Advanced HIV disease and associated factors among young people aged 15-24 years at a tertiary hospital in Sierra Leone: a cross-sectional study.

BACKGROUND: Advanced HIV disease (AHD) in young people living with HIV (PLHIV) is an increasingly pressing public health issue in sub-Saharan Africa. Despite global progress in early HIV testing and reducing HIV-related deaths, many youths experience increased rates of HIV disease progression in sub-Saharan Africa. This study describes the burden, clinical manifestations, and factors for disease progression among young PLHIV aged 15 - 24 years seeking medical services at a major public hospital in Sierra Leone. METHODS: We performed a cross-sectional analysis of routinely collected data for PLHIV patients aged 15 to 24 seen at Connaught Hospital in Sierra Leone between September 2022 and March 2023. We estimated the proportion of AHD in young PLHIV and performed logistic regression modelling to explore predictors of AHD. The statistical significance level was set at 0.05 for all statistical tests. RESULTS: Of the 581 PLHIV that were reported, 238 (40.9%) were between the ages of 15 and 24 years, with a median age of 22 (20-24), and 151 (63.5%) were females. On review, 178 (74.8%) has initiated antiretroviral therapy regimen (ART); 117 (65.7%) were actively on ART for ≤ 6 months, while 114 (64%) had interruptions with their ART treatment. The overall prevalence of AHD was 41.6% (99/238); 46.7% (35/68) of young PLHIV at the HIV clinic, and 39.3% (64/163) of admission. Sex-Female (OR, 0.51; 95% CI, 0.28-0.94; p = 0.030), and Tertiary Education level (OR, 0.27; 95% CI, 0.10 - 0.78; p = 0.015) have significantly lower odds of AHD in the entire study population. While for inpatients, Age (young Adults) of PLHIV (OR, 1.23; 95% CI, 1.00-1.52; p = 0.047) had 1.23 times the odds of AHD compared to adolescents, and being female (OR, 0.27; 95% CI, 0.08-0.84; p = 0.024), Overweight-Body mass index (OR, 0.10; 95% CI, 0.01-0.77; p = 0.028), Tertiary Education level (OR, 0.08; 95% CI, 0.01-0.52; p = 0.008) have significantly lower odds of AHD. Common conditions reported for the AHD group in the medical wards are tuberculosis (13.58%), hepatitis B (6.13%), Kaposi sarcoma (3.07%), and oesophagal candidiasis (2.45%). CONCLUSION: We reported a high prevalence of advanced HIV among young patients in a tertiary Hospital in Sierra Leone. One in two young PLHIV aged 15 to 24 years reported AHD, emphasizing the need to strengthen public health measures that address access to and retention of HIV services.

Evaluation of the routine implementation of pulse oximeters into integrated management of childhood illness (IMCI) guidelines at primary health care level in West Africa: the AIRE mixed-methods research protocol.

BACKGROUND: The AIRE operational project will evaluate the implementation of the routine Pulse Oximeter (PO) use in the integrated management of childhood illness (IMCI) strategy for children under-5 in primary health care centers (PHC) in West Africa. The introduction of PO should promote the accurate identification of hypoxemia (pulse blood oxygen saturation Sp02 < 90%) among all severe IMCI cases (respiratory and non-respiratory) to prompt their effective case management (oxygen, antibiotics and other required treatments) at hospital. We seek to understand how the routine use of PO integrated in IMCI outpatients works (or not), for whom, in what contexts and with what outcomes. METHODS: The AIRE project is being implemented from 03/2020 to 12/2022 in 202 PHCs in four West African countries (Burkina Faso, Guinea, Mali, Niger) including 16 research PHCs (four per country). The research protocol will assess three complementary components using mixed quantitative and qualitative methods: a) context based on repeated cross-sectional surveys: baseline and aggregated monthly data from all PHCs on infrastructure, staffing, accessibility, equipment, PO use, severe cases and care; b) the process across PHCs by assessing acceptability, fidelity, implementation challenges and realistic evaluation, and c) individual outcomes in the research PHCs: all children under-5 attending IMCI clinics, eligible for PO use will be included with parental consent in a cross-sectional study. Among them, severe IMCI cases will be followed in a prospective cohort to assess their health status at 14 days. We will analyze pathways, patterns of care, and costs of care. DISCUSSION: This research will identify challenges to the systematic implementation of PO in IMCI consultations, such as health workers practices, frequent turnover, quality of care, etc. Further research will be needed to fully address key questions such as the best time to introduce PO into the IMCI process, the best SpO2 threshold for deciding on hospital referral, and assessing the cost-effectiveness of PO use. The AIRE research will provide health policy makers in West Africa with sufficient evidence on the context, process and outcomes of using PO integrated into IMCI to promote scale-up in all PHCs. TRIAL REGISTRATION: Trial registration number: PACTR202206525204526 retrospectively registered on 06/15/2022.

Prevalence and factors associated with advanced HIV disease among young people aged 15 - 24 years in a national referral hospital in Sierra Leone: A cross-sectional study.

Background: Advanced HIV in young people living with HIV is an increasingly pressing public health issue in sub-Saharan Africa. Despite global progress in early HIV testing and reducing HIV-related deaths, many young people with HIV continue to experience HIV disease progression in sub-Saharan Africa. This study provides an overview of the prevalence, clinical manifestations, and factors associated with advanced HIV in young people seeking medical services in a major hospital in Sierra Leone. Methods: We used a cross-sectional design to collect data from HIV patients aged 15 to 24 years at a major hospital in Sierra Leone between September 2022 and March 2023. Advanced HIV was defined as (i) CD4+ below 200 cells/mm3 or (ii) WHO clinical stage 3 or 4. Logistic regression models determined the association between observable independent characteristics and advanced HIV. The statistical significance level was set at 0.05 for all statistical tests. Results: About 40% (231/574) of patients were recruited; 70.6% (163/231) were inpatients, and 29.4% (68/231) were outpatients. The mean age was approximately 21.6 years (SD ±2.43). The overall prevalence of advanced HIV was 42.9% (99/231), 51.5% (35/68) of outpatients, and 39.3% (64/163) of inpatients. Age of inpatients (OR, 1.23; 95% CI, 1.00-1.52; p= 0.047) was associated with a higher risk. Female sex (OR, 0.51; 95% CI, 0.28-0.94; p= 0.030), higher education (OR, 0.27; 95% CI, 0.10 - 0.78; p= 0.015), and Body Mass (OR, 0.10; 95% CI, 0.01-0.77; p= 0.028) were at lower risk of advance HIV. Common conditions diagnosed in this population are tuberculosis (13.58%), hepatitis B (6.13%), Kaposi sarcoma (3.07%), and esophageal candidiasis (2.45%). Conclusion: We reported a high prevalence of advanced HIV among young patients in a referral Hospital in Sierra Leone. This emphasises the need to strengthen public health measures and policies that address challenges of access to HIV services.

SARS-CoV-2 Infection in Ivory Coast: A Serosurveillance Survey among Gold Mine Workers.

Of the 107 million COVID-19 cases worldwide, less than 2 million have been reported in African countries. The aim of this study was to evaluate the seroprevalence of SARS-CoV-2 infection in Ivory Coast mine workers. From July 15 to October 13, 2020, a voluntary serological test campaign was conducted in 3 sites: two gold mines, and the headquarters in Abidjan. Rapid tests to detect IgG and IgM on capillary blood were performed. To identify independent sociodemographic characteristics associated with a higher SARS-CoV-2 seroprevalence rate, a multivariate logistic regression analysis was performed. A total of 1,687 subjects were tested; 91% were male (n = 1,536), and the mean age was 37 years. The overall seroprevalence was 25.1% (n = 422), ranging between 13.6% (11.2-16.1%), 34.4% (31.1-37.7%), and 34.7% (26.2-43.2%) in mine A, in mine B, and in Abidjan, respectively. Among the 422 seropositive subjects, 74 reported mild symptoms in the three previous months and one was hospitalized for severe COVID-19 infection. SARS-CoV-2 seroprevalence is high in both gold miners and administrative staff working in Ivory Coast. The burden of infection in West Africa has probably been underestimated till now.

Post-exposure prophylaxis after non-occupational HIV exposure: impact of recommendations on physicians' experiences and attitudes.

OBJECTIVE(S): To evaluate the impact of official recommendations for non-occupational HIV post-exposure prophylaxis (PEP), issued in France in 1998, on physicians' prescriptions and attitudes and the occurrence of severe PEP side-effects. DESIGN: Two surveys were carried out among hospital physicians involved in HIV care, before (1997) and after (1999) the publication of recommendations. METHODS: Questionnaires explored, for the last 12 months, description of PEP requests and prescriptions, detailed description of the latest treated exposure, prescription attitudes towards five exposure scenarios and types of severe side-effects of antiretroviral drugs (in 1999 only). RESULTS: Nationally, from 1997 to 1999, PEP requests and prescriptions increased sevenfold and ninefold, respectively. Most requests followed sexual exposure (71% in 1997 and 86% in 1999; P = 10(-6)). The proportion of prescriptions for exposure to a known HIV-infected person decreased from 78% in 1997 to 41% in 1999 (P = 10(-6)). Three-drug combination therapies increased from 46% in 1997 to 83% in 1999 (P = 10(-6)). In 1999, 13 (0.9%; 95% confidence interval, 0.5-1.5%) severe reversible adverse events occurred among patients on a three-drug regimen. Prescription attitudes based mainly on risk assessment in 1997 (64% versus 33% in 1999) were based mainly on the request of the patient in 1999 (41% versus 11% in 1997). CONCLUSION: Recommendations were followed by an increase of PEP, particularly after less risky exposures, and a substantial risk of severe side-effects. PEP should be restricted to well-documented exposures for which the risk of transmission outweighs the risk of severe side-effects. Drug regimens should be revised.

Trends in post-infection CD4 cell counts and plasma HIV-1 RNA levels in HIV-1-infected patients in France between 1997 and 2005.

OBJECTIVE: We studied trends in initial post infection CD4 cell counts and viral load values in patients diagnosed at estimated time of primary infection between 1997 and 2005 in France. POPULATION AND METHODS: We selected from the French Hospital Database on HIV infection white patients with documented dates of sexually transmitted HIV-1 infection who had a first CD4 cell count (n = 1441) or viral load assay (n = 1402) within 12 months after infection and before any antiretroviral therapy. Chronological trends in initial CD4 cell counts and viral load values were studied by using linear regression analysis. RESULTS: The initial CD4 cell count declined by an average of 5.76 cells per cubic millimeter per year [95% confidence interval (CI): -11.28 to -0.24 cells/mm3 per year] and compared with 1997 initial viral load increased significantly by a mean of 0.376 log10 copies per milliliter (95% CI: 0.044 to 0.707 log10 copies/mL) in 1999, 0.548 log10 copies per milliliter (95% CI: 0.288 to 0.808 log10 copies/mL) in 2000-2002, and 0.525 log10 copies per milliliter (95% CI: 0.267 to 0.7783 log10 copies/mL) in 2003-2005. CONCLUSION: We think that lower CD4 cell counts and higher viral loads at a given time post infection suggest a more rapid progression of the disease and therefore an increased HIV pathogenicity.