Additional payment despite free health care in Burkina Faso / Paiement additionnel malgré la gratuité des soins au Burkina Faso

Introduction: Free health care for children under five years of age in Burkina Faso was introduced in 2016 in order to remove the financial barrier to accessing care. Additional health expenses remain despite this free health care, which may compromise access to health services for the poorest patients. Methods: This partial medico-economic evaluation included a descriptive study of additional health expenses paid by parents. Payment receipts and parents' declarations were consulted. Results: The average monthly income of the parents was 73,026.79 FCFA ($132) with 5.08% of the parents having no income. The total direct cost was 6,043,785 FCFA ($10939). The total additional direct cost was 2,181,150 FCFA ($3,950) or 36.09% of the total direct cost. The average percentage of free care was 65.50%. 7.7% of parents were dissatisfied with the free schooling. 34.48% were unprepared for additional expenses, 43.97% of parents had difficulty paying the additional costs and of these 80% reported that they had exhausted their savings to meet the prescriptions. Conclusions: Additional health expenses remain high despite free care. This can compromise the care of the poorest patients. A reorganization of free health care is necessary.

Introduction: La gratuité des soins chez les enfants de moins de 5 ans au Burkina Faso a été introduite en 2016 afin de lever la barrière financière dans l'accès aux soins. Des dépenses de santé additionnelles subsisteraient malgré cette gratuité, ce qui peut compromettre l'accès aux services de santé des patients les plus démunis. Méthodes: Il s'agit d'une évaluation médico-économique partielle, notamment l'étude descriptive des dépenses de santé additionnelles payées par les parents. Nous avons consulté les reçus de paiement et les déclarations des parents. Résultats: Le revenu mensuel des parents était en moyenne de 73 026,79 FCFA (132 $) avec 5,08 % des parents qui n'ont pas de revenu. Le coût direct total était de 6 043 785 FCFA (10 939 $). Le coût direct total additionnel était de 2 181 150 FCFA (3 950 $), soit 36,09 % du coût direct total. Le pourcentage moyen de prise en charge de la gratuité était de 65,50 %. Près de 10 % (7,7 %) des parents étaient insatisfaits de la gratuité ; ils étaient 34,48 % à ne pas être préparés à honorer des dépenses supplémentaires, 43,97 % avaient eu du mal à payer les frais supplémentaires et parmi ces derniers, 80 % ont déclaré avoir épuisé leur économie pour honorer les prescriptions. Conclusions: Les dépenses de santé additionnelles restent élevées malgré la gratuité des soins. Cela peut compromettre la prise en charge des patients les plus pauvres. Une réorganisation de la gratuité des soins s'avère nécessaire.

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.

Prognostic Factors of the Lethality of Stroke at the Sourô Sanou University Teaching Hospital of Burkina Faso.

INTRODUCTION: Stroke is a major public health concern. It is a frequent pathology, 80% of which is of ischemic origin. Approximately 86% of all stroke deaths worldwide occur in low- and middle-income countries. The objective of this study was to investigate prognostic factors for in hospital lethality of stroke cases admitted in a public university hospital in Burkina Faso. METHODS: This was a retrospective cohort study with a descriptive and analytical aim on adults admitted for a stroke confirmed by a brain scan at the Sourô Sanou University Teaching Hospital (CHUSS) of Bobo-Dioulasso over the period from January 1, 2009, to December 31, 2013. RESULTS: The proportion of cases confirmed by the brain CT scan was 32% of all patients admitted for stroke in the CHUSS. The overall case fatality was 27.6%. This lethality was more pronounced in patients with hemorrhagic stroke (35.8%) compared to patients with ischemic stroke (22.4%). Median survival was higher in patients with ischemic stroke than those with hemorrhagic one (36 and 25 days, respectively) with a statistically significant difference (p value = 0.001). In multivariate analysis and hemorrhagic stroke (hazard ratio [HR]: 2.25; CI 95%: 1.41-3.61), an altered state of consciousness (HR: 1.90; CI 95%: 1.20-2.99) and the presence of central facial paralysis (HR: 1.67; CI 95%: 1.04-2.67) are factors that increased significantly the lethality. CONCLUSION: The study has identified three prognostic factors of lethality that are the hemorrhagic stroke type, the altered state of consciousness, and the central facial paralysis. Given the high case fatality, it is important to develop and implement effective prevention and management strategies adapted to the resources for the optimal control of stroke in Africa.

A review of 65 years of human adenovirus seroprevalence.

Introduction: Human adenovirus (HAdV)-derived vectors have been used in numerous pre-clinical and clinical trials during the last 40 years. Current research in HAdV-based vaccines focuses on improving transgene immunogenicity and safety. Because pre-existing humoral immunity against HAdV types correlate with reduced vaccine efficacy and safety, many groups are exploring the development of HAdV types vectors with lower seroprevalence. However, global seroepidemiological data are incomplete. Areas covered: The goal of this review is to centralize 65 years of research on (primarily) HAdV epidemiology. After briefly addressing adenovirus biology, we chronical HAdV seroprevalence studies and highlight major milestones. Finally, we analyze data from about 50 studies with respect to HAdVs types that are currently used in the clinic, or are in the developmental pipeline. Expert opinion: Vaccination is among the most efficient tools to prevent infectious disease. HAdV-based vaccines have undeniable potential, but optimization is needed and antivector immunity remains a challenge if the same vectors are to be administrated to different populations. Here, we identify gaps in our knowledge and the need for updated worldwide epidemiological data.

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.