Epidemiology of malaria among HIV/AIDS patients in sub-Saharan Africa: A systematic review and meta-analysis of observational studies.

Background: Malaria and HIV remain two leading causes of morbidity and mortality to patients in developing African countries. Both infectious diseases have been documented to account for an enormous morbidity and mortality in Sub-Saharan Africa. The geographical overlap in sub-Saharan Africa and South America has led to similarities in co-infection with Plasmodium and HIV, this has resulted in the quick progression and severity of both diseases particularly among the poor, and contributes to the poverty of sub-Saharan African nations by taking a toll on young people who contribute greatly to the workforce of the economy. The present study was conducted to determine the prevalence of malarial infection in HIV patients receiving high active antiretroviral therapy in university Uyo teaching hospital, Uyo Nigeria.Methods: A predesigned structured questionnaire was administered to collect bio data and socio-demographic characteristics from the participants consisting 35 HIV infected adult patients and 32 non HIV infected adults as controls. All HIV patients were receiving HAART during this study. The HAART regimens used by HIV infected patients consist of zidovudine, lamivudine, efavirenze, and nevirapine.Results: About 5 (14.2%) HIV patients on HAART had falciparum malaria. No falciparum malaria was detected in HIV negative participants. Of the five positive malaria cases detected in HIV patients, 8.5% were females and 5.7% were males.Conclusions: There was no significant difference of malaria parasite infection by gender (P = 0.88), age group (P = 0.17), and CD4+ count (O.R:1.0, P = 0.81).

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Current prevalence of falciparum malarial infection among HIV patients on highly active antiretroviral therapy in university of Uyo teaching hospital, Uyo Nigeria

Background Despite public health significance of dual infections of human immunodeficiency virus (HIV) and malaria in developing countries like Nigeria, information on the association between malaria parasite density count (MPDC) and hematological parameter changes among HIV-infected individuals is rarely available. Objectives To evaluate burden of HIV and malaria dual infections and assess the predictive association of MPDC with hematological parameter changes among HIV infected adults attending two antiretroviral treatment clinics in Kano, Nigeria. Methodology. This was a cross-sectional study consisting of 1521 consented participants randomly selected between June 2015 and May 2016. Participants' basic characteristics and clinical details were collected using a pretested and validated standardized questionnaire. Collected venous blood was analyzed for malaria by rapid testing and microscopy including malaria parasite density; hematological parameters were estimated using a Sysmex XP-300 autoanalyzer. Data was reviewed, cleaned, and analyzed using SPSS software version 23.0. Mean hematological parameters and HIV/malaria status were compared using the independent t-test; hematological parameters and MPDC relationship was tested by simple linear regression analysis. Statistically significant difference at probability of <0.05 was considered for all variables. Results The majority (70.6%) of the participants were females. Mean (SD) age was 37.30 ± (10.41) years and ranged from 18 to 78 years. 25.4% of participants had dual infection, 99% due to Plasmodium falciparum species. Mean MPDC was 265 ± 31.8 (SD) cells/μl and ranged from 20 to 2500 cells/μl. Dual infection was highest (37.5%) among respondents in the age group ≥60 years. Prevalence was similar among other age groups (p = 0.165) and gender (p = 0.942). Of the 16 hematological parameters evaluated, 11 showed significant difference between HIV mono-infected and dual infected participants. Of the 11 parameters, only 7 (Hb, MCHC, red cells count, neutrophil and lymphocyte percentage, absolute lymphocyte count, and red cell distribution width) were significantly predictive of changes with respect to MPDC. Conclusions MPDC was significantly predictive of changes in 7 hematological parameters among dual infected participants in these settings. In routine malaria diagnosis, MPDC determination with respect to changes in some hematological parameters should be considered in ART programs for improved patient management.

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Malaria Parasite Density as a Predictor of Hematological Parameter Changes among HIV Infected Adults Attending Two Antiretroviral Treatment Clinics in Kano, Northwest Nigeria.

Background: Despite a notable reduction in the incidence and prevalence of HIV and malaria, both diseases remain the leading cause of morbidity and mortality, especially in sub-Saharan Africa. The aim of the research study is to provide epidemiological data of malaria among HIV positive individuals, establish the socio-economic determinants associated with HIV-malaria co-infection, and develop a co-infection intervention model. This research study will enable health policymakers to develop new health policies in the management and care of HIV-malaria co-infected patients. 

Methods and Analysis: The study design will be a retrospective, descriptive cross-sectional study. Case files of HIV positive individuals receiving care and treatment will be randomly selected at six selected peri-urban secondary hospitals. Interviews will be conducted among HIV positive patients, health managers, and doctors at selected hospitals. A mixed method (quantitative and qualitative) will be adopted in the research study. Proportional allocation will be used to select an estimated 1,652 case files of registered patients to be reviewed across the study location.

Statistical Package for Social Sciences version 25.0 will be used for data analysis. The categorical variable will be illustrated as a percentage and compared using Chi-square and Fisher’s exact test. Backward multivariate analysis will be used to evaluate HIV-malaria co-infection and associated health outcomes. The continuous variables will be summarised as mean, ± SD or median, interquartile range, and compared using student t-test or Wilcoxon test. Values of P < 0.05 will be considered significant. Qualitative data will be analysed using NVivo 12 software. 

Strengths and Limitations of This Study

Strengths


	The proposed large sample size of case files to be reviewed will enhance the validity and precision of the research study. 


Limitations


	Data that will be generated might not be adequate to make a generalized conclusion for the whole country.  
	 


Q= Quarter.

Since the study involves the use of secondary data (generated from patient case files), missing data is anticipated.

 


	Strike actions by health care workers were also expected. 
	Another limitation is that the research study will not be conducted as a prospective cohort study. 


Ethics and Dissemination 

Considering the research study involves the use of secondary data, the ethical approval issued to conduct the study covers the informed consent of the participants’ information. Copies of written informed consent, participant consent, and confidentiality forms will be provided to the participants both in English and in the native language, notably Hausa, TIV, and Yoruba. Verbal informed and signed informed consent to take part in the study will be obtained from the participants. This study was approved by the University of KwaZulu-Natal Biomedical Research Ethics Committee (BREC)-Reference Number: (BE654/17). Ethical approval was also obtained from the Kwara State Ministry of Health (MOH/KS/EU/777/225), Benue State Ministry of Health (MOH/STA/204/56), and the Nasarawa State Ministry of Health: NHREC 18/06/2017). 

Findings from this study will be published in peer-reviewed local and international journals. Findings will also be made available to health policymakers at the state ministry of health and hospital facilities selected for the study. The principal investigators and the health providers will sensitize patients on the study outcome.

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Human Immunodeficiency Virus and Malaria Co-Infection among Adults in the North-Central Zone of Nigeria, in the era of Improved access to Prevention and Control: A Study Protocol

Background:Malaria and HIV are 2 significant infections of critical public health concern globally. Malaria infection is one of the preceding causes of morbidity and mortality in endemic developing...

https://journals.sagepub.com/doi/pdf/10.1177/1178636120947680

Status of Anaemia and Malaria Co-infection With HIV From HAART Clinics in Federal Capital Territory, Nigeria: A Cross-Sectional Study.

Background: Malaria and HIV diseases kill millions of people yearly, and they are the scourges of developing nations. This study was conducted to determine the coinfections of malaria and HIV, and the effect of demographic characters on HIV-infected patients receiving highly active antiretroviral therapy (HAART) in Kogi State, Nigeria. Methods: Five hundred and eleven participants consisting of 411 (51 males and 360 females) HIV-infected patients on HAART and 100 (8 males and 92 females) apparently healthy HIV-noninfected individuals who served as controls were enrolled in this study. Blood sample was collected from each participant and malaria was diagnosed using the standard procedure. Results: An overall prevalence of 7.8% and 2% of malarial infection was observed in HIV-infected patients on HAART and non-HIV participants, respectively. The prevalence of malaria among HIV patients on HAART differed signifi cantly (P Conclusion: Diagnosis of malaria among HIV patients on HAART is advocated.

Stephen Okoosi

Papers

Prevalence of malaria among HIV patients on highly active antiretroviral therapy in Kogi State, North Central Nigeria