[Trends of HIV and syphilis prevalence among pregnant women in antenatal clinics in Togo: Analysis of sentinel serosurveillance results between 2008 and 2016]. / Tendances des prévalences du VIH et de la syphilis chez les femmes enceintes en consultation prénatale au Togo : Analyse des résultats de la sérosurveillance sentinelle entre 2008 et 2016.

Introduction: The aim of our work was to analyse the trends of HIV infection and syphilis among pregnant women in prenatal consultation (PNC) in healthcare facilities in Togo. Methods: This was an analytical retrospective study, covering the period from 2008 to 2016 and focusing on pregnant women aged 15 to 49 seen in PNC for the first time in maternal and child health services in Togo. Results: During the study period, 41,536 pregnant women were registered in 2008, 2009, 2010, 2014 and 2016, respectively 8079, 8572, 8430, 7920 and 8535.The mean age of the patients was 26 ± 6 year in 2008, 2009 and 2010. The overall HIV prevalence decreased from 3.4% in 2008 to 2.9% in 2016 (p = 0.0145). It fell from 1% in 2008 to 0.5% in 2016 and from 3.6% in 2008 to 1.4% in 2016 (p < 0.0001) among 15-19 year-old and 20-24 year-old respectively. HIV prevalence in rural areas is two times lower than in urban areas between 2008 and 2016 with a statistically significant difference. The prevalence of syphilis decreased significantly from 2008 (1.3%) to 2016 (0.6%), (p < 0.0001). It is low and not associated with age in 2008; 0.2% and 0.4% in 2016 respectively in the 15 to 19 and 20 to 24 age groups. This prevalence is significantly low between 2008 and 2016 in both urban and rural areas. Conclusion: Our study documents a relatively low prevalence of syphilis and HIV among pregnant women in Togo, with a significant decrease among adolescents and young women, attesting to the effectiveness of the increased screening and comprehensive prevention of sexually transmitted infections (STIs) and HIV, including the antiretroviral treatment as prevention (TASP) approach, and the neonatal syphilis elimination programme in the country.

Effectiveness of co-trimoxazole to prevent Plasmodium falciparum malaria in HIV-positive pregnant women in sub-Saharan Africa: an open-label, randomized controlled trial.

BACKGROUND: Human immunodeficiency virus (HIV) and malaria during pregnancy cause substantial perinatal mortality. As co-trimoxazole (CMX) protects children and HIV-positive adults against malaria, we compared the effectiveness of daily CMX with sulfadoxine-pyrimethamine intermittent preventive treatment (IPT-SP) on malaria risk in HIV-positive pregnant women in a Plasmodium falciparum-endemic African area. METHODS: From January 2009 to April 2011, we included in a randomized noninferiority trial all HIV type 1-infected pregnant women (≤28 weeks' gestation, CD4 count ≥200 cells/µL, hemoglobin level ≥7 g/L) in 19 health centers in Togo. Women were randomly assigned to daily 800 mg/160 mg CMX, or IPT-SP. The primary outcome was the proportion of malaria-free pregnancies. Other outcomes included malaria incidence, parasitemia, placental malaria, anemia, and infants' birth weight. RESULTS: Of 264 women randomly assigned to the CMX or IPT-SP group, 126 of 132 and 124 of 132, respectively, were included in the analysis. There were 33 confirmed cases of clinical malaria among 31 women in the CMX group, and 19 among 19 women in the IPT-SP group. Ninety-five of 126 (75.4%) women in the CMX group and 105 of 124 (84.7%) in the IPT-SP group remained malaria-free during their pregnancy (difference, 9.3%; 95% confidence interval [CI], -.53 to 19.1, not meeting the predefined noninferiority criterion). The incidence rate in intention-to-treat analysis was 108.8 malaria episodes per 100 person-years in CMX (95% CI, 105.4-112.2) and 90.1 in IPT-SP (95% CI, 86.8-93.4) (not significant). Prevalence of parasitemia was 16.7% in the CMX group vs 28% in the IPT-SP group (P = .02). Histology revealed 20.3% placental malaria in the CMX group vs. 24.6% in the IPT-SP group (not significant). Grade 3-4 anemia was more frequent in the CMX group (10% vs 4%; P = .008). No pregnant women died. Median birth weight was similar. CONCLUSIONS: Daily CMX was not noninferior to IPT-SP for preventing maternal malaria but safe and at least similar regarding parasitemia or placental malaria and birth outcomes. Clinical Trials Registration ISRCTN98835811.

Loss of HIV-infected patients on potent antiretroviral therapy programs in Togo: risk factors and the fate of these patients.

INTRODUCTION: National programs are facing challenges of loss to follow-up of people living with HIV/AIDS (PLWHA) on antiretroviral therapy (ART). We sought to identify risk factors associated with early loss to follow-up among HIV-infected patients on ART in Togo and the outcome of such patients. METHODS: This was a retrospective cross-sectional study using medical records of all patients older than age 15 years enrolled at 28 treatment centers who were on ART programs and who were lost to follow-up from 2008 to 2011. RESULTS: Of the 16,617 patients on ART, 1,216 (7.3%) were lost to follow-up. Most (94.1%) were infected with HIV-1 and 32.6% were in WHO stage III or IV. The median CD4 count was 118/mm3 (IQR: 58-178 cells/mm3). No telephone number was mentioned in the medical records of 212 patients. Of the 1004 patients whose phone number was listed, 802 patients (79.9%) were not reachable on the recorded number, 114 patients (11.4%) were alive and 88 patients (8.8%) had died. In multivariate analysis, factors associated with loss to follow-up during the first 6 months of ART were: age below 35 years (OR = 1.6; 95%CI: 1.2-2.2), female sex (OR = 1.8; 95%CI: 1.3-2.5), WHO stage III or IV (OR = 1.7; 95%CI: 1.3-2.2), existence of an opportunistic infection (OR = 2.3; 95%CI: 1.5-3.1), and follow-up in a public centre (OR = 1.9; 95%CI: 1.2-3.3). CONCLUSION: This study identified several factors associated with lost to follow-up during the first 6 months of ART, and confirmed high mortality among these patients. The National AIDS Program should strengthen medical support of PLWHA in Togo including active case follow-up.

High prevalence of HIV-1 drug resistance among patients on first-line antiretroviral treatment in Lomé, Togo.

BACKGROUND: With widespread use of antiretroviral (ARV) drugs in Africa, one of the major potential challenges is the risk of emergence of ARV drug-resistant HIV strains. Our objective is to evaluate the virological failure and genotypic drug-resistance mutations in patients receiving first-line highly active antiretroviral therapy (HAART) in routine clinics that use the World Health Organization public health approach to monitor antiretroviral treatment (ART) in Togo. METHODS: Patients on HAART for one year (10-14 months) were enrolled between April and October 2008 at three sites in Lomé, the capital city of Togo. Plasma viral load was measured with the NucliSENS EasyQ HIV-1 assay (Biomérieux, Lyon, France) and/or a Generic viral load assay (Biocentric, Bandol, France). Genotypic drug-resistance testing was performed with an inhouse assay on plasma samples from patients with viral loads of more than 1000 copies/ml. CD4 cell counts and demographic data were also obtained from medical records. RESULTS: A total of 188 patients receiving first-line antiretroviral treatment were enrolled, and 58 (30.8%) of them experienced virologic failure. Drug-resistance mutations were present in 46 patients, corresponding to 24.5% of all patients enrolled in the study. All 46 patients were resistant to non-nucleoside reverse-transcriptase inhibitors (NNRTIs): of these, 12 were resistant only to NNRTIs, 25 to NNRTIs and lamivudine/emtricitabine, and eight to all three drugs of their ARV regimes. Importantly, eight patients were already predicted to be resistant to etravirine, the new NNRTI, and three patients harboured the K65R mutation, inducing major resistance to tenofovir. CONCLUSIONS: In Togo, efforts to provide access to ARV therapy for infected persons have increased since 2003, and scaling up of ART started in 2007. The high number of resistant strains observed in Togo shows clearly that the emergence of HIV drug resistance is of increasing concern in countries where ART is now widely used, and can compromise the long-term success of first- and second-line ART.