Task-sharing with nurses to enhance access to HIV treatment in Côte d'Ivoire.

OBJECTIVE: We report the first national programme in Côte d'Ivoire to evaluate the feasibility of nurse-led HIV care as a model of task-sharing with nurses to increase coverage and decentralisation of HIV services. METHODS: Twenty-six public HIV facilities implemented either a nurse-with-onsite-physician or a nurse-with-visiting-physician model of HIV task-sharing. Routinely collected patient data were reviewed to analyse patient characteristics of those enrolling in care and initiating antiretroviral therapy (ART). Retention, loss to programme and death were compared across facility-level characteristics. RESULTS: A total of 1224 patients enrolled in HIV care, with 666 initiating ART, from January 2012 to May 2013 (median follow-up 13 months). The majority (94%) were adults ≥15 years. Fourteen facilities provided ART initiation for the first time during the pilot period; 20 facilities were primary level. Nurse-led care with a visiting physician was provided in 14 of the primary-level facilities. Nurse-led ART care with an onsite physician was provided in all secondary-level facilities and six of the primary-level facilities. During the pilot, 567 (85%) of patients were retained, 28 (4.2%) died, 47 (7.1%) were lost to follow-up, and 24 (3.6%) transferred. Five deaths (10.9%) were recorded among children as compared to 23 deaths (3.7%) among adults (P = 0.037). There were no differences in retention by model of nurse-led ART care. CONCLUSION: Task-sharing of HIV care and ART initiation with nurses in Côte d'Ivoire is feasible. This pilot illustrates two models of nurse-led HIV care and has informed national policy on nurse-led HIV care in Côte d'Ivoire.

[Interest of microalbuminuria in preventing kidney damage during systemic lupus erythematosus (SLE) under corticoid therapy]. / Intérêt de la microalbuminurie dans la prévention des atteintes rénales au cours du lupus érythémateux disséminé (LED) sous corticothérapie.

This study aimed to evaluate the benefits of microalbuminuria in preventing kidney damage in systemic lupus erythemathosus. This was a prospective study of 6 months has focused on 25 patients of both sexes aged over 14 with SLE whose diagnosis was based on the criteria of the American College of Rheumatology, having a negative proteinuria at the dipstick (Ketodiastix(®)) and a balance sheet normal renal (creatinine and uraemia normal). Each month, samples of venous blood were achieved at the elbow in patients fasted for the night (12pm). The serum obtained was used for measurement of creatinine and urea, according to conventional methods, by a Hitachi 902(®) automated random type. The determination of urinary albumin by immuno-nephelometric method (Hitachi 902(®)), in search of microalbuminuria has involved the collection of urine over 24 hours in a sterile jar containing crystals of thymol as an antiseptic. In the presence of microalbuminuria, the dose of prednisone was progressively increased by 5 mg until no microalbuminuria. We found: 1) that creatinine and blood urea remained normal during the 6 months of study, 2) the disappearance of microalbuminuria first two months after increasing the daily dose of corticosteroid with a significant decrease of albuminuria from day 0 to day 180 (p = 0.001, day 180 vs day 0), 3) a female predominance with a sex ratio of 0.13. In conclusion, the regular dosage and systematic albuminuria to microalbuminuria appears to be a reliable means for diagnosis of lupus glomerulonephritis in the subclinical stage to prevent renal complications that occur during the Supported Lupus erythematosus.

Potential health implication of in vitro human low-density lipoprotein-vitamin E oxidation modulation by polyphenols derived from Côte d'Ivoire's oil palm species.

Antioxidant activities of polyphenolic compounds extracted (PPEs) from ripe fruits of oil palms are investigated by studying their in vitro effects on human low-density lipoprotein (LDL) oxidation. Four oil palm species ( Elaeis guineensis ) are issued from the National Centre of Agronomic Research of Côte d'Ivoire, of which two are parental varieties (HP1 and HP2), while the other two are crossing varieties (HP3 and HP4). The main identified compounds were rutin (HP3 and HP4) and caffeic and chlorogenic (5-caffeoyl quinic) acids (HP1, HP3, and HP4). The highest total phenolic content was found for HP4, while it was significantly lower for HP2. Antioxidative effects were monitored by Cu(2+)- or 2,2'-azobis(2-amidinopropane) hydrochloride (AAPH)-induced generation of conjugated dienes (lag time and oxidation rate). The highest PPE specific antioxidant activity (SAA) values were obtained with crossing varieties (HP3 and HP4) in the copper-oxidation assay. In the AAPH-oxidation assay, SAA values were comparable for all four varieties. PPEs were effective at preventing LDL-vitamin E depletion in vitro. They could exert direct beneficial antioxidant effects on vitamin E and other antioxidants contained in food and beverages in vivo, within the gastrointestinal (GI) tract. These data could also be of particular importance for a healthier nutrition or the management of chronic diseases by a polyphenol-rich diet.

In a randomized controlled trial of iron fortification, anthelmintic treatment, and intermittent preventive treatment of malaria for anemia control in Ivorian children, only anthelmintic treatment shows modest benefit.

Anemia is common among children in sub-Saharan Africa and its etiology is multifactorial. Likely causes of anemia are low bioavailability of dietary iron, malaria, and helminth infection. In this study, we aimed to assess the effect of iron fortification, intermittent preventive treatment (IPT) of malaria, and anthelmintic treatment on hemoglobin concentration and anemia prevalence among school children. The study was a 6-mo, randomized, double-blind, controlled trial enrolling 591 6- to 14-y-old school children in Côte d'Ivoire using the following: 1) iron-fortified biscuits providing an additional 20 mg iron/d as electrolytic iron 4 times/wk; 2) IPT of malaria with sulfadoxine-pyrimethamine at 0 and 3 mo; and 3) anthelmintic treatment at 0 and 3 mo as the interventions. Prevalence of anemia, iron deficiency, malaria parasitemia, and helminth infection was 70.4, 9.3, 57.7, and 54.8%, respectively. Iron fortification did not improve iron status, IPT of malaria did not affect malaria burden, and neither had an impact on anemia prevalence. Anthelmintics significantly reduced the burden of helminth infections and decreased anemia prevalence (odds ratio: 0.4, 95% CI: 0.3, 0.7). The low prevalence of iron deficiency and an extended dry season that decreased malaria transmission likely reduced the potential impact of iron fortification and IPT. In this setting, anthelmintic treatment was the only intervention that modestly decreased rates of anemia.