Studies on the anti-inflammatory and toxic effects of the stem bark of Khaya ivorensis (Meliaceae) on rats.

Khaya ivorensis A. Chev. (Meliaceae) is a common feature in anti-malarial recipe prescribed by African traditional medical practitioners. Investigations have proved that Khaya species possesses some level of anti-plasmodial activity. Anti-inflammatory and toxicity studies were carried out on this plant using the Ugo Basile model 7140 and routine toxicity study methods, respectively, on adult wistar rats. The brain, spleen, heart, liver and kidneys were examined for dismorphological features, following oral administration of the ethanolic extract of K. ivorensis at the daily dose levels of 1000, 500 or 125 mg/kg for 7, 14 and 7 days after cessation of drug administration. The study showed that tissue toxicity, especially neurotoxicity was dose dependent, similarly the anti-inflammatory effect. The toxicity appeared to be reversible at lower doses. The wide margin between the therapeutic and toxic dosages makes the extract a possible safe drug in the management of malaria.     

The physiologic climate of Nigeria

This study describes the spatial and temporal variations in the physiologic climate of Nigeria for 1951–2009 in terms of effective temperature (ET), temperature-humidity index (THI), relative strain index (RSI) and perception of 3,600 sampled populations. The main hypotheses are that (i) the existing vegetation-based ecological region could adequately elucidate the physiologic climate of the country, and (ii) physiologic stress has significantly increased over the years (1951–2009). Trends and changes in the selected indices (ET, THI and RSI) were examined over two time slices: 1951–1980 and 1981–2009. The results show that (1) the montane region was the most comfortable physiologic climate in Nigeria, and the regions around the Rivers Niger and Benue troughs were the most uncomfortable in most parts of the year, (2) physiologic stress in most parts of Nigeria has significantly increased in 1981–2009 over 1951–1980 (p?≤?0.05), (3) coping strategies to the uncomfortably hot and cold climate in Nigeria are limited to dressing mode, clothing materials and use of air conditioners or fan, (4) ET, THI and RSI results could be similar, and complementary; but each is with its strengths and weaknesses for annual or seasonal representations, which the others complemented for the interpretation of the physiologic climate of Nigeria. The study concluded that the relationship between the ecological classification of Nigeria and physiologic climate is rather complex, and the former could not elucidate the latter. The study cited inadequate meteorological data, especially on wind chill, and health records as limiting factors of studies on the Nigerian physiologic climates and the effect of extreme thermal conditions on the people.     

Towards Universal Voluntary HIV Testing and Counselling: A Systematic Review and Meta-Analysis of Community-Based Approaches

Background

Effective national and global HIV responses require a significant expansion of HIV testing and counselling (HTC) to expand access to prevention and care. Facility-based HTC, while essential, is unlikely to meet national and global targets on its own. This article systematically reviews the evidence for community-based HTC.

Methods and Findings

PubMed was searched on 4 March 2013, clinical trial registries were searched on 3 September 2012, and Embase and the World Health Organization Global Index Medicus were searched on 10 April 2012 for studies including community-based HTC (i.e., HTC outside of health facilities). Randomised controlled trials, and observational studies were eligible if they included a community-based testing approach and reported one or more of the following outcomes: uptake, proportion receiving their first HIV test, CD4 value at diagnosis, linkage to care, HIV positivity rate, HTC coverage, HIV incidence, or cost per person tested (outcomes are defined fully in the text). The following community-based HTC approaches were reviewed: (1) door-to-door testing (systematically offering HTC to homes in a catchment area), (2) mobile testing for the general population (offering HTC via a mobile HTC service), (3) index testing (offering HTC to household members of people with HIV and persons who may have been exposed to HIV), (4) mobile testing for men who have sex with men, (5) mobile testing for people who inject drugs, (6) mobile testing for female sex workers, (7) mobile testing for adolescents, (8) self-testing, (9) workplace HTC, (10) church-based HTC, and (11) school-based HTC. The Newcastle-Ottawa Quality Assessment Scale and the Cochrane Collaboration''s “risk of bias” tool were used to assess the risk of bias in studies with a comparator arm included in pooled estimates. 117 studies, including 864,651 participants completing HTC, met the inclusion criteria. The percentage of people offered community-based HTC who accepted HTC was as follows: index testing, 88% of 12,052 participants; self-testing, 87% of 1,839 participants; mobile testing, 87% of 79,475 participants; door-to-door testing, 80% of 555,267 participants; workplace testing, 67% of 62,406 participants; and school-based testing, 62% of 2,593 participants. Mobile HTC uptake among key populations (men who have sex with men, people who inject drugs, female sex workers, and adolescents) ranged from 9% to 100% (among 41,110 participants across studies), with heterogeneity related to how testing was offered. Community-based approaches increased HTC uptake (relative risk [RR] 10.65, 95% confidence interval [CI] 6.27–18.08), the proportion of first-time testers (RR 1.23, 95% CI 1.06–1.42), and the proportion of participants with CD4 counts above 350 cells/µl (RR 1.42, 95% CI 1.16–1.74), and obtained a lower positivity rate (RR 0.59, 95% CI 0.37–0.96), relative to facility-based approaches. 80% (95% CI 75%–85%) of 5,832 community-based HTC participants obtained a CD4 measurement following HIV diagnosis, and 73% (95% CI 61%–85%) of 527 community-based HTC participants initiated antiretroviral therapy following a CD4 measurement indicating eligibility. The data on linking participants without HIV to prevention services were limited. In low- and middle-income countries, the cost per person tested ranged from US$2–US$126. At the population level, community-based HTC increased HTC coverage (RR 7.07, 95% CI 3.52–14.22) and reduced HIV incidence (RR 0.86, 95% CI 0.73–1.02), although the incidence reduction lacked statistical significance. No studies reported any harm arising as a result of having been tested.

Conclusions

Community-based HTC achieved high rates of HTC uptake, reached people with high CD4 counts, and linked people to care. It also obtained a lower HIV positivity rate relative to facility-based approaches. Further research is needed to further improve acceptability of community-based HTC for key populations. HIV programmes should offer community-based HTC linked to prevention and care, in addition to facility-based HTC, to support increased access to HIV prevention, care, and treatment.

Review Registration

International Prospective Register of Systematic Reviews CRD42012002554 Please see later in the article for the Editors'' Summary     

Factors Associated with HIV Prevalence and HIV Testing in Sierra Leone: Findings from the 2008 Demographic Health Survey

BackgroundThe Sierra Leone Demographic Health Survey 2008 found an HIV prevalence of 1.5%. This study investigates associations with HIV infection and HIV testing.MethodsHouseholds were selected using stratified multi-stage sampling. In all selected households women aged 15–49 were eligible. In every second household men aged 15–59 were also eligible. Participants were asked to consent for anonymous HIV testing. All participants interviewed and tested were analysed. Multiple logistic regression identified associations with HIV infection, undiagnosed infection and with ever having a voluntary HIV test among sexually active participants.ResultsOf 7495 invited 86% (6,475) agreed to an interview and HIV test. Among 96 HIV positive participants, 78% had never taken a voluntary HIV test so were unaware of their serostatus, and 86% were sexually active in the last 12 months among whom 96% did not use a condom at last intercourse. 11% of all participants had previously voluntarily tested. Among women who had tested, 60% did so in antenatal care. We found that those living in an urban area, and those previously married, were more likely to be HIV infected. Voluntary HIV testing was more common in those aged 25–44, living in an urban area, females, having secondary or higher education, having first sexual intercourse at age 17 years or older, and using condoms at last sex. Although 82% of men and 69% of women had heard of HIV, only 35% and 29% respectively had heard of antiretroviral therapy.ConclusionsThe HIV prevalence in Sierra Leone has been stable. HIV testing, however, is uncommon and most infected individuals are unaware of their serostatus. This could allow the epidemic to escalate as individuals with undiagnosed infection are unlikely to change their behaviour or access treatment. Improving knowledge and increasing testing need to remain central to HIV prevention interventions in Sierra Leone.