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BACKGROUND: Hospital-based surveillance of antimicrobial resistance may be irrelevant as a guide to antimicrobial use for urinary tract infections (UTIs) in primary care. OBJECTIVES: To highlight the value of online computerized decision support systems (CDSS) in providing information on the surveillance of antimicrobial resistance in community-acquired UTIs. METHODS: We collected the susceptibility profile for key antibiotics by type of UTI involving Escherichia coli from 2017 to 2020, using queries for UTI (Q-UTI) submitted to a French CDSS. We compared these results with those from the MedQual French surveillance system for community-acquired UTI and the European Antimicrobial Resistance Surveillance Network (EARS-NET) for invasive infections. RESULTS: We collected 43â591 Q-UTI, of which 10â192 (23%) involved E. coli: 40% cystitis, 32% male-UTI, and 27% pyelonephritis. Resistance was 41.3% (95% CI, 40.3%-42.2%) for amoxicillin, 16.6% (95% CI, 15.9%-17.3%) for fluoroquinolones, 6.6% (95% CI, 6.1%-7.0%) for third-generation cephalosporins (3GC), and 5.7% (95% CI, 5.2%-6.1%) for aminoglycosides. Resistance to amoxicillin was lower than that reported in MedQual (42.7%, P valueâ=â0.004), and in EARS-NET (55.2%, P valueâ<â0.001). For fluoroquinolones, resistance was higher than in MedQual (12.0%, P valueâ<â0.001) and EARS-NET (15.8%, P valueâ=â0.041). In complicated pyelonephritis and male UTI, fluoroquinolone resistance peaked at â¼20%. For 3GC, all UTI had higher resistance than in MedQual (3.5%, P valueâ<â0.001), but lower than in EARS-NET (9.5%, P valueâ<â0.001). Aminoglycoside resistance was not reported by MedQual, and was lower than in EARS-NET (7.1%, P valueâ<â0.001). CONCLUSIONS: CDSS can inform prescribers in real-time about the ecology and surveillance of E. coli resistance in community-acquired UTI. In complicated upper UTIs, they can underline the risk of empirical use of fluoroquinolones and suggest preferential use of 3GC.
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Anti-Infecciosos , Infecções Urinárias , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Farmacorresistência Bacteriana , Escherichia coli , Feminino , Fluoroquinolonas , Humanos , Masculino , Atenção Primária à Saúde , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/epidemiologiaRESUMO
We evaluated an elvitegravir-cobicistat-emtricitabine-tenofovir alafenamide single-tablet regimen for human immunodeficiency virus postexposure prophylaxis. The completion rate and adherence were good, and the tolerance was acceptable; no seroconversion was observed. We confirm that this regimen could be appropriate for postexposure prophylaxis. CLINICAL TRIALS REGISTRATION: NCT02998320.
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Fármacos Anti-HIV , Infecções por HIV , HIV-1 , Adenina/análogos & derivados , Alanina , Fármacos Anti-HIV/uso terapêutico , Cobicistat/uso terapêutico , Combinação de Medicamentos , Emtricitabina/uso terapêutico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/prevenção & controle , Humanos , Quinolonas , Comprimidos/uso terapêutico , Tenofovir/análogos & derivadosRESUMO
OBJECTIVES: To describe the implementation and use of a computerized decision support system (CDSS) for antibiotic prescription in primary care in France (Antibioclic). The CDSS targets 37 infectious diseases and has been freely available on a website since 2011. METHODS: Description and implementation of the architecture of a CDSS for antibiotic prescription in general practice. Analysis of the queries made between 2012 and 2018 on the CDSS by GPs. Analysis of two cross-sectional studies of users in 2014 and 2019. RESULTS: The number of queries increased from a median of 796/day [IQR, 578-989] in 2012 to 11 125/day [5592-12 505] in 2018. Unique users increased from 414/day [245-494] in 2012 to 5365/day [2891-5769] in 2018. Time taken to make a query was 2 min [1.9-2.1]. Among 3 542 347 queries in 2018, 78% were for adults. Six situations accounted for ≥50% of queries: cystitis; acute otitis media; acute sinusitis; community-acquired pneumonia; sore throat; and pyelonephritis. Queries concerned pathologies for which antibiotic prescription was necessary (64%), was conditional on additional clinical steps (34%) or was not recommended (2%). Most users (81%) were GPs, with median age of 38 years [31-52] and 58% were female. Among the 4016 GPs who responded to the surveys, the vast majority (96%) reported using the CDSS during the consultation, with 24% systematically using Antibioclic to initiate an antibiotic course and 93% having followed the CDSS recommendation for the latest prescription. Most GPs were comfortable using the CDSS in front of a patient. CONCLUSIONS: Antibioclic has been adopted and is widely used in primary care in France. Its interoperability could allow its adaptation and implementation in other countries.
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Antibacterianos , Sistemas de Apoio a Decisões Clínicas , Adulto , Antibacterianos/uso terapêutico , Estudos Transversais , Farmacorresistência Bacteriana , Feminino , França , Humanos , Prescrições , Atenção Primária à SaúdeRESUMO
We evaluated awareness of treatment as prevention (TasP) among adults people living with HIV (PLHIV) in five infectious disease departments in Paris, then how they perceived its impact on their sexual well-being. This cross-sectional multicenter survey was conducted in 2014 during scheduled clinical appointments using a self-administered questionnaire. We analyzed 520 questionnaires (42% women, 54% men of whom 57% were MSM [men who have sex with men]). 75% of women were born abroad, most commonly in sub-Saharan Africa, whereas 64% of men were French-born. The mean time since HIV diagnosis was 12.8 ± 7.8 years. Eighty-seven percent [84-90%]95% reported being aware of the impact of ART on HIV transmission, 94% MSM, 86% women, 83% heterosexual men. PLHIV reported that they gained awareness of TasP through medical doctors (86%). The fear of transmission was perceived as alleviated for 73% [69%;78%]95%, more often among MSM; the sexual life was reported to be improved for 28% [24%;33%]95%; and ART adherence to be improved for 45% [40%;50%]95%, more often among women. The awareness of TasP was relatively high, but it seems important to understand the features of male and female populations of PLHIV to adapt counseling during follow-up appointments, as women's answers differed in various regards.
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Infecções por HIV , Minorias Sexuais e de Gênero , Estudos Transversais , Feminino , Infecções por HIV/prevenção & controle , Homossexualidade Masculina , Humanos , Masculino , Paris , Comportamento Sexual , Parceiros Sexuais , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Suboptimal use of antibiotics is a driver of antimicrobial resistance (AMR). Clinical decision support systems (CDSS) can assist prescribers with rapid access to up-to-date information. In low- and middle-income countries (LMIC), the introduction of CDSS for antibiotic prescribing could have a measurable impact. However, interventions to implement them are challenging because of cultural and structural constraints, and their adoption and sustainability in routine clinical care are often limited. Preimplementation research is needed to ensure relevant adaptation and fit within the context of primary care in West Africa. OBJECTIVE: This study examined the requirements for a CDSS adapted to the context of primary care in West Africa, to analyze the barriers and facilitators of its implementation and adaptation, and to ensure co-designed solutions for its adaptation and sustainable use. METHODS: We organized a workshop in Burkina Faso in June 2019 with 47 health care professionals representing 9 West African countries and 6 medical specialties. The workshop began with a presentation of Antibioclic, a publicly funded CDSS for antibiotic prescribing in primary care that provides personalized antibiotic recommendations for 37 infectious diseases. Antibioclic is freely available on the web and as a smartphone app (iOS, Android). The presentation was followed by a roundtable discussion and completion of a questionnaire with open-ended questions by participants. Qualitative data were analyzed using thematic analysis. RESULTS: Most of the participants had access to a smartphone during their clinical consultations (35/47, 74%), but only 49% (23/47) had access to a computer and none used CDSS for antibiotic prescribing. The participants considered that CDSS could have a number of benefits including updating the knowledge of practitioners on antibiotic prescribing, improving clinical care and reducing AMR, encouraging the establishment of national guidelines, and developing surveillance capabilities in primary care. The most frequently mentioned contextual barrier to implementing a CDSS was the potential risk of increasing self-medication in West Africa, where antibiotics can be bought without a prescription. The need for the CDSS to be tailored to the local epidemiology of infectious diseases and AMR was highlighted along with the availability of diagnostic tests and antibiotics using national guidelines where available. Participants endorsed co-design involving all stakeholders, including nurses, midwives, and pharmacists, as central to any introduction of CDSS. A phased approach was suggested by initiating and evaluating CDSS at a pilot site, followed by dissemination using professional networks and social media. The lack of widespread internet access and computers could be circumvented by a mobile app with an offline mode. CONCLUSIONS: Our study provides valuable information for the development and implementation of a CDSS for antibiotic prescribing among primary care prescribers in LMICs and may, in turn, contribute to improving antibiotic use, clinical outcomes and decreasing AMR.
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Antibacterianos/uso terapêutico , Sistemas de Apoio a Decisões Clínicas/normas , Atenção Primária à Saúde/métodos , Adulto , África Ocidental , Feminino , Humanos , Masculino , MédicosRESUMO
Transmission of an infection from health care workers to patients. The transmission of a communicable disease from a HCW to one or more patients has been demonstrated for airborne transmission disease like flu or tuberculosis and also for blood borne infections like HIV, HBV and HCV through an accidental blood exposure. The risk is globally controlled by vaccination in HCWs for flu and HBV infections but also by PCI infections control procedures as standard precautions, air precautions, and rapid specific treatment among infected professionals. The occurrence of a case can be an indicator of a failure in quality in care. Occupational medicine in Health care settings is crucial in prevention of HCW infection to patient.
Risque de transmission d'une infection du soignant aux soignés. La transmission d'un agent infectieux du professionnel de santé à un ou plusieurs patients est documentée pour des infections à transmission respiratoire comme la grippe ou la tuberculose mais aussi pour les infections virales virémiques telles que celles liées au virus de l'immunodéficience humaine et aux virus des hépatites B et C lors d'accidents d'exposition au sang. Ce risque est très largement maitrisé par la vaccination des soignants lorsqu'elle existe (grippe, hépatite B) mais aussi et essentiellement par des mesures d'hygiène telles que les précautions standard, les précautions complémentaires respiratoires et le traitement rapide des infections chez les professionnels. Les cas survenus constituent un indicateur de défaut de qualité des soins. Leur survenue met en lumière le rôle de la médecine du travail dans les établissements de santé.
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Infecções por HIV , Hepatite B , Hepatite C , Transmissão de Doença Infecciosa do Profissional para o Paciente , Intervenção Coronária Percutânea , Pessoal de Saúde , HumanosRESUMO
BACKGROUND: Across various stages of the COVID-19 pandemic and related vaccine recommendations in France, we assessed the association of the 7C-psychological antecedents with vaccine uptake/intention for booster vaccination among healthcare-sector workers (HCSWs). We also assessed whether 7C-antecedent profiles changed over time. METHODOLOGY: The Research Group for the Prevention of Occupational Infections in Healthcare Workers (GERES) conducted three repeated web-surveys which were disseminated by email chain-referral among HCSWs throughout France. The questionnaires waves took place: July-November 2021, February-March 2022 and January-March 2023 (P2, P3 and P4). We also reanalysed data from a prior similar study conducted late 2020-early 2021 (Moirangthem et al. (2022)) (P1). To evaluate the association of 7C-items with vaccine uptake-intention for future vaccination, we estimated adjusted prevalence ratios (aPR) using robust variance Poisson regression. We report the 7C-item population attributable loss in vaccine intention. RESULTS: The four surveys (P1-P4) encompassed 5234, 339, 351 and 437 participants. At earlier stages of the vaccine campaign, the principal antecedents of vaccine intention were favorable perception of vaccination benefit-risk-balance (BRB) (vs. unfavorable, aPR: 2.32), reactance to employer encouragement for vaccination (motivates vs. dissuades-me, aPR:2.23), vaccine confidence (vs. not-being-confident, aPR: 1.71) and social conformism towards vaccination (favorable vs. skeptical opinion in private environment, aPR: 1.33). Under a vaccine mandate for HCSWs, only perceiving vaccination as a collective action was associated with current vaccine status (agree vs. disagree, aPR: 2.19). At later stages of the epidemic, hypothetical booster vaccine intentions were strongly associated with BRB perception (favorable vs. unfavorable, aPR: 2.07) and perceiving vaccination as a collective action (agree vs. disagree, aPR: 1.69). Fearing a severe side effect from vaccination decreased population vaccine intention by 26.2 %. CONCLUSION: Our results suggest that both 7C-antecedents and their association with vaccine behaviour can change over time, and underscore the importance of assuring confidence in vaccine safety.
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BACKGROUND: Factors associated with the appropriateness of antibiotic prescribing in primary care have been poorly explored. In particular, the impact of computerised decision-support systems (CDSS) remains unknown. OBJECTIVES: We aim at investigating the uptake of CDSS and its association with physician characteristics and professional activity. METHODS: Since May 2022, users of a CDSS for antibiotic prescribing in primary care in France have been invited, when registering, to complete three case vignettes assessing clinical situations frequently encountered in general practice and identified as at risk of antibiotic misuse. Appropriateness of antibiotic prescribing was defined as the rate of answers in line with the current guidelines, computed by individuals and by specific questions. Physician's characteristics associated with individual appropriate antibiotic prescribing (< 50%, 50-75% and > 75% appropriateness) were identified by multivariate ordinal logistic regression. RESULTS: In June 2023, 60,067 physicians had registered on the CDSS. Among the 13,851 physicians who answered all case vignettes, the median individual appropriateness level of antibiotic prescribing was 77.8% [Interquartile range, 66.7%-88.9%], and was < 50% for 1,353 physicians (10%). In the multivariate analysis, physicians' characteristics associated with appropriateness were prior use of the CDSS (OR = 1.71, 95% CI 1.56-1.87), being a general practitioner vs. other specialist (OR = 1.34, 95% CI 1.20-1.49), working in primary care (OR = 1.14, 95% CI 1.02-1.27), mentoring students (OR = 1.12, 95% CI 1.04-1.21) age (OR = 0.69 per 10 years increase, 95% CI 0.67-0.71). CONCLUSION: Individual appropriateness for antibiotic prescribing was high among CDSS users, with a higher rate in young general practitioners, previously using the system. CDSS could improve antibiotic prescribing in primary care.
Individual appropriateness for antibiotic prescribing is high among CDSS users.CDSS use could passively improve antibiotic prescribing in primary care.Factors associated with appropriateness for antibiotic prescribing for primary care diseases are: prior use of CDSS, general practice speciality vs. other specialities, younger age and mentoring of students.
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Antibacterianos , Prescrição Inadequada , Padrões de Prática Médica , Atenção Primária à Saúde , Humanos , Antibacterianos/uso terapêutico , Padrões de Prática Médica/estatística & dados numéricos , Feminino , Masculino , Pessoa de Meia-Idade , Prescrição Inadequada/estatística & dados numéricos , França , Adulto , Sistemas de Apoio a Decisões Clínicas , Modelos Logísticos , Análise MultivariadaRESUMO
Context: Homeless individuals face exacerbated risks of infectious diseases, including sexually transmitted infections (STIs). Programs led by Community Health Workers (CHWs) have demonstrated potential to enhance healthcare access for marginalized groups such as homeless families. This study aims to evaluate the feasibility and effectiveness of a novel CHW-based outreach program addressing sexual health issues among individuals residing in homeless hostels. Methods: Twelve social homeless hostels in the greater Paris region were selected as program implementation sites. An outreach program was developed consisting of two interventions: sexual health workshops and STI screening sessions (HIV and hepatitis B and C) accompanied by individual interviews, both conducted by CHWs within each hostel over an 8-week period and scheduled weekly. Feasibility, participation and engagement were evaluated using complementary methods including qualitative field observations, semi-structured interviews and focus groups with CHWs, satisfaction questionnaires for participants, and quantitative outcome data collection of each intervention. Results: A total of 80 program activities (workshops and screening sessions) were conducted. Among the participants, 542 women and 30 men engaged in workshops. During the 30 Rapid Diagnostic Testing sessions, 150 individuals underwent testing for HIV, hepatitis B, and/or hepatitis C. Positivity rates were 6.7% for hepatitis B and 0.9% for hepatitis C. No HIV infections were detected. Participant satisfaction rates were consistently high (>76%) across workshops. Qualitative analysis unveiled two critical axes influencing program feasibility and effectiveness: program organization and CHW involvement. Discussion: This assessment of the program highlights its feasibility among a population that is difficult to reach through conventional healthcare efforts. The intervention's potential effectiveness is suggested by self- and CHW-reported improvements in sexual health literacy and high rates of referral to the healthcare system, as well as holistic well-being considerations. CHW involvement is a vital determinant of program success, as are robust coordination among stakeholders, deep understanding of the target population, and strong partner engagement. Conclusion: This outreach program amplifies the voices of often-overlooked populations while empowering them to navigate health and social challenges. Although these workshops serve as lifelines for those frequently excluded from mainstream services, long-term improvements to the health and wellbeing of homeless populations will necessitate systemic governmental intervention.
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Infecções por HIV , Hepatite B , Hepatite C , Saúde Sexual , Masculino , Humanos , Feminino , Agentes Comunitários de Saúde , Paris , Serviços de Saúde Comunitária/métodos , Infecções por HIV/prevenção & controle , Hepatite B/prevenção & controleRESUMO
The quadritherapy by isoniazid, rifampicin, pyrazinamide and ethambutol, is still the gold standard for the treatment of tuberculosis disease. Except for severe presentations, the treatment remains based on a 6 months therapy with a 2 months induction phase. During the first health care contact, looking for an immunosupression and risk factors of hepatotoxicity and multiresistant strains is necessary. A close supervision by medical staff is recommended during all treatment duration. Rifampicin expose to drug interactions. In France, once the diagnosis is made, the referent practitioner and the biologist must notify the case to the local Health Authorities which is in charge of finding and treat, if needed, the newly infected case contacts. In order to prevent transmission, a respiratory isolation must be performed for smear positive patients. In case of renal or hepatic previous impairment, a multidisciplinary and closely supervision is recommended. Treatment of extensively and multi drug resistant (MDR) tuberculosis is based on combination of 2nd line drugs, and a prolonged treatment is advised. Expert supervision is necessary for case management.
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Antituberculosos/uso terapêutico , Tuberculose/tratamento farmacológico , Adulto , Algoritmos , Antituberculosos/administração & dosagem , Antituberculosos/efeitos adversos , Doença Hepática Induzida por Substâncias e Drogas/diagnóstico , Doença Hepática Induzida por Substâncias e Drogas/prevenção & controle , Doença Hepática Induzida por Substâncias e Drogas/terapia , Quimioterapia Combinada , Humanos , Adesão à Medicação/estatística & dados numéricos , Monitorização Fisiológica/métodos , Isolamento de Pacientes/métodos , Isolamento de Pacientes/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Tuberculose/transmissãoRESUMO
The individual determinants of vaccine acceptance among health workers (HCWs) have been described in the literature, but there is little evidence regarding the impact of vaccine characteristics and contextual factors (e.g., incentives, communication) on vaccination intentions. We developed a single profile discrete choice experiment (DCE) to assess the impact of seven attributes on stated vaccination intention against an unnamed disease, described as frequent with rapid clinical evolution and epidemic potential (similar to influenza or pertussis). Attributes evaluated vaccine characteristics (effectiveness, security profile), inter-individual aspects (epidemic risk, controversy, potential for indirect protection, vaccine coverage) and incentives (e.g., badge, hierarchical injunction). A total of 1214 French hospital-based HCWs, recruited through professional organizations, completed the online DCE questionnaire. The relative impact of each attribute was estimated using random effects logit models on the whole sample and among specific subgroups. Overall, 52% of included HCWs were vaccinated against influenza during 2017-18 and the average vaccination acceptance rate across all scenarios was 58%. Aside from the management stance, all attributes' levels had significant impact on vaccination decisions. Poor vaccine safety had the most detrimental impact on stated acceptance (OR 0.04 for the level controversy around vaccine safety). The most motivating factor was protection of family (OR 2.41) and contribution to disease control (OR 2.34). Other motivating factors included improved vaccine effectiveness (OR 2.22), high uptake among colleagues (OR 1.89) and epidemic risk declared by health authorities (OR 1.76). Social incentives (e.g., a badge I'm vaccinated) were dissuasive (OR 0.47). Compared to HCWs previously vaccinated against influenza, unvaccinated HCWs who were favorable to vaccination in general were most sensitive towards improved vaccine effectiveness. Our study suggests that vaccine safety considerations dominate vaccine decision-making among French HCWs, while adapted communication on indirect protection and social conformism can contribute to increase vaccination acceptance.
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Vacinas contra Influenza , Influenza Humana , Atitude do Pessoal de Saúde , Estudos Transversais , Pessoal de Saúde , Hospitais , Humanos , Influenza Humana/prevenção & controle , Aceitação pelo Paciente de Cuidados de Saúde , Inquéritos e Questionários , VacinaçãoRESUMO
BACKGROUND: This study aimed to assess, by rapid tests, the immune status against COVID-19 among Healthcare Workers (HCW) with history of symptoms, and for whom SARS-CoV-2 detection was either not documented or negative. METHODS: Whole blood by finger prick and serum samples were taken from HCW for use with 2 rapid lateral flow tests and an automated immunoassay. RESULTS: Seventy-two HCWs were included, median duration between symptoms onset and serology sampling was 68 days. Anti-SARS-CoV-2 antibodies were detected by rapid test in 11 HCW (15.3%) and confirmed in the 10 with available serum by the automated immunoassay. The frequency of ageusia or anosmia was higher in participants with SARS-CoV-2 antibodies (P = 0.0006 and P = 0.029, respectively). CONCLUSIONS: This study, among symptomatic HCW during the first wave in France, showed that 15% had IgG anti-SARS-CoV-2, a higher seroprevalence than in the general population. Rapid lateral flow tests were highly concordant with automated immunoassay.
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Teste Sorológico para COVID-19 , COVID-19/diagnóstico , Pessoal de Saúde , Testes Imediatos , SARS-CoV-2/isolamento & purificação , Adulto , Anticorpos Antivirais/sangue , COVID-19/sangue , Feminino , Humanos , Imunoensaio , Masculino , Pessoa de Meia-Idade , Paris/epidemiologia , Projetos Piloto , Estudos Prospectivos , SARS-CoV-2/imunologia , Sensibilidade e Especificidade , Estudos SoroepidemiológicosRESUMO
OBJECTIVES: To analyse preferences around promotion of COVID-19 vaccination among workers in the healthcare and welfare sector in Fance at the start of the vaccination campaign. DESIGN: Single-profile discrete-choice experiment. Respondents in three random blocks chose between accepting or rejecting eight hypothetical COVID-19 vaccination scenarios. SETTING: 4346 healthcare and welfare sector workers in France, recruited through nation-wide snowball sampling, December 2020 to January 2021. OUTCOME: The primary outcomes were the effects of attributes' levels on hypothetical acceptance, expressed as ORs relative to the reference level. The secondary outcome was vaccine eagerness as certainty of decision, ranging from -10 to +10. RESULTS: Among all participants, 61.1% made uniform decisions, including 17.2% always refusing vaccination across all scenarios (serial non-demanders). Among 1691 respondents making variable decisions, a strong negative impact on acceptance was observed with 50% vaccine efficacy (compared with 90% efficacy: OR 0.05, 95% CI 0.04 to 0.06) and the mention of a positive benefit-risk balance (compared with absence of severe and frequent side effects: OR 0.40, 0.34 to 0.46). The highest positive impact was the prospect of safely meeting older people and contributing to epidemic control (compared with no indirect protection: OR 4.10, 3.49 to 4.82 and 2.87, 2.34 to 3.50, respectively). Predicted acceptance was 93.8% for optimised communication on messenger RNA vaccines and 16.0% for vector-based vaccines recommended to ≥55-year-old persons. Vaccine eagerness among serial non-demanders slightly but significantly increased with the prospect of safely meeting older people and epidemic control and reduced with lower vaccine efficacy. DISCUSSION: Vaccine promotion towards healthcare and welfare sector workers who hesitate or refuse vaccination should avoid the notion of benefit-risk balance, while collective benefit communication with personal utility can lever acceptance. Vaccines with limited efficacy will unlikely achieve high uptake.
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Vacinas contra COVID-19 , COVID-19 , Idoso , Estudos Transversais , Atenção à Saúde , França , Humanos , Pessoa de Meia-Idade , SARS-CoV-2 , VacinaçãoRESUMO
The aim of this study was to assess the analytical performances, sensitivity and specificity, of two rapid tests (Covid- Presto® test rapid Covid-19 IgG/IgM and NG-Test® IgM-IgG COVID-19) and one automated immunoassay (Abbott SARS-CoV-2 IgG) for detecting anti- SARS-CoV-2 antibodies. This study was performed with: (i) a positive panel constituted of 88 SARS-CoV-2 specimens collected from patients with a positive SARS-CoV-2 RT-PCR, and (ii) a negative panel of 120 serum samples, all collected before November 2019, including 64 samples with a cross-reactivity panel. Sensitivity of Covid-Presto® test for IgM and IgG was 78.4% and 92.0%, respectively. Sensitivity of NG-Test® for IgM and IgG was 96.6% and 94.9%, respectively. Sensitivity of Abbott IgG assay was 96.5% showing an excellent agreement with the two rapid tests (κ = 0.947 and κ = 0.936 for NGTest ® and Covid-Presto® test, respectively). An excellent agreement was also observed between the two rapid tests (κ = 0.937). Specificity for IgM was 100% and 86.5% for Covid-Presto® test and NG-Test®, respectively. Specificity for IgG was 92.0%, 94.9% and 96.5% for Covid-Presto®, NGTest ®, and Abbott, respectively. Most of the false positive results observed with NG-Test® resulted from samples containing malarial antibodies. In conclusion, performances of these 2 rapid tests are very good and comparable to those obtained with automated immunoassay, except for IgM specificity with the NG-Test®. Thus, isolated IgM should be cautiously interpreted due to the possible false-positive reactions with this test. Finally, before their large use, the rapid tests must be reliably evaluated with adequate and large panel including early seroconversion and possible cross-reactive samples.
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Anticorpos Antivirais/sangue , Teste para COVID-19/métodos , COVID-19/diagnóstico , Imunoensaio/métodos , SARS-CoV-2/imunologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Masculino , Pessoa de Meia-Idade , Sensibilidade e EspecificidadeRESUMO
North Africa is one of the rare regions where the HIV epidemic is growing. In France, 5% of the migrants discovering their HIV infection are from North Africa. The objective of this study was to compare the sociodemographic characteristics and outcomes of North African and French HIV-infected patients. This study was conducted in the HIV clinic of Bichat Hospital (Paris, France). The North African HIV-infected patients were born in Algeria, Tunisia, or Morocco or had lived there for more than 6 months. They were matched for age and gender (1:2) to patients born in France who had never lived outside France for more than 6 months. Sociodemographic, clinical, and immunovirological characteristics of North African and French patients were compared using conditional logistic regression. Among 4,738 eligible patients, 285 North Africans were identified. CD4 levels at HIV diagnosis were not significantly different between North African and French patients, but were more frequently <200/mm3 in the former than the latter at treatment initiation (p = .02). CDC stage 3 disease occurred more frequently in the first 3 years of care in our center in North African patients than in French patients (p = .01), and control of the HIV viral load over the 12 months preceding inclusion was better in French patients (p = .0001). There was no difference regarding loss to care. These results highlight possible issues in adherence to antiretroviral treatment in North African patients, which may be related to differences in the acceptability of the disease.
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População Negra/estatística & dados numéricos , Infecções por HIV/etnologia , Adulto , África do Norte/etnologia , Idoso , Idoso de 80 Anos ou mais , Antirretrovirais/uso terapêutico , Contagem de Linfócito CD4 , Feminino , França/epidemiologia , França/etnologia , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/transmissão , Humanos , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente , Estudos Retrospectivos , Migrantes/estatística & dados numéricos , Carga Viral , Adulto JovemRESUMO
OBJECTIVE: To assess the prevalence of and factors associated with squamous intraepithelial lesions and condyloma [human papillomavirus (HPV)-related lesions) in HIV-infected patients. DESIGN: A cross-sectional study in a tertiary-care university hospital conducted in 516 consecutive outpatients. INTERVENTION: A systematic examination for macroscopic HPV-related lesions through anoscopy with histological confirmation, evaluation of dysplasia and HPV typing. Sexual behaviours were assessed using a semi-directive questionnaire. RESULTS: Of 473 patients examined, (200 homosexual men, 123 heterosexual men, 150 women), 108 (23%) had histologically confirmed anal HPV-related lesions (36, 15 and 11% of the respective populations), including 51 (47%) with only endoanal localization. Among these 108 patients, histological dysplasia of grades I or II and grade III were noted in 59 and two patients, respectively, invasive endoanal cancer in one; three patients also had high-risk oncogenicity HPV without dysplasia. Independent identified associated factors of HPV-related condyloma were the number of incidents of sexual intercourse per month [odds ratio (OR) 1.04; 95% confidence interval (CI) 1.01-1.06], CD4 cell count below 200 x 10 cells/l (OR 3.22; 95% CI 1.37-7.60), history of anal HPV lesion (OR 4.57; 95% CI 2.13-9.81), and receptive anal intercourse (OR 2.30; 95% CI 1.11-4.77). The two latter factors remained associated with histological dysplasia (OR 2.82; 95% CI 1.38-5.76 for history of anal condyloma, and OR 4.29; 95% CI 2.18-8.44 for receptive anal intercourse). CONCLUSION: The high rate of condyloma and histological dysplasia seen argues for a systematic screening for these lesions in HIV-infected individuals.
Assuntos
Doenças do Ânus/virologia , Neoplasias do Ânus/virologia , Carcinoma in Situ/virologia , Condiloma Acuminado/diagnóstico , Infecções por HIV/virologia , Comportamento Sexual , Adulto , Canal Anal/patologia , Canal Anal/virologia , Doenças do Ânus/patologia , Neoplasias do Ânus/patologia , Carcinoma in Situ/patologia , Condiloma Acuminado/patologia , Condiloma Acuminado/virologia , Estudos Transversais , Feminino , Infecções por HIV/patologia , Heterossexualidade , Homossexualidade , Humanos , Hibridização In Situ , Masculino , Pessoa de Meia-Idade , Razão de Chances , Papiloma/diagnóstico , Papiloma/patologia , Papiloma/virologia , Prevalência , RiscoRESUMO
A small proportion of bacilli are naturally resistant to each antituberculous drug. Nevertheless the resistance is not expressed and wild isolates almost never show any resistance. Multidrug resistant tuberculosis is defined as resistance to at least isoniazid and rifampicin. Extensively drug resistant tuberculosis (XDR) is also resistant to more than 3 of the 6 classes of second line drugs including fluoroquinolones and aminoglycosides. The multidrug resistance is increasing in Asia and Eastern Europe. For the moment, the phenomena is rare in France (involving 1,1% of tuberculosis cases with 4% of MDR tested XDR). The best preventive measure consists in a proper use of antituberculosis drugs with combined therapy including at least 3 active drugs during the first 2 months. Another challenge is to be aware of the possiblility of resistance and to prevent further transmission to other patients by airborne isolation measures, particularly in immunosuppressed patients.