HPV DNA Testing and Mobile Colposcopy for Cervical Precancer Screening in HIV Positive Women: A Comparison Between Two Settings in Ghana and Recommendation for Screening.

INTRODUCTION: Women living with HIV (WLHIV) have higher prevalence and persistence rates of high-risk human papillomavirus (hr-HPV) infection with a six-fold increased risk of cervical cancer. Thus, more frequent screening is recommended for WLHIV. OBJECTIVES: This retrospective descriptive cross-sectional study was conducted to investigate and compare the prevalence of hr-HPV infection and abnormal findings on mobile colposcopy in two cohorts of WLHIV following cervical screening in rural and urban settings in Ghana. METHODS: Through the mPharma 10 000 Women Initiative, WLHIV were screened via concurrent hr-HPV DNA testing (MA-6000; Sansure Biotech Inc., Hunan, China) and visual inspection (Enhanced Visual Assessment [EVA] mobile colposcope; MobileODT, Tel Aviv, Israel) by trained nurses. The women were screened while undergoing routine outpatient reviews at HIV clinics held at the Catholic Hospital, Battor (rural setting) and Tema General Hospital (urban setting), both in Ghana. RESULTS: Two-hundred and fifty-eight WLHIV were included in the analysis (rural, n = 132; urban, n = 126). The two groups were comparable in terms of age, time since HIV diagnosis, and duration of treatment for HIV. The hr-HPV prevalence rates were 53.7% (95% CI, 45.3-62.3) and 48.4% (95% CI, 39.7-57.1) among WLHIV screened in the rural vs urban settings (p-value = .388). Abnormal colposcopy findings were found in 8.5% (95% CI, 5.1-11.9) of the WLHIV, with no significant difference in detection rates between the two settings (p-value = .221). Three (13.6%) of 22 women who showed abnormal colposcopic findings underwent loop electrosurgical excision procedure (LEEP), leaving 19/22 women from both rural and urban areas with pending treatment/follow-up results, which demonstrates the difficulty faced in reaching early diagnosis and treatment, regardless of their area of residence. Histopathology following LEEP revealed CIN III in 2 WLHIV (urban setting, both hr-HPV negative) and CIN I in 1 woman in the rural setting (hr-HPV positive). CONCLUSIONS: There is a high prevalence of hr-HPV among WLHIV in both rural and urban settings in this study in Ghana. Concurrent HPV DNA testing with a visual inspection method (colposcopy/VIA) reduces loss to follow-up compared to performing HPV DNA testing as a standalone test and recalling hr-HPV positive women for follow up with a visual inspection method. Concurrent HPV DNA testing and a visual inspection method may also pick up precancerous cervical lesions that are hr-HPV negative and may be missed if HPV DNA testing is performed alone.

Self-sampling and HPV DNA testing for cervical precancer screening in a cohort of nuns in Ghana: a cross-sectional cohort study.

Background: The need for cervical cancer screening has been emphasised in at-risk cohorts of women to reduce their risk of cervical cancer. Some women with decreased risk of acquiring human papillomavirus (HPV) infections, such as Catholic nuns, receive less attention and on occasion are missed in cervical cancer screening programmes. This study aimed to determine the high-risk HPV (hr-HPV) prevalence in such a cohort to emphasise the need for cervical precancer screening among all women. To improve compliance, we employed self-sampling. Methods: This descriptive cross-sectional cohort study involved the data of 105 Catholic nuns subjected to cervical screening using self-samples in the Greater Accra, Volta, and Central regions of Ghana between June 4, 2022 and June 30, 2022. hr-HPV testing was performed on self-samples using the MA-6000 HPV DNA platform. Screen-positive nuns underwent follow-up pap smears and EVA colposcopy. In addition to descriptive analysis, univariate and multivariable nominal logistic regression was used to explore the relationship between hr-HPV positivity and selected continuous and categorical factors. Findings: 105 nuns from three convents were screened with hr-HPV DNA testing (MA-6000). Twenty-five tested positive for hr-HPV (prevalence of 23.8% (95% CI, 15.7-32.0) [HPV 18 only (n = 2, 1.9%), non-HPV 16/18 genotypes (others) (n = 22, 21.0%), and mixed infection with HPV 16 and other genotype(s) (n = 1, 1.0%)]. Pap smears for all 25 hr-HPV-positives came in as negative for intraepithelial lesions or malignancy, whereas EVA mobile colposcopy showed minor abnormal findings in two (8.0%; 95% CI, 1.0-26.0), both of whom were managed conservatively. Interpretation: Our findings suggest that the hr-HPV prevalence in this cohort of nuns is similar to that of the general population. To meet the World Health Organization's target for cervical cancer elimination, it is important that all women are given access to cervical cancer screening and preventative services. Further, increasing 'anonymity' and privacy among nuns through self-sampling may be crucial to expanding choice, coverage, and uptake of screening in support of their health rights. Funding: None.

Evaluating operational parameters of the careHPV, GeneXpert, AmpFire, and MA-6000 HPV systems for cervical precancer screening: Experience from Battor, Ghana.

In response to calls by the World Health Organization for cervical precancer screening services in low-resource settings to lean toward HPV DNA testing, a number of testing platforms have been made available. This study aimed to evaluate the operational parameters of four HPV testing systems in previous (careHPV) and current (GeneXpert, AmpFire, and MA-6000) use in a secondary healthcare setting in terms of 'appropriateness', ease of use, throughput, and diagnostic yield. This descriptive retrospective cohort analysis included 6056 women who presented to our facility between June 2016 and March 2022 for cervical precancer screening via HPV testing. A large majority of this cohort underwent AmpFire testing (55.8%), followed by careHPV (23.3%), MA-6000 (14.7%), and GeneXpert (6.1%). MA-6000 showed the highest hr-HPV positivity rate of 26.4% (95% CI, 23.6-29.5), followed by AmpFire (17.2%; 95% CI, 15.9-17.5). GeneXpert and careHPV showed similar hr-HPV positivity rates of 14.8% (95% CI, 11.3-18.8) and 14.8% (95% CI, 13.0-16.8), respectively. For the AmpFire and MA-6000 platforms, which utilize similar detection and reporting formats, we found a significant excess detection rate of 9.2% (95% CI, 6.1-12.4; p-value <0.0001) for MA-6000 compared to AmpFire. At the genotype level, MA-6000 also detected significantly higher rates of HPV 16 and other hr-HPV types (both p-values <0.001) than AmpFire; there was no difference in detection for HPV 18. Based on our experiences and preliminary analysis, we believe that the choice of HPV testing platform cannot be accomplished with a one-size-fits-all approach. Factors worth considering are the financial implications of platform acquisition, costs to clients, and throughput when screening programs are not sufficiently large. We describe our successes and challenges with the different platforms which we believe will be helpful to centers in low-income countries as they transition into using HPV DNA testing for cervical precancer screening.

Rabies is still a fatal but neglected disease: a case report.

BACKGROUND: Rabies, caused by a lyssavirus, is a viral zoonosis that affects people in many parts of the world, especially those in low income countries. Contact with domestic animals, especially dogs, is the main source of human infections. Humans may present with the disease only after a long period of exposure. Nearly half of rabies cases occur in children <15 years old. We report on a fatal case of rabies in a Ghanaian school child 5 years after the exposure incident, and the vital role of molecular tools in the confirmation of the diagnosis. CASE PRESENTATION: The patient, an 11-year-old junior high school Ghanaian student from the Obuasi Municipality in Ghana, presented with aggressive behavior, which rapidly progressed to confusion and loss of consciousness within a day of onset. Her parents reported that the patient had experienced a bite from a stray dog on her right leg 5 years prior to presentation, for which no antirabies prophylaxis was given. The patient died within minutes of arrival in hospital (within 24 hours of symptom onset). Real-time polymerase chain reaction testing of cerebrospinal fluid obtained after her death confirmed the diagnosis of rabies. Subsequent phylogenetic analysis showed the virus to belong to the Africa 2 lineage of rabies viruses, which is one of the predominant circulating lineages in Ghana. CONCLUSION: The incubation period of rabies is highly variable so patients may only present with symptoms long after the exposure incident. Appropriate molecular testing tools, when available as part of rabies control programmes, are vital in confirming cases of rabies.

Collecting standardized urban health indicator data at an individual level for school-aged children living in urban areas: methods from EURO-URHIS 2.

Background: Measuring health and its determinants in urban populations is essential to effectively develop public health policies maximizing health gain within this context. Adolescents are important in this regard given the origins of leading causes of morbidity and mortality develop pre-adulthood. Comprehensive, accurate and comparable information on adolescent urban health indicators from heterogeneous urban contexts is an important challenge. EURO-URHIS 2 aimed to develop standardized tools and methodologies collecting data from adolescents across heterogenous European urban contexts. Questionnaires were developed including (i) comprehensive assessment of urban health indicators from 7 pre-defined domains, (ii) use of previously validated questions from a literature review and other European surveys, (iii) translation/back-translation into European languages and (iv) piloting. Urban area-specific data collection methodologies were established through literature review, consultation and piloting. School-based surveys of 14-16-year olds (400-800 per urban area) were conducted in 13 European countries (33 urban areas). Participation rates were high (80-100%) for students from schools taking part in the surveys from all urban areas, and data quality was generally good (low rates of missing/spoiled data). Overall, 13 850 questionnaires were collected, coded and entered for EURO-URHIS 2. Dissemination included production of urban area health profiles (allowing benchmarking for a number of important public health indicators in young people) and use of visualization tools as part of the EURO-URHIS 2 project. EURO-URHIS 2 has developed standardized survey tools and methodologies for assessing key measures of health and its determinants in adolescents from heterogenous urban contexts and demonstrated the utility of this data to public health practitioners and policy makers.

Hepatitis B and C viral infections among blood donors from rural Ghana.

OBJECTIVE: To investigate the prevalence of Hepatitis B and C infections and co-infections among blood donors in a rural community of Ghana. DESIGN: A retrospective study. METHOD: Samples of blood donated between January 2007 and December 2008 were screen for Hepatitis B and C viruses at the Agogo Presbyterian Hospital. RESULTS: The prevalence of Hepatitis B viral (HBV) infection was highest in females 21.4% (95% CI: 11.6-34.4) in 2006 than males in the same year 13.2% (95% CI: 10.8-15.9). Hepatitis C viral (HCV) infection was highest among males at 11.6% (95% CI: 9.5-13.8) in 2007. HBV and HCV co-infection was higher in males 2.6% (95% CI: 1.6-3.8) than females 1.3% (95% CI: 0-7.0) in 2007. The overall prevalence of HBV and HCV was 13.8% (95% CI: 11.4-16.4) and 9.4% (95% CI: 7.4-11.6) respectively in 2006. The rate of co-infection of HBV and HCV however increased from 1.6% (95% CI: 0.8-2.7) in 2006 to 2.2% (95% CI: 1.3-3.2) in 2008 in males and from 0% (95% CI: 0-6.4) in 2006 to 1.2% (95% CI: 0-6.5) in 2008 in females. CONCLUSION: The single infections of HBV and HCV reduced but co-infection of these transfusion transmitted infections (TTI) increased. Measures such as more sensitive techniques and education must be employed in these areas.

The microbiology of Ghanaian cocoa fermentations analysed using culture-dependent and culture-independent methods.

Export of cocoa beans is of great economic importance in Ghana and several other tropical countries. Raw cocoa has an astringent unpleasant taste and a spontaneous fermentation is the first step in a process leading to cocoa beans with the characteristic cocoa flavour and taste. The microbiology of Ghanaian cocoa fermentations was investigated using culture-dependent and culture-independent methods. Samples were collected at 12 hour intervals during 96-144 hour tray and traditional heap fermentations. Yeast, Lactic Acid Bacteria (LAB), Acetic Acid Bacteria (AAB) and Bacillus spp. were enumerated on suitable substrates and identified using phenotypic and molecular methods. The yeast and bacterial micro-populations involved in the cocoa fermentation were further investigated using the culture-independent method Denaturing Gradient Gel Electrophopresis (DGGE). A microbiological succession was observed during the fermentations. At the onset of fermentation yeasts were the dominating microorganisms. Lactic Acid Bacteria became dominant after 12-24 h of fermentation and remained predominant throughout the fermentations with AAB reaching high counts in the mid phase of fermentation. Bacillus spp. were only detected during heap fermentations where they reached high numbers during the later stages of fermentation. Hanseniaspora guilliermondii was the predominant yeast during the initial phase and Pichia membranifaciens during the later phases of fermentation. A number of other yeast species including three putatively undescribed species were isolated during the fermentations. Lactobacillus fermentum was the dominant LAB in most samples. Several other LAB including Lactobacillus plantarum, Leuconostoc pseudomesenteroides, Leuconostoc pseudoficulneum, Pediocococcus acidilactici and a putatively undescribed LAB species were detected during the fermentations. Acetobacter syzygii, Acetobacter pasteurianus and Acetobacter tropicalis were the predominant AAB in all investigated fermentations. During the later stages of heap fermentation Bacillus licheniformis and occasionally other Bacillus spp. were detected in high numbers. In general the culture-based findings were confirmed using DGGE. However, DGGE indicated that Lc. pseudoficulneum plays a more important role during the fermentation of cocoa than expected from the culture-based findings as it yielded a strong band in most DGGE fingerprints. Cluster analysis of the DGGE fingerprints revealed that the DGGE fingerprints clustered according to fermentation site. Within each fermentation site the profiles clustered according to fermentation time. The DGGE method seems to offer a relatively fast and reliable tool for studying yeast and bacterial dynamics during cocoa fermentations.

Investigation of fractions present in the stem bark of Annickia kummeriae on their P-glycoprotein inhibitory pump activity.

Using MCF-7R cells and rhodamine 6G as the fluorescent probe, a bioassay-targeted purification process was pursued in order to isolate the active P-gp inhibitory fractions from Annickia kummeriae. Of 24 fractions obtained in the first preparative liquid chromatography (p-LC) run, only fraction 1 exhibited activity. Further p-LC fractionation led to the separation of fraction 1 into fractions 1.1-1.8. Fractions 1.4, 1.5 and 1.6 proved to be active by inducing a significant accumulation of rhodamine 6G by 3.3-, 4.5- and 4.9-fold at 10 microg/mL, and by 5.3-, 6.3- and 6.8-fold at 100 microg/mL, respectively. Fraction 1.6 was separated into several fractions by using an analytical liquid chromatography (a-LC) system. Fractions 1.6.18, 1.6.19 and 1.6.20 were active and they induced an accumulation of rhodamine 6G by 3.0-, 1.8- and 3.5-fold at 1x microg/mL and by 4.8-, 6.7- and 6.8-fold at 10x microg/mL, respectively. Afterwards, 28.3 mg of fraction 1.6 was processed by a-LC, and fractions 1.6.18, 1.6.19 and 1.6.20 were collected separately and dried. The amounts of materials recovered were 6.2, 7.4 and <1 mg, corresponding to 21.9%, 26.1% and <3.5% of fraction 1.6, respectively. From the total amount injected and the relative masses represented by these fractions, it can be calculated that the 1x microg/mL level corresponded to ca. 35, 42 and <5 microg/mL, respectively. Fluorescence microscopy revealed that incubation of the cells with rhodamine 6G alone did not show any fluorescence, whereas cells which were incubated in medium containing rhodamine 6G together with fraction 1.4, 1.6 or reserpine, clearly indicated accumulation of the dye intracellularly. This is an indication that the active compounds effected high intracellular fluorescence by inducing accumulation of the dye in the cells through inhibition of the P-gp pump.

An evaluation of an innovative multimedia educational software program for asthma management: report of a randomized, controlled trial.

BACKGROUND: Asthma continues to be a substantial cause of morbidity in pediatric populations. New strategies are needed to provide cost-effective educational interventions for children with asthma, particularly those in the inner city. OBJECTIVE: To assess the effectiveness of a multimedia educational software program about asthma. SETTING: A hospital-based primary care clinic and an affiliated neighborhood health center. DESIGN: Randomized, controlled trial. POPULATION: Children 3 to 12 years old with physician-diagnosed asthma. INTERVENTION: An interactive educational computer program, Asthma Control, designed to teach children about asthma and its management. Using a graphic display of a child going through simulated daily events, the game emphasizes: 1) monitoring; 2) allergen identification; 3) use of medications; 4) use of health services; and 5) maintenance of normal activity. Control group participants reviewed printed educational materials with a research assistant. OUTCOMES: Acute health care use (emergency department and outpatient) was the primary outcome. Secondary outcome measures included maternal report of asthma symptom severity, child functional status and school absences, satisfaction with care, and parental and child knowledge of asthma. RESULTS: A total of 137 families were enrolled in the study (76 intervention, 61 control). Both intervention and control groups showed substantial improvement in all outcomes during the 12-month follow-up period. Aside from improvement in knowledge after use of the computer program, no differences were demonstrated between the 2 groups in primary or secondary outcome measures. Children reported enjoyment of program use. CONCLUSIONS: This trial of an educational software program found that it did not produce greater improvement than occurred with review of traditional written materials. Because both groups showed substantial improvement over baseline, computer-based education may be more cost-effective. Alternatively, improvements in illness severity over time may overshadow the effects of such interventions. Rigorous comprehensive evaluations such as this are necessary to assess new interventions intended to improve management and outcomes of asthma.