Using adult care visits to diagnose HIV infection in children, Burkina Faso.

Objective: To estimate the feasibility, positivity rate and cost of offering child testing for human immunodeficiency virus (HIV) to mothers living with HIV attending outpatient clinics in Burkina Faso. Methods: We conducted this implementation study in nine outpatient clinics between October 2021 and June 2022. We identified all women ≤ 45 years who were attending these clinics for their routine HIV care and who had at least one living child aged between 18 months and 5 years whose HIV status was not known. We offered these mothers an HIV test for their child at their next outpatient visit. We calculated intervention uptake, HIV positivity rate and costs. Findings: Of 799 eligible children, we tested 663 (83.0%) and identified 16 new HIV infections: 2.5% (95% confidence interval, CI: 1.5-4.1). Compared with HIV-negative children, significantly more HIV-infected children were breastfed beyond 12 months (P-value: 0.003) and they had not been tested before (P-value: 0.003). A significantly greater proportion of mothers of HIV-infected children were unaware of the availability of child testing at 18 months (P-value: < 0.001) and had more recently learnt their HIV status (P-value: 0.01) than mothers of HIV-negative children. The intervention cost 98.1 United States dollars for one child testing HIV-positive. Barriers to implementing this strategy included shortages of HIV tests, increased workload for health-care workers and difficulty accessing children not living with their mothers. Conclusion: Testing HIV-exposed children through their mothers in outpatient clinics is feasible and effective in a low HIV-prevalence setting such as Burkina Faso. Implementation of this strategy to detect undiagnosed HIV-infected children is recommended.

Patients infected by tuberculosis and human immunodeficiency virus facing their disease, their reactions to disease diagnosis and its implication about their families and communities, in Burkina Faso: a mixed focus group and cross sectional study.

BACKGROUND: Patients facing tuberculosis (TB) and human immunodeficiency virus (HIV) infection receive particular care. Despite efforts in the care, misconceptions about TB and HIV still heavily impact patients, their families and communities. This situation severely limits achievement of TB and HIV programs goals. This study reports current situation of TB patients and patients living with HIV/AIDS (PLWHA) facing their disease and its implications, by comparing results from both qualitative and quantitative study design. METHODS: Cross sectional study using mixed methods was used and excluded patients co-infected by TB and HIV. Focus group included 96 patients (6 patients per group) stratified by setting, disease profile and gender; from rural (Orodara Health District) and urban (Bobo Dioulasso) areas, all from Hauts-Bassins region in Burkina Faso. Quantitative study included 862 patients (309 TB patients and 553 PLWHA) attending TB and HIV care facilities in two main regions (Hauts-Bassins and Centre) of Burkina Faso. RESULTS: A content analysis of reports found TB patients and PLWHA felt discriminated and stigmatized because of misconceptions with its aftermaths (rejection, emotional and financial problems), mainly among PLWHA and women patients. PLWHA go to healers when facing limited solutions in health system. There are fewer associations for TB patients, and less education and sensitization sessions to give them opportunity for sharing disease status and learning from other TB patients. TB patients and PLWHA still need to better understand their disease and its implication. Access to care (diagnosis and treatment) remains one of the key issues in health system, especially for PLWHA. Individual counseling is centered among PLWHA but not for TB patients. With research progress and experiences sharing, TB patients and PLWHA have some hope to implement their life project, and to receive psychosocial and nutritional support. CONCLUSION: Despite international aid, TB patients and PLWHA are facing misconceptions effects. There is a need to reinforce health education towards patients and healers, inside community, health centers and associations, and for specific settings. International aid must be adapted to specific targets and strategies implementing programs. Maintaining psychosocial and nutritional support is crucial for better outcomes of medication adherence. Individual counseling has to be centered among TB patients and PLWHA.

Medication-adherence predictors among patients with tuberculosis or human immunodeficiency virus infection in Burkina Faso.

BACKGROUND: Adherence to treatment remains a key issue for tuberculosis (TB) and human immunodeficiency virus (HIV) programs. The study objective was to identify potential determinants of medication adherence (MA) among patients with TB, HIV, or both. METHODS: In this cross-sectional study, adult patients attending TB or HIV clinics were recruited in two main regions (Centre and Hauts-Bassins) of Burkina Faso from August to October 2010. Questionnaires were collected and simple and multiple step-wise linear regression models were used to identify predictors of MA. RESULTS: In total, 1043 patients (309 with TB, 553 with HIV, and 181 coinfected with both) participated in this study. For patients with TB, adjusted predictors of good MA were no alcohol use, ever been lost to follow-up, and awareness of disease transmission. For patients with HIV, adjusted predictors of good MA were less stigma, good knowledge about TB transmission, and awareness of disease transmission. For patients with dual infection, adjusted predictors of good MA was good attitude. Furthermore, adjusted predictors of poor MA for patients with TB or with dual infection were poor financial access to care and high number of persons sleeping in the household, respectively. CONCLUSION: This study provides information on MA in patients infected with TB, HIV, and those coinfected with TB and HIV. TB and HIV programs have to consider the environment of the patient and its characteristics, including stigma, attitude, status of loss to follow-up, TB knowledge, financial access to care, alcohol use, awareness of disease transmission, and number of persons sleeping in the household. These identified factors in this study need to be taken into account for a specific patient profile and during sensitization, project planning, and research stages.

Risk factors of tuberculosis infection among HIV/AIDS patients in Burkina Faso.

Tuberculosis (TB) and HIV coinfection is the leading cause of mortality among TB patients and people living with HIV/AIDS (PLWHAs). There is still a need to look for cognitive and behavioral determinants of TB among PLWHAs. This study aims at identifying risk factors of TB infection among PLWHAs in Burkina Faso. A cross-sectional study design and consecutive recruitment method were employed. Adult patients attending TB hospitals or HIV clinics were recruited in two main regions (Hauts-Bassins and Centre) of Burkina Faso from August to October 2010. Stepwise logistic regression models were used for statistical analysis. In total, 734 PLWHAs, including 181 (24.7%) coinfected with TB, participated in this study. Of the latter, 53.4% were from the Hauts-Bassins region and 46.6% from the Centre region. Adjusted TB risk factors among PLWHAs were urban setting, TB history, higher number of persons living in the household, and poor geographic access to care. Moreover adjusted TB risk factors among PLWHAs consisted of CD4 cell counts below 200/µl, a history of sexually transmissible infections, and a past or present history of pulmonary asthma. In addition, lack of education and arterial hypertension were additional risk factors in the Hauts-Bassins region; for PLWHAs in the Centre region, male gender, jobs not in the private and public sector, and past or present history of cardiovascular disease were additional risk factors for TB. Common and different risk factors for TB were identified for PLWHAs in the Hauts-Bassins and Centre regions. This information will be incorporated into the HIV/TB control programs in the future.