bluuebunny/crossref_metadata_2025_split huggingface dataset:
PO 8481 HIGH HEPATITIS B VIRUS INCIDENCE AMONG HIV-1-INFECTED TREATMENT-NAIVE ADULTS IN BOTSWANA
Authors: Phinius Bonolo B , Bokete Resego , Anderson Motswedi , Mbangiwa Tshepiso , Choga Wonderful , Moyo Sikhulile , Musonda Rosemary , Marlink Richard , Gaseitsiwe Simani 
Published: April 2019

BackgroundHepatitis B virus (HBV) is one of the leading causes of death worldwide despite a moderately potent vaccine. HBV prevalence has been shown to be higher in patients infected with the human immunodeficiency virus (HIV), hence increased liver-related morbidity and mortality, as well as general poor health outcomes in HIV-HBV co-infection. We estimated the HBV incidence among HIV-1-infected treatment-naïve adults in a longitudinal cohort in Botswana.MethodsPlasma samples from 200 HIV-1C-infected treatment-naïve participants from a completed longitudinal cohort from 2004 to 2007 were screened for HBV surface antigen (HBsAg). HBsAg was assessed using Murex version 3 enzyme-linked immunosorbent assay as per manufacturer’s instructions at 4 timepoints, 12 months apart. We estimated HBV incidence with 95% confidence interval (CI). Cox proportional regression method was used to estimate hazard ratios [gender, age (≤35 or>35) years, CD4+T cell count (≤450 or>450) cells/µL and HIV viral load suppression (≤400 or>400) copies/mL].ResultsThe median age of screened individuals was 32 years [Q1, Q3; 28, 40] and 83.5% [167/200] were female. Baseline median CD4+T cell count was 466.35 cells/µL [Q1, Q3: 380.43, 605.75] and median HIV viral load was 13 450 copies/mL [Q1, Q3: 2365, 37 400]. The HBV incidence was 3.6/100 person-years [95% CI: 2.2–5.6]. There were no significant differences by gender, age, HIV viral load suppression and CD4+T cell count.ConclusionWe report for the first time a high HBV incidence among HIV-infected adults in Botswana. HBV incidence was high in this population despite generally high CD4 +T cell counts and lower HIV viral loads. Early screening of HBV in HIV-infected individuals is vital and should be included in the national HIV treatment guidelines.
PO 8504 EFFECT OF INCREASED USER FEES IN ACCESSING NEW TUBERCULOSIS DIAGNOSTIC SERVICES IN TANZANIA
Authors: Ngadaya Esther , Kimaro Godfather , Shemtandulo Ramadhani , Sandi Erica , Simsokwe Sunday , Nguma Oliva , Kibwana Omari , Mgina Nicholaus , Mfinanga Godfrey S 
Published: April 2019

BackgroundWhile user fees in healthcare systems have been associated with quality improvement, a substantial increase may have a detrimental effect. This paper reports on the effects of increasing user fees on utilisation of TB diagnostic services in Tanzania.MethodsWe retrospectively analysed data on TB diagnostic services utilisation between July 2013 and June 2015 in Mnazi Mmoja Zanzibar (MMZ), Musoma and Sumbawanga hospitals. In July 2014, user fees in Musoma were increased substantially from 2 to 5 US dollar; Sumbawanga increased the fees stepwise, from 1 to 2 US dollar in July 2014, and from2 to 3 US dollar in January 2015 MMZ did not raise the fees. We compared TB services utilisation before and after introduction of user fees.ResultsOut of 7483 presumptive TB patients registered in all sites, 50.2% were males. Over half (3969) were registered before the user fee was increased. Among 3969, 1579 (39.8%) were from Musoma, 922 (23.2%) from Sumbawanga and 1468 (37.0%) from MMZ. Of the 3514 patients registered after the introduction of user fees, 983 (28%), 952 (27.1%) and 1579 (44.9%) patients were from Musoma, Sumbawanga and MMZ, respectively. The number of presumptive TB patients seeking TB diagnostic services at Musoma decreased significantly by 38% from 1579 to 983 after the increase of user fees (p=0.001). More females (817; 51.8% vs 458, 35.9%) attended Musoma before user fees were increased as compared to males whose attendance did not differ much (761; 48.2% vs 525; 53.4%); (p=0.01). There was no significant decrease of patients at Sumbawanga and MMZ.ConclusionThere was a significant decrease in the number of presumptive TB patients who accessed new TB diagnostic services in Musoma after a substantial increase of user fees, the effect was stronger among women. Although user fees are beneficial, they should be increased stepwise so as not to affect service utilisation.
PO 8529 INTRODUCING A UNIQUE RESEARCH CAPACITY DEVELOPMENT PLATFORM SUPPORTING PREPAREDNESS FOR EFFECTIVELY COMBATING EPIDEMIC OUTBREAKS
Authors: Jamieson Nina , Lang Trudie 
Published: April 2019

BackgroundIn 2013, WHO stated that unless low-income countries become the generators, rather than the recipients, of health research data there will never be any real improvement in the devastating public health challenges these countries face. The Global Health Network was cited as an important agent for change in addressing this need.The Global Health Network built an innovative digital platform, generating and supporting communities of practice focused on global health research. We have established a vast online knowledge-sharing resource, so far visited by more than 1.5 million frontline healthcare workers and researchers globally. Over 400,000 times online modules were taken by users from our target countries using our Training Centre, which offers a wide range of high-quality research skills courses. We also support skills development through regionally-led activities. Here we present how our approach is applied to support preparedness for epidemic outbreaks in Africa.MethodsA community of practice was set up for the EDCTP2 ALERRT programme on The Global Health Network platform (https://alerrt.tghn.org/). It provides a mechanism for research staff to work together, share ideas, methods and approaches to foster knowledge exchange and collaboration. The ALERRT community of practice platform hosts training courses, help topics, templates, guidance – everything that is needed to run a good clinical study. The initial set of resources is available now, others are being developed following the knowledge gap analysis. In addition, our online platform offers free participation in the Professional Development Scheme – a unique framework to track research skills development.ResultsThe ALERRT capacity development community of practice was launched in April 2018. We will present how this regionally-championed initiative is being taken up and what difference it is already making to the community of researchers.
PO 8536 BIOMEDICAL ETHICS AND REGULATORY CAPACITY BUILDING PARTNERSHIP FOR PORTUGUESE-SPEAKING AFRICAN COUNTRIES (BERC-LUSO)
Authors: do Céu Patrão Neves Maria , A Ribeiro Maria , S Carvalho Ana , Araújo Joana , Oliveira Martins Sofia , P Martins Ana , Mota Helder Filipe , Rhodes Baião Luís , Batista Jorge , Morais Afonso Joana De , Mangueira Katiza , D Reis Carla , Na Banga Cunhate , Sitoie Tânia 
Published: April 2019

BERC-Luso is a project for building Ethics and Regulatory Capacity, to be developed in four sub-Saharan African countries: Angola, Guinea-Bissau, Mozambique and Cape Verde, and to be implemented in 2018–2021. National Ethics Committees (NECs) and National Regulatory Authorities (NRAs) have been engaged (6 institutions) with the partnership of 4 Portuguese institutions (experts in ethical review and regulatory supervision).Considering that: 1) clinical trials are fundamental to improve healthcare and develop biomedical research; but 2) can only take place within regulatory systems and under ethical review protocols; and 3) some African countries still lack an adequate legislative framework and the expertise to assure good ethical review and regulatory supervision, it is urgent to change the current situation.The BERC-Luso project will unfold at four different levels, each aiming at a specific goal in converging dynamics.Legislative level: Presentation of a comparative study ofthe Portuguese Speaking African Partner Countries’ legislation on NECs and NRAs with recommendations for revision in compliance with the international requirements. The goal is to promote adequate internationally recognised legislation.Educational level: Implementation of an intensive and comprehensive Education Programme, both theoretical and practical, reflexive and normative, ethical and legal, addressing the needs of the countries involved, within their cultural contexts, and in their own mother tongue. The goal is to promote capacity building.Training level: Organisation of intensive internships, demanding participants to accurately apply everything they have learned to their everyday practice. The goal is to have knowledgeable and skilled experts.Networking level: Build powerful digital tools to connect partner institutions, staff and participants during the project and beyond, creating a digital repository of documents, and different tools for ethical and regulatory evaluation.These actions converge to provide internationally recognised legislation and expertise for the development of biomedical research for the benefit of the population.
PO 8538 STRENGTHENING SOCIAL STRATEGIES TO ENGAGE SUB-SAHARAN AFRICAN SOCIETIES TO VALUE CLINICAL RESEARCH: THE EXPERIENCE IN CONDUCTING CLINICAL TRIALS IN LAMBARéNé
Authors: C Angoissa Minsoko Pamela , T Agnandji Selidji 
Published: April 2019

BackgroundOver the last two decades, clinical research activities have increased significantly in sub-Saharan Africa but societal engagement to make research socially and economically valuable is limited. Thus, engaging communities when designing clinical research and promoting social impacts of research are becoming key objectives among stakeholders involved in clinical research in sub-Saharan Africa. However, there is a need to define concepts and indicators to assess the strength of community engagement as well as the social impacts of clinical research.Here, we hypothesised that the social meanings of willingness to participate and compliance to clinical trial procedures are relevant indicators to assess community engagement.MethodsWe conducted a retrospective, prospective case study of clinical trials conducted in CERMEL between 1995 and 2017. We performed a social meaning framework analysis of the following processes: protocol design, ethical and regulatory clearance, informed consent and medical study procedures. We identified the social meanings of each procedure according to the involvement of social components (actors, ideas, communication strategies).ResultsA total of 42 clinical trials were identified in the ClinicalTrials.gov and Pan-African Clinical Trials Registry databases and confirmed by the top management of CERMEL. Between 1995 and 2004, there was little social meaning connected to trial procedures. This period was associated with poor compliance to study procedures. Between 2005 and 2017, compliance to study procedures improved. Detailed results will be presented during the meeting.ConclusionThe rise in willingness to participate in clinical research and improved compliance with study procedures were associated with the introduction of social components to medical procedures. Both indicators may be relevant to assess the strength of community engagement.
OC 8435 MULTI-BIOMARKER TEST STRIP FOR POINT-OF-CARE SCREENING FOR ACTIVE TUBERCULOSIS: A FIVE-COUNTRY MULTI-CENTRE TEST EVALUATION
Authors: Corstjens Paul , Hooij Anouk Van , Tjon Kon Fat Elisa , Herdigein Shannon , Namuganga Anna Ritah , Diergaardt Azaria , Mutavhatsindi Hygon , Gindeh Awa , Mihret Adane , Van De Spuy Gian , Gunther Gunar , Howe Rawleigh , Mayanja-Kizza Harriet , Sutherland Jayne , Chegou Novel N , Ottenhoff Tom , Walzl Gerhard , Geluk Annemieke 
Published: April 2019

BackgroundInexpensive rapid screening tests that can be used at the point-of-care (POC) are vital to combat tuberculosis. Particularly, less invasive non-sputum-based biomarker tests for all TB forms can help controlling transmission. Availability of such tests would significantly accelerate and streamline diagnostic approaches, improve cost-efficiency and decrease unnecessary costly GeneXpert referrals.MethodsMulti-biomarker test (MBT) devices measuring levels of selections of up to six serum proteins simultaneously on a single lateral flow (LF) strip were produced. The strip contains individual capture lines for a biomarker selection allowing discrimination of TB-patients from other respiratory diseases (ORD). Only biomarkers successfully evaluated with singleplex strips (single biomarker tests) were applied to the MBT device. Quantitative signals are recorded with a low-cost handheld reader compatible with the applied luminescent up-converting particle (UCP) label. Biomarker selection and algorithms used to distinguish potential-TB and ORD are flexible.ResultsResults obtained with MBT strips containing multiple test lines correlate well with singleplex LF strips. Using LF tests for 5 selected biomarkers a sensitivity of 94% and specificity of 96% could be achieved with a confirmed South African selection of 20 TB and 31 non-TB samples. Patients were designated TB positive when scoring a value above the cut-off threshold for at least 3 out of 5 biomarkers. Serum samples of potential TB patients collected at five medical research institutes (Ethiopia, Namibia, South Africa, The Gambia, Uganda) were tested locally with MBT strips comprised of CRP, SAA, IP-10, Ferritin, ApoA-I and IL-6 and results analysed to obtain an overall pan-Africa applicable signature.ConclusionEvaluated POC applicable UCP-LF devices detecting serum biomarker signatures can help to distinguish active TB from other respiratory diseases and as such can prioritise highest-risk patients for further care. Ongoing prospective studies evaluate the MBT strip with fingerstick blood and do not require a laboratory or trained phlebotomist anymore.
PO 8569 INNOVATIVE DOMESTIC FINANCING FOR HEALTH RESEARCH & DEVELOPMENT IN THE EAST AFRICAN COMMUNITY
Authors: Ngirabega Jean De Dieu , Twungubumwe Novat , Pulakkal Nandan K , Bahati Prince N , Kamali Anatoli , Kibiki Gibson S 
Published: April 2019

BackgroundAccess to domestic financial resources is a pre-requisite for strengthening health research and development (R&D). Therefore, the East African Health Research Commission (EAHRC) commissioned a study to assess the financial needs of the East African Community (EAC) region and propose innovative domestic financing mechanisms for R and D in East Africa.MethodsThis study used a four-pronged approach as follows: a desk review of secondary data, followed by a survey to collect quantitative data from health R&D organisations and relevant ministries, followed by key informant interviews and, finally, a validation workshop. The study used 2014–2015 as the baseline year.ResultsOnly 51 out of 160 organisations responded to the survey. Using triangulation of desk reviews, national budgets documents and reported organisational budgets, the annual investment in health R&D in the EAC is estimated at USD 301.71 million of which 86% is financed from external sources. The share of health R&D financing in the GDP and health budget stood at 0.21% and 1.27% respectively, while the share of domestic financing of health R&D to GDP was as low as 0.03%The innovative domestic financing options suggested included: allocation of 10% of the USD 560 million of the sin-taxes collected; taxing 1% of the estimated USD 3 billion from inward remittances; fundraising for at least 2.5% of the USD 18.67 private sector investment in corporate social responsibility; issuing social impact bonds and the EAC Health Research Fund with an estimated annual performance of USD 20 million.ConclusionIn order to sustain health R&D investments in EAC, the EAHRC proposes to develop a 10 year domestic financing roadmap using a strategic mix of tax- and non-tax-based innovations.
PO 8572 CAUSES OF HOSPITALISATION AND MORTALITY IN CHILDREN UNDER 5 YEARS OLD, NATIONAL HOSPITAL OF GUINEA-BISSAU, 2015–2017
Authors: Silva Isaquel B , Øland Christian B 
Published: April 2019

BackgroundStudying the causes of hospitalisation is useful to understand the profile of illness and identify the most effective interventions. Guinea-Bissau was projected to reduce the under-5 mortality rate from 200 to 80/1000 live births (2005–2015); and the causes of the deaths were attributed: neonatal, pneumonia, malaria and diarrhea. In 2014 the mortality rate was 55/1000 live births in Guinea-Bissau, and malaria, diarrhea and respiratory infection were the main causes of illness. The present study aims to describe the main causes of hospitalisation and death in children under 5 years in the paediatric clinic of the ‘Simão Mendes’ National Hospital.MethodDescriptive and retrospective study, with search of data from health care records. STATA and Microsoft Excel programmes were used for data analysis and cleaning. Cases defined as: children under 5 years of age, diagnosed from 2015 to 2017.ResultsIn 17,250 cases of hospitalisation, the overall lethality rate for 2015–2017 was calculated at 7.5%. There was an increase in the lethality rate (10.8%) in 2017. Among the main causes of hospitalisation were gastrointestinal infection (26.9%), malaria (23%), respiratory infection (17.6%) and septicaemia (16.1%). Septicaemia is the disease with the highest lethality rate during these three years (18%), the case fatality rate due to gastrointestinal infection in 2017 (7.7%) was double compared with 2015 and 2016; 19% of deaths occured for those who lived far from hospital (>40 km).Conclusion2017 had fewer hospitalisation cases and is the year with the highest lethality rate. Gastrointestinal infection and malaria were the main causes of hospitalisation. The rate of lethality from diarrhoea and septicaemia has increased significantly and with worse outcome in those living far from Bissau.
OC 8450 ABSENCE OF MINORITY HIV-1 DRUG-RESISTANT VARIANTS FOLLOWING MOTHER-TO-CHILD TRANSMISSION DOES NOT PREDICT VIROLOGIC SUCCESS OF FIRST-LINE ANTIRETROVIRAL THERAPY
Authors: Kityo Cissy , Wit Tobias Rinke De , Nankya Immaculate , Balinda Sheilla , Sigaloff Kim , Ndashimye Emmanuel , Mugyenyi Peter , Quinones-Mateu Miguel 
Published: April 2019

BackgroundAlthough minority HIV-1 drug-resistant HIV-1 variants may be selected under antiretroviral pressure, leading to therapy failure, their clinical significance remains controversial. This is particularly relevant in the case of prevention of mother-to-child transmission (MTCT), where transmitted drug resistance can affect treatment outcomes.MethodsAn ultrasensitive HIV-1 genotyping assay based on deep sequencing (DEEPGENHIV) with a 1% mutation frequency sensitivity, was used to quantify MTCT drug-resistant variants in 38 prenatally HIV-infected children experiencing (Group I, n=27) or not (Group II, n=11) virologic failure 12 months after initiating first-line antiretroviral therapy (ART) as part of a paediatric cohort in Uganda.ResultsInfants were infected with subtype A(n=20), D(n=16) or C(n=2) HIV-1 strains, distributed equally between both patients’ groups. Similarly, no significant difference was observed in intra-patient HIV-1 diversity among viruses obtained from Group I or II individuals at baseline. DEEPGENHIV was able to detect all the mutations originally detected in samples obtained from four control patients in Group II, where drug resistance was identified at baseline using Sanger sequencing, e.g. K65R (78% mutation frequency), K103N (47%), or M184V (85%). More importantly, a series of low abundance (<20% detection limit of Sanger) primary and compensatory mutations associated with resistance to PIs (D30N, Q48V), NRTIs (D67N, K219Q), or NNRTIs (L100I, K103N) were identified in both groups of patients, although just a few seem to have been selected and became majority variants after 12 or 24 months of ART.ConclusionDEEPGENHIV improves the detection of minority viral variants in infants following MTCT; however, most of the emergent HIV-1 drug resistance mutations were not present at low frequency at baseline in subjects failing ART, most likely being generated and selected following exposure to treatment. Further studies, using this or other ultrasensitive assays, are needed to better understand the transmission, dynamics and overall evolution of minority drug-resistant viruses in MTCT.
PO 8584 MULTIPLEXED MOLECULAR DETECTION OF MALARIA IN SIERRA LEONE
Authors: Ansumana Rashid , Lamin Joseph M , Lahai Joseph , Bangura Umaru 
Published: April 2019

BackgroundDespite several control measures and policy changes in Africa, malaria remains one of the most prevalent diseases in West Africa. The gold standard for malaria diagnosis is microscopy. However, due to low technical capacities in resource-poor countries, rapid immunochromatographic tests are commonly used. In Sierra Leone,P. falciparum-specific ICT with histidine-rich proteins2(HRP-2) are used. HRP2 is specific toP. falciparumand the kit cannot be used to detect other species of malaria which are also present in the disease ecology in Sierra Leone.MethodsIn this study, we assessed 182 febrile subjects for malaria between April 2017-July 2018 at the Mercy Hospital Research Laboratory in Sierra Leone. The blood samples collected were assessed using the Walter Reed Army Institute for Research(WRAIR) multiplex malaria PCR kit packaged by BioGX, Inc. (Alabama, USA) for detecting and speciation of malaria from human blood. Thin and thick slides were done for each sample and the images recorded by a digital scope.ResultsResults show that, out of 163 samples run by multiplex PCR for malaria, 81 (49.7%) were positive forP. falciparum, while 82 (50.3%) were positive forPlasmodium vivax.ConclusionThe presence ofP. vivaxin the disease ecology without any significant difference (p>0.05) withP. falciparumposes problems for clinical outcomes of febrile illnesses. Pan-malaria diagnostics in combination withP. falciparumcould avert under-diagnosis of malaria.
PO 8596 ENHANCING LABORATORY DIAGNOSIS OFMYCOBACTERIUM TUBERCULOSISIN SAMPLES FROM CHILDREN IN THE GAMBIA
Authors: Ayorinde Abigail , Coker Edward G , Mendy Alieu , Cole Fatoumatta , Sillah Abdou K , Mendy Francis S , Egere Uzochukwu , Kampmann Beate , Tientcheu Leopold D 
Published: April 2019

BackgroundRoutine laboratory diagnostic methods forM. Tuberculosiscomplex (MTBC) in induced sputum samples such as smear microscopy, GeneXpert and liquidMycobacteriagrowth indicator tube (MGIT) culture are often negative due to the paucibacillary nature of childhood tuberculosis. We hypothesise that prolonged incubation beyond routine culture time could potentially improve MTBC detection in specimens.MethodsOut of over 1000 induced sputum samples collected during our childhood TB contact tracing research programme, we randomly selected 102 MTBC-negative MGIT cultures that had either been reported as contaminated (n=35) or negative (n=67) and further incubated these at 37°C for the duration of one month. Ziehl-Neelsen microscopy, MPT64 Antigen secretion and GeneXpert tests were repeated on all samples to detect MTBC. Bacterial DNA was extracted by CTAB method and genotyped using spoligotyping analysis.ResultsOf the 1160 routinely collected induced-sputum samples 12 (1%) were smear-positives; 41 (3.5%) Xpert-positives and 51 (4.4%) MGIT culture MTBC-positives. The remaining MGIT cultures were flagged as contaminated 393 (33.9%) or MTBC-negative 644 (55.5%). After prolonged incubation and retesting of the randomly selected ones, 26/102 (25.5%) were now microscopy-positive, 2/55 (3.63%) were GeneXpert-positive, 8/102 (7.8%) MPT64-Antigen-positive, and 38/102 (37.2%) had readable spoligotyping patterns. The predominant lineages were Mtb-Euro-American 16 (42.1%), Mtb-Indo-Oceanic 11 (28.9%) andM. africanumWest African type-2 8 (21%).ConclusionProlonged incubation of routinely MTBC-negative induced-sputum cultures yielded positive results upon retest, highlighting the low sensitivity of routine diagnosis tools on pauci-bacillary paediatric samples. Spoligotyping was more sensitive to detect MTBC compared to GeneXpert. However, prolonged incubation will cause diagnostic delays and thus better strategies are needed to improve timely childhood TB diagnosis.