Tenofovir Adherence in the Prevention of Mother-to-Child Transmission of Hepatitis B in the Democratic Republic of the Congo: A Qualitative Study Applying the Information-Motivation-Behavioral Skills Model

Background: Hepatitis B virus (HBV) remains a leading infectious cause of death worldwide, and is highly prevalent in Sub-Saharan Africa (SSA). The prevention of mother-to-child transmission (PMTCT) programs for HBV are critical to reaching elimination targets and utilizing existing HIV testing and treatment infrastructure. Building on a feasibility study to introduce tenofovir disoproxil fumarate antiviral therapy to pregnant women with high-risk HBV in the Democratic Republic of the Congo (DRC), we examine the social and psychological facilitators of medication adherence of women who participated in this HBV PMTCT program.Methods: This study utilizes a qualitative exploratory approach involving women in Kinshasa, DRC who were identified as high-risk HBV during pregnancy and completed the pilot tenofovir antiviral program. Six participants were identified and completed in-depth, open-ended phone interviews. This study adopts a modified Information-Motivation-Behavioral Skills model (IMB+) to identify emerging themes related to tenofovir adherence.Results: A strong trust in healthcare workers, family support, and improved awareness of the disease and treatment options through enrollment in the PMTCT program facilitated tenofovir adherence. Barriers to medication adherence included social stigma and low healthcare literacy specific to HBV.Conclusions: Our study highlights the feasibility of medication adherence in HBV PMTCT programs in a low-resource setting and the importance of incorporating initiatives that address hepatitis B stigma and other social barriers. These findings are relevant to future HBV PMTCT scale-up, which is needed in the DRC and in similar African contexts with high HBV prevalence. Trial registration: The parent study was registered with clinicaltrials.gov under identifier NCT03567382. Date of registration: 25/06/2018

Nearly Complete Genome Sequences of Eight Rabies Virus Strains Obtained from Domestic Carnivores in the Democratic Republic of the Congo

In this report, we describe eight nearly complete genome sequences of rabies virus strains collected in the Democratic Republic of the Congo from domestic carnivores in 2017 and 2018. All of them clustered into a specific phylogroup among the Africa 1b lineage in the Cosmopolitan clade.

Poliovirus immunity among adults in the Democratic Republic of the Congo: a cross-sectional serosurvey

Background Vaccination efforts to eradicate polio currently focus on children under 5 years of age, among whom most cases of poliomyelitis still occur. However, in the Democratic Republic of the Congo (DRC), an outbreak of wild poliovirus type 1 occurred in 2010–2011 in which 16% of cases occurred among adults; in a related outbreak in the neighboring Republic of Congo, 75% of cases occurred among the same adult age-group. Given that infected adults may transmit poliovirus, this study was designed to assess adult immunity against polioviruses. Methods We assessed poliovirus seroprevalence using dried blood spots from 5,526 adults aged 15–59 years from the 2013–2014 Demographic and Health Survey in the DRC. Results Among adults in the DRC, 74%, 72%, and 57% were seropositive for neutralizing antibodies for poliovirus types 1, 2, and 3, respectively. For all three serotypes, seroprevalence tended to be higher among older age groups, those living in households with more children, and among women. Conclusions Protection against poliovirus is generally low among adults in the DRC, particularly for type 3 poliovirus. The lack of acquired immunity in adults suggests a potentially limited poliovirus circulation over the lifetime of those surveyed (spanning 1954 through 2014) and transmission of vaccine-derived poliovirus in this age group while underscoring the risk of these outbreaks among adults in the DRC.

Vaccination dropout rates among children aged 12-23 months in Democratic Republic of the Congo: a cross-sectional study

Background Overall, 1.8 million children fail to receive the 3-dose series for diphtheria, tetanus and pertussis each year in the Democratic Republic of the Congo (DRC). Currently, an emergency plan targeting 9 provinces including Kinshasa, the capital of the DRC, is launched to reinforce routine immunization. Mont Ngafula II was the only health district that experienced high vaccination dropout rates for nearly five consecutive years. This study aimed to identify factors predicting high immunization dropout rates among children aged 12-23 months in the Mont Ngafula II health district. Methods A cross-sectional household survey was conducted among 418 children in June-July 2019 using a two-stage sampling design. Socio-demographic and perception data were collected through a structured interviewer-administered questionnaire. The distribution of 2017-2018 immunization coverage and dropout rate was extracted from the local health district authority and mapped. Logistic random effects regression models were used to identify predictors of high vaccination dropout rates. Results Of the 14 health areas in the Mont Ngafula II health district, four reported high vaccine coverage, only one recorded low vaccine coverage, and three reported both low vaccine coverage and high dropout rate. In the final multivariate logistic random effects regression model, the predictors of immunization dropout among children aged 12-23 months were: living in rural areas, unavailability of seats, non-compliance with the order of arrival during vaccination in health facilities, and lack of a reminder system on days before the scheduled vaccination. Conclusions Our results advocate for prioritizing targeted interventions and programs to strengthen interpersonal communication between immunization service providers and users during vaccination in health facilities and to implement an SMS reminder system on days before the scheduled vaccination.

‘Where are the dead flies!’: perceptions of local communities towards the deployment of Tiny Targets to control tsetse in the Democratic Republic of the Congo

The National Programme for the control of human African trypanosomiasis in Democratic Republic of Congo includes a large-scale vector control operation using Tiny Targets. These are small panels of insecticide-impregnated cloth that are deployed in riverine habitat where tsetse flies concentrate. The effectiveness of Tiny Targets depends partly on acceptance by local communities. In 2018, we conducted research to explore the perception and acceptability of Tiny Targets in two different village clusters where Tiny Targets had been deployed by the local community or external teams. We conducted fourteen focus group discussions and seven semistructured interviews in three villages from each cluster in the Yasa Bonga health zone. Our findings showed that acceptability was better in the cluster where communities were involved in the deployment of Tiny Targets. Also in this cluster, awareness about Tiny Targets was satisfactory and the project was implemented within local customs, which promoted a positive perception of Tiny Targets and their benefits. In the cluster where external teams deployed Tiny Targets, a lack of information and communication, stereotypes applied by communities towards the deployment teams and the impression of inadequate respect for local customs led to anxiety and a misleading interpretation of the purpose of Tiny Targets and negatively influenced acceptability. This study highlights the importance of involving communities for programme acceptance. Our research underlined how awareness campaigns and communication are essential, but also how working within the scope of community social norms and customs are equally important. Prospects for the successful use of Tiny Targets are greater when communities are involved because the use can be adapted to social norms.

Synopsis of the genus Drosera (Droseraceae) in Angola and the Democratic Republic of the Congo

While some African Floras were continuously revised and several are now almost completed, the Flora of Angola’s ‘Conspectus Florae Angolensis’ still remains incomplete. This applies also for Droseraceae and the genus Drosera. Our study aims to provide an identification key for Drosera of Angola and the Democratic Republic of the Congo, including all morphological characters of the different Angolan and Congolese taxa. Loans from different herbaria were studied. A list of important morphological characters was combined with data obtained by observations and measurements. Beside the identification key, nine species descriptions with drawings of the main characteristics, distribution maps and SEM-pictures of pollen and seed morphology are provided. The possibility of hybridisation is discussed. Despite difficulties such as varying morphology or hybridisation in some species, the identification key enables researchers to identify specimens by morphological characters.