[Revival after Ebola: multidisciplinary assessment at 1 year, prospect and follow-up study of surviving patients from Ebola in Guinea (PostEboGui cohort)]. / (Re)vivre après Ebola : bilan à un an et perspectives d'une étude d'évaluation et accompagnement des patients déclarés guéris d'une infection par le virus Ebola en Guinée (cohorte PostEboGui).

Ebola virus disease (EVD) epidemic that spread in West Africa from the end of 2013 to early 2016 has reached more people than all past epidemics. Beyond care management of acute phase ill patients and measures for the control of the epidemic, the outcome of Ebola survivors became an important question as their number increased and raised new issues. A multidisciplinary prospective cohort of survivors in Guinea has been launched by IRD UMI 233 and Donka National Hospital, Conakry, Guinea, to assess the long-term clinical, psychological, sociological, immunological, and viral outcomes potentially related to EVD. This paper describes PostEboGui Programme, constraints and changes to the initial proposal, participants, first results, and new issues, 1 year after its start, in a descriptive and critical view. We started also to work on ethical aspects in the context of epidemics and of mass interventions with a risk of overinvestigation of patients.

[Hospital care for a child living with HIV in Dakar. What is the cost for the family?]. / Hospitalisation d'un enfant vivant avec le VIH à Dakar. Quel coût pour la famille ?

In sub-Saharan Africa, hospitalization is one of the main gateway for testing and care of children living with the HIV. The aim of this study is to estimate the direct costs of the hospitalization of children living with the HIV in Dakar (Senegal). The various expenses were collected daily with the medical file and by interview from the accompanying persons in 30 children. Median age was 9 years (1-17) with a sex ratio of 1.3. Siteen children were orphan and 7 died during the sur- vey. The median duration of the hospitaization was 20 days (3-71). Children older than 5 years had longer hospitalization duration than those under 5 years (p = 0.0001). The average full cost was 175,701 FCFA (268 €), distributed as follow: cost in the hospital 36%, cost of drugs 31%, cost of medical care 20% other non-medical expenses 13%. This survey explores an underdocumented aspect of HIV pediatric care : cost of hospitalization. It also addresses the issue of non-medical expenses resulting from the hospitalization, with regards to the families' income.

[Assessing the direct cost of medical care for HIV between the third and tenth year of ARV treatment in Dakar]. / Évaluation du coût direct de la prise en charge médicale du VIH entre la troisième et la dixième année de traitement ARV à Dakar.

The direct cost of medical care for HIV infection-excluding ARVs, viral load and CD4 counts-was assessed for patients who received ARV treatment in Senegal within the framework of the ANRS cohort 1215, between the third and tenth year of follow-up. The average annual direct cost was estimated at 120 /patient/year; this amount remained stable over the first ten years of treatment follow-up. Biological assessments for routine follow-up account for the majority of these costs (66%), followed by drugs (26%). Given the level of economic poverty facing by families, patients cannot bear such expenses over several years. However, these costs appear low enough to be covered by HIV-treatment programs or included in Universal Health Coverage systems.

[Free dispensing of antiretroviral treatments in Africa]. / Pour une délivrance gratuite des traitements antirétroviraux en Afrique.

The bio-clinical efficacy of ART in Africa has now been proven. In 2001, the resolution adopted by the UNGASS meeting confirms that "effective prevention, care and treatment strategies will require [...] a non-discriminatory access to [...] anti-retroviral therapies". Most of the programmes that give access to ART initiated in the sub-Saharan region in 1998 are based on the principle that the patients participate financially to the purchases of ART. Some countries (Côte d'Ivoire, Senegal, and Mali) subsidize ART medications to favour a better access. The financial contribution of patients is supposed to: 1/ translate patient support into government action; 2/ favour a closer therapeutic adherence; 3/ assure the access programmes sustainability. However, despite the subsidies provided by some states, the cost of medical treatment greatly exceeds the resources available to most of the sufferers. The analysis of ART access programmes, specifically in Senegal and Côte d'Ivoire, shows that: 1/ Patient support to government action does not need to be more demonstrated while general access to treatment is officially recognised and recommended by the United Nations. 2/ Patient involvement and better adherence have been noted with patients that receive free ART. 3/ Patient contribution represents less than 10% of the medication's purchasing cost, thus, the cost recovery is marginal and does not allow for sustainable ART access programmes. The cost charged to patients for ARV still represents a major obstacle for proper medical management. Care programmes in African countries should implement free access to ART as a priority.

[How to manage HIV seropositive or AIDS patients in rural Burkina Faso?]. / Quelle prise en charge pour les malades séropositifs ou sidéens en milieu rural au Burkina Faso?

This article is based on an ethnographical study carried out in 1996. It describes and analyzes the methods of medical and family management of HIV-positive and full-blown AIDS patients in the rural environment of Burkinabé. A number of recommendations are made. Biomedical management of these patients is almost non-existent (currently there is no serology or screening advice available at the dispensary). The patient is never informed of an AIDS diagnosis. The relations between the medical personnel and the patients are dominated by a sense of powerlessness and constant fear of infection. None of the traditional doctors of the region admits to treating AIDS although traditional medicine is used throughout the illness. Family management ranges from complete rejection of the patient to supportive but often misdirected care. It is determined by at least five elements: (1) the composition of the family unit and the nature of relations between the sick individual and the rest of the family, (2) the economic status of the patients, his family group and his parents, (3) the initial uncertainties of the diagnosis of the illness, (4) the fear of contagion and (5) the fear of gossip. Management of these patients would be improved by: (1) real access to counseling and screening, (2) the involvement of health workers in this activity and in the notification of the diagnosis to the peripheral medical organizations, (3) the education of the staff about the risks of contamination and care of the terminally ill, (4) reeducation of the public about the non-contagious nature of the sick by personal counseling given by health care professionals and (5) the material support of families. This is of vital importance but is difficult to achieve in the context of chronic poverty.

PIP: An ethnographic survey of some 10 Mossi villages with a total population of about 13,000 in Oubritenga province carried out between 1993 and 1996 provided information for an analysis of the medical and family management of HIV-seropositive and AIDS patients in rural Burkina Faso. None of the 1000 consultations held annually in the one available dispensary concerned management of seropositive patients. The incurability of AIDS, lack of resources of both the family and the dispensary, feelings of powerlessness of the health workers, and fear of infection discouraged efforts to treat HIV and AIDS patients. Consequently, health workers were unable to provide advice on preventing further spread or on management of the condition, and the opportunity to use statistics from the patient register for epidemiological surveillance was lost. Patients used the services of the 40 or 50 traditional practitioners in the area to obtain treatment for specific symptoms at all stages of HIV infection, although, as in the dispensary, the diagnosis of AIDS was never specified. The daily management of AIDS patients varied from complete rejection to supportive care under the influence of five major elements: 1) the composition of the domestic group and the nature of the relations between the patient and the family; 2) the economic power of the patient, his domestic group, and his extended family; 3) initial uncertainty concerning the diagnosis; 4) increasing fear of contracting AIDS; and 5) fear of disapproval or gossip. Many aspects of the management of AIDS characterize the final stages of any other mortal illness. But shame, fear of infection, and fear of gossip are peculiar to AIDS. Improved patient management is likely to require access to diagnosis and counseling in the dispensaries, training of health workers in the risks of infection and care of the terminally ill, reassurance of the public by health workers that casual contact does not spread AIDS, and material assistance for affected families.