Postabortion care service availability, readiness, and access in Burkina Faso: results from linked female-facility cross-sectional data.

BACKGROUND: Little is known about postabortion care (PAC) services in Burkina Faso, despite PAC's importance as an essential and life-saving component of emergency obstetric care. This study aims to evaluate PAC service availability, readiness, and accessibility in Burkina Faso. METHODS: Data for this study come from the Performance Monitoring for Action (PMA) Burkina Faso project and the Harmonized Health Facility Assessment (HHFA) conducted by the Institut de Recherche en Sciences de la Santé and the Ministry of Health. PMA data from a representative sample of women aged 15-49 (n = 6,385) were linked via GPS coordinates to HHFA facility data (n = 2,757), which included all public and private health facilities in Burkina Faso. We assessed readiness to provide basic and comprehensive PAC using the signal functions framework. We then calculated distance to facilities and examined percent within 5 kms of a facility with any PAC, basic PAC, and comprehensive PAC overall and by women's background characteristics. RESULTS: PAC services were available in 46.4% of health facilities nationwide; only 38.3% and 35.0% of eligible facilities had all basic and comprehensive PAC signal functions, respectively. Removal of retained products of conception was the most common missing signal function for both basic and comprehensive PAC, followed by provision of any contraception (basic) or any LARC (comprehensive). Nearly 85% of women lived within 5 km of a facility providing any PAC services, while 50.5% and 17.4% lived within 5 km of a facility providing all basic PAC and all comprehensive PAC signal functions, respectively. Women with more education, greater wealth, and those living in urban areas had greater odds of living within 5 km of a facility with offering PAC, basic PAC, or comprehensive PAC. CONCLUSIONS: Results indicate a need for increased PAC availability and readiness, prioritizing basic PAC services at the primary level-the main source of care for many women-which would reduce structural disparities in access. The current deficiencies in PAC signal a need for broader strengthening of the primary healthcare services in Burkina Faso to reduce the burden of unsafe abortion-related morbidity and mortality while improving maternal health outcomes more broadly.

Leptospirosis Cases among Outpatients with Non-Malaria Fever Attending Primary Care Clinics during the Rainy Season in Bobo Dioulasso, Burkina Faso.

Leptospirosis is presumably an important cause of non-malarial fever in West Africa. In this study, outpatients consulting in primary care clinics during the rainy season were tested for leptospirosis, and clinical characteristics associated with leptospirosis cases were explored. Patients with fever ≥ 39°C were recruited in nine primary health care centers in Bobo Dioulasso (Burkina Faso). Diagnosis of malaria was ruled out using a rapid diagnostic test (RDT; SD Bioline Malaria®). Leptospirosis cases were defined as patients who tested positive for Leptospira IgM (Leptocheck-WB RDT and Leptospira IgM ELISA assay, Panbio) or DNA in plasma (LipL32 polymerase chain reaction [PCR]). Among 350 patients, 202 tested positive for malaria and were excluded, and 148 met the eligibility criteria and were included. Among these, 26 subjects were considered to be leptospirosis cases: 23 tested positive for Leptospira IgM (15.5%) and three tested positive by PCR (2.2%). Headaches, abdominal symptoms, and myalgia were frequently reported without any difference between leptospirosis cases and negative cases. Cough was more frequently observed among subjects testing positive for leptospirosis (P = 0.02). Water exposure, presence of a skin injury, and walking barefoot were associated with a Leptospira-positive test. All leptospirosis cases recovered without sequelae. A significant portion of outpatients with non-malarial febrile illness during the rainy season in Burkina Faso had epidemiological factors associated with leptospirosis and tested positive for Leptospira. The favorable outcome of leptospirosis cases was reassuring; this could be due in particular to the young age of the patients.

Leptospirosis seroprevalence and risk factors among slaughterhouse workers in Burkina Faso.

Objectives: The objectives of this study were to determine the seroprevalence and risk factors of leptospirosis among slaughterhouse workers in Burkina Faso. Methods: We performed a cross-sectional survey of slaughterhouse workers from Ouagadougou and Bobo Dioulasso between March and April 2021. Blood was collected by venipuncture and serum samples were tested using enzyme-linked immunosorbent assay and microscopic agglutination test. Questionnaires were used to collect information from these workers on sociodemographic characteristics, work activities, knowledge of zoonosis, and risky behaviors. Results: Of the 172 subjects investigated, 28 (16.28%) were found seropositive for leptospirosis using enzyme-linked immunosorbent assay or microscopic agglutination test. The main Leptospira infecting serogroup were Mini, Autumnalis, Canicola, Copenhageni, L. mayottensis (ND), Icterohaemorrhagiae, Pyrogenes/Tarassovi (cross reaction), Panama, and Ballum. Risk factors according to multivariate analysis, included residence (P = 0.02), working at the bleeding station (P = 0.03), contact with feces and urine (P = 0.04), and the practice of agriculture outside the slaughterhouse (P = 0.05). Conclusion: These findings indicate that a significant proportion of slaughterhouse workers are being exposed to pathogenic Leptospira. Public-health interventions against leptospirosis will need to target this occupational group. Proper personal protective equipment and information about the disease should be disseminated among slaughterhouses.

Evaluation of ten (10) SARS-CoV-2 rapid serological tests in comparison with WANTAI SARS-CoV-2 ab ELISA in Burkina Faso, West Africa.

BACKGROUND: The aim of this study was to evaluate the performance of ten (10) SARS-CoV-2 serological rapid diagnostic tests in comparison with the WANTAI SARS-CoV-2 Ab ELISA test in a laboratory setting. MATERIALS AND METHODS: Ten (10) SARS-CoV-2 serological rapid diagnostic tests (RDTs) for SARS-CoV-2 IgG/IgM were evaluated with two (2) groups of plasma tested positive for one and negative for the other with the WANTAI SARS-CoV-2 Ab ELISA. The diagnostic performance of the SARS-CoV-2 serological RDTs and their agreement with the reference test were calculated with their 95% confidence intervals. RESULTS: The sensitivity of serological RDTs ranged from 27.39 to 61.67% and the specificity from 93.33 to 100% compared to WANTAI SARS-CoV-2 Ab ELISA test. Of all the tests, two tests (STANDARD Q COVID-19 IgM/IgG Combo SD BIOSENSOR and COVID-19 IgG/IgM Rapid Test (Zhejiang Orient Gene Biotech Co., Ltd)) had a sensitivity greater than 50%. In addition, all ten tests had specificity greater than or equal to 93.33% each. The concordance between RDTs and WANTAI SARS-CoV-2 Ab ELISA test ranged from 0.25 to 0.61. CONCLUSION: The SARS-CoV-2 serological RDTs evaluated show low and variable sensitivities compared to the WANTAI SARS-CoV-2 Ab ELISA test, with however a good specificity. These finding may have implications for the interpretation and comparison of COVID-19 seroprevalence studies depending on the type of test used.

Herpes simplex virus type 2 (HSV-2) and its association with HIV, HCV, HBV, HTLV-1&2 and syphilis among men who have sex with men in Burkina Faso.

PURPOSE: This study aimed to estimate herpes simplex virus type 2 (HSV-2) seroprevalence and its association with HIV, HBV, HCV, HTLV-1&2 and syphilis among men who have sex with men (MSM) in Ouagadougou, Burkina Faso, West Africa. MATERIALS AND METHODS: We screened MSM sera for HSV-2 antibodies. A total of 329 sera were collected from an HIV and syphilis behavioral and biological cross-sectional survey conducted among MSM in Ouagadougou from January to April 2013. Serum samples were tested using Enzyme Linked Immuno-Sorbent Assay (ELISA) for the detection of IgG antibodies to HSV-2. Also, antibodies to HTLV-1&2, HBsAg and anti-HCV antibodies were screened by ELISA. Laboratory assays were performed according to manufacturers' instructions at the Biomedical Research Laboratory at the "Institut de Recherche en Sciences de la Sante" (IRSS) in Burkina Faso. RESULTS: The seroprevalence of HSV-2 infection among MSM was 14.3%(95% CI: 10.6-18.1), with disparities according to age and occupation. HSV-2 seroprevalence was high among MSM who were seropositive for HIV (40% versus 13.9%), for syphilis (42.9% versus 13.3%), for HCV (32.5% versus 11.7%) and for HTLV-1&2 (38.5% versus 12.9%) compared to people seronegative for these pathogens. Multivariate analysis showed that HIV-positive (ORa â€‹= â€‹5.34, p â€‹= â€‹0.027), anti-HCV-positive (ORa â€‹= â€‹4.44, p â€‹= â€‹0.001), and HTLV-1&2 positive (aOR â€‹= â€‹4.11, p â€‹= â€‹0.046) were associated with HSV-2 infection among MSM. However, no significant statistical association between HSV-2 and syphilis was found. CONCLUSION: HSV-2 seroprevalence among MSM in Burkina Faso is relatively high. Positive associations between sexual transmitted infections including HIV with HSV-2 suggest that HSV-2 infection's prevention should be strengthened through HIV transmission control programs.

Prevalence and factors associated with the occurrence of sexual violence among people with disabilities in Burkina Faso.

A person with a disability regardless of the gender has an increased risk of sexual coercion and violence in various ways. This study aimed to analyze the prevalence and the risk factors associated with lifetime sexual violence among people with disabilities (PWDs) in Burkina Faso. We conducted a secondary analysis of a cross-sectional study carried out in Central, Central-East, Central-West and "Hauts Bassins" regions of Burkina Faso. PWDs were selected during a household survey through a two-stage random sampling technique. The prevalence of sexual violence in people disabilities was 7.4% (95%: CI 5.8-9.4). Females with disabilities were more likely than males with disabilities to report lifetime sexual violence (8.9% vs. 4.9%). The place where the person usually spends time and the disability duration were significantly associated with the occurrence of sexual violence among females with disability. There is no association between the other demographic characteristics and sexual violence among people with disability.

Prevalence and factors associated with stigma among people with disabilities in Niger in 2018: a multi-level analysis.

People with disability face stigmatization in most of African countries. The objective of this study was to determine the prevalence and the factors associated with stigma among people living with a disability in Niger. This is a secondary analysis of data from a cross sectional study on disability and HIV conducted in Niger from June to November 2018. People with disabilities in grades 3 and 4 identify with Washington Group Short Set of Questions, aged 15-60, were included. Factors associated with stigma were identified by a binary multilevel regression model. A total of 820 participants were included. The prevalence of stigma was 18%. People with intellectual (adjusted odds ratio [aOR]: 1.89; 95% Confidence interval [95%CI] [1.58-5.03]) and cognitive (aOR:2.82; 95%CI 1, 14-3.13]were more likely to experience stigma than other types of disabilities. People with disabilities over the age of 20 were 57% to 71% less likely to be stigmatized than people with disabilities aged 15-19. Living in the same accommodation with other people with disabilities was also a protective factor against the experience. There is a need to implement interventions to reduce the stigmatization of people with disabilities in Niger.

International virtual confidential reviews of infection-related maternal deaths and near-miss in 11 low- and middle-income countries - case report series and suggested actions.

BACKGROUND: Obstetric infections are the third most common cause of maternal mortality, with the largest burden in low and middle-income countries (LMICs). We analyzed causes of infection-related maternal deaths and near-miss identified contributing factors and generated suggested actions for quality of care improvement. METHOD: An international, virtual confidential enquiry was conducted for maternal deaths and near-miss cases that occurred in 15 health facilities in 11 LMICs reporting at least one death within the GLOSS study. Facility medical records and local review committee documents containing information on maternal characteristics, timing and chain of events, case management, outcomes, and facility characteristics were summarized into a case report for each woman and reviewed by an international external review committee. Modifiable factors were identified and suggested actions were organized using the three delays framework. RESULTS: Thirteen infection-related maternal deaths and 19 near-miss cases were reviewed in 20 virtual meetings by an international external review committee. Of 151 modifiable factors identified during the review, delays in receiving care contributed to 71/85 modifiable factors in maternal deaths and 55/66 modifiable factors in near-miss cases. Delays in reaching a GLOSS facility contributed to 5/85 and 1/66 modifiable factors for maternal deaths and near-miss cases, respectively. Two modifiable factors in maternal deaths were related to delays in the decision to seek care compared to three modifiable factors in near-miss cases. Suboptimal use of antibiotics, missing microbiological culture and other laboratory results, incorrect working diagnosis, and infrequent monitoring during admission were the main contributors to care delays among both maternal deaths and near-miss cases. Local facility audits were conducted for 2/13 maternal deaths and 0/19 near-miss cases. Based on the review findings, the external review committee recommended actions to improve the prevention and management of maternal infections. CONCLUSION: Prompt recognition and treatment of the infection remain critical addressable gaps in the provision of high-quality care to prevent and manage infection-related severe maternal outcomes in LMICs. Poor uptake of maternal death and near-miss reviews suggests missed learning opportunities by facility teams. Virtual platforms offer a feasible solution to improve routine adoption of confidential maternal death and near-miss reviews locally.

Predicting factors of sexual behaviours at risk of HIV infection among people living with disabilities: a generalized structural equation model.

Many studies have shown the HIV vulnerability of people with disabilities (PWD). This vulnerability is supported by risky sexual behaviours, which need to be well described. The objective of this study is to identify predictors of sexual behaviours at risk of HIV infection among PWD in Burkina Faso. We conducted a population-based cross-sectional study on disability and HIV in four regions in Burkina Faso. PWD were selected through a probabilistic method. The Washington Group Short questionnaire was used to identify PWD. Five sexual risk behaviours were considered in this analysis (having multiple sex partners, starting sex at an early age, having had sex with a nonregular partner, sex in return for payment and condomless sex). A composite variable was created and called "risky sexual behaviour (RSB)", which was defined in three categories (low risk, moderate risk and high risk) based on the co-occurrence of the individual sexual risk behaviours. Generalized structural equation was used to identify the predictors of RSB withincome possession as a mediator. A total of 973 PWD were included in this study. The proportion of PWD who were engaged in at least two risky sexual behaviours was 9.5% (95%CI: 6.5-13.8), those with one risky sexual behaviour represented 42.8% (95%CI: 39.4-46.3) and less than half ( 47.7% (95%CI: 43.3-52.1)) werenot engaged in risky sexual behaviour. The prevalence of HIV increased with the level of risky sexual behaviour. Age, education level and type of disability have a significant direct effect on RSB. Indeed, the oddof engaging in sexual risk behaviour was low among PWD who attended at least secondary school compared to those who were not schooled (adjusted odds ratio (aOR): 0.62 (95%CI: 0.41-0.92). The indirect effect of sex on RSB mediating by income possession was significant. Indeed, women with income have a low oddof engaging in RSB compared to men (aOR: 0.83 [95%CI: 0.71-0.98]). Our results confirm a certain ambivalence in the sexuality of people with disabilities. Hence, there is a need for a particular focus on risky sexual behaviour to enable the development of an effective HIV strategy in this group.

Factors influencing hesitancy towards adult and child COVID-19 vaccines in rural and urban West Africa: a cross-sectional study.

OBJECTIVES: This study aims: (1) to identify and describe similarities and differences in both adult and child COVID-19 vaccine hesitancy, and (2) to examine sociodemographic, perception-related and behavioural factors influencing vaccine hesitancy across five West African countries. DESIGN: Cross-sectional survey carried out between 5 May and 5 June 2021. PARTICIPANTS AND SETTING: 4198 individuals from urban and rural settings in Burkina Faso, Guinea, Mali, Senegal and Sierra Leone participated in the survey. STUDY REGISTRATION: The general protocol is registered on clinicaltrial.gov. RESULTS: Findings show that in West Africa at the time only 53% of all study participants reported to be aware of COVID-19 vaccines, and television (60%, n=1345), radio (56%; n=1258), social media (34%; n=764) and family/friends/neighbours (28%; n=634) being the most important sources of information about COVID-19 vaccines. Adult COVID-19 vaccine acceptance ranges from 60% in Guinea and 50% in Sierra Leone to 11% in Senegal. This is largely congruent with acceptance levels of COVID-19 vaccinations for children. Multivariable regression analysis shows that perceived effectiveness and safety of COVID-19 vaccines increased the willingness to get vaccinated. However, sociodemographic factors, such as sex, rural/urban residence, educational attainment and household composition (living with children and/or elderly), and the other perception parameters were not associated with the willingness to get vaccinated in the multivariable regression model. CONCLUSIONS: Primary sources of information about COVID-19 vaccines include television, radio and social media. Communication strategies addressed at the adult population using mass and social media, which emphasise COVID-19 vaccine effectiveness and safety, could encourage greater acceptance also of COVID-19 child vaccinations in sub-Saharan countries. TRIAL REGISTRATION NUMBER: NCT04912284.

Prevalence and factors associated with HIV infection among people with disabilities in Mali.

Previous studies on HIV and disability have reported the vulnerability of people with disabilities (PWDs) to HIV and the need to include them in HIV prevention programs. However, in Mali, data on HIV among this population is scarce. This study aims to estimate HIV prevalence and risk factors among people with disabilities in Mali. We conducted a household-based cross-sectional study in six regions of Mali. The Washington Group (WG) short questionnaire was used to identify PWDs in the household. A total of 1051 PWDs were included in the study. The prevalence of HIV infection among people with disabilities in Mali was 2.38% (25/1051), with a 95% confidence interval (CI) of 1.58%-3.44%. HIV prevalence was higher in women (3.31% [95%CI: 2.14-4.88]) than in men (0.78% [95%CI: 0.22-2.06]). People with visual or intellectual functional limitations were the most affected, with 3.93% (95%CI: 2.22-6.44) and 2.67% (95%CI: 0.56-8.28), respectively. Multivariate analysis shows that age, sex, type of disability and sexual violence are the risk factors for HIV infection among people with disabilities in Mali. These results suggest that HIV strategies should include people with disabilities in order to achieve the target of ending the HIV/AIDS epidemic by 2030 in Mali.

Low prevalence of HIV infection among persons with disabilities in Niger: findings from a household-based cross-sectional study in 2018.

The aim of this work was to report for the first time the prevalence of HIV infection among people with disabilities (PWDs) in Niger. The Washington Group Short questionnaire was used to identify people with disabilities during a household survey. Blood samples for HIV testing were collected using the Dried Blood Sampling (DBS) method. HIV testing was performed according to the Niger national HIV testing guideline. A total of 21,979 persons aged 15-69 years were screened, of them 2237 (10.17%) had disabilities and 949 participants (4.32%) had severe disabilities (level 3 or 4). Finally, 821 participants agreed to participate in the HIV testing. Female persons with disabilities accounted for the majority (52.25%). People with physical impairment were mostly represented (39.27%) followed by those with visual impairment (38.66%). At least one-third had multiple impairs (36.91%). HIV prevalence among person with disabilities was 0.66% (95% CI: 0.33-1.30). There is no difference between HIV prevalence and type of disabilities or socio-demographic characteristics. Hence, there is a need to consider them in the development and implementation of an effective HIV strategy.

Prevalence and risk factors of HIV infection among people with disabilities in Burkina Faso.

This study aimed to determine the prevalence and risk factors of HIV infection among people with disabilities (PWDs) in Burkina Faso. We carried out a cross-sectional study on level 3 and/or 4 disabled people. Identification of PWDs aged 15-69 years was done in households using the Washington Group (WG) Short questionnaire, following by HIV behavioural survey and HIV testing. Multi-level binary logistics Bayesian analysis was done to identify factor associated with HIV. In total, 973 PWDs were included in this study. HIV prevalence was 4.6% (3.3-6.1%). Independent factors associated with HIV infection were aged 35-44 years old (AOR: 8.93; 95% CrI: 3.57-18.89), had visual or hearing impairments (AOR: 6.38; 95%CrI: 1.95-15.44), no income (AOR:6.11; 95% CrI: 2.49-12.48), and had casual sex partners (AOR: 6.28; 95% CrI: 3.27-11.13). HIV prevalence is high compared to the general population. These data suggest a need for comprehensive and specific HIV prevention among people with disabilities, including awareness for safer sexual behaviours.

Prevalence and factors associated to the occurrence of sexual violence among people with disabilities in Burkina Faso.

A person with a disability regardless of the gender has an increased risk of sexual coercion and violence in various ways. This study aimed to analyze the prevalence and the risk factors associated with lifetime sexual violence among people with disabilities (PWDs) in Burkina Faso. We conducted a secondary analysis of a cross-sectional study carried out in four regions (Central, Central-East, Central-West and 'Hauts Bassins' regions) of Burkina Faso. PWDs were selected during a household survey through a two-stage random sampling technique. The prevalence of sexual violence in people disabilities was 7.4% (95%: CI 5.8-9.4). Females with disabilities were more likely than males with disabilities to report lifetime sexual violence (8.9% vs 4.9%). The place where the person usually spends time and the disability duration were significantly associated with the occurrence of sexual violence among female with disability. No significant association was found between different and sexual violence among people with disabilities. Sexual violence is frequent among PWDs in Burkina Faso. Specific policy to protect PWDs particularly women with disabilities from sexual violence is urgently needed.

Prevalence and risk factors of violence among persons with disabilities in Burkina Faso.

This study aimed to analyse factors associated with violence against people with disabilities in Burkina Faso. This is a secondary analysis of data from cross-sectional study among people with disability with Grade 3-4 between 15 and 65 years of age. The prevalence of violence was 13.9%. Persons with physical or multiple disabilities were more likely to suffer violence, while people with physical, intellectual, or multiple disabilities were less likely to suffer violence than those with visual disabilities. Additionally, those between 34 and 55 years were less likely to suffer violence than those over 55. Monogamous and polygamous people with disabilities were 1.9 and 4.3 times, respectively, more likely to be victims of violence than single people. People without formal education were 1.47 times more likely to experience violence than those with education; those living in a family or alone in a housing unit were 2.79 and 12.61 times, respectively, more likely to experience violence than those living with others in a housing unit. Findings suggest that violence is common against all persons with disabilities, but that some factors make violence more likely. There is a need for a policy against violence among people with disability.

Accessibility and use of HIV prevention services among people with disabilities in Burkina Faso and Niger.

ABSTRACTOur study aims to determine the predictors of access to HIV services among disabled persons in two West African countries. This was a secondary analysis from a cross-sectional study carried out in Burkina Faso, in 2017 and Niger, in 2018. People with a disability of severity 3 or 4 and aged 15-69 were included in the study. Access to HIV-related services was measured separately through three variables (access to condoms when needed, history of testing for HIV and ever attended at an HIV-related service). Factors associated with access to HIV-related services were identified using logistic regression. 1794 participants were recorded, including 973 in Burkina Faso and 821 in Niger. The ability to easily obtain a condom when needed was reported by 29.4% of respondents in Burkina Faso and 5.7% of respondents in Niger. The proportion of participants who had been tested for HIV was 32.2% in Burkina Faso and 13.6%. We observed that 5.7% and 3.5% of the participants were in contact with an HIV-related service. Only educational status was associated with access to HIV prevention services in both countries. There is a need to increase the access to HIV prevention for disabled persons in the two countries.

Pharmacokinetic study of two different rifabutin doses co-administered with lopinavir/ritonavir in African HIV and tuberculosis co-infected adult patients.

BACKGROUND: This study aimed to assess the pharmacokinetic profile of 150 mg rifabutin (RBT) taken every other day (every 48 h) versus 300 mg RBT taken every other day (E.O.D), both in combination with lopinavir/ritonavir (LPV/r), in adult patients with human immunodeficiency virus (HIV) and tuberculosis (TB) co-infection. METHODS: This is a two-arm, open-label, pharmacokinetic, randomised study conducted in Burkina Faso between May 2013 and December 2015. Enrolled patients were randomised to receive either 150 mg RBT EOD (arm A, 9 subjects) or 300 mg RBT EOD (arm B, 7 subjects), both associated with LPV/r taken twice daily. RBT plasma concentrations were evaluated after 2 weeks of combined HIV and TB treatment. Samples were collected just before drug ingestion and at 1, 2, 3, 4, 6, 8, and 12 h after drug ingestion to measure plasma drug concentration using an HPLC-MS/MS assay. RESULTS: The Cmax and AUC0-12h medians in arm A (Cmax = 296 ng/mL, IQR: 205-45; AUC0-12h = 2528 ng.h/mL, IQR: 1684-2735) were lower than those in arm B (Cmax = 600 ng/mL, IQR: 403-717; AUC0-12h = 4042.5 ng.h/mL, IQR: 3469-5761), with a statistically significant difference in AUC0-12h (p = 0.044) but not in Cmax (p = 0.313). No significant differences were observed in Tmax (3 h versus 4 h). Five patients had a Cmax below the plasma therapeutic limit (< 300 ng/mL) in the 150 mg RBT arm, while the Cmax was above this threshold for all patients in the 300 mg RBT arm. Additionally, at 48 h after drug ingestion, all patients had a mycobacterial minimum inhibitory concentration (MIC) above the limit (> 64 ng/mL) in the 300 mg RBT arm, while 4/9 patients had such values in the 150 mg RBT arm. CONCLUSION: This study confirmed that the 150 mg dose of rifabutin ingested EOD in combination with LPV/r is inadequate and could lead to selection of rifamycin-resistant mycobacteria. TRIAL REGISTRATION: PACTR201310000629390, 28th October 2013.

Pharmacokinetics of plasma lopinavir and ritonavir in tuberculosis-HIV co-infected African adult patients also receiving rifabutin 150 or 300 mg three times per week.

BACKGROUND: To evaluate the pharmacokinetic of plasma lopinavir (LPV) and ritonavir (RTV) when co-administered with three times weekly (TPW) rifabutin (RBT) at a dose of either 150 or 300 mg in African tuberculosis (TB) and HIV co-infected adult patients. METHODS: This is a pharmacokinetic study conducted in Ouagadougou among patients treated with a standard dosage of LPV/RTV 400/100 mg twice daily and RBT 150 mg TPW (arm A = 9 patients) or rifabutin 300 mg TPW (arm B = 7 patients) based regimens. Patients were recruited from the Bogodogo and Kossodo district hospitals in Ouagadougou from May 2013 to December 2015. Study inclusion criteria were that the patients were between 18 and 60 years of age, HIV-1 infected with pulmonary tuberculosis confirmed or suspected. Subsequent blood samples for pharmacokinetic monitoring were collected at 1, 2, 3, 4, 6, 8 and 12 h after combined drug ingestion for plasma drug monitoring using HPLC/MS assays. RESULTS: The medians LPV Cmax and Tmax were respectively, 20 µg/mL and 4 h for the RBT 150 mg group (arm A) and 7.7 µg/mL and 3 h for the RBT 300 mg group (arm B). The AUC0-12 of LPV was 111.8 µg h/mL in patients belonging to arm A versus 69.9 µg/mL for those in arm B (p = 0.313). The C0 of LPV was lower than 4 µg/mL in three patients receiving RBT 300 mg. Of note, the RTV plasma concentrations were nearly halved among patients on RBT 300 mg compared to those on lower RBT doses. The AUC0-12 of RTV in arm A was 12.7 µg h/mL versus 6.6 µg h/ml in arm B (p = 0.313). CONCLUSION: In our study, the pharmacokinetic of LPV and RTV was found to be highly variable when coadministrated with RBT 150 mg or 300 mg three times per week. There is a need for specific large study to verify clinical and virological effects of this variation, especially when coadministrated with RBT of 300 mg TPW, and to prevent viral resistance in response to under-dosing of LPV. Trial registration PACTR201310000629390. Registered 28 October 2013, http://www.pactr.org/.

Assessment Of Maternity Staff Training And Knowledge Of Obstetric Care In Burkina Faso: A Repeated Cross-Sectional Study.

BACKGROUND AND AIM: The quality of maternity care in low-income countries has often been questioned. The objective of this study was to describe the trend of the percentage of staff trained on selected obstetric care topics and their level of knowledge of maternal care over a 5-year period in Burkina Faso. METHODS: We conducted a secondary analysis of data from two national emergency obstetric and newborn care (EmONC) needs assessments. Staff members' knowledge scores were determined at the facility level for 2010 and 2014 and were further categorized into low (less than 50%), medium (50 to 74%) or high (at least 75%) levels. We used McNemar's test with a 5% significance level to compare the distribution of the proportions in 2010 versus 2014. RESULTS: Out of 789 facilities surveyed in the 2014 assessment, 736 (93.3%) were eligible for this study. Most of them were primary healthcare centers (87.2%). Overall, 21.6% (n=197) of health workers in 2010 and 39% in 2014 were midwives. The proportions of staff who received training on focused antenatal care (FANC) and on how to perform active management of the third stage of labor (AMSTL) have increased by 15.8% and 14.7%, respectively. A significant proportion of facilities had health workers with a low level of knowledge of FANC (p<0.001), the parameters that indicate the start of labor (p<0.001), the monitoring of labor progress (p<0.001) and AMSTL (p<0.001). There was no significant change in staff knowledge in hospitals over the 5-year period. CONCLUSION: From 2010 to 2014, the proportion of staff trained in obstetric care has increased. Their level of knowledge also improved, except in hospitals. However, further efforts are needed to reach a high level of knowledge.

Seroepidemiology of syphilis among men who have sex with men in Burkina Faso, West Africa.

Men who have sex with men (MSM) have a disproportionate risk of acquiring sexually transmitted infections (STIs), such as syphilis. However, prevalence and determinants of syphilis among this population are less known in West Africa. This study aims to estimate syphilis prevalence among MSM in Burkina Faso. We conducted a cross-sectional biological and behavior survey in the two main cities of Burkina Faso, Ouagadougou and Bobo-Dioulasso. MSM were recruited using Respondent Driven Sampling (RDS) methods. Data were collected from January to April 2013 in Ouagadougou and from May to August 2013 in Bobo-Dioulasso. Out of the 657 MSM screened for syphilis, 6.1% (40/657) tested positive for Treponema pallidum antibodies and 1.1% (7/657) for active syphilis. Population-weighted prevalence of active syphilis was 2.1% (95% CI, 01.1-04.4) in Ouagadougou and 0.0% in Bobo-Dioulasso. Serologic markers of syphilis (anti-Treponema antibodies) were found among 7.4% (95% CI 5.0-10.8) of MSM in Ouagadougou and 5.0% (95% CI 3.1-8.0) in Bobo-Dioulasso. No significant differences were found in syphilis serological markers prevalence by participants' sociodemographic and behavioral characteristics. The prevalence of syphilis among MSM is low and comparable to that of other individuals of reproductive age in Burkina Faso. This low prevalence is very encouraging and suggests implementation of effective public health intervention programs which direct resources and services toward MSM to prevent further spread of syphilis infection and to limit HIV transmission in this group.