Preventive measures to prevent loss to follow-up in highly active antiretroviral therapy (HAART): implementing a strategy in Ziguinchor (Casamance, Senegal) in 2014.

Since 2010, the Pharmacie et Aide Humanitaire (PAH) in Casamance (Senegal) has been maintaining a software package (Tacojo) that allows monthly monitoring of the distribution of treatment to every patient with HIV infection receiving highly active antiretroviral therapy (HAART). We used this program to set up measures to prevent the loss to follow-up of patients receiving HAART. Our involvement focused on two main areas. First, each patient is routinely contacted after inclusion, to help us to understand the patient's experience of the disease and the treatment. This process aims to improve adherence to the treatment. Then, all patients who miss an appointment are routinely contacted by telephone within seven days of that appointment. The goal is to understand the reasons for the absence and to encourage patients to continue their treatment. Despite the lack of distance due to the relative newness of this program, these preventive measures have shown hopeful results (80% of the patients came back after a call). It would be interesting to apply it in a sustainable manner and in more medical facilities.

[Is too much money harmful for innovation?]. / Recevoir trop d'argent nuit-il à l'innovation ?

Significant sums have been allocated to countries to enable them to make measurements of HIV viral load available at the level of districts and departments. Wanting to make this examination available to all HIV-infected patients appears fair, but it is possible to envision other strategies for decentralizing this process. It is generally agreed that every additional examination entails loss to follow-up and thus to treatment. On the other hand, a lack of resources induces more innovation, as demonstrated over the last half century for short courses of tuberculosis treatment, combined vaccines, and essential and generic drugs. Body weight is the best indicator for monitoring HIV viral load. We sought to determine if it is possible to raise awareness of this measurement that requires simple resources and provides an immediate result, available to healthcare providers in outlying areas. Specifically, we studied the measurement of body fat percentage, which appears to be a promising choice. A trial conducted in Casamance with an impedance meter incorporated into a commercially available scale yielded negative results for this specific task (measurement irregularities due to the condition of the soles of the patients' feet). It seems important to us to study scientifically the interest of this indicator scientifically and its performance in the field pragmatically, with more accessible measurement methods, such as skinfold (a method that has been demonstrated its efficacy in physical anthropology and in the domain of sports).

[Cost recovery and reinforcement of the primary healthcare system in a rural community in Casamance, Senegal]. / Recouvrement des coûts et renforcement du système de soins primaires de santé dans une communauté rurale de Casamance (Sénégal).

This study was conducted by two pharmacists from Caen, France and two healthcare officials from the region of Ziguinchor and Bignona in Casamance, Senegal. Data showed that with good community awareness and proper supervision a minimum cost recovery policy could be implemented at health posts (cases de santé). This approach enables purchasing of more medicines and lowers operating costs. Additional funding is necessary to pay for building renovation and meaningful wages for healthcare workers.