INTRODUCTION:Mother-to-child transmission (MTCT) of HIV, syphilis, and hepatitis B virus (HBV) commonly observed in the WHO African region is associated with excess morbidity and mortality. Despite some progress, the coverage of interventions to prevent MTCT of these infections remains insufficient, particularly for syphilis and HBV. To fulfil these gaps and achieve the triple elimination of MTCT of these infections by 2030, the World Health Organization (WHO) advocates for integration of prevention of MTCT (PMTCT) activities for HBV with HIV and syphilis antenatal services. In partnership with the local governments, the TRI-MOM project, conducted in 2 phases, aims to evaluate a simplified (based on inexpensive rapid diagnostic tests), integrated (in maternal and child health services) and coordinated (between the various programs and health care workers) strategy for the triple elimination of HIV, syphilis and HBV MTCT in Burkina Faso and The Gambia. METHODS AND ANALYSIS:The strategy will be implemented in 5 rural and urban health facilities in each country and will include four activities: i) training sessions for healthcare workers working in maternal and child health services, ii) screening of pregnant women of the three infections using rapid diagnostic tests at the first antenatal visit, iii) clinical assessment and treatment of women tested positive for any of the 3 infections, and iv) raising awareness on HIV, Syphilis and HBV PMTCT among pregnant women and empowering those screened positive. 17,000 pregnant women are expected to be screened. The strategy will be evaluated through an interdisciplinary, mixed-methods approach comprising three studies: i) a quantitative and qualitative cross-sectional study conducted both before and after the implementation of the strategy to assess its impact on triple screening coverage in pregnant women; ii) a an intervention study with longitudinal follow-up of pregnant women positive for any of the three infections to assess the coverage of PMTCT measures; and iii) a cost and cost-effectiveness analysis of the project compared to the reference situation in each country, which will rely on a micro costing study to estimate the incremental cost of the strategy per mother/child couple compared with the reference situation in each country, and compare it to the number of avoided infections. ETHICS AND DISSEMINATION:The study protocol has been approved by the competent authorities of the countries participating to the research (the LSHTM/MRCUG Scientific Coordinating Committee, the Gambia Government/MRC Joint Ethics Committee, the LSHTM ethics committee, the Burkinabe National Ethical Committee for Research in Health and the French Commission on Information Technology and Liberties). Results on the feasibility and acceptability of the triple elimination strategy will be disseminated using different media including policy briefs, posters and articles. TRIAL REGISTRATION NUMBER:ClinicalTrials.gov NCT05951751.
Dengue outbreaks have occurred in Burkina Faso since 2013, but the country experienced its first chikungunya outbreak in Pouytenga in 2023. Thus, a field investigation was undertaken to determine entomological risk factors associated with the chikungunya outbreak to inform decision-making and respond to the outbreak. Field entomological investigations were performed during the chikungunya outbreak in Pouytenga in September-October 2023. Adult mosquitoes were collected indoors and outdoors using Prokopack aspirators in selected households, while BG-sentinel traps were deployed in public places to assess mosquito density. The presence of chikungunya virus (CHIKV), dengue virus (DENV), yellow fever virus (YFV) and Zika virus (ZIKV) in Aedes aegypti was investigated by reverse transcription quantitative polymerase chain reaction (RT qPCR). Water-holding containers were screened for the presence of Aedes larvae and/or pupae and to determine traditional Stegomyia indices. Aedes mosquito eggs were also collected using oviposition traps, with the resulting adults used to assess susceptibility status to pyrethroid, carbamate and organophosphate insecticides. A total of 784 adult mosquitoes were collected using both BG-sentinel trap (n = 183) and Prokopack aspirator (n = 601). Aedes aegypti was the only species of Aedes collected and represented 16% (122/784) of all mosquitoes. Two out of the three pools of Ae. aegypti mosquitoes were positive for chikungunya virus while one pool was positive for dengue virus, representing minimum infection rates (MIR) of 48.8 and 24.4, respectively. Terracotta jars, drums/barrel and tyres were the most predominant and positive breeding sites. The house index (HI), container index (CI) and Breteau index (BI) were all over the threshold criteria for arbovirus risk. Aedes aegypti from the population showed resistance to deltamethrin and pirimiphos-methyl but were susceptible to malathion. Our results indicate a high risk of CHIKV and DENV infection in mosquitoes during the chikungunya outbreak in Pouytenga. We emphasise the need to implement sustainable entomological and epidemiological surveillance at sentinel sites for early detection of circulating arboviruses, along with intensified vector control measures to prevent outbreaks.
Malaria remains the leading cause of under-five mortality in Burkina Faso, one of the ten most affected countries globally. Despite substantial control efforts, persistent inequalities continue to limit progress. Addressing the complex and interrelated determinants of malaria is crucial to achieving national elimination targets. This study examined the prevalence of malaria and its associated individual and contextual factors using nationally representative data. We analyzed data from 5674 children aged 6–59 months included in the 2021 Burkina Faso Demographic and Health Survey (DHS), which used a two-stage stratified cluster sampling design. Malaria infection was defined by positive microscopy results. Modified Poisson regression models were applied to estimate adjusted prevalence ratios (aPR). The overall malaria prevalence among children under five was 14.1
People living with HIV (PLWH) are known to maintain a degree of immune deficiency despite efficient antiretroviral therapy and may exhibit diminished responses to vaccines. In this study, we assessed the immune response to SARS-CoV-2 infection and vaccines in two geographically distinct PLWH populations. PLWH and HIV-negative (HIV-) participants were recruited from Qu&bec City (QC), Canada, and Bobo-Dioulasso (BD), Burkina Faso, for two visits at 24-week intervals during the predominance of the Omicron variant, from May 2022 to September 2023. Blood samples were collected at each visit for the detection of antibodies against spike (anti-S) and nucleocapsid (anti-N) proteins of SARS-CoV-2 in platelet-free plasma. A total of 360 participants were enrolled. We detected anti-S antibodies in 99% of participants, indicating that nearly all had prior exposure to the SARS-CoV-2 spike antigen, either through vaccination or prior infection. Anti-S titers showed no difference between PLWH and HIV& participants in each location, while significantly higher titers were observed in participants from QC compared to BD. In contrast, anti-N antibodies, indicative of prior infection, were detected in 39% and 86% of the participants in QC and BD, respectively, suggesting that the virus circulated largely in the latter population. No difference in anti-N levels was observed between PLWH and HIV& participants in BD. However, participants in QC had significantly lower titers compared to HIV participants. Overall, this study shows that PLWH develop robust antibody responses to SARS-CoV-2 vaccination, comparable to those observed in HIV& participants. Significant geographic differences were observed in anti-S titers, irrespective of HIV status, with participants from QC displaying higher titers. In contrast, participants from BD had higher anti-N antibody prevalence and titers, reflecting more SARS-CoV-2 infections in BD than in QC. Finally, analysis of anti-S antibody titers against several circulating variants revealed significantly lower levels in unvaccinated participants and in those vaccinated with monovalent vaccines in BD. No significant difference was observed between monovalent and bivalent vaccines administered in QC. All authors have seen and approved the manuscript. ### Competing Interest Statement The authors have declared no competing interest. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study was approved by the ethics committee of the "Centre de recherche du CHU de Québec-Université Laval" (registration number CER-2022-6241) and the Burkina Faso Ministry of Health Research Ethics Committee (Deliberation n°2022-03-048). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The study protocol, results and informed consent documents will be made available to researchers upon request from the corresponding author. Researchers will be asked to complete a concept sheet for their proposed analyses to be reviewed, and the investigators will consider the overlap of the proposed project with active or planned analyses and the appropriateness of the study data for the proposed analysis. Canadian Institutes of Health Research (CIHR), Emerging COVID-19 Research Gaps & Priorities (July 2021) - HIV and SARS-CoV-2, EGS-179454
Background Preparedness for emerging pathogens can be strengthened by leveraging lessons from COVID-19 therapeutic trials. The COVERAGE Africa trial (NCT04920838, ANRS033, 2021-22), one of the few COVID-19 therapeutics trials conducted in resource-limited settings, sought to identify early treatment strategies for ambulatory patients at-risk for severe disease in Guinea and Burkina Faso. This implementation research, based on secondary data from the Burkina Faso sites, aimed to document the trial's implementation and to identify the factors that influence it.Methods The PEARLES framework was applied to identify and classify indicators related to political, economic, administrative, regulatory, logistical, ethical and societal factors influencing trial's implementation. Data drawn from regulatory documents, weekly internal reports, financial documents, programmatic data, equipment receipt slips, contracts and logistical documents, as well as the dynamic of recruitment in the trial were analysed to describe these indicators as either facilitators-supporting the trial's execution as planned-or barriers-causing delays, hindering progress or leading to deviations.Results Barriers to trial implementation included: (1) the trial's adaptive design, needing iterative protocol amendments leading to regulatory delays that were aggravated by the misalignment between national and international care guidelines, (2) funding disbursement lags, (3) challenges in participants' enrolment due to inadequate screening sites organisation that compromised patient confidentiality and (4) significant increase in the refusal rate during the trial, rising from 3% in 2021 to 38% in 2022. Despite these constraints, mitigation strategies such as prefinancing, mobile team deployment and site renovations enabled effective trial delivery. Strong governmental support, rapid mobilisation of funders and flexibility in staff deployment facilitated trial's implementation.Conclusion To enhance trial readiness in emergency situations, countries need political commitment, preapproved protocols, dedicated research infrastructure and rapid funding mechanisms. Stakeholder engagement and preparedness exercises are essential to strengthen clinical trial capacity in low-resource settings particularly across sub-Saharan Africa.
