Malaria an opportunistic infection in HIV/AIDS patients? - A Nigerian experience

Genetic diversity of Plasmodium falciparum in people living with HIV in Ogbomoso, Nigeria: Implications for malaria transmission and treatment

Introduction

HIV and malaria coexist in individuals across sub-Saharan Africa, a region profoundly impacted by both diseases. Plasmodium falciparum exhibits significant genetic diversity in high-transmission areas, which may further complicate the clinical outcomes of people living with HIV (PLWH). This study investigates the genetic diversity of P. falciparum among PLWH in Ogbomoso, Nigeria.

Materials and Methods

A total of 254 blood samples were collected from HIV-positive patients attending clinics at LAUTECH Teaching Hospital and BOWEN Teaching Hospital in Ogbomoso, Oyo State, Nigeria. Malaria infection was diagnosed using a rapid diagnostic test (RDT), microscopy, and nested polymerase chain reaction (nPCR). Genotyping of msp-1, msp-2, and glurp genes was performed to assess genetic diversity. The distribution of allelic families was analysed descriptively using SPSS v.27, and a p-value≤ 0.05 was considered statistically significant.

Results

Among the 254 samples, females (72.8%; mean age 40.7 years) were the most predominant. The prevalence of P. falciparum was 5.9%, 55.1%, and 40.6% by RDT, microscopy, and nPCR, respectively. The msp-1 geno-typing identified 170 distinct variants, with the K1, MAD20, and RO33 families detected at frequencies of 34.7%, 30.0%, and 35.3%, respectively. The msp-2 genotyping revealed 56 alleles, predominantly from the FC27 family (73.2%). The multiplicity of infection (MOI) for msp-1, msp-2, and glurp genes was 2.02, 1.13, and 1.00, respectively, while the expected heterozygosity (HE) values were 0.86, 0.52, and 0.10, respectively. Most msp-1 (68.5%) and glurp (31.1%) samples exhibited polyclonality, whereas msp-2 samples were predominantly monoclonal (22.1%). .

Conclusions

Despite the high malaria transmission intensity in the region, P. falciparum isolates from PLWH exhibited relatively low genetic diversity, suggesting a potential reduction in malaria transmission and signalling the effectiveness of malaria control strategies. Further studies are needed to explore the underlying factors leading to reduced transmission and low genetic variations in this population and their potential impact on malaria transmission and treatment outcomes in PLWH.

Video-based education messaging to enhance optimal uptake of malaria preventive therapy in pregnant women: a mixed methods study involving pregnant women and midwives in Uganda

BACKGROUND

Malaria prevention during pregnancy significantly minimizes maternal-fetal adverse events. However, optimal uptake of malaria preventive therapy in pregnancy (MPTp) remains a major challenge for both women living with HIV and those without. In Uganda, suboptimal uptake of MPTp is primarily due to inadequate knowledge among women. This study aimed to develop and assess the feasibility and acceptability of an educational video to improve knowledge of MPTp among pregnant women living with and without HIV.

METHODS

This study describes the second phase of a mixed methods study conducted among pregnant women (living with and without HIV) and midwives from a public antenatal care clinic in Kampala, Uganda. The study was conducted from October 2022 to Jan 2024, and the first phase involved qualitative data collection from pregnant women, health workers, and Ministry of Health officials to develop a video-based intervention to enhance uptake of MPTp. The second phase involved administration of the developed intervention to a group of purposively selected pregnant women living with and without HIV. Questionnaires, focus group discussions, and interviews were used to collect data among women and midwives, and to assess feasibility and acceptability of the intervention. Quantitative data were summarized using descriptive statistics and analysed using different scales of measurement including the modified system usability scale and the Evidence-based Practice and Attitude Scale (EBPAS), which assessed acceptability among pregnant women and midwives, respectively. The qualitative data were coded and analysed using inductive and deductive thematic methods in Atlas ti.8.

RESULTS

A total of 45 women and six midwives were enrolled in the current study phase. The mean age (± standard deviation, SD) of the women was 26 ± 6 years, and the median gestational age (interquartile range, IQR) was 24 (20-32) weeks, and less than half (42%, n = 19) were living with HIV. On the system usability scale, most women (91%, n = 41) rated the intervention as good or excellent, and most (93%, n = 42) were satisfied or very satisfied with the intervention. On the EBPAS, midwives perceived the intervention as reliable with Cronbach's alpha of 0.74, and all midwives found the intervention appropriate and feasible in their facility. All women comprehended and highly accepted the intervention.

CONCLUSION

The video-based intervention for uptake of MPTp was found acceptable among women and midwives and was feasible and appropriate to a public health facility. Future studies would test the effectiveness of the intervention in improving knowledge and uptake of MPTp.

Exploring salivary metabolome alterations in people with HIV: towards early diagnostic markers

Background

The human immunodeficiency virus (HIV) remains a critical global health issue, with a pressing need for effective diagnostic and monitoring tools.

Methodology

This study explored distinctions in salivary metabolome among healthy individuals, individuals with HIV, and those receiving highly active antiretroviral therapy (HAART). Utilizing LC-MS/MS for exhaustive metabolomics profiling, we analyzed 90 oral saliva samples from individuals with HIV, categorized by CD4 count levels in the peripheral blood.

Results

Orthogonal partial least squares-discriminant analysis (OPLS-DA) and other analyses underscored significant metabolic alterations in individuals with HIV, especially in energy metabolism pathways. Notably, post-HAART metabolic profiles indicated a substantial presence of exogenous metabolites and changes in amino acid pathways like arginine, proline, and lysine degradation. Key metabolites such as citric acid, L-glutamic acid, and L-histidine were identified as potential indicators of disease progression or recovery. Differential metabolite selection and functional enrichment analysis, combined with receiver operating characteristic (ROC) and random forest analyses, pinpointed potential biomarkers for different stages of HIV infection. Additionally, our research examined the interplay between oral metabolites and microorganisms such as herpes simplex virus type 1 (HSV1), bacteria, and fungi in individuals with HIV, revealing crucial interactions.

Conclusion

This investigation seeks to contribute understanding into the metabolic shifts occurring in HIV infection and following the initiation of HAART, while tentatively proposing novel avenues for diagnostic and treatment monitoring through salivary metabolomics.

Attitudes and perceptions towards developing a health educational video to enhance optimal uptake of malaria preventive therapy among pregnant women in Uganda: a qualitative study involving pregnant women, health workers, and Ministry of health officials

BACKGROUND

Malaria in pregnancy remains a major global public health problem. Intermittent prophylaxis treatment of malaria in pregnancy with Sulphadoxine-pyrimethamine and co-trimoxazole is efficacious for prevention of malaria in pregnancy HIV negative and positive women, respectively. However, uptake of the recommended doses of therapies has remained suboptimal in Uganda, majorly due to inadequate knowledge among pregnant women. Therefore, this study aimed to explore attitudes and perceptions towards developing an educational video for malaria preventive therapy.

METHODS

We conducted an exploratory study with qualitative methods among pregnant women attending antenatal care at Kisenyi Health Center IV (KHCIV), health workers from KHCIV, and officials from the Ministry of Health. The study was conducted at KHCIV from October 2022 to March 2023. Focus group discussions (FGD) were conducted among purposively selected pregnant women and key informant interviews (KII) among health workers and Ministry of Health officials. Data were analyzed using inductive and deductive thematic methods in atlas ti.8.

RESULTS

A total of five FGDs comprising of 7-10 pregnant women were conducted; and KIIs were conducted among four mid-wives, two obstetricians, and two Ministry of Health officials. Generally, all respondents mentioned a need for interventions to improve malaria preventive knowledge among pregnant women; were positive about developing an educative video for malaria preventive therapy in pregnancy; and suggested a short, concise, and edutaining video focusing both the benefits of taking and risks of not taking malaria preventive therapy. They proposed that women may be encouraged to view the video as soon as they conceive and throughout the pregnancy. It also was suggested that the video may be viewed on television sets in maternal and reproductive health clinics and homes, and on smart phones.

CONCLUSION

Pregnant women, health workers, and Ministry of Health officials were positive about the development of a short edutaining video on malaria preventive therapy that focuses on both benefits of taking and risks of not taking the malaria preventive therapy in pregnancy. This information guided the video development and therefore, in the development of health educative videos, client and stakeholder inputs may always be solicited.