[Which information is given during the purchase of an HIV self-test in a Caen pharmacy? A Comprehensive transversal and observational study using surveys, without modification of practice]. / Quelles sont les informations délivrées lors d'une demande d'achat d'autotest du VIH dans les pharmacies de Caen ? Enquête transversale observationnelle par questionnaire, exhaustive, sans modification de pratiques.

INTRODUCTION: HIV infection affects about 150,000 people in France. In total, 30,000 of them are unaware of their serostatus. In this context, HIV self-testing has arrived in France in September 2015. The aim of our study was to analyze the level of application of the recommendations during the purchase of an HIV self-test. Our primary hypothesis was that the delivered information is poor. METHODS: We realized a comprehensive transversal and observational study with surveys without modification of practice in all Caen pharmacies. The primary endpoint was the seller's assessment of the presence or possibility of an emergency situation requiring a post-exposure prophylaxis and suitability assessment of self-testing for the patient's case. RESULTS: Seven pharmacies out of the 41 visited (17.07%) validated our primary endpoint. In all pharmacies, 43.9% had HIV self-tests available for sale. The availabality of the self-tests is linked to the main endpoint (P<0.005). In total, 31.71% of the vendors redirected the patient to another method of screening (general practitioner, sexual health clinic…). DISCUSSION: The delivered information about HIV self-tests is poor. Improving it would put the pharmacist at the heart of the HIV screening strategy. The introduction of training for the professionnals in our region could be interesting to improve the dispensing of the self-tests.

A series of 238 cytomegalovirus primary infections during pregnancy: description and outcome.

OBJECTIVE: To analyze the outcome of maternal primary cytomegalovirus (CMV) infection. METHODS: Retrospective analysis of a cohort of 238 patients with maternal primary CMV infection detected at routine screening. The cases were managed with serial ultrasound (US) scans, and amniocentesis was performed in 36.1% of cases. All prenatal results were confirmed at birth. RESULTS: The average age was 31.9 (18-44) years. Patients were symptomatic in 21% of cases. The rate of intrauterine transmission was 24.9%, and it was 8.8%, 19%, 30.6%, 34.1% and 40% in the preconceptional period, the periconceptional period, and the first, second and third trimesters of pregnancy, respectively (p = 0.025). There was a significantly higher risk of US abnormalities when maternal infection occurred during the preconceptional or periconceptional period and the first trimester compared with later (p < 0.001). Because of US abnormalities, pregnancy was terminated in 18 cases at the parents' request. Three infected newborns were symptomatic; all three cases were suspected at US before birth. We did not observe any symptomatic fetal infection when maternal infection occurred after 14 weeks of gestation. A number of clinically asymptomatic cases (5.5%) developed hearing loss. CONCLUSION: The rate of materno fetal transmission is linearly correlated to the gestational age at infection. No severe case of congenital infection was observed if maternal infection occurred after 14 weeks of gestation.

Evolution of awareness and knowledge of congenital cytomegalovirus infection among health care providers in France between 2011 and 2018.

BACKGROUND: Cytomegalovirus (CMV) is the most frequent cause of congenital viral infection. Approximately 1 % of newborns are congenitally infected and in up to 10 % of them the consequences are severe. Antenatal and postnatal treatments, although promising, are still under evaluation. Hygiene counseling to prevent CMV infection is important and should be systematic. OBJECTIVE: To evaluate health care providers' awareness of CMV maternal and congenital infection in France. STUDY DESIGN: A questionnaire on CMV infection was sent in 2018 by e-mail to obstetricians, pediatricians, midwives and laboratory physicians, and members of medical or midwifery associations. We evaluated their knowledge concerning CMV epidemiology, transmission, symptoms in adults, newborns and long-term effects (scores from 0 to 30) and compared the results with those of our 2012 published study. RESULTS: Of the 597 respondents who completed the questionnaire, 91 % were unaware of the precise transmission route of CMV, 33 % wrongly thought thatin utero therapy for congenital CMV infection was a current standard of care in France, and less than half were familiar with the HAS (Haute Autorité de Santé) and CNGOF (Collège National des Gynécologues et Obstétriciens Français) recommendations. When respondents' knowledge of CMV was greater, patients were given more hygiene counseling. Between 2011 and 2018, knowledge improved among doctors and midwives concerning the route of transmission, the symptoms in adults, and the long-term effects of CMV infection. CONCLUSIONS: Knowledge is improving among healthcare providers, but gaps remain. To bridge these gaps, health care providers should improve their knowledge about congenital CMV by various means: medical reviews, continuing medical education, meetings, conferences, the Internet. Moreover, greater knowledge will allow for more effective counseling of pregnant women, as recommended by HCSP and CNGOF in France.

Awareness of cytomegalovirus infection among pregnant women in France.

BACKGROUND: Cytomegalovirus (CMV) is the most frequent cause of congenital virus infection. Approximately 1% of newborns are infected by CMV at birth with severe consequences among 10% of them. Efficacy of hygienic counselling is nowadays established and should be spread. OBJECTIVE: To evaluate pregnant women's awareness of cytomegalovirus infection in France. STUDY DESIGN: Pregnant women receiving prenatal care, at any moment of their pregnancy, in two different obstetrics clinics with different information policies, were asked to complete a written questionnaire about CMV infection. RESULTS: More than half (217/362, 60%) of the pregnant women had heard of congenital CMV infection, and most of them (72%) knew the hygiene measures to use to prevent infection. Nevertheless, most could not correctly identify the symptoms associated with congenital CMV disease. Awareness was associated with hospital's policy concerning CMV infection information, the mother's educational level, parity, and employment in health care. Indeed, when information is supposed to be given (hospital A), 74% (vs 34%) know congenital CMV infection and among them the knowledge is more precise. CONCLUSIONS: This study tends to confirm that there is a large gap between knowledge of CMV and the burden of this disease. To bridge this gap, women should receive education about congenital CMV. Hospital-based prenatal education increases awareness and knowledge about CMV and CMV prevention.

Awareness and knowledge of congenital cytomegalovirus infection among health care providers in France.

BACKGROUND: Cytomegalovirus (CMV) is the most frequent cause of congenital virus infection. CMV infects approximately 1% of newborns at birth with severe consequences among 10% of them and antenatal and postnatal treatments, although promising, are still under evaluation in randomised control trials. Efficacy of hygienic counselling to prevent CMV infection is nowadays established and should be spread. OBJECTIVE: To evaluate health care providers' awareness of CMV infection during pregnancy in France. STUDY DESIGN: A questionnaire on CMV infection was sent by e-mail to obstetricians, paediatricians, midwives and laboratory physicians, members of medical or midwives association. We evaluated their knowledge concerning CMV epidemiology, transmission, symptoms in adults, newborns and children. RESULTS: The questionnaire was completed by 800 respondents (half midwives and one third obstetricians). Most of them were unaware of the precise transmission route of CMV. Laboratory physicians had the highest score concerning maternal symptoms and post natal long term effects. 20% of respondents were wrongly convinced that in utero treatment options for congenital CMV infection were already available in France at the time of the study. The mean knowledge scores regarding transmission and neonatal symptoms increased with a more advanced career stage (i.e. older age) among obstetrician. CONCLUSIONS: This study tends to confirm that there is a large gap between knowledge of CMV during pregnancy and the burden of this disease. To bridge this gap, health care providers should improve their knowledge about congenital CMV by various means: medical reviews, continuing medical education, meetings, conferences, the Internet.