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Introduction: The national algorithm for the diagnosis of HIV infection in Togo leads sometimes to discordant or indeterminate results. The objective of this study was to explore the characteristics of discordant and indeterminate HIV serologies at the National Reference Center for HIV testing (CNR-VIH) in Togo. Material and methods: Through a cross-sectional study, we analyzed the cases of discordant and indeterminate serologies from 2016 to 2018 at the CNR-VIH. Three kind of tests were used. The first one is a screening test also called “test 1” is very sensitive while the confirmatory test also called “test 2” is very specific and used when the sample is reactive with test 1. The third test is an immunoblotting test which is used in case of discordance between test 1 and test 2 results. We used Vironostika HIV Uni-Form II Ag/Ab (BioMerieux, Geneva, Switzerland), Determine Alere HIV-1/2 Serum/Plasma (Chiba, Japan) and Murex HIV Ag/Ab (Dartford, UK) as test 1 while Tri-Dot HIV-I/II (J. Mitra & Pvt Ltd. New Delhi-110-India Co.) and Inno-Lia HIV-I/II Score (Fujirebio, Ghent, Belgium) were used respectively as test 2 and test 3. The test 3 allowed us to determine the antibodies involved in the occurrence of indeterminate serologies. A pool of indeterminate samples was tested for qualitative detection of HIV-1 RNA by RT-PCR using the NucliSENS EasyQ HIV-1 platform from BioMérieux. Results: A total of 555 discordant serologies corresponding to 4.3% of all serologies performed over the 3 years have been analyzed. The average age of the subjects tested was 36.9 ± 17.4 years and men were slightly more represented with a sex ratio of 1.03. Of the 555 samples, 81 (14.7%) were reactive with 53 (9.6%) cases of HIV-1 and 28 (5.1%) cases of HIV-2. Two hundred and thirty-one (41.6%) samples were negative while the remaining 243 (43.8%) were indeterminate. The frequencies of antibodies (Ab) against gp120, gp41, p24, p31, p17, gp105 and gp36 were respectively 10.3%, 46.3%, 15.5 %, 11.2%, 8.8%, 5.4% and 5.0%. Among the 257 cases for which gp41 Ab had been detected, 202 (78.6%) were cases of indeterminate serology with the only presence of gp41 Ab. Qualitative HIV-1 RNA testing on 71 (29.2%) indeterminate samples was negative. Conclusion: This study showed that discordant serologies are frequently found in our common practice in Togo. The use of immunoblotting tests has the advantage of making it possible to elucidate more than half of these discordant serologies. The contribution of molecular biology techniques is uncertain. The large majority of these indeterminate serologies are due to cross-reactions particularly with gp41. These indeterminate serologies require not only further studies for their understanding but also an update of HIV diagnosis algorithm in Togo.

International audience; Background HIV pre-exposure prophylaxis (PrEP) data in men who have sex with men (MSM) in west Africa are essential to guide its large-scale implementation. We assessed the uptake of event-driven and daily PrEP, HIV incidence, and changes over time in sexual behaviours and prevalence of bacterial sexually transmitted infections (STIs) in MSM in Burkina Faso, Côte d'Ivoire, Mali, and Togo. Methods We did a prospective cohort study from Nov 20, 2017, to April 14, 2020, in four community-based clinics in Abidjan (Côte d'Ivoire), Bamako (Mali), Lomé (Togo), and Ouagadougou (Burkina Faso). Participants were MSM aged 18 years or older at substantial risk of HIV infection. Participants could choose between event-driven (2+1+1 dosing) and daily oral PrEP (tenofovir disoproxil fumarate 300 mg plus emtricitabine 200 mg), switch regimen, and discontinue or restart PrEP. We compared HIV incidence in this study with that of the same cohort before the availability of PrEP (CohMSM). Statistical analysis included the Kaplan-Meier method and mixed-effects regression models. This study is registered with ClinicalTrials.gov, NCT03459157. Findings We followed up 598 participants for a total of 743•6 person-years. At enrolment, 445 (74%) of 598 participants chose event-driven PrEP and 153 (26%) of 598 chose daily PrEP. 60 (13%) of 445 and 65 (42%) of 153 partici pants switched PrEP regimen at least once (p

The aim of our work was to analyse the trends of HIV infection and syphilis among pregnant women in prenatal consultation (PNC) in healthcare facilities in Togo.This was an analytical retrospective study, covering the period from 2008 to 2016 and focusing on pregnant women aged 15 to 49 seen in PNC for the first time in maternal and child health services in Togo.During the study period, 41,536 pregnant women were registered in 2008, 2009, 2010, 2014 and 2016, respectively 8079, 8572, 8430, 7920 and 8535.The mean age of the patients was 26 ± 6 year in 2008, 2009 and 2010. The overall HIV prevalence decreased from 3.4% in 2008 to 2.9% in 2016 (p = 0.0145). It fell from 1% in 2008 to 0.5% in 2016 and from 3.6% in 2008 to 1.4% in 2016 (p0.0001) among 15-19 year-old and 20-24 year-old respectively. HIV prevalence in rural areas is two times lower than in urban areas between 2008 and 2016 with a statistically significant difference. The prevalence of syphilis decreased significantly from 2008 (1.3%) to 2016 (0.6%), (p0.0001). It is low and not associated with age in 2008; 0.2% and 0.4% in 2016 respectively in the 15 to 19 and 20 to 24 age groups. This prevalence is significantly low between 2008 and 2016 in both urban and rural areas.Our study documents a relatively low prevalence of syphilis and HIV among pregnant women in Togo, with a significant decrease among adolescents and young women, attesting to the effectiveness of the increased screening and comprehensive prevention of sexually transmitted infections (STIs) and HIV, including the antiretroviral treatment as prevention (TASP) approach, and the neonatal syphilis elimination programme in the country.

Background Men who have sex with men (MSM) are at high risk of human papillomavirus (HPV) infection. We assessed (i) the prevalence of high-risk HPV (HR-HPV) infection and associated factors, and (ii) the prevalence of vaccine-preventable HPV infections in MSM in Burkina Faso, Côte d’Ivoire, Mali, and Togo. Methods A cross-sectional study was conducted in 2017–2018 among MSM ≥18 years old followed in community-based clinics. HPV infection was investigated in oral and anal samples using the e-BRID system. Factors associated with HR-HPV infection were identified using multivariate logistic regressions. Results Among 631 participants, 425 were HIV-negative and 206 HIV-positive. HR-HPV prevalence ranged from 9.2% to 34.8% in the former, and 33.3% to 71.0% in the latter, according to the study country. In multivariate analysis, HIV infection (adjusted odds ratio (aOR) 3.61, 95% confidence interval (CI) 2.48–5.27) and study country (4.73, 2.66–8.43 for Mali; 3.12, 1.68–5.80 for Burkina Faso; 3.51, 1.92–6.42 for Togo) were associated with HR-HPV infection. Other associated factors were low educational level, self-defined homosexual identity, and condomless anal sex. The prevalence of infections which can be prevented with bivalent, quadrivalent, and nonavalent vaccines was 5.9, 27.1, and 34.6% in HIV-negative participants, and 18.9, 43.7, and 54.9% in HIV-positive participants, respectively. Conclusions HR-HPV prevalence was very heterogeneous between the study countries in both HIV-negative and HIV-positive MSM. Vaccine-preventable HPV infections predominated. Vaccination should be proposed to young MSM to reduce the burden of HPV infection in this vulnerable population and their female partners in West Africa.

Aim: This study aimed to assess the prevalence and the distribution of HPV genotypes among HIV-negative women of child-bearing age in Lomé, Togo. Materials & methods: From April 2014 to September 2015, a cross-sectional study was conducted among HIV-negative women attending gynecological consultation in six health centers in Lomé. Cervical swabs were obtained from 324 women. HPV test was performed using HPV Direct Flow Chip. Results: The prevalence of any type and oncogenic HPV was 9.3 and 8.3%, respectively. A total of 13 different genotypes HPV, high risk (16, 18, 35, 45, 52, 53, 68, 82) and low risk (6, 40, 43, 44/65, 62/81), were found. Conclusion: Findings from this study provide essential insights for planning future public health strategies, including HPV vaccination programs.

Background Pediatric bacterial meningitis (PBM) causes severe morbidity and mortality within Togo. Thus, as a member of the World Health Organization coordinated Invasive Bacterial Vaccine Preventable Diseases network, Togo conducts surveillance targeting Streptococcus pneumoniae (pneumococcus), Neisseria meningitidis (meningococcus), and Haemophilus influenzae, at a sentinel hospital within the capital city, Lomé, in the southernmost Maritime region. Methods Cerebrospinal fluid was collected from children, Streptococcus pneumoniae was the predominant pathogen responsible for pediatric bacterial meningitis during longitudinal sentinel surveillance within Togo, from 2010 to 2016. However, pneumococcal meningitis cases decreased by 88.1% (52/59) postvaccine introduction; from 59 cases prevaccine introduction to 7 cases postvaccine introduction.

Objectives This study aimed to describe HIV testing uptake, as well as HIV prevalence and its associated factors among older adults aged ≥50 years in health facilities in Togo. Methods A cross-sectional study was carried out from February 2018 to June 2019 among hospitalized older adults aged ≥50 years in tertiary and secondary hospitals in Togo. HIV testing was performed according to the national algorithm. Socio-demographic data and HIV testing history were collected using a standardized questionnaire. Results A total of 619 patients (43.9% female) of median age 61 years, (IQR: 55–70) were recruited and offered HIV testing. Among them, 25.7% had never previously tested for HIV. In total, 91.6% (567/619) accepted HIV testing while 8.4% (52/619) refused to be tested. Of those who tested, forty patients were HIV positive, yielding a prevalence of 7.1%. Twenty-three patients (57.5%) were newly diagnosed with HIV infection. In multivariable analysis, two factors were associated with HIV infection: living alone (aOR = 5.83; 95%CI = [2.26–14.53]) and being Conclusion The majority of older adults in this study accepted testing for HIV and almost three in five HIV positive older adults were newly diagnosed with HIV as a result of this testing. There is an urgent need to integrate older adults into responses to the HIV epidemic and to strengthen targeted prevention care and treatment in this population.

Background In December 2019, the COVID-19 outbreak began in China and quickly spread throughout the world and was reclassified as a pandemic in March 2020. The first case of COVID-19 was declared in Togo on March 5. Two months later, few data were available to describe the circulation of the new coronavirus in the country. Objective This survey aimed to estimate the prevalence of SARS-CoV-2 in high-risk populations in Lomé. Materials and methods From April 23, 2020, to May 8, 2020, we recruited a sample of participants from five sectors: health care, air transport, police, road transport and informal. We collected oropharyngeal swabs for direct detection through real-time reverse transcription polymerase chain reaction (rRT-PCR) and blood for antibody detection by serological tests. The overall prevalence (current and past) of infection was defined by positivity for both tests. Results A total of 955 participants with a median age of 36 (IQR 32–43) were included, and 71.6% (n = 684) were men. Approximately 22.1% (n = 212) were from the air transport sector, 20.5% (n = 196) were from the police sector, and 38.7% (n = 370) were from the health sector. Seven participants (0.7%, 95% CI: 0.3–1.6%) had a positive rRT-PCR test result at the time of recruitment, and nine (0.9%, 95% CI: 0.4–1.8%) were seropositive for IgM or IgG against SARS-CoV-2. We found an overall prevalence of 1.6% (n = 15), 95% CI: 0.9–2.6%. Conclusion The prevalence of SARS-CoV-2 infection among high-risk populations in Lomé was relatively low and could be explained by the various measures taken by the Togolese government. Therefore, we recommend targeted screening.

Background Men who have sex with men (MSM) using preexposure prophylaxis (PrEP) are at risk for sexually transmitted infections (STIs). Therefore, PrEP services should include regular screening for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) at urethra, anorectum, and pharynx. However, financial and logistic challenges arise in low-resource settings. We assessed a new STI sample pooling method using the GeneXpert instrument among MSM initiating PrEP in West Africa. Methods Urine, anorectal, and pharyngeal samples were pooled per individual for analysis. In case of an invalid result only (strategy 1) or a positive result of the pool (strategy 2), samples were analyzed individually to identify the infection's biological location. The results of 2 different pooling strategies were compared against the individual results obtained by a criterion standard. Results We found a prevalence of 14.5% for chlamydia and 11.5% for gonorrhea, with a predominance of infections being extragenital (77.6%). The majority of infections were asymptomatic (88.2%). The pooling strategy 1, had a sensitivity, specificity and agreement for CT of 95.4%, 98.7%, and 0.93, respectively; and 92.3%, 99.2%, and 0.93 for pooling strategy 2. For NG, these figures were 88.9%, 97.7%, and 0.85 for strategy 1, and 88.9%, 96.7%, and 0.81 for strategy 2. Conclusions West African MSM have a high prevalence of extragenital and asymptomatic STIs. The GeneXpert method provides an opportunity to move from syndromic toward etiological STI diagnosis in low-income countries, as the platform is available in African countries for tuberculosis testing. Pooling will reduce costs of triple site testing.

Introduction: In haemodialysis patients, the risk of acquiring blood-borne viral infections is an important cause of the dialysis’s process. Indeed, viral infections are quite common in chronic haemodialysis patients including those due to viral hepatitis B and HIV. Objective: Determine the prevalence of HIV infection and hepatitis B infection among chronic hemodialysis patients of Togo. Methods: A cross-sectional study was conducted in chronic hemodialysis patients of Togo from January 1st to December 31st, 2016. Sociodemographic and clinical data were collected. Antigen HBs was screened by a rapid immunochromatographic test (SD BIOLINE® HBsAg), and HIV antibodies were detected using a combination of 2 rapid diagnostic test, SD BIOLINE® HIV-1/2 (first step) and TRIDOT test (second step). Results: During the study period, 95 subjects were included. Patient’s age was ranking from 13 to 80 years with a mean of 46.6 years. The sex-ratio (M/F) was 1.8 and a duration average of dialysis was 51.7 months. The aetiologies of the chronic endstage kidney failure were related respectively to a vascular renal disease for 42.1% of the patients, glomerular nephropaty for 34.74%, interstitial nephropaty for 9.47% and hereditary for 3.16%. For 10.53% of the patients, the initial renal disease remained indefinite. Prevalence of antigen HBs and HIV antibodies were respectively 10.5% and 7.4%. The frequency of co-infection HBV and HIV was 1.1%. Conclusion: The rates of HBV infection and HIV infection remain high in chronic hemodialysis in Togo, somewhat which is linked to an endemic aspect of these two viruses in the country. The type of initial renal disease (glomerular) and the vascular way (the central catheters) established the risk factors for the HIV infection while for the infection of HVB no factor was incriminated.

According to WHO, the rates of smear-negative and extra-pulmonary pulmonary tuberculosis are increasing in high prevalence HIV epidemic areas. Delays in diagnosis of tuberculosis can lead to large excess of mortality. It is extremely important to provide a strong diagnosis tool of tuberculosis if we want to reduce mortality due particularly to TB co-infection in HIV infected people in low-income countries such as Togo. This study aims to assess the performance of Determine™ TB LAM Antigen, a rapid diagnostic test (RDT) for tuberculosis. It was an evaluation study, conducted at the National Reference Laboratory for Mycobacteria located at the Sylvanus Olympio University Teaching Hospital in Lome, Togo from 01 July to 15 November 2017. We performed the assessment onto 100 urine specimens collected from 100 subjects (HIV-infected or not). The test allows qualitative detection of the Lipo Arabinno Mannan (LAM) antigen of Mycobacteria in the urine. Bacilloscopy was chosen as gold standard. Overall, the test Determine™ TB LAM presented a sensitivity of 31.25% and a specificity of 95%. In contrast, the sensitivity and specificity of the test were respectively 82.35% and 66.67% in the group of HIV-infected subjects. In HIV non-infected subjects, the sensitivity was 17.46% and the specificity was 100%. Determine™ TB LAM Antigen test can help detect TB in HIV-infected people unable to expectorate in our settings.

Background The aim of this study was to estimate the prevalence and factors associated with Trichomonas vaginalis (T. vaginalis) among men who have sex with men (MSM) and female sex workers (FSW) in Togo in 2017. A cross-sectional bio-behavioral study was conducted from August to October 2017 using a respondent-driven sampling method in four cities in Togo. Methods A standardized questionnaire was used to record socio-demographic data and sexual behavior patterns. T. vaginalis detection by molecular biology tests was performed using Allplex STI Essential Assay which detect also 6 others micro-organisms. A blood sample was drawn and serological test using SD Bioline Duo VIH/Syphilis rapid test was performed for HIV and syphilis testing. Results A total of 517 key populations including 310 FSW and 207 MSM with median age 24 years, interquartile range (IQR) [20–28 years] were included. The overall prevalence of T. vaginalis, HIV, Mycoplasma genitalium, Chlamydia trachomatis (C. trachomatis), Neisseria gonorrhoeae were 3.9%, 16.8%, 9.3%, 7.5% and 7.2% respectively. T. vaginalis prevalence among FSW was 6.5% (95%CI= [4.1–9.9]) and 0.0% (95%CI= [0.0-2.3]) among MSM. Logistic regression was conducted to identify factors associated with T. vaginalis infection. Living in Lomé (AOR = 3.19; 95%CI= [1.11–11.49]), having had sexual intercourse before the age of 18 (AOR = 5.72; 95%CI= [1.13–10.89]), and being infected with C. trachomatis (AOR = 3.74; 95%CI= [2.95–12.25]) were factors associated with T. vaginalis among FSW. Conclusion The prevalence of T. vaginalis infection using molecular test was low among MSM and FSW in Togo. Extensive studies are needed to confirm and better understand the epidemiology of T. vaginalis in these populations and in other populations in Togo.

Background The aim of this study was to estimate the prevalence and factors associated with Trichomonas vaginalis (T. vaginalis) among female sex workers (FSW) in Togo in 2017. A cross-sectional bio-behavioral study was conducted from August to October 2017 using a respondent-driven sampling method in four cities in Togo. Method A standardized questionnaire was used to record socio-demographic data and sexual behavior patterns. T. vaginalis detection by molecular biology tests was performed using Allplex STI Essential Assay which detect also 6 others micro-organisms. A blood sample was drawn and serological test using SD Bioline Duo VIH/Syphilis rapid test was performed for Human immunodeficiency virus (HIV) and syphilis testing. Results A total of 310 FSW with median age 25 years, interquartile range (IQR) [21–32 years] were included. The prevalence of T. vaginalis was 6.5% (95%CI = [4.1–9.9]) and, overall, prevalence of other STI ranged from 4.2% (95%CI = [2.3–7.2]) for N. gonorrhoeae to 10.6% (95% CI = [7.5–14.7]) for HIV. Binary logistic regression was conducted to assess factors associated with T. vaginalis infection. Living in Lomé (aOR = 3.19; 95%CI = [1.11–11.49]), having had sexual intercourse before the age of 18 (aOR = 5.72; 95%CI = [1.13–10.89]), and being infected with C. trachomatis (aOR = 3.74; 95%CI = [2.95–12.25]) were factors associated with T. vaginalis among FSW. Conclusion The prevalence of T. vaginalis infection using molecular test was low among FSW in Togo. Extensive studies are needed to confirm and to better understand the epidemiology of T. vaginalis among this population and in other populations in Togo.

Monovalent rotavirus vaccine (RV1) was introduced in the immunization schedule of Togo in June 2014. We evaluated the impact of rotavirus vaccines on acute gastroenteritis (AGE) and rotavirus-associated hospitalizations in Togolese children.Sentinel surveillance for AGE (defined as ≥3 liquid or semi-liquid stools/24 h lasting7 days) hospitalizations among children5 years of age was conducted in two sites in the capital city, Lome. ELISA was used for diagnosis of rotavirus infection in children with AGE. Additionally, review of hospitalization registers was performed at five hospitals to assess trends in AGE hospitalizations among children aged5 years. For the vaccine impact assessment, pre-rotavirus vaccine introduction (July 2010-June 2014) and post-rotavirus vaccine introduction (July 2014-June 2016) periods were compared for annual changes in proportions of hospitalizations associated with AGE and rotavirus.During the pre-vaccine period, sentinel surveillance showed that 1017 patients were enrolled and 57% (range, 53-62%) tested positive for rotavirus, declining to 42% (23% reduction) in the first post-vaccine year and to 26% (53% reduction) in the second post-vaccine year; declines were most marked among infants. The patient register review showed that, compared with pre-vaccine rotavirus seasons, declines in hospitalizations due to all-cause AGE during post-vaccine rotavirus seasons were 48% among1 year age-group in both first and second years following vaccine introduction. Among 1-4 year olds no reduction was noted in the first year and a 19% decline occurred in the second year.We report rapid and marked reduction in the number of AGE hospitalizations and the proportion of AGE hospitalizations attributable to rotavirus in the first two years post- RV1 implementation in Togo. It is necessary to monitor long-term vaccine impact on rotavirus disease burden through continued surveillance.

BackgroundMen who have sex with Men (MSM) using Pre-exposure prophylaxis (PrEP) are at risk for Sexually Transmitted Infections (STIs). Therefore, PrEP services should include regular screening for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) at urethra, anorectum and pharynx. However, financial and logistic challenges arise in low resource settings. We assessed a new STI sample pooling method using the GeneXpert instrument among MSM initiating PrEP in West-Africa.MethodsUrine, anorectal and pharyngeal samples were pooled per individual for analysis. Unpooled samples were analyzed in case of an invalid or positive result of the pool, to identify the infection’s biological location. The results of two different pooling strategies were compared against a gold standard.ResultsWe found a prevalence of 14.5% for chlamydia and 11.5% for gonorrhea, with a predominance of infections being extra-genital (77.6%). The majority of infections were asymptomatic (88.2%). The pooling strategy with unpooling of invalid results only, had a sensitivity, specificity and agreement for CT of 95.4%, 98.7% and 0.93, respectively; and 92.3%, 99.2% and 0.93 with additional unpooling of positive results. For NG, these figures were 88.9%, 97.7% and 0.85 for testing of invalid results, and 88.9%, 96.7% and 0.81 with unpooling of positive results.ConclusionWest-African MSM have a high prevalence of extra-genital and asymptomatic STIs. The GeneXpert method provides an opportunity to move from syndromic towards etiological STI diagnosis in low income countries, as the platform is available in all African countries for tuberculosis testing. Pooling will reduce costs of triple site testing.

Background Syndromic diagnosis of sexually transmitted infections (STIs) has shown its limits among MSM using PrEP due to the many asymptomatic infections. However, testing three biological sites (urethra, pharynx and anorectum) is expensive. Our objective was to implement and to evaluate a pooling method using the locally available GeneXpert instrument to test for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) in the framework of the West-African CohMSM-PrEP study (Togo and Burkina Faso). Methods Duplicate pharyngeal (P) and anorectal (A) e-swabs and first-void urine (U) samples were taken from every participant (n=192 in total). A specimen pool per participant (400 µL of each sample) was made and tested using the Xpert CT/NG kit. If positive, the individual samples were tested to confirm the site of infection. Duplicate individual samples were also tested for evaluation purposes using the Abbott CT/NG molecular technique and in-house qPCR. Results A total of 32 CT infections (10U-20A-2P) and 34 NG infections (5U-19A-10P) were found. Twelve results obtained by testing of the pools were discordant from the individual testing using Abbott CT/NG. When unpooling the samples, one discordant result was solved. Three CT infections (1 in each samplingsite) and four NG infections (2A and 2P) were missed; one CT (P) and three NG (A) infection were found to be false positive (one in each sampling site). This converts into a respective sensitivity and specificity of 91.2% (95%CI: 76.3–98.1%) and 99.8% (95%CI: 99.0–100.0%) for CT and 88.6% (95%CI: 73.3–96.8%) and 99.4% (95%: 98.3–99.9%) for NG of the pooling strategy. Cohen’s Kappa agreement was 0.94 for CT and 0.89 for NG which is an almost perfect agreement. Conclusion We showed that this pooling strategy performs well using the FDA approved point-of-care assay GeneXpert. This may be a very cost-effective strategy and also feasible, as the assay is widespread throughout the African continent for tuberculosis testing. Disclosure No significant relationships.

Background Men who have sex with men (MSM) coming forward for Pre-Exposure Prophylaxis (PrEP) are at high risk for HIV and other Sexually Transmitted Infections (STIs). However, little is known about the prevalence of STIs among MSM in West-Africa. Yet, understanding the STI epidemic among MSM will improve STI management. In the framework of a PrEP demonstration study in West-Africa (CohMSM-PrEP), we tested all participants for STIs at enrollment. Methods The study was conducted in Abidjan-Cote d’Ivoire, Bamako-Mali, Lome-Togo and Ouagadougou-Burkina Faso. Participants (n=507) were tested for the following STIs using the GeneXpert instrument: Chlamydia trachomatis (CT)/Neisseria gonorrhoeae (NG) in Anorectum (A), Urine (U) and Pharynx (P), and Trichomonas vaginalis (TV) in urine. Mycoplasma genitalium (MG) was tested using the S-DiagMGTV multiplex assay in A-U-P samples. Results The overall prevalence of CT was 17.9% (19.4%, 22.0% 16.4%, and 13.6% in Lome, Abidjan, Bamako and Ouagadougou, respectively). Most CT infections were anorectal (12.3%, followed by urethral (5.7%). In Bamako, the second most infected sample type was pharyngeal (6.0%) instead of urine (5.0%). Overall prevalence of NG was 15.8% (9.7%; 25.0%; 6.0%, 22.3% in Lome, Abidjan, Bamako and Burkina, respectively). Most NG infections were found in the anorectum (10.7%), followed by the pharynx (5.7%). In Mali, no pharyngeal NG infections were detected. MG infection was 26.0% for Lome and 27.6% for Ouagadougou (results for other sites not yet available). The majority of MG infections were found in the anorectum (15.4%). Among all participants, only one urine sample with TV has been found in Bamako. Conclusion We showed a very high prevalence of extra-genital STIs among PrEP users in West-Africa. We also detected infections which would not have been treated if a syndromic management approach would have been applied (87.9%). In order to limit transmission of infections we recommend to test also extra-genital sites for STIs in this population. Disclosure No significant relationships.

Background: In Togo, the HIV/AIDS epidemic is characterized by the circulation of the 2 subtypes of HIV. Thus, patients infected with HIV-2 are diagnosed and monitored in the care centers. Objective: To document the trend of HIV-2 prevalence over a decade of activities of the National Reference Center for HIV tests and screening (CNR-VIH). Methods: A cross sectional study was carried out from the screening data archived from January 2005 to December 2014 at the CNR-VIH, a laboratory located in the Sylvanus Olympio University Hospital (CHU SO) Lome. The sampling consisted of adults and children outpatients or those who were hospitalized in CHU SO, subjects presenting for voluntary testing, pregnant women and patients or samples referred for HIV confirmation. All samples were tested for HIV-1 and HIV-2 infections by combining ELISA and rapid diagnostic tests. Result: During the decade, 34,077 subjects were screened for HIV infection. The overall prevalence of HIV infection was 20.70% (7055/34077). In 10 years, the prevalence of HIV infection in CNR-VIH decreased significantly from 35.40% CI95% [34.50% - 36.20%] in 2005 to 14.20% CI95% [13.60% - 14.70%] in 2014 (p = 0.03). The prevalence of HIV-1, HIV-2 and dual HIV1&HIV-2 was respectively 20.40%, 0.23% and 0.07%, with annual prevalence of HIV-2 between 0.07% and 0.39%. The differences between the HIV-2 prevalence over the decade were not statistically significant (p > 0.15). A 4-year-old child from mother-to-child HIV-2 transmission was diagnosed. Sixty-five percent of adult patients were over 40 years of age with an average age of 43.5 ± 11.3 years. Conclusion: Data from the National Reference Center for HIV Tests in Togo over the last ten years confirm the existence of a weak epidemic of HIV- 2 infection with a tendency towards stability.

The use of plasma is an obstacle to realize HIV-1 viral load in sub-Saharan Africa. In this context, the dried blood spot (DBS) is an interesting tool for sample collections. This approach was tested using a DBS hole-punch device (PUNCHER). Plasma and DBS samples were obtained from 102 patients, comprising 17 HIV-1 negative patients and 85 HIV-1 infected patients. The PUNCHER’s performance used to cut DBS was evaluated with the following criteria: ease of use, time savings and safety. VL was measured in parallel on plasma and DBS samples using NucliSENS EasyQ HIV-1. The correlation between plasma and DBS results was strong (R = 0.91; P < 0.001). The mean difference (± standard deviation) was -0.59 ± 0.52 log10 copies/ml. The sensitivity and specificity of DBS were 91.3% (n= 74) for the 81 VL detectable samples and 100% for the 21 VL undetectable samples, respectively. On a scale of 10, the PUNCHER’s performance scored 9.3 for ease of use, 8.6 for time savings and 10 for safety. PUNCHER is highly efficient at cutting DBS, and the VL resulting from DBS correlated well with those obtained from plasma. Key words: Puncher, dried blood spot (DBS), viral load, performance.

Togo introduced monovalent rotavirus vaccine starting 19 June 2014. We compared all-cause acute gastroenteritis (AGE) hospitalizations and rotavirus-associated hospitalizations during the prevaccine period (July 2008-June 2014) to 1 year after vaccine introduction (July 2014-June 2015). The proportion of children with AGE who tested positive for rotavirus declined from 53% (645/1223) in prevaccine years to 36% (68/187) in the postvaccine year (P< .01). The decline only occurred in children

Human papillomavirus (HPV) infection is the most common sexually transmitted disease worldwide, and it particularly affects people living with human immunodeficiency virus (HIV). This study aimed to estimate the prevalence of HPV and to describe HPV genotypes in HIV-1 infected women in Lome, Togo. From September 2014 to September 2015, a cross-sectional study was conducted in two treatment and care centers for people living with HIV: the Centre Hospitalier Universitaire Sylvanus Olympio and the non-profit organization ‘Espoir Vie Togo’. Women living with HIV-1, aged 18 years and older, receiving a combination antiretroviral therapy for at least 12 months, and who gave their informed consent to participate in the study were recruited. Cervical swabs were collected using a cytobrush, and cells were stored in a preservative solution. HPV testing was performed using e-BRID equipment. Blood samples were collected for CD4+ count using a flow cytometer and for HIV viral load using polymerase chain reaction. A total of 221 HIV-1 infected women were enrolled. The prevalence of any type and oncogenic HPV was 22.2%, 95% confidence interval (95% CI): [17.1–28.2] and 16.7% (95%CI: 12.3–22.3), respectively. The most prevalent genotypes were: 18 (8.6%), 68 (4.1%), and 62/81 (2.7%). Only 1.3% (3/221) of participants were infected with HPV16. In regression analysis, no factor was associated with HRHPV. Conclusion This study showed the diversity of circulating HPV genotypes in Togo. Programs of HPV vaccination and early detection of benign or precancerous lesions should be implemented to reduce cancer-related comorbidities.

Background Sub-Saharan Africa is a region of both high human immunodeficiency virus (HIV) and anal cancer incidence. We conducted the first national study in Togo to assess human papillomavirus (HPV), HIV, and other sexually transmitted infection (STI) prevalence among men who have sex with men (MSM). Methods A multicentric cross-sectional study was conducted among MSM recruited in 4 Togolese cities. Anal swabs were collected to test HPV, herpes simplex virus (HSV), and 7 STIs. Results Among the 207 MSM, HIV and high-risk HPV (hrHPV) overall prevalence were 26.1% and 44.9%, respectively. The most common hrHPV types were HPV-35 (15.0%) and HPV-16 (13.0%). Prevalence of hrHPV and multiple HPV infections were higher among HIV-infected than among HIV-uninfected MSM (85.2% vs 30.7%, P < 10–5 and 85.2% vs 28.7%, P < 10–5, respectively). Other STIs, except hepatitis B virus, were also more prevalent among HIV-infected MSM (Neisseria gonorrhoeae, P = .03; Mycoplasma genitalium, P = .04; HSV-2, P = .001; and a trend for Chlamydia trachomatis, P = .06). In multivariate analysis (adjusted odds ratio [95% confidence interval]), HIV (10.1 [4.0–25.6]), living in Lomé (2.8 [1.1–7.1]), HSV-2 excretion (26.7 [2.9–244.3]), C. trachomatis (11.7 [2.3–58.9]), and M. genitalium infection (9.6 [3.1–29.9]) were associated with increased risk of hrHPV infection. Conclusions We report a high burden of anal STIs with an unusual hrHPV type distribution among MSM, highlighting the critical need of implementation of a national strategy regarding prevention of STIs and vaccination against HPV.

Introduction: Access to antiretroviral treatment (ART) in resource-limited countries has increased signif-icantly but scaling up ART into rural areas is more recent and information on treatment outcome in rural areas is still very limited. We reported here virological outcome and drug resistance in ART in rural settings in Togo. Methods: HIV-1 infected adults (≥18 years) and infants were enrolled in routine medical visit at 12 on first-line ART in three HIV care centers. Epidemiological and demographic information and data on ART history were collected. Viral load (VL) was determined and genotypic drug resistance testing was performed on all samples with viral load above 1000 copies/ml. Results: 102 adult patients and 27 infants were consecutively enrolled. Virological failure was observed in 28 (21.5%) patients. For 25/28 patients, sequencing was successful and drug resistance mutations were observed in 23 (92%) of them. The global prevalence of drug resistance in the study population was thus at least 17.8% (23/129), with 7 (6.9%) patients infected with HIV strains that are resistant to two of the three first-line antiretroviral (ARVs) drugs and 9 (8.3%) to all three first-line ARVs. As expected, the observed drug resistance mutations were mainly associated with the drugs used in first line regimens, zidovudine, lamivudine and effavirenz/nevirapine but several patients accumulated high numbers of mutations and developed also cross-resistance to abacavir, didanosine or the new non-nucleoside reverse transcriptase inhibitor drugs, like etravirine and rilpivirine. Conclusion: The observations on ART treatment outcome from ART clinics in rural areas are the same as observed in previous observations in Lome, the capital city. Although access to viral load will improve treatment outcome, better programme management and implementation of actions to improve factors as patient adherence, drugs stock-outs and lost to follow-up are also essential.

Objectives Sub-Saharan Africa is a region with high incidence of both human immunodeficiency virus (HIV) and cervical cancer. We conducted the first national study in Togo to assess prevalence of human papillomavirus (HPV), HIV and other sexually transmitted infections (STIs) among female sex workers (FSW). Methods A multicentric cross-sectional study was conducted among FSW recruited in hot spots (clubs, streets) in four Togolese cities. HPV and STIs were tested from cervical and anal swabs. HIV and syphilis were screened with rapid tests. Results In all, 310 FSW were recruited; HIV and cervical high-risk HPV (hrHPV) prevalence were 10.6% (33/310) and 32.9% (102/310), respectively. The most frequent hrHPV types were HPV58 (13.6%, 19/140), HPV35 (12.9%, 18/140), HPV31 (12.1%, 17/140) and HPV16 (10.7%, 15/140). Prevalence of hrHPV and multiple hrHPV infections showed higher rates in HIV-positive than in HIV-negative FSW (48.5% versus 31.0%, p 0.04 and 21.2% versus 9.0%, p 0.03; respectively). Prevalence of hrHPV was higher in cervical than anal swabs (34.1% versus 20.7%, p 0.0004). High-risk HPV anal infections were more frequent among HIV-positive than HIV-negative FSW (51.9% versus 17.3%, p 2 × 10−5). Concomitant anal and cervical hrHPV infections were present in 43.2% (41/95) of hrHPV-positive FSW. Overall prevalence in the cervix of Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium and Trichomonas vaginalis were 4.2%, 6.1%, 5.5% and 6.5%, respectively. Conclusions This first African study on paired cervical and anal samples showed a high prevalence of genital HPV infections with a rather high rate of concomitant HPV infections but low type concordance. We report an unusual distribution of hrHPV types. These findings highlight the critical need for implementation of a national HPV vaccination strategy.

Background. The limited access to virological monitoring in developing countries is a major weakness of the current antiretroviral treatment (ART) strategy in these settings. We conducted a large cross-sectional study in Burkina Faso, Cameroon, Cote d'Ivoire, Senegal, Togo, Thailand, and Vietnam to assess virological failure and drug resistance mutations (DRMs) after 12 or 24 months of ART. Methods. Between 2009 and 2011, we recruited adults attending ART centers 10-14 months (the M12 group) or 22-26 months (M24 group) after initiating ART. Demographic and clinical data were collected on site, and viral load was measured. Samples with a viral load of >= 1000 copies/mL, considered as the failure threshold, were geno-typed for drug resistance assessment. Results. Overall, 3935 patients were recruited (2060 at M12 and 1875 at M24). Median ages varied from 32 to 42 years. Median CD4(+) T-cell counts at ART initiation were low (99-172 cells/mu L). The main ART regimens included stavudine/zidovudine plus lamivudine plus nevirapine/efavirenz. Overall, virological failure frequency was 11.1% for M12 patients and 12.4% for M24 patients, and 71.0% to 86.1% of these patients, respectively, had drug-resistant virus. Across sites, virological failure varied from 2.9% to 20.6% in M12 patients and from 3.7% to 26.0% in M24 patients. Predominant DRMs were associated with ART regimens, but virus in several patients accumulated DRMs to drugs not received, such as abacavir, didanosine, tenofovir, etravirine, and rilpivirine. Conclusions. Our findings show heterogeneous virological failure and illustrate that, in addition to routine access to viral load, good management of ART programs is even more critical to improve treatment outcomes in resource-limited countries.

Contexte?: l’une des insuffisances des programmes de lutte contre le VIH se rapporte aux actions a l’endroit des groupes vulnerables, notamment les usagers de drogues (UD). Cette etude avait pour objectif d’estimer la seroprevalence du VIH et les facteurs associes chez les usagers de drogues au Togo.Methode?: une etude descriptive transversale a ete realisee chez les consommateurs de drogues au Togo du 7 novembre 2011 au 7 janvier 2012 ciblant tous les consommateurs de drogues quels que soient le mode et le type de produits, âges de 18 ans et plus et qui vivaient depuis au moins trois mois sur le territoire du Togo. La prevalence du VIH a ete estimee avec son intervalle de confiance (IC) a 95 %. Des analyses univariee et multivariee ont ete effectuees pour determiner les facteurs associes a la prevalence du VIH.Resultats?: au total, 387 UD ont participe a l’enquete dont 235 (60,7 %) a Lome. L’âge median des UD etait de 32 ans, l’etendue interquartile (EIQ) [25-39 ans] et 10 des UD (2,6 %) etaient des femmes. Le mode principal de consommation de drogues etait «?le fait de fumer ou d’inhaler?», rapporte par 92,8 % des UD?; et 2,8 % d’entre eux utilisaient la voie intraveineuse. L’acceptation du test VIH etait de 98,4 %. La prevalence du VIH chez les consommateurs de drogues etait de 5,5 %, avec un IC a 95 % [3,2-7,8 %].Conclusion?: la prevalence du VIH chez les consommateurs de drogues etait de 5,5 % contre 3,2 % dans la population generale en 2010 au Togo, des actions de prevention a l’endroit de cette population s’averent indispensables.

Background. No data are available on HIV/hepatitis B virus (HBV) or hepatitis C virus coinfection in Togo, and patients are not routinely tested for HBV infection.Objectives. To determine the prevalence of HBV and the risk of HBV drug resistance during antiretroviral treatment in HIV-coinfected patients in Togo.Method. This cross-sectional study was carried out in Lomé, Togo, from January 2010 to December 2011 among HIV-infected patients who had been on antiretroviral therapy (ART) for at least 6 months.Results. In total, 1 212 patients (74.9% female) living with HIV/AIDS and treated with ART were included in the study. The seroprevalence of hepatitis B surface antigen (HBsAg) was 9.7% (117/1 212; 95% confidence interval (CI) 8.04 - 11.45). Of these 117 HBsAg-positive patients, 16 (13.7%) were hepatitis B e antigen (HBeAg)-positive, and 115 (98.3%) were on lamivudine. The HBV DNA load was >10 IU/ mL in 33/117 patients overall (38%), and in 87.5% of 16 HBeAg positive patients (p10 IU/mL were HBeAg positivity (adjusted odds ratio (aOR) 6.4; p=0.001) and a higher level of education (aOR 6.5; p=0.026). The prevalence of HBV resistance to lamivudine was 13.0% (15/115; 95% CI 7.0 - 19.0). The detected resistance mutations were rtL180M (14/15 patients) and rtM204V/I (15/15).Conclusion. The seroprevalence of HBV among ART-treated HIV-infected patients in Togo was 9.7%. The prevalence of HBV lamivudine resistance mutations after 2 years of ART was 13.0%. These results suggest that HBV screening before ART initiation can be based on HBsAg testing.

Background. Recently, test developers have created rapid point-of-care tests that can simultaneously detect multiple infections within the same specimen using a single device. The SD BIOLINE Duo HIV/Syphilis rapid point-of-care test uses a solid-phase immunochromatographic assay to detect immunoglobulin (Ig)G, IgM, and IgA antibodies to human immunodeficiency virus (HIV)-specific antigens (HIV-1 gp41, sub O, HIV-2 gp36) and recombinant Treponema pallidum antigen (17 kDa) in human serum. This study was a multisite laboratory-based evaluation of the performance of SD BIOLINE HIV/Syphilis Duo test using previously characterized sera in 6 countries. Methods. Laboratories in Ghana, Mexico, Laos, Togo, Kenya, and Myanmar participated in the evaluation during 2012–2013. Each site characterized sera using T pallidum particle agglutination assay or T pallidum hemagglutination assay and HIV enzyme immunoassay, Western blot, and/or HIV antibody rapid tests. Those gold standard test results were compared with SD BIOLINE Duo test results. We calculated the sensitivity and specificity of test performance and used the exact binomial method to calculate 95% confidence intervals (CIs). Results. The sensitivity and specificity for the HIV antibody test component (n = 2336) were estimated at 99.91% (95% CI, 99.51% and 100%) and 99.67% (95% CI, 99.16% and 99.91%), respectively. For the T pallidum test component (n = 2059), the sensitivity and specificity were estimated at 99.67% (95% CI, 98.82% and 99.96%) and 99.72% (95% CI, 99.29% and 99.92%), respectively. Conclusions. The sensitivity and specificity of the SD BIOLINE HIV/Syphilis Duo test were consistently high across sera specimens from 6 countries around the world. Dual rapid tests should be considered for improved HIV and syphilis screening coverage.

Togo is a cholera-endemic country bordered by other countries where this disease is endemic. We describe the epidemiology of cholera in Togo, using national surveillance data.We reviewed national surveillance data housed in the National Ministry of Health. Districts submitted reports of summary weekly case counts and deaths at the national level. Data were available at the district level during 2008-2010 and at the national level from 1996 onward. Microbiological confirmation usually was not performed, and case identification was based on clinical suspicion.From 1996 through 2010, Togo had 12 676 reported cholera cases and 554 deaths. Annual national cholera incidence varied from 0.9 to 66 cases per 100 000 population, with little variation except for 2 large epidemics during 1998 and 2001. The case-fatality ratio declined from 12%-17% during 1996-1997 to1% during 2008-2010. During 2008-2010, 85% of 26 district-level outbreaks occurred in the capital Lomé or the coastal Maritime Region. The average outbreak duration was 6 weeks, and only 2 lasted15 weeks.While cholera control remains elusive in Togo, reductions in case-fatality ratios have occurred, possibly due to improvements in case management. The short duration of outbreaks may preclude reactive vaccination; however, the restricted geographic location may make preventive immunization attractive.

BACKGROUND: There is no data on HIV seroprevalence among prisoners in Togo. METHODS: A cross-sectional study was conducted among prisoners in Togo from November 2011 to January 2012. The study population was included by selecting the most densely populated prison in each of the six Togo regions and by including prisoners (at least18years of age and having been in prison for more than 30days) on a voluntary basis. HIV prevalence was estimated with a 95% confidence interval (CI). RESULTS: One thousand three hundred and fourty-two prisoners were included in the study. Their median age was 28years (IQR 25-33years) and 39 (2.9%) were women. The median time spent in the prison was 10months interquartile range [4-24months]. HIV testing was accepted by 96.0%. HIV seroprevalence in prisons was 4.3% 95 CI% [3.2-5.5%]. Few prisoners (2.9%) reported having had sex in prisons. The only factor associated with HIV infection was gender with an HIV seroprevalence of 14.3% for women compared to 4.0% for men (P=0.003). CONCLUSION: The prevention and the management of HIV infection should be a priority in Togolese prisons. This requires implementing healthcare facilities in prisons. Copyright (c) 2013. Published by Elsevier SAS.

BACKGROUND: Global genetic diversity of HIV-1 is a major challenge to the development of HIV vaccines. We aimed to estimate the regional and global distribution of HIV-1 subtypes and recombinants during 1990-2015. METHODS: We searched PubMed, EMBASE (Ovid), CINAHL (Ebscohost), and Global Health (Ovid) for HIV-1 subtyping studies published between Jan 1, 1990, and Dec 31, 2015. We collected additional unpublished HIV-1 subtyping data through a global survey. We included prevalence studies with HIV-1 subtyping data collected during 1990-2015. We grouped countries into 14 regions and analysed data for four time periods (1990-99, 2000-04, 2005-09, and 2010-15). The distribution of HIV-1 subtypes, circulating recombinant forms (CRFs), and unique recombinant forms (URFs) in individual countries was weighted according to the UNAIDS estimates of the number of people living with HIV (PLHIV) in each country to generate regional and global estimates of HIV-1 diversity in each time period. The primary outcome was the number of samples designated as HIV-1 subtypes A, B, C, D, F, G, H, J, K, CRFs, and URFs. The systematic review is registered with PROSPERO, number CRD42017067164. FINDINGS: This systematic review and global survey yielded 2203 datasets with 383 519 samples from 116 countries in 1990-2015. Globally, subtype C accounted for 46·6% (16 280 897/34 921 639 of PLHIV) of all HIV-1 infections in 2010-15. Subtype B was responsible for 12·1% (4 235 299/34 921 639) of infections, followed by subtype A (10·3%; 3 587 003/34 921 639), CRF02_AG (7·7%; 2 705 110/34 921 639), CRF01_AE (5·3%; 1 840 982/34 921 639), subtype G (4·6%; 1 591 276/34 921 639), and subtype D (2·7%; 926 255/34 921 639). Subtypes F, H, J, and K combined accounted for 0·9% (311 332/34 921 639) of infections. Other CRFs accounted for 3·7% (1 309 082/34 921 639), bringing the proportion of all CRFs to 16·7% (5 844 113/34 921 639). URFs constituted 6·1% (2 134 405/34 921 639), resulting in recombinants accounting for 22·8% (7 978 517/34 921 639) of all global HIV-1 infections. The distribution of HIV-1 subtypes and recombinants changed over time in countries, regions, and globally. At a global level during 2005-15, subtype B increased, subtypes A and D were stable, and subtypes C and G and CRF02_AG decreased. CRF01_AE, other CRFs, and URFs increased, leading to a consistent increase in the global proportion of recombinants over time. INTERPRETATION: Global and regional HIV diversity is complex and evolving, and is a major challenge to HIV vaccine development. Surveillance of the global molecular epidemiology of HIV-1 remains crucial for the design, testing, and implementation of HIV vaccines. FUNDING: None. ispartof: LANCET INFECTIOUS DISEASES vol:19 issue:2 pages:143-155 ispartof: location:United States status: published