Psychoactive substance (PAS) use among people living with HIV (PLHIV) can adversely affect treatment adherence, disease progression, and mental health. Despite growing concern, there is limited data on the prevalence and correlates of substance use in this population in Togo. This study aimed to assess the prevalence, patterns, and associated factors of PAS use among PLHIV in Lomé. A cross-sectional survey was conducted between August and October 2023 among PLHIV attending HIV clinic of the infectious and tropical diseases department of the CHU Sylvanus Olympio in Lomé. Data were collected using a structured, pre-tested questionnaire administered through face-to-face interviews. Information was gathered on sociodemographic characteristics, ART adherence, and use of PAS (alcohol, tobacco, cannabis, others) in the past 12 months. Using STATA version 15.1, multivariate logistic regression analysis was used to determine factors associated with substance use. A total of 510 PLHIV were included in this study, of which 71.6

Men engaged in transactional sex (METS) represent a neglected key population in sub-Saharan Africa (SSA), yet little is known about their burden of sexually transmitted infections (STIs) and associated factors. This study assessed the prevalence of self-reported STIs (SR-STI) and identified individual, community, and country-level determinants among this group. We analyzed pooled recent nationally representative Demographic and Health Survey (DHS) data from 26 SSA countries. This study included 10,128 men who reported engagement in transactional sex within the past 12 months. Weighted prevalence estimates were calculated, and multilevel logistic regression models were applied to examine individual-, community-, and country-level determinants of SR-STI symptoms, adjusting for survey year. AIC and BIC were used as comparative model selection criteria to identify the best-fitting model among the sequential multilevel models built. The participants’ mean (± SD) age was 29.8 (± 10.2) years. The overall weighted prevalence of SR-STIs among METS was 19.5

Introduction:Epidermodysplasia verruciformis (EV) is a rare genodermatosis characterized by chronic human papillomavirus infection of the skin and a risk of carcinomatous degeneration. We report a case of EV complicated by multiple cutaneous carcinomas of the scalp in a 19-year-old subject. Case Presentation:A 19-year-old male, phototype VI according to Fitzpatrick's classification, was referred to the dermatology department of CHU Kara with multiple painful tumoral lesions of the scalp that had been evolving for about 1 year. Clinical examination revealed hypochromic macules (Pityriasis versicolor-like), hypochromic verrucous flat papules scattered over the face, scalp, neck, trunk, and upper limbs. These lesions were associated with occasional pruritus. Apart from these lesions, there were three ulcerative-bourgeonous tumors on the scalp. A normal blood count was obtained, and the HIV serological test was negative. Histological examination of lesion biopsies confirmed the diagnosis of squamous cell carcinoma for all three lesions. Patient management was limited by lack of financial resources. Conclusion:As sub-Saharan Africa is characterized by fragile health systems and high solar gradients, particular emphasis must be placed on preventive measures for skin cancers in patients with genodermatoses at risk of degeneration.

Conidiobolomycosis is a rare tropical deep cutaneous mycosis characterized by dysmorphic facial involvement giving, in advanced forms, a “hippopotamus snout” appearance. We report the case of a patient presenting with conidiobolomycosis at Kara University Hospital in Togo. The patient, a 32-year-old farmer, presented with a 2-month history of progressive facial swelling associated with headache and clear rhinorrhea. Clinical examination revealed a swollen face with increased involvement of the upper lip, erythema and a clear nasal discharge. A tomodensitometry of the face and histological examination of a skin biopsy provided further support for the diagnosis of conidiobolomycosis. The patient was put on itraconazole 400mg/day with a good clinical evolution. To our knowledge, no case has ever been reported in Togo.

Introduction: Seborrheic dermatitis (SD) is a chronic, recurrent and common inflammatory dermatosis. The aim of this study was to describe the prevalence and factors associated with SD and to assess the quality of life of patients in Lomé. Patients and method: This was a descriptive study with prospective collection that took place in public dermatology departments in Lomé from January 1, 2021 to December 31, 2022. DS severity was assessed with the SEDASI (Seborrheic Dermatitis Area and Severity Index) score; stress with the Perceived Stress Scale (PSS) score and quality of life with the DLQI (Dermatology Life Quality Index). Data analysis was performed using EPI Info 7.2.5.0 software. Results: A total of 113 (3.2%) of the 3,590 patients seen in consultation had DS. The mean age of patients was 30.4 ± 11.7 years, with a sex ratio of 1.6. Lesions were pruritic in 77%; erythematous (87.6%) and scaly (81.3%), and mainly located in the nasolabial fold (78.8%). DS was mild in 78.8%. Also, 55.7% had a high degree of stress. DS had an impact on quality of life, mainly in the area of leisure/social activities (17.8%), and 30.7% felt embarrassed or lacked confidence because of their dermatosis. Conclusion: DS is common in Lomé hospitals. Although not severe, it impairs patients’ quality of life. Hence the importance of psychological care for patients.

Sexually transmitted infections (STIs) are a major public health concern, particularly among adolescents and young adults (AYA) in West Africa who reported higher prevalence of risky sexual behaviors. We therefore proposed a protocol for systematic review and meta-analysis to assess the prevalence of risky sexual behaviors for STIs among adolescents and young adults living in West Africa. Systematic searches of electronic databases (PubMed/MEDLINE, Embase, African Index Medicus) will be conducted. Studies published between January 1, 2013, and June 30, 2023, on the prevalence of sexual behaviors associated with STIs risk in AYA living in West Africa will be included. Two reviewers will independently conduct studies selection, data extraction, and risk of bias assessment. The selection of eligible studies will be based on titles and abstracts, followed by full-text review. The risk of bias assessment for eligible studies will be performed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool. If possible, a meta-analysis of data on the prevalence of each sexual risk behavior will be performed. The heterogeneity will be statistically assessed using a I2 statistic. This protocol is developed following the guideline of Preferred Reporting Items for Systematic Reviews and Meta-analyses Protocols 2015. STATA or R software will be used for the meta-analysis. This review will estimate the prevalence of risky sexual behaviors among AYA aged 15–24 years in West Africa to inform appropriate interventions.

Condom use is an essential component of strategies to improve the sexual and reproductive health of adolescents and young adults (AYA). However, it remains a challenge for many Sub-Saharan African countries, including Liberia. This study aimed to examine the effects of individual and contextual factors on condomless sex within the past 12 months among AYA in Liberia. A secondary analysis was conducted using data from the 2019-2020 Liberia Demographic and Health Survey (2019-20 LDHS). Sexually active AYA were included in the study. A simultaneous assessment of the effects of individual and community characteristics on unprotected sex was conducted using a multilevel mixed-effects logistic regression model. The adjusted odds ratios (aORs) and their 95

Albinism is a genodermatosis that predisposes affected persons to actinic dermatoses and skin cancers. This study aimed to review published studies on skin cancers in persons with albinism. This was an analysis of the literature published before January 1, 2022 on skin cancers in people with albinism worldwide. The articles included were searched in the following databases: PubMed, Lissa, Pascal, and Google Scholar. Over the search period, 74 articles on skin cancer in persons with albinism were included. Most of them (51.4%) were published in Africa. The average age of patients with skin cancers in these studies was around 40, and the female/male sex ratio was 1:1.3. Overall, 1143 skin cancers were reported in 850 patients. Squamous cell carcinoma (SCC) was the most frequent skin cancer (648 cases; 56.7%), followed by basal cell carcinoma (BCC; 427 cases; 37.4%) with a BCC/SCC ratio of 1:1.5, and melanoma (39 cases; 3.4%). Of the 1143 cases of skin cancer, 998 (87.3%) were reported in Africa. The most common skin cancer in Africa was SCC, in contrast with Europe and America, where it was BCC. Melanoma was the least reported in Africa, with a frequency of 0.9%. African persons with albinism are more affected by skin cancers than people with albinism from other continents, mainly SCC, probably because of the high sunlight exposure. Preventive measures (popularization and respect of photoprotection measures, systematic and regular examination of the skin) and early and holistic management are essential to reduce the prevalence among this population in Africa.

Objective: The aim of this study was to describe the epidemiological and clinical profile of Kaposi’s disease (KD) from 1990 to 2020 in dermatology in Lomé (Togo). Patients and Method: This is a case series of KD including all records of patients seen as outpatients and/or hospitalised for KD of clinical and/or histological diagnosis between 1990 and 2020 in the public dermatology services of Lomé. Results: During the study period, 307 cases of KD were recorded, with a hospital frequency of 0.24%. The mean age of the patients was 40.03 ± 13.71 years, with extremes ranging from 6 to 90 years, and they were predominantly male (M/F = 1.5). The mean duration of KD before consultation was 639.96±1029.3 days (extremes: 14 to 7300 days). Skin lesions were found in 97.7% of patients (n=300). 134 (66%) and 52 (70.3%) patients with HIV-associated KD and endemic KD respectively had angiomatous nodules; 134 (66%) and 45 (60.8%) patients had infiltration. These lesions were mainly located on the right legs and feet, respectively 62.6% and 55.7% in HIV-associated KD and 51.3% and 70.3% in endemic KD. Mucosal lesions were present in 32.6% (n=100) of patients and the most common was the buccal mucosa whatever the type of KD; but more frequent in HIV-associated KD in 82 patients (40.4%). Of the 307 patients surveyed, 42 deaths were recorded (13.7%), patients surveyed, 42 deaths were recorded (13.7%), including 35 among the 203 patients with HIV-associated KD (17.2%). Conclusion: Our study shows a predominance of HIV-associated MK over the 30 years of the study. Widespread use of antiretroviral treatment with the “test and treat” strategy will help to reduce mortality.

Introduction:Scabies is an often-neglected skin parasitosis which can affect patients' quality of life, and its treatment may be delayed in some poor African countries due to a lack of trained healthcare personnel or a lack of financial resources. The aim of this study was to describe the treatment-seeking paths of patients seen in dermatological consultations in Lomé for scabies, the direct costs of treatment and the impact of this condition on the quality of life of patients suffering from it. Patients and method:This was a descriptive and analytical study of patients diagnosed with scabies in one of Lomé's dermatology departments from January 1 to December 31, 2021. The variables studied were sociodemographic; the patient's therapeutic course prior to the dermatology consultation; the direct cost of the present consultation and the patient's quality of life. The Dermatology Life Quality Index (DLQI) was used. Statistical analysis was performed with EPI Info software version 7.2.5.0. Results:A total of 157 patients were selected, including 114 cases of clinical scabies. The median age of patients was 26 years, and 29.3% were under 15 years of age. The sex-ratio M/F = 1.03. Out of them, 139 patients had one or more courses of treatment prior to the dermatological consultation, including self-medication (80.9%), consultations with non-dermatological healthcare personnel (62.4%). The average cost to the patient and family of drugs prescribed during the dermatological consultation was 19,817 CFA francs (30.2 €). The mean DQLI score for adults was 7.4, and 34.9% had moderate impairment of quality of life. The mean CDQLI score for children was 7.2, and 71.4 % had moderate impairment of quality of life. Conclusion:Scabies is a parasitosis that impair patients' life quality. In the absence of subsidized treatment and financial resources for patients, treatment remains limited, which could contribute to the spread of the disease.

Background: The burden of human immunodeficiency virus (HIV) in cervical cancer remains a major public health challenge in developing countries, like Togo. Precancerous lesions include all cellular abnormalities that have malignant potential that can develop into cancer. The objective of this study was to determine the prevalence and factors associated with precancerous cervical lesions in HIV-infected women in our context. Methods: A cross-sectional descriptive study was carried out from November 31, 2022, to January 31, 2023, in an HIV care center in Lomé (Non-Governmental Organization Espoir Vie Togo [NGO EVT] Grand-Lomé-Togo). Results: A total of 271 women were included with a mean age of 47.0 years and a standard deviation of 10.0 years, among whom 20.7% do not have any scholar education. Only 6.7% of them had previously performed cervical smear examinations. The prevalence of precancerous cervical lesions observed in people living with human immunodeficiency virus (PLHIV) was 11.4% with a 95% confidence interval (CI) of 5.0 to 15.4. Cytological abnormalities were marked by low-grade squamous intraepithelial lesion (LSIL) (5.1%), followed by the presence of atypical squamous cells of undetermined significance (ASCUS) (3.5%). A statistically significant association was found between parity and the presence of precancerous lesions ( P = .014). Conclusions: In this study, more than 1 out of 10 women living with HIV had precancerous cervical lesions, and parity was the factor associated. The implementation of a systematic screening program for precancerous cervical lesions and human papillomavirus (HPV) infection integrated into HIV care is necessary for early treatment.

Objective: The aim of this study was to evaluate the knowledge, attitudes, and practices of people with albinism (PWAs) related to photoprotection and prevention of skin cancers in Togo. Materials and Method: A qualitative, cross-sectional study was conducted over a period of three months in the year 2020 among PWAs over eighteen years of age residing in Lomé, Togo. Results: A total of 78 PWAs were interviewed. Their mean age was 23.38 ± 15.11 years (extremes: 18 and 63 years), and their sex ratio (M/F) was 0.81. In terms of knowledge, all PWAs declared that photoprotection was essential to prevent skin cancers. Interview data revealed the following strengths: wearing a wide-brimmed hat (n = 77; 98.7%) and using sunscreen cream (n = 75; 96.2%) were the main means/measures of prevention. In terms of attitudes, only 27 PWAs (34.6%) said that a dermatology consultation would be their first reaction to an unusual skin lesion. The main prevention means/measures in their possession were wide-brimmed hats (91.3%), sunscreen creams (85.9%), dark clothes (76.9%), and tinted glasses (70.5%). Regarding the practices, sunscreen creams were used by 88.5% of PWAs (n = 69). About two-thirds (64.1%) of respondents used tinted glasses to protect themselves from the sun. Finally, less than a quarter of the respondents (17.9%) consulted a dermatologist for a skin lesion in the last twelve months. Conclusion: The results of this study indicated that PWAs in Togo have fairly good knowledge about photoprotection and prevention of skin cancers. Attitudes and practices were generally positive but some behaviors such as dermatological follow-up still require improvement. Key words: Albinism, Sun protection, Skin cancers, Togo

Skin lightening is a fairly common practice in sub-Saharan Africa, with the epidemiological extent of this fashion phenomenon. To date, no awareness-raising campaign has resulted in a reduction in the frequency of this practice, even with the knowledge of its complications. Systemic complications and skin cancers following the use of depigmenting cosmetics are not as rare as people tend to believe. Systemic complications and skin cancers are among the voluntary cosmetic consequences. Another way of raising awareness needs to be reinvented to effectively raise awareness of the harmful effects of depigmentation. Key words: Systemic complications, Skin cancers, Voluntary depigmentation

Introduction: malignant tumors including soft tissue sarcomas can occur during neurofibromatosis type 1. We report a case of sarcomatous degeneration of a plexiform neurofibroma with multivisceral metastases in a Togolese patient with neurofibromatosis type 1. Observation: A 33-year-old female patient with neurofribromatosis type 1 presented with an altered general condition, pain and changes in the appearance of the plexiform tumour of her neurofibromatosis, which had been evolving for one month. Physical examination revealed multiple coffee-white spots (greater than 10), with tumours of soft consistency and variable size, scattered over the body. There was also a larger tumour (approx. 9cmx6 cm), located on the inside of the left ankle, fixed, firm and painful to palpation. The abdomen was enlarged and tender, with no tenderness or contracture. Examination of lymph nodes was normal. Anatomopathological examination of the biopsy-exeresis of this tumour revealed a proliferation of clusters of small, rounded, undifferentiated cells with reduced cytoplasm and hyperchromatic nuclei, with clear anisokaryosis and numerous atypical mitotic figures. There were also a few vascular emboli. We therefore concluded that this plexiform neurofibroma was malignant, and the extension work-up revealed pulmonary, pancreatic and adrenal metastases. The patient died 3 weeks after diagnosis in respiratory distress. Conclusion: Malignant degeneration of plexiform neurofibromas is possible in patients with neurofibromatosis type 1. It is therefore important to monitor these patients for early detection in order to limit the risk of metastasis and death.

BackgroundIn the global strategy to eliminate leprosy, there remains a need for early case detection to successfully interrupt transmissions. Poor knowledge about leprosy and leprosy-related stigma are key drivers of delayed diagnosis and treatment. Sensitization campaigns to inform and increase awareness among the general population are an integral part of many national neglected tropical disease programs. Despite their importance, the effectiveness of such campaigns has not been rigorously studied in the West African context. A multilingual rural setting with low health literacy in this region presents challenges to the potential impact of sensitization campaigns. ObjectiveThe primary objective of this study is to assess the causal effect of common practice community sensitization campaigns on leprosy-related knowledge and stigma at the community level and among community health volunteers. Additionally, we will test the potential of novel educational audio tools in the 15 most prominent local languages to overcome literacy and language barriers and amplify sensitization campaigns. MethodsWe will conduct a cluster randomized controlled trial using a sequential mixed methods approach in 60 rural communities across all regions of Togo, West Africa. The study features 2 intervention arms and 1 control arm, with intervention and control assignments made at the community level through randomization. Communities in intervention arm 1 will receive a sensitization campaign in line with the current Togolese national neglected tropical disease program. Communities in intervention arm 2 will receive the same sensitization campaign along with educational audio tools distributed to community households. The control arm will receive no intervention before data collection. Quantitative outcome measures on knowledge and stigma will be collected from a random sample of 1200 individuals. Knowledge will be assessed using the 9-item standardized Knowledge, Attitudes, and Practices Questionnaire. Stigma will be measured using the 7-item Social Distance Scale and the 15-item Explanatory Model Interview Catalogue Community Stigma Scale. We will estimate intention-to-treat effects at the individual level, comparing the outcomes of the intervention and control arms. In an accompanying qualitative component, we will conduct in-depth interviews with community members, community health volunteers, and health care workers in both treatment arms and the control arm to explore intervention and stigma-related experiences. ResultsThis paper describes and discusses the protocol for a mixed methods cluster randomized controlled trial. Data collection is planned to be completed in June 2024, with ongoing data analysis. The first results are expected to be submitted for publication by the end of 2024. ConclusionsThis trial will be among the first to test the causal effectiveness of community-based sensitization campaigns and audio tools to increase knowledge and reduce leprosy-related stigma. As such, the results will inform health policy makers, decision-makers, and public health practitioners designing sensitization campaigns in rural multilingual settings. Trial RegistrationGerman Clinical Trials Register DRKS00029355; https://drks.de/search/en/trial/DRKS00029355 International Registered Report Identifier (IRRID)DERR1-10.2196/52106

Objective: The aim of this study was to list the various dermatoses observed in consultations at dermatology departments in Lomé. Method: This was a retrospective descriptive study conducted over a 16-year period (1 January 2005 to 31 December 2020) in the public dermatology departments of Lomé. Patient files were reviewed. Pathologies were grouped into immuno-allergic, inflammatory, infectious and tumoral dermatoses, sexually transmitted infections and other dermatoses. Results: During the study period, 42523 patient files were reviewed, 2730 files (6.4%) were excluded for incomplete information. July was the month with the highest frequency of consultations (11%). The average age of patients was 26.36 +/- 16.85 years (range: 1 month to 102 years) and the sex ratio (M/F) was 0.6. The age range 0-15 years was the most represented 29%. Immuno-allergic dermatoses accounted for 40.9% of consultations, followed by inflammatory dermatoses (21.4%) and infectious dermatoses (20.7%). The top 5 causes of consultation in general were: eczema 23.5%; prurigo 9.3%; irritant dermatitis 8.9%; acne 5.5% and pruritus 4.4%. Conclusion: Our study shows a high frequency of immunoallergic dermatoses in Lomé. Dermatoses are also influenced by climate change, the country’s development and various social trends.

Objective: The aim of this study was to describe the evolution of Kaposi’s disease (KD) between 1990 and 2020 in dermatology in Lomé (Togo). Patients and Method: This is a series of cases of KD including all the records of patients seen on an outpatient basis or hospitalised for KD of clinical and/or histological diagnosis between 1990 and 2000 (period of non-general introduction of ART), 2000 to 2010 (initial and increasing introduction of ART) and between 2010 and 2020 (period of general introduction of ART) in the public dermatology departments of Lomé. Results: During the study period, 307 cases of MK were recorded, with a hospital frequency of 0.24%. The mean age of the patients was 40.03±13.71 years, with extremes ranging from 6 to 90 years and a male predominance (M/F= 1.5). The overall frequencies of KD from 1990 to 2000, 2000 to 2010 and 2010 to 2020 were 0.10, 0.30 and 0.25 respectively (p=0.002) and were dominated by HIV-associated KD (66%). During the same periods, 1990 to 2000, 2000 to 2010 and 2010 to 2020, the overall incidence was 3.00, 12.20 and 14.09 respectively (p<0.0001). Of the 307 patients, 13.7% (n=42) died, the majority in the HIV-associated form of KD. Conclusion: Our study shows a significant increase in the incidence of MK over the 30 years of the study, with a predominance of HIV-associated MK. The generalized use of antiretroviral treatment with the «test and treat» strategy will help to reduce this mortality.

Introduction : La téléexpertise en dermatologie représente une piste pour modifier l’exercice médical en réponse aux besoins d’économies de la santé. Le but de cette étude était d’évaluer les activités médicales de la phase pilote du projet de téléexpertise en dermatologie au Togo. Méthode : Il s’agit d’une étude transversale menée en octobre 2020 sur les 20 sites de la phase pilote. Cette évaluation consistait en une revue documentaire et l’analyse des données postées sur la plateforme de téléexpertise. Résultats : Au total, 738 (10,8 %) des 6 810 consultations dermatologiques ont été postées sur la plateforme de téléexpertise. Sur les 738 cas, l’expertise du dermatologue n’a pas permis de poser un diagnostic dans 119 cas (16,1 %). Cette expertise a confirmé l’hypothèse clinique unique proposée par l’agent de santé dans 275 cas (37,3 %) et a permis de conclure à un diagnostic parmi plusieurs hypothèses cliniques dans 30 cas (4,1 %). Au contraire, le diagnostic du dermatologue ne figurait pas dans les hypothèses de l’agent de santé dans 201 cas (27,2 %), et aucune hypothèse clinique n’avait été formulée dans 113 cas (15,3 %). La concordance entre l’hypothèse clinique proposée par l’agent de santé et le diagnostic du dermatologue était de 48,8 %. Concernant l’acceptabilité de la téléexpertise, un seul refus a été enregistré. Tous les patients étaient très satisfaits de cette pratique. Conclusions : Les résultats montrent la faisabilité et l’acceptabilité de la téléexpertise par les personnels de santé et les patients. La concordance diagnostique de 48,8 % montre la relative efficacité de la délégation de tâches.

Introduction:Tele-expertise in dermatology represents an opportunity to change medical practice in response to the need for cost savings in the health sector. The aim of this study was to evaluate the medical activities of the pilot phase of the tele-expertise project in Togo.Method:A cross-sectional study was conducted in October 2020 on the 20 sites of the pilot phase. This evaluation consisted of a literature review and analysis of data posted on the tele-expertise platform.Results:A total of 738 (10.8%) of the 6810 dermatological consultations were posted on the tele-expertise platform. Of the 738 cases, the dermatologist’s expertise did not allow a diagnosis to be made in 119 cases (16.1%). This expertise confirmed the single clinical hypothesis proposed by the health worker in 275 cases (37.3%) and allowed a diagnosis to be made among several clinical hypotheses in 30 cases (4.1%). On the contrary, the dermatologist’s diagnosis was not included in the health worker’s hypotheses in 201 cases (27.2%), and no clinical hypothesis was formulated in 113 cases (15.3%). The concordance between the clinical hypothesis proposed by the health worker and the diagnosis of the dermatologist was 48.8%. Regarding the acceptability of the tele-expertise, only one refusal was recorded. All patients were very satisfied with this practice.Conclusions:The results show the feasibility and acceptability of tele-expertise by health care personnel and patients. The diagnostic concordance of 48.8% shows the relative efficiency of task delegation.