Persistence rate of cervical human papillomavirus infections and abnormal cytology in Rwanda.

OBJECTIVES: In this study, we determined the incidence and persistence of human papillomavirus (HPV) strains and of squamous intraepithelial lesions (SIL) or worse cytology in 237 HIV-positive and HIV-negative Rwandan women and whether the interleukin (IL)-28B single nucleotide polymorphism (SNP) at rs12979860 correlated with susceptibility to and persistence of HPV infection. METHODS: Cervical samples were collected at baseline and after 9, 18 and 24 months for a 40-HPV DNA screening test and a ThinPrep Pap test. Genotyping of the IL-28B SNP rs12979860 was performed using real-time polymerase chain reaction (PCR). RESULTS: Chronic high-risk (HR) HPV infections occurred in 56% of HIV-positive women, while no HIV-negative women developed HPV chronicity. High-grade SIL (HSIL) or cancer was diagnosed in 38% of HIV-positive women with persistent HR-HPV infections. HIV and HR-HPV positivity at baseline were factors associated with an increased risk of HPV persistence. Additionally, HR-HPV positivity at baseline was associated with an increased risk of developing HSIL or worse cytology. The unfavourable T/x genotype at rs12979860 is common among Africans, and women with this genotype were found to be more commonly infected with HPV. CONCLUSIONS: HPV screening in Rwanda may help to identify women at risk of developing cervical cancer and polymorphism in IL-28B may be associated with risk of contracting  HPV infection.

Screening for human papillomavirus, cervical cytological abnormalities and associated risk factors in HIV-positive and HIV-negative women in Rwanda.

OBJECTIVES: Cervical cancer is the major cause of death from cancer in Africa. We wanted to assess the prevalence of human papillomavirus (HPV) infections and associated risk factors and to determine whether HPV testing could serve as a screening method for squamous intraepithelial lesions (SILs) in Rwanda. We also wanted to obtain a broader understanding of the underlying risk factors for the establishment of HPV infection in Rwanda. METHODS: A total of 206 HIV-positive women, 172 HIV-negative women and 22 women with unknown HIV status were recruited at the University Teaching Hospitals of Kigali (UTHK) and of Butare (UTHB) in Rwanda. Participants underwent an interview, cervical sampling for a Thinprep Pap test and a screening test analysing 37 HPV strains. RESULTS: Only 27% of HIV-positive women and 7% of HIV-negative women had been screened for cervical cancer before. HPV16 and HPV52 were the most common HPV strains. HIV-positive women were more commonly infected with high-risk (HR) HPV and multitype HPV than HIV-negative women. The sensitivity was 78% and the specificity 87% to detect high-grade SIL (HSIL) with HPV screening. Among HIV-negative women, being divorced was positively associated with HR-HPV infection, while hepatitis B, Trichomonas vaginalis infection and HR-HPV infection were factors positively associated with SILs. Ever having had gonorrhoea was positively associated with HR-HPV infection among HIV-positive women. HR-HPV infection and the number of live births were positively associated with SILs. CONCLUSIONS: The currently used quadrivalent vaccine may be insufficient to give satisfactory HPV coverage in Rwanda. HPV Screening may be effective to identify women at risk of developing cervical cancer, particularly if provided to high-risk patients.

Sexual risk behaviour in a cohort of HIV-negative and HIV-positive Rwandan women.

Here we wanted to assess whether sexual risk behaviour differs dependent by human immunodeficiency virus (HIV) status by following 100 HIV- and 137 HIV+ women recruited at two university teaching hospitals in Rwanda. Women were tested for sexually transmitted infections (STIs; trichomoniasis, syphilis, hepatitis B and C) and for reproductive tract infections (RTIs; candidiasis, bacterial vaginosis (BV)) and were interviewed at baseline and 9 months later. BV was the most prevalent infection, while syphilis was the most common STI with a 9-month incidence of 10.9% in HIV+ women. Only 24.5% of women positive for any RTI/STI contacted their health facility and got treatment. More HIV- women than HIV+ women had had more than one sexual partner and never used condoms during the follow-up period. The use of condoms was affected neither by marital status nor by concomitant STIs besides HIV. Our data highlight the importance of public education regarding condom use to protect against STIs in an era when HIV no longer is a death sentence.

SEQUENTIAL LOW COST INTERVENTIONS DOUBLE HAND HYGIENE RATES AMONG MEDICAL TEAMS IN A RESOURCE LIMITED SETTING. RESULTS OF A HAND HYGIENE QUALITY IMPROVEMENT PROJECT CONDUCTED AT UNIVERSITY TEACHING HOSPITAL OF KIGALI (CHUK), KIGALI, RWANDA.

OBJECTIVE: To assess the impact of multimodal low-cost interventions on hand hygiene practices among medical teams. DESIGN: A four week prospective observational study. SETTING: Medical wards of the University Teaching Hospital of Kigali (CHUK), Kigali, Rwanda. SUBJECTS: Medical teams comprising students, residents and consultant physicians. INTERVENTIONS: During week one, baseline hand sanitising rate (HSR)--the percentage of hand hygiene opportunities during which hands were sanitised- was recorded. On week two, alcohol based handrubs (ABHRs) were provided and placed strategically on every ward. For week three and four respectively, hand hygiene posters (HHPs) were placed at entry sites of each ward at eye level and subsequently at the head of each patient's bed. MAIN OUTCOME MEASURES: Post-intervention HSR was recorded weekly during morning ward rounds. The differences between pre-intervention and post-intervention HSRs as well as end-of-study pre- and post-contact HSR were assessed for significance using Pearson chi square test. RESULT: A total of 780 HHOs were covertly observed throughout the study. Baseline HSR was 24.8%. During week 2, there was a non-significant increase in HSR (26.6% vs. 24.8%, p = 0.66). Overall, hand sanitising rates doubled from 24.8% to 50.6% following all study interventions (p < 0.001). There was a significant increase in post-patient contact and pre-patient contact HSRs with rates improving from 25.2% to 58% and 24.5% to 43% respectively (P < 0.01). CONCLUSION: Our study showed that low-cost interventions involving ensuring availability of ABHRs and posting HHPs significantly increased HSRs among medical teams but post-intervention rates were suboptimal.

Active surveillance for asymptomatic carriers of carbapenemase-producing Klebsiella pneumoniae in a hospital setting.

The spread of carbapenemase-producing Klebsiella pneumoniae (CPKP) is a challenging public health threat. Early identification and isolation of infected patients and carriers are key measures of control. This study describes a CPKP screening strategy in a tertiary Italian hospital. During the five-month study period, 1687 patients were screened by rectal swabs. Of these, 65 (3.9%) tested positive for CPKP; 5.1% of case contacts tested positive. Screening case contacts appears to be the essential surveillance component for detecting asymptomatic carriers of CPKP. The added value of selective CPKP screening on hospital admission depends on the frequency of carriers among incoming patients.