Experiences and perceptions of health professionals towards the quality of care for people living with HIV in Tunisia: a qualitative study.

Introduction: human immunodeficiency virus (HIV) infection continues to be a public health issue, especially in low- and middle-income countries, including Tunisia. In 2020, 32% of people living with HIV were on treatment. Management of HIV infection remains a real challenge for both patients and care providers. Our study aimed to describe the perceptions and attitudes of health professionals toward care for people living with HIV (PLHIV). Methods: a qualitative study was carried out between 2020 and 2021. Interviews with key informants were conducted in order to identify the strengths and weaknesses of the care for PLHIV, as well as their suggestions for improvement. Eight key informants in HIV care from different profiles were interviewed: healthcare providers from a specialized university hospital, the Ministry of Health, and civil society representatives working in the field of HIV. Interviews were transcribed and analyzed thematically using "QDA Miner" software. Results: the frequency of PLHIV who have interrupted medical follow-up was perceived as worrisome, and increasing. Along with individual factors, non-adherence to treatment was also attributed to systemic factors related to stock shortages, geographical inaccessibility, and shortfall in human resources. Stigmatization of PLHIV in healthcare facilities outside the specialized hospital was also highlighted. This has been linked to gaps in the training of care providers on the modes of the virus transmission. Conclusion: health professionals face many challenges in the care of PLHIV. There is an urgent need to improve treatment availability and accessibility, strengthen social assistance for PLHIV and fight against stigmatization, especially in healthcare settings.

The Delta variant wave in Tunisia: Genetic diversity, spatio-temporal distribution and evidence of the spread of a divergent AY.122 sub-lineage.

Introduction: The Delta variant posed an increased risk to global public health and rapidly replaced the pre-existent variants worldwide. In this study, the genetic diversity and the spatio-temporal dynamics of 662 SARS-CoV2 genomes obtained during the Delta wave across Tunisia were investigated. Methods: Viral whole genome and partial S-segment sequencing was performed using Illumina and Sanger platforms, respectively and lineage assignemnt was assessed using Pangolin version 1.2.4 and scorpio version 3.4.X. Phylogenetic and phylogeographic analyses were achieved using IQ-Tree and Beast programs. Results: The age distribution of the infected cases showed a large peak between 25 to 50 years. Twelve Delta sub-lineages were detected nation-wide with AY.122 being the predominant variant representing 94.6% of sequences. AY.122 sequences were highly related and shared the amino-acid change ORF1a:A498V, the synonymous mutations 2746T>C, 3037C>T, 8986C>T, 11332A>G in ORF1a and 23683C>T in the S gene with respect to the Wuhan reference genome (NC_045512.2). Spatio-temporal analysis indicates that the larger cities of Nabeul, Tunis and Kairouan constituted epicenters for the AY.122 sub-lineage and subsequent dispersion to the rest of the country. Discussion: This study adds more knowledge about the Delta variant and sub-variants distribution worldwide by documenting genomic and epidemiological data from Tunisia, a North African region. Such results may be helpful to the understanding of future COVID-19 waves and variants.

Mental health status of adults under institutional quarantine: a cross-sectional survey in Tunisia.

INTRODUCTION: restrictive measures imposed during the COVID-19 pandemic, such as quarantine, may induce psychiatric outcomes among concerned individuals. The present study aimed to describe the mental health status of Tunisian adults under mandatory institutional quarantine imposed during the COVID-19 pandemic, and to determine factors influencing the occurrence of psychiatric symptoms. METHODS: a cross-sectional phone survey was conducted from April to November 2020 using convenience sampling of persons who had experienced mandatory institutional quarantine. A standardized questionnaire was administered to participants including questions about socio-demographic characteristics and quarantine related information. Generalized anxiety disorder, depression symptoms, and sleep quality during quarantine were assessed using, respectively, the generalized anxiety disorder-7 (GAD-7), the centre for epidemiological studies depression (CES-D-10) and the insomnia severity index (ISI) scales. Bivariate and multivariate analyses were performed to determine factors associated with anxiety and/or depression and with clinical insomnia. RESULTS: among 506 participants, 38.3% experienced anxiety and/or depression symptoms (anxiety: 15.4%; depression: 37.4%) and 19.2% had clinical insomnia. The prevalence of anxiety and/or depression symptoms and insomnia were higher among women those who spent three hours or above on COVID-19 news, those who had economic difficulties due to COVID-19 pandemic, those who were not satisfied by the accommodation conditions of quarantine facilities, and those who had experienced stigma. CONCLUSION: high prevalence of psychiatric symptoms among quarantined individuals was found in this study. Psychological interventions should thus be an integral part of the COVID-19 control strategy in order to provide adequate psychological support to persons quarantined due to COVID-19.