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Phytolacca dodecandra (L’ Herit), or ‘Endod’, is one of the widely known medicinal plants in Ethiopia. Berries of the endod have been used as a detergent for centuries. The present study was aimed to test the hepatoprotective effects of the plant against acetaminophen (APAP)-induced liver injury in rats. Mice of either sex were used for oral acute toxicity tests and APAP-induced lethality tests. Hepatoprotective experiments were done on male rats using 2 g/kg of APAP to induce liver damage. Liver enzymes, total bilirubin (TB), and lipid profile were determined. Liver tissues were also examined histopathologically to see a morphologic change in the control and experiment groups. The protective effect of the plant extract was also tested through sodium pentobarbital (SPB)-induced sleeping time. A significant increase in serum levels of liver enzymes, TB, low-density lipoprotein (LDL), and triglycerides (TGs) was seen from oral administration of 2 g/kg APAP. Total cholesterol (TC) and high-density lipoprotein (HDL) levels were decreased. Serum levels of all parameters were reversed to normal after administration of silymarin 100 mg/kg and, 100, 200, and 400 mg/kg doses of the extract. A significant dose-dependent hepatoprotective effect of Phytolacca dodecandra Methanol Root Extract (PDME) was seen in terms of LDL. Histopathological investigations and SPB-induced sleeping time confirmed the findings of biochemical analysis. The findings of the present study indicate that PDME protected the liver from APAP injury.

The study assessed the concentration of natural radionuclides in soil samples from the Bambasi district in Ethiopia’s Benishangul Gumuz region using a gamma-ray spectrometer equipped with a high-purity germanium (HPGe) detector. The measured activity concentrations of 238U, 232Th, and 40K in soil samples varied from 46.2 ± 2.25 to 88.49 ± 5.73 Bq/kg, 73.4 ± 4.12 to 119.65 ± 8.45 Bq/kg, and 176.78 ± 8.63 to 396.71 ± 25.39 Bq/kg, respectively. The average concentration of 238U and 232Th exceeded the recommended worldwide population weighted average values of 32.0 and 45.0 Bq/kg, respectively, while the average concentration of 40K was below the recommended value of 420.0 Bq/kg. The mean absorbed dose rate was calculated to be 91.6 ± 5.1 nGy/h, which is above the recommended safe value of 59 nGy/h. The average annual effective dose equivalents for indoor and outdoor exposure were determined to be 2.65 ± 0.14 mSv/y and 0.66 ± 0.1 mSv/y, respectively. The calculated mean values of the internal hazard index, external hazard index, and gamma index across all soil samples were 0.72 ± 0.05, 0.55 ± 0.02, and 0.72 ± 0.02, respectively, all below the recommended safe threshold of one. These findings suggest that the activity concentrations observed in the soil samples exceed safe levels, indicating the necessity for further investigation into radioactivity levels and epidemiological studies regarding potential hazards from high background radiation.

Abstract The goal of this study was to assess the radiation dose delivered accuracy and the acceptable image quality parameter from the 16-slice Philips CT scanner in order to evaluate the current methodology for quality controls of computed tomography systems. The measured volume computed tomography dose index was 101 mGy and the displayed volume computed tomography dose index was 10.2 mGy and the dose length product is 680 mGy*cm for head scan, and the measured volume computed tomography dose index was 6.1 mGy and the displayed volume computed tomography dose index was 6.3 mGy and the dose length product was 587 mGy*cm for body scan, respectively. The image quality parameters were 4.4 HU, 2.3 HU, and 10 HU for uniformity, contrast-to-noise ratio, and computed tomography number accuracy (CT number accuracy) for quality assurance phantom, respectively. We propose that discussions and collaboration regarding patient and particular equipment adjustments be coordinated among radiologists, medical imaging technologists, and medical physicists. This can increase image quality, reduce absorbed radiation, and improve hospital medical care.

The study assessed the concentration of natural radionuclides in soil samples from the Bambasi district in Ethiopia's Benishangul Gumuz region using a gamma‐ray spectrometer equipped with a high‐purity germanium (HPGe) detector. The measured activity concentrations of 238U, 232Th, and 40K in soil samples varied from 46.2 ± 2.25 to 88.49 ± 5.73 Bq/kg, 73.4 ± 4.12 to 119.65 ± 8.45 Bq/kg, and 176.78 ± 8.63 to 396.71 ± 25.39 Bq/kg, respectively. The average concentration of 238U and 232Th exceeded the recommended worldwide population weighted average values of 32.0 and 45.0 Bq/kg, respectively, while the average concentration of 40K was below the recommended value of 420.0 Bq/kg. The mean absorbed dose rate was calculated to be 91.6 ± 5.1 nGy/h, which is above the recommended safe value of 59 nGy/h. The average annual effective dose equivalents for indoor and outdoor exposure were determined to be 2.65 ± 0.14 mSv/y and 0.66 ± 0.1 mSv/y, respectively. The calculated mean values of the internal hazard index, external hazard index, and gamma index across all soil samples were 0.72 ± 0.05, 0.55 ± 0.02, and 0.72 ± 0.02, respectively, all below the recommended safe threshold of one. These findings suggest that the activity concentrations observed in the soil samples exceed safe levels, indicating the necessity for further investigation into radioactivity levels and epidemiological studies regarding potential hazards from high background radiation. [ABSTRACT FROM AUTHOR]

Phytolacca dodecandra (L' Herit), or 'Endod', is one of the widely known medicinal plants in Ethiopia. Berries of the endod have been used as a detergent for centuries. The present study was aimed to test the hepatoprotective effects of the plant against acetaminophen (APAP)-induced liver injury in rats. Mice of either sex were used for oral acute toxicity tests and APAP-induced lethality tests. Hepatoprotective experiments were done on male rats using 2 g/kg of APAP to induce liver damage. Liver enzymes, total bilirubin (TB), and lipid profile were determined. Liver tissues were also examined histopathologically to see a morphologic change in the control and experiment groups. The protective effect of the plant extract was also tested through sodium pentobarbital (SPB)-induced sleeping time. A significant increase in serum levels of liver enzymes, TB, low-density lipoprotein (LDL), and triglycerides (TGs) was seen from oral administration of 2 g/kg APAP. Total cholesterol (TC) and high-density lipoprotein (HDL) levels were decreased. Serum levels of all parameters were reversed to normal after administration of silymarin 100 mg/kg and, 100, 200, and 400 mg/kg doses of the extract. A significant dose-dependent hepatoprotective effect of Phytolacca dodecandra Methanol Root Extract (PDME) was seen in terms of LDL. Histopathological investigations and SPB-induced sleeping time confirmed the findings of biochemical analysis. The findings of the present study indicate that PDME protected the liver from APAP injury. [ABSTRACT FROM AUTHOR]

AbstractThe specific activity concentrations of naturally occurring radionuclides in soil samples collected from suburban areas of Assosa City was measured using a High purity Germanium (HPGe) detector. The average specific activity concentrations of 238U and 232Th exceed the recommended safe value of 35.0 and 30.0 Bq kg−1, respectively. For 40K, the average activity concentration is below the recommended safe value of 400.0 Bq kg−1. The calculated mean value of the absorbed dose rate is 72.8 ± 3.72 nGy h−1 which exceed the recommended safe value of 59 nGy h−1. The calculated mean annual effective dose equivalent values for indoor and outdoor are 2.11 ± 0.1 mSv y−1 and 0.52 ± 0.02 mSv y−1, respectively. The calculated mean values of the internal hazard index, external hazard index, and gamma index are 0.43 ± 0.013, 0.56 ± 0.01, and 0.5 ± 0.01, respectively, and those values are below the recommended safe value of one. The mean value of excessive lifetime cancer risk is above the threshold value of 0.29 × 10−3. From this study, it is recommended that Assosa soil needs further investigations. [ABSTRACT FROM AUTHOR]

Identification and prevention of drug-related problems have become the central role of patient-centered pharmacy practitioners. After the initiation of patient-oriented pharmacy service, many studies evaluating magnitude of drug-related problems at facility level in Ethiopia have been conducted, though the extent of the problem at a national level remains unknown. Hence, this systematic review and meta-analysis is undertaken with the aim of quantifying the prevalence of drug-related problems in Ethiopian public healthcare settings using Cipolle/Strand classification system. Electronic databases were searched including PubMed, EMBASE, Web of Science, MEDLINE and HINARI, Google Scholar and ResearchGate for both published and unpublished works. Data on study characteristics and outcomes were extracted using the format developed on Microsoft Excel. The primary measure was the pooled prevalence of drug-related problems. The meta-analysis was conducted using OpenMeta[Analyst].A total of 17 studies were included in this systematic review and meta-analysis. The pooled prevalence of drug-related problems of patients who experienced at least one drug-related problem during their therapy was found to be 69.4% (95% confidence interval: 61.5–77.4). The most frequently reported types of drug-related problems were “need for additional drug and “noncompliance,” together accounting for more than half of the drug-related problems. The most frequently reported factors associated with drug-related problems were patients’ age, polypharmacy, comorbidities and the number days of hospital stay.The prevalence of drug-related problems in Ethiopian public healthcare settings was found to be high. Inconsistent reporting of drug-related problems was observed across the studies. It is imperative to design and implement interventions aimed at reducing drug-related problems. Responsible stakeholders should adopt uniform drug-related problem classification approach to ensure uniform reporting of drug-related problems in Ethiopian healthcare settings

OBJECTIVE:The study was aimed to explore patient safety culture of community pharmacists working in Dessie and Gondar towns, Northern Ethiopia. METHODS:A cross-sectional study was conducted from 1st to 31st March 2018. In this cross-sectional survey, the Pharmacy Survey on Patient Safety Culture (PSOPSC), developed by the Agency for Healthcare Research and Quality (AHRQ), was used to collect data. PSOPSC is a self-administered questionnaire. The questionnaire was distributed among staffs who work in community pharmacies of Dessie and Gondar towns. All staffs available on data collection period in the pharmacy were included. The Statistical Package for Social Science (SPSS) software version 25 was used to enter and analyze the data. RESULTS:A total of 120 participants were approached and completed the questionnaire. Results from the study showed that high positive response rate was demonstrated in the domains of "Teamwork" (90.2%) followed by physical space and environment (83.1%). On the other hand, the result also identified that there is an enormous problem related to mistake communication (44.8%) and work pressure (45%). In addition, significant difference of percent positive responses were obtained across towns and staff working hours. CONCLUSIONS:The patient safety culture of community pharmacists is appreciable especially with respect to their teamwork. Besides, urgent attention should be given to areas of weakness, mainly in the domain of "mistake communication" and "staffing and work pressure".

BackgroundThe emergence of chronic diseases as major causes of disability and death has necessitated the introduction of new strategies to effectively address the ever-changing nature of public health problems. As a result, the role of community pharmacies in promoting public health is growing in recent years through the provision of extended pharmacy services. This study was conducted with the aim of assessing community's extent of use and approval of extended pharmacy services at community pharmacies in Bonga town, Southwest Ethiopia.Materials and methodsCommunity based cross-sectional study was conducted in Bonga town, Southwest Ethiopia, on households selected by systematic random sampling. Data was collected using semi-structured questionnaire. Data was collected by personally delivering questionnaires to respondents in selected households. Results of the study were described by frequency, mean and standard deviation (SD). Binary logistic analysis was performed to identify potential associations between dependent and independent variables.ResultsOut of 356 individuals included in the study, 58.4% recalled visiting community pharmacy premises during the previous six months. Out of these, 34.6% visited the community pharmacies to get extended pharmacy services. College educated participants were 19.4 times more likely to have used extended pharmacy services as compared to illiterate individuals whereas those who earn monthly income more than 5000 Ethiopian Birr were 3.6 times more likely than those with monthly income of 2000 Ethiopian Birr or less. Of the total participants, 91.3% approved the provision of extended pharmacy services in community pharmacies.ConclusionThe extent of community's use of extended pharmacy services at community pharmacies was found to be low. Nevertheless, majority of the study subjects approved the provision of extended pharmacy services at community pharmacies. Efforts to improve the practice of extended pharmacy service provision at community pharmacies should be made by all stake holders.

Abstract Background Although asthma cannot be cured, appropriate management can ensure adequate control of the disease, prevent disease progression and even reverse the illness, enabling people to enjoy good quality of life. Predisposing factors for inappropriate asthma management, including limited diagnostic options and inadequate supply of medications, are features of health institutions in developing countries like Ethiopia. This study was launched to determine the appropriateness of asthma management in patients visiting ambulatory clinic of the Gondar University Hospital. Methods Cross-sectional study was conducted on asthmatic patients who were on chronic follow-up at Gondar University Hospital. Data were collected by review of patients’ medical records and through a semi-structured questionnaire. The Global Initiative for Asthma guideline was used as a reference for determining the appropriateness of asthma management whereas the eight-item Morisky medication adherence scale (MMAS-8) was used to collect data on patients’ adherence to asthma medications. Results The study participants’ ages ranged from 20 to 80 years with a mean age of 49.3 ± 13.6 years. Mild asthma showed a slight predominance in frequency accounting for 38.7% of cases. Asthma management was found to be inappropriate in 52.0% of the patients. Inappropriateness of therapy is attributed to incorrect dosing of medications, addition of unnecessary medications and omission of necessary medications. Patients who had moderate asthma were more likely to receive appropriate treatment [AOR = 728: 63.2, 8386.06], whereas having a treatment regimen of beclomethasone with salbutamol was found to be predictor of inappropriate treatment [AOR = 0.004: 0.001, 0.07]. More than half (56.7%) of the study subjects reported to have high adherence to their medications. Having no formal education was a predictor of low adherence to asthma medications [AOR = 0.051: 0.003, 0.978] whereas, increased monthly income was found to have a positive association with adherence [AOR = 1.923: 1.037, 3.566]. Discussion High prevalence of inappropriate therapy in this study may be attributed primarily to limited accessibility of asthma medications, as 86% of the patients received medium dose beclomethasone with salbutamol for exacerbations despite being at different severity of asthma and level of control. Conclusion The findings of the study showed more than half of asthmatic patients received inappropriate treatment. Nevertheless, a larger proportion of the patients claimed to be highly adherent to their medications.

Natural radioactivity levels in the eastern coastline of Lake Hawassa sediment samples of Ethiopia’s Sidama Region have been measured. Sediment samples were collected and analyzed using gamma-ray spectrometery (high purity germanium detector) to evaluate the radioisotopes of 238U (214Pb, 214Bi), 232Th (228Ac, 212Pb), and 40K and their ranges of activity concentrations were 11.70 to 29.73 Bq kg −1, 19.01 to 58.61 Bq kg −1, and BDL to 827.21 Bq kg −1, with average values of 16.51 ± 1.20 Bq kg −1, 28.17 ± 2.27 Bq kg −1, and 673.95 ± 29.92 Bq kg −1 (dry mass), respectively. The radiological hazard indices average values (radium equivalent ( Req ) (108.69 Bq kg −1 ); hazard index ( Hex (0.29); excess lifetime cancer risk (ELCR) (0.23 x 10−3 ); absorbed dose rate (DR) (52.70 nGy h−1 ); annual effective dose equivalent (AEDE) (0.07 mSv 1 yr − ); and annual gonadal dose equivalent (AGDE) (0.38 mSv yr −1 ) were also evaluated and compared to the worldwide-recommended values. All results of radiological hazard indices obtained in this study were lower than their worldwide-recommended values were 370 Bq kg −1, ≤1, 59 nGy h−1, 0.07mSv yr −1, 0.29 × 10−3, and 0.3mSv yr−1 of radium equivalent activity, external hazard index, outdoor absorbed dose rate, outdoor annual effective dose equivalent, excess lifetime cancer risk, and annual gonadal dose equivalent, respectively. This suggests the eastern coastline of Lake Hawassa is safe from radioactive risk for aquatic species and various human activities, and appears as essential radiometric baseline information for further environmental monitoring programs. [ABSTRACT FROM AUTHOR]

Background: Cervical cancer is causing a huge burden in Sub-Saharan Africa (SSA). It mainly affects women in their young ages making female university students at risk of cervical cancer. Knowledge and awareness about cervical cancer and human papillomavirus (HPV) in SSA including Ethiopia is very poor. We aimed to assess the knowledge and awareness of cervical cancer and HPV in University of Gondar (UOG) medicine and health science female students.A cross-sectional study was done. Methods: This study was conducted from April 1 to May 30, 2016 at UOG, College of Medicine and Health Sciences, Gondar, Northwest Ethiopia. Undergraduate female students were included in the study. A 14-item self-administered questionnaire was then provided to each of the participants to measure their level of knowledge and awareness about cervical cancer and HPV. Results: A total of 267 female students participated in the study (mean age 20.58 ± 1.22). More than half of the participants (59.6%) did not know the main cause of cervical cancer, whereas just about a fifth of them (19.5%) identified HPV as the main cause of cervical cancer. As high as 83.9% of the participants did not know other causes of cervical cancer. Binary logistic analysis revealed that students from midwifery (adjusted odds ratios [AOR] = 14.14, P < 0.05), anesthesiology (AOR = 9.66, P < 0.05) and medicine (AOR = 5.84, P < 0.05) departments were associated with knowledge of the main cause of cervical cancer. Conclusions: Knowledge about cervical cancer and its causes were found to be inadequate among higher education female students. Hence, awareness about cervical cancer, causes and its prevention, importance of screening and vaccination should be promoted through university's campaign, curricular changes, and community and research projects.

HIV-1 subtype C T-cell responses measured in a diverse population of infected Ethiopian subjects using synthetic Gag peptides is presented as it is a necessary requisite in the development of HIV vaccine.

Background: The HIV-1 epidemic in Ethiopia has been shown to be dominated by two phylogenetically distinct subtype C clades, the Ethiopian (C’-ET) and East African (C-EA) clades, however, little is known about the temporal dynamics of the HIV epidemic with respect to subtypes and distinct clades. Moreover, there is only limited information concerning transmission of HIV-1 drug resistance (TDR) in the country. Methods: A cross-sectional survey was conducted among young antiretroviral therapy (ART)-naïve individuals recently diagnosed with HIV infection, in Gondar, Ethiopia, 2011–2013 using the WHO recommended threshold survey. A total of 84 study participants with a median age of 22 years were enrolled. HIV-1 genotyping was performed and investigated for drug resistance in 67 individuals. Phylogenetic analyses were performed on all available HIV sequences obtained from Gondar (n = 301) which were used to define subtype C clades, temporal trends and local transmission clusters. Dating of transmission clusters was performed using BEAST. Result: Four of 67 individuals (6.0%) carried a HIV drug resistance mutation strain, all associated with non-nucleoside reverse transcriptase inhibitors (NNRTI). Strains of the C-EA clade were most prevalent as we found no evidence of temporal changes during this time period. However, strains of the C-SA clade, prevalent in Southern Africa, have been introduced in Ethiopia, and became more abundant during the study period. The oldest Gondar transmission clusters dated back to 1980 (C-EA), 1983 (C-SA) and 1990 (C’-ET) indicating the presence of strains of different subtype C clades at about the same time point in Gondar. Moreover, some of the larger clusters dated back to the 1980s but transmissions within clusters have been ongoing up till end of the study period. Besides being associated with more sequences and larger clusters, the C-EA clade sequences were also associated with clustering of HIVDR sequences. One cluster was associated with the G190A mutation and showed onward transmissions at high rate. Conclusion: TDR was detected in 6.0% of the sequenced samples and confirmed pervious reports that the two subtype C clades, C-EA and C’-ET, are common in Ethiopia. Moreover, the findings indicated an increased diversity in the epidemic as well as differences in transmission clusters sizes of the different clades and association with resistance mutations. These findings provide epidemiological insights not directly available using standard surveillance and may inform the adjustment of public health strategies in HIV prevention in Ethiopia. [ABSTRACT FROM AUTHOR]

Background Hepatitis B Virus is a major public health problem worldwide. In 2012 alone, over 350 million chronic carriers and 1. 2 million annual deaths were occurred. Hepatitis B Virus causes 60 to 80% of the world's primary liver cancer and nearly 90% infants infected due to vertical transmission are at higher risk of developing chronic liver disease and cancer. Hence determining the burden of maternal and neonatal Hepatitis B Virus infection is a priority. Methods A cross sectional study was conducted from July - September 2012 at St. Paul's Hospital Millennium Medical College and Selam Health Center, Addis Ababa, Ethiopia. Blood samples from delivering mothers (n = 265) and their corresponding cords (n = 265) were collected. A pretested questionnaire was used to collect data. Hepatitis B Virus surface antigen was detected using Enzyme Linked Immunosorbent Assay. Frequency analysis and logistic regression test was used to identify the potential risk factors associated with Hepatitis B Virus positivity using SPSS Version -15. Results A total of 265 delivering women with the mean age of 25.8 years were enrolled in the study. Of these delivering women, 8 (3.0%) of mothers were positive for Hepatitis B Virus surface antigen, whereas 6 (2.3%) of cord bloods were positives with 75% concordance rate of exposed infants with sero-positive mothers. However, only one maternal positive case was observed for Hepatitis B e Ag test. Only 11% of the mothers know their Hepatitis B Virus status. Of the total mothers assessed for possible risk factors, 69(26%) had only one type, while 161(60.8%) had multiple exposure factors such as ear pricing, history of tribal marks, abortion, multiple-sexual partner and history of surgical procedures experienced from high to low frequency. The remaining 35(13.2%) of the participants had not experienced possible risk factors. Conclusion Though the maternal positivity rate was low, the rate of positivity in cord bloods was almost equal to those infected mothers. Therefore, screening of pregnant mothers and vaccination of infants could help to reduce the transmission. To minimize the higher overall risk exposure status of mothers, increasing awareness and intensive public health education is also recommended. [ABSTRACT FROM AUTHOR]

Soil samples were collected from vegetable agricultural areas in and around Addis Ababa, and their levels of radioactivity were measured. Gamma spectrometry with high-purity germanium detector was used to quantify radioactivity level. The average concentration of 226Ra, 232Th, and 40K were 32.8 ± 2.1, 62.4 ± 4.4, and 544.3 ± 23.3 Bq kg-1 respectively. The mean values of 232Th and 40K are higher, whereas the value of 226Ra is comparable with world average values. Radiological hazard indices, including radium equivalent activity (Raeq), absorbed dose rate (Dr), outdoor annual effective dose equivalent (Deff), external hazard index (Hex), internal hazard index (Hin), and gamma radiation representative level index (Iγ), were calculated based on the activity concentration of 226Ra, 232Th and 40K. The mean values were 163.9 Bq kg-1, 78.7 nGy h-1, 0.10 mSv y-1, 0.44, 0.53, and 0.60 respectively. All indices are lower than global recommended limit values. These results revealed that radiation hazard due to radionuclides in the soil of the study area is insignificant., (© The Author(s) 2024. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Most human immunodeficiency virus type 1 (HIV-1) transmission in developing countries occurs through heterosexual intercourse or during birth from mother to child. It is critical to characterize the virus of the genital tract variants as a target for the development of an HIV-1 vaccine and microbicidal therapies. We compared the C2V3 env domain genetic diversity of HIV-1 in female genital secretions and in plasma from Ethiopian women seeking care for sexually transmitted infections (STIs). Sequences within an individual differed between the plasma and cervicovaginal lavage (CLV) compartments with nucleotide and amino acid median difference values of 8.3 and 4.8%, respectively. Sequence diversity in CVL was greater than in plasma. And the V3 loop positive charge was often more elevated in CVL. These are markers of the differential evolution of the viruses in CVL and peripheral blood indicating that limited evolution at the site of contact is not the limiting factor determining the preferential transmission of macrophage tropic viruses.

Surveillance for HIV-1 prevalence and subtypes in Afar Region, Ethiopia was performed among police recruits in the year 2000, by unlinked anonymous testing. Of 408 samples tested, 26 (6.4%) appeared positive for HIV-1 antibodies. There was a trend for higher HIV-1 seroprevalence in women (9.5%, 9/95) than men (5.4%, 17/313), which was significant in one of the 5 administrative areas: Zone 4 (p = 0.01). Around the principal transportation route connecting Addis Ababa to the harbor of Djibouti there was a significantly (p = 0.03) higher HIV-1 seroprevalence of 12.7% (14/110) than elsewhere in Afar Region. In addition, 13 (34%) of the 29 administrative sub-areas (woredas) of Afar Region delivered HIV-1 positive police recruits. Prevalence of syphilis antibodies was 7.4% (30/408), increasing by age, correlating with HIV-1 positive serology (p = 0.001) and with 23.3% (7/30) active cases. Of 22 specimens sequenced, 12 had gp120 V3 regions from Ethiopian subtype C, 9 subtype C' and 1 subtype A. In conclusion, even in very remote areas in Ethiopia, such as Afar Region, the HIV-1 epidemic is established, being primarily of subtype C. Regular HIV-1 surveillances will be necessary to guide action to prevent further spread in this vulnerable area.

To evaluate a simple and rapid testing strategy to diagnose HIV infection in Ethiopia, we subjected a panel of 688 sera with known HIV serologic status (confirmed by ELISA/WB or double ELISA) to 3 rapid assays: Determine HIV-1/2, Capillus HIV-1/2 and Serocard HIV. Samples were obtained from participants in a cohort study on HIV-infection (72%), from tuberculosis patients (18%) and from participants in surveillance studies among police recruits and commercial sex workers (10%). The panel consisted of 249 HIV-1 positive samples, of which 68 were HIV-1 subtype C and 1 HIV-1 subtype A, and 439 HIV-1 negative samples. Determine and Capillus were 100% sensitive and 99.8% specific, Serocard was 100% sensitive and specific. On retrospective evaluation, both parallel (samples tested simultaneously by two rapid assays) and serial (samples tested by two consecutive rapid assays) testing algorithms were 100% sensitive and specific when compared to ELISA/WB or double ELISA testing strategy. In conclusion rapid assays have high sensitivity and specificity. HIV serodiagnosis based on rapid assays may therefore be a valuable alternative in voluntary counselling and testing centres and in facilities where sophisticated laboratories are not available.

The Western blot (WB) assay is the most widely accepted confirmatory assay for the detection of antibodies to human immunodeficiency virus type 1 (HIV-1). However, indeterminate WB reactivity to HIV-1 proteins may occur in individuals who do not appear to be infected with HIV. The profiles of WB reactivity among Ethiopians are hardly known. Here, we describe the profiles of indeterminate WB reactivity in Ethiopians with discordant screening assays. Between 1996 and 2000, a total of 12,124 specimens were tested for HIV-1 antibodies. Overall, 1,437 (11.9%) were positive for HIV-1 antibody. Ninety-one ( approximately 0.8%) gave equivocal results because of discordant results among the various screening assays and indeterminate WB profiles by the American Red Cross (ARC) criteria. Most (30.4%) of these indeterminate WB results were due to p24 reactivity. However, 12 samples (13.2%) displayed reactivity to p24 and gp41 or to p24 and gp120/160 proteins (positive by Centers for Disease Control and Prevention [CDC] criteria). Only two samples (2.2%) were reactive to both env glycoproteins gp41 and gp120/160 (positive by the World Health Organization [WHO] criteria). Of 31 WB assays initially indeterminate by the ARC criteria and with follow-up samples, 29 (93.5%) became negative when retested subsequently while 2 (6.5%) remained indeterminate for more than a year and were thus considered negative. Using CDC and WHO criteria, 6 (19.4%) and 2 (6.5%), respectively, of these WB assays would have been considered falsely positive. In addition, 17 indeterminate samples were negative when assessed by a nucleic acid-based amplification assay for HIV-1 viremia. In general, there was 97.8% concordance between the ARC and WHO criteria and 85.7% concordance between the ARC and CDC criteria for an indeterminate WB result. The ARC criteria best met the specified objectives for diagnosis in our setting.