Patients In sub-Saharan Africa Research Articles

Abstract 89: Translation and Linguistic Validation of the Mastectomy Module of the BREAST-Q Questionnaire for Use in Nigeria

Abstract Purpose: The majority of breast cancer patients in sub-Saharan Africa are recommended to have mastectomy; The impact of mastectomy on a predominantly young African patient population requires evaluation. The BREAST-Q is a validated patient-reported outcome measure of quality-of-life following breast surgery that has been translated into 30 languages-none in Africa. This study aimed to translate and validate the mastectomy module of the BREAST-Q for use in Nigeria. Methods: The BREAST-Q mastectomy module was translated from English to Yoruba (a major Nigerian language) and linguistically validated using best practice guidelines. Translation was performed in 4 steps: forward translation (x 2), back translation, back translation review, and cognitive interviews with post-mastectomy patients. The translated BREAST-Q instrument was administered to post-mastectomy patients (n=21) alongside the EORTC-QLQ BR23 to evaluate construct validity. Results: The translation process identified phrases not amenable to direct translation, including “emotionally healthy” and descriptions of pain (“nagging,” “throbbing,” “sharp”). Translations were amended to reflect local context and question intent. Patients provided suggestions to simplify complex phrases, such as “discomfort in your breast area.”during cognitive interviews. Internal consistency within scales was over the 0.70 threshold for psychosocial wellbeing (α=0.84-0.87), sexual wellbeing (α =0.98-0.99), physical wellbeing in chest (α =0.84-0.86), and satisfaction with care (α =0.89-0.93). ICC for test-retest reliability was moderate (0.46-0.63). Conclusion: The Yoruba version of the BREAST-Q mastectomy module in Yoruba presents a conceptually equivalent version in a language that is easy to understand.. We will use this validated instrument in a pilot study of Nigerian patients to identify targets for intervention to improve the patient experience and compliance with breast cancer surgery. Citation Format: Olalekan Olasehinde, Anya Romanoff. Translation and Linguistic Validation of the Mastectomy Module of the BREAST-Q Questionnaire for Use in Nigeria [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 89.

Particularities of COVID-19 infection in chronic hemodialysis patients in Sub-Saharan Africa: experience from Senegal (West Africa)

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) appeared in December 2019 in China and has rapidly become a major global health concern. Patients with end-stage renal disease receiving dialysis treatment are very exposed to the SARS-CoV-2 during their frequent visits to healthcare facilities and immune induced by uremia. The aim of our work was to describe the particularity of COVID-19 infection in hemodialysis patients in sub-Saharan Africa and in Ziguinchor, south of Senegal, particularly. To do this, we conducted a monocentric prospective study over a period of 16 months at the Ziguinchor hemodialysis center and compared our results to a study that focuses on the seroprevalence of SARS-CoV-2 in chronic hemodialysis patients. We found a low prevalence of COVID-19 infection while the majority of our patients were in contact with the virus.

The Influence of Cytochrome P450 Polymorphisms on Pharmacokinetic Profiles and Treatment Outcomes Among Malaria Patients in Sub-Saharan Africa: A Systematic Review.

Sub-Saharan Africa (SSA) population is genetically diverse and heterogenous thus variability in drug response among individuals is predicted to be high. Cytochrome P450 (CYP450) polymorphisms is a major source of variability in drug response. This systematic review presents the influence of CYP450 single nucleotide polymorphisms (SNPs), particularly CYP3A4*1B, CYP2B6*6 and CYP3A5*3 on antimalarial drug plasma concentrations, efficacy and safety in SSA populations. Searching for relevant studies was done through Google Scholar, Cochrane Central Register of controlled trials (CENTRAL), PubMed, Medline, LILACS, and EMBASE online data bases. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were used. Two independent reviewers extracted data from the studies. Thirteen studies reporting the influence of CYP450 SNPs on plasma concentrations, efficacy and safety were included in the final data synthesis. CYP3A4*1B, CYP3A5*5, CYP2B6*6 and CYP2C8*2 did not affect antimalarial drug plasma concentration significantly. There was no difference in treatment outcomes between malaria patients with variant alleles and those with wild type alleles. This review reports lack of influence of CYP3A4*1B, CYP3A5*3, CYP2C8*3 and CYP2B6*6 SNPs on PK profiles, efficacy and safety in SSA among P. falciparum malaria patients.

Are IL-1 family cytokines important in management of sickle cell disease in Sub-Saharan Africa patients?

Sickle cell disease (SCD) is the most common genetic disease found in Africa and throughout the world. It is responsible for a high rate of hemolysis, systemic inflammation, and modulation of the immune system with the involvement of immunological molecules, such as cytokines. IL-1β is a major inflammatory cytokine. IL-18 and IL-33, members of IL-1 family, also exhibit characteristics of inflammation-related cytokines. Thus, in order to contribute to the evaluation of the severity and prognosis of SCD in Africa, this study aimed to estimate the cytokine response, in particular the levels of cytokines of the IL-1 family, in sickle cell patients living in a Sub-Saharan country. Ninety patients with a diagnosis of SCD were recruited with different hemoglobin types. Samples were assessed for cytokine levels using the Human Inflammation Panel assay from BioLegend. The assay allows the simultaneous quantification of 13 human inflammatory cytokines/chemokines, i.e., IL-1β, IFN-α2, IFN-γ, TNFα, MCP-1 (CCL2), IL-6, IL-8 (CXCL8), IL-10, IL-12p70, IL-17A, IL-18, IL-23, and IL-33. the assessment of plasma cytokines in SCD patients revealed significantly increased levels of IL-1 family cytokines in crisis compared to steady state, suggesting a substantial involvement of these cytokines in clinical exacerbation. This suggests the possibility of a causal effect in the SCD pathology and can open the way to define better care, pointing toward new therapeutic avenues for sickle disease in Sub-Saharan Africa.

Knowledge Attitude and Practices of Health Care Workers towards Colorectal Cancer Screening in Primary Care Settings in Durban, South Africa: A Cross-Sectional Survey

BACKGROUND: South Africa has the highest number of colorectal cancer (CRC) patients in sub-Saharan Africa, with the CRC projected new cases at 8 000 per 100 000 population by 2030. Screening assists with the early detection and control of cancer. This study determined knowledge, attitude, and practices (KAP) related to CRC among Health Care Workers (HCWs).
 
 METHODS: A cross-sectional descriptive study was conducted between April and November 2021 using a self-administered close-ended questionnaire. Data was collected from 109 HCWs in public primary health care facilities in Durban, South Africa. Summary descriptive and association analysis were conducted using IBM SPSS vs. 28.
 
 RESULTS: Overall CRC screening knowledge score was 12% (mean 13) with 39% that were familiar with the National Department of Health Cancer Control framework. Only 15% of participants perceived the Perceived the National Cancer Control Guidelines to be influential for the implementation of colorectal cancer screening. 70% of participants would recommend CRC screening to patients. Over one-fifth, (22%) of participants felt that fecal occult blood, flexible sigmoidoscopy, and colonoscopy were effective for CRC screening. Over a third (44%) preferred a structured CRC screening programme. Most participants (81%) were willing to recommend CRC screening to their patients. Only 10% of participants had ever conducted colorectal screening before. The vast majority were unfamiliar with the types of CRC screening tests. Lack of CRC screening guidelines, training, equipment and CRC low burden were identified as barriers to screening.
 
 CONCLUSION: The vast majority of HCWs lacked knowledge of the CRC screening programme and its procedures. However, the vast majority of HCWs were willing to conduct screening once trained. This study also highlighted perceived health systems barriers affecting CRC screening. Currently, South Africa does not have national guidelines for CRC screening in South Africa, hence, a national risk differentiation CRC screening guideline is needed to guide implementation at the PHC level. Health systems strengthening interventions, including training of HCWs, availability of screening tests and materials to facilitate the integration of CRC screening noting that PH already implements screening programmes for other cancer types. 

Health Equity in Sickle Cell Research and Access to Therapy

Health Equity in Sickle Cell Research and Access to Therapy

Relationships between Self-Efficacy and Post-Stroke Activity Limitations, Locomotor Ability, Physical Activity, and Community Reintegration in Sub-Saharan Africa: A Cross-Sectional Study.

Stroke self-efficacy is under-investigated in sub-Saharan Africa. In particular, studies focusing on the relationship between self-efficacy and post-stroke functional outcomes are scarce. This cross-sectional study aimed to explore the association between self-efficacy and post-stroke activity limitations, locomotor ability, physical activity, and community reintegration in Benin, a sub-Saharan African country. To achieve this purpose, a selection of stroke patients was made from the admission registers of the physiotherapy clinics (rehabilitation units) of three reference hospitals in Benin from January to April 2018. Stroke patients who were still continuing their rehabilitation sessions were informed by direct contact. Those who had already finished their sessions were informed by telephone. Sixty stroke patients of those contacted gave their consent and were recruited for this study. The sample consisted of 44 men and 16 women with a mean age of 56.7 ± 10.4 years. Activity limitations, locomotor ability, physical activity, community reintegration, and self-efficacy were self-reported using ACTIVLIM-Stroke, Abiloco-Benin, the Africa francophone version of the International Physical Activity Questionnaire (IPAQ-AF), the Reintegration to Normal Living Index (RNLI), and a French version of the Stroke Self-efficacy Questionnaire (SSEQ-F), respectively. Spearman's rank correlation coefficients (ρ) were calculated to characterize the relationship between self-efficacy and activity limitations, locomotor ability, physical activity, and community reintegration. According to the results, self-efficacy showed a moderate correlation with physical activity (ρ = 0.65; p < 0.001) and high correlations with activity limitations (ρ = 0.81; p < 0.001), locomotor ability (ρ = 0.72; p < 0.001), and community reintegration (ρ = -0.84; p < 0.001). Thus, self-efficacy emerges as an important factor associated with the functional recovery of stroke patients in sub-Saharan Africa.

Normal central foveal thickness in a thousand eyes of healthy patients in sub Saharan Africa using fourier domain optical coherence tomography.

Optical coherence tomography provides high resolution in vivo images of the retina which are essential for diagnosis and follow up of patients with retina disorders like macula edema and exudative age-related macular degeneration. Establishing the normal range of central fovea values in our population provides vital baseline data for comparison. To report the range of normal central fovea thickness measurements in eyes of healthy hospital patients in sub-Saharan Africa using a commercially available Fourier domain optical coherence tomography (OCT) scan. A retrospective non-comparative review of case files of a thousand consecutive healthy patients who had retina OCT scans between January 2015 and December 2019 was done. Data from 1000 consecutive eyes of 500 healthy patients were used for the study. There were 181 females and 319 males. The mean central foveal thickness was 239.48 microns (μm), with a minimum thickness of 200.0 μm and maximum thickness of 297.0 μm. Males had significantly (P < 0.001) thicker mean CFT (mean CFT = 241.77 μm) compared with females (mean CFT = 235.43 μm). The mean CFT increased with age of participants by 0.139 μm (P < 0.001) for every year of life below 70. The mean central foveal thickness (CFT) in eyes of healthy patients in our study was 239.48 μm with a range from 200 μm to 297.0 μm. Males had thicker mean CFT compared with females and there was a significant increase in mean CFT by 0.139 μm (P < 0.001) for every year of life below 70.

Review on Determinants of Hepatitis B Viral Antigens and Antibodies among HBV Positive Patients in Sub-Saharan Africa

Hepatitis B is a viral infection which can be deadly if not treated, supervised and managed properly. It accounts for the majority of death cases in Sub-Saharan Africa. Policy makers and Governmental institutions need to be informed in order to help in the management of the disease which will thereby decrease death toll. This review was undertaken to identify the determinants of Hepatitis b viral antigens and antibodies among Hepatitis B positive patients in Sub-Saharan Africa. Google Scholar database site was searched from February 3rd to February 7th 2023 for peer-reviewed papers on causes of Hepatitis B viral load in Sub-Saharan Africa. A total of 17 articles were retrieved from the web database which included 12 countries which reported outcomes of 9,682 patients mostly 50.93% (4,931) females and 49.07% (4,751) males. More than half of the participants were co-infected with HIV and mostly were pregnant or had Chronic Hepatitis b. Males were mostly seen to have elevated levels of Hepatitis B viral load than Females. Attitudes such as poor adherence and alcohol consumption were seen to be contributing determinant of hepatitis b viral load. Hepatitis B Genotype E was found to have high viral loads than other genotypes. It is important to do routine screening of hepatitis B genotype and viral load test which can help in management and reduce risk of having chronic liver damage and cancer. Governmental institutions and policy makers should provide programs that will guide patients in adhering to anti-viral drugs intake and having a good lifestyle.

Opportunities for improving hypertension control in sub-Saharan Africa.

Hypertension is currently one of the most common risk factors for the development of cardiovascular disease. An estimated 46% of the adult population in sub-Saharan Africa (SSA) has hypertension and its increasing prevalence is associated with factors such as urbanization and adverse lifestyle behavior. The process of managing hypertension in SSA includes increasing screening and diagnosis, and treatment of diagnosed patients. In addition to this process, community-based interventions have also highlighted promotion of educating healthcare providers and building capacity within the health system. Although there seems to be a process in place to control blood pressure of hypertensive individuals in SSA, optimal management of hypertension in this region remains a challenge, and the need for implementation of innovative strategies to achieve optimal BP control in hypertensive individuals remains critical. Various hypertension guidelines recommend the use of out-of-office blood pressure monitoring as a technique to control hypertension. Thus far, several publications have highlighted the potential of implementing the use of home blood pressure telemonitoring (HTM) in general practice, globally. HTM is a telemedicine strategy that is implemented to remotely transmit blood pressure data and additional health information of patients from the comfort of their home to the health practitioner. To date, there is evidence from various controlled trials reporting that prolonged and regular use of HTM is associated with a significant reduction of blood pressure in hypertensive patients compared with usual care. Despite HTM being reported as a potential measure for control of hypertension, there are no known estimates of hypertensive patients being managed using HTM in SSA and there have been few successful HTM programs implemented in SSA. HTM activity is reported in only 4 out of 46 countries in SSA using telephone calls, text messages and mobile phone health applications. In these HTM programs, significant reduction in blood pressure of patients was reported showing the great potential that HTM has in controlling blood pressure of hypertensive patients in SSA.

Protective interaction of human phagocytic APC subsets with Cryptococcus neoformans induces genes associated with metabolism and antigen presentation.

Cryptococcal meningitis is the most common cause of meningitis among HIV/AIDS patients in sub-Saharan Africa, and worldwide causes over 223,000 cases leading to more than 181,000 annual deaths. Usually, the fungus gets inhaled into the lungs where the initial interactions occur with pulmonary phagocytes such as dendritic cells and macrophages. Following phagocytosis, the pathogen can be killed or can replicate intracellularly. Previous studies in mice showed that different subsets of these innate immune cells can either be antifungal or permissive for intracellular fungal growth. Our studies tested phagocytic antigen-presenting cell (APC) subsets from the human lung against C. neoformans. Human bronchoalveolar lavage was processed for phagocytic APCs and incubated with C. neoformans for two hours to analyze the initial interactions and fate of the fungus, living or killed. Results showed all subsets (3 macrophage and 3 dendritic cell subsets) interacted with the fungus, and both living and killed morphologies were discernable within the subsets using imaging flow cytometry. Single cell RNA-seq identified several different clusters of cells which more closely related to interactions with C. neoformans and its protective capacity against the pathogen rather than discrete cellular subsets. Differential gene expression analyses identified several changes in the innate immune cell's transcriptome as it kills the fungus including increases of TNF-α (TNF) and the switch to using fatty acid metabolism by upregulation of the gene FABP4. Also, increases of TNF-α correlated to cryptococcal interactions and uptake. Together, these analyses implicated signaling networks that regulate expression of many different genes - both metabolic and immune - as certain clusters of cells mount a protective response and kill the pathogen. Future studies will examine these genes and networks to understand the exact mechanism(s) these phagocytic APC subsets use to kill C. neoformans in order to develop immunotherapeutic strategies to combat this deadly disease.

Anesthetists knowledge, practices, and associated factors towards infection prevention in Addis Ababa public hospitals, Addis Ababa, Ethiopia

BackgroundEvery year, hundreds of millions of individuals are afflicted by preventable illnesses in the health care system. In surgical patients in Sub-Saharan Africa, the rate of nosocomial infection ranges from 2.5 to 30.9%. Anesthesia doctors have a direct impact on the risk of perioperative infection. In the operating theater, 7% of surgical patients have a healthcare-associated infection. According to a study, bacterial transmission in the OR anesthesia work area was linked to 30-day postoperative illnesses in as many as 16% of surgical patients. ObjectiveThis study aims to assess anesthetists knowledge, practices, and associated factors towards infection prevention in xxx public hospitals. Methodology: A cross-sectional survey of 220 anesthetists working in xxx hospitals was undertaken using standardized pretested and self-administered questionnaires. The information gathered was double-checked for accuracy before being entered into the EPI INFO7 software and then exported to SPSS version 24 for analysis. For bivariate and multivariable analysis, descriptive statistical analysis was done, and a logistic regression model was built. A 95% confidence level and an alpha of 0.05 were employed to determine the existence of a relationship between variables. ResultA total of 220 anesthetists took part. 82.7% (95% of CL: 77.7–87.7) and 48.2% (95% of CL: 41.4–55.4) of respondents were rated as knowledgeable about infection prevention and safe procedures, respectively. The presence of an infection prevention committee and recommendations is significantly linked to both knowledge and practice in infection prevention. ConclusionAccording to the findings of this study, the majority of anesthetists have a good understanding of infection prevention and nearly half of anesthetists have inadequate infection prevention practice. Infection prevention guidelines should be developed, enough supplies of personal protective equipment should be available, and an infection prevention committee should be strengthened.

Psychosocial aspects of adult cancer patients: A scoping review of sub-Saharan Africa.

Psychosocial aspects of adult cancer patients in sub-Saharan Africa (SSA) have been described in silos of research articles. Integrative analysis of regional evidence is lacking. This review aimed to describe the scope of existing research on mental health problems, identify research gaps and make informed research, policy and practice recommendations. Search was conducted for original peer-reviewed research articles, irrespective of their quality, on psychosocial aspects of cancer in all SSA countries using PubMed, Google Scholar, Google search, African Index Medicus and direct searches of reference list of pertinent journal articles. Publications in English or translated to English were included. Case reports, dissertations, abstracts, publications without primary focus on psychosocial issues, psychosocial issues in children and studies conducted with SSA populations living outside the sub-region were excluded. The methodological framework described by Arksey and O'Malley was used to synthesize and present the results. Inductive approach was used to arrive at the thematic areas. Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guideline was used to describe the review. Eighty-three studies conducted across 15 countries were identified. Six thematic areas emerged namely; psychosocial needs, psychiatric disorders, coping strategies, suicidality, psychometrics and psychosocial interventions. Fifteen of 46 countries had at least one study with the majority of articles emanating from Nigeria. Research articles on psychosocial needs, psychiatric morbidities and coping strategies appears adequate for systematic review in SSA region. Despite the overwhelming evidence of high unmet psychosocial needs, a huge gap exists regarding psychosocial interventions. Further research is needed into identified gaps in the region and quality of evidence of these studies need to be improved upon. Comprehensive policies and action plan development are sin qua non for addressing psychosocial problems of adults with cancer in SSA.

Risk factors for mortality in COVID-19 patients in sub-Saharan Africa: A systematic review and meta-analysis.

Mortality rates of coronavirus-2019 (COVID-19) disease continue to increase worldwide and in Africa. In this study, we aimed to summarize the available results on the association between sociodemographic, clinical, biological, and comorbidity factors and the risk of mortality due to COVID-19 in sub-Saharan Africa. We followed the PRISMA checklist (S1 Checklist). We searched PubMed, Google Scholar, and European PMC between January 1, 2020, and September 23, 2021. We included observational studies with Subjects had to be laboratory-confirmed COVID-19 patients; had to report risk factors or predictors of mortality in COVID-19 patients, Studies had to be published in English, include multivariate analysis, and be conducted in the sub-Saharan region. Exclusion criteria included case reports, review articles, commentaries, errata, protocols, abstracts, reports, letters to the editor, and repeat studies. The methodological quality of the studies included in this meta-analysis was assessed using the methodological items for nonrandomized studies (MINORS). Pooled hazard ratios (HR) or odds ratios (OR) and 95% confidence intervals (CI) were calculated separately to identify mortality risk. In addition, publication bias and subgroup analysis were assessed. Twelve studies with a total of 43598 patients met the inclusion criteria. The outcomes of interest were mortality. The results of the analysis showed that the pooled prevalence of mortality in COVID-19 patients was 4.8%. Older people showed an increased risk of mortality from SARS-Cov-2. The pooled hazard ratio (pHR) and odds ratio (pOR) were 9.01 (95% CI; 6.30-11.71) and 1.04 (95% CI; 1.02-1.06), respectively. A significant association was found between COVID-19 mortality and men (pOR = 1.52; 95% CI 1.04-2). In addition, the risk of mortality in patients hospitalized with COVID-19 infection was strongly influenced by chronic kidney disease (CKD), hypertension, severe or critical infection on admission, cough, and dyspnea. The major limitations of the present study are that the data in the meta-analysis came mainly from studies that were published, which may lead to publication bias, and that the causal relationship between risk factors and poor outcome in patients with COVID-19 cannot be confirmed because of the inherent limitations of the observational study. Advanced age, male sex, CKD, hypertension, severe or critical condition on admission, cough, and dyspnea are clinical risk factors for fatal outcomes associated with coronavirus. These findings could be used for research, control, and prevention of the disease and could help providers take appropriate measures and improve clinical outcomes in these patients.

Suboptimal blood pressure control and its associated factors among people living with diabetes mellitus in sub-Saharan Africa: a systematic review and meta-analysis

BackgroundSuboptimal blood pressure control among people living with diabetes mellitus (DM) is one of the primary causes of cardiovascular complications and death in sub-Saharan Africa (SSA). However, there is a paucity of evidence on the prevalence and associated factors of suboptimal blood pressure control in SSA. Therefore, this review aimed to estimate its pooled prevalence and associated factors among people living with DM in SSA. MethodsWe systematically searched PubMed, African Journals OnLine, HINARI, ScienceDirect, Google Scholar, and direct Google to access observational studies conducted in SSA. Microsoft Excel spreadsheet was used to extract the data, which was exported into STATA/MP version 16.0 for further analyses. Heterogeneity across studies was checked using Cochran’s Q test statistics and I2 test, and small study effect was checked using Funnel plot symmetry and Egger’s statistical test at a 5% significant level. A random-effects model was used to estimate the pooled prevalence and associated factors of suboptimal blood pressure control at a 95% confidence interval (CI) and significance level of p < 0.05.ResultsOf the 7329 articles retrieved, 21 articles were eligible for the meta-analysis. After performing random-effects model, the pooled prevalence of suboptimal blood pressure control was 69.8% (95% CI: 63.43, 76.25%). Poor adherence to antihypertensive treatment (OR = 1.7; 95% CI: 1.03–2.80, I2 = 0.0%, p = 0.531) and overweight (OR = 2.4, 95% CI: 1.57–3.68, I2 = 0.00%, p = 0.47) were significantly associated with suboptimal blood pressure control.ConclusionsThe prevalence of suboptimal blood pressure control among diabetic patients in SSA was high, and poor adherence to antihypertensive treatment and overweight were significantly associated with suboptimal blood pressure control. Hence, there is an urgent need for initiatives to improve and control hypertension, and preventive measures should concentrate on modifiable risk factors.Systematic review registrationPROSPERO CRD42020187901.

HIV-1 integrase resistance associated mutations and the use of dolutegravir in Sub-Saharan Africa: A systematic review and meta-analysis.

As sub-Saharan Africa (SSA) countries are transitioning to dolutegravir (DTG)-based ART, baseline data are required for optimal monitoring of therapeutic response. In this frame, we sought to generate up-to-date evidence on the use of integrase-strand transfer inhibitors (INSTI) and associated drug resistance mutations (DRMs) within SSA. In this systematic review and meta-analysis, we included randomized and non-randomized trials, cohort-studies, cross-sectional studies, and case-reports published on INSTI or integrase DRMs in SSA. We included studies of patients exposed to DTG, raltegravir (RAL) or elvitegravir (EVG). Primary outcomes were "the rate of virological control (VC:<50copies/ml)" and "the presence of DRMs" on INSTI-based regimens among patients in SSA. We synthesised extracted data using subgroup analysis, and random effect models were used where appropriate. Additional analyses were conducted to assess study heterogeneity. We identified 1,916 articles/citations through database searches, of which 26 were included in the analysis pertaining to 5,444 patients (mean age: 37±13 years), with 67.62% (3681/5444) female. Specifically, 46.15% (12/26) studies focused on DTG, 26.92% (7/26) on RAL, 23.08% (6/26) on both DTG and RAL, and 3.85% (1/26) on EVG. We found an increasing use of DTG overtime (0% before 2018 to 100% in 2021). Median treatment duration under INSTI-based regimens was 12 [9-36] months. Overall, the rate of VC was 88.51% [95%CI: 73.83-97.80] with DTG vs. 82.49% [95%CI: 55.76-99.45] and 96.55% [95%CI: 85.7-100.00] with RAL and EVG, respectively. In univariate analysis, VC with DTG-containing vs. other INSTI-regimens was significantly higher (OR = 1.44 [95%CI: 1.15-1.79], p = 0.0014). Among reported DRMs at failure, the only DTG resistance-mutations were G118R and R263K. In SSA, DTG presents a superiority effect in VC compared to other INSTIs. Nonetheless, the early detection of INSTI-DRMs calls for sentinel surveillance for a successful transition and a sustained efficacy of DTG in SSA. PROSPERO Registration Number: CRD42019122424.

Burden of atrial fibrillation among adults with heart failure in sub-Saharan Africa: a systematic review and meta-analysis

ObjectivesThis study aimed to estimate the prevalence of atrial fibrillation (AF) in adults with heart failure (HF) and summarise the all-cause mortality ratio among adult patients with coexisting HF and...

Glycaemic control among type 2 diabetes patients in sub-Saharan Africa from 2012 to 2022: a systematic review and meta-analysis

BackgroundThere is an increased burden of diabetes globally including in sub-Saharan Africa. The literature shows that glycaemic control among type 2 diabetes patients is poor in most countries in sub-Saharan Africa. Understanding the factors influencing glycaemic control in this region is therefore important to develop interventions to optimize glycaemic control. We carried out a systematic review to determine the prevalence and factors associated with glycaemic control in sub-Saharan Africa to inform the development of a glycaemic control framework in the Democratic Republic of the Congo.MethodsWe searched five databases (African Index Medicus, Africa-Wide Information, Global Health, PubMed, and Web of Science) using the following search terms: type-2 diabetes, glycaemic control, and sub-Saharan Africa. Only peer-reviewed articles from January 2012 to May 2022 were eligible for this review. Two reviewers, independently, selected articles, assessed their methodological quality using Joanna Briggs checklists, and extracted data. A meta-analysis was performed to estimate the prevalence of glycaemic control. Factors associated with glycaemic control were presented as a narrative synthesis due to heterogeneity as assessed by the I2.ResultsA total of 74 studies, involving 21,133 participants were included in the review. The pooled prevalence of good glycaemic control was 30% (95% CI:27.6–32.9). The glycaemic control prevalence ranged from 10–60%. Younger and older age, gender, lower income, absence of health insurance, low level of education, place of residence, family history of diabetes, longer duration of diabetes, pill burden, treatment regimen, side effects, use of statins or antihypertensives, alcohol consumption, smoking, presence of comorbidities/complications, and poor management were associated with poor glycaemic control. On the other hand, positive perceived family support, adequate coping strategies, high diabetes health literacy, dietary adherence, exercise practice, attendance to follow-up, and medication adherence were associated with good glycaemic control.ConclusionSuboptimal glycaemic control is pervasive among patients with type-2 diabetes in sub-Saharan Africa and poses a significant public health challenge. While urgent interventions are required to optimize glycaemic control in this region, these should consider sociodemographic, lifestyle, clinical, and treatment-related factors. This systematic review and meta-analysis protocol is registered in PROSPERO under CRD 42021237941.

The economic burden of treating uncomplicated hypertension in Sub-Saharan Africa: a systematic literature review

Background and ObjectivesHypertension is one of the leading cardiovascular risk factors with high numbers of undiagnosed and untreated patients in Sub Saharan Africa (SSA). The health systems and affected people are often overwhelmed by the social and economic burden that comes with the disease. However, the research on the economic burden and consequences of hypertension treatment remains scare in SSA. The objective of our review was to compare different hypertension treatment costs across the continent and identify major cost drivers.Material and MethodsSystematic literature searches were conducted in multiple databases (e.g., PubMed, Web of Science, Google Scholar) for peer reviewed articles written in English language with a publication date from inception to Jan. 2022. We included studies assessing direct and indirect costs of hypertension therapy in SSA from a provider or user perspective. The search and a quality assessment were independently executed by two researchers. All results were converted to 2021 US Dollar.ResultsOf 3999 results identified in the initial search, 33 were selected for data extraction. Costs differed between countries, costing perspectives and cost categories. Only 25% of the SSA countries were mentioned in the studies, with Nigeria dominating the research with a share of 27% of the studies. We identified 15 results each from a user or provider perspective. Medication costs were accountable for the most part of the expenditures with a range from 1.70$ to 97.06$ from a patient perspective and 0.09$ to 193.55$ from a provider perspective per patient per month. Major cost drivers were multidrug treatment, inpatient or hospital care and having a comorbidity like diabetes.ConclusionHypertension poses a significant economic burden for patients and governments in SSA. Interpreting and comparing the results from different countries and studies is difficult as there are different financing methods and cost items are defined in different ways. However, our results identify medication costs as one of the biggest cost contributors. When fighting the economic burden in SSA, reducing medication costs in form of subsidies or special interventions needs to be considered.Trial registrationRegistration: PROSPERO, ID CRD42020220957.

Global Myeloma Trial Participation and Drug Access in the Era of Novel Therapies.

PURPOSEThe globalization of clinical trials has accelerated recent advances in multiple myeloma (MM). However, it is unclear whether trial enrollment locations are reflective of the global burden of MM and whether access to novel therapies is timely and equitable for countries that participate in those trials.METHODSTo assess this, we characterized where MM trials that led to US Food and Drug Administration (FDA) approvals were conducted and determined how often and quickly these drug regimens received approval in their participating trial countries on the basis of country income level and geographic region.RESULTSA systematic review was conducted to identify all MM clinical trials that met their primary endpoint, enrolled patients outside the United States, and resulted in FDA approval from 2005 to 2019. A total of 18 pivotal MM clinical trials were identified. High-income countries enrolled patients in 100% (18/18) of the trials identified, whereas upper-middle and lower-middle-income countries were represented in 61% (11/18) and 28% (5/18) of trials, respectively. No patients from low-income countries were enrolled. One trial enrolled patients in sub-Saharan Africa, and no trials enrolled patients in South Asia/Caribbean. For drugs/regimens that were approved in their participating countries, the median time from FDA approval to approval was 10.9 months. There were no drugs approved in lower-middle-income trial countries. MM trials leading to FDA approval are generally run in high-income, European, and Central Asian countries.CONCLUSIONThere are substantial disparities in where novel therapies are evaluated and where they are ultimately approved for use on the basis of income level and geography.