The EDCTP Alumni Network

Dr
Boris Kevin Tchounga

Related fellows

Ms Emily Awuor Abuonji

RESEARCH ASSISTANT

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Dr Obinna Ekwunife

Senior Lecturer

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Dr Zivai Nenguke

Project Director

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Profile EDCTP Fellowship 1

Project Title

Epidemiology, Diagnosis algorithms and prognostic role of Immunologic and Inflammatory Markers among HIV-2 infected individuals in West Africa

EDCTP Project

TMA2016CDF1597

EDCTP Program

EDCTP2

EDCTP Project Call

Career Development Fellowship (CDF)

Project Objectives

This study will be organized into three axes, each with specific objectives. Axis 1: Epidemiology The aim is to provide accurate estimates of HIV-2 prevalence in West Africa using a mixed-method approach. The specific objectives are: • To estimate the prevalence of HIV-2 infection in west African countries using national health and demographic survey data • To estimate the proportion of new HIV-2 infected patients in west African countries based on laboratory surveillance platform • To realize mathematic modification on HIV-2 prevalence worldwide using existing datasets Axis 2: Diagnosis The aim is to improve the diagnosis and classification of HIV-2 and dually infected patients using molecular biology. The specific objectives are: • To confirm the HIV-1 & HIV-2 dual infection using molecular biology To describe the prevalence of dual infections in the WADA HIV-2 cohorts To evaluate a diagnostic algorithm based on rapid HIV tests for the routine diagnosis of dual infection in West Africa Axis 3: Disease progression and inflammatory markers: To describe the proportion and characteristics of long-term non-progressors and elite controllers among HIV-2 infected individuals in the WADA HIV-2 cohort To describe morbidity, disease progression and correlates among HIV-2 infected individuals in West Africa • To describe the temporal evolution of soluble biomarkers of inflammation and the correlation with morbidity and disease progression

Study Design

Axis 1: Epidemiology of HIV-2 infection First we will estimate the prevalence of HIV-2 infection: the estimates of the national prevalence of HIV-2 infection will be based on the testing of the dried blood spot collected during the last national demography and health survey (DHS) organized in selected participating countries where DHS was recently conducted. The HIV diagnosis during the DHS is based on the use of two serial ELISA tests. No discriminative test is used during the DHS laboratory analyses. According to the methodology of DHS in most West African countries, after the survey, the DBS are stored in the referral laboratory till the next DHS round. This survey will be conducted in collaboration with the national HIV program of each participating center. The DBS of HIV positive DHS participants will be collected in each country and transferred to the CEDRES in Côte d’Ivoire, were an indirect immuno-enzymatic test allowing the qualitative detection of both HIV-1 (gp120) and HIV-2 (gp36) antibodies will be performed. This test has been adapted from Francis Barin’s essay for HIV-1 (40), and has shown 98% specificity (41) and 80% concordance with real-time DNA PCR (18). It is approved by the French National AIDS Research Agency (ANRS) and routinely used in the reference laboratory of the study as homemade Elisa.

Project Summary

Human immunodeficiency virus type 2 (HIV-2) is a retrovirus responsible for an AIDS epidemic localized in West Africa, were the circulation of both HIV-1 and HIV-2 leads to co-infections with both viruses (HIV-1&2). The HIV-2 infection is characterized by a longer asymptomatic phase and a slower disease progression than HIV-1 infection, as well as the intrinsic resistance of HIV-2 to non-nucleoside reverse transcriptase inhibitors (NNRTIs). It is mandatory to differentiate HIV-1 from HIV-2 infection before initiating antiretroviral therapy (ART), but the diagnosis is still challenging, especially for the HIV-1 and HIV-2 dually infected individuals. It is then critical to explore new diagnosis algorithm based on routinely used HIV rapid tests, to ensure the peripheral diagnosis of patients dually infected in West Africa. Another challenge is the difficulty to describe the epidemiology of HIV-2 and dual infection in West Africa. The conflicting report on the epidemic trend of HIV-2 infection and the lack of updated data lead to low consideration for HIV-2 infected patients in the WHO guidelines for antiretroviral therapy. In the context of challenging access to integrase inhibitors in Africa, generating updated data on the epidemiology of HIV-2 infection is critical to enhance the advocacy and improve the holistic care of people living with HIV-2. Furthermore, the important mortality reported among HIV-2 infected individuals may be the consequence of immune activation and persistence of soluble biomarkers as demonstrated in HIV-1 infection. However, the role and mechanism of immunologic and inflammatory biomarkers on disease progression and prognosis of HIV-2 infected patients are still poorly understood. Thus, providing a better understanding of morbidity, disease progression and the role of soluble biomarkers in the prognosis of HIV-2 infected individuals could improve the holistic care of these patients. This research project will rely on the West African HIV-2 cohort, and the related biobank to (i) evaluate new diagnosis algorithm for HIV-1&2 dual infection, (ii) produce more accurate and updated epidemiologic data on HIV-2 infection and (iii) explore disease progression and prognostic role of immunologic and inflammatory markers in HIV-2 infection. A mix-method approach including longitudinal analysis, demographic survey sampling and geospatial modelling, as well as specific biological testing on biobank samples, will be developed during three-years research project. The accurate epidemiologic data, the improved diagnosis of HIV-2 patients and the better understanding of dynamics and correlates of disease progression that will arise from this project, will help inform specific guidelines for HIV-2 infection. This project is organized in three different axes, allowing the exploration of the main questions regarding HIV-2 infection. This configuration allow the recruitment of graduate students in epidemiology, immunology and biostatistics, who will be trained and have the opportunity to develop skill in research under the supervision of the fellow. Finally, the results and the scientific production expected from this grant will be essential for the career development of the fellow who will then established as senior researcher in his field.

Host Organisation

Department	Institution	Country
clinical and operational research	Programme PACCI	Cote D'ivoire

Sites

Centre intégré de Recherche bioclinique d'Abidjan (CIRBA) Centre Medical de Suivi des Donneurs de sang (CMSDS) Service des Maladies Infectieuses et Tropicales du CHU de Treichville (SMIT) Unite des soins ambulatoires et de conseil CHU de Treichville (USAC) Centre de Prise en charge de recherche et de Formation (CePReF) CHU sourou Sanou Hopital du jour Bobo dioulasso

Current Organisation

Elizabeth Glazer Pediatric AIDS Foundation / PACCI Research Center

Current Job Title

Associate Director of Public Health Evaluation / Project Coordinator

Biography

Publications

Authors:

Phillipe Lepère Yélamikan Touré Alexandra M Bitty-Anderson Simon P Boni Gildas Anago Boris Tchounga Pendadiago Touré Albert Minga Eugène Messou Guillaume Kanga Serge Koule Armel Poda Alexandra Calmy Didier K Ekouevi Patrick A Coffie

Journal:

JMIR mHealth and uHealth

Content:

Date:

2019-11-13

Authors:

Journal:

BMC infectious diseases

Content:

In West Africa where HIV-1 and HIV-2 co-circulate, the co-infection with hepatitis B virus (HBV) and hepatitis Delta virus (HDV) is not well described. This study aimed at estimating the prevalence of HBV and HBV/HDV co-infection according to HIV types and risk factors for HBV infection among West African HIV-infected patients.A cross-sectional survey was conducted within the IeDEA West Africa cohort from March to December 2012 in Côte d'Ivoire (three sites), Burkina Faso and Mali (one site each). All HIV-infected adult patients on antiretroviral therapy (ART) or not who attended one of the participating HIV clinics during the study period and agreed to participate were included. Blood samples were collected and re-tested for HIV type discrimination, HBV and HDV serology as well as HBV viral load. Logistic regression was used to identify risk factors for HBV infection.A total of 791 patients were included: 192 HIV-1, 447 HIV-2 and 152 HIV-1&2 dually reactive. At time of sampling, 555 (70.2%) were on ART and median CD4+ cell count was 472/mm3 (inter-quartile range [IQR]: IQR: 294-644). Sixty-seven (8.5%, 95% CI 6.6-10.6) patients were HBsAg positive without any difference according to HIV type (7.9% in HIV-1, 7.2% in HIV-1&2 dually reactive and 9.4% in HIV-2; p = 0.61). In multivariate logistic analysis, age ≤ 30 years old (adjusted odds ratio [aOR] 5.00, 95% CI 1.96-12.76), age between 31 and 49 years old (aOR 1.78, 95% CI 1.00-2.21) and male gender (aOR 2.15, 95% CI 1.25-3.69) were associated with HBsAg positivity. HBV DNA testing was performed in 36 patients with blood sample available (25 on ART) and 8 (22.2%) had detectable HBV DNA. Among the HBsAg-positive individuals, 14.9% (95% CI 7.4-25.7) were also positive for anti-HDV antibody without any difference according to HIV type (28.6% in HIV-1, 14.3% in HIV-2 and 0.0% in HIV-1&2 dually reactive; p = 0.15).HBV and HBV/HDV co-infection are common in West Africa, irrespective of HIV type. Therefore, screening for both viruses should be systematically performed to allow a better management of HIV-infected patients. Follow-up studies are necessary to determine the impact of these two viruses on HIV infection.

Date:

2017-07-04

Authors:

Boris K. Tchounga

Journal:

Plos One

Content:

Introduction

The long-term prognosis of HIV-2-infected patients receiving antiretroviral therapy (ART) is still challenging, due to the intrinsic resistance to non-nucleoside reverse transcriptase inhibitors (NNRTI) and the suboptimal response to some protease inhibitors (PI). The objective was to describe the 5-years outcomes among HIV-2 patients harboring drug-resistant viruses.

Methods

A clinic-based cohort of HIV-2-patients experiencing virologic failure, with at least one drug resistance mutation was followed from January 2012 to August 2017 in Côte d’Ivoire. Follow-up data included death, lost to follow-up (LTFU), immuno-virological responses. The Kaplan-Meier curve was used to estimate survival rates.

Results

A total of 31 HIV-2 patients with virologic failure and with at least one drug resistance mutation were included. Two-third of them were men, 28(90.3%) were on PI-based ART-regimen at enrolment and the median age was 50 years (IQR = 46–54). The median baseline CD4 count and viral load were 456 cells/mm³ and 3.7 log₁₀ c/mL respectively, and the participants have been followed-up in median 57 months (IQR = 24–60). During this period, 21 (67.7%) patients switched at least one antiretroviral drug, including two (6.5%) and three (9.7%) who switched to a PI-based and an integrase inhibitor-based regimen respectively. A total of 10(32.3%) patients died and 4(12.9%) were LTFU. The 36 and 60-months survival rates were 68.5% and 64.9%, respectively. Among the 17 patients remaining in care, six(35.3%) had an undetectable viral load (<50 c/mL) and for the 11 others, the viral load ranged from 2.8 to 5.6 log₁₀ c/mL. Twelve patients were receiving lopinavir at the time of first genotype, five(42%) had a genotypic susceptibility score (GSS) ≤1 and 4(33%) a GSS >2.

Conclusions

The 36-months survival rate among ART-experienced HIV-2 patients with drug-resistant viruses is below 70%,lower than in HIV-1. There is urgent need to improve access to second-line ART for patients living with HIV-2 in West Africa

Date:

2020-08-05

Authors:

Journal:

Revue d'epidemiologie et de sante publique

Content:

BACKGROUND: Limited data are available on HIV infection among vulnerable populations in sub-saharan African countries, especially among men who have sex with men (MSM). The aim of this study was to estimate HIV prevalence and the factors associated with HIV infection among MSM in Togo in 2011. METHOD: A cross-sectional survey was carried out among MSM aged at least 18years old, living in Togo for at least 3months. They were recruited through the snowball method in six cities of Togo from November 2011 to January 2012. A survey form was used and an HIV screening test was proposed to the participants. The HIV prevalence was estimated with a 95% confidence interval. Univariate and multivariate analyses were performed to identify factors associated with HIV infection. RESULTS: A total of 758 MSM were enrolled in this study, including 498 (67.5%) from Lomé, the capital of Togo. The median age was 24years with an interquartile range of [21-27years] and 271 MSM (35.7%) were students. The vast majority of MSM were Togolese (90.3%) and 14.6% were married or committed to a woman. HIV testing was accepted by 488 MSM (64.3%) but only 408 (53.8%) finally accepted a blood sample collection. The prevalence of HIV infection was 19.6% [95% confidence interval, 15.9-23.8]. In multivariate analysis, three factors were associated with HIV infection: living in Lomé, with an HIV prevalence of 29.8% against 4.3% in the other cities of Togo [adjusted odds ratio (aOR)=9.68; P<0.001]; having a good knowledge of HIV transmission modes (aOR=0.59; P=0.049); and not having a regular sex partner (aOR=1.69; P=0.049). CONCLUSION: One MSM out of five was HIV-infected. Intervention programs targeting this vulnerable population are urgently needed, to reduce HIV incidence in Togo.

Date:

2014-03-06

Authors:

Journal:

Sante publique (Vandoeuvre-les-Nancy, France)

Content:

Stigma and discrimination experienced by people living with HIV (PLWHA) prevent and delay access to prevention and treatment services. The aim of this study was to describe the patterns of stigma and discrimination experienced by PLWHA in Togo and to identify the associated factors.A cross-sectional study was conducted in 2013 among PLWHA in Togo in order to collect data on stigma or discrimination experiences. Univariate and multivariate analyses were performed to identify associated factors.A total of 891 PLWHA were interviewed, including 848 (95.2%) receiving antiretroviral therapy. External stigma (37.9%) was the major form of stigmatization followed by internalized stigma (35.4%). The main features of external stigma were gossip (36.5%) and issues to access education (36.0%). Internalized stigma mainly consisted of a feeling of guilt (37.6%) and self-devaluation (36.0%). In univariate and multivariate analysis, female gender was significantly associated with stigma (aOR = 1.73, 95% CI [1.08-2.77]). Of the 891 PLWHA, 75 (8.4%) reported a violation of their rights. Finally 27 (4.1%) were discouraged from having children by a health professional because of their HIV status.Stigma affects more than one-third of PLWHA in Togo, more particularly females. It appears necessary to design new interventions and integrate psychosocial care in the management of PLWHA, in addition to antiretroviral therapy.

Date:

2017-11-01

Authors:

Ekouévi DK Avettand-Fènoël V Tchounga BK Coffie PA Sawadogo A Minta D Minga A Eholie SP Plantier JC Damond F Dabis F Rouzioux C IeDEA West Africa collaboration

Journal:

Content:

Date:

2015-01-01

Authors:

Journal:

Sexually transmitted infections

Content:

BACKGROUND:Cervical cancer prevention strategies recommend human papilloma virus (HPV) vaccination for female adolescents prior to their sexual debut. While HIV is a major risk factor for HPV infection in women of childbearing age, its prevalence among HIV-infected adolescent female is mostly unknown. This study aimed to describe the HPV prevalence and correlates among perinatally HIV-infected adolescent females prior to HPV immunisation. METHODS:A cross-sectional survey was conducted from January to June 2016, in the four major paediatric HIV clinics of Abidjan, Côte d'Ivoire. All HIV-infected females aged 11-16 years were approached to participate in the study. A questionnaire assessing sexual behaviours and genital hygiene practices was administered to participants completed with a systematic vaginal swab collection. HPV genotyping was performed using the Anyplex II HPV28 Detection (Seegene). A logistic regression analysis was performed to identify factors associated with the presence of HPV infection. HPV immunisation was proposed free of charge to all participants. RESULTS:A total of 250 participants were included, with a median age of 13 years (IQR 11-14). Among them, 237 (94.8%) were on antiretroviral treatment with a median CD4 count of 660 (IQR 439-914) cells/mm3. The overall prevalence of at least one HPV was 3.6% (95% CI 1.6 to 6.7) and the prevalence of at least one carcinogenic HPV was 2.8% (95% CI 0.7 to 4.8). Vaginal cleansing was reported by 75 (30%) of participants, with a median age at initiation of 12 years (IQR 10-13). Sexual activity was self-reported by 12 (4.8%) participants with a median age at sexual debut of 11 years (IQR 10-14). HPV infection was associated with vaginal cleansing (adjusted OR=7.0 (95% CI 1.4 to 31.6)). CONCLUSION:The reported low prevalence of carcinogenic HPV infections supports the appropriateness of HPV immunisation in this population. The reported association between cleansing practices and HPV infection deserves further prospective longitudinal studies.

Date:

2020-07-13

Authors:

Tchounga BK Ekouevi DK Eholie SP

Journal:

Content:

Date:

2015-01-01

Authors:

Journal:

Journal of public health in Africa

Content:

Little is known on the impact of HIV-2 infection on HCV viral replication. The aim of the study was to compare HCV prevalence and viral replication based on HIV types in West Africa. A cross-sectional survey was conducted within the IeDEA HIV-2 West Africa cohort from March to December 2012. All HIVinfected adult patients who attended participating HIV clinics during the study period were included. Blood samples were collected and re-tested for HIV type discrimination, HCV serology and viral load. A total of 767 patients were enrolled: 186 HIV-1, 431 HIV-2 and 150 HIV-1&2 dually reactive. At time of sampling, 531 (69.2%) were on ART and median CD4+ cell count was 472/mm3. Thirty (3.9%, 95% CI 2.7-5.5) patients were anti-HCV positive (4.3% in HIV-1, 4.0% in HIV-1&2 dually reactive and 3.7% in HIV-2; p=0.91). Detectable HCV RNA was identified in 21 (70.0%) patients (100% in HIV-1 and HIV- 1&2 dually reactive vs. 43.8% in HIV-2; p=0.003). Systematic screening should be promoted and performed in this population, since HCV is now potentially curable in sub- Saharan Africa.

Date:

2018-10-10

Authors:

Horo AG Didi-Kouko Coulibaly J Koffi A Tchounga B Seni K Aka KE Kone M

Journal:

Content:

Date:

2015-01-01

Authors:

Tchounga BK Hønge BL Eholie SP Coffie PA Jespersen S Wejse C Dabis F Geoffrey GS Ekouevi DK IeDEA West Africa collaboration

Journal:

Content:

Date:

2016-11-01

Authors:

Journal:

International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics

Content:

OBJECTIVE:To report the successes and challenges of scaling up a population-based cervical cancer (CC) screening program from HIV clinics to various healthcare facilities in Abidjan, Côte d'Ivoire. METHOD:A retrospective analysis of characteristics, outcomes, and follow-up of women attending an initial CC screening visit in Abidjan between January 2010 and December 2014. Data were collected via forms that were systematically completed during CC screening visits. Data from the 2014 population census were used to estimate screening coverage. RESULTS:Among 16 169 women attending an initial CC screening, 1616 (10.0%) had a positive VIA test. Among 848 women eligible for immediate cryotherapy, 618 (72.9%) underwent the "see-and-treat" approach. The 1-year follow-up rate after cryotherapy was 23.1% (143/618), and was higher among women with HIV (111/362, 30.7%) than among other women (32/256, 12.5%) (P=0.001). The estimated coverage of CC screening in Abidjan was 1.2% (95% confidence interval, 0.6-3.1). CONCLUSION:Despite successful expansion of CC screening from HIV clinics to other facilities, the estimated screening coverage of the targeted population remained low. Follow-up of positively screened and treated women is a major challenge, especially outside HIV clinics, and would benefit from an innovative information system proving unique identification and tracking systems.

Date:

2019-09-17

Authors:

Nouaman MN Meless DG Coffie PA Arrivé E Tchounga BK Ekouévi DK Anoma C Eholié SP Dabis F Jaquet A IeDEA West Africa collaboration

Journal:

Content:

Date:

2015-12-01

Authors:

Balestre E Ekouevi DK Tchounga B Eholie SP Messou E Sawadogo A Thiébaut R May MT Sterne JA Dabis F International Epidemiological Database to Evaluate AIDS (IeDEA) West Africa Collaboration

Journal:

Content:

Date:

2016-01-01

Authors:

Ekouevi DK D'almeida S Salou M Kariyiare BG Coffie PA Dagnra AC Tchounga B Becquet R Prince-David M Pitche VP

Journal:

Content:

Date:

2013-07-01

Authors:

Journal:

PloS one

Content:

BACKGROUND:In Côte d'Ivoire, people living with HIV (PLHIV) have free access to antiretroviral therapy (ART) and cotrimoxazole. Yet, they may use other medications to treat non-HIV diseases. Scarce data are available regarding the use of non-HIV medications in Africa. This study describes the use of non-HIV medications and identifies the factors associated with their use by PLHIV on ART in Côte d'Ivoire. METHODS:A cross-sectional study was conducted in six HIV clinics in 2016. HIV-1-infected adults receiving ART for at least one year were eligible. A standardized questionnaire was used to collect demographics, HIV characteristics and medication use data. Associated factors were identified using a multivariate adjusted Poisson regression. RESULTS:A total of 1,458 participants (74% women) were enrolled. The median age was 44 years, and the median duration of ART was 81 months. A total of 696 (48%) participants reported having used at least one non-HIV medication. Among the 1,519 non-HIV medications used, 550 (36%) had not been prescribed and 397 (26%) were from the nervous system class. Individuals who were more likely to report the use of at least one non-HIV medication included those who had been treated in an Abidjan HIV clinic, had a high school education level, had a monthly income between 152 and 304 euros, had a poor perceived health status, had WHO advanced clinical stage, had used traditional medicine products and had not used cotrimoxazole. CONCLUSION:Almost half PLHIV on ART reported using non-HIV medication. Further research is needed to assess whether the use of non-HIV medication is appropriate given about a third of those medications are not being prescribed.

Date:

2019-09-16

Authors:

Journal:

Journal of acquired immune deficiency syndromes (1999)

Content:

BACKGROUND:Most HIV-exposed infants access early infant diagnosis (EID) through the prevention of mother-to-child transmission (PMTCT) service points. However, there are limited data on HIV positivity in non-PMTCT health care settings (pediatric wards, emergency departments, outpatient departments, tuberculosis clinics, etc.). The introduction of point-of-care testing provided an opportunity to describe HIV positivity at alternative health service points and associated risk factors. METHODS:We performed a cross-sectional subanalysis with data from 58 health facilities in Cameroon. The risk of a child being HIV positive at a health service point was considered as a dependent variable, and exploratory variables were assessed using multivariate models with a significance level of 0.05. RESULTS:Overall, 2254 HIV-exposed infants identified by clinical or biological screening were tested by polymerase chain reaction using point-of-care EID. Approximately 74.3% of the infants were tested at a PMTCT entry point, whereas 25.7% were tested at non-PMTCT service points. The positivity yield was 5.7% (95 of the 1674) at the PMTCT service point and 17.6% (102 of the 580) at non-PMTCT service points. Non-PMTCT service points [adjusted odds ratio (aOR): 1.95; 95% confidence interval (CI): 1.36 to 2.80] and vaginal delivery (aOR: 2.56; 95% CI: 1.25 to 5.25) were independently associated with HIV positivity. In a separate analysis (infants aged 0-6 months), mixed feeding mode (aOR: 3.68; 95% CI: 2.00 to 6.77) was also associated with HIV positivity. CONCLUSIONS:More than half of children newly identified as HIV-positive were tested at non-PMTCT service points. The highest EID positivity yields were found in non-PMTCT service points. Strengthening HIV testing in non-PMTCT service points may help to identify additional infected children and improve timely initiation of treatment and care.

Date:

2020-07-01

Authors:

Tchounga BK Inwoley A Coffie PA Minta D Messou E Bado G Minga A Hawerlander D Kane C Eholie SP Dabis F Ekouevi DK WADA Collaboration

Journal:

Content:

Date:

2014-01-01

Authors:

Tchounga B Ekouevi DK Balestre E Dabis F

Journal:

Content:

Date:

2016-09-01

Authors:

Journal:

Medecine et sante tropicales

Content:

Digital health has the potential to strengthen health systems and empower patients to prevent ill health and manage their own care. To confirm this potential, however, it is urgent to shift from pilot studies to the implementation of programs at a sufficient scale, with interoperable solutions and integrated into the national health system, while respecting human rights. It is also important to plan for studies to demonstrate the impact and produce the necessary evidence. Francophone sub-Saharan Africa can catch up in this area.

Date:

2017-11-01

Authors:

Journal:

BMC public health

Content:

BACKGROUND:Tuberculosis is among the top-10 causes of mortality in children with more than 1 million children suffering from TB disease annually worldwide. The main challenge in young children is the difficulty in establishing an accurate diagnosis of active TB. The INPUT study is a stepped-wedge cluster-randomized intervention study aiming to assess the effectiveness of integrating TB services into child healthcare services on TB diagnosis capacities in children under 5 years of age. METHODS:Two strategies will be compared: i) The standard of care, offering pediatric TB services based on national standard of care; ii) The intervention, with pediatric TB services integrated into child healthcare services: it consists of a package of training, supportive supervision, job aids, and logistical support to the integration of TB screening and diagnosis activities into pediatric services. The design is a cluster-randomized stepped-wedge of 12 study clusters in Cameroon and Kenya. The sites start enrolling participants under standard-of-care and will transition to the intervention at randomly assigned time points. We enroll children aged less than 5 years with a presumptive diagnosis of TB after obtaining caregiver written informed consent. The participants are followed through TB diagnosis and treatment, with clinical information prospectively abstracted from their medical records. The primary outcome is the proportion of TB cases diagnosed among children < 5 years old attending the child healthcare services. Secondary outcomes include: number of children screened for presumptive active TB; diagnosed; initiated on TB treatment; and completing treatment. We will also assess the cost-effectiveness of the intervention, its acceptability among health care providers and users, and fidelity of implementation. DISCUSSION:Study enrolments started in May 2019, enrolments will be completed in October 2020 and follow up will be completed by June 2021. The study findings will be disseminated to national, regional and international audiences and will inform innovative approaches to integration of TB screening, diagnosis, and treatment initiation into child health care services. TRIAL RESISTRATION:NCT03862261, initial release 12 February 2019.

Date:

2020-05-06

Authors:

Tchounga BK Jaquet A Coffie PA Horo A Sauvaget C Adoubi I Guie P Dabis F Sasco AJ Ekouevi DK

Journal:

Content:

Date:

2014-04-01

Authors:

Boris K. Tchounga Cristian Apetrei Charlotte Charpentier Patrick A. Coffie François Dabis Diane Descamps Serge P. Eholie Didier K. Ekouevi

Journal:

PLOS ONE

Content:

Date:

2020-08-05

Authors:

Journal:

Archives de pediatrie : organe officiel de la Societe francaise de pediatrie

Content:

BACKGROUND: Early infant diagnosis of HIV is the key step for the early initiation of HAART among HIV-exposed children. The aim of this study was to estimate the proportion of children born to mothers infected with HIV who completed the early infant HIV diagnosis process and the factors associated with this complete process. METHODS: We conducted a retrospective cohort study at Tokoin University Hospital in the pediatrics ward. This study included all HIV-exposed children born between July 2009 and June 2011. The association between the mother's, spouse's, and child's characteristics as well as access to early HIV diagnosis by PCR (blood collection and reporting of results before the 6months of age) was studied using logistic regression analysis. RESULTS: A total of 455 HIV-exposed children were included: for 52.7%, the first test was PCR, 99 of them received their results, 59 of whom received their results before the 6th month of life (undergoing the complete process). In multivariate analysis, the only factor associated with the complete process of early HIV diagnosis was the maternal age≥28years (adjusted odds ratio, 1.75, 95% CI [1.18-2.76]). CONCLUSION: The availability of early infant PCR diagnosis remains a challenge and innovative strategies must be implemented.

Date:

2014-08-28

Authors:

Journal:

International journal of cancer

Content:

Hepatocellular carcinoma (HCC) is a leading cause of cancer in West Africa where HBV infection is endemic. However, limited information is available on other risk factors such as alcohol use, HCV and HIV infection. A case-control study was conducted in referral hospitals of Abidjan (Cote d'Ivoire), Bamako (Mali) and Lome (Togo). Cases were matched with controls on age, gender and participating site. The diagnosis of HCC relied on the combination of one or more space-occupying lesions suggestive of an HCC on a standardized abdominal ultrasound and an α-fetoprotein level ≥400 ng/ml. HIV, HBV and HCV serology were performed. Hazardous alcohol use was assessed using the AUDIT questionnaire. A conditional logistic regression model was used to measure odds ratio (OR) with their 95% confidence intervals (CI). A total of 160 cases and 320 controls were included. Cases were predominantly men (80.0%) with a median age of 47 years (IQR 38-57). Hazardous alcohol use (OR = 4.5 [CI 1.1-18.5]), HBV infection (OR = 62.5 [CI 20.5-190.7]) and HCV infection OR = 35.9 [CI 10.0-130.3]) were independently associated with HCC. Combining the effect of HBV infection and alcohol, HBV-infected hazardous drinkers had an OR = 149.8 (CI 13.5-1 667.0), HBV mono-infected had an OR = 57.4 (CI 18.8-175.3) (ref: HBV-negative). Aside the independent association of alcohol use and HBV and HCV infection with HCC, a synergic effect between alcohol use and HBV infection was identified. Timely screening and care of HBV infection and hazardous drinking might prevent a significant number of HCC in West Africa.

Date:

2018-04-10

Authors:

Journal:

Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases

Content:

OBJECTIVES:Sub-Saharan Africa is a region with high incidence of both human immunodeficiency virus (HIV) and cervical cancer. We conducted the first national study in Togo to assess prevalence of human papillomavirus (HPV), HIV and other sexually transmitted infections (STIs) among female sex workers (FSW). METHODS:A multicentric cross-sectional study was conducted among FSW recruited in hot spots (clubs, streets) in four Togolese cities. HPV and STIs were tested from cervical and anal swabs. HIV and syphilis were screened with rapid tests. RESULTS:In all, 310 FSW were recruited; HIV and cervical high-risk HPV (hrHPV) prevalence were 10.6% (33/310) and 32.9% (102/310), respectively. The most frequent hrHPV types were HPV58 (13.6%, 19/140), HPV35 (12.9%, 18/140), HPV31 (12.1%, 17/140) and HPV16 (10.7%, 15/140). Prevalence of hrHPV and multiple hrHPV infections showed higher rates in HIV-positive than in HIV-negative FSW (48.5% versus 31.0%, p 0.04 and 21.2% versus 9.0%, p 0.03; respectively). Prevalence of hrHPV was higher in cervical than anal swabs (34.1% versus 20.7%, p 0.0004). High-risk HPV anal infections were more frequent among HIV-positive than HIV-negative FSW (51.9% versus 17.3%, p 2 × 10-5). Concomitant anal and cervical hrHPV infections were present in 43.2% (41/95) of hrHPV-positive FSW. Overall prevalence in the cervix of Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium and Trichomonas vaginalis were 4.2%, 6.1%, 5.5% and 6.5%, respectively. CONCLUSIONS:This first African study on paired cervical and anal samples showed a high prevalence of genital HPV infections with a rather high rate of concomitant HPV infections but low type concordance. We report an unusual distribution of hrHPV types. These findings highlight the critical need for implementation of a national HPV vaccination strategy.

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2019-04-30

Authors:

Ekouevi DK Coffie PA Salou M Kariyiare BG Dagnra AC Tchounga B Prince-Davi M Becquet R Pitche VP

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2013-01-01

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Boris K. TchoungaID 1¤a * Charlotte Charpentier2 Patrick A. Coffie3 Franc¸ois Dabis4¤ b Diane Descamps2 Serge P. Eholie3 Didier K. Ekouevi4¤ c

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2020-01-01

Authors:

Bakai TA Ekouevi DK Tchounga BK Balestre E Afanvi KA Goilibe KB Kassankogno Y Pitche VP

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2016-01-01

Authors:

Boris Tchounga Simon Pierre Boni Jean Jacques Koffi Apollinaire G Horo Aristophane Tanon Eugène Messou Serge-Olivier Koulé Innocent Adoubi Didier K Ekouevi Antoine Jaquet

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BMJ Open

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2019-08-01

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BMC infectious diseases

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Few data are available on antiretroviral therapy (ART) response among HIV-2 infected patients. We conducted a systematic review on treatment outcomes among HIV-2 infected patients on ART, focusing on the immunological and virological responses in adults.Data were extracted from articles that were selected after screening of PubMed/MEDLINE up to November 2012 and abstracts of the 1996-2012 international conferences. Observational cohorts, clinical trials and program reports were eligible as long as they reported data on ART response (clinical, immunological or virological) among HIV-2 infected patients. The determinants investigated included patients' demographic characteristics, CD4 cell count at baseline and ART received.Seventeen reports (involving 976 HIV-2 only and 454 HIV1&2 dually reactive patients) were included in the final review, and the analysis presented in this report are related to HIV-2 infected patients only. There was no randomized controlled trial and only two cohorts had enrolled more than 100 HIV-2 only infected patients. The median CD4 count at ART initiation was 165 cells/mm3, [IQR; 137-201] and the median age at ART initiation was 44 years (IQR: 42-48 years). Ten studies included 103 patients treated with three nucleoside reverse transcriptase inhibitors (NRTI). Protease inhibitor (PI) based regimens were reported by 16 studies. Before 2009, the most frequent PIs used were Nelfinavir and Indinavir, whereas it was Lopinavir/ritonavir thereafter. The immunological response at month-12 was reported in six studies and the mean CD4 cell count increase was +118 cells/μL (min-max: 45-200 cells/μL).Overall, clinical and immuno-virologic outcomes in HIV-2 infected individuals treated with ART are suboptimal. There is a need of randomized controlled trials to improve the management and outcomes of people living with HIV-2 infection.

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2014-08-26

Dr Boris Kevin Tchounga

Related fellows

Ms Emily Awuor Abuonji

Dr Obinna Ekwunife

Dr Zivai Nenguke

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Dr
Boris Kevin Tchounga