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Revegue MHDT, Jesson J, Dago-Akribi HA, Dahourou D, Ogbo P, Moh C, Amoussou-Bouah U, N’Gbeche MS, Eboua FT, Kouassi EM, Kouadio K, Cacou MC, Horo A, Msellati P, Sturm G, Leroy V. [Sexual and reproductive health of adolescents living with HIV in pediatric care programs in Abidjan : Structured provision of care and perceptions of health care workers in 2019]. Rev Epidemiol Sante Publique 2022; 70:163-176. [PMID: 35752510 PMCID: PMC9926011 DOI: 10.1016/j.respe.2022.04.003] [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: 03/07/2021] [Revised: 03/31/2022] [Accepted: 04/16/2022] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The majority of adolescents living with HIV (ALHIV) reside in sub-Saharan Africa, with sexual and reproductive health (SRH) needs to be met. The health care facilities and professionals involved have a major role to assume in the quality of SRH services offered to these teenagers. OBJECTIVE To investigate the SRH services offered to ALHIV subjects in pediatric facilities in Abidjan, Ivory-Coast. METHODS In 2019 we conducted an exploratory cross-sectional study using qualitative and quantitative methods in three pediatric facilities caring for ALHIV subjects (CIRBA, CTAP and CePReF) and participating in the IeDEA (International epidemiologic databases to Evaluate AIDS project) in Abidjan, Ivory Coast. This study included: (1) an inventory of SRH services, using a questionnaire and direct observation, describing their adaptation to the teenagers' needs and their inclusion in provision of care; (2 an assessment by means of semi-structured interviews of 14 health professionals' perceptions of the SRH needs of the ALHIV subjects with whom they worked. Quantitative data were expressed in percentages and qualitative data from the interviews were analyzed through inductive thematic analysis. RESULTS The care provided in the three facilities was poorly adapted to the teenagers' needs. Few SRH services were effectively provided to the ALHIV subjects in the different centers. The services essentially consisted in condom distribution and organization of SRH-based focus groups. Exceptionally, hormonal contraception was offered to teenage girls. Barriers to the services were largely due to poorly equipped facilities, particularly in terms of SRH offer, health professionals' experience, and support provided for ALHIV subjects and their parents. The health professionals were desirous of SRH skill-building programs enabling them to deliver optimal, adequately contextualized SRH services to the teenagers. CONCLUSIONS In pediatric programs addressed to ALHIV subjects in three Abidjan facilities, the teenagers' SRH needs remain unmet. It is urgently necessary to strengthen the health facilities by means of improved equipment, enhanced awareness of teenagers' needs, and training programs enabling the health professionals to provide more adapted sexual and reproductive health services.
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Affiliation(s)
| | - J. Jesson
- Inserm, Université de Toulouse 3, CERPOP, Toulouse, France
| | - H. Aka Dago-Akribi
- Département de psychologie, Université de Cocody, Abidjan, Côte d’Ivoire
| | - D.L. Dahourou
- Département biomédical et de santé publique, Institut de recherche en sciences de la santé (IRSS/CNRST), Ouagadougou, Burkina Faso,Centre Muraz, Bobo-Dioulasso, Burkina Faso
| | - P. Ogbo
- Centre intégré de recherches biocliniques, Abidjan, Côte d’Ivoire
| | - C. Moh
- Département de psychologie, Université de Cocody, Abidjan, Côte d’Ivoire,Programme PACCI, Abidjan, Côte d’Ivoire
| | | | - M-S. N’Gbeche
- Centre de prise en charge, de recherche et de formation, CePReF, Aconda, Abidjan, Côte d’Ivoire
| | - F. Tanoh Eboua
- Department de pédiatrie, Centre hospitalier universitaire de Yopougon, Abidjan, Côte d’Ivoire
| | - E. Messou Kouassi
- Centre de prise en charge, de recherche et de formation, CePReF, Aconda, Abidjan, Côte d’Ivoire
| | - K. Kouadio
- Centre intégré de recherches biocliniques, Abidjan, Côte d’Ivoire
| | - M-C. Cacou
- Département de psychologie, Université de Cocody, Abidjan, Côte d’Ivoire
| | - A. Horo
- Service de gynécologie obstétrique, Centre hospitalier universitaire de Yopougon, Abidjan, Côte d’Ivoire
| | - P. Msellati
- Programme PACCI, Abidjan, Côte d’Ivoire,UMI TransVIHMI, Institut de recherche pour le développement, Montpellier, France
| | - G. Sturm
- Laboratoire cliniques psychopathologique et interculturelle EA4591, Université de Toulouse 2, Toulouse, France,Service universitaire de psychiatrie de l’enfant et de l’adolescent (SUPEA), CHU de Toulouse, Toulouse, France
| | - V. Leroy
- Inserm, Université de Toulouse 3, CERPOP, Toulouse, France
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Dahourou DL, Masson D, Aka-Dago-Akribi H, Gauthier-Lafaye C, Cacou C, Raynaud JP, Moh C, Bouah B, Sturm G, Oga M, Msellati P, Leroy V. [HIV Disclosure to the Child/Adolescent in Central and West Francophone Africa]. Bull Soc Pathol Exot 2019; 112:14-21. [PMID: 31225728 DOI: 10.3166/bspe-2019-0063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 02/22/2019] [Indexed: 11/20/2022]
Abstract
We report the attitudes and practices of health care workers involved in the disclosure process to adolescents living with HIV (ALHIV) in a network including West and Central African French-speaking countries, and the experiences of young living with HIV (YLHIV). During a three-day workshop in Abidjan, Côte d'Ivoire, caregivers (doctors, psychologists, social workers) from 19 pediatric HIV treatment sites shared their practices and difficulties, and four YPLHIV their own disclosure experience. Thirty five participants from eight West/Central African countries (Benin, Burkina Faso, Ivory Coast, Cameroon, Mali, Democratic Republic of Congo, Senegal, Togo) contributed: 14 doctors, eight psychologists, six counselors, three social workers. The experience of the centers was variable, but the age at disclosure was late: 34% of 1296 adolescents between 10 and 12 years of age knew their status. The median age at disclosure was 13 years (range: 11-15 years). The practice of the disclosure was often complex, because of multiple factors (fear of the parents of the breaking of the secrecy, lack of communication between professionals). The individual disclosure was the main practice. Four centers practiced HIV disclosure in group sessions to facilitate mirror support, and one used peer-to-peer support. YPLHIV have advocated for an earlier disclosure, from 10 years. In West and Central Africa, the process of HIV disclosure remains complex for parents and caregivers, and occurs too late. The development of a good practice guideline for HIV disclosing adapted to socio-cultural contexts should help to improve this process.
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Affiliation(s)
| | - D Masson
- Programme Grandir, Paris, France
| | - H Aka-Dago-Akribi
- Département de psychologie, Université Félix Houphouët-Boigny, PACCI, Abidjan, Côte d'Ivoire
| | - C Gauthier-Lafaye
- Service universitaire de psychiatrie de l'enfant et de l'adolescent (SUPEA), CHU de Toulouse, Toulouse, France
| | - C Cacou
- Département de psychologie, Université Félix Houphouët-Boigny, PACCI, Abidjan, Côte d'Ivoire
| | - J-P Raynaud
- Service universitaire de psychiatrie de l'enfant et de l'adolescent (SUPEA), CHU de Toulouse, Toulouse, France.,INSERM U1027, Université de Toulouse 3, Toulouse, France
| | - C Moh
- Département de psychologie, Université Félix Houphouët-Boigny, PACCI, Abidjan, Côte d'Ivoire
| | - B Bouah
- Département de psychologie, Université Félix Houphouët-Boigny, PACCI, Abidjan, Côte d'Ivoire
| | - G Sturm
- Laboratoire cliniques psychopathologique et interculturelle, Université Jean Jaurès Toulouse 2, Toulouse
| | | | - P Msellati
- IRD, UMI 233, U1175 INSERM, Université de Montpellier, PACCI, Abidjan
| | - V Leroy
- INSERM U1027, Université de Toulouse 3, Toulouse, France
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Berteloot L, Marcy O, Nguyen B, Ung V, Tejiokem M, Nacro B, Goyet S, Dim B, Blanche S, Borand L, Msellati P, Delacourt C. Value of chest X-ray in TB diagnosis in HIV-infected children living in resource-limited countries: the ANRS 12229-PAANTHER 01 study. Int J Tuberc Lung Dis 2019; 22:844-850. [PMID: 29991391 DOI: 10.5588/ijtld.18.0122] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To evaluate inter-reader agreement and diagnostic accuracy of chest radiography (CXR) in the diagnosis of tuberculosis (TB) in children with human immunodeficiency virus (HIV) infection. DESIGN HIV-infected children with clinically suspected TB were enrolled in a prospective study conducted in Burkina Faso, Cambodia, Cameroon and Viet Nam from April 2010 to December 2014. Three readers-a local radiologist, a paediatric pulmonologist and a paediatric radiologist-independently reviewed the CXRs. Inter-reader agreement was then assessed using the κ coefficient. Diagnostic accuracy of CXR was assessed in culture-confirmed cases and controls. RESULTS A total of 403 children (median age 7.3 years, interquartile range 3.5-9.7; 49.6% males) were enrolled. Inter-reader agreement was as follows: between local radiologist and paediatric pulmonologist, κ = 0.36 (95%CI 0.27-0.45); local radiologist and paediatric radiologist, κ = 0.16 (95%CI 0.08-0.24); and paediatric pulmonologist and paediatric radiologist, κ = 0.30 (95%CI 0.21-0.40). Among 51 cases and 151 controls, after a consensus, CXR had a sensitivity of 71.4% (95%CI 58.8-84.1) and a specificity of 50.0% (95%CI 41.9-58.1). Alveolar opacities and enlarged lymph nodes on CXR had limited specificity for TB (64.7% and 70.2%, respectively). Miliary and/or nodular opacities patterns on CXR were more specific to TB (specificity 94.3%). CONCLUSION CXR showed poor-to-fair inter-reader agreement and limited diagnostic accuracy for TB in HIV-infected children, likely due to comorbidities. Radiological criteria for this specific population require further investigation.
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Affiliation(s)
- L Berteloot
- Service de Radiologie Pédiatrique, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - O Marcy
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia, Centre Institut national de la santé et de la recherche médicale Unité 1219, Université de Bordeaux, Bordeaux Population Health, Bordeaux, France
| | - B Nguyen
- Department of Radiology, Pham Ngoc Thach Hospital, Ho Chi Minh City, Viet Nam
| | - V Ung
- TB/HIV Department, National Paediatric Hospital, Phnom Penh, University of Health Sciences, Phnom Penh, Cambodia
| | - M Tejiokem
- Service d'Epidémiologie et de Santé Publique, Centre Pasteur du Cameroun, Réseau International des Instituts Pasteur, Yaounde, Cameroon
| | - B Nacro
- Service de Pédiatrie, Centre Hospitalier Universitaire Souro Sanou, Bobo Dioulasso, Burkina Faso
| | - S Goyet
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - B Dim
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - S Blanche
- Unité d'Immunologie, Hématologie et Rhumatologie pédiatrique, Hôpital Universitaire Necker-Enfants Malades, Paris
| | - L Borand
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - P Msellati
- Unité mixte internationale 233, Unité 1175 Recherches Translationnelles sur le VIH et les Maladies Infectieuses, Institut de recherche pour le développement, Université de Montpellier
| | - C Delacourt
- Service de Pneumologie et d'Allergologie Pédiatriques, Hôpital Universitaire Necker-Enfants Malades, Paris, France
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Abstract
Most HIV-infected children in Sub-Saharan Africa are born where programs for the prevention of mother-to-child transmission of HIV (PMTCT) exist but are not universally operational. The expansion of PMTCT programs in Cameroon was among the largest in francophone Africa, but despite highly variable estimates of PMTCT uptake (ranging from 20% to 66%), it is clear that not enough HIV-infected pregnant Cameroonian women benefit from treatment to prevent HIV transmission to their children. The reasons why HIV-infected women in Cameroon do not use treatments to prevent this transmission remain partially unidentified. We conducted a qualitative study of the therapeutic itineraries (treatments taken and motivations) followed by HIV-infected pregnant women in Cameroon to understand the barriers to accessing high-quality PMTCT care. Here we construct the therapeutic itinerary for HIV-infected pregnant women, and identify the barriers at each step. Lack of financial independence, personal support, and empowering information were the primary obstacles at multiple steps.
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Affiliation(s)
- C C Landefeld
- a Cleveland Clinic Lerner College of Medicine , Case Western Reserve University , Cleveland , OH , USA
| | - L A Fomenou
- b Département d'Anthropologie , Université de Yaoundé I , Yaoundé , Cameroon
| | - F Ateba
- c Centre Mère-Enfant , Fondation Chantal Biya , Yaoundé , Cameroon
| | - P Msellati
- d UMI 233, IRD, INSERM U 1175/PACCI Abidjan , Côte d'Ivoire
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Keita A, Toure A, Sow M, Raoul H, Magassouba N, Delaporte E, Etard JF, Abel L, Ayouba A, Baize S, Bangoura K, Barry A, Barry M, Cissé M, Delaporte E, Delmas C, Desclaux A, Diallo S, Diallo M, Diallo M, Étard JF, Etienne C, Faye O, Fofana I, Granouillac B, Hébert E, Izard S, Kassé D, Keita A, Koivugui L, Kpamou C, Lacarabaratz C, Leroy S, Marchal C, Levy Y, Magassouba N, March L, Msellati P, Niane H, Peeters M, Pers YM, Raoul H, Sacko S, Savané I, Sow M, Taverne B, Touré A, Traoré F. Extraordinary long-term and fluctuating persistence of Ebola virus RNA in semen of survivors in Guinea: implications for public health. Clin Microbiol Infect 2017; 23:412-413. [DOI: 10.1016/j.cmi.2016.11.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Revised: 09/01/2016] [Accepted: 11/02/2016] [Indexed: 11/16/2022]
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Bompaire F, Saliou Sow M, Duron S, Toure A, Msellati P, Delaporte E, De Greslan T. Séquelles neurologiques de l’infection à virus Ebola. Rev Neurol (Paris) 2017. [DOI: 10.1016/j.neurol.2017.01.400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Hien H, Meda N, Diagbouga S, Zoure E, Yaméogo S, Tamboura H, Somé J, Ouiminga A, Rouet F, Drabo A, Hien A, Nicolas J, Chappuy H, Van de Perre P, Msellati P, Nacro B. 24-Month adherence, tolerance and efficacy of once-a-day antiretroviral therapy with didanosine, lamivudine, and efavirenz in African HIV-1 infected children: ANRS 12103/12167. Afr Health Sci 2013; 13:287-94. [PMID: 24235926 DOI: 10.4314/ahs.v13i2.13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND There is no data on long-term benefit of once-a-day antiretroviral therapy (ART) with combination of DDI, 3TC and EFV to allow its use in future therapeutic strategies. OBJECTIVES To assess 24-month immuno-virological, adherence, tolerance, and effectiveness of a once-a-day ART with DDI, 3TC and EFV. METHODS A phase 2 open trial including 51 children aged from 30 months to 15 years, monitored a once-a-day regimen for 24 months from 2006 to 2008 in the Departement de Pediatrie du CHUSS, at Bobo-Dioulasso in Burkina Faso. We tested immunological and virological response, adherence, tolerance and resistance of the treatment. RESULTS Children with CD4 >25% at 24 months were 67.4% (33/49) CI 95% [54%, 80%]. The proportion of children with viral plasma RNA <300 cp / ml at 24 months of treatment was 81.6 % (40/49) CI [68.0% 91.2%]. Good adherence was obtained with more than 88% adherence > 95% over the 24 months. Drugs were well tolerated. CONCLUSIONS Given the limited number of antiretroviral drugs available in Africa and the inadequacy of laboratory monitoring in support program, once-a-day treatment and especially the DDI-based combination strategies could be an attractive operational option.
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Affiliation(s)
- H Hien
- Unité de recherche Santé de la Reproduction VIH et Maladies Associées, Centre MURAZ, Bobo-Dioulasso, Burkina Faso ; Institut de recherche en sciences de la santé, Bobo-Dioulasso, Burkina Faso
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Varenne B, Fournet F, Cadot E, Msellati P, Ouedraogo HZ, Meyer PE, Cornu JF, Salem G, Petersen PE. [Family environment and dental health disparities among urban children in Burkina Faso]. Rev Epidemiol Sante Publique 2011; 59:385-92. [PMID: 22000043 DOI: 10.1016/j.respe.2011.07.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2010] [Revised: 06/28/2011] [Accepted: 07/18/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Dental caries is the most common multifactorial disease in children and has substantial negative impact on daily life. In sub-Saharan Africa, few data are available on the relationship between dental caries and the social and family environment of children. The objectives of the present study were firstly to assess the level of prevalence and severity of dental caries of children in Ouagadougou, the capital city of Burkina Faso and secondly to determine whether or not individual factors, family and living conditions are linked with dental health disparities within the population. METHODS Interview and clinical data were obtained from a household-based cross-sectional survey. A two-stage stratified sampling technique was applied in four areas of Ouagadougou representing different stages of urbanization. RESULTS The final study population included 1606 children aged 6-12 years. For the overall group the total caries prevalence rate was 48.2%. Results showed that the dental health status of the mother, social integration of the householder and socioeconomic level of the household were associated with the dental health of children. Disparities in dental health were prominent; poor dental health was relatively frequent in children from households poorly integrated into social networks with rather acceptable standard in terms of material wealth. CONCLUSION Our study showed that individual factors as well as family-related and environmental factors had an influence on their caries experience. The rapidly changing lifestyle affects oral health and the burden of oral diseases is expected to increase initially in people of upper classes and later in disadvantaged people. Disease prevention focussing on common risk factors of chronic diseases should be enhanced. In addition, the accessibility of quality fluoride products (e.g. toothpaste, salt, water) should be facilitated as soon as possible.
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Affiliation(s)
- B Varenne
- Institut de Recherche pour le Développement (IRD), Ouagadougou, Burkina Faso.
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Kouanda S, Bocoum FY, Doulougou B, Bila B, Yameogo M, Sanou MJ, Sawadogo M, Sondo B, Msellati P, Desclaux A. User fees and access to ARV treatment for persons living with HIV/AIDS: implementation and challenges in Burkina Faso, a limited-resource country. AIDS Care 2011; 22:1146-52. [PMID: 20824567 DOI: 10.1080/09540121003605047] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Access to antiretroviral (ARV) treatment remains a crucial problem for patients living with HIV/AIDS (PLWHA) in limited-resources countries. Some African countries have adopted the principle of providing ARV free of charge, but Burkina Faso opted for a direct out-of-pocket payment at the point of care delivery, with subsidized payments and mechanisms for the poorest populations to receive these services free of charge. Our objectives were to determine the proportion of PLWHA who pay for ARV and to identify the factors associated with ARV access in Burkina Faso. A cross-sectional study was performed in 13 public health facilities, 10 Nongovernmental Organizations and association health facilities, and three faith-based health facilities. In each facility, 20 outpatients receiving ARV were interviewed during a routine clinic visit. A multivariate analysis by logistic regression was performed. Among the expected 520 patients receiving ARV, 499 (96.0%) were surveyed. The majority of patients (79%) did not pay for their ARV treatment, thereby limiting cost recovery from patient payments. In a multivariate analysis, level of education and income were associated with free access to ARV. Patients with no education more frequently received free ARV than those who had received some level of education (OR 2.7, 95% CI [1.3-5.6]). Patients without any income or with less than US$10 per month were more likely to receive free ARV (OR 2.6 [95% CI 1.3-5.2]) than those who earned more than US$10 per month. However, 16% of patients without any income and 21% of those without employment paid for ARV, and the costs of drugs for opportunistic infections, food, and transport remained a burden for 85%, 91%, and 74%, respectively, of those who did not pay for ARV. Free access to a minimum care package for every PLWHA would enhance access to ARV.
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Affiliation(s)
- S Kouanda
- Institut de recherche en sciences de la sante, Ouagadougou, BP, Burkina Faso.
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Rouet F, Chaix ML, Inwoley A, Anaky MF, Fassinou P, Kpozehouen A, Rouzioux C, Blanche S, Msellati P. Frequent Occurrence of Chronic Hepatitis B Virus Infection among West African HIV Type-1--Infected Children. Clin Infect Dis 2008; 46:361-366. [DOI: 10.1086/525531] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Coulibaly M, Noba V, Rey JL, Msellati P, Ekpini R, Chambon JF, Malkin JE. [Assessment of a programme of prevention of mother-to-child transmission of HIV in Abidjan, Ivory Coast (1999-20002)]. Med Trop (Mars) 2006; 66:53-8. [PMID: 16615616] [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: 05/08/2023]
Abstract
The purpose of this article is to report the results of a programme for prevention of mother-to-child transmission (PMCT) of HIV conducted from 1999 to 2002 by the PNLS in Abidjan, Ivory Coast. This programme was supported by grants from the Fonds de solidarité international (FSTI) and the Glaxo Smith Kline (GSK) Foundation. After pre- and posttest counselling, pregnant women from 4 PMI centres underwent screening for HIV. Seropositive women were offered short course AZT and the possibility of financial assistance for breast-feeding. All programme activities were carried out in close cooperation with association members. A total of 22466 tests were given and 18116 women returned for results. Among the 1829 seropositive women to whom PMCT intervention was proposed, 667 received short course AZT. The rate of transmission at 18 months was 162%. In addition 69 mothers and 28 children eligible for ARV therapy benefited from tritherapy. Limiting factors, at each phase, and efficacy of intervention were analyzed.
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Affiliation(s)
- M Coulibaly
- ESTHER (Ensemble pour une solidarité thérapeutique hospitalière en réseau) 36, rue de Charenton, 75015 Paris
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Djohan G, Kouakoussui A, Msellati P. Coût direct de la prise en charge des enfants infectés par le VIH au stade asymptomatique Abidjan (Côte d'Ivoire) 2000-2003. Santé Publique 2005; 17:627-36. [PMID: 16485443 DOI: 10.3917/spub.054.0627] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The objective of this study was to estimate the direct cost of medical and psychological care provided to asymptomatic HIV-infected children in Abidjan, Cote d'Ivoire. For this purpose, a retrospective study was carried out among a group of asymptomatic HIV-infected children in Abidjan who were part of the "projet enfant Yopougon" (ANRS 1244/1278). The study reviewed these childrens' hospital records and files dating between October 2000 and March 2003. The follow up period for a total of 46 children represented a cumulative of 83.4 children years and showed that 8 potentially death-threatening medical events were recorded on average per child per year. The mean annual cost for the management and delivery of medical and psychological care per asymptomatic HIV-infected child was 132, 730 FCFA per year, or rather 11,000 FCFA (16.63 Euros) per month. This relatively low cost should be used to advocate for more financial support from governments and the international community to contribute to more effective management of care and services for HIV-infected children.
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Affiliation(s)
- G Djohan
- Projet Enfant Yopougon, Programme PACCI, 09 BP 3669 Abidjan 09 (Côte d'Ivoire)
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Kouakoussui A, Fassinou P, Anaky MF, Elenga N, Laguide R, Wemin ML, Toure R, Menan H, Rouet F, Msellati P. Respiratory manifestations in HIV-infected children pre- and post-HAART in Abidjan, the Ivory Coast. Paediatr Respir Rev 2004; 5:311-5. [PMID: 15531256 DOI: 10.1016/j.prrv.2004.07.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Among children infected with human immunodeficiency virus (HIV), respiratory diseases are a frequent cause of morbidity and mortality. This review describes respiratory manifestations of paediatric HIV infection before and after the beginning of HAART in Abidjan, Ivory Coast. In an observational cohort, HIV infected children had quarterly clinical visits and a day-clinic available all week for ill children. CD4 and viral load were measured at baseline and every 6 months thereafter. All children with a CD4 percentage below 25% were prescribed daily cotrimoxazole prophylaxis. Ninety-eight children (of a total of 282) were recruited before HAART and treated during the follow-up, there were 56 boys and 42 girls, with a mean age of 6.2 years at inclusion. The mean percentage of CD4 before HAART was 8.7%. Twelve children had a history of pulmonary tuberculosis and five were on antituberculosis treatment at inclusion. Fifty-one per cent presented with abnormalities on chest X-ray at inclusion. Before initiation of HAART, respiratory manifestations represented 32.4% of morbidity events and the incidence for 100 child/months was 9.29 for URTI, 15.2 for bronchitis, 6.07 for LRTI, 0.71 for tuberculosis and 0.36 for Pneumocystis carinii. After the initiation of HAART, respiratory manifestations represented 40.9% of all morbidity events and the incidence for 100 child/months was 5.35 for URTI, 9.48 for bronchitis, 2.17 for LRTI and 0.16 for tuberculosis. During HAART treatment, the incidence of respiratory infections decreased dramatically compared to before the antiretroviral treatment. However, respiratory events still represented 40% of all events occurring following the start of HAART therapy.
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Affiliation(s)
- A Kouakoussui
- Projet Enfant Yopougon, PACCI, Abidjan, Côte d'Ivoire
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14
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Elenga N, Msellati P, Fassinou P, Viho I, Dabis F. [Zidovudine-associated mitochondriopathy: three possible observations in Abidjan, Côte d'Ivoire]. Bull Soc Pathol Exot 2004; 97:253-6. [PMID: 17304745] [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: 05/14/2023]
Abstract
In Africa, prevention of mother-to-child transmission of HIV (PMTCT) with antiretrovirals is becoming a key component of the response to the pandemic. Toxicity issues remain however a concern and require careful monitoring. We report here three observations of mild neurological deterioration among children for whom a diagnosis of mitochondrial dysfunction was considered possible. These children were identified within a PMTCT research program (ANRS 049) conducted in Abidjan, Côte d'Ivoire, and evaluating a short regimen of maternal zidovudine monotherapy for PMTCT of HIV type 1. Maternal HIV-1 infection was diagnosed during pregnancy before enrolment in the randomised trial (two cases) or in the subsequent open cohort (one case). These three women had been allocated to the ZDV group and had no particular medical history. Pregnancy check-up was negative except the diagnosis of HIV-1 infection. The three children were diagnosed as uninfected by HIV-1. Symptoms developed by the age of six months (two cases) and 13 months (one case): growth failure, anthropometric abnormalities, impaired psycho-motor development, generalised and repeated seizures. The evolution of these three HIV-uninfected children was favourable after 12 to 18 months. The transient nature of these abnormalities is compatible with mild complications of mitochondrial dysfunction. We conclude however that the anticipated benefits of PMTCT with antiretrovirals in Africa greatly outweigh the potential risks and should not lead to reconsider their public health interest
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Affiliation(s)
- N Elenga
- Programme PACCI, CHU de Treichville, BP 2890, Abidjan 18, Côte d'Ivoire.
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15
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Sakarovitch C, Msellati P, Leroy V, Bequet L, Atta H, Viho I, Ouassa T, Welffens-Ekra C, Dabis F, Alioum A. E2-4 Incidence de l’infection par le virus de l’immunodéficience humaine chez les femmes à Abidjan, Côte d’Ivoire : estimation à partir de données de prévalences issues du dépistage de femmes enceintes. Rev Epidemiol Sante Publique 2004. [DOI: 10.1016/s0398-7620(04)99201-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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16
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Anaky M, Laguide R, Kouakoussui A, Wemin L, Aka H, Kakou C, Fassinou P, Rouet F, Msellati P. P6-9 Utilisation des services de santé par les enfants infectés par le virus de l’immunodéficience humaine à Abidjan : Projet Enfant Yapougon. Rev Epidemiol Sante Publique 2004. [DOI: 10.1016/s0398-7620(04)99291-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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17
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Elenga N, Kouakoussui KA, Bonard D, Fassinou P, Laguide R, Arnon-Tanoh FD, Rouet F, Vincent V, Timité KAM, Msellati P. Infections à mycobactéries atypiques et VIH chez l'enfant à Abidjan (Côte-d'Ivoire). Arch Pediatr 2004; 11:864-6. [PMID: 15234387 DOI: 10.1016/j.arcped.2004.03.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2004] [Accepted: 03/16/2004] [Indexed: 11/30/2022]
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18
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Brou H, Desgrées-du-Loû A, Souville M, Moatti JP, Msellati P. Prophylactic use of cotrimoxazole against opportunistic infections in HIV-positive patients: knowledge and practices of health care providers in Côte d'Ivoire. AIDS Care 2003; 15:629-37. [PMID: 12959812 DOI: 10.1080/09540120310001595113] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We present here the results of a survey conducted in Côte d'Ivoire, Africa, among healthcare providers, on the knowledge of prophylactic use of cotrimoxazole to prevent opportunistic infections in HIV-infected persons. The survey was conducted in 15 health centres, involved or not in the 'initiative of access to treatment for HIV infected people'. Between December 1999 and March 2000, 145 physicians and 297 other health care providers were interviewed. In the analysis, the health centres were divided into three groups: health centres implicated in the initiative of access to treatment for HIV-infected people with a great deal of caring for HIV-infected people, health centres implicated in this initiative but caring for few HIV-infected people, and health centres not specifically involved in the care of HIV-infected people. Six per cent of physicians and 50% of other health care providers had never heard of cotrimoxazole prophylaxis. The level of information about this prophylaxis is related to the level of HIV-related activities in the health centre. Among health care providers informed, knowledge on the exact terms of prescription of the cotrimoxazole is poor. In conclusion, it appears that the recommendations for primary cotrimoxazole prophylaxis of HIV-infected people did not reach the whole health care provider population. Most physicians are informed but not other health workers, even if the latter are often the only contact of the patient with the healthcentre. The only medical staff correctly informed are the physicians already strongly engaged in the care of HIV-infected people.
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Affiliation(s)
- H Brou
- ENSEA, Abidjan, Côte d'Ivoire.
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19
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Coulibaly-Traoré D, Msellati P, Vidal L, Ekra CW, Dabis F. [The Ditrame (ANRS 049) clinical trial aimed at reducing the mother-child transmission of HIV in Abidjan. Participants' understanding of the trial principles]. Presse Med 2003; 32:343-50. [PMID: 12712680] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
OBJECTIVE The HIV vaccine attempts in developing countries have underlined many ethical questions on the informed consent of the participants. These problems have already been encountered in the context of studies on the prevention of mother-child transmission (MCT) of HIV in Africa. This study is aimed at describing the level of understanding and interpretations that these women have of the clinical trial, randomisation and placebo, as well as their motivations for participating in the study. METHODS This was a qualitative study conducted in 1997 by a sociologist in the form of in-depth, structured interviews among 57 women participating in a clinical trial on the prevention of MCT of HIV. The interview included a section on the representation of MCT then questions on the eventual sharing of information concerning the HIV-infection status, the motivations for participating in the study and the understanding of the randomIsation and the placebo. RESULTS Nearly half of the women had not shared the result of their blood test with anyone. Their isolation enhanced the difficulties in getting information on the study. The notion of a probability of transmission was not easy to explain in terms adapted to the level of education of the women. The randomisation was understood as a number pulled out of a hat during a lucky draw. The women did not really understand the pictures used to describe the placebo. They claimed that they wanted to participate in the study essentially to protect their child and to have access to treatment. CONCLUSION The correct information of patients participating in clinical trials requires repeated interventions throughout the research period. When there is no social protection, the notion of freedom of choice itself, including the idea of informed consent, is relative and the pragmatic choices made by the women clearly show this. These elements must be taken into consideration in the projects of vaccination trials.
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Vaz P, Elenga N, Fassinou P, Msellati P, Nicolas J, Blanche S. [HIV-1 infection in children in African countries]. Med Trop (Mars) 2003; 63:465-72. [PMID: 14763301] [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: 04/28/2023]
Abstract
The prognosis of HIV infection is dramatic for children living in poor countries. Over 50% die within two years. The World Health Organization has estimated that 1500 children will be infected daily until large-scale national programs for prevention of mother-to-child transmission are implemented. A better understanding of the causes underlying early morbidity could lead to a substantial reduction in mortality pending use of antiretroviral drugs which have demonstrated promising results in preliminary tests on children in poor countries.
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Affiliation(s)
- P Vaz
- Service de Pédiatrie, Hôpital Central de Maputo, Mozambique
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21
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Mandelbrot L, Msellati P, Meda N, Leroy V, Likikouët R, Van de Perre P, Dequae-Merchadoux L, Sylla-Koko F, Ouangre A, Ouassa T, Ramon R, Gautier-Charpentier L, Cartoux M, Dosso M, Dabis F, Welffens-Ekra C. 15 Month follow up of African children following vaginal cleansing with benzalkonium chloride of their HIV infected mothers during late pregnancy and delivery. Sex Transm Infect 2002; 78:267-70. [PMID: 12181464 PMCID: PMC1744488 DOI: 10.1136/sti.78.4.267] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To study mother to child HIV-1 transmission (MTCT) and infant mortality following benzalkonium chloride (BC) disinfection. METHODS A randomised, double blind phase II placebo controlled trial. Women testing positive for HIV-1 infection in prenatal care units in Abidjan, Côte d'Ivoire, and Bobo-Dioulasso, Burkina Faso, from November 1996 to April 1997 were eligible, with their informed consent. Women self administered daily a vaginal suppository of 1% BC (53) or matched placebo (54) from 36 weeks of pregnancy, plus a single dose during labour. The neonate was bathed with 1% BC solution or placebo within 30 minutes after birth. MTCT rate was assessed based on repeated polymerase chain reaction (PCR) and serology results. For the present analysis, children were followed up to 15 months. RESULTS A total of 107 women were enrolled. Of 103 eligible liveborn children, 23 were HIV infected, 75 uninfected, and five of indeterminate status. MTCT transmission rate was 24.2% overall (95% confidence interval (CI): 14.3% to 30.4%). On an intent to treat basis, the transmission rate did not differ between the two groups (23.5%, CI 13.8 to 38.5, in the BC group and 24.8%, CI 15.0 to 39.6, in the placebo group at 15 months). Similarly, there was no difference in mortality at 15 months (22.9%, CI 13.7 to 36.9, in the BC group and 16.5%, CI 9.0 to 29.4, in the placebo group). CONCLUSION This analysis failed to suggest any benefit of BC disinfection on mother to child HIV transmission or perinatal and infant mortality.
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Affiliation(s)
- L Mandelbrot
- Maternité Port Royal, Hopital Cochin, Paris, France UR091, Institut de Recherche pour le Développement (IRD)/LPE, Marseille, France.
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22
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Desgrées-du-Loû A, Msellati P, Viho I, Yao A, Yapi D, Kassi P, Welffens-Ekra C, Mandelbrot L, Dabis F. Incidence of pregnancies among African HIV-infected women, Abidjan, 1995-2000. AIDS 2001; 15:2327-30. [PMID: 11698710 DOI: 10.1097/00002030-200111230-00018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- A Desgrées-du-Loû
- Institut de Recherche pour le Développement (IRD) (ex ORSTOM) O4 BP 293, Abidjan, Côte d'Ivoire
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23
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Rouet F, Montcho C, Rouzioux C, Leroy V, Msellati P, Kottan JB, You B, Viho I, Dabis F. Early diagnosis of paediatric HIV-1 infection among African breast-fed children using a quantitative plasma HIV RNA assay. AIDS 2001; 15:1849-56. [PMID: 11579248 DOI: 10.1097/00002030-200109280-00015] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the performance of a quantitative plasma HIV-1 RNA assay for HIV infection diagnosis among African breast-fed children. METHODS Serial plasma specimens collected in the first week, at day 45-90, 6 months and 9-12 months of age from HIV-exposed children born to HIV-1-infected women enrolled in the DITRAME ANRS 049a perinatal intervention trial (Abidjan, Côte d'Ivoire) were tested for HIV-1 plasma RNA using a branched DNA (bDNA) assay. Sensitivity and specificity of this RNA test were assessed in comparison with a qualitative DNA polymerase chain reaction (PCR) performed on the same blood samples and allowing a reliable detection of the predominant subtype A. RESULTS Among 91 samples from 53 infected children which tested positive by DNA PCR, the sensitivity of the bDNA test was 100% [95% confidence interval (CI), 96.0-100.0] at < or = 8 days (n = 19), 6-12 weeks (n = 43), 6 months (n = 26), and 9-12 months (n = 3). The median plasma HIV-1 RNA viral load ranged from 242 000 copies/ml at < or = 8 days to more than 500 000 copies/ml at day 45-90 and at 6 months. Of 106 specimens from 106 uninfected children who were DNA PCR- negative at month 3 or 6 of age, HIV-1 RNA was undetectable in 103, yielding an overall specificity for the bDNA test of 97.2% (95% CI, 92.0-99.4). The viral load in the three remaining samples with false-positive results was low (410, 937 and 3752 copies/ml, respectively). CONCLUSIONS The quantitative bDNA assay appears a suitable tool for early, reliable and easy diagnosis of paediatric HIV-1 infection among a population of African breast-fed children.
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Affiliation(s)
- F Rouet
- CeDReS, Programme PAC-CI, Abidjan, Côte d'Ivoire.
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24
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Aka-Dago-Akribi H, Msellati P, Yapi D, Welfens-Ekra C, Dabis F. Procreation and child desire of women living with HIV in Abidjan, Co^te d'Ivoire. PSYCHOL HEALTH MED 2001. [DOI: 10.1080/13548500120053391] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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25
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Aka-Dago-Akribi H, Msellati P, Yapi D, Welfens-Ekra C, Dabis F. Procreation and child desire of women living with HIV in Abidjan, Cote d'Ivoire. PSYCHOL HEALTH MED 2001. [DOI: 10.1080/13548500125035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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26
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Dabis F, Elenga N, Meda N, Leroy V, Viho I, Manigart O, Dequae-Merchadou L, Msellati P, Sombie I. 18-Month mortality and perinatal exposure to zidovudine in West Africa. AIDS 2001; 15:771-9. [PMID: 11371692 DOI: 10.1097/00002030-200104130-00013] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To study mortality in African children born to HIV-1-infected mothers exposed peripartum to zidovudine. METHODS A randomized placebo-controlled trial in Abidjan and Bobo-Dioulasso. Pregnant women received either 300 mg zidovudine twice daily from 36-38 weeks' gestation, 600 mg during labour, and 300 mg twice daily for 7 days post-partum or a matching placebo. Determinants of mortality were studied up to 18 months, overall and among the infected children: treatment, centre, timing of infection, mother and child HIV disease. RESULTS There were 75 infant deaths among 407 live births. The risk of death at 18 months was 176/1000 in the zidovudine arm and 221 for placebo. Relative hazard (RH, zidovudine versus placebo) was 0.47 [95% confidence interval (CI) 0.2-1.0] up to 230 days of life. Maternal CD4 lymphocyte count < 200/mm3 (RH 2.92; CI 1.4-6.1) and child HIV-1 infection (RH 12.6; CI 6.6-24.3) increased mortality of all children born to HIV-1-infected mothers. There were 101 children infected (40 in the zidovudine group), and 51 died. Their 18 month probability of death was 590/1000 in the zidovudine group and 510 in the placebo group. Among infected children, maternal zidovudine reduced the risk of death on or before day 230 (RH 0.18; CI 0.1-0.5). Maternal CD4 lymphocyte count < 200/mm3 (RH 3.25; CI 1.3-8.4), maternal death (RH 9.65; CI 1.7-56.0), diagnosis of paediatric infection on or before day 12 (RH 18.1; CI 4.8-69.0) and between days 13 and 45 (RH 7.63; CI 2.0-29.5), clinical paediatric AIDS (RH 5.37; CI 2.3-12.7) were risk factors for death in HIV-1-infected children. CONCLUSION Mother-to-child transmission reduction by zidovudine is safe and beneficial to African children. The mortality of HIV-1-infected children is high. Peripartum maternal zidovudine exerts a protective effect for at least 8 months.
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Affiliation(s)
- F Dabis
- Unité INSERM no. 330, ISPED, Université Victor Segalen Bordeaux 2, Bordeaux, France.
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27
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Leroy V, Montcho C, Manigart O, Van de Perre P, Dabis F, Msellati P, Meda N, You B, Simonon A, Rouzioux C. Maternal plasma viral load, zidovudine and mother-to-child transmission of HIV-1 in Africa: DITRAME ANRS 049a trial. AIDS 2001; 15:517-22. [PMID: 11242149 DOI: 10.1097/00002030-200103090-00011] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To study the relationship between maternal plasma RNA levels and mother-to-child transmission (MTCT) of HIV-1 in African breastfed children. DESIGN Nested case-control study within a randomized trial assessing the efficacy of a short maternal zidovudine (ZDV) regimen to reduce MTCT. METHODS Eligible women received either 300 mg of ZDV twice a day until labour, 600 mg at the beginning of labour and 300 mg twice a day for 7 days post-partum or a placebo. The diagnosis of paediatric HIV-1 infection was based on PCR tests at days 1--8, 45, 90 and 180 then on serology performed at 3 monthl intervals. Plasma HIV-1 RNA was measured at inclusion and on day 8 after delivery for all women who did transmit HIV to their children (cases) using a Chiron branched DNA assay (sensitivity 50 copies/ml) and compared with women who did not transmit (two per case) matched for phase trial, treatment allocation and site. RESULTS At inclusion, mean log10 viral load was 4.6 among 55 transmitting mothers and 3.7 among 117 non transmitters (P = 0.0001). Among transmitters, the mean difference in log10 viral load between day 8 post-partum and inclusion was -0.13 in the ZDV group (n = 23) versus 0.27 in the placebo group (n = 32; P = 0.01); among non transmitters it was -0.35 for the ZDV group (n = 47) versus 0.27 in the placebo group (n = 70; P < 10(-4)). In multivariate logistic regression analysis, odds ratios for MTCT were 8.7 (95% confidence interval, 3.7-20.6) for 1 log(10) increase of maternal RNA at inclusion and 4.2 (95% confidence interval, 1.7--10.3) for 1 log(10) increase difference from inclusion to day 8 post-partum. CONCLUSION High maternal viral load at inclusion strongly predicts MTCT of HIV in Africa. A short ZDV treatment regimen decreases significantly maternal viral load from its pretreatment level.
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Affiliation(s)
- V Leroy
- INSERM U330, ISPED, Université Victor Segalen, Bordeaux, France
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28
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Msellati P, Hingst G, Kaba F, Viho I, Welffens-Ekra C, Dabis F. Operational issues in preventing mother-to-child transmission of HIV-1 in Abidjan, Côte d'Ivoire, 1998-99. Bull World Health Organ 2001; 79:641-7. [PMID: 11477967 PMCID: PMC2566468] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023] Open
Abstract
OBJECTIVE To demonstrate the feasibility, from the public health standpoint, of preventing mother-to-child transmission of human immunodeficiency virus type 1 (HIV-1) in Africa. METHODS Voluntary counselling and HIV serotesting were routinely provided in four health centres in Abidjan, Côte d'Ivoire, for six months in 1998-99. Peripartum treatment with zidovudine and alternatives to breastfeeding were provided free to HIV-infected women. FINDINGS Of the 4309 pregnant women in the study who attended their first antenatal care visit, 3756 benefited from individual counselling and pretesting (87.2%), and 3452 (80.1%) agreed to undergo HIV serotesting. Overall HIV prevalence was (12.89%) and 5% for women aged under 18 years. Among the 2998 HIV-negative women, 71% returned for their test result, whereas only 60% of the 445 HIV-positive women did so. A total of 124 HIV-positive women were informed of their serostatus and the possibility of preventing mother-to-child transmission of HIV; 100 started treatment and 80 completed zidovudine prophylaxis. At 6 weeks of age, 36 of the 78 liveborn children were being breastfed (46%), two were being mixed-fed and 41 (52%) were being artificially fed. CONCLUSIONS In Abidjan, voluntary counselling and HIV testing with a view to preventing mother-to-child transmission was feasible in antenatal care units and was well accepted by pregnant women. An insufficient proportion of women returned to obtain their test results. This was especially so among HIV-positive women, the target group for preventing mother-to-child transmission of HIV. Additional staff were required in order to offer voluntary counselling and HIV testing to the study women. Close supervision and strong commitment of health workers were essential. Alternatives to breastfeeding were effectively proposed to HIV-positive women, with active follow-up of children and clinical, nutritional and social support.
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Affiliation(s)
- P Msellati
- UR 091, Institut de Recherche pour le Développement, Abidjan, Côte d'Ivoire.
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29
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Bonard D, Msellati P, Rigouts L, Combe P, Coulibaly D, Coulibaly IM, Portaels F. What is the meaning of repeated isolation of Mycobacterium africanum? Int J Tuberc Lung Dis 2000; 4:1176-80. [PMID: 11144462] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
Mycobacterium africanum is a member of the tuberculosis complex, together with M. tuberculosis and M. bovis. Its morphological growth is quite different from that of M tuberculosis. It is a causative agent of the same tuberculosis disease, and its precise identification seems important only for epidemiological purposes. We report here the repetitive isolation of 17 M. africanum strains (among 321 TB complex strains) during a national primary resistance survey in C te d'Ivoire in 1995. All of the M. africanum strains were isolated in four regions located in the same geographical area. They showed biochemical heterogeneity yielding three patterns, none of which was specific to one region. Molecular analysis by RFLP for 14 strains showed identical patterns for four strains, two by two, and a clustering of 62-77% homology for eight of the 14 strains (57%). This report confirms that M. africanum is less frequent than M. tuberculosis. Its repeated isolation may reflect inter-human transmission. Biochemical similarities between strains may not always be associated with a common geographical origin.
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Affiliation(s)
- D Bonard
- Centre de Diagnostic et de Recherche sur le SIDA et les Infections Opportunistes CHU de Treichville, Abidjan, C te d'Ivoire.
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30
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Faye-Ketté H, La Ruche G, Ali-Napo L, Messou N, Viho I, Welffens-Ekra C, Dosso M, Msellati P. Genital mycoplasmas among pregnant women in Cóte d'Ivoire, West Africa: prevalence and risk factors. Int J STD AIDS 2000; 11:599-602. [PMID: 10997504 DOI: 10.1258/0956462001916452] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A cross-sectional study was conducted among pregnant women in Côte d'Ivoire to assess the prevalence and the factors associated with mycoplasma colonization. A positive culture was found in 400 of 551 women (73%); Ureaplasma urealyticum was identified in 22%, Mycoplasma hominis in 20% and both microorganisms in 31%. Mycoplasma colonization was not associated with genital symptoms or signs. Young age, low educational level, antimicrobial chemotherapy before consultation and presence of bacterial vaginosis were factors independently associated with M. hominis colonization. Among women colonized with M. hominis, HIV seroprevalence was 21% in women with high amounts of M. hominis (> or = 10(4) colour-changing units per ml) versus 7% in women with lower amounts (P=0.01). U. urealyticum was found more often in unmarried women and when pregnancy was less than 20 weeks. Mycoplasma colonization is frequent among pregnant women in Abidjan, but their pathogenicity requires further study.
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Affiliation(s)
- H Faye-Ketté
- Institut Pasteur de Cocody, Abidjan, Côte d'Ivoire
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Leroy V, Giraudon I, Viho I, Elenga N, Msellati P, Welffens-Ekra C, Dabis F. Medical care costs of children born to HIV-infected mothers, in Abidjan, Côte d'Ivoire 1996-1997. DITRAME Study Group (ANRS 049a clinical trial). AIDS 2000; 14:1076-8. [PMID: 10854000 DOI: 10.1097/00002030-200005260-00030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Dabis F, Newell ML, Fransen L, Saba J, Lepage P, Leroy V, Cartoux M, Meda N, Whynes DK, Peckham C, Nduati R, Msellati P, Vincenzi ID, van de Perre P. Prevention of mother-to-child transmission of HIV in developing countries: recommendations for practice. The Ghent International Working Group on Mother-To-Child Transmission of HIV. Health Policy Plan 2000; 15:34-42. [PMID: 10731233 DOI: 10.1093/heapol/15.1.34] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Different approaches to prevent mother-to-child transmission of HIV are being evaluated in developing countries. The first trials using a short regimen of zidovudine have been successful in Thailand, Côte d'Ivoire and Burkina Faso. International and local strategies are now being considered. The Ghent International Working Group on Mother-to-Child Transmission of HIV developed public health policy options to integrate these interventions into basic and maternal and child health (MCH) services. METHODS The following tasks were undertaken: a critical review of randomized trials; an international pooled analysis of late postnatal transmission of HIV through breastfeeding; a review of the cost-effectiveness and cost-benefit of antiretroviral prophylaxis; a feasibility assessment of preventive strategies, including a postal survey on HIV voluntary counselling and testing (VCT) of pregnant women; the identification of requirements and research priorities for prenatal, obstetric and paediatric care. These projects provided the background for a three-day workshop in Ghent, Belgium, in November 1997. Conclusions were further refined, based on 1998 research findings. RESULTS A summary of relevant evidence and ten public health recommendations are reported. VCT for pregnant women, a short regimen of zidovudine together with alternatives to breastfeeding currently represent the best option to reduce vertical transmission in most developing countries. The primary goal of the integrated package supporting these interventions is to alleviate overall maternal and infant morbidity and mortality. CONCLUSION Prevention of mother-to-child transmission of HIV should now be considered for integration into basic health and MCH services of selected countries, with the involvement of governments and donor agencies.
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Affiliation(s)
- F Dabis
- Unité INSERM No. 330, Université Victor Segalen Bordeaux 2, France.
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Msellati P, Meda N, Leroy V, Likikouët R, Van de Perre P, Cartoux M, Bonard D, Ouangre A, Combe P, Gautier-Charpentier L, Sylla-Koko F, Lassalle R, Dosso M, Welffens-Ekra C, Dabis F, Mandelbrot L. Safety and acceptability of vaginal disinfection with benzalkonium chloride in HIV infected pregnant women in west Africa: ANRS 049b phase II randomized, double blinded placebo controlled trial. DITRAME Study Group. Sex Transm Infect 1999; 75:420-5. [PMID: 10754950 PMCID: PMC1758266 DOI: 10.1136/sti.75.6.420] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To study the tolerance and acceptability in Africa of a perinatal intervention to prevent vertical HIV transmission using benzalkonium chloride disinfection. DESIGN A randomized, double blinded phase II trial. SETTING Prenatal care units in Abidjan (Côte d'Ivoire) and Bobo-Dioulasso (Burkina Faso). PATIENTS Women accepting testing and counselling who were seropositive for HIV-1 and under 37 weeks of pregnancy were eligible. A total of 108 women (54 in each group) enrolled from November 1996 to April 1997, with their informed consent. INTERVENTION Women self administered daily a vaginal suppository of 1% benzalkonium chloride or matched placebo from 36 weeks of pregnancy, and a single intrapartum dose. The neonate was bathed with 1% benzalkonium chloride solution or placebo within 30 minutes after birth. MAIN OUTCOME MEASURES Adverse events were recorded weekly, with a questionnaire and speculum examination in women through delivery, and examination of the neonate through day 30. The incidence of genital signs and symptoms in the women and cutaneous or ophthalmological events in newborns were compared between groups on an intent to treat basis. RESULTS The median duration of prepartum treatment was 21 days (range 0-87 days). Compliance was 87% for prepartum and 69% for intrapartum treatment, and 88% for the neonatal bath, without differences between the two groups. In women, the most frequent event was leucorrhoea; the incidence of adverse events did not differ between treatment groups. In children, the incidence of dermatitis and conjunctivitis did not differ between the benzalkonium chloride and placebo groups (p = 0.16 and p = 0.29, respectively). CONCLUSION Vaginal disinfection with benzalkonium chloride is a feasible and well tolerated intervention in west Africa. Its efficacy in preventing vertical HIV transmission remains to be demonstrated.
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Affiliation(s)
- P Msellati
- Programme SIDA ORSTOM, Abidjan, Côte d'Ivoire
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Spira R, Lepage P, Msellati P, Van De Perre P, Leroy V, Simonon A, Karita E, Dabis F. Natural history of human immunodeficiency virus type 1 infection in children: a five-year prospective study in Rwanda. Mother-to-Child HIV-1 Transmission Study Group. Pediatrics 1999; 104:e56. [PMID: 10545582 DOI: 10.1542/peds.104.5.e56] [Citation(s) in RCA: 173] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To compare morbidity and mortality of human immunodeficiency virus type 1 (HIV-1)-infected and HIV-1-uninfected children and to identify predictors of acquired immunodeficiency syndrome (AIDS) and death among HIV-1-infected children in the context of a developing country. DESIGN Prospective cohort study. SETTING Maternal and child health clinic of the Centre Hospitalier de Kigali, Rwanda. PARTICIPANTS Two hundred eighteen children born to HIV-1-seropositive mothers and 218 born to seronegative mothers of the same age and parity were enrolled at birth. OUTCOME MEASURES Deaths, clinical AIDS, nonspecific HIV-related manifestations, and use of health care services. RESULTS Fifty-four infected and 347 uninfected children were followed up for a median of 27 and 51 months, respectively. With the exception of chronic cough, the risk of occurrence of nonspecific HIV-related conditions was 3 to 13 times higher in infected than in uninfected children. The recurrence rate and severity of these findings were increased systematically in infected infants. Estimated cumulative risk of developing AIDS was 28% and 35% at 2 and 5 years of age, respectively. Estimated risk of death among infected children at 2 and 5 years of age was 45% and 62%, respectively, a rate 21 times higher than in uninfected children. Median survival time after estimated infection was 12.4 months. Early infection, early onset of HIV-related conditions, failure to thrive, and generalized lymphadenopathy were associated with subsequent risk of death and/or AIDS, whereas lymphoid interstitial pneumonitis was predictive of a milder disease. CONCLUSIONS In Africa, HIV-1-infected children develop disease manifestations early in life. Specific clinical findings are predictive of HIV-1 disease, AIDS stage, and death. Bimodal expression of HIV-1 pediatric disease is encountered in Africa, as in industrialized countries, but prognosis is poorer. human immunodeficiency virus infection, children, vertical transmission, natural history, Africa.
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Affiliation(s)
- R Spira
- Unité INSERM U 330, Université Victor Segalen Bordeaux 2, Bordeaux, France.
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Giraudon I, Leroy V, Msellati P, Elenga N, Ramon R, Welffens-Ekra C, Dabis F. [The costs of treating HIV-infected children in Abidjan, Ivory Coast, 1996-1997]. Sante 1999; 9:277-81. [PMID: 10657769] [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: 02/15/2023]
Abstract
Little is known about the costs of treating HIV-infected children in Africa. However, this is one of the factors that must be taken into account when assessing the cost-effectiveness of strategies aimed at reducing the transmission of HIV from mother to child. The aim of this study was to estimate the direct costs of the treatment of African children born to HIV-infected mothers and the additional costs of treating those children who are themselves infected with the virus. We assessed the direct costs of care for a sample of children born in 1996 to HIV-positive mothers participating in a clinical trial to evaluate the efficacy of administering a short course of zidovudine to the mother in the peri-partum period, in Abidjan, Ivory Coast (DITRAME ANRS 049a). We systematically reviewed the medical records of these children and recorded drug prescriptions, clinical investigations, consultations with medical specialists, hospital admissions and transportation costs during their first year of life. This study included 78 children, 15 of whom were HIV-positive. The mean cost of treatment was 1,671 FF (254 Euros) per child-year for infected children, 709 FF (108 Euros) more than the mean cost of treatment for HIV-negative children born to HIV-positive mothers. Thus, HIV infection resulted in a 74% increase in treatment costs. The mean cost of a drug prescription was 50 FF (7.6 Euros), and could have been halved if only generic drugs had been prescribed. This study was limited to the direct costs of pediatric HIV infection and did not take into account the cost of health service provision in Ivory Coast or the indirect costs for the family. These results were obtained in the context of a prospective clinical trial within a system providing free and unlimited access to health care. In a city where the mean salary of a civil servant is 900 FF (137 Euros) per month, the expenditure necessary to pay for the basic care of one HIV-infected child is high. Health-care services in sub-Saharan Africa should make more use of generic drugs and pediatric HIV infection provides a clear example of the benefits to be obtained by such a rational strategy for the use of scarce health resources.
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Affiliation(s)
- I Giraudon
- Inserm U 330, Université Victor-Ségalen Bordeaux-II, 146 rue Léo-Saignat, 33076 Bordeaux Cedex, France
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Dosso M, Bonard D, Msellati P, Bamba A, Doulhourou C, Vincent V, Peyre M, Traore M, Koffi K, Coulibaly IM. Primary resistance to antituberculosis drugs: a national survey conducted in Côte d'Ivoire in 1995-1996. Ivoirian Study Group on Tuberculosis Resistance. Int J Tuberc Lung Dis 1999; 3:805-9. [PMID: 10488889] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
Abstract
SETTING A national survey of resistance to the antituberculosis drugs used in Côte d'Ivoire was conducted in 1995-1996. OBJECTIVE To determine the rate of primary resistance to antituberculosis drugs. METHODS Consecutive new tuberculous patients with positive smear were recruited from tuberculosis centres and rural health centres. Drug susceptibility testing was performed according to the proportion method. Positive cultures were tested against streptomycin, isoniazid, rifampicin, and ethambutol. All resistant strains and 10% of all randomly sampled cultures were sent to an external laboratory for quality control. Human immunodeficiency virus (HIV) tests were performed for consenting patients at the tuberculosis centres. RESULTS Among the 430 samples, 320 were available for analysis. Primary resistance to antituberculosis drugs was observed for 13.4% of the patients (43/320); multidrug resistance (to at least isoniazid and rifampicin) was observed for 5.3% of the patients; 14.2% of HIV-negative and 16.2% of HIV-positive patients were resistant to at least one antituberculosis drug (P = 0.70). CONCLUSION This study is representative of antituberculosis drug resistance in Côte d'Ivoire. The rate of primary resistance is high and emphasises the need for a sentinel survey of tuberculous resistance. The National Tuberculosis Control Programme needs to make improvements in its management of tuberculosis cases.
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Affiliation(s)
- M Dosso
- Laboratoire de Bacteriologie, Institut Pasteur de Côte d'Ivoire, Abidjan
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Ramon R, Sawadogo D, Koko FS, Noba V, Likikouët R, Gourvellec G, Viho I, Mandelbrot L, Dabis F, Ekra CW, Msellati P. Haematological characteristics and HIV status of pregnant women in Abidjan, Côte d'Ivoire, 1995-96. Trans R Soc Trop Med Hyg 1999; 93:419-22. [PMID: 10674094 DOI: 10.1016/s0035-9203(99)90143-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
To describe the haematological profile of pregnant women and to compare these characteristics according to HIV serostatus in Abidjan, Côte d'Ivoire, a cross-sectional study was made in the context of a research intervention programme to reduce mother-to-child transmission (MTCT) of HIV (ANRS 049 trial). HIV testing was systematically proposed to pregnant women attending the mother and child health clinic of a community health centre. Blood samples were tested for HIV antibodies using Genelavia and Peptilav. The haematological parameters were measured with a Coulter counter. From May 1995 to March 1996, 1646 pregnant women accepted HIV testing and had a full blood count available. The prevalence of HIV infection was 12.0% (n = 197). The prevalence of anaemia (haemoglobin [Hb] < 11 g/dL) was 70.1%, n = 1155 (95% confidence interval 68-72%) and significantly higher in HIV+ (81.7%, n = 161) than in HIV- women (68.9%, n = 994) (P < 0.001). Severe anaemia (Hb < 7 g/dL) was present in 1.9% of the women (n = 31), 4.6% (n = 9) in HIV+ and 1.5% (n = 22) in HIV- women (P < 0.001). HIV infection, primigravidae and secundigravidae were factors independently associated with anaemia. Anaemia was highly prevalent in this population while severe anaemia was rare. HIV infection was a contributor to anaemia in pregnancy. As zidovudine, with its known haematological toxicity, has recently been introduced to prevent MTCT of HIV in developing countries, screening HIV+ women for severe anaemia is necessary.
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Affiliation(s)
- R Ramon
- Laboratoire d'Hématologie, Centre Hospitalier Universitaire (CHU) de Yopougon, Abidjan, France
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Msellati P, Meda N, Welffens-Ekra C, Leroy V, Van de Perre P, Mandelbrot L, Dabis F. Zidovudine and reduction of vertical transmission of HIV in Africa. ANRS 049 Trial Group. Am J Public Health 1999; 89:947-8. [PMID: 10358695 PMCID: PMC1508660 DOI: 10.2105/ajph.89.6.947] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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La Ruche G, Messou N, Ali-Napo L, Noba V, Faye-Ketté H, Combe P, Bonard D, Sylla-Koko F, Dhéha D, Welffens-Ekra C, Dosso M, Msellati P. Vaginal douching: association with lower genital tract infections in African pregnant women. Sex Transm Dis 1999; 26:191-6. [PMID: 10225584 DOI: 10.1097/00007435-199904000-00001] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Douching, a common practice, could further increase the risk of genital infections. GOAL OF THIS STUDY To describe douching practices in pregnant women and to evaluate associations with lower genital tract infections. STUDY DESIGN Cross-sectional study in Abidjan, Côte d'Ivoire. RESULTS Among 552 women included, douching before consultation was reported by 97% and was common practice for 98%. Intravaginal drying agents were used by 10%. Genital warts were less frequent for women who usually douched (p = 0.015). U. urealyticum infection was associated with douching and with the use of intravaginal agents. Diagnosis of genital infections was independent of douching with water or soap, but chlamydial infection was associated with douching with antiseptics, used by 14% of the women (p = 0.036). HIV infection was two times more frequent in women using antiseptics (p = 0.17). CONCLUSION The study confirms the widespread practice of douching in African pregnant women. The harmful effects of antiseptics need to be substantiated.
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Affiliation(s)
- G La Ruche
- National AIDS Program, Abidjan, Côte d'Ivoire
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Desgrées du Loû A, Msellati P, La Ruche G, Welffens-Ekra C, Ramon R, Dabis F. Estimation of HIV-1 prevalence in the population of Abidjan by adjustment of the prevalence observed in antenatal centres. AIDS 1999; 13:526-7. [PMID: 10197385 DOI: 10.1097/00002030-199903110-00015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Desgrées du Loû A, Msellati P, Yao A, Noba V, Viho I, Ramon R, Welffens-Ekra C, Dabis F. Impaired fertility in HIV-1-infected pregnant women: a clinic-based survey in Abidjan, Côte d'Ivoire, 1997. AIDS 1999; 13:517-21. [PMID: 10197381 DOI: 10.1097/00002030-199903110-00011] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Differences in fertility among HIV-1-positive and HIV-negative women tested in prenatal clinics were suspected by routine data collection in Abidjan, Côte d'Ivoire. This study was conducted on detailed fertility patterns among women at the same antenatal care centres, in order to assess these differences. METHOD The survey was carried out on 1201 consecutive women who agreed to be tested for HIV. Data collected included a detailed account of pregnancies, the time interval between the last two pregnancies, and the health status at the time of the survey. Blood samples were tested for HIV and syphilis with informed consent. RESULTS Despite an earlier exposure to pregnancy risk, HIV-1-infected women aged 25 years and above, had, on the average, fewer pregnancies than uninfected women. An analysis of the interval between the last two pregnancies among multigravidae showed that, all things being equal, being HIV-1 positive decreased the risk of being pregnant by 17% (Cox regression, hazard ratio = 0.83, 95% confidence interval (CI): 0.69-0.99). This shift in the occurrence of the last pregnancy was more profound among HIV-1-positive women already at the symptomatic or AIDS stage, than among asymptomatic women. CONCLUSION These data confirm that women infected by HIV-1 would become pregnant less often than uninfected women, for an equal exposure to the risk of pregnancy. Therefore HIV-1-positive women could be under-represented at antenatal centres. Programmes involving such settings both for epidemiological surveillance and the reduction of mother-to-child transmission should take this observation into account.
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Affiliation(s)
- A Desgrées du Loû
- Institut de Recherche pour le Dévelopment, Programme Sida, Abidjan, Côte d'Ivoire
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Dabis F, Msellati P, Meda N, Welffens-Ekra C, You B, Manigart O, Leroy V, Simonon A, Cartoux M, Combe P, Ouangré A, Ramon R, Ky-Zerbo O, Montcho C, Salamon R, Rouzioux C, Van de Perre P, Mandelbrot L. 6-month efficacy, tolerance, and acceptability of a short regimen of oral zidovudine to reduce vertical transmission of HIV in breastfed children in Côte d'Ivoire and Burkina Faso: a double-blind placebo-controlled multicentre trial. DITRAME Study Group. DIminution de la Transmission Mère-Enfant. Lancet 1999; 353:786-92. [PMID: 10459959 DOI: 10.1016/s0140-6736(98)11046-2] [Citation(s) in RCA: 374] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Zidovudine reduces the rate of vertical transmission of HIV in non-breastfed populations. We assessed the acceptability, tolerance, and 6-month efficacy of a short regimen of oral zidovudine in African populations practising breastfeeding. METHODS A randomised double-blind placebo-controlled trial was carried out in public clinics of Abidjan, Côte d'Ivoire, and Bobo-Dioulasso, Burkina Faso. Eligible participants were women aged 18 years or older, who had confirmed HIV-1 infection and pregnancy of 36-38 weeks duration, and who gave written informed consent. Exclusion criteria were severe anaemia, neutropenia, abnormal liver function, and sickle-cell disease. Women were randomly assigned zidovudine (n=214; 300 mg twice daily until labour, 600 mg at beginning of labour, and 300 mg twice daily for 7 days post partum) or matching placebo (n=217). The primary outcome was the diagnosis of HIV-1 infection in the infant on the basis of sequential DNA PCR tests at days 1-8, 45, 90, and 180. We compared the probability of infection at a given age in the two groups. Analyses were by intention to treat. FINDINGS Women were enrolled between September, 1995, and February, 1998, when enrolment to the placebo group was stopped. Analysis was based on 421 women and 400 lifeborn infants. Baseline demographic, clinical, and laboratory characteristics were similar in the two groups. The Kaplan-Meier probability of HIV infection in the infant at 6 months was 18.0% in the zidovudine group (n=192) and 27.5% in the placebo group (n=197; relative efficacy 0.38 [95% CI 0.05-0.60]; p=0.027). Adjustment for centre, period of recruitment, mode of delivery, maternal CD4-cell count, duration of labour, prolonged rupture of membranes, and duration of breastfeeding did not change the treatment effect. The proportions of women taking more than 80% of the planned maximum dose were 75% before delivery, 81% during labour, and 83% post partum, without statistical difference between the groups. No major adverse biological or clinical event was reported in excess among women and children of the zidovudine group. INTERPRETATION A short course of oral zidovudine given during the peripartum period is well accepted and well tolerated, and provides a 38% reduction in early vertical transmission of HIV-1 infection despite breastfeeding.
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Affiliation(s)
- F Dabis
- Unité INSERM 330, Université Victor Segalen Bordeaux 2, France.
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Leroy V, Newell ML, Dabis F, Peckham C, Van de Perre P, Bulterys M, Kind C, Simonds RJ, Wiktor S, Msellati P. International multicentre pooled analysis of late postnatal mother-to-child transmission of HIV-1 infection. Ghent International Working Group on Mother-to-Child Transmission of HIV. Lancet 1998; 352:597-600. [PMID: 9746019 DOI: 10.1016/s0140-6736(98)01419-6] [Citation(s) in RCA: 192] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND An understanding of the risk and timing of mother-to-child transmission of HIV-1 in the postnatal period is important for the development of public-health strategies. We aimed to estimate the rate and timing of late postnatal transmission of HIV-1. METHODS We did an international multicentre pooled analysis of individual data from prospective cohort studies of children followed-up from birth born to HIV-1-infected mothers. We enrolled all uninfected children confirmed by HIV-1-DNA PCR, HIV-1 serology, or both. Late postnatal transmission was taken to have occurred if a child later became infected. We calculated duration of follow-up for non-infected children from the time of negative diagnosis to the date of the last laboratory follow-up, or for infected children to the mid-point between the date of last negative and first positive results. We stratified the analysis for breastfeeding. FINDINGS Less than 5% of the 2807 children in four studies from industrialised countries (USA, Switzerland, France, and Europe) were breastfed and no HIV-1 infection was diagnosed. By contrast, late postnatal transmission occurred in 49 (5%) of 902 children in four cohorts from developing countries, in which breastfeeding was the norm (Rwanda [Butare and Kigali], Ivory Coast, Kenya), with an overall estimated risk of 3.2 per 100 child-years of breastfeeding follow-up (95% CI 3.1-3.8), with similar estimates in individual studies (p=0.10). Exact information on timing of infection and duration of breastfeeding was available for 20 of the 49 children with late postnatal transmission. We took transmission to have occurred midway between last negative and first positive HIV-1 tests. If breastfeeding had stopped at age 4 months transmission would have occurred in no infants, and in three if it had stopped at 6 months. INTERPRETATION Risk of late postnatal transmission is consistently shown to be substantial for breastfed children born to HIV-1-positive mothers. This risk should be balanced against the effect of early weaning on infant mortality and morbidity and maternal fertility.
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Affiliation(s)
- V Leroy
- Unité INSERM 330, Université Victor Segalen Bordeaux 2, France.
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Nkengasong J, Sylla-Koko F, Peeters M, Ellenberger D, Sassan-Morokro M, Ekpini RA, Msellati P, Greenberg AE, Combe P, Rayfield M. HIV-1 group O virus infection in Abidjan, Côte d'Ivoire. AIDS 1998; 12:1565-6. [PMID: 9727587 DOI: 10.1097/00002030-199812000-00028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Desgrées du Loû A, Msellati P, Ramon R, Noba V, Viho I, Dabis F, Mandelbrot L, Welffens-Ekra C. HIV-1 infection and reproductive history: a retrospective study among pregnant women, Abidjan, Côte d'Ivoire, 1995-1996. Ditrame Project. Int J STD AIDS 1998; 9:452-6. [PMID: 9702593 DOI: 10.1258/0956462981922610] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aim of this paper is to determine the differences of fertility between HIV-1 infected and uninfected women in Abidjan, Côte d'Ivoire, using data available in an observational study conducted in 1995 and 1996 in 2 antenatal care centres in the district of Yopougon, Abidjan, within an intervention programme to reduce mother-to-child HIV-1 transmission (DITRAME project, ANRS 049). Fertility indicators have been constructed from retrospective data on pregnancies and births, and univariate and multivariate analyses have been performed on these indicators and stratified by age groups to compare HIV-1 positive and HIV-negative populations. The main outcome measures were the number of pregnancies, the number of miscarriages, the risk of miscarriage and the proportion of primigravida. Four thousand, three hundred and ninety-six women agreed to HIV testing: 12.1% were found to be HIV-1 infected. HIV-1 positive women had significantly fewer pregnancies than HIV-negatives in age-groups 25-29 (P = 0.05) and 30-34 (P = 0.008). The risk of having had at least one abortion or stillbirth was significantly higher for HIV-1 infected women than for HIV-negatives (OR = 1.28, 95% CI: 1.02-1.60), when controlling for social and demographic factors. This study suggests that HIV-1 infection has deleterious consequences on female fertility, with lower fertility rates and more frequent adverse pregnancy outcomes. Family planning and antenatal care services should consider antenatal HIV counselling and testing in women in areas of high HIV prevalence.
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Msellati P, Ramon R, Viho I, Noba V, Mandelbrot L, Dabis F, Welffens Ekra C. Prevention of mother-to-child transmission of HIV in Africa: uptake of pregnant women in a clinical trial in Abidjan, Côte d'Ivoire. AIDS 1998; 12:1257-8. [PMID: 9677183 DOI: 10.1097/00002030-199810000-00026] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Amon-Tanoh Dick F, Domoua K, N'Goan-Domoua A, Msellati P. Etiologies des complications pulmonaires du SIDA pédiatrique en Afrique sub-saharienne. Med Mal Infect 1998. [DOI: 10.1016/s0399-077x(98)80124-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Coulibaly D, Msellati P, Dedy S, Welffens-Ekra C, Dabis F. [Attitudes and behavior of pregnant women towards HIV screening in Abidjan (Ivory Coast) in 1995 and 1996]. Sante 1998; 8:234-8. [PMID: 9690325] [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: 02/08/2023]
Abstract
A research program into ways of reducing the maternal transmission of HIV (Project DITRAME, trial ANRS 049) was started in December 1994 in the maternity and child health clinics of the University Hospital and a community health center (Formation Sanitaire de Yopougon, FSU) in Abidjan. The first stage of this program was the introduction of voluntary HIV testing for pregnant women. During their first visit to the maternity clinic, all women were asked their age, how long they had been pregnant and where they were planning to give birth. Women over the age of 18, less than 32 weeks into gestation, who were planning to give birth in Abidjan were routinely offered an HIV test. Women who gave written consent to the test then gave a blood sample for HIV testing. Those testing positive for HIV were given posttest counseling and were invited to participate in a clinical trial of AZT. There were high rates of refusal to be tested and failure to return for posttest counseling during the first year of voluntary HIV testing. We therefore carried out a qualitative study of the reasons for refusal and failing to return. The study involved in-depth interviews with 50 pregnant women who refused to be tested and 50 others who missed the posttest appointment. Most of the women who refused to be tested thought they were probably HIV-positive. The main reason for refusing the test was the fear that the disease process would accelerate once they were informed of their HIV infection. Many women were also afraid of the reactions of their relatives, and particularly of their husband or partner, to a positive test result. There was also concern about possible breaches of confidentiality. Some women felt that pregnancy was not the best time to find out that they were HIV-positive. The reasons for not returning after testing were essentially the same, although some women were confused about the date of the appointment or did not understand the difference between standard prenatal blood test and HIV testing. Our study shows that even when most pregnant women accept the test, there are persistent problems. Some relate to the perception of HIV infection in Africa as "the disease" that cannot be cured, resulting in the view that there is no point in knowing that you are infected. Refusal to be tested is also associated with the socioeconomic vulnerability of women and their fear of exclusion. Means of reducing the maternal transmission of HIV will shortly become available in developing countries. Therefore, we need to address this problem and make voluntary HIV testing for pregnant women as widely available as possible.
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Affiliation(s)
- D Coulibaly
- Institut d'ethnosociologie, Université d'Abidjan, Côte d'Ivoire
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Simonon A, Mulder-Kampinga GA, van de Perre P, Karita E, Msellati P, Kuiken C, Goudsmit J. Evolution of human immunodeficiency virus subtype A in women seroconverting post partum and in their offspring post-natally infected by ingestion of breast milk. J Gen Virol 1997; 78 ( Pt 9):2225-33. [PMID: 9292010 DOI: 10.1099/0022-1317-78-9-2225] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The evolution of genomic RNA of human immunodeficiency virus type 1 (HIV-1), subtype A, was studied in three Rwandan mother-child pairs over a period of 12-30 months. In two pairs a homogeneous subtype A V3 sequence population was observed at seroconversion and the virus populations in the children resembled those in the mothers. One of these mother-child pairs was infected with an A/C recombinant virus (Ap17/Cp24). In the third pair, a heterogeneous V3 sequence population was observed in the maternal seroconversion sample but the V3 sequence population in the child's sample was homogeneous. In each individual the intra- and intersample variation (between the seroconversion and follow-up samples) increased over time in both the V3 region and p17gag. Independent evolution for 1-2 years did not abolish the epidemiological relationship between virus populations in mother and child.
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Affiliation(s)
- A Simonon
- AIDS Reference Laboratory, National AIDS Control Program, Kigali, Rwanda
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Meda N, Msellati P, Welffens-Ekra C, Cartoux M, Leroy V, Van de Perre P, Salamon R. [The reduction of mother-child transmission of HIV infection in developing countries: potential intervention strategies, obstacles to implementation and perspectives. The Reduction of Mother-Child Transmission of HIV Infection in Africa Group]. Sante 1997; 7:115-25. [PMID: 9273118] [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: 02/05/2023]
Abstract
Mother to child transmission (MCT) of Human Immunodeficiency Virus (HIV) is the main cause of the spread of the HIV epidemic in the pediatric population. It is estimated that to date, three million children worldwide have been infected by HIV. The epidemic burden in developing countries is dramatic. Ninety-five percent of the world's HIV-infected women are living in developing countries. In industrialized countries, antiretroviral treatment of pregnant women and newborns with azidothymidine (AZT, ACTG 076 regimen) and discouraging breast feeding by HIV-infected mothers are effectively reducing MCT of HIV. However, there are three major obstacles to the systematic application of these strategies in developing countries: (a) difficulties in implementing the complex AZT administration and its corollary the avoidance of breast feeding; (b) the complexity of the logistics of the ACTG 076 regimen; (c) cost. Indeed, in developing countries the socioeconomic situation of the populations are precarious and health structures and services are underdeveloped. In addition, the anxiety and the reluctance of general population in the face of the HIV problem and the high prevalence of maternal anemia reduce the acceptability and safety of AZT treatment for pregnant women in developing regions. Only interventions that are applicable, acceptable, safe, affordable, of low cost and integrated into health system will be able to reduce HIV MCT. We now know that MCT occurs mostly during the perinatal period and the maternal viral load in blood, in cervical secretions and in breast milk appears to be the main determinant of transmission. Maternal vitamin A deficiency may also favor MCT of HIV. It is however possible that this association is confounded by the relationship between advanced maternal HIV disease (a known risk factor for transmission) and vitamin A deficiency. In spite of these uncertainties concerning determinants of MCT of HIV, several interventions have been designed. The first involves treating the mother with antiretroviral drugs for the perinatal period. The second is vaginal disinfection by application of virucidal antiseptics during the perinatal period. The third is to give vitamin A supplements to pregnant women and children. Finally, passive immunotherapy with anti-HIV antibodies applied to pregnant women and/or new born, may be beneficial. The feasibility, safety and efficacy of these potential interventions have not yet been demonstrated in developing countries. In view of the dramatic spread of HIV infection in these countries, the evaluation of these interventions is of utmost priority. These trials are necessary because of the public health emergency but should be performed in strict respect of human rights and medical ethics.
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Affiliation(s)
- N Meda
- Centre Muraz, Organisation de coordination et de coopération pour la lutte contre les grandes endémies (OCCGE), Burkina Faso
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