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Lemaire JF, Cohn J, Kakayeva S, Tchounga B, Ekouévi PF, Ilunga VK, Ochieng Yara D, Lanje S, Bhamu Y, Haule L, Namubiru M, Nyamundaya T, Berset M, de Souza M, Machekano R, Casenghi M. Improving TB detection among children in routine clinical care through intensified case finding in facility-based child health entry points and decentralized management: A before-and-after study in Nine Sub-Saharan African Countries. PLOS Glob Public Health 2024; 4:e0002865. [PMID: 38315700 PMCID: PMC10843113 DOI: 10.1371/journal.pgph.0002865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 01/03/2024] [Indexed: 02/07/2024]
Abstract
In 2022, an estimated 1.25 million children <15 years of age developed tuberculosis (TB) worldwide, but >50% remained undiagnosed or unreported. WHO recently recommended integrated and decentralized models of care as an approach to improve access to TB services for children, but evidence remains limited. The Catalyzing Paediatric TB Innovation project (CaP-TB) implemented a multi-pronged intervention to improve TB case finding in children in nine sub-Saharan African countries. The intervention introduced systematic TB screening in different facility-based child-health entry-points, decentralisation of TB diagnosis and management, improved sample collection with access to Xpert® MTB/RIF or MTB/RIF Ultra testing, and implementation of contact investigation. Pre-intervention records were compared with those during intervention to assess effect on paediatric TB cascade of care. The intervention screened 1 991 401 children <15 years of age for TB across 144 health care facilities. The monthly paediatric TB case detection rate increased significantly during intervention versus pre-intervention (+46.0%, 95% CI 36.2-55.8%; p<0.0001), with variability across countries. The increase was greater in the <5 years old compared to the 5-14 years old (+53.4%, 95% CI 35.2-71.9%; p<0.0001 versus +39.9%, 95% CI 27.6-52.2%; p<0.0001). Relative contribution of lower-tier facilities to total case detection rate increased from 37% (71.8/191.8) pre-intervention to 50% (139.9/280.2) during intervention. The majority (89.5%) of children with TB were identified through facility-based intensified case-finding and primarily accessed care through outpatient and inpatient departments. In this multi-country study implemented under real-life conditions, the implementation of integrated and decentralized interventions increased paediatric TB case detection. The increase was driven by lower-tier facilities that serve as the primary point of healthcare contact for most patients. The effect was greater in children < 5 years compared to 5-14 years old, representing an important achievement as the TB detection gap is higher in this subpopulation. (Study number NCT03948698).
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Affiliation(s)
| | - Jennifer Cohn
- Division of Infectious Diseases, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Shirin Kakayeva
- Elizabeth Glaser Pediatric AIDS Foundation, Washington, District of Columbia, United States of America
| | - Boris Tchounga
- Elizabeth Glaser Pediatric AIDS Foundation, Yaounde, Cameroon
| | | | - Vicky Kambaji Ilunga
- Elizabeth Glaser Pediatric AIDS Foundation, Kinshasa, République Démocratique du Congo
| | | | - Samson Lanje
- Elizabeth Glaser Pediatric AIDS Foundation, Maseru, Lesotho
| | - Yusuf Bhamu
- Elizabeth Glaser Pediatric AIDS Foundation, Lilongwe, Malawi
| | - Leo Haule
- Elizabeth Glaser Pediatric AIDS Foundation, Dar es Salaam, Tanzania
| | - Mary Namubiru
- Elizabeth Glaser Pediatric AIDS Foundation, Kampala, Uganda
| | | | - Maude Berset
- Elizabeth Glaser Pediatric AIDS Foundation, Geneva, Switzerland
| | | | - Rhoderick Machekano
- Elizabeth Glaser Pediatric AIDS Foundation, Washington, District of Columbia, United States of America
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Dzudie A, Tchendjou P, Khan EM, Ajeh R, Thienemann F, Tiam A, Tchounga B, Fokam J, Ndongmo C, Ebasone PV, Mabou G, Goura AP, Shu EN, Katayi T, Nji PA, Ngamani ML, Lengouh C, Tabala FN, Takem EN, Bakor A, Nekame LG, Djikeussi T, Semengue ENJ, Fon KT, Chenwi C, Nasah JL, Ngeke GN, Tasha MR, Ndiforkwah N, Nyemb G, Nshom E, N´Draman C, Wenze CA, Simo L, Ndayisaba G, Kang WK, Nka AD, Tchakounte BY, Lekeumo S, Neba E, Agbornkwai N, Bwemba TA, Muffih PT, Zoung-Kany Bisseck AC, Njock LR. Research for Health Care and Policy on HIV/AIDS: proceedings of the third edition of the Cameroon HIV Research (CAM-HERO) 2022, Kribi, Cameroon, from 1 st to 3 rd December 2022. Pan Afr Med J 2023; 46:6. [PMID: 37928216 PMCID: PMC10620442 DOI: 10.11604/pamj.2023.46.6.40711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 06/28/2023] [Indexed: 11/07/2023] Open
Abstract
Cameroon is committed to reaching HIV epidemic control through coordinated efforts by the Ministry of Public Health, the National AIDS Control Committee, bilateral/multilateral institutions and implementing partners. The third edition of the Cameroon HIV Research Forum (CAM-HERO) was held in Kribi from December 1st to 3rd, 2022, with the theme "Research for Health Care and Policy on HIV/AIDS." The conference brought together local and international scientists and clinicians, policymakers, and regulatory authorities to 1) disseminate HIV research findings and HIV policy; 2) foster operational research collaboration; 3) build research capacity through training on basics of research methods and CAM-HERO young investigator Awards; and 4) initiate a guideline for promoting HIV/AIDS research in Cameroon. The main activities included training on research methodology and basic principles in bioethics, presentations of selected abstracts, and awards for top research. A total of 35 abstracts (16 oral presentations, 16 posters, and 3 late-breaker-abstracts) were selected for presentation following a rigorous review. The conference ended with evidence-based recommendations and a way-forward statement for the development of a National Guide for HIV/AIDS research in Cameroon, with the aim of improving the quality and quantity of research agenda and projects nationwide.
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Affiliation(s)
- Anastase Dzudie
- Clinical Research Education, Networking and Consultancy, Yaoundé, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- Department of Internal Medicine and Subspecialties, Douala General Hospital, Douala, Cameroon
- Lown Scholars Program, Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, United States of America
| | - Patrice Tchendjou
- Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), Yaoundé, Cameroon
| | - Eveline Mboh Khan
- Cameroon Baptist Convention Health Services (CBCHS), Bamenda, Cameroon
| | - Rogers Ajeh
- Clinical Research Education, Networking and Consultancy, Yaoundé, Cameroon
- National AIDS Control Committee, Ministry of Public Health, Yaoundé, Cameroon
| | - Friedrich Thienemann
- General Medicine & Global Health, Department of Medicine and Cape Heart Institute, Faculty of Health Science, University of Cape Town, Cape Town, South Africa
- Department of Internal Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Boris Tchounga
- Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), Yaoundé, Cameroon
| | - Joseph Fokam
- Chantal BIYA International Reference Centre for research on HIV/AIDS Prevention and Management, Yaounde, Cameroon
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
- National HIV Drug Resistance Prevention and Surveillance Working Group, Ministry of Public Health, Yaounde, Cameroon
| | - Clement Ndongmo
- Division of Global HIV and TB, Center for Global Health, U.S, Center for Diseases Control and Prevention, Yaoundé, Cameroon
| | - Peter Vanes Ebasone
- Clinical Research Education, Networking and Consultancy, Yaoundé, Cameroon
- Department of Medicine, Faculty of Health Science, University of Cape Town, Cape Town, South Africa
| | - Gabriel Mabou
- Clinical Research Education, Networking and Consultancy, Yaoundé, Cameroon
| | | | - Emile Nforbih Shu
- Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), Yaoundé, Cameroon
| | - Tshimwanga Katayi
- Cameroon Baptist Convention Health Services (CBCHS), Bamenda, Cameroon
| | - Pascal Atanga Nji
- Cameroon Baptist Convention Health Services (CBCHS), Bamenda, Cameroon
| | | | - Clarisse Lengouh
- Clinical Research Education, Networking and Consultancy, Yaoundé, Cameroon
| | - Felicite Naah Tabala
- Division of Health Operational Research, Ministry of Public Health, Yaoundé, Cameroon
| | - Ebako Ndip Takem
- Division of Global HIV and TB, Center for Global Health, U.S, Center for Diseases Control and Prevention, Yaoundé, Cameroon
| | - Albert Bakor
- Cameroon Baptist Convention Health Services (CBCHS), Bamenda, Cameroon
| | | | - Tatiana Djikeussi
- Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), Yaoundé, Cameroon
| | | | - Kandel Tebong Fon
- Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), Yaoundé, Cameroon
| | - Collins Chenwi
- Chantal BIYA International Reference Centre for research on HIV/AIDS Prevention and Management, Yaounde, Cameroon
| | | | - George Njie Ngeke
- Clinical Research Education, Networking and Consultancy, Yaoundé, Cameroon
| | | | | | - Grace Nyemb
- Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), Yaoundé, Cameroon
| | - Emmanuel Nshom
- Cameroon Baptist Convention Health Services (CBCHS), Bamenda, Cameroon
| | - Clovis N´Draman
- Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), Yaoundé, Cameroon
| | | | - Leonie Simo
- Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), Yaoundé, Cameroon
| | - Gilles Ndayisaba
- Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), Yaoundé, Cameroon
| | - Walters Kum Kang
- Cameroon Baptist Convention Health Services (CBCHS), Bamenda, Cameroon
| | - Alex Durand Nka
- Chantal BIYA International Reference Centre for research on HIV/AIDS Prevention and Management, Yaounde, Cameroon
| | | | - Simplice Lekeumo
- Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), Yaoundé, Cameroon
| | - Esther Neba
- Bamenda Regional Hospital, Bamenda, Cameroon
| | | | - Therese Abong Bwemba
- Catholic University of Central Africa, School of Health Sciences, Yaounde, Cameroon
| | - Pius Tih Muffih
- Cameroon Baptist Convention Health Services (CBCHS), Bamenda, Cameroon
| | | | - Louis Richard Njock
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- General Secretariat, Ministry of Public Health, Yaoundé, Cameroon
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Powell L, Denoeud-Ndam L, Herrera N, Masaba R, Tchounga B, Siamba S, Ouma M, Petnga SJ, Machekano R, Pamen B, Okomo G, Simo L, Casenghi M, Rakhmanina N, Tiam A. HIV matters when diagnosing TB in young children: an ancillary analysis in children enrolled in the INPUT stepped wedge cluster randomized study. BMC Infect Dis 2023; 23:234. [PMID: 37069518 PMCID: PMC10107571 DOI: 10.1186/s12879-023-08216-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 04/03/2023] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND Children under age five years, particularly those living with HIV (CLHIV), are at risk for rapid progression of tuberculosis (TB). We aimed to describe TB clinical presentations, diagnostic pathways and treatment outcomes in CLHIV compared to children without HIV in Cameroon and Kenya. METHODS This sub-analysis of a cluster-randomized trial evaluating the integration of pediatric TB services from May 2019 to March 2021 enrolled children age < 5 years with TB. We estimated the HIV infection rate with 95% confidence interval (CI). We compared TB clinical presentations, diagnostic pathways and treatment outcomes in CLHIV and children without HIV. Finally, we investigated whether HIV infection was associated with a shorter time to TB diagnosis (≤ 3 months from symptoms onset) after adjusting for covariates. Univariable and multivariable logistic regression analysis were performed with adjusted odds ratios (AORs) presented as measures of the association of covariates with HIV status and with shorter time to TB diagnosis. RESULTS We enrolled 157 children with TB (mean age was 1.5 years) and 22/157 (14.0% [9.0-20.4%]) were co-infected with HIV. CLHIV were more likely to initially present with acute malnutrition (AOR 3.16 [1.14-8.71], p = 0.027). Most TB diagnoses (140/157, 89%) were made clinically with pulmonary TB being the most common presentation; however, there was weak evidence of more frequent bacteriologic confirmation of TB in CLHIV, 18% vs. 9% (p = 0.067), due to the contribution of lateral-flow urine lipoarabinomannan to the diagnosis. HIV positivity (AOR: 6.10 [1.32-28.17], p = 0.021) was independently associated with a shorter time to TB diagnosis as well as fatigue (AOR: 6.58 [2.28-18.96], p = 0.0005), and existence of a household contact diagnosed with TB (AOR: 5.60 [1.58-19.83], p = 0.0075), whereas older age (AOR: 0.35 [0.15-0.85], p = 0.020 for age 2-5 years), night sweats (AOR: 0.24 [0.10-0.60], p = 0.0022) and acute malnutrition (AOR: 0.36 [0.14-0.92], p = 0.034) were associated with a delayed diagnosis. The case fatality rate was 9% (2/22) in CLHIV and 4% (6/135) in children without HIV, p = 0.31. CONCLUSIONS These results altogether advocate for better integration of TB services into all pediatric entry points with a special focus on nutrition services, and illustrate the importance of non-sputum-based TB diagnostics especially in CLHIV. TRIAL REGISTRATION NCT03862261, first registration 05/03/2019.
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Affiliation(s)
- L Powell
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - L Denoeud-Ndam
- Elizabeth Glaser Pediatric AIDS Foundation, Geneva, Switzerland.
| | - N Herrera
- Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, USA
| | - R Masaba
- Elizabeth Glaser Pediatric AIDS Foundation, Nairobi, Kenya
| | - B Tchounga
- Elizabeth Glaser Pediatric AIDS Foundation, Yaounde, Cameroon
| | - S Siamba
- Elizabeth Glaser Pediatric AIDS Foundation, Nairobi, Kenya
| | - M Ouma
- Elizabeth Glaser Pediatric AIDS Foundation, Nairobi, Kenya
| | - S J Petnga
- Elizabeth Glaser Pediatric AIDS Foundation, Yaounde, Cameroon
| | - R Machekano
- Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, USA
| | - B Pamen
- Department of Disease, Epidemic and pandemic control, Ministry of Health, Yaounde, Cameroon
| | - G Okomo
- Department of Health, Homa Bay county Government, Homa Bay, Kenya
| | - L Simo
- Elizabeth Glaser Pediatric AIDS Foundation, Yaounde, Cameroon
| | - M Casenghi
- Elizabeth Glaser Pediatric AIDS Foundation, Geneva, Switzerland
| | - N Rakhmanina
- Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, USA
| | - A Tiam
- Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, USA
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Katirayi L, Tchendjou P, Tchounga B, Mbunka M, Wicks M, Conserve DF. Changing attitudes towards HIV testing and treatment among three generations of men in Cameroon: a qualitative analysis using the Fogg Behavior Model. BMC Public Health 2023; 23:501. [PMID: 36922812 PMCID: PMC10015680 DOI: 10.1186/s12889-023-15139-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 01/25/2023] [Indexed: 03/17/2023] Open
Abstract
INTRODUCTION Men are less likely than women to test for HIV and promptly initiate antiretroviral treatment, resulting in advanced HIV disease and increased mortality rates among them. METHODS In-depth interviews were conducted with men and leaders in the west and central regions of Cameroon. Men were recruited from existing community groups and stratified by age: 21-30 years, 31-40 years, and 41 years and older. Community leaders were recommended by the community dialogue structure chairman. Interviews were conducted using a semi-structured guide in English or French, depending on the participant's preference. Transcripts were coded in the MAXQDA v.12 software and analyzed using thematic analysis and by age group. The Fogg Behavior Model was used to gain a deeper understanding of the different perceptions across all age groups. RESULTS Younger men (21-30 years) were generally more accepting of HIV testing, as it had become normative behavior. Although financial barriers could limit access, free testing was mentioned as a prompt to initiate HIV testing. The middle age men (31-40 years) had the most concerns about HIV testing interrupting their work day and recommended increasing testing locations and hours. The older men (41 + years) were the least motivated to get tested, citing worries about the impact on their social standing within the community. All age groups reported being motivated to begin treatment if they were found to be HIV-positive. Participants also provided insights regarding community HIV testing and treatment messaging. Younger and older men preferred to hear directly from qualified health professionals, but younger men noted that social media, radio, and TV could be utilized. Middle age men also identified TV and radio as effective mediums, if door-to-door messaging was not an option. CONCLUSIONS The study highlights important considerations when planning future information-sharing activities for HIV testing and treatment. Since lived experiences differ across generations and societal roles continue to change, not only should the content of messages differ among the generations, but the means of communication must also be considered to ensure the messages are conveyed through a trusted source.
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Affiliation(s)
- Leila Katirayi
- Research Department, Elizabeth Glaser Pediatric AIDS Foundation, 1350 Eye St NW, Suite 400, Washington, DC 20005 USA
| | - Patrice Tchendjou
- Programs Department, Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroon
| | - Boris Tchounga
- Research Department, Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroon
| | - Muhamed Mbunka
- Research Department, Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroon
| | - Madison Wicks
- Department of Anthropology, George Washington University, Washington, DC USA
| | - Donaldson F. Conserve
- Milken Institute School of Public Health, George Washington University, Washington, DC USA
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Ka’e AC, Nka AD, Yagai B, Domkam Kammogne I, Ngoufack Jagni Semengue E, Nanfack AJ, Nkenfou C, Tommo Tchouaket MC, Takou D, Sosso SM, Fainguem N, Abba A, Pabo W, Kamgaing N, Temgoua E, Tchounga B, Tchendjou P, Tetang S, Njom Nlend AE, Ceccherini-Silberstein F, Mercedes Santoro M, Fokam J. The mother-to-child transmission of HIV-1 and profile of viral reservoirs in pediatric population: A systematic review with meta-analysis of the Cameroonian studies. PLoS One 2023; 18:e0278670. [PMID: 36649370 PMCID: PMC9844886 DOI: 10.1371/journal.pone.0278670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 11/21/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The mother-to-child transmission of HIV-1 (MTCT) remains on the major route of HIV-transmission among pediatric populations in Africa. Though a prevention of MTCT (PMTCT) high-priority country, data on the MTCT burdens in Cameroon remains fragmented. OBJECTIVE We sought to assess the pooled MTCT rate, its risk-factors, and to characterize viral reservoirs of infected-children in Cameroon. METHODS All relevant observational cohort and cross-sectional studies conducted in Cameroon were searched from PubMed, African Journals Online, Google scholar, ScienceDirect and academic medical education databases. Heterogeneity and publication bias were respectively assessed by the I2 statistic and the Egger/funnel plot test. Meta-analysis was performed using the random effects model. MTCT rate >5% was considered as "high". This review was registered in the Prospero database, CRD42021224497. RESULTS We included a total of 29 studies and analyzed 46 684 children born from HIV-positive mothers. The overall rate of MTCT was 7.00% (95% CI = 6.07-8.51). According to regions, the highest burden was in Adamaoua-region (17.51% [95% CI:14.21-21.07]) with only one study found. PMTCT option-B+ resulted in about 25% reduction of MTCT (8.97% [95% CI: 8.71-9.24] without option-B+ versus 2.88% [95% CI: 5.03-9.34] with option-B+). Regarding risk-factors, MTCT was significantly associated with the absence of PMTCT-interventions both in children (OR:5.40 [95% CI: 2.58-11.27]) and mothers (OR: 3.59 [95% CI: 2.15-5.99]). Regarding viral reservoirs, a pro-viral DNA mean of 3.34±1.05 log10/mL was observed among 5/57 children and archived HIV drug resistance mutations were identified in pro-viral DNA marker among 21/79 infected-children. CONCLUSION In spite of the dropdown in MTCT following option-B+ implementation, MTCT remains high in Cameroon, with substantial disparities across regions. Thus, in this era of option-B+, achieving MTCT elimination requires interventions in northern-Cameroon. The variation in pro-viral load in infected-children underlines the relevance of characterizing viral reservoirs for possible infection control in tropical settings.
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Affiliation(s)
- Aude Christelle Ka’e
- Chantal Biya International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), Yaounde, Cameroon
- University of Rome “Tor Vergata” (UTV-Rome), Rome, Italy
- * E-mail: (ACK); (JF)
| | - Alex Durand Nka
- Chantal Biya International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), Yaounde, Cameroon
- University of Rome “Tor Vergata” (UTV-Rome), Rome, Italy
| | - Bouba Yagai
- Chantal Biya International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), Yaounde, Cameroon
- University of Rome “Tor Vergata” (UTV-Rome), Rome, Italy
| | | | - Ezechiel Ngoufack Jagni Semengue
- Chantal Biya International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), Yaounde, Cameroon
- University of Rome “Tor Vergata” (UTV-Rome), Rome, Italy
| | - Aubin Joseph Nanfack
- Chantal Biya International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), Yaounde, Cameroon
| | - Celine Nkenfou
- Chantal Biya International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), Yaounde, Cameroon
- Higher Teachers Training College, University of Yaounde I, Yaounde, Cameroon
| | - Michel Carlos Tommo Tchouaket
- Chantal Biya International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), Yaounde, Cameroon
- Catholic University of Central Africa (UCAC), Yaounde, Cameroon
| | - Desire Takou
- Chantal Biya International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), Yaounde, Cameroon
| | - Samuel Martin Sosso
- Chantal Biya International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), Yaounde, Cameroon
| | - Nadine Fainguem
- Chantal Biya International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), Yaounde, Cameroon
- University of Rome “Tor Vergata” (UTV-Rome), Rome, Italy
| | - Aissatou Abba
- Chantal Biya International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), Yaounde, Cameroon
| | - Willy Pabo
- Chantal Biya International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), Yaounde, Cameroon
- University of Buea, Buea, Cameroon
| | - Nelly Kamgaing
- Chantal Biya International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), Yaounde, Cameroon
| | - Edith Temgoua
- National AIDS Control Committee (CNLS), Yaounde, Cameroun
| | - Boris Tchounga
- Elisabeth Glaser Pediatric AIDS Foundation (EGPAF), Douala, Cameroon
| | - Patrice Tchendjou
- Elisabeth Glaser Pediatric AIDS Foundation (EGPAF), Douala, Cameroon
| | - Suzie Tetang
- National Social Welfare Hospital (CHE), Yaounde, Cameroon
| | | | | | | | - Joseph Fokam
- Chantal Biya International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), Yaounde, Cameroon
- University of Buea, Buea, Cameroon
- * E-mail: (ACK); (JF)
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Zobo PC, Touré FY, Coulibaly I, Bitty-Anderson AM, Boni SP, Niangoran S, Guié A, Kouakou H, Tchounga B, Coffie PA, Ekouevi DK. Prevalence of hypertension and other cardiovascular disease risk factors among university students from the National Polytechnic Institute of Côte d'Ivoire: A cross-sectional study. PLoS One 2023; 18:e0279452. [PMID: 36602980 PMCID: PMC9815567 DOI: 10.1371/journal.pone.0279452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 12/08/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Cardiovascular diseases (CVD) are the leading causes of death in the world, mainly occurring in low-and-middle income countries. The aim of this study was to estimate the prevalence of hypertension and other cardiovascular risk factors among university students at a National Polytechnic Institute in Côte d'Ivoire. METHODS A cross-sectional study was conducted among students of the National Polytechnic Institute of Côte d'Ivoire. Sample was selected using a non-probabilistic convenient sampling method. Anthropometric measurements, blood pressure and capillary blood glucose were measured. A logistic regression model allowed to determine factors associated with hypertension. RESULTS A total of 2,030 students, 79.7% males and 20.3% females, with a median age of 20 years (IQR = [19-22]) participated in the study. On hypertension knowledge, 96.9% (n = 1,968) of students reported having heard of hypertension; salty foods were reported by more than a third as a cause of hypertension (n = 734; 37.3%), while 114 (5.8%) and 157 (8.0%) selected tobacco and alcohol as causes of hypertension, respectively. The overall prevalence of hypertension was 6.0%, higher in males (6.8%) compared to females (2.7%) (p < 0.001). As for CVD risk factors, 148 (7.3%) were overweight or obese; 44.0% of males and 36.6% of females reported alcohol consumption. In multivariate analysis, being a female (OR = 4.16; CI 95% = [1.96-9.09]; p<0.001), being 25 years old and older (OR = 3.34; CI 95% = [2.01-5.55]; p = 0.001), tobacco use (OR = 2.65; CI 95% = [1.41-4.96]; p = 0.002), being overweight or obese (OR = 3.75; CI 95% = [2.13-6.59]; p<0,001) and having abnormal waist circumference (OR = 6.24; CI 95% = [1.99-19.51]; p = 0.002) were significantly associated with high blood pressure. CONCLUSION CVD risk factors are prominent among young adults in Côte d'Ivoire. Appropriate behavioural health interventions promoting a healthy lifestyle for young adults should be urgently implemented for CVD burden reduction.
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Affiliation(s)
| | - Frank Y. Touré
- PACCI Program, Abidjan, Côte d’Ivoire
- * E-mail: (FYT); (PAC)
| | - Iklo Coulibaly
- Department of Cardiology and Cardiothoracic Surgery, Training and Research Unit of Medical Sciences, Félix Houphouët Boigny University, Abidjan, Côte d’Ivoire
- Heart Institute of Abidjan, Abidjan, Côte d’Ivoire
| | | | | | | | | | | | | | - Patrick A. Coffie
- PACCI Program, Abidjan, Côte d’Ivoire
- Department of Dermatology and Infectiology, Training and Research Unit of Medical Sciences, Félix Houphouët Boigny University, Abidjan, Côte d’Ivoire
- Department of Infectious and Tropical Diseases, University Hospital Center of Treichville, Abidjan, Côte d’Ivoire
- * E-mail: (FYT); (PAC)
| | - Didier K. Ekouevi
- PACCI Program, Abidjan, Côte d’Ivoire
- Département of Public Health, University of Lomé, Lomé, Togo
- Inserm Center, 1219, University of Bordeaux, Bordeaux, France
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7
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Tchendjou P, Ebasone PV, Dzudie A, Khan EM, Fokam J, Muffih PT, Ndjolo A, Nyoto LB, Kouanfack C, Mabou G, Djikeussi T, Sih C, Ateudjieu J, Tchounga B, Tchakounte BY, Lekeumo S, Tabala FN, Atanga B, Simo L, Bakari M, Zemsi A, Nforbih ES, Ndayisaba G, Petnga SJ, Nguemo JL, Ngamani ML, Fon P, Nasah J, Neba E, Njie G, Ndiforkwah N, Semengue EN, Katayi T, Tene G, Nji PA, Njankou E, Agbornkwai N, Tiam A, Ditekemena J, Ndongmo C, Bwemba TA, Billong SC, Bisseck ACZK, Njock LR. Evidence for an enhanced HIV/AIDS policy and care in Cameroon: proceedings of the second Cameroon HIV Research Forum (CAM-HERO) 2021. Pan Afr Med J 2022; 43:92. [PMID: 36699972 PMCID: PMC9834801 DOI: 10.11604/pamj.2022.43.92.37080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 09/20/2022] [Indexed: 11/07/2022] Open
Abstract
To attain the HIV 95-95-95 goals by 2030 in Cameroon, high quality research to inform policy and patient care is of utmost importance. In the context of limited workforce and resources, collaborations, sharing of locally-adapted strategies and other field experience, leveraging on existing and innovative platforms would facilitate a coordinated and optimal AIDS response at country level. The second edition of the Cameroon HIV Research Forum (CAM-HERO) conference took place both physically and virtually on November 18 and 19, 2021 in Kribi, on the theme "Research for Policy and Care". This scientific event brought together Cameroonian HIV/AIDS researchers, experienced clinicians and regulatory authorities to foster i) the dissemination of research findings and facilitate translation into policy, ii) operational research collaboration, iii) identification of new research areas, and iv) capacity building. To achieve the set objectives during this event, a consensus on research priorities for accelerating the achievement of three 95 HIV goals in Cameroon were summarized; meeting sessions included 31 abstract presentations, 13 discussions, and presentations on various aspects of HIV research including ethics, administrative procedures and needs for capacity building; training of young scientists on guidelines for research proposal development toward ethical clearance was done; and a platform for discussion between researchers and regulatory authorities was conducted around the design and setting-up of a national HIV/AIDS research agenda. CAM-HERO 2021 brought together HIV researchers, experts and junior scientists around major programmatic challenges, evidence to translate into practice, research priorities on HIV/AIDS. Collaborations were reinforced, capacities were strengthened, and footprints were established towards a consensus on a national HIV/AIDS research agenda.
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Affiliation(s)
- Patrice Tchendjou
- Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), Yaoundé, Cameroon
| | | | - Anastase Dzudie
- Clinical Research Education, Networking and Consultancy, Yaoundé, Cameroon,,Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon,,Department of Internal Medicine and Subspecialities, Douala General Hospital, Douala, Cameroon,,Lown Scholars Program, Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, USA,,Corresponding author: Anastase Dzudie, Department of Internal Medicine and Subspecialties, Douala General Hospital, Douala, Cameroon.
| | - Eveline Mboh Khan
- Cameroon Baptist Convention Health Services (CBCHS), Bamenda, Cameroon
| | - Joseph Fokam
- Chantal Biya International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), Yaoundé, Cameroon,,Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Pius Tih Muffih
- Cameroon Baptist Convention Health Services (CBCHS), Bamenda, Cameroon
| | - Alexis Ndjolo
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon,,Chantal Biya International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), Yaoundé, Cameroon
| | | | - Charles Kouanfack
- HIV Day Hospital, Yaoundé Central Hospital, Yaoundé, Cameroon,,Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
| | - Gabriel Mabou
- Clinical Research Education, Networking and Consultancy, Yaoundé, Cameroon
| | - Tatiana Djikeussi
- Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), Yaoundé, Cameroon
| | - Colette Sih
- Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), Yaoundé, Cameroon
| | - Jerome Ateudjieu
- Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon,,Division of Health Operational Research, Ministry of Public Health, Yaoundé, Cameroon
| | - Boris Tchounga
- Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), Yaoundé, Cameroon
| | | | - Simplice Lekeumo
- Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), Yaoundé, Cameroon
| | - Felicite Naah Tabala
- Division of Health Operational Research, Ministry of Public Health, Yaoundé, Cameroon
| | - Benjamin Atanga
- Division of Health Operational Research, Ministry of Public Health, Yaoundé, Cameroon
| | - Leonie Simo
- Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), Yaoundé, Cameroon
| | - Madeleine Bakari
- Division of Health Operational Research, Ministry of Public Health, Yaoundé, Cameroon
| | - Armel Zemsi
- Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), Yaoundé, Cameroon
| | - Emile Shu Nforbih
- Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), Yaoundé, Cameroon
| | - Gilles Ndayisaba
- Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), Yaoundé, Cameroon
| | - Saint Just Petnga
- Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), Yaoundé, Cameroon
| | - Julie Laure Nguemo
- Clinical Research Education, Networking and Consultancy, Yaoundé, Cameroon
| | | | - Phyllis Fon
- Clinical Research Education, Networking and Consultancy, Yaoundé, Cameroon,,Limbe Regional Hospital, Limbe, Cameroon
| | - Judith Nasah
- Clinical Research Education, Networking and Consultancy, Yaoundé, Cameroon,,Limbe Regional Hospital, Limbe, Cameroon
| | - Esther Neba
- Clinical Research Education, Networking and Consultancy, Yaoundé, Cameroon,,Bamenda Regional Hospital, Bamenda, Cameroon
| | - George Njie
- Clinical Research Education, Networking and Consultancy, Yaoundé, Cameroon,,Bamenda Regional Hospital, Bamenda, Cameroon
| | - Nicoline Ndiforkwah
- Clinical Research Education, Networking and Consultancy, Yaoundé, Cameroon,,Jamot Hospital, Yaoundé, Cameroon
| | - Ezechiel Ngoufack Semengue
- Chantal Biya International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), Yaoundé, Cameroon
| | - Tshimwanga Katayi
- Cameroon Baptist Convention Health Services (CBCHS), Bamenda, Cameroon
| | - Gilbert Tene
- Cameroon Baptist Convention Health Services (CBCHS), Bamenda, Cameroon
| | - Pascal Atanga Nji
- Cameroon Baptist Convention Health Services (CBCHS), Bamenda, Cameroon
| | | | - Nyenty Agbornkwai
- Cameroon Baptist Convention Health Services (CBCHS), Bamenda, Cameroon
| | - Appolinaire Tiam
- Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), Yaoundé, Cameroon
| | - John Ditekemena
- Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), Yaoundé, Cameroon
| | - Clement Ndongmo
- Division of Global HIV and TB, Center for Global health, U.S, Center for Diseases Control and Prevention, Yaoundé, Cameroon
| | | | - Serge Clotaire Billong
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon,,National AIDS Control Committee, Ministry of Public Health, Yaoundé, Cameroon
| | - Anne Cecile Zoung-Kany Bisseck
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon,,Division of Health Operational Research, Ministry of Public Health, Yaoundé, Cameroon
| | - Louis Richard Njock
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon,,General Secretariat, Ministry of Public Health, Yaoundé, Cameroon
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Tchounga B, Ajeh R, Djikeussi T, Ebasone PV, Tchendjou P, Anoubissi J, Semengue ENJ, Nkouanfack C, Kamgang FY, Varloteaux M, Tchakounte BY, Tabala FN, Atanga B, Simo L, Ateudjieu J, Zemsi A, Nasah LJ, Ngeke NG, Ndiforkwah N, Bouseko MT, Sandjong FT, Shu EN, Bakari M, Tiojio Y, Ndayisaba G, Annereke N, Ntabe AC, Bwemba TA, Billong SC, Bisseck ACZK, Ditekemena J, Dzudie A. Outcomes of the first meeting of the CAMEROON HIV RESEARCH FORUM (CAM-HERO). Pan Afr Med J 2022; 40:166. [PMID: 34970408 PMCID: PMC8683448 DOI: 10.11604/pamj.2021.40.166.31058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 11/17/2021] [Indexed: 12/05/2022] Open
Abstract
Research is a vital component for the development of any country. In Cameroon, HIV Operational research is rapidly growing, however, it faces some intractable problems which can only be solved through an urgent, strategic, efficient, and collaborative approach involving key stakeholders. The Kribi meeting (09 and 10th December 2020) brought together under the auspices of the Ministry of Public Health leading HIV research organisations and connected HIV researchers and actors from different sectors. These actors disseminated and discussed recent research findings and worked out mechanisms to advance HIV research development, developed new ideas and identified priority research areas, with emphasis on translational research. The official launching and consolidation of Cam-HERO was a critical step and it is hoped that these synergistic efforts will catalyse attainment of the 95-95-95 goals in Cameroon.
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Affiliation(s)
- Boris Tchounga
- Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroon
| | - Rogers Ajeh
- Clinical Research Education, Networking and Consultancy, Yaoundé, Cameroon.,Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | | | - Peter Vanes Ebasone
- Clinical Research Education, Networking and Consultancy, Yaoundé, Cameroon.,Department of Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Jean Anoubissi
- National AIDS Control Committee, Ministry of Public Health, Yaoundé, Cameroon
| | | | - Charles Nkouanfack
- HIV Day Hospital, Yaoundé Central Hospital, Yaoundé, Cameroon.,Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
| | - Fabrice Youbi Kamgang
- Division of the Fight against Diseases, Ministry of Public Health, Yaoundé, Cameroon
| | - Marie Varloteaux
- Cameroon Office, National Agency for Research on AIDS (ANRS), Yaoundé, Cameroon
| | | | - Felicite Naah Tabala
- Division of Health Operational Research, Ministry of Public Health, Yaoundé, Cameroon
| | - Benjamin Atanga
- Division of Health Operational Research, Ministry of Public Health, Yaoundé, Cameroon
| | - Leonie Simo
- Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroon
| | - Jérôme Ateudjieu
- Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
| | - Armel Zemsi
- Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroon
| | | | | | | | | | | | | | - Madeleine Bakari
- Division of Health Operational Research, Ministry of Public Health, Yaoundé, Cameroon
| | - Yves Tiojio
- Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroon
| | | | | | | | | | - Serge Clotaire Billong
- National AIDS Control Committee, Ministry of Public Health, Yaoundé, Cameroon.,Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Anne Cecile Zoung-Kanyi Bisseck
- Division of Health Operational Research, Ministry of Public Health, Yaoundé, Cameroon.,Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - John Ditekemena
- Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroon
| | - Anastase Dzudie
- Clinical Research Education, Networking and Consultancy, Yaoundé, Cameroon.,Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.,Service of Internal Medicine and Subspecialities, Douala General Hospital, Douala, Cameroon.,Lown Scholars Program, Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, USA
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9
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Dzudie A, Tchounga B, Ajeh R, Kouanfack C, Ebasone PV, Djikeussi T, Nyoto LB, Fokam J, Ateudjieu J, Tchendjou P, Semengue ENJ, Kamgang FY, Anoubessi J, Varloteaux M, Youngui B, Tabala FN, Atanga B, Simo L, Zemsi A, Shu EN, Ndayisaba G, Nyenti A, Ntabe AC, Bwemba TA, Sobngwi E, Billong SC, Ditekemena J, Bissek ACZK, Njock LR. Research priorities for accelerating the achievement of three 95 HIV goals in Cameroon: a consensus statement from the Cameroon HIV Research Forum (CAM-HERO). Pan Afr Med J 2021; 40:124. [PMID: 34909092 PMCID: PMC8641633 DOI: 10.11604/pamj.2021.40.124.31068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 09/05/2021] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION the Treat-All remains the globally endorsed approach to attain the 95-95-95 targets and end the AIDS pandemic by 2030, but requires some country-level contextualization. In Cameroon, the specific research agenda to inform strategies for improving HIV policy was yet to be defined. METHODS under the patronage of the Cameroon Ministry of health, researchers, policy makers, implementing partners, and clinicians from 13 institutions, used the Delphi method to arrive at a consensus of HIV research priorities. The process had five steps: 1) independent literature scan by 5 working groups; 2) review of the initial priority list; 3) appraisal of priorities list in a larger group; 4) refinement and consolidation by a consensus group; 5) rating of top research priorities. RESULTS five research priorities and corresponding research approaches, resulted from the process. These include: 1) effectiveness, safety and active toxicity monitoring of new and old antiretrovirals; 2) outcomes of Antiretroviral Therapy (ART) with focus in children and adolescents; 3) impact of HIV and ART on aging and major chronic diseases; 4) ART dispensation models and impact on adherence and retention; 5) evaluations of HIV treatment and prevention programs. CONCLUSION the research priorities resulted from a consensus amongst a multidisciplinary team and were based on current data about the pandemic and science to prevent, treat, and ultimately cure HIV. These priorities highlighted critical areas of investigation with potential relevance for the country, funders, and regulatory bodies.
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Affiliation(s)
- Anastase Dzudie
- Clinical Research Education, Networking and Consultancy, Yaoundé, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- Service of Internal Medicine and Subspecialities, Douala General Hospital, Douala, Cameroon
- Lown Scholars Program, Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, USA
| | - Boris Tchounga
- Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroon
| | - Rogers Ajeh
- Clinical Research Education, Networking and Consultancy, Yaoundé, Cameroon
| | - Charles Kouanfack
- HIV Day Hospital, Yaoundé Central Hospital, Yaoundé, Cameroon
- Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
| | - Peter Vanes Ebasone
- Clinical Research Education, Networking and Consultancy, Yaoundé, Cameroon
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | | | | | - Joseph Fokam
- International Reference Centre Chantal Biya (IRCCB), Yaoundé, Cameroon
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Jérôme Ateudjieu
- Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
| | | | | | - Fabrice Youbi Kamgang
- Division of the Fight against Diseases, Ministry of Public Health, Yaoundé, Cameroon
| | - Jean Anoubessi
- National AIDS Control Committee, Ministry of Public Health, Yaoundé, Cameroon
| | - Marie Varloteaux
- Cameroon office, National Agency for Research on AIDS (ANRS), Yaoundé, Cameroon
| | - Boris Youngui
- Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroon
| | - Felicite Naah Tabala
- Division of Health Operational Research, Ministry of Public Health, Yaoundé, Cameroon
| | - Benjamin Atanga
- Division of Health Operational Research, Ministry of Public Health, Yaoundé, Cameroon
| | - Leonie Simo
- Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroon
| | - Armel Zemsi
- Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroon
| | | | | | | | | | | | - Eugene Sobngwi
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Serge Clotaire Billong
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- National AIDS Control Committee, Ministry of Public Health, Yaoundé, Cameroon
| | - John Ditekemena
- Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroon
| | - Anne Cecile Zoung-Kanyi Bissek
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- Division of Health Operational Research, Ministry of Public Health, Yaoundé, Cameroon
| | - Louis Richard Njock
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- General Secretariat, Ministry of Public Health, Yaoundé, Cameroon
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10
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Boni SP, Gnahatin F, Comoé JC, Tchounga B, Ekouevi D, Horo A, Adoubi I, Jaquet A. Barriers and facilitators in cervical cancer screening uptake in Abidjan, Côte d'Ivoire in 2018: a cross-sectional study. BMC Cancer 2021; 21:952. [PMID: 34433459 PMCID: PMC8390229 DOI: 10.1186/s12885-021-08650-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 07/29/2021] [Indexed: 12/24/2022] Open
Abstract
Backgrounds Cervical cancer (CC) incidence remains unacceptably high in Côte d’Ivoire. In an effort to prevent this malignant condition, a national CC screening program has been scaled up in the country. This study aimed at assessing CC screening uptake and its associated factors in Abidjan in 2018. Methods A cross-sectional survey was conducted from July to September 2018 in the main healthcare facilities of three randomly selected out of the eight health districts of Abidjan. During the study period, a standardized questionnaire was administrated by research assistants to all women aged 25 to 55 years old, attending the three participating facilities. Demographics, knowledge on CC, personal history of CC screening and reasons for not attending CC screening were collected. A logistic regression model was computed to document factors associated with reported CC screening uptake. Results A total of 1158 women with a median age of 32 years (IQR [27–36]), including 364 (31.4%) with no formal education were included. Of those participants, 786 (67.9%) had ever heard about CC. CC screening uptake at least once was reported by 7.5% [95% CI: 6.0–9.0] participants. In multivariable analysis, being ≥45 years (aOR: 6.2 [2.3–17.2]), having a university level (aOR: 2.8 [1.2–6.6]) (versus non formal education) and access to mass campaign information (aOR: 18.2 [8.5–39.1]) were associated with a reported CC screening uptake. The main reported barriers to CC screening were unawareness towards CC screening (75.5%), negligence (20.5%), fear of CC detection (3.9%) and fear of additional costs (3.3%). Conclusion CC screening uptake remains low despite current initiatives to support awareness and prevention in Abidjan. Awareness campaigns need to be massively increased with the adjunction of tailored messages based on the level of women’s education to enhance the CC screening coverage and reach the WHO goal of CC elimination by 2030.
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Affiliation(s)
- Simon P Boni
- Programme National de Lutte contre le Cancer (PNLCa), Abidjan, Côte d'Ivoire. .,Programme PAC-CI, Site ANRS Treichville, Abidjan, Côte d'Ivoire.
| | - Franck Gnahatin
- Programme National de Lutte contre le Cancer (PNLCa), Abidjan, Côte d'Ivoire
| | - Jean-Claude Comoé
- Jhpiego, a John Hopkins University affiliate, oncology department, Abidjan, Côte d'Ivoire
| | - Boris Tchounga
- Elizabeth Glaser Paediatric AIDS Foundation, Yaoundé, Cameroon
| | - Didier Ekouevi
- University of Bordeaux, Inserm, French National Research Institute for Sustainable Development (IRD), UMR, 1219, Bordeaux, France.,Département de Santé Publique, Université de Lomé, Lomé, Togo
| | - Apollinaire Horo
- Département mère-enfant, Université Félix Houphouët Boigny, Abidjan, Côte d'Ivoire.,Service de Gynéco-Obstétrique, Centre Hospitalier Universitaire de Yopougon, Abidjan, Côte d'Ivoire
| | - Innocent Adoubi
- Programme National de Lutte contre le Cancer (PNLCa), Abidjan, Côte d'Ivoire.,Service de cancérologie, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d'Ivoire.,Département Cancérologie-Immunologie-Hématologie, Université Félix Houphouët Boigny, Abidjan, Côte d'Ivoire
| | - Antoine Jaquet
- University of Bordeaux, Inserm, French National Research Institute for Sustainable Development (IRD), UMR, 1219, Bordeaux, France
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11
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Jaquet A, Boni SP, Boidy K, Tine J, Tchounga B, Touré SA, Koffi JJ, Dial C, Monnereau A, Diomande I, Tanon A, Seydi M, Dabis F, Diop S, Koffi G. Chronic viral hepatitis, HIV infection and Non-Hodgkin lymphomas in West Africa, a case-control study. Int J Cancer 2021; 149:1536-1543. [PMID: 34124779 DOI: 10.1002/ijc.33709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/17/2021] [Accepted: 05/28/2021] [Indexed: 12/09/2022]
Abstract
Non-Hodgkin lymphomas (NHL) are underestimated causes of cancer in West Africa where chronic viral hepatitis and HIV are endemic. While the association with HIV infection has already been characterized, limited information is available on the association between chronic viral hepatitis and NHL in sub-Saharan Africa. A case-control study was conducted in referral hospitals of Abidjan (Cote d'Ivoire) and Dakar (Senegal). Cases of NHL were matched with controls on age, gender and participating site. The diagnosis of NHL relied on local pathological examination completed with immunohistochemistry. HIV, HBV and HCV serology tests were systematically performed. A conditional logistic regression model estimated the associations by the Odds Ratio (OR) with their 95% confidence interval (CI). A total of 117 NHL cases (Abidjan n = 97, Dakar n = 20) and their 234 matched controls were enrolled. Cases were predominantly men (68.4%) and had a median age of 50 years (IQR 37-57). While Diffuse Large B-cell lymphoma were the most reported morphological type (n = 35) among mature B-cell NHL, the proportion mature T-cell NHL (30%) was high. The prevalence figures of HBV, HCV and HIV infection were 12.8%, 7.7% and 14.5%, respectively among cases of NHL. In multivariate analysis, HBV, HCV and HIV were independently associated with NHL with OR of 2.23 (CI 1.05-4.75), 4.82 (CI 1.52-15.29) and 3.32 (CI 1.54-7.16), respectively. Chronic viral hepatitis B and C were significantly associated with NHL in West Africa. Timely preventive measures against HBV infection and access to curative anti-HCV treatment might prevent a significant number of NHL.
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Affiliation(s)
- Antoine Jaquet
- University of Bordeaux, Inserm, French National Research Institute for Sustainable Development (IRD), Bordeaux, France
| | - Simon P Boni
- Programme National de Lutte Contre le Cancer (PNLCa), Abidjan, Côte d'Ivoire.,Programme PACCI/Site ANRS Abidjan, Abidjan, Côte d'Ivoire
| | - Kouakou Boidy
- Service d'hématologie, Centre Hospitalier Universitaire de Yopougon, Abidjan, Côte d'Ivoire
| | - Judicaël Tine
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire de Fann, Dakar, Senegal
| | - Boris Tchounga
- Programme PACCI/Site ANRS Abidjan, Abidjan, Côte d'Ivoire.,Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroon
| | - Sokhna A Touré
- Service d'hématologie, Centre National de Transfusion Sanguine, Dakar, Senegal
| | | | - Cherif Dial
- Service Anatomopathologie, Hôpital de Grand Yoff, Dakar, Senegal
| | - Alain Monnereau
- University of Bordeaux, Inserm, French National Research Institute for Sustainable Development (IRD), Bordeaux, France
| | - Isidore Diomande
- Service Anatomopathologie, Centre Hospitalier Universitaire Cocody, Abidjan, Côte d'Ivoire
| | - Aristophane Tanon
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d'Ivoire
| | - Moussa Seydi
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire de Fann, Dakar, Senegal
| | - François Dabis
- University of Bordeaux, Inserm, French National Research Institute for Sustainable Development (IRD), Bordeaux, France
| | - Saliou Diop
- Service d'hématologie, Centre National de Transfusion Sanguine, Dakar, Senegal
| | - Gustave Koffi
- Service d'hématologie, Centre Hospitalier Universitaire de Yopougon, Abidjan, Côte d'Ivoire
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12
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Jaquet A, Boni S, Tchounga B, Comoe K, Tanon A, Horo A, Diomandé I, Didi-Kouko Coulibaly J, Ekouevi DK, Adoubi I. Changes in HIV-Related Cervical Cancer Over a Decade in Côte d'Ivoire. JCO Glob Oncol 2021; 7:782-789. [PMID: 34043415 PMCID: PMC8457855 DOI: 10.1200/go.21.00006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/22/2021] [Accepted: 04/22/2021] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Major improvements have occurred in access to invasive cervical cancer (ICC) screening in HIV-infected women over the past decade in sub-Saharan Africa. However, there is limited information on changes in the burden of HIV-related ICC at a population level. Our objective was to compare HIV-related ICC over a decade and document factors associated with HIV infection in women with ICC in Côte d'Ivoire. METHODS A repeated cross-sectional study was conducted in referral hospitals of Abidjan, Côte d'Ivoire, through the 2009-2011 and 2018-2020 periods. Women diagnosed with ICC were systematically tested for HIV. Demographics, ICC risk factors, cancer stage (International Federation of Gynecology and Obstetrics), and HIV characteristics were collected through questionnaires. Characteristics of HIV-related ICC were compared between the periods, and factors associated with HIV in women diagnosed with ICC in 2018-2020 were documented through a multivariable logistic model. RESULTS During the 2009-2011 and 2018-2020 periods, 147 and 297 women with ICC were diagnosed with estimated HIV prevalence of 24.5% and 21.9% (P = .53), respectively. In HIV-infected women, access to antiretroviral treatment increased from 2.8% to 73.8% (P < 10-4) and median CD4 cell count from 285 (IQR, 250-441) to 492 (IQR, 377-833) cells/mm3 (P = .03). In women diagnosed with ICC during the 2018-2020 period, HIV infection was associated with a less advanced clinical stage (International Federation of Gynecology and Obstetrics I or II stage) (adjusted OR, 2.2 [95% CI, 1.1 to 4.4]) and with ICC diagnosis through a systematic screening (adjusted OR, 10.5 [95% CI, 2.5 to 45.5]). CONCLUSION Despite a persistently high proportion of HIV-related ICC over time in Côte d'Ivoire, HIV was associated with less advanced clinical stage at ICC diagnosis. Recent improvements in ICC screening services across HIV clinics might explain this association and support their implementation across non-HIV health facilities.
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Affiliation(s)
- Antoine Jaquet
- University of Bordeaux, Inserm, French National Research Institute for Sustainable Development (IRD), Bordeaux, France
| | - Simon Boni
- Programme National de Lutte contre le Cancer (PNLCa), Abidjan, Cote d'Ivoire
- Programme PACCI /site ANRS Abidjan, Abidjan, Cote d'Ivoire
| | - Boris Tchounga
- Programme PACCI /site ANRS Abidjan, Abidjan, Cote d'Ivoire
- Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroon
| | - Kouassi Comoe
- Programme National de Lutte contre le Cancer (PNLCa), Abidjan, Cote d'Ivoire
- Service de cancérologie, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d'Ivoire
| | - Aristophane Tanon
- Service des Maladies Infectieuses et Tropicales (SMIT), CHU de Treichville, Abidjan, Côte d'Ivoire
| | - Apollinaire Horo
- Service de Gynécologie obstétrique, CHU de Yopougon, Université Félix Houphouet Boigny, Abidjan, Côte d'Ivoire
| | - Isidore Diomandé
- Service anatomopathologie, Centre Hospitalier Universitaire (CHU) Cocody, Abidjan, Cote d'Ivoire
| | | | - Didier K. Ekouevi
- University of Bordeaux, Inserm, French National Research Institute for Sustainable Development (IRD), Bordeaux, France
- Université de Lomé, Département de Santé Publique, Lomé, Togo
| | - Innocent Adoubi
- Programme National de Lutte contre le Cancer (PNLCa), Abidjan, Cote d'Ivoire
- Service de cancérologie, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d'Ivoire
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13
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Tchendjou P, Nzima V, Lekeumo S, Sacks E, Bianchi F, Lemaire JF, Zoung Kanyi Bissek AC, Binde T, Ngoh EA, Tchounga B, Tiam A, Cohn J. HIV Mother-to-Child Transmission in Cameroon: EID Positivity Yields and Key Risk Factors by Health Service Points After Usage of POC EID Systems. J Acquir Immune Defic Syndr 2021; 84 Suppl 1:S34-S40. [PMID: 32520913 DOI: 10.1097/qai.0000000000002374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Most HIV-exposed infants access early infant diagnosis (EID) through the prevention of mother-to-child transmission (PMTCT) service points. However, there are limited data on HIV positivity in non-PMTCT health care settings (pediatric wards, emergency departments, outpatient departments, tuberculosis clinics, etc.). The introduction of point-of-care testing provided an opportunity to describe HIV positivity at alternative health service points and associated risk factors. METHODS We performed a cross-sectional subanalysis with data from 58 health facilities in Cameroon. The risk of a child being HIV positive at a health service point was considered as a dependent variable, and exploratory variables were assessed using multivariate models with a significance level of 0.05. RESULTS Overall, 2254 HIV-exposed infants identified by clinical or biological screening were tested by polymerase chain reaction using point-of-care EID. Approximately 74.3% of the infants were tested at a PMTCT entry point, whereas 25.7% were tested at non-PMTCT service points. The positivity yield was 5.7% (95 of the 1674) at the PMTCT service point and 17.6% (102 of the 580) at non-PMTCT service points. Non-PMTCT service points [adjusted odds ratio (aOR): 1.95; 95% confidence interval (CI): 1.36 to 2.80] and vaginal delivery (aOR: 2.56; 95% CI: 1.25 to 5.25) were independently associated with HIV positivity. In a separate analysis (infants aged 0-6 months), mixed feeding mode (aOR: 3.68; 95% CI: 2.00 to 6.77) was also associated with HIV positivity. CONCLUSIONS More than half of children newly identified as HIV-positive were tested at non-PMTCT service points. The highest EID positivity yields were found in non-PMTCT service points. Strengthening HIV testing in non-PMTCT service points may help to identify additional infected children and improve timely initiation of treatment and care.
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Affiliation(s)
- Patrice Tchendjou
- Strategic Information and Evaluation Unit, EGPAF Yaounde, Yaounde, Cameroon
| | - Valery Nzima
- Clinical Services Unit, EGPAF Yaounde, Yaounde, Cameroon
| | - Simplice Lekeumo
- Strategic Information and Evaluation Unit, EGPAF Yaounde, Yaounde, Cameroon
| | - Emma Sacks
- Global Clinical Research Unit, EGPAF, Washington, DC
| | - Flavia Bianchi
- Global Strategic Information and Evaluation Unit, Washington, DC
| | | | | | - Thierry Binde
- Strategic Information and Evaluation Unit, EGPAF Yaounde, Yaounde, Cameroon
| | - Elvis Akwo Ngoh
- Strategic Information and Evaluation Unit, EGPAF Yaounde, Yaounde, Cameroon
| | - Boris Tchounga
- Public Health & Evaluation Unit, EGPAF Yaounde, Yaounde, Cameroon
| | | | - Jennifer Cohn
- Innovation and Technology Unit, EGPAF, Geneva, Switzerland
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14
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Vasiliu A, Eymard-Duvernay S, Tchounga B, Atwine D, de Carvalho E, Ouedraogo S, Kakinda M, Tchendjou P, Turyahabwe S, Kuate AK, Tiendrebeogo G, Dodd PJ, Graham SM, Cohn J, Casenghi M, Bonnet M. Community intervention for child tuberculosis active contact investigation and management: study protocol for a parallel cluster randomized controlled trial. Trials 2021; 22:180. [PMID: 33653385 PMCID: PMC7927252 DOI: 10.1186/s13063-021-05124-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 02/11/2021] [Indexed: 01/22/2023] Open
Abstract
Background There are major gaps in the management of pediatric tuberculosis (TB) contact investigation for rapid identification of active tuberculosis and initiation of preventive therapy. This study aims to evaluate the impact of a community-based intervention as compared to facility-based model for the management of children in contact with bacteriologically confirmed pulmonary TB adults in low-resource high-burden settings. Methods/design This multicenter parallel open-label cluster randomized controlled trial is composed of three phases: I, baseline phase in which retrospective data are collected, quality of data recording in facility registers is checked, and expected acceptability and feasibility of the intervention is assessed; II, intervention phase with enrolment of index cases and contact cases in either facility- or community-based models; and III, explanatory phase including endpoint data analysis, cost-effectiveness analysis, and post-intervention acceptability assessment by healthcare providers and beneficiaries. The study uses both quantitative and qualitative analysis methods. The community-based intervention includes identification and screening of all household contacts, referral of contacts with TB-suggestive symptoms to the facility for investigation, and household initiation of preventive therapy with follow-up of eligible child contacts by community healthcare workers, i.e., all young (< 5 years) child contacts or older (5–14 years) child contacts living with HIV, and with no evidence of TB disease. Twenty clusters representing TB diagnostic and treatment facilities with their catchment areas are randomized in a 1:1 ratio to either the community-based intervention arm or the facility-based standard of care arm in Cameroon and Uganda. Randomization was stratified by country and constrained on the number of index cases per cluster. The primary endpoint is the proportion of eligible child contacts who initiate and complete the preventive therapy. The sample size is of 1500 child contacts to identify a 10% difference between the arms with the assumption that 60% of children will complete the preventive therapy in the standard of care arm. Discussion This study will provide evidence of the impact of a community-based intervention on household child contact screening and management of TB preventive therapy in order to improve care and prevention of childhood TB in low-resource high-burden settings. Trial registration ClinicalTrials.gov NCT03832023. Registered on 6 February 2019 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05124-9.
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Affiliation(s)
- Anca Vasiliu
- French National Research Institute for Sustainable Development (IRD UMI 233 TransVIHMI- UM-INSERM U1175), Montpellier, France
| | - Sabrina Eymard-Duvernay
- French National Research Institute for Sustainable Development (IRD UMI 233 TransVIHMI- UM-INSERM U1175), Montpellier, France
| | - Boris Tchounga
- Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroon
| | | | - Elisabete de Carvalho
- French National Research Institute for Sustainable Development (IRD UMI 233 TransVIHMI- UM-INSERM U1175), Montpellier, France
| | - Sayouba Ouedraogo
- French National Research Institute for Sustainable Development (IRD UMI 233 TransVIHMI- UM-INSERM U1175), Montpellier, France
| | | | | | | | | | - Georges Tiendrebeogo
- French National Research Institute for Sustainable Development (IRD UMI 233 TransVIHMI- UM-INSERM U1175), Montpellier, France
| | - Peter J Dodd
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Stephen M Graham
- Centre for International Child Health, University of Melbourne and Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia.,International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - Jennifer Cohn
- Elizabeth Glaser Pediatric AIDS Foundation, Geneva, Switzerland
| | | | - Maryline Bonnet
- French National Research Institute for Sustainable Development (IRD UMI 233 TransVIHMI- UM-INSERM U1175), Montpellier, France.
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15
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Tchounga B, Horo A, Boni S, Tanon A, Folquet MA, Garrigue I, Leroy V, Dabis F, Ekouevi D, Jaquet A. Human papilloma viruses infection among adolescent females perinatally infected with HIV in Côte d'Ivoire. Sex Transm Infect 2020; 97:238-243. [PMID: 32661070 DOI: 10.1136/sextrans-2019-054420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 04/24/2020] [Accepted: 06/08/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Cervical cancer prevention strategies recommend human papilloma virus (HPV) vaccination for female adolescents prior to their sexual debut. While HIV is a major risk factor for HPV infection in women of childbearing age, its prevalence among HIV-infected adolescent female is mostly unknown. This study aimed to describe the HPV prevalence and correlates among perinatally HIV-infected adolescent females prior to HPV immunisation. METHODS A cross-sectional survey was conducted from January to June 2016, in the four major paediatric HIV clinics of Abidjan, Côte d'Ivoire. All HIV-infected females aged 11-16 years were approached to participate in the study. A questionnaire assessing sexual behaviours and genital hygiene practices was administered to participants completed with a systematic vaginal swab collection. HPV genotyping was performed using the Anyplex II HPV28 Detection (Seegene). A logistic regression analysis was performed to identify factors associated with the presence of HPV infection. HPV immunisation was proposed free of charge to all participants. RESULTS A total of 250 participants were included, with a median age of 13 years (IQR 11-14). Among them, 237 (94.8%) were on antiretroviral treatment with a median CD4 count of 660 (IQR 439-914) cells/mm3. The overall prevalence of at least one HPV was 3.6% (95% CI 1.6 to 6.7) and the prevalence of at least one carcinogenic HPV was 2.8% (95% CI 0.7 to 4.8). Vaginal cleansing was reported by 75 (30%) of participants, with a median age at initiation of 12 years (IQR 10-13). Sexual activity was self-reported by 12 (4.8%) participants with a median age at sexual debut of 11 years (IQR 10-14). HPV infection was associated with vaginal cleansing (adjusted OR=7.0 (95% CI 1.4 to 31.6)). CONCLUSION The reported low prevalence of carcinogenic HPV infections supports the appropriateness of HPV immunisation in this population. The reported association between cleansing practices and HPV infection deserves further prospective longitudinal studies.
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Affiliation(s)
- Boris Tchounga
- Programme PACCI, site de recherche ANRS, Abidjan, Côte d'Ivoire
| | - Apollinaire Horo
- Service de Gynécologie-Obstétrique, Centre Hospitalier Universitaire de Yopougon, Abidjan, Côte d'Ivoire
| | - Simon Boni
- Programme National de Lutte contre le Cancer, Abidjan, Côte d'Ivoire
| | - Aristophane Tanon
- Service des Maladies Infectieuses et Tropicales, CHU de Treichville, Abidjan, Côte d'Ivoire
| | | | | | - Valeriane Leroy
- Université de Toulouse, Centre INSERM U1027, Toulouse, France
| | - François Dabis
- University of Bordeaux, Inserm, French National Research Institute for Sustainable Development (IRD), UMR 1219, Bordeaux, France
| | - Didier Ekouevi
- University of Bordeaux, Inserm, French National Research Institute for Sustainable Development (IRD), UMR 1219, Bordeaux, France.,Université de Lomé, Département des Sciences Fondamentales et Santé Publique, Lome, Togo
| | - Antoine Jaquet
- University of Bordeaux, Inserm, French National Research Institute for Sustainable Development (IRD), UMR 1219, Bordeaux, France
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16
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Denoeud-Ndam L, Otieno-Masaba R, Tchounga B, Machekano R, Simo L, Mboya JP, Kose J, Tchendjou P, Bissek ACZK, Okomo GO, Casenghi M, Cohn J, Tiam A. Integrating pediatric TB services into child healthcare services in Africa: study protocol for the INPUT cluster-randomized stepped wedge trial. BMC Public Health 2020; 20:623. [PMID: 32375741 PMCID: PMC7201651 DOI: 10.1186/s12889-020-08741-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 04/20/2020] [Indexed: 11/16/2022] Open
Abstract
Background Tuberculosis is among the top-10 causes of mortality in children with more than 1 million children suffering from TB disease annually worldwide. The main challenge in young children is the difficulty in establishing an accurate diagnosis of active TB. The INPUT study is a stepped-wedge cluster-randomized intervention study aiming to assess the effectiveness of integrating TB services into child healthcare services on TB diagnosis capacities in children under 5 years of age. Methods Two strategies will be compared: i) The standard of care, offering pediatric TB services based on national standard of care; ii) The intervention, with pediatric TB services integrated into child healthcare services: it consists of a package of training, supportive supervision, job aids, and logistical support to the integration of TB screening and diagnosis activities into pediatric services. The design is a cluster-randomized stepped-wedge of 12 study clusters in Cameroon and Kenya. The sites start enrolling participants under standard-of-care and will transition to the intervention at randomly assigned time points. We enroll children aged less than 5 years with a presumptive diagnosis of TB after obtaining caregiver written informed consent. The participants are followed through TB diagnosis and treatment, with clinical information prospectively abstracted from their medical records. The primary outcome is the proportion of TB cases diagnosed among children < 5 years old attending the child healthcare services. Secondary outcomes include: number of children screened for presumptive active TB; diagnosed; initiated on TB treatment; and completing treatment. We will also assess the cost-effectiveness of the intervention, its acceptability among health care providers and users, and fidelity of implementation. Discussion Study enrolments started in May 2019, enrolments will be completed in October 2020 and follow up will be completed by June 2021. The study findings will be disseminated to national, regional and international audiences and will inform innovative approaches to integration of TB screening, diagnosis, and treatment initiation into child health care services. Trial resistration NCT03862261, initial release 12 February 2019.
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Affiliation(s)
| | | | | | | | | | | | - Judith Kose
- EGPAF, Nairobi, Kenya.,Erasmus University Medical Centre, Rotterdam, the Netherlands
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17
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Lepère P, Touré Y, Bitty-Anderson AM, Boni SP, Anago G, Tchounga B, Touré P, Minga A, Messou E, Kanga G, Koule S, Poda A, Calmy A, Ekouevi DK, Coffie PA. Exploring the Patterns of Use and Acceptability of Mobile Phones Among People Living With HIV to Improve Care and Treatment: Cross-Sectional Study in Three Francophone West African Countries. JMIR Mhealth Uhealth 2019; 7:e13741. [PMID: 31719023 PMCID: PMC6881784 DOI: 10.2196/13741] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 06/07/2019] [Accepted: 06/19/2019] [Indexed: 01/16/2023] Open
Abstract
Background The use of mobile technology in health care (mobile health [mHealth]) could be an innovative way to improve health care, especially for increasing retention in HIV care and adherence to treatment. However, there is a scarcity of studies on mHealth among people living with HIV (PLHIV) in West and Central Africa. Objective The aim of this study was to assess the acceptability of an mHealth intervention among PLHIV in three countries of West Africa. Methods A cross-sectional study among PLHIV was conducted in 2017 in three francophone West African countries: Côte d’Ivoire, Burkina Faso, and Togo. PLHIV followed in the six preselected HIV treatment and care centers, completed a standardized questionnaire on mobile phone possession, acceptability of mobile phone for HIV care and treatment, preference of mobile phone services, and phone sharing. Descriptive statistics and logistic regression were used to describe variables and assess factors associated with mHealth acceptability. Results A total of 1131 PLHIV—643 from Côte d’Ivoire, 239 from Togo, and 249 from Burkina Faso—participated in the study. Median age was 44 years, and 76.1% were women (n=861). Almost all participants owned a mobile phone (n=1107, 97.9%), and 12.6% (n=140) shared phones with a third party. Acceptability of mHealth was 98.8%, with the majority indicating their preference for both phone calls and text messages. Factors associated with mHealth acceptability were having a primary school education or no education (adjusted odds ratio=7.15, 95% CI 5.05-10.12; P<.001) and waiting over one hour before meeting a medical doctor on appointment day (adjusted odds ratio=1.84, 95% CI 1.30-2.62; P=.01). Conclusions The use of mHealth in HIV treatment and care is highly acceptable among PLHIV and should be considered a viable tool to allow West and Central African countries to achieve the Joint United Nations Programme on HIV/AIDS 90-90-90 goals.
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Affiliation(s)
- Phillipe Lepère
- Institut de Santé Globale, Université de Genève, Suisse, Genève, Switzerland
| | | | | | | | | | | | | | - Albert Minga
- Centre Médical de Suivi des donneurs de sang, Abidjan, Cote D'Ivoire
| | - Eugène Messou
- Entre de Prise en charge et de Formation à Yopougon-Attié, Abidjan, Cote D'Ivoire
| | - Guillaume Kanga
- Centre Intégré de Recherches Biocliniques d'Abidjan, Abidjan, Cote D'Ivoire
| | - Serge Koule
- Unité de soins ambulatoires et de conseils, Abidjan, Cote D'Ivoire
| | - Armel Poda
- Hôpital de Jour, Service des Maladies Infectieuses et Tropicales, CHU Souro Sanou, Bobo Dioulasso, Burkina Faso
| | - Alexandra Calmy
- Unité Virus de L'immunodéficience Humaine, Service des maladies infectieuses, Hôpital Universitaire de Genève, Genève, Switzerland
| | - Didier K Ekouevi
- Programme PACCI, Abidjan, Cote D'Ivoire.,Centre Africain de Recherche en Epidémiologie et en Santé Publique, Lomé, Togo.,Département Santé Publique, Université de Lomé, Lomé, Togo.,Centre Inserm - 1219, Université de Bordeaux, Bordeaux, France
| | - Patrick A Coffie
- Programme PACCI, Abidjan, Cote D'Ivoire.,Département de Dermatologie et d'Infectiologie, Unités de Formation et de Recherche des Sciences Médicales, Université Félix Houphouët Boigny,, Abidjan, Cote D'Ivoire.,Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Treichville, Abidjan, Cote D'Ivoire
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18
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Boni S, Tchounga B, Comoe K, Guie P, Adié M, Horo A, Messou E, Ekouévi DK, Dabis F, Adoubi I, Jaquet A. Assessment of the scale-up of cervical cancer screening in Abidjan stratified by HIV status. Int J Gynaecol Obstet 2019; 147:246-251. [PMID: 31482577 DOI: 10.1002/ijgo.12959] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 05/30/2019] [Accepted: 08/14/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To report the successes and challenges of scaling up a population-based cervical cancer (CC) screening program from HIV clinics to various healthcare facilities in Abidjan, Côte d'Ivoire. METHOD A retrospective analysis of characteristics, outcomes, and follow-up of women attending an initial CC screening visit in Abidjan between January 2010 and December 2014. Data were collected via forms that were systematically completed during CC screening visits. Data from the 2014 population census were used to estimate screening coverage. RESULTS Among 16 169 women attending an initial CC screening, 1616 (10.0%) had a positive VIA test. Among 848 women eligible for immediate cryotherapy, 618 (72.9%) underwent the "see-and-treat" approach. The 1-year follow-up rate after cryotherapy was 23.1% (143/618), and was higher among women with HIV (111/362, 30.7%) than among other women (32/256, 12.5%) (P=0.001). The estimated coverage of CC screening in Abidjan was 1.2% (95% confidence interval, 0.6-3.1). CONCLUSION Despite successful expansion of CC screening from HIV clinics to other facilities, the estimated screening coverage of the targeted population remained low. Follow-up of positively screened and treated women is a major challenge, especially outside HIV clinics, and would benefit from an innovative information system proving unique identification and tracking systems.
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Affiliation(s)
- Simon Boni
- Programme PACCI site ANRS de Côte d'Ivoire, Abidjan, Côte d'Ivoire.,Programme National de Lutte contre le Cancer, Abidjan, Côte d'Ivoire
| | - Boris Tchounga
- Programme PACCI site ANRS de Côte d'Ivoire, Abidjan, Côte d'Ivoire.,Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroon
| | - Kouassi Comoe
- Programme National de Lutte contre le Cancer, Abidjan, Côte d'Ivoire.,Service de cancérologie CHU de Treichville, Abidjan, Côte d'Ivoire
| | - Privat Guie
- Service de Gynécologie obstétrique, CHU de Treichville, Abidjan, Côte d'Ivoire
| | - Mesmin Adié
- Programme National de Lutte contre le Cancer, Abidjan, Côte d'Ivoire
| | - Apollinaire Horo
- Service de Gynécologie obstétrique, CHU de Yopougon, Abidjan, Côte d'Ivoire
| | - Eugène Messou
- Centre de Prise en charge, de Recherche et de Formation (CePReF), Abidjan, Côte d'Ivoire
| | - Didier K Ekouévi
- Programme PACCI site ANRS de Côte d'Ivoire, Abidjan, Côte d'Ivoire.,Département des Sciences Fondamentales et Santé Publique, Université de Lomé, Lomé, Togo.,Centre Inserm 1219 & Institut de Santé Publique d'épidémiologie et de développement, Université de Bordeaux, Bordeaux, France
| | - François Dabis
- Centre Inserm 1219 & Institut de Santé Publique d'épidémiologie et de développement, Université de Bordeaux, Bordeaux, France.,Agence Nationale de Recherche sur le VIH et Les Hépatites Virale, Paris, France
| | - Innocent Adoubi
- Programme National de Lutte contre le Cancer, Abidjan, Côte d'Ivoire.,Service de cancérologie CHU de Treichville, Abidjan, Côte d'Ivoire
| | - Antoine Jaquet
- Centre Inserm 1219 & Institut de Santé Publique d'épidémiologie et de développement, Université de Bordeaux, Bordeaux, France
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19
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Mama Djima M, Ekouevi DK, Gregoire JP, Tchounga B, Coffie PA, Tran VT, Touré FY, Moisan J. Use of non-HIV medication among people living with HIV and receiving antiretroviral treatment in Côte d'Ivoire, West Africa: A cross-sectional study. PLoS One 2019; 14:e0221335. [PMID: 31525222 PMCID: PMC6746366 DOI: 10.1371/journal.pone.0221335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 08/06/2019] [Indexed: 11/18/2022] Open
Abstract
Background In Côte d’Ivoire, people living with HIV (PLHIV) have free access to antiretroviral therapy (ART) and cotrimoxazole. Yet, they may use other medications to treat non-HIV diseases. Scarce data are available regarding the use of non-HIV medications in Africa. This study describes the use of non-HIV medications and identifies the factors associated with their use by PLHIV on ART in Côte d’Ivoire. Methods A cross-sectional study was conducted in six HIV clinics in 2016. HIV-1-infected adults receiving ART for at least one year were eligible. A standardized questionnaire was used to collect demographics, HIV characteristics and medication use data. Associated factors were identified using a multivariate adjusted Poisson regression. Results A total of 1,458 participants (74% women) were enrolled. The median age was 44 years, and the median duration of ART was 81 months. A total of 696 (48%) participants reported having used at least one non-HIV medication. Among the 1,519 non-HIV medications used, 550 (36%) had not been prescribed and 397 (26%) were from the nervous system class. Individuals who were more likely to report the use of at least one non-HIV medication included those who had been treated in an Abidjan HIV clinic, had a high school education level, had a monthly income between 152 and 304 euros, had a poor perceived health status, had WHO advanced clinical stage, had used traditional medicine products and had not used cotrimoxazole. Conclusion Almost half PLHIV on ART reported using non-HIV medication. Further research is needed to assess whether the use of non-HIV medication is appropriate given about a third of those medications are not being prescribed.
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Affiliation(s)
- Mariam Mama Djima
- PACCI, CHU Treichville, Abidjan, Côte d’Ivoire
- Institut Pasteur de Côte d’Ivoire, Abidjan, Côte d’Ivoire
- Faculté de pharmacie, Université Laval, Québec, Canada
- * E-mail:
| | - Didier Koumavi Ekouevi
- PACCI, CHU Treichville, Abidjan, Côte d’Ivoire
- Centre Inserm U 1219, ISPED, Université Victor Segalen, Bordeaux, France
- Université de Lomé, Département de Santé Publique, Lomé, Togo
| | - Jean-Pierre Gregoire
- Faculté de pharmacie, Université Laval, Québec, Canada
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec–Université Laval, Québec, Canada
| | | | | | | | | | - Jocelyne Moisan
- Faculté de pharmacie, Université Laval, Québec, Canada
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec–Université Laval, Québec, Canada
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Tchounga B, Boni SP, Koffi JJ, Horo AG, Tanon A, Messou E, Koulé SO, Adoubi I, Ekouevi DK, Jaquet A. Cervical cancer screening uptake and correlates among HIV-infected women: a cross-sectional survey in Côte d'Ivoire, West Africa. BMJ Open 2019; 9:e029882. [PMID: 31473620 PMCID: PMC6720463 DOI: 10.1136/bmjopen-2019-029882] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES Despite the increasing number of interventions aiming to integrate cervical cancer screening into HIV clinics in sub-Saharan Africa, Women living with HIV (WLHIV) still have a high risk of developing cervical cancer. The aim of this study was to estimate the coverage of cervical cancer screening and associated factors among WLHIV in Abidjan, Côte d'Ivoire. DESIGN Cross-sectional survey conducted from May to August 2017. SETTINGS Outpatient setting in the four highest volume urban HIV clinics of government's or non-governmental organisation's sector in Côte d'Ivoire. PARTICIPANTS All WLHIV, aged 25-55 years, followed since at least 1 year, selected through a systematic sampling procedure. INTERVENTION A standardised questionnaire administered to each participant by trained healthcare workers. OUTCOME Cervical cancer screening uptake. RESULTS A total of 1991 WLHIV were included in the study, aged in median 42 years (IQR 37-47), and a median CD4 count (last known) of 563 (378-773) cells/mm3. Among the participants, 1913 (96.1%) had ever heard about cervical cancer, 1444 (72.5%) had been offered cervical cancer screening, mainly in the HIV clinic for 1284 (88.9%), and 1188 reported a personal history of cervical cancer screening for an overall coverage of 59.7% (95% CI 57.6 to 62.0). In multivariable analysis, university level (adjusted OR (aOR) 2.1; 95% CI 1.4 to 3.1, p<0.001), being informed on cervical cancer at the HIV clinic (aOR 1.5; 95% CI 1.1 to 2.0, p=0.017), receiving information self-perceived as 'clear and understood' on cervical cancer (aOR 1.7; 95% CI 1.4 to 2.2, p<0.001), identifying HIV as a risk factor for cervical cancer (aOR 1.4; 95% CI 1.1 to 1.8, p=0.002) and being proposed cervical cancer screening in the HIV clinic (aOR 10.1; 95% CI 7.6 to 13.5, p<0.001), were associated with cervical cancer screening uptake. CONCLUSION Initiatives to support cervical cancer screening in HIV care programmes resulted in effective access to more than half of the WLHIV in Abidjan. Efforts are still needed to provide universal access to cervical cancer screening, especially among socioeconomically disadvantaged WLHIV.
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Affiliation(s)
- Boris Tchounga
- Operations Research IeDEA, Programme PACCI, Site ANRS, Abidjan, Lagune, Côte d'Ivoire
- Public Health Evaluation and Research, Elizabeth Glaser Pediatric AIDS Foundation, Yaounde, Center, Cameroon
| | - Simon Pierre Boni
- Operations Research IeDEA, Programme PACCI, Site ANRS, Abidjan, Lagune, Côte d'Ivoire
- Research, Programme National de Lutte contre le Cancer, Abidjan, Lagune, Côte d'Ivoire
| | - Jean Jacques Koffi
- Operations Research IeDEA, Programme PACCI, Site ANRS, Abidjan, Lagune, Côte d'Ivoire
| | - Apollinaire G Horo
- Service de Gynécologie obstétrique, CHU de Yopougon, Abidjan, Lagune, Côte d'Ivoire
| | - Aristophane Tanon
- Service des Maladies Infectieuses et Tropicales, CHU de Treichville, Abidjan, Côte d'Ivoire
| | - Eugène Messou
- Centre de Prise en Charge de Recherche et de Formation CEPREF, Abidjan, Côte d'Ivoire
| | - Serge-Olivier Koulé
- Unité de soins ambulatoires et de conseils d'Abidjan, USAC, Abdjan, Côte d'Ivoire
| | - Innocent Adoubi
- Research, Programme National de Lutte contre le Cancer, Abidjan, Lagune, Côte d'Ivoire
- Service de cancérologie CHU de Treichville, Abidjan, Lagune, Côte d'Ivoire
| | - Didier K Ekouevi
- Département des Sciences Fondamentales et Santé Publique, Université de Lomé, Lome, Togo
- Centre Inserm 1219 and Institut de Santé Publique d'épidémiologie et de développement, Université de Bordeaux, Bordeaux, Girond, France
| | - Antoine Jaquet
- Centre Inserm 1219 and Institut de Santé Publique d'épidémiologie et de développement, Université de Bordeaux, Bordeaux, Girond, France
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Ferré VM, Ekouevi DK, Gbeasor-Komlanvi FA, Collin G, Le Hingrat Q, Tchounga B, Salou M, Descamps D, Charpentier C, Dagnra AC. Prevalence of human papillomavirus, human immunodeficiency virus and other sexually transmitted infections among female sex workers in Togo: a national cross-sectional survey. Clin Microbiol Infect 2019; 25:1560.e1-1560.e7. [PMID: 31051265 DOI: 10.1016/j.cmi.2019.04.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 04/03/2019] [Accepted: 04/08/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Sub-Saharan Africa is a region with high incidence of both human immunodeficiency virus (HIV) and cervical cancer. We conducted the first national study in Togo to assess prevalence of human papillomavirus (HPV), HIV and other sexually transmitted infections (STIs) among female sex workers (FSW). METHODS A multicentric cross-sectional study was conducted among FSW recruited in hot spots (clubs, streets) in four Togolese cities. HPV and STIs were tested from cervical and anal swabs. HIV and syphilis were screened with rapid tests. RESULTS In all, 310 FSW were recruited; HIV and cervical high-risk HPV (hrHPV) prevalence were 10.6% (33/310) and 32.9% (102/310), respectively. The most frequent hrHPV types were HPV58 (13.6%, 19/140), HPV35 (12.9%, 18/140), HPV31 (12.1%, 17/140) and HPV16 (10.7%, 15/140). Prevalence of hrHPV and multiple hrHPV infections showed higher rates in HIV-positive than in HIV-negative FSW (48.5% versus 31.0%, p 0.04 and 21.2% versus 9.0%, p 0.03; respectively). Prevalence of hrHPV was higher in cervical than anal swabs (34.1% versus 20.7%, p 0.0004). High-risk HPV anal infections were more frequent among HIV-positive than HIV-negative FSW (51.9% versus 17.3%, p 2 × 10-5). Concomitant anal and cervical hrHPV infections were present in 43.2% (41/95) of hrHPV-positive FSW. Overall prevalence in the cervix of Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium and Trichomonas vaginalis were 4.2%, 6.1%, 5.5% and 6.5%, respectively. CONCLUSIONS This first African study on paired cervical and anal samples showed a high prevalence of genital HPV infections with a rather high rate of concomitant HPV infections but low type concordance. We report an unusual distribution of hrHPV types. These findings highlight the critical need for implementation of a national HPV vaccination strategy.
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Affiliation(s)
- V M Ferré
- Université de Paris, IAME, INSERM, F-75018 Paris, France; AP-HP, Hôpital Bichat, DEBRC, F-75018 Paris, France
| | - D K Ekouevi
- Université de Lomé, Faculté des Sciences de la Santé, Département de Santé Publique, Lomé, Togo; Centre Africain de Recherche en Epidémiologie et en Santé Publique (CARESP), Lomé, Togo; ISPED, Université de Bordeaux & Centre INSERM U1219 - Bordeaux Population Health, Bordeaux, France
| | - F A Gbeasor-Komlanvi
- Université de Lomé, Faculté des Sciences de la Santé, Département de Santé Publique, Lomé, Togo; Centre Africain de Recherche en Epidémiologie et en Santé Publique (CARESP), Lomé, Togo
| | - G Collin
- Université de Paris, IAME, INSERM, F-75018 Paris, France; AP-HP, Hôpital Bichat, DEBRC, F-75018 Paris, France
| | - Q Le Hingrat
- Université de Paris, IAME, INSERM, F-75018 Paris, France; AP-HP, Hôpital Bichat, DEBRC, F-75018 Paris, France
| | - B Tchounga
- Programme PACCI, site ANRS, Abidjan, Cote d'Ivoire
| | - M Salou
- Université de Lomé, Centre de Biologie Moléculaire et d'Immunologie, Lomé, Togo
| | - D Descamps
- Université de Paris, IAME, INSERM, F-75018 Paris, France; AP-HP, Hôpital Bichat, DEBRC, F-75018 Paris, France
| | - C Charpentier
- Université de Paris, IAME, INSERM, F-75018 Paris, France; AP-HP, Hôpital Bichat, DEBRC, F-75018 Paris, France.
| | - A C Dagnra
- Université de Lomé, Centre de Biologie Moléculaire et d'Immunologie, Lomé, Togo; Programme national de lutte contre le sida et les infections sexuellement transmissibles, Lomé, Togo
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22
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Saka B, Tchounga B, Ekouevi DK, Sehonou C, Sewu E, Dokla A, Maboudou A, Kassankogno Y, Palokinam Pitche V. [Stigma and discrimination experienced by people living with HIV in Togo, in 2013]. Sante Publique 2018; 29:897-907. [PMID: 29473404 DOI: 10.3917/spub.176.0897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Stigma and discrimination experienced by people living with HIV (PLWHA) prevent and delay access to prevention and treatment services. The aim of this study was to describe the patterns of stigma and discrimination experienced by PLWHA in Togo and to identify the associated factors. METHODS A cross-sectional study was conducted in 2013 among PLWHA in Togo in order to collect data on stigma or discrimination experiences. Univariate and multivariate analyses were performed to identify associated factors. RESULTS A total of 891 PLWHA were interviewed, including 848 (95.2%) receiving antiretroviral therapy. External stigma (37.9%) was the major form of stigmatization followed by internalized stigma (35.4%). The main features of external stigma were gossip (36.5%) and issues to access education (36.0%). Internalized stigma mainly consisted of a feeling of guilt (37.6%) and self-devaluation (36.0%). In univariate and multivariate analysis, female gender was significantly associated with stigma (aOR = 1.73, 95% CI [1.08-2.77]). Of the 891 PLWHA, 75 (8.4%) reported a violation of their rights. Finally 27 (4.1%) were discouraged from having children by a health professional because of their HIV status. CONCLUSION Stigma affects more than one-third of PLWHA in Togo, more particularly females. It appears necessary to design new interventions and integrate psychosocial care in the management of PLWHA, in addition to antiretroviral therapy.
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Jaquet A, Tchounga B, Tanon A, Bagny A, Ekouevi DK, Traore HA, Sasco AJ, Maiga M, Dabis F. Etiology of hepatocellular carcinoma in West Africa, a case-control study. Int J Cancer 2018; 143:869-877. [PMID: 29569722 DOI: 10.1002/ijc.31393] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 03/12/2018] [Accepted: 03/14/2018] [Indexed: 12/11/2022]
Abstract
Hepatocellular carcinoma (HCC) is a leading cause of cancer in West Africa where HBV infection is endemic. However, limited information is available on other risk factors such as alcohol use, HCV and HIV infection. A case-control study was conducted in referral hospitals of Abidjan (Cote d'Ivoire), Bamako (Mali) and Lome (Togo). Cases were matched with controls on age, gender and participating site. The diagnosis of HCC relied on the combination of one or more space-occupying lesions suggestive of an HCC on a standardized abdominal ultrasound and an α-fetoprotein level ≥400 ng/ml. HIV, HBV and HCV serology were performed. Hazardous alcohol use was assessed using the AUDIT questionnaire. A conditional logistic regression model was used to measure odds ratio (OR) with their 95% confidence intervals (CI). A total of 160 cases and 320 controls were included. Cases were predominantly men (80.0%) with a median age of 47 years (IQR 38-57). Hazardous alcohol use (OR = 4.5 [CI 1.1-18.5]), HBV infection (OR = 62.5 [CI 20.5-190.7]) and HCV infection OR = 35.9 [CI 10.0-130.3]) were independently associated with HCC. Combining the effect of HBV infection and alcohol, HBV-infected hazardous drinkers had an OR = 149.8 (CI 13.5-1 667.0), HBV mono-infected had an OR = 57.4 (CI 18.8-175.3) (ref: HBV-negative). Aside the independent association of alcohol use and HBV and HCV infection with HCC, a synergic effect between alcohol use and HBV infection was identified. Timely screening and care of HBV infection and hazardous drinking might prevent a significant number of HCC in West Africa.
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Affiliation(s)
- Antoine Jaquet
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France.,Inserm, ISPED, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France
| | - Boris Tchounga
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France.,Inserm, ISPED, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France.,Programme PACCI, CHU de Treichville, Abidjan, Côte d'Ivoire
| | - Aristophane Tanon
- Service de Maladies Infectieuses et Tropicales (SMIT), CHU de Treichville, Abidjan, Côte d'Ivoire
| | - Aklesso Bagny
- Service d'hépato-gastroentérologie, CHU Campus, Lomé, Togo
| | - Didier K Ekouevi
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France.,Inserm, ISPED, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France.,Programme PACCI, CHU de Treichville, Abidjan, Côte d'Ivoire.,Département de Santé Publique, Faculté des Sciences de la santé, Université de Lomé, Lomé, Togo
| | - Hamar A Traore
- Service de médecine interne, CHU du Point G, Bamako, MALI
| | - Annie J Sasco
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France.,Inserm, ISPED, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France
| | - Moussa Maiga
- Service d'Hépato-Gastroentérologie, Hôpital Gabriel Touré, Bamako, Mali
| | - François Dabis
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France.,Inserm, ISPED, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France
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Abstract
PURPOSE OF REVIEW People living with HIV-2 infected usually initiate antiretroviral therapy (ART) at an advanced period in the course of their infection after a long asymptomatic period characterized by high CD4 cell count and thus at a relatively advanced age. In the new international context of early and universal ART initiation, the aim was to review survival patterns among HIV-2 infected patients, either on ART or not. RECENT FINDINGS Very few reports were published on mortality in people living with HIV-2 during the last 5 years. People living with HIV-2 experience high mortality rates although lower than people living with HIV-1 before ART initiation. They seem to survive longer regardless of the conditions of ART use. Mortality is associated with late presentation, male sex, CD4 cell count less than 500 cell/μl, high plasma viral load, hemoglobin rate less than 8 g/dl and body mass index less than 18 kg/m. SUMMARY People living with HIV-2 initiate ART later than HIV-1 and HIV duals, resulting in higher disease progression and mortality rate. The clinical management of HIV-2 infected patients should now include early diagnosis and treatment initiation as per international guidelines. Further research needs to explore the 'what to start' question and document specific causes of death in people living with HIV-2 and enrolled in care in Africa.
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Affiliation(s)
- Boris Tchounga
- aUniversité de Bordeaux, ISPED, Centre INSERM U1219-Bordeaux Population HealthbProgramme PACCI, site de recherche ANRS, Abidjan, Côte d'IvoirecDépartement de Santé Publique, Université de Lomé, Lomé-Togo
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Balestre E, Ekouevi DK, Tchounga B, Eholie SP, Messou E, Sawadogo A, Thiébaut R, May MT, Sterne JA, Dabis F. Immunologic response in treatment-naïve HIV-2-infected patients: the IeDEA West Africa cohort. J Int AIDS Soc 2016; 19:20044. [PMID: 26861115 PMCID: PMC4748109 DOI: 10.7448/ias.19.1.20044] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 12/09/2015] [Accepted: 12/21/2015] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Response to antiretroviral therapy (ART) among individuals infected with HIV-2 is poorly described. We compared the immunological response among patients treated with three nucleoside reverse-transcriptase inhibitors (NRTIs) to boosted protease inhibitor (PI) and unboosted PI-based regimens in West Africa. METHODS This prospective cohort study enrolled treatment-naïve HIV-2-infected patients within the International Epidemiological Databases to Evaluate AIDS collaboration in West Africa. We used mixed models to compare the CD4 count response to treatment over 12 months between regimens. RESULTS Of 422 HIV-2-infected patients, 285 (67.5%) were treated with a boosted PI-based regimen, 104 (24.6%) with an unboosted PI-based regimen and 33 (7.8%) with three NRTIs. Treatment groups were comparable with regard to gender (54.5% female) and median age at ART initiation (45.3 years; interquartile range 38.3 to 51.8). Treatment groups differed by clinical stage (21.2%, 16.8% and 17.3% at CDC Stage C or World Health Organization Stage IV for the triple NRTI, boosted PI and unboosted PI groups, respectively, p=0.02), median length of follow-up (12.9, 17.7 and 44.0 months for the triple NRTI, the boosted PI and the unboosted PI groups, respectively, p<0.001) and baseline median CD4 count (192, 173 and 129 cells/µl in the triple NRTI, the boosted PI and the unboosted PI-based regimen groups, respectively, p=0.003). CD4 count recovery at 12 months was higher for patients treated with boosted PI-based regimens than those treated with three NRTIs or with unboosted PI-based regimens (191 cells/µl, 95% CI 142 to 241; 110 cells/µl, 95% CI 29 to 192; 133 cells/µl, 95% CI 80 to 186, respectively, p=0.004). CONCLUSIONS In this observational study using African data, boosted PI-containing regimens had better immunological response compared to triple NRTI combinations and unboosted PI-based regimens at 12 months. A randomized clinical trial is still required to determine the best initial regimen for treating HIV-2 infected patients.
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Affiliation(s)
- Eric Balestre
- University Bordeaux, ISPED, Centre INSERM U1219-Epidemiologie-Biostatistique, F-33000 Bordeaux, France
- INSERM, ISPED, Centre INSERM U1219-Epidemiologie-Biostatistique, F-33000 Bordeaux, France;
| | - Didier Koumavi Ekouevi
- University Bordeaux, ISPED, Centre INSERM U1219-Epidemiologie-Biostatistique, F-33000 Bordeaux, France
- INSERM, ISPED, Centre INSERM U1219-Epidemiologie-Biostatistique, F-33000 Bordeaux, France
- Programme PAC-CI, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d'Ivoire;
| | - Boris Tchounga
- University Bordeaux, ISPED, Centre INSERM U1219-Epidemiologie-Biostatistique, F-33000 Bordeaux, France
- INSERM, ISPED, Centre INSERM U1219-Epidemiologie-Biostatistique, F-33000 Bordeaux, France
- Programme PAC-CI, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d'Ivoire
| | - Serge Paul Eholie
- Programme PAC-CI, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d'Ivoire
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d'Ivoire
- Département de Dermatologie-Infectiologie de l'Unité de Formation et de Recherche des Sciences médicales, Université Félix Houphouet Boigny, Abidjan, Côte d'Ivoire
| | - Eugène Messou
- Programme PAC-CI, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d'Ivoire
- Centre de Prise en charge de Recherche et de Formation, Hôpital Yopougon Attié, Abidjan, Côte d'Ivoire
| | - Adrien Sawadogo
- Institut Supérieur des Sciences de la santé, Université Polytechnique de Bobo-Dioulasso, Nasso, Burkina Faso
| | - Rodolphe Thiébaut
- University Bordeaux, ISPED, Centre INSERM U1219-Epidemiologie-Biostatistique, F-33000 Bordeaux, France
- INSERM, ISPED, Centre INSERM U1219-Epidemiologie-Biostatistique, F-33000 Bordeaux, France
| | - Margaret T May
- School of Social and Community Medicine, University of Bristol, Canynge Hall, Bristol, United Kingdom
| | - Jonathan Ac Sterne
- School of Social and Community Medicine, University of Bristol, Canynge Hall, Bristol, United Kingdom
| | - François Dabis
- University Bordeaux, ISPED, Centre INSERM U1219-Epidemiologie-Biostatistique, F-33000 Bordeaux, France
- INSERM, ISPED, Centre INSERM U1219-Epidemiologie-Biostatistique, F-33000 Bordeaux, France
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Ekouevi DK, Dagnra CY, Goilibe KB, Tchounga B, Orne-Gliemann J, Salou M, Anato S, Prince-David M, Pitche VP. [HIV seroprevalence and associated factors among men who have sex with men in Togo]. Rev Epidemiol Sante Publique 2014; 62:127-34. [PMID: 24613465 DOI: 10.1016/j.respe.2013.11.074] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 10/23/2013] [Accepted: 11/12/2013] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Limited data are available on HIV infection among vulnerable populations in sub-saharan African countries, especially among men who have sex with men (MSM). The aim of this study was to estimate HIV prevalence and the factors associated with HIV infection among MSM in Togo in 2011. METHOD A cross-sectional survey was carried out among MSM aged at least 18years old, living in Togo for at least 3months. They were recruited through the snowball method in six cities of Togo from November 2011 to January 2012. A survey form was used and an HIV screening test was proposed to the participants. The HIV prevalence was estimated with a 95% confidence interval. Univariate and multivariate analyses were performed to identify factors associated with HIV infection. RESULTS A total of 758 MSM were enrolled in this study, including 498 (67.5%) from Lomé, the capital of Togo. The median age was 24years with an interquartile range of [21-27years] and 271 MSM (35.7%) were students. The vast majority of MSM were Togolese (90.3%) and 14.6% were married or committed to a woman. HIV testing was accepted by 488 MSM (64.3%) but only 408 (53.8%) finally accepted a blood sample collection. The prevalence of HIV infection was 19.6% [95% confidence interval, 15.9-23.8]. In multivariate analysis, three factors were associated with HIV infection: living in Lomé, with an HIV prevalence of 29.8% against 4.3% in the other cities of Togo [adjusted odds ratio (aOR)=9.68; P<0.001]; having a good knowledge of HIV transmission modes (aOR=0.59; P=0.049); and not having a regular sex partner (aOR=1.69; P=0.049). CONCLUSION One MSM out of five was HIV-infected. Intervention programs targeting this vulnerable population are urgently needed, to reduce HIV incidence in Togo.
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Affiliation(s)
- D K Ekouevi
- Département des sciences fondamentales et santé publique, faculté mixte de médecine et de pharmacie, Lomé, Togo; Inserm, unité 897, 33076 Bordeaux cedex, France; Centre africain de recherche en épidémiologie et sante publique (CARESP), Lomé, Togo
| | - C Y Dagnra
- Département des sciences fondamentales et santé publique, faculté mixte de médecine et de pharmacie, Lomé, Togo; Laboratoire de bactériologie-virologie, CHU de Tokoin, Lomé, Togo
| | - K B Goilibe
- Centre africain de recherche en épidémiologie et sante publique (CARESP), Lomé, Togo
| | - B Tchounga
- Programme PAC-CI, CHU de Treichville, Abidjan, Côte d'Ivoire; Institut de santé publique épidémiologie développement (ISPED), université Bordeaux Segalen, 33076 Bordeaux cedex, France; Programme national de lutte contre le VIH/Sida, Lomé, Togo
| | | | - M Salou
- Département des sciences fondamentales et santé publique, faculté mixte de médecine et de pharmacie, Lomé, Togo; Laboratoire de bactériologie-virologie, CHU de Tokoin, Lomé, Togo
| | - S Anato
- ONG, Arc-en-Ciel, Lomé, Togo
| | - M Prince-David
- Département des sciences fondamentales et santé publique, faculté mixte de médecine et de pharmacie, Lomé, Togo; Laboratoire de bactériologie-virologie, CHU de Tokoin, Lomé, Togo
| | - V P Pitche
- Laboratoire de bactériologie-virologie, CHU de Tokoin, Lomé, Togo.
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Ekouevi D, D’almeida S, Salou M, Kariyiare B, Coffie P, Dagnra A, Tchounga B, Becquet R, Prince-David M, Pitche V. HIV seroprevalence among inmates in Togo. Med Mal Infect 2013; 43:279-85. [DOI: 10.1016/j.medmal.2013.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Revised: 04/21/2013] [Accepted: 06/17/2013] [Indexed: 11/27/2022]
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Ekouevi DK, Coffie PA, Salou M, Kariyiare BG, Dagnra AC, Tchounga B, Prince-Davi M, Becquet R, Pitche VP. [HIV seroprevalence among drug users in Togo]. Sante Publique 2013; 25:491-498. [PMID: 24404731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
CONTEXT In the context of implementing a serological and behavioural surveillance system among drugs users, this study estimated the prevalence of HIV infection and related risk behaviours among drug users (DUs) in Togo. METHOD A cross-sectional study was conducted among DUs in Togo from November 2011 to January 2012. This study involved all DUs regardless of the type of drug and the mode of consumption, over the age of 18 years, who had lived in Togo for at least 3 months. Behavioural data were collected by face-to-face interviews and serum was obtained for HIV antibody testing. HIV prevalence was estimated together with its 95% confidence interval (CI). Univariate and then multivariate analyses were performed to study the factors associated with HIV prevalence. RESULTS A total of 387 DUs participated in the survey and 235 (60.7%) of them were enrolled in Lomé, the country's capital. The median age of DUs was 32 years with an interquartile range of [25-39 years] and 10 (2.6%) were women. The mode of drug consumption was: smoking or inhaling drugs in 92.8% of cases and 2.8% of DUs used drugs by injection. HIV testing was accepted in 98.4% of cases. The estimated HIV prevalence among drugs users was 5.5%, (95% CI, 3.2-7.8%). CONCLUSION This study, the first to be conducted among DUs in Togo, found an HIV prevalence of 5.5%, which is higher than the HIV prevalence in the general population (3.2% in 2010). Specific care of DUs is essential in order to reduce HIV prevalence in Togo.
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Affiliation(s)
- Didier K Ekouevi
- Département des Sciences Fondamentales et Santé Publique, Faculté Mixte de Médecine et de Pharmacie, Université de Lomé, Togo
| | | | - Mounerou Salou
- Département des Sciences Fondamentales et Santé Publique, Faculté Mixte de Médecine et de Pharmacie, Université de Lomé, Togo
| | | | - Anoumou C Dagnra
- Département des Sciences Fondamentales et Santé Publique, Faculté Mixte de Médecine et de Pharmacie, Université de Lomé, Togo
| | - Boris Tchounga
- Programme PAC-CI, CHU de Treichville, Abidjan, Côte d'Ivoire
| | - Mireille Prince-Davi
- Département des Sciences Fondamentales et Santé Publique, Faculté Mixte de Médecine et de Pharmacie, Université de Lomé, Togo
| | - Renaud Becquet
- INSERM, Centre INSERM U897, Epidémiologie et Bio-statistique, Bordeaux, France
| | - Vincent P Pitche
- Programme National de Lutte contre le Sida, Ministère de la santé, Lomé, Togo
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