Hepatitis E Virus Infections among Patients with Acute Febrile Jaundice in Burkina Faso.

Hepatitis E virus infection is a significant public health problem in many parts of the world including Africa. We tested serum samples from 900 patients in Burkina Faso presenting with febrile icterus. They all tested negative for yellow fever, but those from 23/900 (2.6%) patients contained markers of acute HEV infection (anti-HEV IgM and HEV RNA positive). Genotyping indicated that 14 of the strains were HEV genotype 2b. There was an overall HEV IgG seroprevalence of 18.2% (164/900). In a bivariate analysis, the factors linked to HEV exposure were climate and patient age. Older patients and those living in arid regions were more likely to have HEV infection. HEV genotype 2b circulating only in humans can be involved in some acute febrile icterus cases in Burkina Faso. Better access to safe water, sanitation, and improved personal hygiene should improve control of HEV infection in this country.

Reducing Human-Tsetse Contact Significantly Enhances the Efficacy of Sleeping Sickness Active Screening Campaigns: A Promising Result in the Context of Elimination.

BACKGROUND: Control of gambiense sleeping sickness, a neglected tropical disease targeted for elimination by 2020, relies mainly on mass screening of populations at risk and treatment of cases. This strategy is however challenged by the existence of undetected reservoirs of parasites that contribute to the maintenance of transmission. In this study, performed in the Boffa disease focus of Guinea, we evaluated the value of adding vector control to medical surveys and measured its impact on disease burden. METHODS: The focus was divided into two parts (screen and treat in the western part; screen and treat plus vector control in the eastern part) separated by the Rio Pongo river. Population census and baseline entomological data were collected from the entire focus at the beginning of the study and insecticide impregnated targets were deployed on the eastern bank only. Medical surveys were performed in both areas in 2012 and 2013. FINDINGS: In the vector control area, there was an 80% decrease in tsetse density, resulting in a significant decrease of human tsetse contacts, and a decrease of disease prevalence (from 0.3% to 0.1%; p=0.01), and an almost nil incidence of new infections (<0.1%). In contrast, incidence was 10 times higher in the area without vector control (>1%, p<0.0001) with a disease prevalence increasing slightly (from 0.5 to 0.7%, p=0.34). INTERPRETATION: Combining medical and vector control was decisive in reducing T. b. gambiense transmission and in speeding up progress towards elimination. Similar strategies could be applied in other foci.

The impact of clinical research activities on communities in rural Africa: the development of the Clinical Research Unit of Nanoro (CRUN) in Burkina Faso.

BACKGROUND: The opportunities for developing new drugs and vaccines for malaria control look brighter now than ten years ago. However, there are few places in sub-Saharan Africa with the necessary infrastructure and expertise to support such research in compliance to international standards of clinical research (ICH-GCP). The Clinical Research Unit of Nanoro (CRUN) was founded in 2008 to provide a much-needed GCP-compliant clinical trial platform for an imminent large-scale Phase 3 malaria vaccine trial. A dynamic approach was used that entailed developing the required infrastructure and human resources, while engaging local communities in the process as key stakeholders. This provided a better understanding and ownership of the research activities by the local population. CASE DESCRIPTION: Within five years (2008-2013), the CRUN set up a fully and well-equipped GCP-compliant clinical trial research facility, which enabled to attract 25 grants. The research team grew from ten health workers prior to 2008 to 254 in 2013. A Health and Demographic Surveillance System (HDSS), which covers a total population of about 60,000 people in 24 villages was set up in the district. The local community contributed to the development of the facility through the leadership of the king and the mayor of Nanoro. As a result of their active advocacy, the government extended the national electrical grid to the new research center, and later to the entire village. This produced a positive impact on the community's quality of life. The quality of health care improved substantially, due to the creation of more elaborate clinical laboratory services and the acquisition of state-of-the-art equipment. CONCLUSION: Involving the community in the key steps of establishing the centre provided the foundation for what was to become the CRUN success story. This experience demonstrates that when clinical trials research sites are carefully developed and implemented, they can have a positive and powerful impact on local communities in resource-poor settings, well beyond the task of generating expected study data.

[Medium-term acceptability of HIV vaccine clinical trials in Burkina Faso: stakeholders' perceptions]. / Acceptabilité d'un essai vaccinal contre le VIH à moyen terme au Burkina Faso: perceptions des acteurs.

INTRODUCTION: The ideal response to HIV would be the discovery of an effective vaccine. Evaluation of the benefit/risk balance of this vaccine must include Africa, where the majority of HIV infections are observed. This study was designed to identify the perceptions and the medium-term acceptability of a potential vaccine trial in Ouagadougou (Burkina Faso). METHODS: After a "literature review", data were collected from key informants, "pimps" of prostitutes, representatives of HIV and/or AIDS associations, facilitators and peer educators. Data were transcribed and analysed manually. RESULTS: The vast majority of respondents considered that it would be relevant to test an HIV vaccine in Ouagadougou (Burkina Faso). Almost all prostitutes would participate in such a trial and would be motivated by several factors. Potential participants were willing to play the role expected of them. A real communication strategy will be needed to conduct this trial. DISCUSSION: The results of this study are similar to those of previous studies conducted in Burkina Faso concerning the acceptability/feasibility of clinical trials. Acceptability studies of clinical trials are therefore becoming less and less relevant. Reinforcing the skills/capacities of all stakeholders and/or adequate preparation of participants to play the role expected of them are therefore now more important than acceptability studies.

[The Burkinabe experience of the creation of a Community Advisory Committee to improve the support of HIV research projects]. / L'expérience burkinabè de constitution d'un Comité Consultatif Communautaire pour un meilleur accompagnement des projets de recherche sur le VIH.

INTRODUCTION: Community Advisory Committees (CAC) have become indicators of good community involvement in health research all over the world. CACs have been developed only recently in several Sub-Saharan African countries. Many countries wonder about how to create and ensure good functioning of a community advisory committee. The objective of this article is to describe the creation of two CACs in Burkina Faso. METHODS: This qualitative study comprised a literature review phase, a data collection phase conducted on a sample of 27 subjects (research scientists, representatives of AIDS associations or networks and the local technical and/or financial partners of these associations) and an implementation phase. Study participants were selected on a rational basis, the study complied with the ethical principles of research and data were transcribed and analysed manually. RESULTS: Scientists and/or community workers may initiate the creation of a CAC based on the following main elements: the profile of individuals and/or structures, the dynamism of CAC members, reinforcement of their skills and capacities. The CAC must be independent of research scientists and must be designed to be sustainable. DISCUSSION: The difficulties of sustainability and the poor perception of CACs remain major challenges. Continuing collaboration between CAC members and research scientists improves their knowledge in the field of research ethics, allowing the community to perceive CACs as supporters of research.

Epidemiology of sleeping sickness in Boffa (Guinea): where are the trypanosomes?

Human African Trypanosomiasis (HAT) in West Africa is a lethal, neglected disease caused by Trypanosoma brucei gambiense transmitted by the tsetse Glossina palpalis gambiensis. Although the littoral part of Guinea with its typical mangrove habitat is the most prevalent area in West Africa, very few data are available on the epidemiology of the disease in such biotopes. As part of a HAT elimination project in Guinea, we carried a cross-sectional study of the distribution and abundance of people, livestock, tsetse and trypanosomes in the focus of Boffa. An exhaustive census of the human population was done, together with spatial mapping of the area. Entomological data were collected, a human medical survey was organized together with a survey in domestic animals. In total, 45 HAT cases were detected out of 14445 people who attended the survey, these latter representing 50.9% of the total population. Potential additional carriers of T. b. gambiense were also identified by the trypanolysis test (14 human subjects and two domestic animals). No trypanosome pathogenic to animals were found, neither in the 874 tsetse dissected nor in the 300 domestic animals sampled. High densities of tsetse were found in places frequented by humans, such as pirogue jetties, narrow mangrove channels and watering points. The prevalence of T. b. gambiense in humans, combined to low attendance of the population at risk to medical surveys, and to an additional proportion of human and animal carriers of T. b. gambiense who are not treated, highlights the limits of strategies targeting HAT patients only. In order to stop T. b. gambiense transmission, vector control should be added to the current strategy of case detection and treatment. Such an integrated strategy will combine medical surveillance to find and treat cases, and vector control activities to protect people from the infective bites of tsetse.