Prevalence and Associated Factors of Diabetes Mellitus Among Newly Enrolled Tuberculosis Patients in Lubumbashi (DRC).

Background: Tuberculosis and diabetes mellitus are major public health challenges worldwide. The two scourges have bidirectional relationship with high morbidity and mortality. Objective: The present study was conducted to determine the prevalence of diabetes mellitus and identify related factors in patients with tuberculosis. Methods: A cross-sectional study was conducted in 11 tuberculosis screening and treatment centers in Lubumbashi (DRC) from September to December 2022. Adult patient with a positive smear for tuberculosis were systematically screened for diabetes mellitus. Demographic characteristics, history and symptomatology were the variables of interest. Data was entered using Microsoft Excel software. STATA 16 software was used for analysis. Results: A total of 255 tuberculosis patients were recruited and the prevalence of diabetes mellitus among these patients was 11.4% (ie, 29 out of 255). After uni and multivariate logistic regression, a BMI ≤ 18.5 Kg/m2, lack of employment, polyuria and intense thirst were the factors associated with diabetes mellitus in tuberculosis patients. Conclusion: The prevalence of diabetes mellitus in smear positive tuberculosis patients in the present study was higher than the one observed in Central Africa.

[Interventional study on Dolutegravir and other antiretrovirals in patients with subclinical atherosclerosis in the Kinshasa Hospital]. / Étude interventionnelle sur le dolutégravir et les autres antirétroviraux dans l'athérosclérosclérose infra-clinique en milieu hospitalier de Kinshasa.

Introduction: After 2016, the World Health Organization (WHO) proposed Dolutegravir (DTG) as an alternative first-line treatment for adults. Thus, the purpose of this study was to identify biomarkers of cardiometabolic risk capable of demonstrating the beneficial effect of Dolutegravir (DTG) compared to other antiretrovirals in predicting atherosclerosis in people living with HIV (PLHIV) and hospitalized in Kinshasa Hospital. Methods: we conducted an interventional study of people living with HIV who had received antiretroviral therapy (ART) for at least 6 months and were treated in the structures of the network coordinated by the Catholic Church (BDOM-Bureau Diocésain des Oeuvres Médicales) and of the University Clinics of Kinshasa (CUK) between January 2017 and December 2021. Subclinical atherosclerosis was defined as Pulsed Pressure (PP) ≥60 mm Hg; Carotid Intima-Media Thickness (CIMT) > 0.8 mm; and Systolic Pressure Index (SPI) < 0.9. Logistic regression was used in the statistical analysis of associations. Results: a total of 334 PLHIV were recruited, of whom 96.1% (n=321) were on ART and 13.9% (n=13) were ART naïve patients. The mean age of PLHIV was 51±12 years with a female predominance (70.4%; n=235); the independent determinants of subclinical atherosclerosis were marital status (aOR: 4. 95% CI 1.5-10.5; p<0.006), low socioeconomic level (aOR: 10.7, 95% CI 2.3-48.7 p<0.002), duration of HIV infection (aOR: 6.6, 95% CI 2.8-16; p<0.0001), duration of antiretroviral therapy ≥9 years (aOR: 0.3, 95% CI 0.2-0.7; p<0.005) and total cholesterol ratio/high-density lipoprotein-cholesterol (CT/HDL-c)(aOR: 2, 95% CI 1.1-3.6; p= 0.034). The mean values of traditional and emergent variables were significantly higher in the previous ART regimen without DTG than in the new regimen with DTG. However, dyslipidemia was detected during the new DTG-based regimen. Conclusion: dyslipidemia was common during the DTG-based regimen. Marital status, low socioeconomic level, duration of HIV infection, duration of antiretroviral treatment beyond 9 years and the TC/HDL-c ratio were identified as determinants of subclinical atherosclerosis in PLHIV on ART hospitalized in the Kinshasa hospital.

Drivers of the dynamics of the spread of cholera in the Democratic Republic of the Congo, 2000-2018: An eco-epidemiological study.

BACKGROUND: The dynamics of the spread of cholera epidemics in the Democratic Republic of the Congo (DRC), from east to west and within western DRC, have been extensively studied. However, the drivers of these spread processes remain unclear. We therefore sought to better understand the factors associated with these spread dynamics and their potential underlying mechanisms. METHODS: In this eco-epidemiological study, we focused on the spread processes of cholera epidemics originating from the shores of Lake Kivu, involving the areas bordering Lake Kivu, the areas surrounding the lake areas, and the areas out of endemic eastern DRC (eastern and western non-endemic provinces). Over the period 2000-2018, we collected data on suspected cholera cases, and a set of several variables including types of conflicts, the number of internally displaced persons (IDPs), population density, transportation network density, and accessibility indicators. Using multivariate ordinal logistic regression models, we identified factors associated with the spread of cholera outside the endemic eastern DRC. We performed multivariate Vector Auto Regressive models to analyze potential underlying mechanisms involving the factors associated with these spread dynamics. Finally, we classified the affected health zones using hierarchical ascendant classification based on principal component analysis (PCA). FINDINGS: The increase in the number of suspected cholera cases, the exacerbation of conflict events, and the number of IDPs in eastern endemic areas were associated with an increased risk of cholera spreading outside the endemic eastern provinces. We found that the increase in suspected cholera cases was influenced by the increase in battles at lag of 4 weeks, which were influenced by the violence against civilians with a 1-week lag. The violent conflict events influenced the increase in the number of IDPs 4 to 6 weeks later. Other influences and uni- or bidirectional causal links were observed between violent and non-violent conflicts, and between conflicts and IDPs. Hierarchical clustering on PCA identified three categories of affected health zones: densely populated urban areas with few but large and longer epidemics; moderately and accessible areas with more but small epidemics; less populated and less accessible areas with more and larger epidemics. CONCLUSION: Our findings argue for monitoring conflict dynamics to predict the risk of geographic expansion of cholera in the DRC. They also suggest areas where interventions should be appropriately focused to build their resilience to the disease.

Health Care Providers' Knowledge of Tuberculosis and Diabetes Mellitus Comorbidity in Lubumbashi, Democratic Republic of the Congo (DRC).

Background: Tuberculosis-Diabetes mellitus (TB-DM) co-morbidity is a growing scourge in the world. The new approaches and interventions for TB control implemented by the Tuberculosis National Control Program (TNCP) in DRC require the involvement of health care providers for their success. Objective: The objective of this study is to assess the knowledge of health care provider on different aspects of the management of TB-DM co-morbidity and to compare this knowledge according to the health care system, the type of providers and the number of years of experience. Methods: Cross-sectional and analytic study was conducted in 11 health care facilities in the Lubumbashi Health District, selected by reasoned choice, and an electronic questionnaire was administered to health care providers. These providers were interviewed on the different aspects of the management of the TB-DM comorbidity. The data were presented and compared in relation to knowledge about TB, DM, and TB-DM comorbidity. Results: A total of 113 providers were interviewed, predominantly males and physicians. Questions related to knowledge about DM were better answered. Doctors compared to paramedics; tertiary-level providers compared to secondary-level providers had better responses to the different questions. There is a statistically significant correlation between the level of knowledge of TB, DM and the type of health care provider, the number of years of experience. Conclusion: The present study shows that there are gaps in the knowledge of our health care providers and community members on the recommendations of the DRC TB guidelines (Programme AntiTuberculeux Intégré 5: PATI 5) in general and on the management of TB-DM. It is therefore important and necessary to put in place strategies to improve this level of knowledge, which will focus on the extension of the guidelines, the awareness and the training of the stakeholders involved in the control.

Tuberculose chez les enfants de 0-14 ans: résistance primaire de Mycobacterium tuberculosis aux antituberculeux et variants génétiques à Kinshasa / Tuberculosis in children aged 0-14: primary resistance of Mycobacterium tuberculosis to antituberculosis drugs and genetic variants in Kinshasa

Dans les régions endémiques y compris la République Démocratique du Congo, les enfants sont susceptibles d'être exposés à la tuberculose (TB) par un contact dans l'entourage. L'absence de diagnostic peut avoir des conséquences dévastatrices. L'objectif de la présente étude était de déterminer la fréquence de TB, la résistance primaire des souches de Mycobacterium tuberculosis aux antituberculeux ainsi que des variants génétiques. Méthodes. Cette étude transversale et descriptive a été réalisée, entre juin 2011 et décembre 2017, à Kinshasa chez les enfants présumés TB. Les enfants ayant les signes évocateurs de TB figurant dans la tranche d'âge de 0-14 ans étaient inclus. Les échantillons ont été examinés par le Ziehl et mis en culture sur le milieu de Löwenstein-Jensens. Les souches étaient testées aux antituberculeux par la technique des proportions et typées par Spoligotyping. La comparaison des proportions a été faite à l'aide du test de chi-carré de Pearson. Résultats. Quarante-huit souches de Mycobacterium tuberculosis (15,4 %) ont été isolées. Dix souches (20,8%) étaient résistantes à au moins un antituberculeux plus fréquemment à l'INH. Le génotype LAM (66,7 %) et Haarlem (33,3%) était observé. Conclusion. La recherche active de TB infantile confirme qu'elle est relativement fréquente et est résistante à au moins un antituberculeux (surtout à l'INH).

Treatment and case fatality rate of COVID-19 in Africa.

In Africa, the treatment of COVID-19 depends on each country. Several protocols are observed with real results that we described in this study. The objective of this review was to describe the treatment of COVID-19 and the case fatality rate in African countries, by reviewing the literature on treatment and case fatality in African countries whose data was available through the internet during the writing period until February 7, 2021. The majority of African countries had a treatment based on hydroxychloroquine or chloroquine + azithromycin, used in varying doses depending on the country. The lethality in Africa remains low compared to European and American countries. The same treatment being used in some northern countries does not fully explain the low case fatality.

Risk factors for mortality in COVID-19 patients in sub-Saharan Africa: A systematic review and meta-analysis.

AIM: Mortality rates of coronavirus-2019 (COVID-19) disease continue to increase worldwide and in Africa. In this study, we aimed to summarize the available results on the association between sociodemographic, clinical, biological, and comorbidity factors and the risk of mortality due to COVID-19 in sub-Saharan Africa. METHODS: We followed the PRISMA checklist (S1 Checklist). We searched PubMed, Google Scholar, and European PMC between January 1, 2020, and September 23, 2021. We included observational studies with Subjects had to be laboratory-confirmed COVID-19 patients; had to report risk factors or predictors of mortality in COVID-19 patients, Studies had to be published in English, include multivariate analysis, and be conducted in the sub-Saharan region. Exclusion criteria included case reports, review articles, commentaries, errata, protocols, abstracts, reports, letters to the editor, and repeat studies. The methodological quality of the studies included in this meta-analysis was assessed using the methodological items for nonrandomized studies (MINORS). Pooled hazard ratios (HR) or odds ratios (OR) and 95% confidence intervals (CI) were calculated separately to identify mortality risk. In addition, publication bias and subgroup analysis were assessed. RESULTS AND DISCUSSION: Twelve studies with a total of 43598 patients met the inclusion criteria. The outcomes of interest were mortality. The results of the analysis showed that the pooled prevalence of mortality in COVID-19 patients was 4.8%. Older people showed an increased risk of mortality from SARS-Cov-2. The pooled hazard ratio (pHR) and odds ratio (pOR) were 9.01 (95% CI; 6.30-11.71) and 1.04 (95% CI; 1.02-1.06), respectively. A significant association was found between COVID-19 mortality and men (pOR = 1.52; 95% CI 1.04-2). In addition, the risk of mortality in patients hospitalized with COVID-19 infection was strongly influenced by chronic kidney disease (CKD), hypertension, severe or critical infection on admission, cough, and dyspnea. The major limitations of the present study are that the data in the meta-analysis came mainly from studies that were published, which may lead to publication bias, and that the causal relationship between risk factors and poor outcome in patients with COVID-19 cannot be confirmed because of the inherent limitations of the observational study. CONCLUSIONS: Advanced age, male sex, CKD, hypertension, severe or critical condition on admission, cough, and dyspnea are clinical risk factors for fatal outcomes associated with coronavirus. These findings could be used for research, control, and prevention of the disease and could help providers take appropriate measures and improve clinical outcomes in these patients.

Prevalence and Outcomes of COVID -19 Patients with Happy Hypoxia: A Systematic Review.

Background: In Coronavirus disease 2019 (COVID-19), some patients have low oxygen saturation without any dyspnea. This has been termed "happy hypoxia." No worldwide prevalence survey of this phenomenon has been conducted. This review aimed to summarize information on the prevalence, risk factors, and outcomes of patients with happy hypoxia to improve their management. Methods: We conducted a systematic search of electronic databases for all studies published up to April 30, 2022. We included high-quality studies using the Newcastle-Ottawa Scale (NOS) tool for qualitative assessment of searches. The prevalence of happy hypoxia, as well as the mortality rate of patients with happy hypoxia, were estimated by pooled analysis and heterogeneity by I2. Results: Of the 25,086 COVID-19 patients from the 7 studies, the prevalence of happy hypoxia ranged from 4.8 to 65%. The pooled prevalence was 6%. Happy hypoxia was associated with age > 65 years, male sex, body mass index (BMI)> 25 kg/m2, smoking, chronic obstructive pulmonary disease, diabetes mellitus, high respiratory rate, and high d-dimer. Mortality ranged from 01 to 45.4%. The pooled mortality was 2%. In 2 studies, patients with dyspnea were admitted to intensive care more often than those with happy hypoxia. One study reported that the length of stay in intensive care did not differ between patients with dyspnea and those with happy hypoxia at admission. One study reported the need for extracorporeal membrane oxygenation (ECMO) in patients with happy hypoxia. Conclusion: The pooled prevalence and mortality of patients with happy hypoxia were not very high. Happy hypoxia was associated with advanced age and comorbidities. Some patients were admitted to the intensive care unit, although fewer than dyspneic patients. Its early detection and management should improve the prognosis.

Diabetes Mellitus is Associated With Higher COVID-19 Mortality Rates in Sub-Saharan Africa: A Systematic Review and Meta-analysis.

The rate of COVID-19-related mortality among patients with diabetes mellitus in Sub-Saharan Africa (SSA) is unknown. The current study aimed to determine the mortality rate of COVID-19 among diabetes patients in SSA. We performed a systematic review of research articles until July 1, 2021. A literature review was conducted in accordance with the PRISMA guidelines to gather relevant data. A random effects model was used to calculate odds ratios and 95% confidence intervals (CIs). We used Egger's tests and Begg's funnel plot to examine publication bias. The mortality rate of 7778 COVID-19 patients was analyzed using data from seven studies. The I2 test was used to determine the heterogeneity between studies. The meta-analysis revealed that diabetes mellitus was linked to a 1.39-fold increase in the risk of death among COVID-19 inpatients (95% CI: 1.02-1.76). According to our findings, there was no significant heterogeneity between studies, and there was no publication bias. The present review describes an association between diabetes mellitus and the risk of COVID-19 mortality in SSA.

Determinants of Survival of HIV Patients Receiving Dolutegravir: A Prospective Cohort Study in Conflict-Affected Bunia, Democratic Republic of Congo.

This study aims to determine the factors influencing HIV-related mortality in settings experiencing continuous armed conflict atrocities. In such settings, people living with HIV (PLHIV), and the partners of those affected may encounter specific difficulties regarding adherence to antiretroviral therapy (ART), and retention in HIV prevention, treatment, and care programs. Between July 2019 and July 2021, we conducted an observational prospective cohort study of 468 PLHIV patients treated with Dolutegravir at all the ART facilities in Bunia. The probability of death being the primary outcome, as a function of time of inclusion in the cohort, was determined using Kaplan-Meier plots. We used the log-rank test to compare survival curves and Cox proportional hazard modeling to determine mortality predictors from the baseline to 31 July 2021 (endpoint). The total number of person-months (p-m) was 3435, with a death rate of 6.70 per 1000 p-m. Compared with the 35-year-old reference group, older patients had a higher mortality risk. ART-naïve participants at the time of enrollment had a higher mortality risk than those already using ART. Patients with a high baseline viral load (≥1000 copies/mL) had a higher mortality risk compared with the reference group (adjusted hazard ratio = 6.04; 95% CI: 1.78-20.43). One-fourth of deaths in the cohort were direct victims of armed conflict, with an estimated excess death of 35.6%. Improving baseline viral load monitoring, starting ART early in individuals with high baseline viral loads, the proper tailoring of ART regimens and optimizing long-term ART, and care to manage non-AIDS-related chronic complications are recommended actions to reduce mortality. Not least, fostering women's inclusion, justice, peace, and security in conflict zones is critical in preventing premature deaths in the general population as well as among PLHIV.

Determinants of Patients' Adherence to Malaria Treatment in the Democratic Republic of the Congo.

(1) Background: Malaria heavily affects the Democratic Republic of the Congo (DRC) despite the use of effective drugs. Poor adherence to malaria treatment may contribute to this problem. (2) Methods: In one rural and one urban health area in each of the 11 former provinces of the DRC, all households with a case of malaria in the 15 days preceding the survey were selected and the patients or caregivers were interviewed. Adherence to malaria treatment was assessed by self-declaration about its completion. Logistic regression was used to assess predictors. (3) Results: 1732 households participated. Quinine was the most used drug; adherence to artesunate-amodiaquine was the lowest and the main reason for treatment discontinuation was adverse reactions. Predictors of adherence were residence in an urban area, university education, catholic religion, and adoption of recommended behaviour towards a malaria case. Adherence was significantly lower for responders who obtained information on antimalarials from Community Health Workers (CHW). (4) Conclusions: Usage of recommended drugs and adherence to malaria treatment need to be promoted, especially in rural areas, and CHW involvement needs to be improved. Awareness messages need to be made accessible and comprehensible to poorly educated populations and churches need to be involved.

Factors associated with death in COVID-19 patients over 60 years of age at Kinshasa University Hospital, Democratic Republic of Congo (DRC).

Introduction: the objectives of the present study were to determine the mortality rate in patients over 60 years of age with COVID-19 and to identify risk factors. Methods: the present historical cohort study took place at the Kinshasa University Hospital (KUH), DRC. Older patients admitted from March 2020 to May 2021 and diagnosed COVID-19 positive at the laboratory were selected. The relationship between clinical and biological risk factors, treatment, and in-hospital mortality was modeled using Cox regression. Results: of two hundred and twenty-two patients at least 60 years old, 97 died, for a mortality rate of 43.69%. The median age was 70 years (64-74) with extremes of 60 to 88 years. Low oxygen saturation of < 90% (aHR 1.69; 95% CI [1.03-2.77]; p=0.038) was an independent predictor of mortality. The risk of death was reduced with corticosteroid use (aHR 0.54; 95% CI [0.40-0.75]; p=0.01) and anticoagulant treatment (aHR 0.53; 95% CI [0.38-0.73]; p=0.01). Conclusion: mortality was high in seniors during COVID-19 and low oxygen saturation on admission was a risk factor for mortality. Corticosteroid therapy and anticoagulation were protective factors. These should be considered in management to reduce mortality.

Factors Associated with Liver Enzyme Abnormalities in HIV-HBV and/or HCV Co-infected Patients in Kinshasa, Democratic Republic of the Congo: Multicenter Cross-sectional Study.

BACKGROUND AND OBJECTIVE: Liver enzyme abnormalities (LEA) are extremely common and sometimes severe in individuals infected with human immunodeficiency virus (HIV), but data for this disorder are lacking in the developing countries. The objective of this study was to identify factors associated with LEA in HIV-hepatitis B virus (HBV)/hepatitis C virus (HCV) co-infected patients in Kinshasa, Democratic Republic of the Congo. METHODS: This cross-sectional analytical study included 180 people living with HIV (PLWHIV) mono-infected or co-infected with HBV/HCV between November 10, 2013 and January 10, 2014 in Kinshasa. Sociodemographic, clinical, biological, serological, and immunological data were analyzed. Levels of serum glutamate oxaloacetate transferase (SGOT) and serum glutamate pyruvate transaminase (SGPT) were determined. Antibody levels were determined using enzyme-linked immunosorbent assay (ELISA). RESULTS: The mean age of patients was 44.2±11.0 years; female sex was predominant (76.7%). Co-infection, mainly with HBV, but also HCV, was found in 43 (23.9%) patients. Elevated liver enzymes were found in 77 (42.8%) of the patients. No difference was found in the rate of liver enzyme abnormalities between patients with HIV mono-infection or HIV co-infection (46.7% versus 30.2%, respectively; P=0.08). Factors associated with LEA were age ≥50 years (adjusted odds ratio [OR] 2.7; 95% CI 1.4-5.5), duration of HIV infection >3 years (adjusted OR 2.7; 95% CI 1.4-5.5), and CD4 T cells count ≤303 cells/mm3 (adjusted OR 2.2; 95% CI 1.1-4.5). CONCLUSIONS: Liver enzyme abnormalities are frequent in patients co-infected with HIV-HBV/HCV as well as in HIV patients without co-infection. Diagnosis is determined based on age, immunodeficiency, and length of illness.

Incidence and Predictors of Loss to Follow Up among Patients Living with HIV under Dolutegravir in Bunia, Democratic Republic of Congo: A Prospective Cohort Study.

This study aimed to examine the incidence and predictors of loss to follow up (LTFU) in the context of ongoing atrocities caused by armed conflict, where HIV treatment programs and HIV-infected patients may face unique challenges in terms of ART adherence and retention in care. We conducted an observational prospective cohort study of 468 patients living with HIV (PLWHIV) under dolutegravir (DTG) in all health facilities in Bunia between July 2019 and July 2021. Kaplan-Meier plots were used to determine the probability of LTFU as a function of time as inclusive of the cohort. The main outcome variable was LTFU, defined as not taking an ART refill for a period of 3 months or longer from the last attendance for refill, and not yet classified as 'dead' or 'transferred-out.' The log-rank test was used to compare survival curves based on predictors. Cox proportional hazard modeling was used to measure predictors of LTFU from the baseline until 31 July 2021 (the endpoint). A total of 3435.22 person-months (p-m) were involved in follow up, with an overall incidence rate of 33.48 LTFU per 1000 p-m. Patients who had less experience with ART at enrolment and the ethnically Sudanese, had a higher hazard of being LTFU compared to their reference groups. This study reports a high LTFU rate in this conflict setting. An ART program in such a setting should pay more attention to naive patients and other particularly vulnerable patients such as Sudanese during the pre-ART phase. The study implies the implementation of innovative strategies to address this high risk of being LTFU, reducing either the cost or the distance to the health facility.

Biennial surveillance of Plasmodium falciparum anti-malarial drug resistance markers in Democratic Republic of Congo, 2017 and 2019.

BACKGROUND: Because of the loss of chloroquine (CQ) effectiveness, the Democratic Republic of Congo (DRC)'s malaria treatment policy replaced CQ by sulfadoxine-pyrimethamine (SP) as first-line treatment of uncomplicated malaria in 2003, which in turn was replaced by artemisinin-based combination therapies (ACT) in 2005. The World Health Organization (WHO) recommends monitoring of anti-malarial drug resistance every 2 years. The study aimed to provide baseline data for biennial molecular surveillance of anti-malarial drug resistance by comparing data from a study conducted in 2019 to previously published data from a similar study conducted in 2017 in the DRC. METHODS: From July to November 2019, a cross-sectional study was conducted in ten sites which were previously selected for a similar study conducted in 2017 across the DRC. P. falciparum malaria was diagnosed by a rapid diagnostic test (RDT) or by microscopy and dried blood samples (DBS) were taken from patients who had a positive test. Segments of interest in pfcrt and pfk13 genes were amplified by conventional PCR before sequencing. RESULTS: Out of 1087 enrolled patients, 906 (83.3%) were PCR-confirmed for P. falciparum. Like in the 2017-study, none of the mutations known to be associated with Artemisinine (ART) resistance in Southeast Asia was detected. However, non-synonymous (NS) mutations with unknown functions were observed among which, A578S was detected in both 2017 and 2019-studies. The overall prevalence of pfcrt-K76T mutation that confers CQ-resistance was 22.7% in 2019-study compared to 28.5% in 2017-study (p-value = 0.069), but there was high variability between sites in the two studies. Like in 2017-study, the pfcrt 72-76 SVMNT haplotype associated with resistance to amodiaquine was not detected. CONCLUSION: The study reported, within 2 years, the non-presence of molecular markers currently known to be associated with resistance to ART and to AQ in P. falciparum isolated in the DRC. However, the presence of polymorphisms with as-yet unknown functions was observed, requiring further characterization. Moreover, an overall decrease in the prevalence of CQ-resistance marker was observed in the DRC, but this prevalence remained highly variable from region to region.

Modalities and preferred routes of geographic spread of cholera from endemic areas in eastern Democratic Republic of the Congo.

Cholera is endemic along the Great Lakes Region, in eastern Democratic Republic of the Congo (DRC). From these endemic areas, also under perpetual conflicts, outbreaks spread to other areas. However, the main routes of propagation remain unclear. This research aimed to explore the modalities and likely main routes of geographic spread of cholera from endemic areas in eastern DRC. We used historical reconstruction of major outbreak expansions of cholera since its introduction in eastern DRC, maps of distribution and spatiotemporal cluster detection analyses of cholera data from passive surveillance (2000-2017) to describe the spread dynamics of cholera from eastern DRC. Four modalities of geographic spread and their likely main routes from the source areas of epidemics to other areas were identified: in endemic eastern provinces, and in non-endemic provinces of eastern, central and western DRC. Using non-parametric statistics, we found that the higher the number of conflict events reported in eastern DRC, the greater the geographic spread of cholera across the country. The present study revealed that the dynamics of the spread of cholera follow a fairly well-defined spatial logic and can therefore be predicted.

Predictors of Viral Non-Suppression among Patients Living with HIV under Dolutegravir in Bunia, Democratic Republic of Congo: A Prospective Cohort Study.

The Democratic Republic of the Congo adopted the integrase inhibitor dolutegravir (DTG) as part of its preferred first-line HIV treatment regimen in 2019. This study aimed to identify predictors of viral non-suppression among HIV-infected patients under a DTG-based regimen in the context of ongoing armed conflict since 2017 in the city of Bunia in the DRC. We conducted a cohort study of 468 patients living with HIV under DTG in all health facilities in Bunia. We calculated the proportion of participants with an HIV RNA of below 50 copies per milliliter. About three in four patients (72.8%) in this cohort had a viral load (VL) of <50 copies/mL after 6-12 months. After controlling for the effect of other covariates, the likelihood of having non-suppression remained significantly lower among the 25-34 age group and self-reported naïve patients with a baseline VL of ≥50 copies/mL. The likelihood of having non-suppression remained significantly higher among those who were at advanced stages of the disease, those with abnormal serum creatinine, those with high baseline HIV viremia over 1000 copies/mL, and the Sudanese ethnic group compared to the reference groups. This study suggests that we should better evaluate adherence, especially among adolescents and economically vulnerable populations, such as the Sudanese ethnic group in the city of Bunia. This suggests that an awareness of the potential effects of DTG and tenofovir is important for providers who take care of HIV-positive patients using antiretroviral therapy (ART), especially those with abnormal serum creatinine levels before starting treatment.

SARS-CoV2 infection in symptomatic patients: interest of serological tests and predictors of mortality: experience of DR Congo.

BACKGROUND: In symptomatic patients, the diagnostic approach of COVID-19 should be holistic. We aimed to evaluate the concordance between RT-PCR and serological tests (IgM/IgG), and identify the factors that best predict mortality (clinical stages or viral load). METHODS: The study included 242 patients referred to the University hospital of Kinshasa for suspected COVID-19, dyspnea or ARDS between June 1st, 2020 and August 02, 2020. Both antibody-SARS-CoV2 IgM/IgG and RT-PCR method were performed on the day of admission to hospital. The clinical stages were established according to the COVID-19 WHO classification. The viral load was expressed by the CtN2 (cycle threshold value of the nucleoproteins) and the CtE (envelope) genes of SARS- CoV-2 detected using GeneXpert. Kappa test and Cox regression were used as appropriate. RESULTS: The GeneXpert was positive in 74 patients (30.6%). Seventy two patients (29.8%) had positive IgM and 34 patients (14.0%) had positive IgG. The combination of RT-PCR and serological tests made it possible to treat 104 patients as having COVID-19, which represented an increase in cases of around 41% compared to the result based on GeneXpert alone. The comparison between the two tests has shown that 57 patients (23.5%) had discordant results. The Kappa coefficient was 0.451 (p < 0.001). We recorded 23 deaths (22.1%) among the COVID-19 patients vs 8 deaths (5.8%) among other patients. The severe-critical clinical stage increased the risk of mortality vs. mild-moderate stage (aHR: 26.8, p < 0.001). The values of CtE and CtN2 did not influence mortality significantly. CONCLUSION: In symptomatic patients, serological tests are a support which makes it possible to refer patients to the dedicated COVID-19 units and treat a greater number of COVID-19 patients. WHO Clinical classification seems to predict mortality better than SARS-Cov2 viral load.

Mortality associated with COVID-19 and hypertension in sub-Saharan Africa. A systematic review and meta-analysis.

Hypertension is a common comorbidity in COVID-19 patients. However, little data is available on mortality in COVID-19 patients with hypertension in sub-Saharan Africa (SSA). Herein, the authors conducted a systematic review of research articles published from January 1, 2020 to July 1, 2021. Our aim was to evaluate the magnitude of COVID-19 mortality in patients with hypertension in SSA. Following the PRISMA guidelines, two independent investigators conducted the literature review to collect relevant data. The authors used a random effect model to estimate the odds ratio, or hazard ratio, with a 95% confidence interval (CI). Furthermore, the authors used Egger's tests to check for publication bias. For mortality analysis, the authors included data on 29 945 COVID-19 patients from seven publications. The authors assessed the heterogeneity across studies with the I2 test. Finally, the pooled analysis revealed that hypertension was associated with an increased odds of mortality among COVID-19 inpatients (OR 1.32; 95% CI, 1.13-1.50). Our analysis revealed neither substantial heterogeneity across studies nor a publication bias. Therefore, our prespecified results provided new evidence that hypertension could increase the risk of mortality from COVID-19 in SSA.

Retention in care and predictors of attrition among HIV-infected patients who started antiretroviral therapy in Kinshasa, DRC, before and after the implementation of the 'treat-all' strategy.

The retention of patients in care is a key pillar of the continuum of HIV care. It has been suggested that the implementation of a "treat-all" strategy may favor attrition (death or lost to follow-up, as opposed to retention), specifically in the subgroup of asymptomatic people living with HIV (PLWH) with high CD4 counts. Attrition in HIV care could mitigate the success of universal antiretroviral therapy (ART) in resource-limited settings. We performed a retrospective study of PLWH at least 15 years old initiating ART in 85 HIV care centers in Kinshasa, Democratic Republic of Congo (DRC), between 2010 and 2019, with the objective of measuring attrition and to define factors associated with it. Sociodemographic and clinical characteristics recorded at ART initiation included sex, age, weight, height, WHO HIV stage, pregnancy, baseline CD4 cell count, start date of ART, and baseline and last ART regimen. Attrition was defined as death or loss to follow-up (LTFU). LTFU was defined as "not presenting to an HIV care center for at least 180 days after the date of a last missed visit, without a notification of death or transfer". Kaplan-Meier curves were used to present attrition data, and mixed effects Cox regression models determined factors associated with attrition. The results compared were before and after the implementation of the "treat-all" strategy. A total of 15,762 PLWH were included in the study. Overall, retention in HIV care was 83% at twelve months and 77% after two years of follow-up. The risk of attrition increased with advanced HIV disease and the size of the HIV care center. Time to ART initiation greater than seven days after diagnosis and Cotrimoxazole prophylaxis was associated with a reduced risk of attrition. The implementation of the "treat-all" strategy modified the clinical characteristics of PLWH toward higher CD4 cell counts and a greater proportion of patients at WHO stages I and II at treatment initiation. Initiation of ART after the implementation of the 'treat all" strategy was associated with higher attrition (p<0.0001) and higher LTFU (p<0.0001). Attrition has remained high in recent years. The implementation of the "treat-all" strategy was associated with higher attrition and LTFU in our study. Interventions to improve early and ongoing commitment to care are needed, with specific attention to high-risk groups to improve ART coverage and limit HIV transmission.