Investigating animal reservoirs for hepatitis E virus in Bangui, Central African Republic.

BACKGROUND: Hepatitis E virus (HEV) is a major cause of enterotropic viral hepatitis, a major public health problem in many developing countries. In Central African Republic (CAR), HEV genotypes 1, 2, and 3 have been found to have an impact on human health. However, data on HEV in animal reservoirs are still lacking for CAR. Here, we investigated the presence of HEV in farmed pigs and goats in Bangui, the capital city of CAR, using molecular methods. METHODOLOGY: In a prospective study, fecal samples from 61 pigs and 39 goats from farms in five districts (2nd, 4th, 6th, 7th, 8th) of Bangui were collected and tested for HEV RNA by real-time RT-PCR. The samples were further analyzed by nested-PCR and sequenced to determine the genotype and subtype to which the virus belong. RESULTS: In total, 22/100 (22.0%) feces samples were successfully amplified for HEV RNA by real time RT-PCR. All positive samples were from pigs (22/61; 36.1%), while all goat samples were negative (0/39). Twelve HEV RNA samples (12/22 or 54.5%) were successfully amplified by nested RT-PCR, and subsequently sequenced. Phylogenetic analysis revealed that the obtained sequences clustered with subtype 3h and were genetically related to the human HEV sequences from CAR. CONCLUSION: This study confirms that pigs constitute an HEV reservoir, with genotype 3 being the major circulating strain. Further studies are needed to investigate other local reservoirs and to improve knowledge of the molecular epidemiology of HEV in CAR.

Hepatitis E outbreak in the health district of Bocaranga-Koui, Central African Republic, 2018-2019.

BACKGROUND: Hepatitis E virus (HEV) is a major public health disease causing large outbreaks and sporadic cases of acute hepatitis. We investigated an outbreak of HEV infection that occurred in September 2018 in the health district (HD) of Bocaranga-Koui, located in the northwestern part of Central African Republic (CAR). METHODS: Blood samples were collected from 352 patients aged 0-85 years suspected to be infected with yellow fever (YF), according to the World Health Organization YF case definition. The notification forms from recorded cases were used. Water consumed in the HD were also collected. Human samples found negative for anti-YF IgM were then tested by ELISA for anti-HEV IgM and IgG antibodies. Positive anti-HEV (IgM and/or IgG) samples and collected water were then subjected to molecular biology tests using a real time RT-PCR assay, followed by a nested RT-PCR assay for sequencing and phylogenetic analysis. RESULTS: Of the 352 icterus patients included, anti-HEV IgM was found in 142 people (40.3%) and anti-HEV IgG in 175 (49.7%). Although HEV infection was detected in all age groups, there was a significant difference between the 0-10 age groups and others age groups (P = 0.001). Elevated levels of serum aminotransferase were observed in anti-HEV IgM-positive subjects. Phylogenetic analysis showed HEV genotype 1e in infected patients as well as in the contaminated water. CONCLUSION: This epidemic showed that CAR remains an HEV-endemic area. The genotype 1e strain was responsible for the HEV outbreak in Bocaranga-Koui HD. It is necessary to implement basic conditions of hygiene and sanitation to prevent further outbreaks of a HEV epidemics, to facilitate access to clean drinking water for the population, to launch intensive health education for basic hygiene measures, to sett up targeted hygiene promotion activities and, finally, to ensure that formal health care is available.

[OCULO-ORBITAL TUMOURS AT THE NATIONAL UNIVERSITY HOSPITAL CENTRE OF BANGUI (CNHUB), CENTRAL AFRICAN REPUBLIC, IN 2022]. / TUMEURS OCULO-ORBITAIRES AU CENTRE NATIONAL HOSPITALIER UNIVERSITAIRE DE BANGUI (CNHUB), RÉPUBLIQUE CENTRAFRICAINE, EN 2022.

Introduction: Oculo-orbital tumors are common. Their clinical and histological features are multiple. The management of oculo-orbital tumors is a real challenge in sub-Saharan Africa, especially in our context. The aim of this study was to contribute to the improvement of the management of oculo-orbital tumors at the Bangui Teaching Hospital (CNHUB). Methodology: This was a prospective, observational study of oculo-orbital tumors over 12 months from January 1 to December 31, 2022 in the ophthalmology department of the CNHUB. All consenting patients with histologically proven tumors of the eyeball and/or its adnexa were included in this study, regardless of age and sex.The parameters studied were:epidemiological: age, sex, occupation, origin;clinical: time of consultation, functional signs and associated signs, physical examination signs, risk factors;paraclinical: report of the anatomopathological examination of the operating room;therapeutic: treatment modalities (chemotherapy, surgery, palliative treatment, radiotherapy).These data were collected on a pre-established survey form for direct administration. The processing and the production of the results were carried out with Excel and Epi Info 7.0 software. Results: We included 97 patients with a mean age of 37.5 years, ranging from 2 to 70 years. There was a male predominance (sex-ratio = 1.8). Almost all patients lived in Bangui (96%). Patients under 40 years of age were most commonly affected (55%). The majority of tumors were benign (55%). Ocular pain (24%), lacrimation (22%) and orbital swelling (16%) were the main symptoms. Risk factors were mainly age (23%), diabetes (22%), HIV infection (16%) and alcohol and tobacco use (37%). The most common treatments were surgical removal (68%) and enucleation (16%). Chemotherapy was combined with surgery in 37% of cases. Conclusion: Oculo-orbital tumors are frequent in our context. Their morpho-histological presentations are varied. A multidisciplinary approach is important for a good management.

COVID-19 Genomic Surveillance in Bangui (Central African Republic) Reveals a Landscape of Circulating Variants Linked to Validated Antiviral Targets of SARS-CoV-2 Proteome.

Since its outbreak, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) spread rapidly, causing the Coronavirus Disease 19 (COVID-19) pandemic. Even with the vaccines' administration, the virus continued to circulate due to inequal access to prevention and therapeutic measures in African countries. Information about COVID-19 in Africa has been limited and contradictory, and thus regional studies are important. On this premise, we conducted a genomic surveillance study about COVID-19 lineages circulating in Bangui, Central African Republic (CAR). We collected 2687 nasopharyngeal samples at four checkpoints in Bangui from 2 to 22 July 2021. Fifty-three samples tested positive for SARS-CoV-2, and viral genomes were sequenced to look for the presence of different viral strains. We performed phylogenetic analysis and described the lineage landscape of SARS-CoV-2 circulating in the CAR along 15 months of pandemics and in Africa during the study period, finding the Delta variant as the predominant Variant of Concern (VoC). The deduced aminoacidic sequences of structural and non-structural genes were determined and compared to reference and reported isolates from Africa. Despite the limited number of positive samples obtained, this study provides valuable information about COVID-19 evolution at the regional level and allows for a better understanding of SARS-CoV-2 circulation in the CAR.

Prospecting for yaws in the Mbaïki Health District in the Central African Republic.

Introduction: yaws is endemic in the Central African Republic. The last cases of yaws notified by CAR to WHO date back to 2012. The objective of this study was to measure the prevalence of yaws in the health district of Mbaïki and to describe its clinical and epidemiological characteristics. Methods: this is a descriptive cross-sectional study, conducted from April 10 to 18, 2020 in the Mbaïki health district. Yaws cases were sought in 570 households in the 38 selected villages of the district. Any consenting individual over the age of one year with yaws-like skin lesions was a suspected case of yaws and included in the study. Blood was taken from suspected cases for serological testing (TDR, RPR and TPHA). Any suspected case of yaws with positive RPR and TPHA was considered a confirmed case. Results: a total of 1967 people were examined, of whom 113 were considered suspected cases of yaws. All suspected cases were RPR-positive, 41 TPHA-positive and 13 RDT-positive. Forty-one cases of yaws were confirmed in 18 (47.37%) villages. The prevalence of yaws in the Mbaïki health district was 2.08%. Among the cases, 38.94% were children aged 1 to 14. The sex ratio was 1.69. Lesions clinically suggestive of yaws were papilloma-like in 77.00% of cases, followed by micropapules (8.00%) and ulcerations (5.00%). Conclusion: eight of the nine communes in the Mbaïki health district are yaws-endemic. This result suggests the need to implement the Morges strategy in the Mbaïki health district.

Leprosy - neglected tropical disease in Pygmies inhabiting Central African Republic.

Leprosy is a neglected tropical disease that is still present worldwide despite efforts aimed at elimination of the disease. The BaAka Pygmy community inhabiting rural areas in the Central African Republic is one of the most leprosy-vulnerable populations. The aim of the study was to assess the prevalence of leprosy in the BaAka Pygmy population. People living in the Dzanga Sangha protected area were regularly visited by a mobile clinic in 2019/2020. The diagnosis was based on the clinical manifestation of the disease. Deformations of skin and extremities were assessed. In a 12-month period 26 cases of leprosy were diagnosed and 25 patients received treatment. 24 of those patients were BaAka Pygmies, 10 were women, 7 were children under 15 years old and 8 were diagnosed with grade 2 disability. Presented data shows that leprosy in Dzanga Sangha region is not well controlled due to the high transmission rate. Efforts to diagnose and report new leprosy cases should be intensified.

Case study of a 2022 pertussis epidemic in the Baoro sub-prefecture (Central African Republic).

OBJECTIVE: The objective of this survey was to describe epidemiological characteristics and evaluate vaccine effectiveness against pertussis in the sub-prefecture of Baoro (Central African Republic). METHOD: We conducted a case control study from June to July 2022 in the sub-prefecture of Baoro in the district of Baour-Baoro. Community-based definitions of surveillance were applied to include cases and controls. RESULTS: All in all, 143 confirmed and suspected cases and 166 controls were enrolled in this investigation. The epidemic had affected 12 neighborhoods and 9 villages. The village of Bugbassem alone had 32 patients, and 50% of the patients lived in rural areas. The age groups of 12 to 59 months accounted for 58% of cases. Patients were female in 54% of cases (p = 0.8). The attack rate among unvaccinated patients (65%) was higher than that of vaccinated patients (40%), while 15% (N = 21) of children were hospitalized with no recorded deaths. Pentavalent 3rd dose vaccination coverage was 49% in controls versus 33% in cases. Vaccination provided a significant protective effect (Odds Ratio = 0.3; 95% CI: 0.2-0.6). All told, vaccine efficacy against pertussis was 38%. CONCLUSION: Pertussis is a re-emerging disease currently occurring as a result of low pertussis vaccination coverage. It strongly affects rural areas with low vaccination rates. Vaccination strategy requires reinforcement in rural areas.

[Neglected cleft palate treatment at the Pediatric university hospital of Bangui (Central African Republic)]. / Fente palatine négligée traitée au Centre hospitalier universitaire pédiatrique de Bangui (République centrafricaine).

Cleft palate is the absence of the vault of the mouth resulting in communication between the nose and the mouth. The current frequency of cleft is 0.3% among black people. The incriminated etiological factors of this congenital malformation are exogenous and genetic. The diagnostic is clinical and above all marked by the consequences linked to the cleft, which are multiple morphological problems entailing difficulties from the first days of life (sackling impossible in the event of total cleft lip and palate), functional disorders linked to cleft velopalatine by bucco-nasal reflux, major phonation disorder, dysfunction of the Eustachian tubes causing hearing and otorhinolaryngology (ORL) disorders, breathing disorders. Thanks to the progress of ultrasound, the diagnosis can sometimes be made during pregnancy. Obstetric ultrasound can diagnose cleft lip and palate from the 16th week of amenorrhea. The Veau-Wardill classification based on embryology makes it possible to understand the different types.The care is now organized in a multidisciplinary frameware where the coordination of each specialty will make it possible to harmonize the different treatments. The current attitude is based on the principe of early management to restore the functionality of the velopalatine muscle straps as quickly as possible, reducing the risk of phonatory and auditory sequelae.Concerning cleft palates, the data are fragmented and almost non-existent in the Central African Republic, hence the interest in publishing this clinical case highlighted by chance. We report a clinical case of neglected cleft palate in a 13-year-old girl discovered during a cleft lip and palate screening campaign at the Pediatric University Hospital of Bangui.

Molecular characterization of measles viruses in Central African Republic, 2012-2016.

Despite being preventable through vaccination, measles is still one of the most important causes of morbidity and mortality in young children in Africa. In 2015, several African countries, including the Central African Republic (CAR), began implementing national measles elimination programs. However, measles remains a public health problem in Africa, particularly in the CAR. A retrospective study was conducted at the Institut Pasteur de Bangui, using blood samples (n = 255) and oral swabs (n = 7) collected between January 2012 and December 2016 from measles IgM-positive cases, to attempt genotyping of circulating measles virus strains. Overall, 50 samples were positive by real-time polymerase chain reaction, and 40 sequences of acceptable quality were obtained. The phylogenetic analysis showed that 38 strains belonged to genotype B3 suggesting that this genotype was endemic in the CAR during the study period. No genotype B2 sequences were detected, suggesting that this genotype is no longer present in the CAR.

Risk factors for multidrug-resistant tuberculosis in the Central African Republic: A case-control study.

BACKGROUND: The emergence and spread of multidrug-resistant tuberculosis (MDR-TB) presents a challenge to the "End TB by 2035" strategy. This study aimed to identify the risk factors associated with MDR-TB in patients admitted to the pneumo-physiology clinic of the National University Hospital of Bangui in Central African Republic. METHODS: This was a "retrospective" chart review study. Cases were represented by patients more than 18 years of age treated for MDR-TB and controls were patients with "at least rifampicin-susceptible" TB treated "with first-line anti-TB regimen" and who at the end of treatment were declared cured. The status of "cured" was exclusively applicable to non-MDR TB. Risk factors associated with MDR-TB were identified by multivariate analysis. RESULTS: We included 70 cases and 140 controls. The median age was 35 years, IQR (22;46 years). The main factors associated with the occurrence of MDR-TB in multivariate analysis were male gender (0 R = 3.02 [1.89-3.99], p = 0.001), residence in a peri-urban/urban area (0 R = 3.06 [2.21-4.01], p = 0.002), history of previous TB treatment (0 R= 3.99 [2.77-4.25], p < 0.001) and the presence of multidrug-resistant TB in the family (0 R=1.86 [1.27-2.45], p = 0.021). CONCLUSION: The emergence of MDR-TB can be reduced by implementing appropriate strategies, such as preventive therapy in contacts of MDR-TB patients and detecting and appropriately treating MDR-TB patients to prevent further spread of infection.

Laboratory Diagnosis of Mpox, Central African Republic, 2016-2022.

During 2016-2022, PCR testing confirmed 100 mpox cases among 302 suspected cases in the Central African Republic. The highest detection rates were from active lesions (40%) and scabs (36%); cycle thresholds were lower (≈18) than those for blood samples (≈33). Results were consistent for generic primer- and clade I primer-specific PCR tests.

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.

A rapid increase in coverage of COVID-19 vaccination, Central African Republic.

Problem: In 2021, Central African Republic was facing multiple challenges in vaccinating its population against coronavirus disease 2019 (COVID-19), including inadequate infrastructure and funding, a shortage of health workers and vaccine hesitancy among the population. Approach: To increase COVID-19 vaccination coverage, the health ministry used three main approaches: (i) task shifting to train and equip existing community health workers (CHWs) to deliver COVID-19 vaccination; (ii) evidence gathering to understand people's reluctance to be vaccinated; and (iii) bundling of COVID-19 vaccination with the polio vaccination programme. Local setting: Central African Republic is a fragile country with almost two thirds of its population in need of humanitarian assistance. Despite conducting two major COVID-19 vaccination campaigns, by January 2022 only 9% (503 000 people) of the 5 570 659 general population were fully vaccinated. Relevant changes: In the 6 months from February to July 2022, Central African Republic tripled its coverage of COVID-19 vaccination to 29% (1 615 492 out of 5 570 659 people) by August 2022. The integrated polio-COVID-19 campaign enabled an additional 136 040 and 218 978 people to be vaccinated in the first and second rounds respectively, at no extra cost. Evidence obtained through surveys and focus group discussions enabled the health ministry to develop communication strategies to dispel vaccine hesitancy and misconceptions. Lessons learnt: Task shifting COVID-19 vaccination to CHWs can be an efficient solution for rapid scaling-up of vaccination campaigns. Building trust with the community is also important for addressing complex health issues such as vaccine hesitancy. Collaborative efforts are necessary to provide access to COVID-19 vaccines for high-risk and vulnerable populations.

African countries from the Pasteur Network reexamine their syndromic sentinel surveillance system associated with household contact within the AFROSCREEN program.

Surveillance to better detect and respond to new pathogens remains a major challenge for global public health. The Pasteur Network recently held a brainstorming workshop located in Cameroon attended by Pasteur epidemiological teams from Niger, Central African Republic (CAR), Cameroon, Senegal, and Madagascar to discuss how the Pasteur Network in Africa could use the lessons of COVID-19 to set-up a pilot sentinel surveillance scheme given its expertise and involvement during the pandemic. The possibility of coupling sentinel syndromic and biological surveillance already implemented for influenza surveillance with the recent sequencing capacity put in place by the AFROSCREEN program prompted us to consider strengthening surveillance tools to target "Pathogen X" detection in Africa. The perspective project provided by the Pasteur Network teams and shared with other partners of the AFROSCREEN program will target strengthening of the diagnosis of severe acute respiratory infections (IRAS) and the surveillance of IRAS, the evaluation of the impact of SARS-CoV-2 on the epidemiology of IRAS, and the addition of the detection of new pathogens, called "Pathogen X," based on sequencing capacity and epidemiological criteria from One Health approaches.

Five successive waves of SARS-CoV-2 infection in the Central African Republic: a prospective observational study from 2020-2022.

Introduction: the National Laboratory of Clinical Biology and Public Health (NLBPH) in Bangui in the Central African Republic (CAR) carries out the vast majority of molecular screening tests for SARS-CoV-2 infection nationwide. This study aimed to show the contribution of molecular diagnosis and genomic surveillance in monitoring the evolution of longitudinal variations of the SARS-CoV-2 infection epidemic in CAR between 2020 and the end of 2022. Methods: this is an observational study on the variations in the prevalence of detection of SARS-CoV-2 by RT-PCR at the NLCBPH from nasopharyngeal samples taken prospectively over a period of 3 years since the beginning of the COVID-19 epidemic. A subgroup of SARS-CoV-2 positive samples was selected for molecular sequencing performed by Illumina® and MinIon® at the National Institute for Biomedical Research in Kinshasa, Democratic Republic of the Congo. Results: from March 2020 to December 31th, 2022, 88,442 RT-PCR tests were carried out (4/5 of the country) and detected 9,156 cases of SARS-CoV-2 infection in 5 successive waves. The average age of the patients was 39.8 years (extremes ranging from to 92 years). Age(P=0.001), sex(P=0.001) and symptom presentation(P=0.001) were significantly associated with RT-PCR test positivity. Among the different variants identified during successive waves, the Omicron variant predominated during the last two waves. Conclusion: this prospective study over a period of 3 years, marked by 5 successive waves, made it possible to report that age, sex and the presence of clinical symptoms are associated with RT-PCR positivity. Among the different variants identified during successive waves, the Omicron variant predominated during the last two waves.

National Monkeypox Surveillance, Central African Republic, 2001-2021.

We analyzed monkeypox disease surveillance in Central African Republic (CAR) during 2001-2021. Surveillance data show 95 suspected outbreaks, 40 of which were confirmed as monkeypox, comprising 99 confirmed and 61 suspected monkeypox cases. After 2018, CAR's annual rate of confirmed outbreaks increased, and 65% of outbreaks occurred in 2 forested regions bordering the Democratic Republic of the Congo. The median patient age for confirmed cases was 15.5 years. The overall case-fatality ratio was 7.5% (12/160) for confirmed and suspected cases, 9.6% (8/83) for children <16 years of age. Decreasing cross-protective immunity from smallpox vaccination and recent ecologic alterations likely contribute to increased monkeypox outbreaks in Central Africa. High fatality rates associated with monkeypox virus clade I also are a local and international concern. Ongoing investigations of zoonotic sources and environmental changes that increase human exposure could inform practices to prevent monkeypox expansion into local communities and beyond endemic areas.

Prevalence and associated factors of undiagnosed hypertension among adults in the Central African Republic.

The study aimed to estimate the prevalence and associated factors of undiagnosed hypertension (HTN) among adults in the Central African Republic (CAR). In the cross-sectional 2017 CAR (Bangui and Ombella M'Poko) STEPS survey, 3265 persons aged 25 to 64 years (non-pregnant and with complete blood pressure measurement), responded to an interview, biomedical and physical, including blood pressure, measurements. Undiagnosed HTN was classified as systolic BP ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg among adults who had never been told by a doctor or other health worker that they had raised blood pressure or hypertension and had not been taking antihypertensive medication. Binary logistic regressions are used to estimate factors associated with undiagnosed HTN. Among those with HTN (N = 1373), the proportion of undiagnosed HTN was 69.8% and 30.2% diagnosed HTN. In the adjusted logistic regression analysis, male sex (AOR: 2.12, 95% CI 1.39-3.23), current tobacco use (AOR: 1.58, 95% CI 1.03-2.42), and high physical activity (AOR: 1.93, 95% CI 1.00-3.71) were positively associated, and age (AOR: 0.75, 95% CI 0.59-0.96), and underweight (AOR: 0.58, 95% CI 0.37-0.90) were inversely associated with undiagnosed HTN. In addition, among men, ever screened for glucose (AOR: 0.07, 95% CI 0.02-0.27) was negatively associated with undiagnosed HTN, and among women, married or cohabiting (AOR: 1.20, 95% CI 1.00-1.44), current heavy drinking (AOR: 1.41, 95% CI 1.04-1.91) were positively associated with undiagnosed HTN. Seven in ten of the adult population with HTN had undiagnosed HTN in CAR. Efforts should be reinforced to screen for HTN in the general population.

Continuous Circulation of Yellow Fever among Rural Populations in the Central African Republic.

Yellow fever remains a public-health threat in remote regions of Africa. Here, we report the identification and genetic characterisation of one yellow-fever case observed during the investigation of a cluster of nine suspected haemorrhagic fever cases in a village in the Central African Republic. Samples were tested using real-time RT-PCR targeting the main African haemorrhagic fever viruses. Following negative results, we attempted virus isolation on VERO E6 cells and new-born mice and rescreened the samples using rRT-PCR. The whole viral genome was sequenced using an Illumina NovaSeq 6000 sequencer. Yellow-fever virus (YFV) was isolated from one woman who reported farming activities in a forest setting several days before disease onset. Phylogenetic analysis shows that this strain belongs to the East-Central African YFV genotype, with an estimated emergence some 63 years ago. Finally, five unique amino-acid changes are present in the capsid, envelop, NS1A, NS3, and NS4B proteins. More efforts are required to control yellow-fever re-emergence in resource-limited settings.

Analytical performances of Exacto® HIV self-test in the Central African Republic.

We herein evaluated the analytical performances of the CE-IVD capillary blood Exacto® HIV self-test (Biosynex, Strasbourg, France) in the Central African Republic (CAR). A cross-sectional study was conducted on a representative national panel of 200 sera positive for HIV and 200 negative for HIV, randomly selected thorough the CAR for HIV seroprevalence surveillance survey, according to reference test. The Exacto® HIV self-test showed 99.5% (95% CI: 98.2-99.9) sensitivity and 100.0% (95% CI: 99.0-100.0) specificity. The Youden´s J index and Cohen´s Kappa coefficient were 0.995. At HIV-1 seroprevalence of 3.5% in the general adult population of the CAR, the positive and negative predictive values were 100% (95% CI: 99.0-100) and 99.9% (95% CI: 98.9-100), respectively. The results are within the limits required by the WHO (i.e. sensitivity ≥ 99.0% and specificity ≥ 98.0%), making Exacto® HIV self-test suitable for routine use in the CAR.

Response to COVID-19 in the Central African Republic: Coping Strategies Combined With China's Experience.

Objectives: The weak health system, domestic political unrest, poverty, and many other factors in the Central African Republic (CAR) have left the country underprepared for the COVID-19 pandemic, resulting in a greater health threat to the entire country. Rapid measures must therefore be taken to prevent the further spread of COVID-19. Methods: This work encompassed a review of relevant literature. We aim to analyze how far Chinese COVID measures can be transferred to the context of the CAR. Results: We argue that the measure that the CAR can learn from China's success is the involvement of community workers and that greater investment in this model may be the optimal solution. Help from the international community is urgently needed. Conclusion: The CAR can benefit from China's successful experience in fighting the epidemic, but the disparity in the combined power of the two countries does not allow for simple replication of China's strategy.