logistic regression. Results revealed that a total of 3665 donations were collected at the Gabonese National Blood Transfusion Center, of which 100 were con?rmed HBV positive. The seroprevalence of HBsAg among total blood donors was 5.5% (95% confidence interval [CI] = 4.4 - 6.7) indicating a moderate burden. In our multivariate analysis controlling for age, HBsAg positivity was associated with first-time donor status (aOR = 6.5) and residence outside of Libreville (aOR = 1). The prevalence of HBsAg among Gabonese blood donors is at a moderate-level endemicity among first-time donors, indicating the need to further limit the burden. In this Gabonese context, status of first-time blood donor and living in rural settings are primary risk factors of HBV-infection, and henceforth considered as exclusionary criteria for blood donation in Gabon.

  Introduction. La plus forte incidence du VIH au Cameroun se retrouve chez les
adolescent(e)s et jeunes. Le pays consacre pourtant des investissements de
prévention importants pour ce groupe. Pour une mise en œuvre efficace et
efficiente de la lutte contre le VIH dans ce groupe, il est indispensable d’étudier la
distribution spatiale et démographique de ces populations en contexte de
vulnérabilité au VIH au Cameroun.
Méthodes. Cette étude transversale et descriptive a été réalisée dans les dix régions
du Cameroun. L’approche utilisée a été celle de la cartographie programmatique
développée par l’Université de Manitoba (Canada). Les adolescent(e)s et jeunes
vulnérables au VIH étaient des personnes âgées entre 10 et 24 ans en lien avec les
populations clés (PC) telles que : Travailleuses de sexe, Hommes ayant des
rapports sexuels avec des hommes, et Usagers de drogues; soit sur (ou proximité)
les points chauds (PCd); ou vivant avec une PC en dehors du PCd.
Résultats. Au total 3 425 PCds ont été identifiés. Le nombre des adolescent(e)s et
jeunes vulnérables était estimé à 201 653 (155 615-247 691). Les régions du
Littoral, du Centre et de l’Ouest comptaient le plus grand nombre avec
respectivement 37 442 (29 015-45 828), 32 917 (26 901-38 932), et 24 472 (18
332-30 613).
Conclusion. Ces résultats suggèrent de développer des interventions spécifiques de
prévention chez les adolescent(e)s et jeunes autour des « points chauds », ainsi que
la conduite d’études bio-comportementales dans ce groupe, afin de mieux
comprendre l’envergure et les déterminants de leur vulnérabilité.

Background and objective: HIV-1 vertically infected children stand a high risk of HIV-1 drug resistance (HIVDR),
especially after failure to prevention of mother to child transmission (PMTCT) and pediatric antiretroviral therapy
(ART). Thus, surveillance of HIVDR might contribute in delineating optimal pediatric regimens. The objective of
this study was to evaluate HIVDR and subtype distribution among ART-naïve and ART-failing children.
Methods: A study was conducted throughout 2017 amongst 102 children/adolescents at the “Chantal BIYA Inter-
national Reference Centre” (CIRCB) in Cameroon. HIVDR testing was performed in protease-reverse transcriptase
(RT) region and interpreted using the Stanford HIVdbv8.5; subtyping was performed using MEGA v7.0.26; and
data were analyzed using Epi-info v7.1.3.3, with p < 0.05 considered statistically significant.
Results: Sequences were generated from 63 participants (19 ART-naïve, 44 ART-failure); the median-age was re-
spectively 6 [IQR:3.5–11] and 144 [IQR:116.25–185]
months for ART-naïve and ART-failing (median ART-
duration: 23.55 [IQR:7.61–60.91] months, 63.6% re-
ceiving non-nucleoside RT inhibitors [NNRTI]-based
regimens). Among ART-naïve children, overall-HIVDR
was 52.6% (10/19), with 31.6% (6/19) to NNRTI, 26.3%
(5/19) to nucleoside RT inhibitors (NRTI) and 15.8%
(3/19) to ritonavir-boosted protease inhibitor (PI/r).
Among ART-failing children, overall-HIVDR was 97.7%
(43/44), with 95.4% (42/44) to NNRTI, 90.9% (40/44)
to NRTI and 18.2% (8/44) to PI/r. Multi-drug resistance
was found in 21.05% (4/19) ART-naïve versus 85.7%
(24/28) on NNRTI-based and 50% (8/16) on PI-based
regimens; OR = 4.36, p = 0.045. CRF02_AG was preva-
lent (68.2%), without any effect on HIVDR (p = 0.99).

Conclusions: The high rates of HIVDR, in both ART-na-
ïve and ART-failing children, suggest using genotypic HIV-1 drug resistance testing for selecting optimal pediatric
ART-regimens. Multi-drug resistance is concerning among children failing ART and prompts the need of new drugs
(integrase inhibitors, darunavir/ritonavir) for optimal pediatric ART manage