Acceptability and feasibility of home and hospital follow-up in Burkina Faso and Guinea: A mixed-method study among patients of the COVID-19 Coverage-Africa clinical trial.

Patient experiences and perspectives on trial participation and follow-up may influence their compliance with research procedures or negatively impact their well-being. We aimed to explore the acceptability and feasibility of home-based and hospital-based follow-up modalities among COVID-19 patients enrolled in the ANTICOV ANRS COV33 Coverage-Africa trial in Burkina Faso and Guinea. The trial (2021-2022) evaluated the efficacy of treatments to prevent clinical worsening among COVID-19 patients with mild to moderate symptoms. Patients were either based at home or hospitalized, as per national recommendations, and followed-up through face-to-face visits and phone calls. We conducted a mixed-methods sub-study administering a questionnaire to all consenting participants and individually interviewing purposively selected participants. We performed descriptive analyses of Likert scale questions for the questionnaires and thematic analysis for the interviews. We conducted framework analysis and interpretation. Of the 400 trial patients, 220 completed the questionnaire (n = 182 in Burkina Faso, n = 38 in Guinea) and 24 were interviewed (n = 16 and n = 8, respectively). Participants were mostly followed-up at home in Burkina Faso; all patients from Guinea were first hospitalized, then followed-up at home. Over 90% of participants were satisfied with follow-up. Home follow-up was considered acceptable if (i) participants perceived they were not severely ill, (ii) it was combined with telemedicine, and (iii) the risk of stigma could be avoided. Hospital-based follow-up was viewed as a way to prevent contamination of family members, but could be badly experienced when mandatory and conflicting with family responsibilities and commitments. Phone calls were seen as reassuring and as a way to ensure continuity of care. These overall positive findings support the development of home-based follow-up for mildly ill patients in West-Africa, provided that both emotional and cognitive factors at individual, familial/inter-relational, healthcare and national levels be addressed when planning the implementation of a trial, or developing any public health strategy.

Facteurs structurels et communautaires augmentant la vulnérabilité des hommes ayant des relations sexuelles avec des hommes dans la riposte au virus de l'immunodéficience humaine au Burkina Faso.

INTRODUCTION: Worldwide and particularly in Africa, Men who have sex with men (MSM) can play a significant role in response to the Human Immunodeficiency Virus (HIV). In Burkina Faso the fight against HIV within this population seems to be limited by violence towards MSM. PURPOSE OF RESEARCH: The goal of this study was to identify the social obstacles to HIV response among MSM in Burkina Faso. METHODS: It has been a descriptive study with an exploratory aim in a mainly qualitative approach. It was conducted in the two biggest cities as well as two border ones of the country. Nonstructural interviews have been conducted with the help of prevention MSM actors. The data have been thematically analyzed. RESULTS: In the structural level, homosexuality is publically condemned by politicians some of whom seeking its criminalization. According to them it has "come from elsewhere" and is "contrary to morals". Even though there is no legally punishing regulation against it, political and administrative authorities and security forces do not protect MSM against homophobic violence. There is not enough care structures for MSM in the country. At the community level, many religious leaders condemn homosexuality, considered as a sin; they view homosexuality as an "abomination". MSM feel that they are victims of homophobic violence. CONCLUSIONS: The MSM are victims of violence from populations and state institutions too. To reach MSM by activities in response to HIV these obstacles must necessarily be removed.

Representations of HIV/AIDS and HIV status disclosure among serodifferent couples in Burkina Faso / Représentations du VIH/Sida et partage de l'information sur la sérologie dans les couples sérodifférents au Burkina Faso

BACKGROUND: In Burkina Faso, the prevalence of HIV in serodifferent couples is comparable to that of some key populations. Our aim was to show the influence of HIV representation on the disclosure of HIV information in serodifferent couples. METHODS: A cross-sectional qualitative study was carried out from January to September 2019 in the city of Bobo-Dioulasso in Burkina Faso. In-depth individual interviews and focus groups were conducted with each partner of the couple using interview guides. The data was subject to thematic content analysis. RESULTS: The results show that more than three-quarters of the respondents did not share their HIV status. Those who had a negative attitude towards PLWHIV were less keen to share the information, considering that that HIV would transform the infected person negatively in the eyes of others. Also, sharing information was seen as a risk to the couple’s peace and stability. Others found the suffering of HIV so personal that it was difficult to share with others. CONCLUSION: People living with HIV, who see AIDS as a bad disease, fear the social effects of HIV and are therefore less favorable to disclose their HIV status. On the other hand, those who equated HIV with an illness like any other were keen to share information about their status.

Introduction: Au Burkina Faso, la prévalence du VIH dans les couples sérodifférents est comparable à celle des travailleuses de sexe et des hommes ayant des rapports sexuels avec d'autres hommes considérés comme des populations clés dans la lutte contre le VIH. Notre objectif était de montrer l'influence des représentations du VIH sur le partage de l'information sur la sérologie dans les couples sérodifférents. Méthodes: Nous avons réalisé une étude qualitative transversale de janvier à septembre 2019 dans la ville de Bobo-Dioulasso au Burkina Faso. Des entretiens individuels approfondis et des focus groups ont été menés auprès de chaque partenaire du couple au moyen de guides d'entretien. Les données ont fait l'objet d'une analyse de contenu thématique. Résultats: Les résultats révèlent que plus de trois quarts des enquêtés n'avaient pas partagé leur statut sérologique. Ceux qui avaient une attitude négative envers le VIH partageaient moins l'information. Ces enquêtés pensaient que le VIH transformait négativement la personne infectée aux yeux des autres ; aussi, le partage de l'information était considéré comme un risque pour la paix et la stabilité du couple. D'autres considéraient que la souffrance liée au VIH est si personnelle qu'il était difficile de la partager avec les autres. Conclusion: Les personnes Vivant avec le VIH (PVVIH) qui considèrent le sida comme une mauvaise maladie redoutent les effets sociaux du VIH donc sont moins favorables au partage de l'information sur la sérologie. Par contre, celles qui assimilent le VIH à une maladie comme les autres, étaient enclines à partager l'information sur leur sérologie.

Immunovirological discordance among female sex workers who start antiretroviral therapy in Burkina Faso.

BACKGROUND: In people living with HIV/AIDS (PLWHA), initiation of antiretroviral therapy (ART) leads to sustained effective suppression of viral replication and increasing CD4 + T cell count. However, a fraction of ART-treated patients still fail to reach adequate CD4 + T cell number despite a suppressed viral load (VL), and this phenomenon is defined as immunovirological discordance (IVD). In Africa, several studies have reported immunovirological outcomes of antiretroviral therapy, but little is known about IVD occurrence in Female sex workers (FSW). This study aimed to assess the prevalence of IVD and associated factors among a cohort of HIV infected FSW in Burkina Faso. METHODS: We conducted a cohort study from December 2003 to October 2016. Immunovirological discordance was defined as CD4 + T cell gain < 100 cells/µL despite a suppressed VL (VL < 1000 copies/mL) 12 months after ART initiation. The CD4 + T cells were counted using BD FACSCount™ System and point of care Pima™ CD4 + Analyzer. HIV-1 RNA was quantified by real-time polymerase-chain-reaction assay with the use of the ABI 7000 system. We conducted a logistic regression to identify factors associated with discordant responses. RESULTS: Among the 123 HIV-1 infected FSW having at least 12 months follow-up on ART, 105 (85.4%) achieved HIV-1 RNA suppression. Among the latter 25 gained less than 100 CD4 + T cells within 12 months follow-up. The IVD rate was 23.8% (95%CI 16.04%-33.11%). After adjustment for age, WHO clinical stage and ART regimen including nucleoside/nucleotide reverse transcriptase inhibitors, only baseline CD4 + T cell count between 200 to 350 cells/µL (adjusted OR: 4.15; 95%CI 1.13-15.22) and 350 to 500 cells/µL (adjusted OR: 17.50; 95%CI 2.68-114.31) remain significantly associated with IVD occurrence. CONCLUSIONS: Immunovirological discordance response was common in FSW with proportions close to those observed in the general population. A diagnosis and personalized follow-up of patients who do not achieve full immune reconstitution would make it possible to avoid complications in terms of morbidity and mortality.

HIV risk and behaviour among part-time versus professional FSW: baseline report of an interventional cohort in Burkina Faso.

OBJECTIVE: To readjust HIV control programmes in Africa, we assessed the factors associated with high-risk behaviours and HIV infection among young female sex workers (FSW) in Burkina Faso. METHODS: We carried out a cross-sectional study from September 2009 to September 2010 in Ouagadougou, the capital city. FSW were categorised as professionals and part-time sex workers (PTSW). After a face-to-face questionnaire, blood and urine samples were collected for HIV, HSV-2, genital infections and pregnancy. High-risk behaviour was defined as a recent unprotected sex with either casual clients, regular clients or regular partners. RESULTS: We recruited 609 FSW including 188 (30.9%) professionals. Their median age was 21 years (IQR 19-23), and the prevalence of HIV was 10.3% among professionals and 6.5% among PTSW. Only 3 of 46 HIV-infected women were aware of their status. Overall, 277 (45.6%) women reported high-risk behaviours (41.2% among professionals and 47.5% among PTSW), which were driven mainly by non-systematic condom use with regular partners. In multivariable analysis, PTSW (adjusted OR (AOR)=1.89; 95% CI 1.27 to 2.82) and having a primary (AOR=1.75; 95% CI 1.15 to 2.67) or higher education level (AOR=1.80; 95% CI 1.13 to 2.89) remained associated with high-risk behaviours. HIV infection was associated with older age (AOR=1.44; 95% CI 1.22 to 1.71), with being married/cohabiting (AOR=2.70; 95% CI 1.21 to 6.04) and with Trichomonas vaginalis infection (AOR=9.63; 95% CI 2.93 to 31.59), while history of HIV testing was associated with a decreased risk (AOR=0.18; 95% CI 0.08 to 0.40). CONCLUSIONS: This study highlights the need for targeted interventions among young FSW focusing particularly on PTSW, sexual behaviours with regular partners and regular HIV testing.

HIV prevention and care services for female sex workers: efficacy of a targeted community-based intervention in Burkina Faso.

INTRODUCTION: Although interventions to control HIV among high-risk groups such as female sex workers (FSW) are highly recommended in Africa, the contents and efficacy of these interventions are unclear. We therefore designed a comprehensive dedicated intervention targeting young FSW and assessed its impact on HIV incidence in Burkina Faso. METHODS: Between September 2009 and September 2011 we conducted a prospective, interventional cohort study of FSW aged 18 to 25 years in Ouagadougou, with quarterly follow-up for a maximum of 21 months. The intervention combined prevention and care within the same setting, consisting of peer-led education sessions, psychological support, sexually transmitted infections and HIV care, general routine health care and reproductive health services. At each visit, behavioural characteristics were collected and HIV, HSV-2 and pregnancy were tested. We compared the cohort HIV incidence with a modelled expected incidence in the study population in the absence of intervention, using data collected at the same time from FSW clients. RESULTS: The 321 HIV-uninfected FSW enrolled in the cohort completed 409 person-years of follow-up. No participant seroconverted for HIV during the study (0/409 person-years), whereas the expected modelled number of HIV infections were 5.05/409 person-years (95% CI, 5.01-5.08) or 1.23 infections per 100 person-years (p=0.005). This null incidence was related to a reduction in the number of regular partners and regular clients, and by an increase in consistent condom use with casual clients (adjusted odds ratio (aOR)=2.19; 95% CI, 1.16-4.14, p=0.01) and with regular clients (aOR=2.18; 95% CI, 1.26-3.76, p=0.005). CONCLUSIONS: Combining peer-based prevention and care within the same setting markedly reduced the HIV incidence among young FSW in Burkina Faso, through reduced risky behaviours.

[Governance of HIV/AIDS organizations in Bobo-Dioulasso (Burkina Faso)]. / La gouvernance au sein des organisations de lutte contre le VIH à Bobo-Dioulasso (Burkina Faso).

INTRODUCTION: Although HIV/AIDS organizations continue to play a major role in the fight against pandemic HIV infections, they are still faced with enormous governance challenges that impair their operations / interventions and their sustainability. The objective of this study was to develop an inventory of the quality of governance within HIV/AIDS organizations in Bobo-Dioulasso. METHODS: This qualitative research was conducted in 40 organizations from Bobo-Dioulasso. Qualitative data were collected over a 45-day period using an interview guide. Thematic analysis of the data was performed and the results were reported. RESULTS: Although all 40 organizations had established good governance mechanisms, only fifteen complied with the major rules of democratic functioning and the roles of the various bodies. The majority of these organizations (29/40) ignored many democratic rules. The number of members required for the Executive Board was not met in 29/40 organizations resulting in monopolization of decision-making by a handful of people. Technical and financial reports were not published, resulting in limited access to information on the organization's activities. Gender equality also constituted a weakness. DISCUSSION: Application of good governance principles was limited in these organizations. Organization members, leaders and technical and financial partners must reinforce good governance efforts in order to improve good governance in these organizations.

Long-term virological, immunological and mortality outcomes in a cohort of HIV-infected female sex workers treated with highly active antiretroviral therapy in Africa.

BACKGROUND: Concerns have been raised that marginalised populations may not achieve adequate compliance to antiretroviral therapy. Our objective was to describe the long-term virological, immunological and mortality outcomes of providing highly active antiretroviral therapy (HAART) with strong adherence support to HIV-infected female sex workers (FSWs) in Burkina Faso and contrast outcomes with those obtained in a cohort of regular HIV-infected women. METHODS: Prospective study of FSWs and non-FSWs initiated on HAART between August 2004 and October 2007. Patients were followed monthly for drug adherence (interview and pill count), and at 6-monthly intervals for monitoring CD4 counts and HIV-1 plasma viral loads (PVLs) and clinical events. RESULTS: 95 women, including 47 FSWs, were followed for a median of 32 months (interquartile range [IQR], 20-41). At HAART initiation, the median CD4 count was 147 cells/µl (IQR, 79-183) and 144 cells/µl (100-197), and the mean PVLs were 4.94 log10 copies/ml (95% confidence interval [CI], 4.70-5.18) and 5.15 log10 copies/ml (4.97-5.33), in FSWs and non-FSWs, respectively. Four FSWs died during follow-up (mortality rate: 1.7 per 100 person-years) and none among other women. At 36 months, the median CD4 count increase was 230 cells/µl (IQR, 90-400) in FSWs vs. 284 cells/µl (193-420) in non-FSWs; PVL was undetectable in 81.8% (95% CI, 59.7-94.8) of FSWs vs. 100% (83.9-100) of non-FSWs; and high adherence to HAART (> 95% pills taken) was reported by 83.3% (95% CI, 67.2-93.6), 92.1% (95% CI, 78.6-98.3), and 100% (95% CI, 54.1-100) of FSWs at 6, 12, and 36 months after HAART initiation, respectively, with no statistical difference compared to the pattern observed among non-FSWs. CONCLUSIONS: Clinical and biological benefits of HAART can be maintained over the long-term among FSWs in Africa and could also lead to important public health benefits.

Linking HIV prevention and care for community interventions among high-risk women in Burkina Faso--the ARNS 1222 "Yerelon" cohort.

BACKGROUND: Interventions targeting core groups such as high-risk women in Africa have focused mostly on HIV prevention. In this marginalized group, the delegation of HIV care to public services may jeopardize the effectiveness of prevention activities. We assessed the effect of an intervention combining prevention and care among high-risk women on HIV exposure and treatment outcomes. METHODS: In Burkina Faso, high-risk women were recruited by peer educators in an open-cohort study with 4-monthly follow-up visits. Primary prevention included peer-led information, education and communication sessions, condom distribution, regular HIV counselling and testing, and sexually transmitted infections management. Participants were offered free medical care including antiretroviral therapy (ART) and treatment adherence support by psychologists. RESULTS: From December 2003, 658 high-risk women were enrolled and followed up for a median 20.8 months. Seven of the 489 HIV-uninfected women seroconverted (HIV incidence 0.9 of 100 person-years, 95% confidence interval: 0.24 to 1.58). HIV incidence tended to be higher during the first 8 months of follow-up than thereafter (1.43 vs. 0.39 per 100 person-years). Among 47 of 169 HIV-seropositive women who started ART, 79.4% achieved undetectable plasma viral load 6 months after initiation and 81.8% at 36 months. Condom use at last sexual intercourse with clients increased from 81.7% at enrollment to 98.2% at 12 months (P < 0.001) and from 67.2% to 95.9% (P < 0.001) with regular clients. CONCLUSIONS: The integration of HIV care services, including the provision and support of ART, with a peer-led primary prevention package is pivotal to reduce HIV incidence and is likely to modify the local HIV dynamics.

[Understanding and reaching young clandestine sex workers in Burkina Faso to improve response to HIV]. / Comprendre et atteindre les jeunes travailleuses du sexe clandestines du Burkina Faso pour une meilleure riposte au VIH.

In 1998, researchers in Burkina Faso enrolled 300 women more or less involved in commercial sex work in an open cohort to determine whether adequate management of their sexually transmitted infections and exposure to well-designed, well-delivered, and plentiful communication for behaviour change (CBC) might reduce their vulnerability to HIV. In 2000, they observed that the non-professional sex workers (occasional or clandestine sex workers) were more difficult to reach, to mobilize and to keep involved in the project's different activities. This group was also infected at the same or higher rates than professional sex workers because they did not use condoms routinely. To accomplish the project objectives, they therefore chose to recruit more non-professional sex workers in the new cohort of 700 women. This social-anthropological study was conducted to help them to enrol young clandestine sex workers. The overall objective of this study was to understand the life of this category of sex workers and to identify strategic actors to reach them. Using a qualitative method, social anthropologists reviewed literature, identified and geo-referenced all local places suitable to encountering these women, obtained life stories from some of them and interviewed key informants and participants in the field. The results showed that in Bobo-Dioulasso (Burkina Faso): - most young women who are clandestine sex workers are Burkinabe, and girls entering the sex trade are increasingly young and increasingly uneducated; - most of them come from families with low capital (financial, cultural, or social). The parents' socioeconomic status (contextual poverty) results in unmet financial needs, which in turn exposes them to starting work early, including commercial sex work; - of all the income-generating activities available to unskilled young girls, commercial sex work is one of the most profitable and easily accessible; - in the three-fold context of an HIV epidemic, poverty, and unemployment, clandestine commercial sex work is a rational action, insofar as condom use reduces the risk of HIV infection, "clandestinity" reduces the risk of social stigma, and earnings increase financial capital; - girls are coopted into sex work through an initiation process and the initiator explains to the initiate how sex workers think, act, and live, as well as the rules of the trade; - young clandestine commercial sex workers use various strategies to do their work in secret, unidentified, by changing the time, place, period, district, city or country of their work; - young clandestine commercial sex workers maintain friendly relations with men or boys in but have no or conflictual relationships with women and girls. Thus, only other participants in this trade, peer counsellors, and room renters can serve as strategic actors to reach, mobilize and keep these young girls in HIV programmes. Social anthropologists have concluded that one problem in the fight against official or professional commercial sex work is the development of clandestine commercial sex work, which is more dangerous, firstly for its practitioners, who are harder to reach by messages about HIV and thus do not change their behaviour, secondly, for their sexual partners who do not use condoms systematically, and finally for society as a whole, to the extent that social actors are embedded in an informal network, more or less extensive, of sexual partners.

Reduction of HIV-1 RNA levels with therapy to suppress herpes simplex virus.

BACKGROUND: Epidemiologic data suggest that infection with herpes simplex virus type 2 (HSV-2) is associated with increased genital shedding of human immunodeficiency virus type 1 (HIV-1) RNA and HIV-1 transmissibility. METHODS: We conducted a randomized, double-blind, placebo-controlled trial of HSV suppressive therapy with valacyclovir (at a dose of 500 mg twice daily) in Burkina Faso among women who were seropositive for HIV-1 and HSV-2; all were ineligible for highly active antiretroviral therapy. The patients were followed for 24 weeks (12 weeks before and 12 weeks after randomization). Regression models were used to assess the effect of valacyclovir on the presence and quantity of genital and plasma HIV-1 RNA and genital HSV-2 DNA during treatment, adjusting for baseline values, and to evaluate the effect over time. RESULTS: A total of 140 women were randomly assigned to treatment groups; 136 were included in the analyses. At enrollment, the median CD4 cell count was 446 cells per cubic millimeter, and the mean plasma viral load was 4.44 log10 copies per milliliter. With the use of summary-measures analysis, valacyclovir therapy was found to be associated with a significant decrease in the frequency of genital HIV-1 RNA (odds ratio, 0.41; 95% confidence interval [CI], 0.21 to 0.80) and in the mean quantity of the virus (log(10) copies per milliliter, -0.29; 95% CI, -0.44 to -0.15). However, there was no significant decrease in detection of HIV (risk ratio, 0.93; 95% CI, 0.81 to 1.07). HSV suppressive therapy also reduced the mean plasma HIV-1 RNA level by 0.53 log(10) copy per milliliter (95% CI, -0.72 to -0.35). Repeated-measures analysis showed that these effects became significantly stronger during the 3 months of follow-up. CONCLUSIONS: HSV suppressive therapy significantly reduces genital and plasma HIV-1 RNA levels in dually infected women. This finding may have important implications for HIV control. (ClinicalTrials.gov number, NCT00158509 [ClinicalTrials.gov].).

Impact of suppressive herpes therapy on genital HIV-1 RNA among women taking antiretroviral therapy: a randomized controlled trial.

OBJECTIVE: To demonstrate a causal relationship between herpes simplex virus 2 (HSV-2) and increased genital HIV-1-RNA shedding in women on HAART. DESIGN: A randomized, double-blind, placebo-controlled trial of herpes-suppressive therapy (valacyclovir 500 mg twice a day) in HIV-1/HSV-2-infected women taking HAART in Burkina Faso. METHODS: Participants were followed for a total of 12 biweekly visits before and after randomization. The presence and frequency of genital and plasma HIV-1 RNA, and of genital HSV-2 were assessed using summary measures, adjusting for baseline values. Random effect linear regression models were used to assess the impact of treatment on genital and plasma viral loads among visits with detectable virus. RESULTS: Sixty women were enrolled into the trial. Their median CD4 lymphocyte count was 228 cells/mul, and 83% had undetectable plasma HIV-1 RNA at baseline. Valacyclovir reduced the proportion of visits with detectable genital HSV-2 DNA [odds ratio (OR) 0.37, 95% confidence interval (CI) 0.13, 1.05], but had no significant impact on the frequency (OR 0.90, 95% CI 0.31, 2.62) or quantity (reduction of 0.33 log copies/ml, 95% CI -0.81, 0.16) of genital HIV-1 RNA. However, according to pre-defined secondary analyses restricted to women who shed HIV-1 at least once in the baseline phase, valacyclovir reduced both the proportion of visits with detectable HIV-1 shedding (OR 0.27, 95% CI 0.07, 0.99) and the quantity of genital HIV-1 RNA during these visits (-0.71 log10 copies/ml, 95% CI -1.27, -0.14). CONCLUSION: HSV-2 facilitates residual genital HIV-1 replication among dually infected women taking HAART despite HIV-1 suppression at the systemic level.