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Introduction: HIV self-testing is a complementary screening strategy that could facilitate access to HIV care services for street adolescents. The objectives of this study were to assess the acceptability and feasibility of HIV self-testing and their associated factors, to estimate HIV prevalence among street adolescents in Togo, and to describe the sexual behavior of this population., Methods: A cross-sectional study was conducted between July 2021 and May 2022 in Lomé and Kara (Togolese cities with the highest number of street adolescents). Street adolescents aged 13-19 years were included. An oral HIV self-test (OraQuick®) was used. Acceptability was defined as the proportion of adolescents who completed the test, and feasibility was defined as the proportion of adolescents who reported a test with a valid result. An HIV serological test was performed for all participants. A weighted logistic regression model was used to identify the factors associated with the acceptability and feasibility of HIV self-testing., Results: A total of 432 street adolescents (12.3% female) with a median age of 15 years, interquartile range (IQR) [14-17], were included in this study. Of the 231 sexually active adolescents, only 30.3% (n = 70) reported having used a condom during their last sexual intercourse. HIV self-test was offered to a sub-sample of 294 street adolescents. Acceptability was 96.6% (284/294), (95%CI = [93.8-98.3]) and feasibility 98.9% (281/284), (95%CI = [97.0-100.0]). Being 16 years of age or older (aOR = 28.84; p<0.001) was associated with HIV self-test acceptability. Reporting drug abuse (aOR = 0.47; p = 0.020) was negatively associated to acceptability. Having an educational level at least equivalent to secondary school was associated to HIV self-testing feasibility (aOR = 3.92; p = 0.040). Self-test results were correctly interpreted by 98.6% of street adolescents. HIV prevalence was estimated at 0.9% (95%CI [0.4-2.4])., Conclusion: HIV self-testing is acceptable and feasible among street adolescents, a population at high risk of HIV infection in Togo. The provision of HIV self-testing kits, coupled with condom distribution, represents an opportunity to improve access to HIV care services., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Sadio et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

High-risk human papillomavirus (HPV) infections are responsible for cervical cancer. However, little is known about the differences between HPV types and risk categories regarding their genetic diversity and particularly APOBEC3-induced mutations - which contribute to the innate immune response to HPV. Using a capture-based next-generation sequencing, 156 HPV whole genome sequences covering 43 HPV types were generated from paired cervical and anal swabs of 30 Togolese female sex workers (FSWs) sampled in 2017. Genetic diversity and APOBEC3-induced mutations were assessed at the viral whole genome and gene levels. Thirty-four pairwise sequence comparisons covering 24 HPV types in cervical and anal swabs revealed identical infections in the two anatomical sites. Differences in genetic diversity among HPV types was observed between patients. The E6 gene was significantly less conserved in low-risk HPVs (lrHPVs) compared to high-risk HPVs (hrHPVs) (p = 0.009). APOBEC3-induced mutations were found to be more common in lrHPVs than in hrHPVs (p = 0.005), supported by our data and by using large HPV sequence collections from the GenBank database. Focusing on the most common lrHPVs 6 and 11 and hrHPVs 16 and 18, APOBEC3-induced mutations were predominantly found in the E4 and E6 genes in lrHPVs, but were almost absent in these genes in hrHPVs. The variable APOBEC3 mutational signatures could contribute to the different oncogenic potentials between HPVs. Further studies are needed to conclusively determine whether APOBEC3 editing levels are associated to the carcinogenic potential of HPVs at the type and sublineage scales., (© 2024 The Author(s). Journal of Medical Virology published by Wiley Periodicals LLC.)

Background: In Togo, few data are available on viral hepatitis in street adolescents, a vulnerable population due to their lifestyle. The aim of this study was to describe the lifestyle of street adolescents (sexual practices and drug use), to estimate the prevalence of hepatitis B and C viruses, and to describe their HBV immunization profile in Togo., Methods: A cross-sectional study was conducted in Lomé (Togo) in July 2021. Street adolescents aged between 13 and 19 years were included. A questionnaire was used to document lifestyle. ELISA tests were performed for Hepatitis B surface antigen (HBsAg), Hepatitis B core and surface antibodies (anti-HBc, anti-HBs), and antibodies against hepatitis C virus (anti-HCV)., Results: A total of 299 adolescents (5.4% female) with a median age of 15 years (IQR: 14-17) were included. Of these, 70.6% (211/299) were sexually active and 70.6% (149/211) had not used a condom during their last sexual intercourse. Drug use was reported by 42.1% of the adolescents. The most used substances were cannabis (39.0%), cocaine (36.6%), glue solvents (19.5%), and tramadol (11.4%). However, cocaine use may have been overestimated due to information bias. Current HBV infection (HBsAg+) was detected in 3.7% (95%CI: 1.9-6.5) of the adolescents. Isolated anti-HBc + was present in 5.3%. All three HBV markers (HBsAg, anti-HBs, and anti-HBc) were negative in 71.6% of adolescents. Anti-HCV was detected in 4.7% of adolescents., Conclusion: Nearly one in 10 street adolescents has markers for HBV contact/current infection, and approximately 72% of street adolescents may still be infected with HBV, as they have no HBV markers. HCV is also circulating in this population. Given the reported high-risk sexual practices and high levels of drug use, there is an urgent need to develop integrated strategies to prevent infections, including HBV, and drug dependence in this population., (© 2024. The Author(s).)

Background: There is almost no data on the circulation of SARS-CoV-2 among street adolescents. We conducted a study to document the immunization status of street adolescents in Togo against different variants of SARS-CoV-2., Methods: A cross-sectional study was carried out in 2021 in Lomé, the city with the highest number of COVID 19 cases in Togo (60%). Adolescents aged 13- and 19 years old living on the street were eligible for inclusion. A standardized questionnaire was administered face-to-face to adolescents. A sample of blood was taken and aliquots of plasma were transported to the virology laboratory of the Hôpital Bichat-Claude Bernard (Paris, France). SARS-CoV-2 anti-S and anti-N IgG were measured using chemiluminescent microparticle immunoassay. A quantitative miniaturized and parallel-arranged ELISA assay was used to detect IgG antibodies specifically directed against the different SARS-CoV-2 Variants of Concern (VOC)., Results: A total of 299 street adolescents (5.2% female), median age 15 years, interquartile range (14-17 years), were included in this study. The prevalence of SARS-CoV-2 infection was 63.5% (95%CI: 57.8-69.0). Specific-IgG against the ancestral Wuhan strain was developed by 92.0% of subjects. The proportion of patients being immunized against each VOC was 86.8%, 51.1%, 56.3%, 60.0, and 30.5% for the Alpha, Beta, Gamma, Delta, and Omicron VOCs, respectively., Conclusion: This study showed a very high prevalence with approximately 2/3 of Togolese street adolescents having antibodies to SARS-CoV-2 due to a previous infection. These results confirm an under-reporting of COVID-19 cases in Togo, questioning the hypothesis of low virus circulation in Togo and even in Africa., (© 2023. The Author(s).)

Background: The extent of SARS-CoV-2 circulation in African countries is still unclear. Seroprevalence studies are a common approach to epidemiological surveillance, allowing estimation of the proportion of people who have had contact with the virus. We aimed at estimating the seroprevalence of anti-SARS-CoV-2 antibodies and associated factors in Togo at the national level in 2021 according to age groups, gender, and place of residence (rural or urban)., Methods: From 15 May to 31 June 2021, we conducted a nationally representative cross-sectional serological survey in 12 health districts (two districts per health region) in the > 5 years old population in Togo. The Wantai SARS-CoV-2 total antibody assay S protein receptor-binding domain-based ELISA (Wantai Biological Pharmacy Enterprise Co.; Beijing, China) was used to determine the presence of SARS-CoV-2 total antibodies in plasma. Crude and weighted seroprevalences (weighted by age, sex and place of residence) were calculated and then weighted seroprevalences were adjusted according to sensitivity and specificity of the ELISA test. Finally, logistic regression models were performed in order to describe factors associated., Results: Of the 7593 participants, the overall weighted and adjusted seroprevalence of total anti-SARS-CoV-2 antibodies was 65.5% (CI95%: 18.9-21.1). Urban dwellers, young adults (30-49 years) and vaccinated individuals were significantly more likely to be seropositive., Conclusion: The high seroprevalence we observed is consistent with observations across West Africa. Quantification of the level of immunity in the population is needed to know how close we are to herd immunity. In the meantime, vaccination against the COVID-19 remains necessary., (© 2022. The Author(s).)

Purpose: The objective of this study was to estimate the prevalence of malaria and Covid-19 by PCR and serological tests in febrile patients in Lomé., Methods: A cross-sectional study was conducted from September 1 to October 31, 2020 in febrile patients ≥ 10 years in three health facilities in Lomé. Finger stick blood was collected to detect Plasmodium spp. using thin/thick smear and venous blood on EDTA tubes to test for malaria Histidin-Rich-Protein-2 antigen using rapid diagnostic tests (RDT) and SARS-CoV-2 antibodies specific immunoglobulin (Ig) M and G. Detection of SARS-CoV-2 in nasopharyngeal samples was performed by rRT-PCR using GeneXpert., Results: A total of 243 participants (61.7% of female) with median age 28 years (IQR 18-41) were included in the study. Prevalence of malaria was 25.1%, 95% CI [19.8-31.0] and 30.4%, 95% CI [24.7-36.7] for thin/thick smear and rapid malaria test, respectively. Eighteen patients (7.4%, 95% CI [4.4-11.5]) were positive for SARS-CoV-2 and forty-two (17.3%, 95% CI [12.8-22.6]) were positive for IgM and/or IgG against SARS-CoV-2. SARS-CoV-2 IgM seroprevalence was significantly higher in malaria RDT positive participants (33.8% vs. 10.1%, p < 0.001)., Conclusion: This study confirms a possible cross-reactivity between Covid-19 and malaria in case of single use of rapid tests, suggesting a possible past contamination. In case of clinical signs related to Covid-19 in malaria-endemic areas, PCR screening should be requested in order to identify and isolate patients., (© 2022. The Author(s) under exclusive licence to Witold Stefański Institute of Parasitology, Polish Academy of Sciences.)

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., (© 2021. The Author(s).)

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 <60 years (aOR = 3.12; 95%CI = [1.51-6.66])., 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., Competing Interests: The authors have declared that no competing interests exist.

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., Competing Interests: The authors have declared that no competing interests exist

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., (Copyright © 2019 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.)

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., (© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)

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., Objective: 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 &gt;10 IU/mL in 33/117 patients overall (38%), and in 87.5% of 16 HBeAg-positive patients (p&lt;0.0001). In multivariate analysis, factors associated with HBV DNA load &gt;10 IU/mLwere 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.

Context: In the context of implementing a serological and behavioural surveillance system among drugs users, this study estimated the prevalence of HIV infection and related risk behaviours among drug users (DUs) in Togo., Method: A cross-sectional study was conducted among DUs in Togo from November 2011 to January 2012. This study involved all DUs regardless of the type of drug and the mode of consumption, over the age of 18 years, who had lived in Togo for at least 3 months. Behavioural data were collected by face-to-face interviews and serum was obtained for HIV antibody testing. HIV prevalence was estimated together with its 95% confidence interval (CI). Univariate and then multivariate analyses were performed to study the factors associated with HIV prevalence., Results: A total of 387 DUs participated in the survey and 235 (60.7%) of them were enrolled in Lomé, the country's capital. The median age of DUs was 32 years with an interquartile range of [25-39 years] and 10 (2.6%) were women. The mode of drug consumption was: smoking or inhaling drugs in 92.8% of cases and 2.8% of DUs used drugs by injection. HIV testing was accepted in 98.4% of cases. The estimated HIV prevalence among drugs users was 5.5%, (95% CI, 3.2-7.8%)., Conclusion: This study, the first to be conducted among DUs in Togo, found an HIV prevalence of 5.5%, which is higher than the HIV prevalence in the general population (3.2% in 2010). Specific care of DUs is essential in order to reduce HIV prevalence in Togo.

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 © 2013. Published by Elsevier SAS.)