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Hansman E, Mussa A, Ryan R, Babalola CM, Ramontshonyana K, Tamuthiba L, Ndlovu N, Bame B, Klausner JD, Morroni C, Wynn A. Use of Expedited Partner Therapy for Pregnant Women Treated for Sexually Transmitted Infections in Gaborone, Botswana. Sex Transm Dis 2024; 51:331-336. [PMID: 38301627 DOI: 10.1097/olq.0000000000001928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
BACKGROUND Partner notification and treatment for sexually transmitted infections are critical to prevent reinfection and reduce transmission. However, partner treatment rates are low globally. Expedited partner therapy (EPT), in which the patient delivers treatment directly to their partner, may result in more partners treated. We assessed partner notification and treatment outcomes among pregnant women in Gaborone, Botswana, including EPT intent, uptake, and effectiveness. METHODS The Maduo study was a cluster-controlled trial evaluating the effect of antenatal Chlamydia trachomatis and Neisseria gonorrhoeae infection screening in pregnant women. The intervention arm received screening at first antenatal care (ANC), third-trimester, and postnatal care visits. The standard-of-care arm received screening postnatally. Participants screening positive were given options for partner treatment: contact slips, in-clinic treatment, or EPT. Self-reported partner notification and treatment outcomes were assessed at test-of-cure visit. RESULTS Of 51 women who screened positive for C. trachomatis / N. gonorrhoeae at first ANC and returned for test of cure, 100% reported notifying their partner and 48 (94.1%) reported their partner received treatment. At third trimester 100% (n = 5), reported partners were treated. Before testing, EPT intent was lower than EPT uptake at all time points (first ANC: 17.9% vs. 80.4%; third-trimester: 57.1% vs. 71.4%; postnatal care: 0% vs. 80.0%). Partner treatment success was 100% among EPT users compared with 70% among nonusers ( P = 0.006). CONCLUSIONS Partner notification and treatment success was high in this population. Despite low pretest intent to use EPT, uptake was high and associated with greater partner treatment success. Our findings suggest that EPT may be a successful partner treatment strategy to pursue in low- and middle-income countries.
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Affiliation(s)
| | | | - Rebecca Ryan
- Botswana Harvard AIDS Institute Partnership, Princess Marina Hospital, Gaborone, Botswana
| | - Chibuzor M Babalola
- Keck School of Medicine, University of Southern California, 1845 N. Soto Street, Los Angeles, CA
| | | | - Lefhela Tamuthiba
- Botswana Harvard AIDS Institute Partnership, Princess Marina Hospital, Gaborone, Botswana
| | - Neo Ndlovu
- Botswana Harvard AIDS Institute Partnership, Princess Marina Hospital, Gaborone, Botswana
| | - Bame Bame
- Botswana Harvard AIDS Institute Partnership, Princess Marina Hospital, Gaborone, Botswana
| | - Jeffrey D Klausner
- Keck School of Medicine, University of Southern California, 1845 N. Soto Street, Los Angeles, CA
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Alabi OS, Akintayo I, Odeyemi JS, Oloche JJ, Babalola CM, Nwimo C, Popoola O, Mogeni OD, Marks F, Okeke IN. Suboptimal Bacteriological Quality of Household Water in Municipal Ibadan, Nigeria. Am J Trop Med Hyg 2024; 110:346-355. [PMID: 38167625 PMCID: PMC10859799 DOI: 10.4269/ajtmh.23-0134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 10/05/2023] [Indexed: 01/05/2024] Open
Abstract
Access to potable water is difficult for many African residents. This study evaluated the bacteriological quality of household water collected in the dry and wet seasons across five municipal local government areas (LGAs) in Ibadan, a large city in southwest Nigeria. A total of 447 water samples (dry season, n = 250; wet season, n = 197) were aseptically collected from a random sample of mapped households within Ibadan's five municipal LGAs. The pH values and total aerobic and coliform bacterial counts were measured, and samples were screened for Escherichia coli, Salmonella, Shigella, and Yersinia by standard phenotypic techniques and multiplex polymerase chain reaction. The most common source of water was well (53.2%), followed by borehole (34%). None of the households used municipal tap water. Cumulatively, aerobic (P = 0.0002) and coliform (P = 0.0001) counts as well as pH values (P = 0.0002) changed significantly between seasons, with increasing and decreasing counts depending on the LGA. Nonpotable water samples were found to be very common during the dry (86.8%) and wet (74.1%) seasons. Escherichia coli spp., as indicators of recent fecal contamination, were isolated from 115 (25.7%) of the household water sources. Thirty three Salmonella, four enteroaggregative E. coli, and four enterotoxigenic E. coli isolates but no Shigella or Yersinia isolates were identified. This study revealed the absence of treated tap water and the poor quality of alternative sources with detectable pathogens in municipal Ibadan. Addressing the city-wide lack of access to potable water is an essential priority for preventing a high prevalence of feco-orally transmitted infections.
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Affiliation(s)
- Olumuyiwa S. Alabi
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, University of Ibadan, Nigeria
| | - Ifeoluwa Akintayo
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, University of Ibadan, Nigeria
| | - Jesutofunmi S. Odeyemi
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, University of Ibadan, Nigeria
| | - Jeremiah J. Oloche
- Department of Pharmacology and Therapeutics, College of Health Sciences, Benue State University, Makurdi, Nigeria
| | - Chibuzor M. Babalola
- Keck School of Medicine, Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California
| | - Chukwuemeka Nwimo
- Department of Community Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Oluwafemi Popoola
- Department of Community Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Ondari D. Mogeni
- Epidemiology, Public Health, Implementation & Clinical Development Unit, International Vaccine Institute, Seoul, South Korea
| | - Florian Marks
- Epidemiology, Public Health, Implementation & Clinical Development Unit, International Vaccine Institute, Seoul, South Korea
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, United Kingdom
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
- Madagascar Institute for Vaccine Research, University of Antananarivo, Antananarivo, Madagascar
| | - Iruka N. Okeke
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, University of Ibadan, Nigeria
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Yang K, Babalola CM, Mussa A, Ryan R, Wynn A, Simon S, Bame B, Morroni C, Klausner JD. Case series and literature review of chlamydial ophthalmia neonatorum in Botswana. Int J STD AIDS 2023; 34:860-868. [PMID: 37338101 DOI: 10.1177/09564624231173028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
BACKGROUND We describe 12 cases of chlamydial ophthalmia neonatorum and the current scientific evidence on its prevention and treatment. The data presented were obtained from the "Maduo" study, a prospective observational study of the relationship between curable sexually transmitted infections and adverse neonatal outcomes at four antenatal clinics in Gaborone, Botswana. METHODS Infants of mothers with perinatal chlamydia infection were evaluated for chlamydial ophthalmia neonatorum based on clinical presentation of conjunctivitis or positive test via GeneXpert CT/NG assay. Data on 29 infants born to mothers with postnatal C. trachomatis infection were analysed. RESULTS 12 infants were diagnosed with chlamydial ophthalmia neonatorum. Eight of those cases were confirmed with the GeneXpert CT/NG assay while four were identified as probable cases based on clinical history and presentation. Overall, nine infants presented with signs of conjunctivitis, while three who had a positive diagnostic test result had asymptomatic infection. All but one infant had received ocular 1% tetracycline prophylaxis at birth, and four infants had signs suggestive of chlamydial pneumonia at presentation. Two out of five symptomatic cases whose mothers reported completion of their treatment course with erythromycin had lingering symptoms. CONCLUSIONS Our findings affirm that the current prophylaxis and treatment modalities for chlamydial ophthalmia neonatorum are inadequate. To the extent feasible in low- and middle-income countries, we recommend implementation of routine C. trachomatis screening and treatment in pregnant women.
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Affiliation(s)
- Kevin Yang
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Chibuzor M Babalola
- Keck School of Medicine, Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Aamirah Mussa
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Rebecca Ryan
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Adriane Wynn
- University of California, San Diego, Division of Infectious Diseases and Global Public Health, La Jolla, CA, USA
| | | | - Bame Bame
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Chelsea Morroni
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, United Kingdom
| | - Jeffrey D Klausner
- Keck School of Medicine, Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
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Babalola CM, Peters RPH, Mukomana F, Mdingi M, Gigi RMS, Muzny CA, Taylor CM, Medina-Marino A, Klausner JD. A Call to Standardize the Definition and Method of Assessing Women for Vaginal Discharge Syndrome in Pregnancy. Open Forum Infect Dis 2023; 10:ofad157. [PMID: 37035494 PMCID: PMC10077826 DOI: 10.1093/ofid/ofad157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 03/20/2023] [Indexed: 04/09/2023] Open
Affiliation(s)
- Chibuzor M Babalola
- Department of Population and Public Health Science, University of Southern California, Los Angeles, California, USA
| | - Remco P H Peters
- Research Unit, Foundation for Professional Development, East London, South Africa
- Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa
- Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa
| | - Freedom Mukomana
- Research Unit, Foundation for Professional Development, East London, South Africa
| | - Mandisa Mdingi
- Research Unit, Foundation for Professional Development, East London, South Africa
| | - Ranjana M S Gigi
- Research Unit, Foundation for Professional Development, East London, South Africa
- Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
| | - Christina A Muzny
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Christopher M Taylor
- Department of Microbiology, Immunology and Parasitology, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Andrew Medina-Marino
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jeffrey D Klausner
- Department of Population and Public Health Science, University of Southern California, Los Angeles, California, USA
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Mussa A, Wynn A, Ryan R, Babalola CM, Hansman E, Simon S, Bame B, Tamuthiba L, Ramontshonyana K, Ndlovu N, Moshashane N, Masole M, Klausner JD, Morroni C. Prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae infection and associated factors among asymptomatic pregnant women in Botswana. Int J STD AIDS 2023:9564624231163203. [PMID: 36930946 DOI: 10.1177/09564624231163203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
Abstract
BACKGROUND Chlamydia trachomatis (C. trachomatis) and Neisseria gonorrhoeae (N. gonorrhoeae) are curable sexually transmitted infections (STIs) that cause adverse pregnancy and neonatal outcomes. Most countries, including Botswana, do not offer C. trachomatis or N. gonorrhoeae screening during antenatal care (ANC) and instead use a syndromic approach for management of STIs. METHODS The Maduo Study is a prospective, cluster-controlled trial in Botswana evaluating the impact of diagnostic screening for antenatal C. trachomatis and N. gonorrhoeae infections to prevent adverse neonatal outcomes. Using baseline data from the Maduo Study (March 2021-March 2022), we determined the prevalence of C. trachomatis and N. gonorrhoeae infection among asymptomatic pregnant women in Botswana and correlates of infection using multivariable logistic regression. RESULTS Of 251 women who underwent C. trachomatis and N. gonorrhoeae screening at first ANC visit, 55 (21.9%, 95%CI 17.0-27.5) tested positive for C. trachomatis, 1 (0.4%, 95%CI 0-2.2) for N. gonorrhoeae; and 2 (0.8%, 95%CI 0-2.8) for dual C. trachomatis and N. gonorrhoeae infection. Older age was associated with lower odds (aOR 0.93; 95%CI 0.88-0.98; p = 0.011) while any alcohol use during pregnancy was associated with higher odds (aOR = 3.53; 95%CI 1.22-10.16; p = 0.020) of testing positive for C. trachomatis or N. gonorrhoeae. CONCLUSIONS A high frequency of C. trachomatis infections was detected among asymptomatic pregnant women in Botswana indicating that many antenatal STIs are missed by the syndromic management approach. Our results highlight the need for diagnostic C. trachomatis screening during ANC in Botswana and other low- and middle-income countries that rely solely on the syndromic approach for management of STIs.
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Affiliation(s)
- Aamirah Mussa
- 292006Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.,Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Adriane Wynn
- Division of Infectious Diseases and Global Public Health, 8784University of California San Diego, La Jolla, CA, USA
| | - Rebecca Ryan
- 292006Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | | | - Emily Hansman
- 292006Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.,University of California, Los Angeles, CA, USA
| | - Selebaleng Simon
- 292006Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Bame Bame
- 292006Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Lefhela Tamuthiba
- 292006Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | | | - Neo Ndlovu
- 292006Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Neo Moshashane
- 292006Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Maitumelo Masole
- 292006Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | | | - Chelsea Morroni
- 292006Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.,MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
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Babalola CM, Siebert JC, Kallapur SG, Maecker HT, Rosenberg-Hasson Y, Hansman E, Wynn A, Mussa A, Ryan R, Simon S, Morroni C, Klausner JD. Discrete Plasma Cytokine Profiles among Pregnant Women in Botswana by Chlamydia trachomatis infection, HIV status, and Gestational age. J Infect Dis 2022; 226:1298-1299. [PMID: 35876733 DOI: 10.1093/infdis/jiac302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
- Chibuzor M Babalola
- Keck School of Medicine Department of Population and Public Health Sciences at University of Southern California, Los Angeles, CA 90033, USA
| | | | - Suhas G Kallapur
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles 90095, USA.,University of California, Los Angeles Mattel Children's Hospital, 10833 Le Conte Avenue, Los Angeles, CA 90095
| | - Holden T Maecker
- Institute for Immunity, Transplantation, and Infection, Stanford University School of Medicine, Stanford, CA 94305USA
| | - Yael Rosenberg-Hasson
- Institute for Immunity, Transplantation, and Infection, Stanford University School of Medicine, Stanford, CA 94305USA
| | - Emily Hansman
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles 90095, USA
| | - Adriane Wynn
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA 92093USA
| | - Aamirah Mussa
- Botswana Sexual and Reproductive Health Research Initiative, Botswana-Harvard AIDS Institute Partnership, Gaborone, Private Bag BO 320.,Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Rebecca Ryan
- Botswana Sexual and Reproductive Health Research Initiative, Botswana-Harvard AIDS Institute Partnership, Gaborone, Private Bag BO 320
| | - Selebaleng Simon
- Botswana Sexual and Reproductive Health Research Initiative, Botswana-Harvard AIDS Institute Partnership, Gaborone, Private Bag BO 320
| | - Chelsea Morroni
- Botswana Sexual and Reproductive Health Research Initiative, Botswana-Harvard AIDS Institute Partnership, Gaborone, Private Bag BO 320.,Medical Research Council Centre for Reproductive Health, University of Edinburgh, Edinburgh, United Kingdom UK EH16 4TJ
| | - Jeffrey D Klausner
- Keck School of Medicine Department of Population and Public Health Sciences at University of Southern California, Los Angeles, CA 90033, USA
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