Genetic diversity of HPV35 in Chad and the Central African Republic, two landlocked countries of Central Africa: A cross-sectional study.

Human Papillomavirus (HPV)-35 accounts for up 10% of cervical cancers in Sub-Saharan Africa. We herein assessed the genetic diversity of HPV35 in HIV-negative women from Chad (identified as #CHAD) and HIV-infected men having sex with men (MSM) in the Central African Republic (CAR), identified as #CAR. Ten HPV35 DNA from self-collected genital secretions (n = 5) and anal margin samples (n = 5) obtained from women and MSM, respectively, were sequenced using the ABI PRISM® BigDye Sequencing technology. All but one HPV35 strains belonged to the A2 sublineage, and only #CAR5 belonged to A1. HPV35 from #CAR had higher L1 variability compared to #CHAD (mean number of mutations: 16 versus 6). L1 of #CAR5 showed a significant variability (2.29%), suggesting a possible intra-type divergence from HPV35H. Three (BC, DE, and EF) out of the 5 capsid loops domains remained totally conserved, while FG- and HI- loops of #CAR exhibited amino acid variations. #CAR5 also showed the highest LCR variability with a 16bp insertion at binding sites of the YY1. HPV35 from #CHAD exhibited the highest variability in E2 gene (P<0.05). E6 and E7 oncoproteins remained well conserved. There is a relative maintenance of a well conserved HPV35 A2 sublineage within heterosexual women in Chad and MSM with HIV in the Central African Republic.

Young women who sell sex in Bangui, Central African Republic: a neglected group highly vulnerable to HIV.

BACKGROUND: The objectives of this study were to determine the association between the vulnerability factors linked to human immunodeficiency virus (HIV) and other sexually transmitted infection among the young women who sell sex (YWSS) group (15-24 years) and adult sex workers, engaged in consensual sex for money (AFSW). METHODS: A cross-sectional study was conducted among AFSW involved in commercial sex transactions. Prevalence ratios (PR) analysis was carried out using log-binomial regression model. RESULTS: The prevalence of HIV-1 was 29.4% among YWSS compared to 19.6% among female sex worker (PR = 1.43 [1.07-1.91]). Consistent condoms use last 3 months were very low at 22.3% and 41.2%, respectively (PR = 0.52 [0.37-0.74]), the low education level among YWSS versus AFSW (PR = 0.55 [0.40-0.76]); YWSS having been a victim of sexual violence in the last 12 months (PR = 2.00 [1.52-2.63]), were also more likely to be HIV positive. CONCLUSIONS: The YWSS had a high prevalence of HIV, experienced other socioeconomic vulnerabilities and remain a key population for comprehensive HIV programs. To reach all YWSS, programs need to consider many outreach programs and address the shared determinants of HIV risk.

Acceptability of HIV self-testing in African students: a cross-sectional survey in the Democratic Republic of Congo.

INTRODUCTION: The empowerment of young people aged 15-24 years is a key component of an effective AIDS response. HIV self-testing (HIVST) is progressively being implemented in the Democratic Republic of Congo (DRC). METHODS: Socio-demographic and behavioural factors associated with acceptability of HIVST were evaluated among university students in Bunia, DRC. A representative cross-sectional study was conducted using a self-administered semi-structured questionnaire. RESULTS: A total of 1,012 students were recruited. Acceptability of unsupervised HIVST was higher in the group of young students as compared with older students and was markedly associated with prior knowledge on HIVST. CONCLUSION: Adapted communication about HIVST appears likely essential to increase the supply and use of HIVST among students in DRC.

Insufficient education is a key factor of incorrect interpretation of HIV self-test results by female sex workers in Democratic Republic of the Congo: A multicenter cross-sectional study.

We report on field interpretation of HIV self-testing among female sex workers (FSWs) and non-FSWs living in Democratic Republic of the Congo.Two hundred and eight participants [76 (36.5%) FSWs; 132 (63.5%) non-FSWs] were enrolled in Kisangani and Bunia to evaluate their ability to read and interpret the results of a prototype HIV self-test (Exacto Test HIV, Biosynex, Strasbourg, France), according to WHO recommendations. Thirteen standardized tests (6 positive, 5 negative, 2 invalid) were proposed after successive random selection.Two thousand seven hundred and four standardized tests (1248 positive, 1040 negative, 416 invalid) were interpreted; 2435 (90.1%) were correctly interpreted, whereas 269 (9.9%) were misinterpreted. In FSWs and non-FSWs, the test results were similarly correctly interpreted in 87.4% (864/988) and 91.6% (1571/1716), respectively. In multivariate logistic regression analysis, only the variable "educational level" remained strongly associated with the interpretation of positive, negative, and invalid HIV self-test results, but not the variables "commercial sex work" and "language chosen for instructions for use." Incorrect interpretation was significantly higher in participants with insufficient educational level than in those with sufficient education level for positive (13.1% vs 2.6%; adjusted OR: 4.5), negative (22.3% vs 2.6%; adjusted OR: 5.3), and invalid test results (23.8% v 6.4%; adjusted OR: 3.6).Incorrect interpretation of HIV self-test was as common in FSWs and non-FSWs. The lower was the educational level, the greater was the difficulty to interpret results correctly. These observations point that insufficient education level, rather than commercial sex work by itself, constitutes a key factor of incorrect interpretation of HIV self-test.

Unusual and unique distribution of anal high-risk human papillomavirus (HR-HPV) among men who have sex with men living in the Central African Republic.

BACKGROUND: High-risk (HR) human papillomavirus (HPV) infection remains a great concern in relation to African men who have sex with men (MSM), especially those infected with HIV. The prevalence of HR-HPV and associated risk factors was estimated in a cross-sectional observational study covering MSM living in Bangui, Central African Republic. METHODS: MSM receiving care at the Centre National de Référence des Infections Sexuellement Transmissibles et de la Thérapie Antirétrovirale, Bangui, were included. HIV serostatus and socio-demographic and behavioral characteristics were collected. HPV DNA was detected and genotyped on anal swabs using Anyplex™ II HPV28 test (Seegene, South Korea), and HSV DNA by in-house real-time PCR. Logistic regression analyses were used to determine risk factors associated with HPV outcomes. RESULTS: 42 MSM (mean age, 23.2 years; range, 14-39) including 69.1% HIV-1-positive and 30.9% HIV-negative were prospectively enrolled. The prevalence of anal HPV was 69.1%, including 82.7% of HR-HPV which were multiple in 52.0%. The most prevalent genotypes were HPV-35, HPV-58, HPV-59 and HPV-31. While, HPV-16 and HPV-18 were present in a minority of samples. Multiple HR-HPV infection was more frequent in HIV-positive MSM (41.4%) with 2.7 genotypes per anal samples than in HIV-negative (7.7%) with 1.5 genotypes per anal samples. HPV types included in the prophylactic Gardasil-9® vaccine were detected in 68.9% of specimens and HPV-58 was the most frequently detected. MSM infected by HPV-16 and HPV-18 were all infected by HIV-1. Few anal swabs (11.9%) contained HSV-2 DNA without relationship with HPV detection. Condomless receptive anal intercourse was the main risk factor to being infected with any type of HPV and condomless insertive anal intercourse was significantly less associated with HPV contamination than receptive anal intercourse (Odd ratio = 0.02). CONCLUSION: MSM in Bangui are at-risk of HIV and HR-HPV anal infections. The unusual distribution of HPV-35 as predominant HPV suggests possible geographic specificities in the molecular epidemiology of HR-HPV in sub-Saharan Africa. Scaling up prevention strategies against HPV infection and related cancers adapted for MSM in Africa should be prioritized. Innovative interventions should be conceived for the MSM population living in Bangui.

Usefulness of simultaneous screening for HIV-specific and HCV-specific antibodies and HBsAg by a capillary-based multiplex rapid diagnostic test to strengthen linkage-to-care in sub-Saharan patients attending sexually transmitted infection clinic.

Adult outpatients attending the main sexually transmitted infection clinic of Bangui, Central African Republic, were prospectively subjected to a multiplex rapid diagnostic test for human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV). In group I (n = 208) of patients already followed for HIV, 6 (2.9%) were unexpectedly negative, thus corresponding to false positive for HIV by the national HIV algorithm; hepatitis B surface antigen and HCV positivities were high (18.7% and 4.3%, respectively). In group II (n = 71) of patients with unknown HIV status, at least 1 chronic viral disease was diagnosed in 26 (36.6%) patients, including 5 (7.1%) HIV, 17 (23.9%) HBV, and 3 (4.2%) HCV infections.