Outline of Presentation Background Method Results Discussions and Conclusion Recommendations

PREVALENCE OF CLINICALLY CAPTUED AND CONFIRMED MALARIA AMONG HIV SEROPOSITIVE CLINIC ATTENDANTS IN TWO REGIONS IN GHANA Adu-Gyasi D1, Baiden F2, Daanaah O1, Dosoo D1, Adjei G1, Manu A1,3, Sam Newton4, Owusu-Agyei S1,5, Asante KP1 1Kintampo Health Research Centre, P. O. Box 200, Kintampo North, Ghana 2Ensign College of Public Health, Kpong, E/R, Ghana 3London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK 4Kwame Nkrumah University of Science and Technology, School of public Health, Kumasi, A/R, Ghana. 5University of Health & Allied Sciences, PMB 31, Ho. Volta Region. Ghana

Background of KHRC Established in 1994 A Ghana Health Service/Ministry of Health institution under the Research and Development Directorate Long track record of policy-relevant public health research

Mission Our mission is to conduct public health research and develop health research capacity which will contribute to a reduction in ill-health and the achievement of the Millennium Development Goals for Africa’s most disadvantaged communities. To deliver high quality research that is relevant to healthcare priorities in Ghana in particular and across Africa.

About KHRC: Research areas Currently: Maternal and child health Clinical Intervention Trials Malaria, meningitis Relevant studies in other age groups Elderly Adolescents Non communicable diseases Communicable diseases particularly HIV/AIDS, TB, Hepatitis Environmental Health Sciences

INSERT A HEADER FROM THE PUBLISHED PAPER

Background Africa has heavy burdens of both HIV and malaria infection among the most common infections in sub-Saharan Africa. Malaria could have possible effects on HIV transmission and acquisition, disease progression, and response to therapy due to the significant relationship to viral load. Changes in concentrations of HIV RNA could occur in presence of malaria co-infection.

Malaria is associated with an increase in HIV viral load and a fall in CD4-cell count. Conversely, HIV infection disrupts the acquired immune responses to malaria and the efficacy of antimalarial drugs. This study was carried out in five Ghanaian hospitals in two regions to estimate the prevalence of clinically confirmed malaria among HIV patients by evaluating their hospital records.

Methods Retrospective descriptive cross sectional study design that selected 933 folders using systematic random sampling method from five hospitals in two regions in Ghana. Reviewed and collected data on malaria, using Case Record Forms from HIV patients’ folders. Permission was sought from the National AIDS/STI Control Programme/Ghana AIDS Commission. Ethical approval by Ghana Health Service, Kintampo Health Research Centre Institutional Review Board and the London School of Hygiene and Tropical Medicine.

Figure 1: The map of Ghana with the regions and towns of the health facilities that were used for the review and were selected (Adu-Gyasi et al, 2013)

Figure 2: Flow chart for the selection of folders (Adu-Gyasi et al, 2013)

Malaria case definition:  A case of malaria needed to have been confirmed by the laboratory. A laboratory confirmed case of malaria was based on either a blood slide reading or the use of rapid diagnostic test (RDT) kits. The confirmation by team was also made by availability of results in patient folder.

Results The 933 patients records were made up of 272 (29.2%) males and 661 (70.8%) females. Majority of the patients were aged between 21–40 (63.6%) years and the rest were between the ages 1–20 (2.8%) years, 41–60 (31.6%) years and 61–80 (2.1%) years of age.

Figure 3: Distribution of the ages of participants reviewed in the study

Table 1: Age and weight of patients by sex

A total of 38.1% (355/933) of the patients were clinically suspected of having clinical malaria. Of these 339 (95.5%) were referred to the laboratory for confirmation of the diagnosis of malaria. Only 4.4% (15/339) of patients tested were confirmed as cases of malaria among the patients that were clinically suspected of having malaria and subsequently confirmed. Nevertheless, all 339 patients received the antimalarial treatment.

Figure 4: Flow chart of CRF with information on malaria diagnosis.

Table 2: Comparing confirmed malaria among gender and age groups

Table 3: Prevalence of confirmed malaria diagnosed in the various hospitals

Table 4: Prevalence of confirmed malaria and its association with fever Fever, was not significantly associated with a confirmed diagnosis of malaria [OR = 3.11, 95% CI: (0.63, 15.37), P = 0.142].

Table 5: Prevalence of confirmed malaria and its association with fever Fever, was not significantly associated with a confirmed diagnosis of malaria [OR = 3.11, 95% CI: (0.63, 15.37), P = 0.142].

Table 6: Univariate logistic regression of fever, CD4 count, ART use, associated with malaria among HIV patients Fever was significantly associated with presumptive malaria among the patients (OR=4.11, 95% CI: [2.83, 5.96], P<0.001)

Limitations: Quality of Records Keeping Table 7: Review of missing record as quality of records

Conclusions There was a 4.4% prevalence of confirmed malaria and 38.1% of presumptively diagnosed malaria from the case records of HIV patients from the selected hospitals in Ghana. Fever was used to significantly diagnose presumptive malaria but fever was not significantly associated with confirmed malaria. Quality of records keeping was poor and could affect the progress of the control programme.

Recommendations Testing to confirm and diagnose malaria before treatment should be strictly adhered to. Measures introduced to improve data quality and records keeping should be used for the success of the control programme. Strict monitoring of data capture and records keeping should be respected to ensure uniformity across programme control sites

References 1. Mouala C, Guiguet M, Houze S, et al. AIDS. 2009; 23:1997-2004. 2. Mermin J, Ekwaru JP, Liechty CA, et al. The Lancet. 2006;367(9518):1256-61. 3. Kublin JG, Patnaik P, Jere CS, et al. Lancet. 2005;365:233–40. 4. Chalwe V, Jean-Pierre V, Mutale F, et al. Emerging Infectious Diseases. 2009;15(5):749-55. 5. Dennis Adu-Gyasi, Caterina I Fanello, Frank Baiden, et al. Malaria Journal201312:382

Acknowledgements Ghana Health Service Director, Management and staff of Kintampo Health Research Centre Ghana AIDS Commission and NACP Management and staff of Hospitals of study Study participants

THANK YOU