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Nacher M, Lucarelli A, Van-Melle A, Basurko C, Rabier S, Chroum M, Santana T, Verin K, Bienvenu K, El Guedj M, Vaz T, Cisse H, Epelboin L, Le Turnier P, Abboud P, Djossou F, Pradinaud R, Adenis A, Couppié P. Forty Years of HIV Research in French Guiana: Comprehend to Combat. Pathogens 2024; 13:459. [PMID: 38921756 PMCID: PMC11206598 DOI: 10.3390/pathogens13060459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/10/2024] [Accepted: 05/17/2024] [Indexed: 06/27/2024] Open
Abstract
The drivers of the HIV epidemic, the viruses, the opportunistic infections, the attitudes and the resources allocated to the fight against HIV/AIDS, vary substantially across countries. French Guiana, at the crossroads between Amazonian South America and the Caribbean, constitutes a singular context with poor populations and rich country health funding, which has allowed researchers to gather lots of information on the particulars of our epidemic. We aimed to focus on the little known story of forty years of HIV research in French Guiana and emphasize how local research intertwined with public health action has yielded continuous progress, despite the difficult social conditions of the affected population. We searched Web of Science and associated local experts who worked through much of the epidemic in selecting the most meaningful products of local research for clinical and public health outcomes in French Guiana. Research tools and facilities included, from 1991 onwards, the HIV hospital cohort and the HIV-histoplasmosis cohort. Ad hoc studies funded by the ANRS or the European Regional Development fund shed light on vulnerable groups. The cumulative impact of prospective routine collection and focused efforts has yielded a breadth of knowledge, allowing for informed decisions and the adaptation of prevention, testing and care in French Guiana. After this overview, we emphasize that the close integration of research and public health was crucial in adapting interventions to the singular context of French Guiana.
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Affiliation(s)
- Mathieu Nacher
- Comité de Coordination Régionale de la Lutte contre le VIH et les IST, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana; (A.L.); (S.R.); (M.C.); (T.S.); (K.V.); (K.B.); (A.A.)
- Centre d’Investigation Clinique INSERM 1424, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana; (A.V.-M.); (C.B.)
- Département Formation Recherche en Santé, Université de Guyane, 97300 Cayenne, French Guiana;
- Institut Santé des Populations en Amazonie, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana
| | - Aude Lucarelli
- Comité de Coordination Régionale de la Lutte contre le VIH et les IST, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana; (A.L.); (S.R.); (M.C.); (T.S.); (K.V.); (K.B.); (A.A.)
| | - Astrid Van-Melle
- Centre d’Investigation Clinique INSERM 1424, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana; (A.V.-M.); (C.B.)
| | - Célia Basurko
- Centre d’Investigation Clinique INSERM 1424, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana; (A.V.-M.); (C.B.)
| | - Sébastien Rabier
- Comité de Coordination Régionale de la Lutte contre le VIH et les IST, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana; (A.L.); (S.R.); (M.C.); (T.S.); (K.V.); (K.B.); (A.A.)
| | - Malorie Chroum
- Comité de Coordination Régionale de la Lutte contre le VIH et les IST, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana; (A.L.); (S.R.); (M.C.); (T.S.); (K.V.); (K.B.); (A.A.)
| | - Thiago Santana
- Comité de Coordination Régionale de la Lutte contre le VIH et les IST, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana; (A.L.); (S.R.); (M.C.); (T.S.); (K.V.); (K.B.); (A.A.)
| | - Karine Verin
- Comité de Coordination Régionale de la Lutte contre le VIH et les IST, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana; (A.L.); (S.R.); (M.C.); (T.S.); (K.V.); (K.B.); (A.A.)
| | - Ketty Bienvenu
- Comité de Coordination Régionale de la Lutte contre le VIH et les IST, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana; (A.L.); (S.R.); (M.C.); (T.S.); (K.V.); (K.B.); (A.A.)
| | - Myriam El Guedj
- Hôpital de Jour Adultes, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana
| | - Tania Vaz
- Hôpital de Jour Adultes, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana
| | - Hawa Cisse
- Hôpital de Jour Adultes, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana
| | - Loïc Epelboin
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana; (L.E.); (P.L.T.); (P.A.); (F.D.)
| | - Paul Le Turnier
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana; (L.E.); (P.L.T.); (P.A.); (F.D.)
| | - Philippe Abboud
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana; (L.E.); (P.L.T.); (P.A.); (F.D.)
| | - Félix Djossou
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana; (L.E.); (P.L.T.); (P.A.); (F.D.)
| | - Roger Pradinaud
- Service de Dermatologie Vénéréologie, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana;
| | - Antoine Adenis
- Comité de Coordination Régionale de la Lutte contre le VIH et les IST, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana; (A.L.); (S.R.); (M.C.); (T.S.); (K.V.); (K.B.); (A.A.)
- Centre d’Investigation Clinique INSERM 1424, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana; (A.V.-M.); (C.B.)
- Département Formation Recherche en Santé, Université de Guyane, 97300 Cayenne, French Guiana;
- Institut Santé des Populations en Amazonie, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana
| | - Pierre Couppié
- Département Formation Recherche en Santé, Université de Guyane, 97300 Cayenne, French Guiana;
- Institut Santé des Populations en Amazonie, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana
- Service de Dermatologie Vénéréologie, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana;
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Nacher M, Blanc J, Rabier S, Lucarelli A, Adenis A, Basurko C, Louis A, Dotou D, Leneuve M, Osei L, Elenga N, Hcini N. Thirty years of HIV pregnancies in French Guiana: prevention successes and remaining obstetrical challenges. Front Glob Womens Health 2024; 4:1264837. [PMID: 38234591 PMCID: PMC10791775 DOI: 10.3389/fgwh.2023.1264837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 12/13/2023] [Indexed: 01/19/2024] Open
Abstract
Introduction In a context of high HIV prevalence, poor pregnancy follow-up, frequent poverty, preeclampsia, and preterm delivery, we aimed to describe the characteristics and outcomes of pregnancies among women living with HIV in French Guiana. Methods A retrospective cohort study was conducted on HIV-infected pregnancies enrolled between January 1st 1992 to 31st July 2022. Overall, there were 1,774 pregnancies in 881 women living with HIV. Results For 75.1% of pregnancies, the HIV diagnosis was already known before pregnancy and in 67.6% of women, HIV follow-up predated pregnancy. Nearly half of women, 49.6%, only had one pregnancy since having been diagnosed with HIV. Although most women received antiretroviral therapy during pregnancy, for those with the available information we found only 48.5% had an undetectable viral load at delivery. Overall, 15.3% of pregnancies ended with an abortion. There were a total of 110 newborns infected with HIV representing an overall transmission rate of 6.2% (110/1,771). Between 1993 and 2002, the transmission rate was 34%, between 2003 and 2012 it was 1.3%, and between 2013 and 2022 it was 0.7%. Overall, in Cayenne, since 2008, 106 of 581 HIV-infected pregnancies (18.2%) with available information were premature before 37 weeks of pregnancy; of these, 33 (5.7%) were very preterm deliveries and 73 (13.3%) were late preterm deliveries. Over time, in Cayenne, preterm delivery declined significantly. Conclusions The present study emphasizes that, despite spectacular progress in reducing mother to child transmission, pregnancy outcomes among women living with HIV are still preoccupying with high incidence of preterm delivery and low birth weight. Teasing out what fraction is linked to HIV and what fraction is linked to social precariousness and poor follow-up was not possible in this study. Despite the high incidence of very preterm delivery recent progress suggests that coordination efforts to improve follow-up may also have improved obstetrical outcomes.
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Affiliation(s)
- Mathieu Nacher
- Centre d'Investigation Clinique INSERM 1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana
- Amazonian Infrastructures for Population Health, Centre Hospitalier de Cayenne, Cayenne, French Guiana
- Département Formation Recherche Santé, Université de Guyane, Cayenne, French Guiana
| | - Julie Blanc
- Centre d'Investigation Clinique INSERM 1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana
- Amazonian Infrastructures for Population Health, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Sebastien Rabier
- Amazonian Infrastructures for Population Health, Centre Hospitalier de Cayenne, Cayenne, French Guiana
- COREVIH Guyane, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Aude Lucarelli
- Amazonian Infrastructures for Population Health, Centre Hospitalier de Cayenne, Cayenne, French Guiana
- COREVIH Guyane, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Antoine Adenis
- Centre d'Investigation Clinique INSERM 1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana
- Amazonian Infrastructures for Population Health, Centre Hospitalier de Cayenne, Cayenne, French Guiana
- Département Formation Recherche Santé, Université de Guyane, Cayenne, French Guiana
| | - Celia Basurko
- Centre d'Investigation Clinique INSERM 1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana
- Amazonian Infrastructures for Population Health, Centre Hospitalier de Cayenne, Cayenne, French Guiana
- Département Formation Recherche Santé, Université de Guyane, Cayenne, French Guiana
| | - Alphonse Louis
- Service de Gynécologie Obstétrique, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Dominique Dotou
- Service de Gynécologie Obstétrique, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Malika Leneuve
- Service de Gynécologie Obstétrique, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Lindsay Osei
- Collectivité territoriale de Guyane, Protection Maternelle et Infantile, Cayenne, French Guiana
| | - Narcisse Elenga
- Amazonian Infrastructures for Population Health, Centre Hospitalier de Cayenne, Cayenne, French Guiana
- Service de Pédiatrie, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Najeh Hcini
- Amazonian Infrastructures for Population Health, Centre Hospitalier de Cayenne, Cayenne, French Guiana
- Service de Gynécologie Obstétrique, Centre Hospitalier de l’Ouest Guyanais, Saint Laurent du Maroni, French Guiana
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Nacher M, Epelboin L, Bonifay T, Djossou F, Blaizot R, Couppié P, Adenis A, Lucarelli A, Lambert Y, Schaub R, Douine M. Migration in French Guiana: Implications in health and infectious diseases. Travel Med Infect Dis 2024; 57:102677. [PMID: 38049022 DOI: 10.1016/j.tmaid.2023.102677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 11/20/2023] [Accepted: 11/24/2023] [Indexed: 12/06/2023]
Abstract
In French Guiana, more than a third of the population, and nearly half of the adults, are of foreign origin. This immigration is explained by the French standard of living, which is attractive to nationals of surrounding countries. Infectious diseases remain in the top 10 causes of premature death, often in the most precarious populations. In this context we aimed to synthesize the state of the knowledge regarding immigration and infectious diseases in French Guiana and the general implications that follow this diagnosis. For HIV, although the majority of patients are of foreign origin, estimates of the presumed date of infection based on CD4 erosion modelling and from molecular analyses suggest that the majority of transmissions in foreign-born individuals occur in French Guiana and that the Guiana shield has been a crossroad between Latin America and the Caribbean. Among key populations bridging these regions illegal gold miners are very mobile and have the greatest proportion B Caribbean HIV viruses. Gold miners have been a key vulnerable population for falciparum malaria and other tropical diseases such as leishmaniasis, leprosy, or leptospirosis. The complex history of migrations in French Guiana and on the Guiana Shield is also reflected in the fingerprinting of mycobacterium tuberculosis and the high incidence of tuberculosis in French Guiana, notably in immigrants, reflects the incidences in the countries of origin of patients. The high burden of infectious diseases in immigrants in French Guiana is first and foremost a reflection of the precarious living conditions within French Guiana and suggests that community-based proactive interventions are crucial to reduce transmission, morbidity, and mortality from infectious diseases.
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Affiliation(s)
- Mathieu Nacher
- CIC INSERM 1424, Centre Hospitalier de Cayenne, 97300, Cayenne, French Guiana; Université de Guyane, Cayenne, 97300, Cayenne, French Guiana; Amazonian Infrastructures for Population Health & Tropical Medicine, Cayenne, French Guiana.
| | - Loïc Epelboin
- CIC INSERM 1424, Centre Hospitalier de Cayenne, 97300, Cayenne, French Guiana; Université de Guyane, Cayenne, 97300, Cayenne, French Guiana; Amazonian Infrastructures for Population Health & Tropical Medicine, Cayenne, French Guiana; Department of Infectious Diseases, Centre Hospitalier de Cayenne, 97300, Cayenne, French Guiana
| | - Timothée Bonifay
- CIC INSERM 1424, Centre Hospitalier de Cayenne, 97300, Cayenne, French Guiana; Amazonian Infrastructures for Population Health & Tropical Medicine, Cayenne, French Guiana
| | - Félix Djossou
- Amazonian Infrastructures for Population Health & Tropical Medicine, Cayenne, French Guiana; Department of Infectious Diseases, Centre Hospitalier de Cayenne, 97300, Cayenne, French Guiana
| | - Romain Blaizot
- Department of Dermatology, Centre Hospitalier de Cayenne, 97300, Cayenne, French Guiana
| | - Pierre Couppié
- Amazonian Infrastructures for Population Health & Tropical Medicine, Cayenne, French Guiana; Department of Dermatology, Centre Hospitalier de Cayenne, 97300, Cayenne, French Guiana
| | - Antoine Adenis
- CIC INSERM 1424, Centre Hospitalier de Cayenne, 97300, Cayenne, French Guiana; Université de Guyane, Cayenne, 97300, Cayenne, French Guiana; Amazonian Infrastructures for Population Health & Tropical Medicine, Cayenne, French Guiana
| | - Aude Lucarelli
- Amazonian Infrastructures for Population Health & Tropical Medicine, Cayenne, French Guiana; Coordination Regionale de lutte contre le VIH, Centre Hospitalier de Cayenne, 97300, Cayenne, French Guiana
| | - Yann Lambert
- CIC INSERM 1424, Centre Hospitalier de Cayenne, 97300, Cayenne, French Guiana; Université de Guyane, Cayenne, 97300, Cayenne, French Guiana; Amazonian Infrastructures for Population Health & Tropical Medicine, Cayenne, French Guiana
| | - Roxane Schaub
- CIC INSERM 1424, Centre Hospitalier de Cayenne, 97300, Cayenne, French Guiana; Amazonian Infrastructures for Population Health & Tropical Medicine, Cayenne, French Guiana
| | - Maylis Douine
- CIC INSERM 1424, Centre Hospitalier de Cayenne, 97300, Cayenne, French Guiana; Université de Guyane, Cayenne, 97300, Cayenne, French Guiana; Amazonian Infrastructures for Population Health & Tropical Medicine, Cayenne, French Guiana
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Cao R, Lei S, Chen H, Ma Y, Dai J, Dong L, Jin X, Yang M, Sun P, Wang Y, Zhang Y, Jia M, Chen M. Using molecular network analysis to understand current HIV-1 transmission characteristics in an inland area of Yunnan, China. Epidemiol Infect 2023; 151:e124. [PMID: 37462024 PMCID: PMC10540185 DOI: 10.1017/s0950268823001140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/26/2023] [Accepted: 07/07/2023] [Indexed: 08/05/2023] Open
Abstract
HIV-1 molecular surveillance provides a new approach to explore transmission risks and targeted interventions. From January to June 2021, 663 newly reported HIV-1 cases were recruited in Zhaotong City, Yunnan Province, China. The distribution characteristics of HIV-1 subtypes and HIV-1 molecular network were analysed. Of 542 successfully subtyped samples, 12 HIV-1 strains were identified. The main strains were CRF08_BC (47.0%, 255/542), CRF01_AE (17.0%, 92/542), CRF07_BC (17.0%, 92/542), URFs (8.7%, 47/542), and CRF85_BC (6.5%, 35/542). CRF08_BC was commonly detected among Zhaotong natives, illiterates, and non-farmers and was mostly detected in Zhaoyang County. CRF01_AE was frequently detected among married and homosexual individuals and mostly detected in Weixin and Zhenxiong counties. Among the 516 pol sequences, 187 (36.2%) were clustered. Zhaotong natives, individuals aged ≥60 years, and illiterate individuals were more likely to be found in the network. Assortativity analysis showed that individuals were more likely to be genetically associated when stratified by age, education level, occupation, and reporting area. The genetic diversity of HIV-1 reflects the complexity of local HIV epidemics. Molecular network analyses revealed the subpopulations to focus on and the characteristics of the risk networks. The results will help optimise local prevention and control strategies.
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Affiliation(s)
- Rui Cao
- School of Public Health, Kunming Medical University, Kunming, China
| | - Shouxiong Lei
- Division for AIDS/STD Control and Prevention, Zhaotong Center for Disease Control and Prevention, Zhaotong, China
| | - Huichao Chen
- Institute for AIDS/STD Control and Prevention, Yunnan Center for Disease Control and Prevention, Kunming, China
| | - Yanling Ma
- Institute for AIDS/STD Control and Prevention, Yunnan Center for Disease Control and Prevention, Kunming, China
| | - Jie Dai
- Institute for AIDS/STD Control and Prevention, Yunnan Center for Disease Control and Prevention, Kunming, China
| | - Lijuan Dong
- Institute for AIDS/STD Control and Prevention, Yunnan Center for Disease Control and Prevention, Kunming, China
| | - Xiaomei Jin
- Institute for AIDS/STD Control and Prevention, Yunnan Center for Disease Control and Prevention, Kunming, China
| | - Min Yang
- Institute for AIDS/STD Control and Prevention, Yunnan Center for Disease Control and Prevention, Kunming, China
| | - Pengyan Sun
- Institute for AIDS/STD Control and Prevention, Yunnan Center for Disease Control and Prevention, Kunming, China
| | - Yawen Wang
- School of Public Health, Kunming Medical University, Kunming, China
| | - Yuying Zhang
- School of Public Health, Kunming Medical University, Kunming, China
| | - Manhong Jia
- Institute for AIDS/STD Control and Prevention, Yunnan Center for Disease Control and Prevention, Kunming, China
| | - Min Chen
- Health Laboratory Center, Yunnan Center for Disease Control and Prevention, Kunming, China
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Nacher M, Rabier S, Lucarelli A, Hureau L, Adenis A, Hafsi N, Sabbah N. Diabetes in a hospital cohort of persons living with HIV: a descriptive and comparative study in French Guiana. BMC Infect Dis 2023; 23:470. [PMID: 37442942 DOI: 10.1186/s12879-023-08455-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 07/10/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND In French Guiana (population 294,000) the prevalence of type 2 diabetes (10%) and of HIV(1.1%) are very high. Our objective was to determine the prevalence of diabetes and its complications in a HIV cohort. MATERIALS AND METHODS We enrolled HIV-infected persons followed in Cayenne, Kourou, and Saint Laurent du Maroni hospitals between January 1, 1992 and December 31, 2021 in the French Hospital Database for HIV (FHDH) a national database compiling data from all French regions. RESULTS There was no difference of diabetes prevalence between men (8.2%) and women (8.8%), P = 0.4. Patients with diabetes were older (56 years ± 13.4) than those without diabetes (44.7 years ± 13.6) and prevalence increased with age. The proportion of persons with diabetes was greater among virologically suppressed persons (10%) than those with a detectable viral load under antiretroviral treatment (5.8%). Persons with diabetes had substantially greater CD4 counts at diagnosis than persons without diabetes. The majority of macro and microvascular complications were observed in people with diabetes. Persons with diabetes and HIV were significantly less likely to have had AIDS (1.6 versus 2.2 per 100 person-years, respectively). Overall, 374 persons living with HIV of 4167 had died (9%) the proportion of persons with diabetes among the dead was greater than those who did not die 11.7% versus 8.1%, respectively, p = 0.017. However, persons with diabetes were older and hence died older, 62.3 years (SD = 1.9) for deceased persons with diabetes versus 50.4 years (SD = 0.8), P < 0.0001. However, using Cox regression to adjust for age, initial CD4 count, country of birth there was no significant difference in the Hazard for death between persons with diabetes and persons without diabetes (aHR = 0.99, 95%CI = 0.65-1.5), P = 0.9. CONCLUSIONS The prevalence of diabetes in our HIV cohort was high. Persons with diabetes had greater CD4 counts, earlier care, and greater virological suppression than persons without diabetes. There were no significant differences between persons with diabetes and without diabetes in terms of survival.
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Affiliation(s)
- Mathieu Nacher
- CIC INSERM 1424, Centre Hospitalier de Cayenne, Cayenne, 97300, French Guiana.
- DFR Santé, Université de Guyane, Cayenne, 97300, French Guiana.
- COREVIH Guyane, Centre Hospitalier de Cayenne, Cayenne, 97300, French Guiana.
| | - Sebastien Rabier
- COREVIH Guyane, Centre Hospitalier de Cayenne, Cayenne, 97300, French Guiana
| | - Aude Lucarelli
- COREVIH Guyane, Centre Hospitalier de Cayenne, Cayenne, 97300, French Guiana
| | - Louise Hureau
- COREVIH Guyane, Centre Hospitalier de Cayenne, Cayenne, 97300, French Guiana
| | - Antoine Adenis
- CIC INSERM 1424, Centre Hospitalier de Cayenne, Cayenne, 97300, French Guiana
- DFR Santé, Université de Guyane, Cayenne, 97300, French Guiana
- COREVIH Guyane, Centre Hospitalier de Cayenne, Cayenne, 97300, French Guiana
| | - Nezha Hafsi
- Service d'endocrinologie diabétologie, Centre Hospitalier de Cayenne, Cayenne, 97300, French Guiana
| | - Nadia Sabbah
- Service d'endocrinologie diabétologie, Centre Hospitalier de Cayenne, Cayenne, 97300, French Guiana
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Nacher M, Divino F, Leborgne C, Correa V, Rabier S, Lucarelli A, Rhodes S, Gaillet M, Malafaia D, Rousseau C, Sanna A, Gomes M, Adenis A, Peiter P, Michaud C. Sexually transmitted infections on the border between Brazil and French Guiana. Front Public Health 2023; 11:1059137. [PMID: 36761125 PMCID: PMC9906991 DOI: 10.3389/fpubh.2023.1059137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 01/02/2023] [Indexed: 01/26/2023] Open
Abstract
Purpose The border between the State of Amapa, Brazil, and French Guiana is mostly primary forest. In the Oyapock basin, socioeconomic circumstances have fueled sex work, gold mining and the circulation of sexually transmitted infections. Given the lack of comprehensive data on this border area, we describe the different sexually transmitted infections along the Brazil/French Guiana border and the testing and care activity. Methods We conducted a review of the available scientific and technical literature on sexually transmitted infections in this complex border area. Temporal trends were graphed and for Human Immunodeficiency Virus (HIV) we estimated incidence using the European Center for prevention and Disease Control modeling tool. Results Until 2019, 26 of the 46 HIV-infected patients followed and treated in Saint Georges de l'Oyapock were residing on the Brazilian side in Oiapoque. Virological suppression was only achieved for 75% of treated patients; but dropped to 62% during the COVID-19 epidemic. In 2019, cooperation efforts allowed HIV care in Oiapoque, resulting in the transfer of Brazilian patients previously followed on the French side and a substantial increase in the number of patients followed in Oiapoque. The average yearly HIV serological testing activity at the health center in Saint Georges was 16 tests per 100 inhabitants per year; in Camopi it was 12.2 per 100 inhabitants. Modeling estimated the number of persons living with HIV around 170 persons, corresponding to a prevalence of 0.54% and about 40 undiagnosed infections. The model also suggested that there were about 12 new infections per year in Saint Georges and Oiapoque, representing an HIV incidence rate of 3.8 cases per 10,000 per year. HPV prevalence in Saint Georges ranges between 25 and 30% and between 35 and 40% in Camopi. Testing activity for other sexually transmitted infections markedly increased in the past 5 years; the introduction of PCR for chlamydiasis and gonorrhea also had a substantial impact on the number of diagnoses. Conclusions The ongoing cooperation between multiple partners on both sides of the border has led to remarkable progress in primary prevention, in testing efforts, in treatment and retention on both sides of the border. In a region with intense health professional turnover, nurturing cooperation and providing accurate assessments of the burden of sexually transmitted infections is essential to tackle a problem that is shared on both sides of the border.
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Affiliation(s)
- Mathieu Nacher
- INSERM CIC1424 Centre d'Investigation Clinique Antilles Guyane, Cayenne, French Guiana
| | - Flavia Divino
- INSERM CIC1424 Centre d'Investigation Clinique Antilles Guyane, Cayenne, French Guiana
| | - Cyril Leborgne
- Centres délocalisés de prévention et de soins, Centre hospitalier de Cayenne, Cayenne, French Guiana
| | - Valmir Correa
- Laboratorio De Fronteira De Oiapoque, Oiapoque, Brazil
| | - Sébastien Rabier
- COREVIH Guyane, Centre hospitalier de Cayenne, Cayenne, French Guiana
| | - Aude Lucarelli
- COREVIH Guyane, Centre hospitalier de Cayenne, Cayenne, French Guiana
| | | | - Mélanie Gaillet
- Centres délocalisés de prévention et de soins, Centre hospitalier de Cayenne, Cayenne, French Guiana
| | | | - Cyril Rousseau
- Centres délocalisés de prévention et de soins, Centre hospitalier de Cayenne, Cayenne, French Guiana
| | - Alice Sanna
- INSERM CIC1424 Centre d'Investigation Clinique Antilles Guyane, Cayenne, French Guiana
| | | | - Antoine Adenis
- INSERM CIC1424 Centre d'Investigation Clinique Antilles Guyane, Cayenne, French Guiana
| | - Paulo Peiter
- Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
| | - Céline Michaud
- Centres délocalisés de prévention et de soins, Centre hospitalier de Cayenne, Cayenne, French Guiana
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Vasylyeva TI, Horyniak D, Bojorquez I, Pham MD. Left behind on the path to 90-90-90: understanding and responding to HIV among displaced people. J Int AIDS Soc 2022; 25:e26031. [PMID: 36352546 PMCID: PMC9646984 DOI: 10.1002/jia2.26031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 10/20/2022] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION In 2021, the number of people affected by displacement worldwide reached the highest on record, with an estimated 30.5 million refugees and 4.6 million asylum seekers seeking safety across international borders and further 53.2 million people displaced within their countries of origin. Most forcibly displaced persons come from or relocate to lower- and middle-income countries (LMICs) and many of those countries have large HIV epidemics. In this commentary, we describe some of the challenges at the intersection of HIV and displacement vulnerabilities that cannot be easily addressed in resource-limited environments. DISCUSSION HIV transmission and prevention and treatment efforts in the context of displacement are affected by myriad behavioural, social and structural factors across different stages of the displacement journey. For example, structural barriers faced by people experiencing displacement in relation to HIV prevention and care include funding constraints and legal framework deficiencies. Such barriers prevent all forced migrants, and particularly those whose sexual identities or practices are stigmatized against, access to prevention and care equal to local residents. Xenophobia, racism and other social factors, as well as individual risky behaviours facilitated by experiences of forced migration, also affect the progress towards 90-90-90 targets in displaced populations. Current evidence suggests increased HIV vulnerability in the period before displacement due to the effect of displacement drivers on medical supplies and infrastructure. During and after displacement, substantial barriers to HIV testing exist, though following resettlement in stable displacement context, HIV incidence and viral suppression are reported to be similar to those of local populations. CONCLUSIONS Experiences of often-marginalized displaced populations are diverse and depend on the context of displacement, countries of origin and resettlement, and the nature of the crises that forced these populations to move. To address current gaps in responses to HIV in displacement contexts, research in LMIC, particularly in less stable resettlement settings, needs to be scaled up. Furthermore, displaced populations need to be specifically addressed in national AIDS strategies and HIV surveillance systems. Finally, innovative technologies, such as point-of-care viral load and CD4 testing, need to be developed and introduced in settings facing displacement.
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Affiliation(s)
- Tetyana I. Vasylyeva
- Division of Infectious Diseases and Global Public HealthUniversity of California San DiegoSan DiegoCaliforniaUSA
| | - Danielle's Horyniak
- Public Health DisciplineBurnet InstituteMelbourneVictoriaAustralia
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Ietza Bojorquez
- Department of Population StudiesEl Colegio de la Frontera NorteTijuanaMexico
| | - Minh Duc Pham
- Public Health DisciplineBurnet InstituteMelbourneVictoriaAustralia
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
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Nacher M, Koendjbiharie A, Michaud C, Rabier S, Leborgne C, Rousseau C, Lucarelli A, Thorey C, Gonzales A, Terlutter F, Thomas N, Gastel BV, Biacabe S, Eer MV, Vreden S, Hcini N, Woittiez L. Sexually transmitted infections on the border between Suriname and French Guiana: A scoping review. Front Med (Lausanne) 2022; 9:994964. [PMID: 36275821 PMCID: PMC9583868 DOI: 10.3389/fmed.2022.994964] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 09/06/2022] [Indexed: 12/03/2022] Open
Abstract
Purpose The Maroni basin –delineating the border between Suriname and French Guiana— presents sociocultural, geographical and economic circumstances that have been conducive to the circulation of sexually transmitted infections and to delays in diagnosis and care. Given the scarcity of published data, we aimed to describe different sexually transmitted infections along the Maroni and to gain a broader understanding of the epidemiologic situation. Methods We conducted a scoping review of the efforts to approach the problem of sexually transmitted infections in this complex border area. Temporal trends were plotted and crude numbers were divided by local population numbers. Results For HIV, despite increasing testing efforts, most patients still present at the advanced HIV stage (median CD4 count at diagnosis is < 20 per mm3), and 25% of patients in Saint Laurent du Maroni were lost to follow-up within 6 years. However, progress on both sides has led to a decline in AIDS cases and mortality. Despite a rapid increase in the 1990’s along the Maroni, the current HIV prevalence seemed lower (0.52%) in the rural villages than in coastal urban centers (> 1%). High risk HPV infection prevalence among women reaches 23.3%. The incidence of gonorrhea was 4.2 per 1,000 population aged 15-59. For chlamydiasis it was 3.4 per 1,000 population aged 15-59. For syphilis, the incidence was 2.5 per 1,000 population aged 15-59. Gonorrhea, chlamydiasis, hepatitis B detection increased over time with greater testing efforts and new diagnostic tests. Since the COVID-19 epidemic, congenital syphilis has dramatically increased in Saint Laurent du Maroni reaching 808 per 100,000 live births. Conclusion Sexually transmitted infections seemed more prevalent in Saint Laurent du Maroni –the sole urban center—than in the remote villages along the Maroni. The syndromic approach and the heterogeneity of diagnostic platforms presumably overlook most infections in the region. Therefore, a concerted approach and a shared diagnostic upgrade with molecular diagnosis and rapid diagnostic tests seem necessary to reduce the burden of sexually transmitted infections on both sides of the Maroni. Congenital syphilis resulting from COVID-19 disruption of health services requires urgent attention.
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Affiliation(s)
- Mathieu Nacher
- INSERM CIC1424 Centre d’Investigation Clinique Antilles Guyane, Cayenne, French Guiana,*Correspondence: Mathieu Nacher,
| | | | - Céline Michaud
- Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana
| | - Sébastien Rabier
- Centres Délocalisés de Prévention et de Soins, Cayenne, French Guiana,Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Cyril Leborgne
- Centres Délocalisés de Prévention et de Soins, Cayenne, French Guiana,Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Cyril Rousseau
- Centres Délocalisés de Prévention et de Soins, Cayenne, French Guiana,Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Aude Lucarelli
- Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana
| | - Camille Thorey
- Centre Hospitalier de l’Ouest Guyanais, Saint-Laurent-du-Maroni, French Guiana
| | | | - Fredrik Terlutter
- Centre Hospitalier de l’Ouest Guyanais, Saint-Laurent-du-Maroni, French Guiana
| | - Nadia Thomas
- Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana
| | | | - Sophie Biacabe
- Agence Régionale de Santé Guyane, Cayenne, French Guiana
| | | | | | - Najeh Hcini
- Centre Hospitalier de l’Ouest Guyanais, Saint-Laurent-du-Maroni, French Guiana
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Duplan H, Rabier S, Sudre C, Adriouch L, Lucarelli A, Huber F, Mutricy L, Wojcik JM, Vignier N, Pascolini E, Adenis A, Nacher M. The Evolution of HIV Patient Retention and Care in French Guiana: A Broader View From the Système National des Données de Santé. Front Public Health 2022; 10:823193. [PMID: 35252098 PMCID: PMC8891454 DOI: 10.3389/fpubh.2022.823193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 01/04/2022] [Indexed: 11/13/2022] Open
Abstract
Background Although the simplification of antiretroviral (AVR) treatment regimens and follow-up has led to fewer constraints for patients with HIV, their follow-up remains of paramount importance to optimize AVR therapy, to detect and prevent HIV-related morbidity, and prevent secondary infections. The problem of follow-up interruption in French Guiana has been persistent and seemingly impervious to efforts to alleviate it. Objective The objective was to follow the trend of follow-up interruptions and to test the hypothesis that an increasing number of patients was, in fact, followed by private practitioners. Method Using the complementary lenses of the hospital HIV cohort and the health insurance information system, we looked at the incidence of follow-up interruption and the proportion of patients followed by private practitioners. Results We tallied 803 persons that were not known to have died and who were lost to follow-up. Over time, hospital outpatients were lost to follow-up significantly sooner. By contrast, there was a significant trend with more and more patients exclusively followed by private practitioners. Conclusion While hospital outpatient care remains by far the most common mode of patient care, there seems to be a gradual erosion of this model in favor of private practice.
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Affiliation(s)
- Hélène Duplan
- Direction du Service Médical de la Sécurité Sociale, Cayenne, French Guiana
| | - Sébastien Rabier
- COREVIH Guyane, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Christine Sudre
- Direction du Service Médical de la Sécurité Sociale, Cayenne, French Guiana
| | - Leila Adriouch
- COREVIH Guyane, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Aude Lucarelli
- COREVIH Guyane, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Florence Huber
- COREVIH Guyane, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Louise Mutricy
- COREVIH Guyane, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | | | - Nicolas Vignier
- COREVIH Guyane, Centre Hospitalier de Cayenne, Cayenne, French Guiana
- CIC INSERM 1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Etienne Pascolini
- Direction du Service Médical de la Sécurité Sociale, Cayenne, French Guiana
| | - Antoine Adenis
- COREVIH Guyane, Centre Hospitalier de Cayenne, Cayenne, French Guiana
- CIC INSERM 1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Mathieu Nacher
- COREVIH Guyane, Centre Hospitalier de Cayenne, Cayenne, French Guiana
- CIC INSERM 1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana
- Département Formation Recherche Santé, Université de Guyane, Cayenne, French Guiana
- *Correspondence: Mathieu Nacher
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