The accuracy of widal test for typhoid fever diagnosis in Ethiopia: Systematic review and meta-analysis

Introduction: Widal agglutination test is a serologic investigation that is used to diagnose typhoidfever. This is an easy, fairly inexpensive, and readily available test it'ith questionable reliability. The test performance differs from setting to setting depending on the technique used and otherfactors. The accuracy ofthis test in Ethiopia is poorly understood. So, the aim of this scientific work was to analyze the accuracy of Widal agglutination in diagnosing typhoidfever in Ethiopia. Methods: We performed a systematic review and meta-analysis. Two electronic databases (PubMed/Medline and Google scholar) were searched using preset search strategv to find relevant studies. The methodological quality of the studies included was evaluated "'ith a QUADAS-2. We extracted important variables from the eligible articles. Statistical analysis was conducted using STATA version 14. The protocol of our systematic review and metaanalysis is registered in the International Prospective Register of Systematic Reviews (PROSPERO) with the record number CRD42020194252. Results: The electronic quests yielded 42 papers of which 8 "'ere eligible for analysis. The quality of these studies was rated to be moderate based on the QUADAS-2. The pooled sensitivity, specificity, and negative, andpositive predicthe values ofthe Widal test were 80.8%, 53.0%, 98.5%, and 2.1% respecth'ely. Conclusion: The "'idal agglutination test has average specificity, ven good negative predicth'e value, and ven poor positive predictive value for the diagnosis of typhoidfever. Depending on Widal to diagnose typhoid fever may lead to over-diagnosis of typhoid fever and related complications including inappropriate use of antibiotics. There is an urgent needfor quick and dependable tests for diagnosing typhoidfever, particularly in settings like Ethiopia M'here doing timely culture is notfeasible.

The role of serological testing in the SARS-CoV-2 outbreak

Antibody tests for the novel coronavirus, SARS-CoV2, have been developed both as rapid diagnostic assays and for high-throughput formal serology platforms. Although these tests may be a useful adjunct to a diagnostic strategy, they have a number of limitations. Because of the antibody and viral dynamics of the coronavirus, their sensitivity can be variable, especially at early time points after symptom onset. Additional data are required on the performance of the tests in the South African population, especially with regard to development and persistence of antibody responses and whether antibodies are protective against reinfection. These tests may, however, be useful in guiding the public health response, providing data for research (including seroprevalence surveys and vaccine initiatives) and development of therapeutic strategies

COVID-19 antibody testing: from hype to immunological reality

The potential role for serological tests in the current COVID-19 pandemic has generated very considerable recent interest across many sectors worldwide, inter alia pathologists seeking additional weapons for their armoury of diagnostic tests; epidemiologists seeking tools to gain seroprevalence data that will inform improved models of the spread of disease; research scientists seeking tools to study the natural history of COVID-19 disease; vaccine developers seeking tools to assess vaccine efficacy in clinical trials; and companies and governments seeking tools to aid return-to-work decision-making. However, much of the local debate to date has centred on questions surrounding whether regulatory approval processes are limiting access to serological tests, and has not paused to consider the intrinsically limiting impact of underlying fundamental biology and immunology on where and how different COVID-19 serological tests can usefully be deployed in the response to the current pandemic. We review, from an immunological perspective, recent experimental evidence on the time-dependency of adaptive immune responses following SARS-CoV-2 infection and the impact of this on the sensitivity and specificity of COVID-19 antibody tests made at different time points post infection. We interpret this scientific evidence in terms of mooted clinical applications for current COVID-19 antibody tests in identifying acute infections, in confirming recent or past infections at the individual and population level, and in detecting re-infection and protective immunity. We conclude with guidance on where current COVID-19 antibody tests can make a genuine impact in the pandemic

HIV self-testing services for female sex workers, Malawi and Zimbabwe

Objective To present findings from implementation and scale-up of human immunodeficiency virus (HIV) self-testing programmes for female sex workers in Malawi and Zimbabwe, 2013­2018. Methods In Zimbabwe, we carried out formative research to assess the acceptability and accuracy of HIV self-testing. During implementation we evaluated sex workers' preferences for, and feasibility of, distribution of test kits before the programme was scaled-up. In Malawi, we conducted a rapid ethnographic assessment to explore the context and needs of female sex workers and resources available, leading to a workshop to define the distribution approach for test kits. Once distribution was implemented, we conducted a process evaluation and established a system for monitoring social harm. Findings In Zimbabwe, female sex workers were able to accurately self-test. The preference study helped to refine systems for national scale-up through existing services for female sex workers. The qualitative data helped to identify additional distribution strategies and mediate potential social harm to women. In Malawi, peer distribution of test kits was the preferred strategy. We identified some incidents of social harm among peer distributors and female sex workers, as well as supply-side barriers to implementation which hindered uptake of testing. Conclusion Involving female sex workers in planning and ongoing implementation of HIV self-testing is essential, along with strategies to mitigate potential harm. Optimal strategies for distribution and post-test support are context-specific and need to consider existing support for female sex workers and levels of trust and cohesion within their communities

Seroprevalence of antibodies to Hepatitis c virus in newly diagnosed HIV-1/2 positive patients in a tertiary hospital in Portharcourt Nigeria

Background There is a growing burden of Hepatits C virus (HCV) and Human Immunodeficiency virus (HIV) co-infection, with worsening mortality and limitations in the treatment of HIV infected persons. This study was done to determine the seroprevalence of antibodies to HCV in newly diagnosed HIV patients. Materials and Methods A desk review of laboratory records of serological testing for HIV and HCV performed in the Department of Haematology and Blood Transfusion of the University of Port Harcourt Teaching Hospital over a one year period, between July 2015 and June 2016 was done. Serologic test results and data of newly diagnosed HIV patients sent for confirmatory screening and routine HCV screening were obtained from the serology laboratory records. A total of 752 HIV positive cases were screened within this period. Laboratory tests for HIV-1/2 are performed using Determine kit (Alere, USA) and Uni-Gold kit (Trinity Biotech), while that of HCV was done using HCV rapid test strip (Hangzhou Biotest Biotech Co., Ltd, China and Citrus Diagnostics Inc., Canada).Results Out of the 752 newly diagnosed HIV cases, 2 tested positive to antibodies to HCV. Thus the co-infection rate is 0.3%. HCV and HIV co-infection occurred only in females with 30years being the mean age of prevalence. Conclusion The prevalence of HCV in HIV patients in this study is low. The low frequency of HIV/HCV co-infection may be explained by the fact that the high risk group of PWID and MSM are not so prevalent in our environment

Sérologie palustre: quel apport dans un pays d'endémie palustre comme la Côte d'Ivoire?

Introduction: la sérologie palustre semble avoir peu d'intérêt dans les pays d'endémie comme la Côte d'Ivoire. Cependant cet examen a été régulièrement réalisé au laboratoire de Parasitologie de l'Unité de Formation et de Recherche Sciences Médicales d'Abidjan. Le but de notre étude était d'apprécier l'apport de la sérologie palustre dans notre contexte de pays endémique.Méthodes: nous avons réalisé une étude rétrospective portant sur la sérologie palustre qui a utilisé le kit Falciparum spot-IF de Biomérieux à la recherche d'anticorps antiplasmodiaux d'isotype IgG. Elle a concerné les sérologies réalisées de janvier 2007 à février 2011 et dont les résultats étaient disponibles dans le registre.Résultats: au total, 136 patients ont été sélectionnés. L'âge moyen était de 36,3 ans avec des extrêmes de 1 an et 81 ans et un sex-ratio de 0,97. Les indications de sérologie palustre étaient variées, dominées par la splénomégalie (49,3%), les cytopénies (14,7%), la fièvre d'origine indéterminée (13,2%). La quasi-totalité des patients (98,5%) avaient des anticorps antiplasmodiaux avec un titre moyen élevé à 1057,35UI/ml. Il n'existait pas de lien entre l'âge et le titre d'Ac qui était plus élevé pour les cytopénies, les fièvres prolongées et la splénomégalie.Conclusion: la sérologie palustre a peu d'intérêt dans notre pratique courante en zone d'endémie car quelque soit le motif de la prescription, les titres étaient élevés

Resultats du Pastorex dans le diagnostic de méningite à Neisseria Meningitidis comparés à la culture

Introduction : La meningite est un probleme de sante publique dans les pays tropicaux. Elle atteint surtout les enfants et les jeunes adultes et sevit sous forme d'epidemies explosives tous les 10 a 12 ans. En Republique Democratique du Congo (RDC); on a recense au premier trimestre de 2010; 1852 cas dont 182 deces. Une epidemie a fait 17 morts a Kisangani en 2009.Cette etude avait pour objectifs d'identifier le germe en cause dans l'epidemie de 2009; de comparer les resultats biologiques de la meningite selon la coloration au gram; la culture et le test au latex de Pastorexrealises au niveau du liquide cephalorachidien (LCR).Materiel et Methode : Notre echantillon est fait de 33 echantillons de LCR sur lesquels la coloration de Gram; la culture et le test serologique au latex de Pastorex ont ete effectues. Ces echantillons ont ete preleves chez des malades atteints de meningite.Resultat : La coloration au gram a ete positive pour 94 des echantillons contre 6 des echantillons negatifs; 82 des echantillons ont montre des diplocoques gram negatifs. Le test de Pastorex a pour sa part identifie Neisseria meningitidis type C(NMC) dans 87;9 comme agent causal de cette epidemie de meningite. La culture sur gelose au sang du LCR etait concluante chez seulement 51;5 des echantillons. Conclusion : Dans la meningite a N. meningitidis; le test de Pastorexaun avantage diagnostic plus que la culture sur gelose au sang et permet egalement d'identifier le type de N.meningitidis

The World Health Organization African Region external quality assessment scheme for anti-HIV serology

A regional external quality assessment scheme (REQAS) for anti-HIV serology aimed to objectively assess reliability and quality of HIV testing processes in the African region. This involved the distribution of proficiency testing (PT) panels to participating laboratories from 2002 to 2010. During the survey period; this included 16 distributions of PT panels to 49 laboratories in 30 countries; and the overall average score during the nine-year survey period was 98.9; with a frequency of accurate detection; of anti-HIV-1 and/or anti-HIV-2 antibodies in the PT panels; ranging from 93 to 100. Problems highlighted included lack of human resources and frequent stock outs of test kits; reagents and consumables for routine HIV testing. The design of the REQAS allowed appraisal of the reliability of anti-HIV serological testing methods utilised by laboratories for clinical assessment of patients and/or surveillance programmes. The REQAS was able to demonstrate that laboratories participating in the REQAS performed well and sustained their participation in the scheme. This bodes well for clinical diagnosis; surveillance and training activities at these reference laboratories

Application of the Information; Motivation and Behavioural Skills Model for Targeting HIV Risk Behaviour amongst Adolescent Learners in South Africa

This paper discusses the application of an information; motivation and behavioural skills (IMB) model in a school-based programme for the reduction of HIV risk behaviour among 259 Grade 11 learners in two high schools in Alexandra township; Johannesburg. School 1 was the Experimental group; while School 2 was the Control group. After a baseline study (Time 1) at both schools; a 3-week intervention programme was conducted at School 1. A post-test (Time 2) was conducted at both schools. The intervention was repeated at School 2; followed by another post-test (Time 3) at both schools. A final test (Time 4) was conducted at both schools. While there were positive changes in the levels of HIVetAIDS IMB in learner participants; these changes may not be entirely attributed to the intervention. If an IMB model-based intervention is to be maximally effective in reducing HIV-risk behaviour among adolescents; it must focus on the behavioural; structural and socio-cultural contexts in which adolescents live

Analyse serologique de la toxoplasmose pergravidique: evaluation des risques et perspectives du depistage prenatal au centre hospitalier universitaire de Bobo Dioulasso au Burkina Faso

Introduction: La presente etude rapporte les donnees serologiques de 306 serums collectes chez des parturientes au CHU de Bobo Dioulasso et analyses retrospectivement au CHU de Reims en 2011. Le but etait de determiner le statut serologique de ces parturientes et d'en deduire la conduite a tenir. Methodes: La recherche des IgG et des IgM anti toxoplasmiques etait systematique. Les techniques d'agglutination haute sensibilisee et celle d'Immunocapture M ont servi a la recherche respective des anticorps specifiques IgG et des IgM. Resultats: Sur 306 serums analyses; 95 (31) avaient des IgG positifs et aucun n'avait des IgM. Deux cent onze (211) serums (69) des serums n'avaient ni IgG; ni IgM. Conclusion: Nos resultats montrent que 31 des femmes en dehors d'une immunodepression sous jacente; possedent une immunite residuelle vis a vis de Toxoplasma gondii et n'ont pas la necessite d'avoir une surveillance serologique pendant la grossesse. Cependant; 69 (211) des parturientes sont a risque d'une seroconversion; et devraient beneficier de conseils hygieno dietetiques; associes a une surveillance serologique durant la grossesse. Ces resultats montrent l'interet de mettre en place des mesures de prevention contre la toxoplasmose congenitale; etant l'une des affections materno - foetales les plus frequentes par la mise en place d'un diagnostic prenatal de la toxoplasmose en routine dans notre hopital

HIV Counselling and Testing Utilisation and Attitudes of Male Inmates in a South African Prison

The Department of Correctional Services Policy on the management of HIV and AIDS for offenders include voluntary counselling and testing (VCT) for HIV as one of the priorities in the rehabilitation of inmates. The aim of this study was to determine factors associated with the utilisation of VCT services in the correctional centres in terms of level of satisfaction; their experiences and expectations; and motivating factors and barriers for VCT utilisation at Losperfontein Correctional Centre; South Africa. This was a case control study (cases being those who underwent testing and controls those who did not) examining predictors of HIV VCT utilisation among 200male adult sentenced inmates serving medium and maximum sentences. Results indicate that a poor health system (OR=0.34; 95CI:0.23 - 0.50) was inversely associated with HIV testing acceptance in prison; while age; educational level; population group; marital status; length of incarceration and access to HIV testing in prison were not associated with HIV testing acceptance in prison. Half of the participants (50) agreed that VCT services are accessible and are promoted at their correctional centre. Most were satisfied with different components of VCT services; ranging from 79 (fair to very good) for 'the way he/she received you' to 62 'clarified all your concerns'. This study demonstrated some challenges and benefits to the field of health promotion and HIV prevention in the correctionalcentres especially with regard to VCT services

Perceptions of Door-to-Door HIV Counselling and Testing in Botswana

Prevalence of HIV infection in Botswana is among the highest in the world; at 23.9 of 15 - 49-year-olds. Most HIV testing is conducted in voluntary counselling and testing centres or medical settings. Improved access to testing is urgently needed. This qualitative study assessed and documented community perceptions about the concept of door-to-door HIV counselling and rapid testing in two of the highest-prevalence districts of Botswana. Community members associated many positive benefits with home-based; door-to-door HIV testing; including convenience; confidentiality; capacity to increase the number of people tested; and opportunities to increase knowledge of HIV transmission; prevention and care through provision of correct information to households. Community members also saw the intervention as increasing opportunities to engage and influence family members and to role model positive behaviours. Participants also perceived social risks and dangers associated with home-based testing including the potential for conflict; coercion; stigma; and psychological distress within households. Community members emphasised the need for individual and community preparation; including procedures to protect confidentiality; provisions for psychological and social support; and links to appropriate services for HIV-positive persons

An Evaluation of a Refresher Training Intervention for HIV Lay Counsellors in Chongwe District; Zambia

To address a severe shortage of human resources for health; the Zambian Ministry of Health has begun to make use of lay counsellors for HIV counselling and testing. However; their skills and knowledge rarely have been reviewed or refreshed. We conducted a two-day refresher workshop for lay counsellors to review their performance and refresh their skills and knowledge. The objective of this study was to evaluate the refresher training intervention for HIV lay counsellors in the rural district of Chongwe in Zambia. The two-day refreshertraining workshop was held in November 2009. Twenty-five lay counsellors were selected by District Health Office and participated in the workshop. The workshop included: the opening; a pre-training exercise; lectures on quality assurance with regard to testing and safety precautions; lectures on counselling; filling the gap/QetA session; and a post-training exercise. In both the pre- and post-trainingexercise; participants answered 25 true/false questions and tested 10 blood panel samples to demonstrate their knowledge and skill on HIV counselling and testing. The average overall knowledge test score increased from 79 to 95 (p0.001). At the baseline; knowledge test scores in topic of standard precaution and post-exposure prophylaxis were relatively low (58) but rose to 95 after the training (p0.001). The per cent agreement of HIV testing by lay counsellors with reference laboratory was 99.2. Participants' knowledge was improved during the workshop and skill at HIV testing was found to remain at a high level of accuracy. Relatively weak knowledge of standard precautions and post-exposure prophylaxis suggests that lay counsellors are at risk of nosocomial infections; particularly in the absence of refresher training interventions. We conclude that the refresher training was effective for improving the knowledge and skills of lay counsellors and provided an opportunity to monitor their performance

Disclosure in Times of ART: A Relational Analysis of Social Practices

The reach of HIV counseling and testing has grown rapidly since the 2000s; particularly since 2007 when provider-initiated counseling and testing was implemented alongside voluntary counseling and testing and testing for the prevention of motherto- child transmission. Nevertheless; we still know little about the attendant practices of disclosing HIV-positive status. Persistently high rates of non-disclosure raise difficult ethical; public health and human rights issues. The articles in this special issue show that disclosure practices in Africa not only follow the public health rationality but are shaped by fears of stigma that favor secrecy. They show how practices of disclosure are embedded in social relationships. More specifically; they present disclosure practices at the intersection of five social spaces: international norms; national legislation and public health recommendations; household and family settings; couples' relationships; parental relationships; and relationships between health workers and PLWHA. The authors describe how people pursue strategies of disclosure in one or more of these social spaces; which sometimes allows them to avoid barriers (for instance when they choose to disclose only partially to certain 'significant others' in the household). One important finding is that counselors often do not support PLWHA to disclose their HIV status. Counselors themselves may be influenced by divergent logics and experience conflicts in values; they may also lack sufficient knowledge and skills to discuss sensitive issues based on rapidly changing medical data and public health recommendations

Le conseil post-test encourage-t-il les PVVIH a partager leur statut serologique? Pratiques et suggestions des conseillers au Burkina Faso

Full Title:Le conseil post-test encourage-t-il les PVVIH a partager leur statut serologique? Pratiques et suggestions des conseillers au Burkina Faso (Does post-test counseling support PLHIV in disclosing their HIV status? Practices and propositions by counselors in Burkina Faso)Le partage du resultat du test VIH est; selon les normes; aborde lors du counseling post-test. Cependant; alors que les obstacles au partage d'un resultat VIH positif sont attestes; la litterature reste peu abondante sur la maniere dont les directives sont appliquees sur le terrain. L'objectif de cet article est d'examiner les pratiques de conseil concernant le partage du resultat avec l'entourage rapportees par les clients et les prestataires du conseil et test VIH (CTV) au Burkina Faso. Une enquete transversale a ete conduite en milieu urbain et en milieu rural en 2008. Un questionnaire integrant des questions semi-ouvertes a ete utilise. Un nombre total de 542 personnes qui ont realise le test depuis 2007 et 111 prestataires de services de conseil et test VIH ont ete interviewes. Les donnees ont ete analysees sur SPSS 12. Seulement 29des personnes testees declarent que le theme du partage du resultat avec l'entourage a ete discute avec elles lors du counseling post-test. Ce resultat s'explique par les incertitudes et les inquietudes des prestataires sur la maniere de partager et sur les risques de consequences defavorables du partage. Des strategies sont developpees par les prestataires pour soutenir les personnes dont la seropositivite a ete depistee a partager cette information avec l'entourage mais ils reconnaissent que ces actions sont insuffisantes. Les suggestions des prestataires pour ameliorer la situation incluent la lutte contre la stigmatisation vis-a-vis des personnes vivant avec le VIH; le renforcement des competences des prestataires et l'adoption de textes juridiques pour rendre obligatoire le partage du resultat avec le partenaire. En conclusion; l'etude a identifie plusieurs pistes pour ameliorer les pratiques de conseil concernant le partage des resultats au Burkina Faso. Ces observations pourraient avoir une portee globale pour la region Afrique

'When I Get Better I will do the Test': Facilitators and Barriers to HIV Testing in Northwest Region of Cameroon with Implications for TB and HIV/AIDS Control Programmes

The World Health Organization has recommended collaborative activities between TB and HIV programmes with routine counselling and testing for HIV among TB patients in order to improve the uptake of HIV services. We carried out qualitative research interviews with 21 TB patients in four selected TB and HIV/AIDS treatment centres in the Northwest Region of Cameroon to explore the facilitators and barriers to HIV testing. The desire to be healthy and live longer from knowing one's status inspired by the anticipated support from loved ones; faith in a supreme being; influence and trust in the medical authority; encouraged HIV testing. Men also demonstrated their masculinity by testing; thus portraying themselves as positive role models for other men. Meanwhile; the overwhelming burden of facing both TB and HIV simultaneously; influenced by the fear of disclosure of results; harmful gender norms and practices; fear of stigma and discrimination; and misconceptions surrounding HIV/AIDS deterred HIV testing. However; as a result of conflicting emotional experiences regarding to test or not to test; the decision-making process was not straightforward and this complex process needs to be acknowledged by health care providers when advocating for routine HIV testing among TB patients

The Impact of a Buddy System on the Self-Care Behaviours of Women Living with HIV/AIDS in Botswana

A needs assessment done among HIV-positive (HIV+ve) people in Botswana in 2000 indicated that these people required social support. Based on these results; a buddy system for and by HIV+ve women was instituted in Botswana during 2002. This study examined the impact of the buddy system on the self-care behaviours of 116 HIV+ve women volunteers who used the services of COCEPWA (Coping Centre for People with Aids) during 2002. The convenience sample comprised 39 buddies who completed the buddy training programme; 39 patients assigned to the 39 buddies and 38 controls who lived in areas where the buddy programme did not operate. The results indicate that HIV+ve patients who had buddies showed improved self-care behaviours from April 2002 until November 2002 compared to the controls. These self-care behaviours encompassed informing a number of other people about their HIV+ve status; compliance with tuberculosis treatment; CD4 quantification and adherence to antiretroviral therapy. Although the differences were not always statistically significant; the patients showed greater improvements than the controls in all self-care behaviours. Thus the buddy system might have assisted and empowered the patients to achieve higher levels of self-care behaviours than the controls

Bilan des examens serologiques de la toxoplasmose

Introduction : la toxoplasmose peut etre a l'origine de complications chez la femme enceinte a type de fotopathies graves; d'avortements. Cependant ces complications peuvent etre evitees pendant la grossesse par un diagnostic precoce. L'objectif de cette etude est de determiner la prevalence de la toxoplasmose chez la femme pendant la grossesse. Materiels et methodes : nous avons mene cette etude sur 109 femmes enceintes adressees au laboratoire de parasitologie et de mycologie du CHU Le Dantec pour un serodiagnostic de la toxoplasmose en 2002. Nous avons utilise une technique immunoenzymatique en phase solide dont le principe repose sur le changement de coloration en presence d'anticorps de type IgM ou IgG; coloration dont l'intensite est fonction du titre en anticorps. Pour cela deux tests serologiques (S1 et S2); a partir de deux prelevements de sang veineux a 3 semaines d'intervalle; sont realises chez ces femmes enceintes. Cette deuxieme serologie permettra de confirmer ou d'infirmer une toxoplasmose evolutive basee sur la variation du titre en anticorps entre la premiere (S1) et la deuxieme serologie (S2). Resultats : ils montrent qu'a la premiere serologie (S1); sur les 109 patientes; 3etaient positives aux anticorps de type IgM; 22positives a IgG; et 11positives a IgG et IgM. Au total 36des femmes presentent un sero- diagnostic positif a la premiere serologie (S1). La deuxieme serologie (S2) montre que parmi les 36des femmes diagnostiquees positives a la premiere serologie; 11faisaient une toxoplasmose evolutive. Conclusion : Cette etude montre une seroprevalence importante de la toxoplasmose decouverte fortuitement chez les femmes enceintes lors de leur bilan de grossesse