BACKGROUND: Historically, men in sub-Saharan Africa have worse outcomes along the HIV care continuum than women. Brothers for Life (BFL) is a community-based behavior change intervention for men, adapted for Côte d'Ivoire, involving group discussions that address salient gender norms and promote HIV prevention, testing, and linkage to care with support from peer navigators. The goal of this study was to describe the BFL program as implemented in Côte d'Ivoire, evaluate program implementation, and report uptake of HIV testing and treatment among BFL participants. SETTING: Three urban and periurban sites in Côte d'Ivoire. METHODS: The implementation evaluation assessed the fidelity and acceptability of the BFL program and the reach of program completion, testing and peer navigation using qualitative and quantitative approaches. RESULTS: BFL facilitation fidelity and content fidelity were high. Semistructured interviews with BFL participants indicated that men appreciated the format and content and that the BFL program helped some participants overcome their fears and adopt more positive attitudes and behaviors around testing and treatment. Assessments of reach showed that, of the 7187 BFL participants, 81% tested for HIV as part of BFL and 2.3% (135) tested HIV-positive. Of those, 76% (102) accepted peer navigator support, and 97% (131) initiated treatment. After 6 months, 100% of the 131 men who initiated treatment remained in care. CONCLUSION: The implementation of BFL in Côte d'Ivoire successfully achieved the goals of engaging participants in discussions around HIV prevention, encouraging HIV testing, and achieving linkage to care, treatment initiation, and retention.
HIV Infections/diagnosis , HIV Infections/epidemiology , HIV Testing , HIV-1 , Adult , Anti-HIV Agents/therapeutic use , Cote d'Ivoire/epidemiology , Counseling , HIV Infections/drug therapy , Humans , Male , National Health Programs
This qualitative research study explored the role of masculinity in men's engagement in the HIV care continuum in Côte d'Ivoire. The researchers conducted 73 in-depth interviews and 28 focus group discussions with 227 Ivoirian men between November and December 2016 across three urban sites. Participants in the study expressed that fear was the primary barrier to HIV testing and treatment. These men described five value domains-health, sexuality, work and financial success, family, and social status. Men saw HIV as a direct threat to their agency and strength with respect to each of these value domains, thus shedding light on their reluctance to discover their HIV status through HIV testing. With this data, the researchers created the Masculine Values Framework, a descriptive framework of masculine values that can be applied to better understand the behavior men exhibit in Côte d'Ivoire in the face of HIV. The Masculine Values Framework offers practical guidance for developing gender-sensitive HIV-focused social and behavior change programming in Côte d'Ivoire and similar contexts to reach the UNAIDS 90-90-90 targets.
Attention , Fear , HIV Infections/epidemiology , HIV Infections/psychology , Adult , Cote d'Ivoire/epidemiology , Female , Humans , Male , Mental Health , Middle Aged , Public Health Surveillance , Sex Factors
Patients suffering from alcohol use disorder (AUD) are at risk for malnutrition. The mechanisms are presented in this article. Nutrition disorders in the patient with AUD can include malnutrition, micronutrient deficiencies, overweight and obesity. They may contribute to tissue damage and to oncological and cognitive disorders encountered among patients with AUD. Refeeding syndrome can appear during the withdrawal period. A nutrition evaluation should be included in the evaluation of all patients with AUD.
Les patients avec troubles de l'utilisation de l'alcool (TUA) sont à risque de malnutrition. Les mécanismes de celle-ci sont présentés dans cet article. La malnutrition chez le patient avec TUA peut comprendre une dénutrition protéino-calorique, des carences en micronutriments, une surcharge pondérale et l'obésité. La malnutrition peut participer aux lésions tissulaires et aux pathologies oncologiques et cognitives retrouvées chez les patients avec TUA. Le syndrome de renutrition inappropriée peut apparaître durant la période de sevrage. Une évaluation nutritionnelle devrait être incluse dans la prise en charge du patient avec TUA.
Alcohol-Related Disorders , Alcoholism , Nutrition Disorders , Refeeding Syndrome , Alcoholism/complications , Humans , Nutrition Disorders/complications , Obesity
Men in sub-Saharan Africa have lower rates of HIV testing and are less likely to initiate treatment compared to women. Service delivery dimensions are a key factor in facilitating engagement along the HIV treatment continuum for men and women, yet male specific overall perceptions of the service delivery environment have received little attention in West Africa. This study draws on qualitative data collected in Côte d'Ivoire to explore provider-level and structural factors affecting men's engagement in HIV testing and treatment through interviews and focus group discussions conducted with health workers and men living with HIV (some on ART) or whose HIV status was unknown. Factors influencing decisions to test or initiate treatment were considered in terms of perceived benefits and costs. Men described costs at the interpersonal (client-provider) level, such as unwanted disclosure or stigma, which were weighed against the potential for social support and clinical guidance. Likewise, fear of unwanted disclosure operated at the facility level, as the layout of facilities sometimes grouped clients living with HIV together. Notably, the benefits men described from engaging in HIV testing and care all operated at the interpersonal level and none at the facility level. In light of the fact that provider- and facility-level factors influenced the perceptions and experiences of men along the treatment continuum, we offer recommendations to reduce barriers to testing and engagement in care related to service delivery.
Attitude to Health , HIV Infections/epidemiology , Patient Acceptance of Health Care/psychology , Adult , Africa South of the Sahara , Cote d'Ivoire/epidemiology , Focus Groups , HIV Infections/diagnosis , HIV Infections/drug therapy , Humans , Male , Mass Screening , Men/psychology , Middle Aged , Perception , Social Stigma
Malnutrition is a common but underestimated condition in the hospital setting. Malnutrition increases in-hospital mortality and complications, and treatment costs. Simple screening tools such as the mini-nutritional assessment and the nutritional risk score allow identifying patients at risk of malnutrition and starting management. Malnutrition management is a multidisciplinary issue including dieticians, physiatrists, nurses, caregivers and doctors. Meal fractioning and oral nutritional supplements (ONS) should be provided. Frequently, micronutrient supplements are also needed. Particular care should be taken to ensure that the patient consumes the meals and ONS prescribed. Follow-up is based on weight and assessment of prealbumin. Malnutrition status should be systematically reported in the discharge letter.
La dénutrition est fréquente à l'hôpital mais sous-estimée. Elle augmente la mortalité, les complications intrahospitalières, ainsi que les coûts du traitement. Des outils de dépistage tels que le mini-nutritional assessment et le nutritional risk score permettent d'identifier les patients à risque de dénutrition. La prise en charge implique une équipe interprofessionnelle (diététiciennes, physiothérapeutes, infirmières, aides-soignantes et médecins) et se base sur le fractionnement des repas, associé à des suppléments nutritionnels oraux (SNO) adaptés et à des suppléments en micronutriments. Une attention particulière portera sur la consommation effective des repas et des SNO. Le suivi nutritionnel sera complété par la mesure du poids et le dosage de la préalbumine. La documentation dans la lettre de sortie devrait être systématique.
Malnutrition , Nutrition Assessment , Humans , Internal Medicine , Malnutrition/diagnosis , Malnutrition/therapy , Nutritional Status , Patient Discharge
