[Practices and Factors Associated with Recent HIV Testing in the General Population, Côte d'Ivoire: Results of the ANRS Study 12323 DOD-CI]

With 2.9% of HIV prevalence in the general population, Côte d'Ivoire is one of the countries most affected by the HIV epidemic in West Africa. In this country, only 63% of people infected with HIV are aware of their status. A cross-sectional phone survey was conducted with a representative sample of 3,867 individuals to describe the practices and factors associated with a recent HIV testing (≤ 1 year) in Côte d'Ivoire. Data relative to the last done HIV test as well as the socio-demographic characteristics, sexual behavior, access to information, perceptions, capacities and autonomy as well as social and geographical environment of the participants were collected. Logistical regression models were used to identify the associated factors with a recent HIV test (≤ 1 year). Lack of information is one of the main barriers to HIV testing (only 60% of individuals know a place to get tested). For men, despite the fact that HIV testing is free of charge, poor economic conditions seem to be a barrier to testing. The social environment, including peer influence, also appears to have an effect on testing among men. For women, testing is associated with their perceptions of HIV exposure. There is a need to rethink the current HIV testing communication in Côte d'Ivoire and to identify economic or social incentives to remove access barriers to HIV testing.

[Sociodemographic and mental health risk factors: Global and local conditions according to the Survey results "mental health in the general population" in 18 international locations]

INTRODUCTION

Mental Health in General Population survey (MHGP) is a socio-anthropological and epidemiological multicentre research carried out by the WHO Collaborating Centre for Research and Training in Mental Health (Lille, France). It assessed the prevalence of major mental disorders in the general population with 15,747 people aged 18 years and above in 18 sites worldwide: 6 European sites, 4 sites in the Maghreb, 4 sites in the Indian Ocean, 2 sites in the Caribbean and two sites in the Pacific Ocean.

OBJECTIVES

To assess the risk of the presence of at least one mental disorder in terms of sociodemographic factors (gender, age, marital status, family income, education level, professional activity, religious practice and social isolation) and location (zone [Europe, North Africa, Indian Ocean, Caribbean Islands and the Indian Ocean Islands] and "investigation site").

METHODOLOGY

Statistical analysis was performed using data collected in 18 international sites of the MHGP survey. Logistic regression was used to model the relationship between sociodemographic and geographic factors and the presence of at least one disorder (mood disorder, anxiety disorder, psychotic disorder, abuse or dependence on alcohol or drugs), evaluated with the Mini International Neuropsychiatric Interview (MINI) diagnostic questionnaire.

RESULTS

The prevalence of mental disorders rates vary among 18 sites, ranging from 15.5 % (Andorra) to 60 % (Algiers). The adjusted global epidemiological model (18 cluster sites) confirms a decreased level of risk of at least a psychiatric pathology due to a favorable sociodemographic "profile": marital status (married), family income (higher), age group (60 years and above), educational level (university), gender (male), practice of religion (among believers), employment (exercised). Analysis at geographical situation's level confirms existence of sub socio-geo-demographic models differentiated by ranking and levels of variables' modalities. Classification of variables and their modalities is clearly differentiated not only between 5 zones, but also within each of them depending on the sites that comprise it. This produces differentiated models for each of the 18 survey sites.

CONCLUSIONS

The impact of sociodemographic risk factors on mental health is confirmed regardless of World region. However, the implementation of action plans for the prevention of mental disorders requires a detailed understanding of people's needs in terms of the disorder's prevalence, nature and strength of risk factors, at regional and local levels. This observation provides incentives to develop this research axis in world francophone and Latin speaking areas. These epidemiological results can be refined thanks to the data collected in the MHGP surveys about each mental disorder and comorbid conditions, the recourse of populations to assistance or care, as well as results of the socio-anthropological axis.

[Prevalence of psychiatric and substance use disorders among three generations of migrants: Results from French population cohort]

INTRODUCTION

Mental health of migrant populations has become a major public health issue since these populations more often suffer from mental health problems than host populations. The influence of the migration process on the emergence of these disorders and its impact on future generations is uncertain. This study provides an estimate of the prevalence of mental disorders among three generations of migration.

METHOD

The study was conducted in the general population by the French Collaborating Center of the World Health Organization, in France, on a sample of 37,063 people aged 18 and older. The subjects interviewed were selected by a quota sampling method and, thus, were representative of the general population in the 47 study sites in France. This method develops a sample of subjects with the same characteristics as the general population on predefined issues, such as age, sex, educational level and socioprofessional category. The designation of migrant status was based on the country of birth of the subject, the subject's parents and the subject's grandparents. We defined a migrant as first generation (a subject born abroad; n=1911), second generation (at least one parent born abroad; n=4147), or third generation (at least one grandparent born abroad; n=3763) of migrants. The diagnostic tool used was the Mini International Neuropsychiatric Interview (MINI). The MINI is a brief structured diagnostic interview developed by psychiatrists for ICD-10 and DSM-IVTR psychiatric disorders in the general population. The comparisons by generation of migrants were performed by chi-square test for qualitative variables and by an analysis of variance for quantitative variables. The same tests were used to compare the presence of mental disorders according to the characteristics of the population. Factors with a P-value less than 0.2 were entered in a multivariable logistic regression to assess the relationship between the generation of migrants and the presence of mental disorders, adjusting for the confounding factors.

RESULTS

Thirty-eight per cent of migrant subjects have psychological difficulties, versus 30 % in the host population. These results are observed on three successive generations of migrants. Migration status increases risk of depressive disorders (OR=1.555), bipolar disorder (OR=1.597, CI=1.146-2.227), post-traumatic stress disorder (OR=1.615), substance abuse (OR=2.522) and alcohol abuse (OR=1.524), and drug dependence (OR=2.116). This risk is maintained at the second and third generation. The migration process affects mental health of population regardless of socioeconomic status or geographic origin.

CONCLUSION

The consideration of migration and generation of migration shows a specific psychopathological risk profile. This is related to the joint action of a migratory past and precarious socioeconomic situation.

Public health impact of Infanrix hexa (DTPa-HBV-IPV/Hib) reimbursement: A study programme in France. Part 1: Evolution of hepatitis B vaccine coverage rates in infants aged less than 27 months, in the general population - the PopCorn study

BACKGROUND

Reimbursement of the hexavalent vaccine (Infanrix hexa) comprising the DTPa-IPV-Hib components and the hepatitis B valence in a single vaccine was decided in March 2008 in France. The impact of its reimbursement on the hepatitis B vaccine coverage rate was assessed in a study conducted in the general population prior to and after implementation of the reimbursement policy.

METHODS

The PopCorn study (NCT01782794) was a national, cross-sectional and repeated study, with four assessment periods over 3 years, from 2009 to 2012, to assess the hepatitis B vaccine coverage in 12- to 15- and 24- to 27-month-old children, vaccinated between 2007 and 2011 and selected by the quota sampling method. Face-to-face interviews were conducted at their homes and vaccination status was collected using their child's health record. Parents were also interviewed on their perceptions and acceptance of hepatitis B vaccination. Three indicators were calculated to assess hepatitis B vaccination coverage: proportions of infants with at least one dose before 6 months of age, with at least two doses before 6 months of age and with a complete schedule at 24 months of age.

RESULTS

A total of 4903 children were enrolled in the study. An overall significant increase (P-value [P<0.05]) of the three indicators of interest over the four periods of time was observed for both age groups. The proportion of children receiving hepatitis B vaccination before 6 months increased from 21% at baseline (before vaccine reimbursement) to almost 75% at the last assessment period in 2012. More than 60% of 24- to 27-month-old children received a complete schedule in 2012 compared to 33% at baseline. No significant increases in the proportions of parents "favourable" and "moderately in favour" of hepatitis B vaccination were observed across the four evaluation periods (respectively, 17-22% and 48-50%, P=0.09).

CONCLUSION

The rapid increase of hepatitis B vaccination coverage suggests a significant change in hepatitis B vaccination practice related to the hexavalent vaccine's reimbursement. This change was observed in a context of stability regarding parents' perceptions and acceptance of hepatitis B vaccination and of coverage rates for other infant vaccinations.