Evaluation of a short training course of chest X-ray interpretation for the diagnosis of paediatric TB.

BACKGROUND: Chest X-ray (CXR) interpretation is challenging for the diagnosis of paediatric TB. We assessed the performance of a three half-day CXR training module for healthcare workers (HCWs) at low healthcare levels in six high TB incidence countries. METHODS: Within the TB-Speed Decentralization Study, we developed a three half-day training course to identify normal CXR, CXR of good quality and identify six TB-suggestive features. We performed a pre-post training assessment on a pre-defined set of 20 CXR readings. We compared the proportion of correctly interpreted CXRs and the median reading score before and after the training using the McNemar test and a linear mixed model. RESULTS: Of 191 HCWs, 43 (23%) were physicians, 103 (54%) nurses, 18 (9.4%) radiology technicians and 12 (6.3%) other professionals. Of 2,840 CXRs with both assessment, respectively 1,843 (64.9%) and 2,277 (80.2%) were correctly interpreted during pre-training and post-training (P < 0.001). The median reading score improved significantly from 13/20 to 16/20 after the training, after adjusting by country, facility and profession (adjusted ß = 3.31, 95% CI 2.44-4.47). CONCLUSION: Despite some limitations of the course assessment that did not include abnormal non-TB suggestive CXR, study findings suggest that a short CXR training course could improve HCWs' interpretation skills in diagnosing paediatric TB.

CONTEXTE: L'interprétation de la radiographie thoracique (CXR) est un défi pour le diagnostic de la TB pédiatrique. Nous avons évalué la performance d'un module de formation de trois demi-journées sur la CXR destiné aux agents de santé (HCWs) dans six pays où l'incidence de la TB est élevée et où les ressources en services de santé sont limitées. MÉTHODES: Dans le cadre de l'étude de décentralisation TB-Speed, nous avons mis au point un cours de formation de trois demi-journées pour identifier une CXR normale, une CXR de bonne qualité et six caractéristiques suggestives de la TB. Nous avons effectué une évaluation avant et après la formation sur un ensemble prédéfini de 20 clichés radiologiques. Nous avons comparé la proportion de CXR correctement interprétées et le score médian de lecture avant et après la formation à l'aide du test de McNemar et d'un modèle linéaire mixte. RÉSULTATS: Sur les 191 HCWs, 43 (23%) étaient des médecins, 103 (54%) des infirmières, 18 (9,4%) des techniciens en radiologie et 12 (6,3%) d'autres professionnels. Sur 2 840 CXR avec les deux évaluations, respectivement 1 843 (64,9%) et 2 277 (80,2%) ont été correctement interprétées avant et après la formation (P < 0,001). Le score médian de lecture s'est amélioré de manière significative, passant de 13/20 à 16/20 après la formation, après ajustement par pays, établissement et profession (ß ajusté = 3,31; IC 95% 2,44­4,47). CONCLUSION: Malgré certaines limites de l'évaluation du cours qui n'incluait pas de CXR anormale non évocatrice de TB, les résultats de l'étude suggèrent qu'une formation courte sur la CXR pourrait améliorer les compétences d'interprétation des HCWs dans le diagnostic de la TB pédiatrique.

Mapping of Interventions of Social Protection for Tuberculosis Patients in Africa: A Scoping Review Protocol.

BACKGROUND: Tuberculosis (TB) is a public health problem worldwide, particularly in resource-limited countries. It is considered a social disease with a medical component that persists over time due to several social determinants, most of which are closely linked to poverty and difficult socioeconomic conditions. The objective of this exploratory study is to describe the social protection interventions available for people with TB in Africa. METHODS: Searches will be carried out systematically in MEDLINE (PubMed), Embase (Ovid), Web of Science, Scopus and The Cochrane Library, Africa-Wide Information (EBSCOhost), Google Scholar. Articles will be considered if they describe the social protection, successes and challenges associated with the implementation and delivery of social protection interventions offered to people with TB in African countries. Data from the grey literature will also be considered. PRESENTATION OF RESULTS: We will present a narrative description highlighting the successes and challenges of the social protection interventions identified, and a synthesis accompanied by maps (Africa), figures or tables to summarize the data. CONCLUSION: This exploratory study will map the existing literature on social protection interventions for TB patients and guide future research to inform policy and practice decisions.

CONTEXTE: La tuberculose (TB) est un problème de santé publique dans le monde entier, en particulier dans les pays à ressources limitées. Elle est considérée comme une maladie sociale avec une composante médicale qui persiste dans le temps en raison de plusieurs déterminants sociaux, dont la plupart sont étroitement liés à la pauvreté et à des conditions socio-économiques difficiles. L'objectif de cette étude exploratoire est de décrire les interventions de protection sociale disponibles pour les personnes atteintes de TB dans les pays d'Afrique. METHODE: Des recherches seront effectuées systématiquement dans MEDLINE (PubMed), Embase (Ovid), Web Of Science, Scopus et The Cochrane Library, Africa-Wide Information (EBSCOhost), Google Scholar. Les articles seront pris en considération s'ils décrivent la protection sociale, les succès et les défis associés à la mise en œuvre et à l'exécution des interventions de protection sociale offertes aux personnes atteintes de TB dans les pays d'Afrique. Les données issues de la littérature grise seront également prises en compte. PRESENTATION DES RESULTATS: Nous présenterons une description narrative soulignant les succès et les défis des interventions de protection sociale identifiées, ainsi qu'une synthèse accompagnée de cartes (Afrique), de figures ou de tableaux pour résumer les données. CONCLUSION: Cette étude exploratoire permettra de cartographier la littérature existante sur les interventions de protection sociale pour les patients atteints de tuberculose et d'orienter les recherches futures afin d'éclairer les décisions politiques et pratiques.

Profile and Correlates of Sleep Quality and Obstructive Sleep Apnoea among Young Persons in Ibadan, Southwestern Nigeria.

BACKGROUND: Sleep breathing disorders (SDB), especially obstructive sleep apnoea (OSA), are poorly studied in the young population. This study aimed to determine the prevalence of OSA and its associated risk factors among young persons. METHODS: A cross-sectional study design was used, and participants aged 16-35 years were recruited from five tertiary institutions in Ibadan, South Western, Nigeria. The study used a structured questionnaire, stadiometer, weighing scale, tape measure, and digital blood pressure machine to collect data. Patient Health Questionnaire (PHQ 9), Generalized Anxiety Disorder-7(GAD-7), and Pittsburgh sleep quality index (PSQI) were used to assess depression, anxiety, and sleep quality respectively. To assess the risk of OSA, we used both the STOP-Bang questionnaire and the NOSAS score. The Statistical Package for the Social Sciences version 23 was used to analyse the data, and statistical significance was set at <0.05. RESULTS: A total of 354 participants were included in this report with a mean age of 21.2±3.5 years. The female: male ratio was 1.9:1. The mean ±standard deviation of PSQI, GAD-7 score and PHQ-9 were 2.2±1.1, 12.4±5.1 and 15.0±5.4 respectively. The following percentages of participants were found to be at low, intermediate, and high risk for OSA: 94.1%, 5.6%, and 0.3%, respectively. This study showed that age and GAD-7 score were independently associated with the PSQI score while age, body mass index, neck cuff size and PHQ-9 score for OSA score. CONCLUSION: There is a burden of OSA among this population of young people; and modifying anthropometric and psychosocial factors can help mitigate the risk of OSA outcomes.

CONTEXTE: Les troubles respiratoires du sommeil (TRS), en particulier l'apnée obstructive du sommeil (AOS), sont peu étudiés chez la population jeune. Cette étude visait à déterminer la prévalence de l'ASO et ses facteurs de risque associés chez les jeunes. MÉTHODES: Un schéma d'étude transversale a été utilisé, et les participants âgés de 16 à 35 ans ont été recrutés dans cinq institutions tertiaires à Ibadan, au sud-ouest du Nigeria. L'étude a utilisé un questionnaire structuré, une toise, une balance, un ruban à mesurer et un tensiomètre numérique pour collecter les données. Le questionnaire Patient Health Questionnaire (PHQ-9), le Generalized Anxiety Disorder-7 (GAD-7) et l'index de qualité du sommeil de Pittsburgh (PSQI) ont été utilisés pour évaluer la dépression, l'anxiété et la qualité du sommeil respectivement. Pour évaluer le risque d'AOS, nous avons utilisé à la fois le questionnaire STOP-Bang et le score NOSAS. Le logiciel Statistical Package for the Social Sciences version 23 a été utilisé pour analyser les données, et la signification statistique a été fixée à <0,05. RÉSULTATS: Un total de 354 participants ont été inclus dans cette étude avec un âge moyen de 21,2±3,5 ans. Le ratio femmes : hommes était de 1,9:1. Les moyennes ± écart-type du PSQI, du score GAD-7 et du PHQ-9 étaient respectivement de 2,2±1,1, 12,4±5,1 et 15,0±5,4. Les pourcentages suivants de participants étaient classés à faible, intermédiaire et haut risque d'AOS: 94,1 %, 5,6 % et 0,3 %, respectivement. Cette étude a montré que l'âge et le score GAD-7 étaient associés de manière indépendante au score PSQI, tandis que l'âge, l'indice de masse corporelle, la circonférence du cou et le score PHQ-9 étaient associés au score ASO. CONCLUSION: Il existe un fardeau de l'ASO parmi cette population de jeunes; et la modification des facteurs anthropométriques et psychosociaux peut aider à atténuer le risque de résultats d'ASO. MOTS-CLÉS: Apnée obstructive du sommeil; Troubles Respiratoires du Sommeil ; Épidémiologie ; Trouble du sommeil.

PERFORMANCE OF SIX SCREENING SCORES FOR OBSTRUCTIVE SLEEP APNOEA IN AN AFRICAN POPULATION.

Introduction: A screening tool for obstructive sleep apnoea (OSA) is useful in low-income countries where it may be difficult to access sleep recordings. The objective of this study was to assess the performance of six screening scores compared with objective sleep recording in an African population sample. Methods: This analysis is based on the "Benin Sleep and Society" (BeSAS) populational study in which respiratory polygraphy (PG) was performed using a type III device and OSA screening questionnaires (STOP, STOP-Bang, Berlin, NOSAS [≥ 8 and ≥ 5), No-Apnea, GOAL) were administered to participants. PG-defined OSA severity categories were defined according to the apnoea-hypopnoea index (AHI): mild (AHI 5 to <15/h), moderate (AHI 15 to <30/h) or severe (AHI≥30/h), and these were compared to score findings. Results: A total of 1810 subjects (mean age 45.4±14.6 years; 57.3% women) were included. For moderate to severe OSA, the area under the receiving operating characteristic (ROC) curve was greatest for GOAL and No-Apnea (0.70), followed by NoSAS5 (0.69). The highest sensitivity values were for NoSAS5 (0.73), No-Apnea (0.72), and GOAL (0.69), while NoSAS8 had the highest specificity (0.91), followed by Berlin (0.88) and GOAL (0.71). All scores performed poorly with respect to the positive predictive value (PPV), which was highest with NoSAS8 (0.38). Conclusion: This study provides the first comparison of the performance of screening scores for OSA in an African population. Although still low, PPV was highest with NoSAS8. Hence, NoSAS8 would be the screening method of choice for OSA in resource-constrained settings where formal sleep recordings are not accessible.

EVALUATION OF A MODIFIED EPWORTH SLEEPINESS SCALE TO RELIABLY ASSESS EXCESSIVE DAYTIME SLEEPINESS IN LOW-INCOME COUNTRIES: RESULTS FROM THE BENIN SOCIETY AND SLEEP (BESAS) STUDY.

Background: The Epworth Sleepiness Scale (ESS) is a tool widely used to assess excessive daytime sleepiness. Unfortunately, it is not reliable in low-income countries where situations such as reading a book, watching TV or driving a car are not common. The aim of this study was thus to assess the performance of a modified version of the Epworth scale in a low-income country. Methods: We used data from the Benin Society and Sleep (BeSAS) study where the ESS and a modified ESS (mESS) were administered to participants. In the mESS, questions four questions over eight were redesigned to reflect common living situations in Benin. The internal coherence of the mESS was assessed using the Cronbach alpha coefficient (CAC). The discriminatory ability of the scale was assessed by comparing the mean scores according to reported sleep quality, insomnia complaints and apnea-hypopnea index (AHI). Results: A total of 2909 participants were recruited, 1129 were male (38.9%) with a mean age (SD) of 44.7 (14.5) y. Overall, 52.4% (1526) completed all the mESS questions while 453 (15.6%) completed the standard ESS. The CAC of the mES was 0.86 showing good internal coherence. Concerning the discriminatory ability, mean scores for mESS were 7.8 for participants with ISI < 8 vs 9.2 for participants with ISI≥8 (p<0.001), 7.8 for participants withPSQI<5 vs 8.3 for participants with PSQI≥5 (p=0.03). No difference was found when comparing the participants participants using different cut-offs of AHI (15 and 30). Conclusion: The mES is more reliable than ES in the Beninese population. mESS shows good internal coherence and differentiates between insomniacs vs non-insomniacs and between good and poor sleepers. Although the mES is not a perfect score, it appears more relevant in the Benin population than the original Epworth scale but needs further validation/improvement in other low-income countries.

[Early onset of small cell carcinom of the lung in a young patient in Benin]. / Survenue précoce d'un carcinome bronchique à petites cellules chez un sujet jeune au Bénin.

Context Bronchial cancer in a person under 30 years of age is quite rare. It generally occurs after 40 years of age following heavy smoking intoxication. We report a clinical case illustrating the early onset of a small cell lung carcinoma in young heavy smoker. CASE REPORT: A 30-year-old patient, current smoker for about 10 years (15 packs/year), consulted for a cough with haemoptotic sputum. Clinical and paraclinical examinations diagnosed small cell carcinoma of the right lung with some controlatéral metastatic nodules. . He was classified as stage T2bN2M1a. Unfortunately, due to lack of financial accessibility to suitable chemotherapy, the patient died after one month. CONCLUSION: Early-onset of bronchial carcinoma in young smokers calls for strengthened control of teenage tobacco use, especially in Africa, where the phenomenon has been taking on alarming proportions.

Remote Supervision of Basic Management Units for Tuberculosis Care During Covid-19 Period: An Innovative Experience from Benin Republic.

INTRODUCTION: Contingency measures taken by governments with movement restrictions during the COVID-19 pandemic may create difficulties in conducting some field activities for TB control especially the supervision of Basic Management Units (BMUs). We described in this paper an innovative initiative to conduct remote supervision (Esupervision) using Information and Communication Technology tools. SETTING AND METHOD: This initiative was conducted in Benin Republic. To carry out the activity, we used smartphone, WhatsApp® for messaging, CamScanner for scanning (both free applications); and internet connection. BMUs were asked to scan their reports and all necessary documents and sent them by WhatsApp® after scanning. On the day planned for the supervision, the supervisors of each section (clinic, laboratory, food delivery supervision) calls the BMUs health professionals via WhatsApp® video to conduct the activity according to the National Tuberculosis Programme guidelines. RESULTS: Overall, all the main objectives of a supervision were achieved despite some difficulties mainly related to the quality of internet connection. The reports from the different sections were validated for each BMU. For the laboratory activities, general aspects as well as the stock of reagents were evaluated; microcopy fields with an ordinary microscope were visualized. The management of tuberculosis patients was assessed by visualizing the results of bacteriological exams, treatment records, and stocks of medicines. CONCLUSION: Even though, this activity will probably not replace the traditional face-to-face supervision, it could be used in settings where movements are restricted for several reasons including COVID-19 pandemic, conflicts and natural disasters.

INTRODUCTION: Les mesures d'urgence prises par les gouvernements avec des restrictions de mouvements dans le cadre de la pandémie du COVID-19 peuvent créer des difficultés dans la conduite de certaines activités de terrain pour le contrôle de la tuberculose, en particulier la supervision des centres de dépistage et de traitement de la tuberculose (CDT). Nous avons décrit dans cet article, une initiative novatrice pour effectuer la supervision à distance (E-supervision) en utilisant les outils des Technologies de l'Information et de la Communication au Bénin. CADRE ET MÉTHODE: Cette initiative a été conduite en République du Bénin. Pour mener à bien cette activité, nous avons utilisé : smartphone, WhatsApp pour la messagerie et CamScanner ® pour le scannage (deux applications gratuites) ; et la connexion internet. Les agents des CDT ont été invités à envoyer tous les documents aux équipes de supervision via WhatsApp ® après les avoir scannés. Le jour prévu pour la supervision, les superviseurs de chaque section (clinique, laboratoire, gestion des vivres) ont appelé par WhatsApp ® video les acteurs des CDT pour dérouler les différentes séquences de la supervision selon les recommandations du Programme. RÉSULTATS: Dans l'ensemble, tous les principaux objectifs d'une supervision ont été atteints malgré quelques difficultés liées principalement à la qualité de la connexion internet. Les rapports des différentes sections (clinique, laboratoire et gestion des aliments) ont été validés pour chaque CDT. Pour les activités de laboratoire, l'aspect général ainsi que le stock de réactifs ont été évalués ; les champs de microcopie avec un microscope ordinaire ont été visualisés. La gestion des patients tuberculeux a été évaluée en visualisant les résultats des examens bactériologiques, les dossiers de traitement, les stocks de médicaments. CONCLUSION: Bien que cette activité ne remplacera probablement pas la supervision traditionnelle en face à face, elle pourrait être utilisée dans des contextes où les mouvements sont limités pour plusieurs raisons, notamment la pandémie COVID-19, les conflits, les catastrophes naturelles. MOTS CLÉS: Lutte contre la tuberculose, COVID-19, supervision, centres antituberculeux.

[Tuberculosis in older persons in African setting: Epidemiological, diagnostic and evolutive features]. / La tuberculose du sujet âgé en milieu africain : particularités épidémiologiques, diagnostiques et évolutives au Bénin.

OBJECTIVE: To determine the epidemiological, diagnostic and evolutives features of tuberculosis (TB) in older subjects in Benin. PATIENTS AND METHODS: This was a retrospective cohort study of adults TB patients (age≥15 years) who were notified at all the Basic Management Units (BMU) in Benin from January 1st, 2013 to December 31st. Older subjects (age≥60 years) were compared to those less than 60 years named young subjects. The threshold of significance was set at 5%. RESULTS: The analysis was carried out on 6531 cases adults cases notified during the period. 601 (9.2%) were 60 years old or above. The case notification rate (CNR) in elders was more than twice the CNR in young people (68 cases vs. 31 cases per 100,000 population). Older subjects were less often infected with HIV (9.3%) than young's (16.7%), P<0.0001. In new bacteriologically confirmed pulmonary TB negative for HIV, unfavorable treatment outcomes were more frequent in older subjects than in young subjects with more deaths (7.5% vs. 3.0%). On the other hand, in bacteriological confirmed TB seropositive for HIV and all the other cases, treatment outcomes were comparable between the two groups. CONCLUSION: The high CNR and the high death rate in older subjects should plead for a specific care for an adapted management of TB case in this group.

[Factors associated with non-conversion of the direct smear after the initial phase of anti-tuberculous treatment. A study undertaken in three tuberculosis management centres in South Benin]. / Facteurs associés à la non-conversion de la bacilloscopie après la phase d'attaque du traitement antituberculeux. Étude réalisée dans trois centres de prise en charge de la tuberculose au Sud Bénin.

The objective of this work was to describe the profile of routinely managed tuberculosis patients whose sputum smear did not become negative after the initial phase of anti-tuberculous treatment and to analyze the factors associated with this. With this aim a cross-sectional, retrospective, descriptive and analytical study was carried out in a population of adults with pulmonary tuberculosis (PTB) between 2013 and 2014 in three cities in southern Benin (Cotonou, Porto-Novo and Abomey). The data of the patients who did not convert (PTB +) were compared with those who did (PTB-). A multivariate logistic regression analysis was performed. In 1989 (94%) of the cases, 305 (15.3%) were TPB+ with significant differences between the cities. The mean age was 38±13 years vs 34±12 years, respectively, for PTB+and PTB -, P=0.091. At the end of the multivariate analysis, the factors associated with non-conversion were: high bacillary load (≥10 AFB/microscopic field) at diagnosis, HIV+status, and adverse outcome at the end of anti-tuberculous treatment. These patients should be monitored carefully.

[Sensitisation profile to airborne allergens of patients followed for asthma in Cotonou, Benin. A cross-sectional study using prick-tests]. / Profil de sensibilisation aux pneumallergènes des patients suivis pour asthme à Cotonou, Bénin : étude transversale par prick-tests.

RATIONALE: The sensitisation profile to airborne allergens of asthma patients followed in Benin is not known. PATIENTS AND METHODS: A descriptive cross-sectional study was conducted from April to June 2013 at the hospital reference centre. A prick-test was performed in all adults with asthma consulting during this period. The standardized allergenic extracts tested were: mites (Dermatophagoides pteronyssinus [DP], Dermatophagoides farinae [DF] and Blomia tropicalis [BT]), cockroaches, 5 different grasses, Alternaria, dogs and cats. The test was positive when the diameter of the wheal was more than half that of the positive control and/or when the diameter of the wheal was ≥3mm than the negative control. RESULTS: Of the 253 asthmatics tested, 247 (97.6%) had at least one positive skin reaction. The average age was 44 years, the sex ratio was 0.81. Sensitization to mites was the most frequent (99.6%), followed by cockroaches (71.3%), 5 grasses (71.3%), Alternaria (71%), dog (68%) and cat (63.6%). The average number of sensitivities was 5±2. CONCLUSION: Asthmatics monitored in Cotonou have multiple sensitisations dominated by mites.

[Evaluation of tuberculous patients' management when re-treated in Cotonou, Benin]. / Évaluation de la prise en charge des patients admis au régime de retraitement à Cotonou, Bénin.

Retreatment of tuberculosis is the leading risk factor for drug resistance if the management is not adequate and complete. The objective of this study was to evaluate the management of cases of retreatment in Cotonou. This was a retrospective, descriptive cross type which covered a period of 5 years. Outcomes of retreatment cases were compared against those for new cases that were registered during the same period. We analyzed the cases of 389 retreatment patients and 4542 new cases. The success rates of treatment were generally satisfactory (80% vs. 86%, P=0.0001). Of adverse outcomes, the rate of loss of sight of was 12% versus 7%, P=0.26, the rate was 23% for cases of occasions. The failure rate was low and similar in both populations (2%). The retreatment regimen for patients with TB in Cotonou appears to give generally satisfactory results. The high loss to follow-up in case of retreatment means that a personalized therapeutic approach for such patients is needed in general and in particular in the case of defaulters.

[Becoming new pulmonary tuberculosis patients with sputum smear-positive at the end of second month of anti tubercular treatment in Lome]. / Devenir des nouveaux patients tuberculeux pulmonaires a bacilloscopie positive a la fin du deuxieme mois de traitement antituberculeux a Lome.

AIMS: To determine the frequency of the new smear-positive pulmonary tuberculosis patients at the end of the second month of anti-tuberculosis treatment and to analyze the outcomes of their treatment. PATIENTS AND METHOD: It was a retrospective comparative study from January 2006 to June 2008, based on the analysis of the records and treatment cards from the diagnosis and treatment centers of Lome. New sputum smear-positive tuberculosis patients at the end of the second month (smear positive 2 months) constituted the study population. A comparison group consisted of the new tuberculosis patients with sputum smear-negative at the end of the second month (negative smear 2 months). RESULTS: The proportion of sputum smear-positive at 2 months was 5.34% (163/3050). Cure and failure rates were respectively 69.3% and 17.2% for smear-positive 2 months versus 79.1% and 3.7% for control group. The death rate was similar in both groups (3% and 3.7%). CONCLUSION: The smear positive 2 month's patients have a high risk of failure and must receive special attention during their follow-up to improve the results of treatment.

BUT: Déterminer la fréquence des nouveaux patients tuberculeux pulmonaire à bacilloscopie positive à la fin du 2ème mois de traitement antituberculeux et analyser les résultats de leur traitement. PATIENTS ET MÉTHODE: Il s'agissait d'une étude rétrospective comparative de janvier 2006 à juin 2008, basée sur l'analyse des registres et les cartes de traitement de tuberculose des centres de diagnostic et de traitement de Lomé. Les nouveaux patients tuberculeux à bacilloscopie positive à la fin du deuxième mois (frottis mois 2 positif) constituaient la population de l'étude. Un groupe de comparaison était constitué avec les nouveaux patients tuberculeux à bacilloscopie négatif à la fin du deuxième mois (frottis mois 2 négatif). RÉSULTATS: La proportion des frottis mois 2 positif était de 5,34 % (163/3050). Les taux de guérison et d'échec étaient respectivement de 69,3% et de 17,2% chez les frottis 2 positif contre 79,1% et 3,7 % chez les frottis 2 négatif. Le taux de décès était similaire dans les deux groupes (respectivement 3% et 3,7%). CONCLUSION: Les patients à frottis 2 positif ont un risque élevé d'échec et doivent bénéficier d'une attention particulière au cours de leur suivi afin améliorer les résultats de leur traitement.

Management of tuberculosis and HIV co-infection in Cotonou, Benin.

OBJECTIVES: The authors had for aim to assess the management of tuberculosis and HIV co-infection in Cotonou, Benin. PATIENTS AND METHODS: We made a cross-sectional, retrospective, and descriptive study comparing the clinical presentation and outcome of patients with tuberculosis and HIV co-infection versus patients with tuberculosis alone, all managed at the National Pneumophtisiology Center in Cotonou, Benin, in 2009. RESULTS: The rate of HIV screening in TB patients was 99%. One thousand and eighty-six TB patients were included and 259 were HIV positive. The mean age of co-infected patients was 36 years, versus 34 for TB mono-infected patients. The sex ratio among co-infected was 1.15 versus 2.25 among TB patients. Positive pulmonary sputum was less frequent with co-infection. Two hundred and fifty-seven over 259 patients were treated with cotrimoxazole. One hundred and eighty-five over 234 (79.05%) had CD4 counts<350. Eighty-five (46%) of the 185 patients with CD4<350, were given antiretroviral therapy. Treatment success rate was lower for co-infected (75%) than for patients with TB alone (86%), and death rates were higher in co-infected patients (10% vs. 3%). CONCLUSION: High death rate and high rate of lost to follow-up are arguments for systematic antiretroviral treatment of co-infected patients. Early screening for TB and HIV, and reviewing the current national recommendations, as well as an increased governmental effort to provide medicines to all patients in need of ARV are mandatory.