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1.
BMC Palliat Care ; 23(1): 141, 2024 Jun 05.
Artículo en Inglés | MEDLINE | ID: mdl-38840116

RESUMEN

CONTEXT: Palliative care (PC) in most African countries remains under-assessed. Benin has piloted the implementation of a set of indicators proposed by the WHO to measure PC development. OBJECTIVES: To examine the current status of PC in Benin. METHODS: A workshop with stakeholders was organized to assess the WHO indicators in the Beninese context. Indicators were rated based on relevance and feasibility, data sources were agreed upon, and a survey was adapted. Data were collected between March and May 2023. RESULTS: There is emerging community involvement in PC through the presence of patients' rights promoters, as well as a political commitment expressed in the National PC strategy, the inclusion of PC services in the list of basic health services, and an assigned national authority -within the Ministry of Health-responsible for PC. Although no PC-oriented research has been documented, the celebration of the National PC Conference represents the first step to ground PC delivery in evidence. The reported annual consumption of opioids is 0.18 (ME) milligrams per capita, 34% of healthcare establishments have essential medicines for pain and PC, and 16.5% of patients with palliative needs have access to oral morphine. To date, no medical or paramedical schools offer PC training, and there is no official specialization in palliative medicine for doctors. PC is provided by 11 specialist teams (0.08/100,000 inhabitants), none of which provides pediatric care. CONCLUSION: Despite growing political, professional, and community commitments to palliative care, there are challenges in education, research, essential medicines, and access to PC services.


Asunto(s)
Cuidados Paliativos , Organización Mundial de la Salud , Benin , Humanos , Cuidados Paliativos/métodos , Cuidados Paliativos/normas , Cuidados Paliativos/tendencias , Cuidados Paliativos/estadística & datos numéricos , Organización Mundial de la Salud/organización & administración , Encuestas y Cuestionarios , Indicadores de Calidad de la Atención de Salud/estadística & datos numéricos
2.
BMJ Open ; 13(11): e074464, 2023 11 06.
Artículo en Inglés | MEDLINE | ID: mdl-37931972

RESUMEN

OBJECTIVES: This study aims to assess the prevalence and factors associated with anal high-risk human papilloma virus (HR-HPV). DESIGN: A cross-sectional study conducted from 24 August 2020 to 24 November 2020. SETTING: Primary care, Cotonou, Benin. PARTICIPANTS: 204 HIV-negative men who have sex with men initiating oral pre-exposure prophylaxis. PRIMARY OUTCOME MEASURE: Anal HR-HPV genotypes using GeneXpert HPV assay. Fourteen HR-HPV were evaluated: HPV-16 and HPV-18/45 in 2 distinct channels and the 11 other genotypes as a pooled result (31, 33, 35, 39, 51, 52, 56, 58, 59, 66 and 68). The potential independent variables analysed included anal gonorrhoea and chlamydia infections, and sociodemographic and sexual behaviour factors. To assess the determinants of HR-HPV, univariate and multivariate Poisson regression models were performed by using SAS V.9.4. RESULTS: Mean age±SD was 25.9±4.8 years. 131/204 men claimed insertive sex procured more pleasure. Thirty-two participants, accounting for 15.7% of the study sample, had gonorrhoea and/or chlamydia. The prevalence of any HR-HPV genotype was 36.3% (95% CI 30.0% to 43.0%). In total, 7.8% of men had HPV-16 and 7.4% had HPV-18/45. The prevalence for the pooled genotypes (31, 33, 35, 39, 51, 52, 56, 58, 59, 66 and 68) was 29.9%. Receptive anal sex during the last 6 months was strongly associated with prevalent HR-HPV infections. The adjusted proportion ratio (aPR) was 1.93 (95% CI 1.31 to 2.83). Gonorrhoea and chlamydia were also associated with the outcome of interest; p value for both infections was <0.05. The aPR comparing patients who perceived some risk of acquiring HIV to other men was 1.44 (95% CI 1.00 to 2.08). CONCLUSIONS: In Benin, anal HR-HPV was common among HIV-negative men who have sex with men. Among this highly vulnerable population, there is a need for integrated preventive and management strategies targeting HPV and other sexually transmitted infections.


Asunto(s)
Gonorrea , Infecciones por VIH , Infecciones por Papillomavirus , Profilaxis Pre-Exposición , Minorías Sexuales y de Género , Masculino , Humanos , Adulto Joven , Adulto , Homosexualidad Masculina , Estudios Transversales , Virus del Papiloma Humano , Gonorrea/complicaciones , Infecciones por Papillomavirus/epidemiología , Prevalencia , Benin , Factores de Riesgo , Conducta Sexual , Papillomaviridae/genética , Papillomavirus Humano 16 , Infecciones por VIH/epidemiología
3.
J Int AIDS Soc ; 26(6): e26130, 2023 06.
Artículo en Inglés | MEDLINE | ID: mdl-37306106

RESUMEN

INTRODUCTION: Since many countries in sub-Saharan Africa are willing to implement HIV oral pre-exposure prophylaxis (PrEP) for men who have sex with men (MSM), data are needed to assess its feasibility and relevance in real life. The study objectives were to assess drug uptake, adherence, condom use and number of sexual partners, HIV incidence and trends in the prevalence of gonorrhoea and chlamydia. METHODS: In this oral PrEP demonstration study conducted prospectively in Benin, a combination of tenofovir disoproxil fumarate-TDF 300 mg and emtricitabine-FTC 200 mg (TDF-FTC) was offered daily or on-demand to MSM. Participants were recruited from 24 August to 24 November 2020 and followed over 12 months. At enrolment, month-6 and month-12, participants answered to a face-to-face questionnaire, underwent a physical examination and provided blood samples for HIV, gonorrhoea and chlamydia. RESULTS: Overall, 204 HIV-negative men initiated PrEP. The majority of them (80%) started with daily PrEP. Retention rates at month-3, 6, 9 and 12 were 96%, 88%, 86% and 85%, respectively. At month-6 and month-12, respectively, 49% and 51% of the men on daily PrEP achieved perfect adherence (self-reported), that is seven pills taken during the last week. For event-driven PrEP, the corresponding proportions for perfect adherence (last seven at-risk sexual episodes covered) were 81% and 80%, respectively. The mean number (standard deviation) of male sexual partners over the last 6 months was 2.1 (1.70) at baseline and 1.5 (1.27) at month-12 (p-value for trend <0.001). Consistent condom use during the last 6 months was 34% (enrolment), 37% (month-6) and 36% (month-12). Three HIV seroconversions (2-daily and 1-event-driven) were recorded. Crude HIV incidence (95% confidence interval) was 1.53 (0.31-4.50)/100 person-years. Neisseria gonorrhoeae and/or Chlamydia trachomatis prevalence at the anal and/or pharyngeal and/or urethral sites was 28% at baseline and 18% at month-12 (p-value = 0.017). CONCLUSIONS: In West Africa, oral PrEP introduction in routine practice as a component of a holistic HIV prevention package is feasible and may not result in a significant increase in condomless sex among MSM. Since HIV incidence was still higher, additional interventions, such as culturally tailored adherence counselling, may be needed to optimize the benefits of PrEP.


Asunto(s)
Gonorrea , Infecciones por VIH , Profilaxis Pre-Exposición , Minorías Sexuales y de Género , Humanos , Masculino , África Occidental/epidemiología , Benin/epidemiología , Gonorrea/epidemiología , Gonorrea/prevención & control , Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control , Homosexualidad Masculina , Estudios Prospectivos
4.
Pan Afr Med J ; 46: 79, 2023.
Artículo en Francés | MEDLINE | ID: mdl-38282778

RESUMEN

Introduction: men who have sex with men (MSM) are disproportionately affected by hepatitis B virus (HBV) and hepatitis C virus (HCV) worldwide. In Benin, there are no data on MSM. The purpose of this study was to estimate HBV and HCV prevalence and HBV-associated factors in MSM who were HIV negative. Methods: we conducted an analytical cross-sectional study. A two-degree random sampling was used to recruit 204 MSM. An immunochromatographic rapid test and enzyme immunoassays were used to detect HBV and HCV antigens/antibodies. Log-binomial regression was used to identify factors associated with HBV. Results: HbsAg positivity, history of hepatitis B infection and hepatitis C prevalences were 37.7%, 8.8 %, and 0.9 %, respectively. HBsAg positivity and history of hepatitis B were more prevalent in MSM aged ≥30 years compared to younger subjects: 16.7% versus 6.4% (p<0.0001) and 66.7% versus 28.8% (p<0.0001), respectively. Sexual intercourse under the effect of drug or alcohol and living in couple were also associated with HBV. conclusion: the prevalence of hepatitis C was low, but hepatitis B was common, especially among older MSM. Screening and vaccination against hepatitis B should be strengthened in this population.


Asunto(s)
Infecciones por VIH , Hepatitis B , Hepatitis C , Profilaxis Pre-Exposición , Minorías Sexuales y de Género , Masculino , Humanos , Homosexualidad Masculina , Prevalencia , Antígenos de Superficie de la Hepatitis B , Infecciones por VIH/epidemiología , Infecciones por VIH/complicaciones , Coito , Estudios Transversales , Benin/epidemiología , Hepatitis B/epidemiología , Hepatitis B/prevención & control , Hepatitis B/complicaciones , Hepatitis C/epidemiología , Hepatitis C/prevención & control , Hepatitis C/complicaciones , Virus de la Hepatitis B , Hepacivirus , Anticuerpos contra la Hepatitis C
5.
Front Health Serv ; 2: 843058, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-36925823

RESUMEN

Introduction: In sub-Saharan Africa, there is a need to better understand and guide the practice of primary care physicians (PCPs), especially in a crisis context like the COVID-19 pandemic. This study analyses the experiences of PCPs facing COVID-19 in Benin and draws policy lessons. Methods: The study followed a fully mixed sequential dominant status design. Data were collected between April and August 2020 from a sample of PCPs in Benin. We performed descriptive analyses on the quantitative data. We also performed bivariate analyses for testing associations between various outcomes and the public/private status of the PCPs, their localization within or outside the cordon sanitaire put in place at the beginning of COVID-19, and their practice' category. A thematic content analysis was done on qualitative data. Results from both analyses were triangulated. Results: Ninety PCPs participated in the quantitative strand, and 14 in the qualitative. The median percentage of the COVID-19 control measures implemented in the health facilities, as reported by the PCPs, was 77.8% (interquartile range = 16.7%), with no difference between the various groups. While 29.4% of the PCPs reported being poorly/not capable of helping the communities to deal with COVID-19, 45.3% felt poorly/not confident in dealing with an actual case. These percentages were bigger in the private sector. The PCP's experiences were marked by anxiety and fear, with 80.2% reporting stress. Many PCPs (74.1%) reported not receiving support from local health authorities, and 75.3% felt their concerns were not adequately addressed. Both percentages were higher in the private sector. The PCPs especially complained of insufficient training, insufficient coordination, and less support to private providers than the public ones. For 72.4 and 79.3% of the PCPs, respectively, the pandemic impacted services utilization and daily work. There were negative impacts (like a decrease in the services utilization or the quality of care), but also positive ones (like improved compliance to hygiene measures and new opportunities). Conclusion: Our study highlighted the need for more structured support to PCPs for optimizing their contribution to epidemics control and good primary healthcare in Benin. Efforts in this direction can build on several good practices and opportunities.

6.
Sex Transm Dis ; 48(8): 565-571, 2021 08 01.
Artículo en Inglés | MEDLINE | ID: mdl-33448731

RESUMEN

BACKGROUND: HIV preexposure prophylaxis (PrEP) efficacy is closely linked to adherence, and factors associated with PrEP adherence are not well understood and may differ across populations. As PrEP demonstration projects and implementation are ongoing, it is essential to understand factors associated with adherence to oral PrEP to design effective adherence interventions and maximize the public health impact of PrEP. We thus aimed to assess demographic and behavioral factors associated with optimal PrEP adherence (100%) among female sex workers (FSWs) participating in a demonstration project in Cotonou, Benin. METHODS: Female sex workers were provided with daily Truvada and followed quarterly for 1 to 2 years. Sociodemographics, partners, and behaviors were collected through face-to-face questionnaires. Another questionnaire based on sexual the theory of planned behavior and the theory of interpersonal behavior was also administered. Generalized estimating equations were used to identify factors associated with optimal daily adherence. RESULTS: At baseline, 255 FSWs were followed up. One-year increase in age of FSWs was associated with a 3% increase in optimal adherence (prevalence ratio, 1.03; 95% confidence interval, 1.01-1.05; P for trend = 0.0003), and optimal adherence decreased by 31% for every 6 months of follow-up (prevalence ratio, 0.69; 95% confidence interval, 0.59-0.79; P for trend < 0.0001). For the participants who have completed the behavioral questionnaires, high intention to adhere to the treatment was also a predictor of optimal adherence. CONCLUSIONS: Efforts should be geared toward FSWs intending to use PrEP to help them reach adequate adherence levels for effective HIV protection.


Asunto(s)
Fármacos Anti-VIH , Infecciones por VIH , Profilaxis Pre-Exposición , Trabajadores Sexuales , Fármacos Anti-VIH/uso terapéutico , Benin/epidemiología , Demografía , Femenino , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control , Humanos , Lactante , Cumplimiento de la Medicación
7.
BMC Womens Health ; 20(1): 248, 2020 11 09.
Artículo en Inglés | MEDLINE | ID: mdl-33167931

RESUMEN

BACKGROUND: Behavioural and structural factors related to sex work, place female sex workers (FSWs) at high risk of maternal mortality and morbidity (MMM), with a large portion due to unintended pregnancies and abortions. In the African context where MMM is the highest in the world, understanding the frequency and determinants of pregnancy and abortion among FSWs is important in order to meet their sexual and reproductive health needs. METHODS: Data from two Beninese cross-sectional surveys among FSWs aged 18+ (2013, N = 450; 2016, N = 504) were merged. We first performed exploratory univariate analyses to identify factors associated with pregnancy and abortion (p < 0.20) using Generalized Estimating Equations with Poisson regression and robust variance. Multivariate analyses first included all variables identified in the univariate models and backward selection (p ≤ 0.05) was used to generate the final models. RESULTS: Median age was 39 years (N = 866). The proportion of FSWs reporting at least one pregnancy during sex work practice was 16.4%, of whom 42.3% had more than one. Most pregnancies ended with an abortion (67.6%). In multivariate analyses, younger age, longer duration in sex work, previous HIV testing, having a boyfriend and not using condoms with him were significantly (p < 0.05) associated with more pregnancies. CONCLUSION: One FSW out of five had at least one pregnancy during her sex work practice. Most of those pregnancies, regardless of their origin, ended with an abortion. Improving access to various forms of contraception and safe abortion is the key to reducing unintended pregnancies and consequently, MMM among FSWs in Benin.


Asunto(s)
Aborto Inducido , Embarazo no Planeado , Trabajadores Sexuales , Aborto Inducido/estadística & datos numéricos , Adulto , Benin , Estudios Transversales , Femenino , Humanos , Embarazo , Factores de Riesgo , Trabajadores Sexuales/estadística & datos numéricos , Adulto Joven
8.
Medicine (Baltimore) ; 99(21): e20063, 2020 May 22.
Artículo en Inglés | MEDLINE | ID: mdl-32481273

RESUMEN

BACKGROUND: Measuring adherence to PrEP (pre-exposure prophylaxis) remains challenging. Biological adherence measurements are reported to be more accurate than self-reports and pill counts but can be expensive and not suitable on a daily basis in resource-limited countries. Using data from a demonstration project on PrEP among female sex workers in Benin, we aimed to measure adherence to PrEP and compare self-report and pill count adherence to tenofovir (TFV) disoproxil fumarate (TDF) concentration in plasma to determine if these 2 measures are reliable and correlate well with biological adherence measurements. METHODS: Plasma TFV concentrations were analyzed in samples collected at day 14 follow-up visit and months 6, 12, 18, and 24 (or at last visit when follow-up was shorter). Self-reported adherence was captured at day 14 follow-up visit and then quarterly by asking participants to report the number of missed pills within the last week. For pill count, medications were refilled monthly and participants were asked to bring in their medication bottles at each follow-up visit. Using generalized estimating equations adherence measured by self-report and pill count was compared to plasma drug concentrations. RESULTS: Of 255 participants, 47.1% completed follow-up. Weighted optimal adherence combining data from all visits was 26.8% for TFV concentration, 56.0% by self-report and 18.9% by pill count. Adherence measured by both TFV concentrations and self-report decreased over time (P = .009 and P = .019, respectively), while the decreasing trend in adherence by pill count was not significant (P = .087). The decrease in adherence was greater using TFV concentrations than the other 2 adherence measures. CONCLUSION: With high levels of misreporting of adherence using self-report and pill count, the objective biomedical assessment of adherence via laboratory testing is optimal and more accurately reflects PrEP uptake and persistence. Alternative inexpensive and accurate approaches to monitor PrEP adherence should be investigated.


Asunto(s)
Fármacos Anti-VIH/administración & dosificación , Cumplimiento de la Medicación/estadística & datos numéricos , Profilaxis Pre-Exposición/métodos , Tenofovir/administración & dosificación , Adulto , Fármacos Anti-VIH/sangre , Benin , Femenino , Infecciones por VIH/prevención & control , Humanos , Persona de Mediana Edad , Autoinforme , Trabajadores Sexuales , Tenofovir/sangre
9.
Pan Afr Med J ; 33: 45, 2019.
Artículo en Francés | MEDLINE | ID: mdl-31448008

RESUMEN

Tuberculosis is a public health problem, especially in the developing countries. Bacillary pulmonary tuberculosis is the most common form of tuberculosis while genital tuberculosis is rare and underdiagnosed. We here report a case of endometrial tuberculosis. The study involved a 72-year old female patient with SC hemoglobinopathy consulting her gynecologist because of chronic leukorrhea. Cytobacteriologic assessment of vaginal swabs showed Streptococcus agalactatiae. Despite suitable antibiotic therapy, the evolution was marked by the persistence of leukorrhea. Pelvic ultrasonography objectified thickened endometrium, appearing as hyperechoic at the base of the uterus. This was suggestive of endometrial cancer. Anatomo-pathological examination of endometrial curettage samples showed granulomatous endometritis suggesting follicular tuberculosis. Outcome was favorable under antituberculosis treatment. In TB endemic areas, genital tuberculosis is not exceptional and should be suspected in patients with chronic leukorrhea despite suitable treatment.


Asunto(s)
Antituberculosos/administración & dosificación , Endometritis/diagnóstico , Endometrio/patología , Tuberculosis de los Genitales Femeninos/diagnóstico , Anciano , Neoplasias Endometriales/diagnóstico , Endometritis/microbiología , Endometrio/microbiología , Femenino , Humanos , Tuberculosis de los Genitales Femeninos/tratamiento farmacológico , Tuberculosis de los Genitales Femeninos/patología , Enfermedades Uterinas/diagnóstico , Enfermedades Uterinas/tratamiento farmacológico , Enfermedades Uterinas/microbiología
10.
Artículo en Francés | AIM (África) | ID: biblio-1264250

RESUMEN

Objectif: Décrire les signes et l'évolution du paludisme en médecine interne.Patients et méthodes : Etude transversale, descriptive sur 2 ans (1er janvier 2012 au 31 décembre 2013) en médecine interne de l'hôpital de Zone de Comè (Bénin). Etaient inclus, les patients chez qui le paludisme a été diagnostiqué en cours d'hospitalisation. Les données ont été analysées avec SPSS 18.0.Résultats : 45 cas de paludisme ont été diagnostiqués parmi les 317 cas de fièvre enregistrés pen-dant la période d'étude, soit 14,2%. La sex-ratio était de 0,88 et l'âge moyen de 36,69±13,76 ans. Les autres symptômes les plus fréquents étaient l'asthénie (55,6%), les vomissements (22,2%) et les cé-phalées (20,0%). 25 patients (55,6%) avaient au moins un critère de gravité ; 4,4% étaient décédés et 6,6% ont été transféré vers un niveau supérieur. Conclusion : Le paludisme est fréquent en Médecine. Promptement pris en charge, l'évolution est souvent favorable


Asunto(s)
Benin , Medicina Interna , Malaria/complicaciones , Malaria/diagnóstico , Malaria/mortalidad
11.
Artículo en Francés | AIM (África) | ID: biblio-1264251

RESUMEN

Introduction : Les connectivites sont peu diagnostiquées en Afrique au sud du Sahara probablement en raison d'une insuffisance de couverture du continent en service spécialisés. Il est nécessaire d'établir des politiques de dépistages Objectif : Etablir le panorama des connectivites dans un service de médecine interne après la réorga-nisation de sa prise en charge Méthode : Il s'agit d'une étude transversale descriptive qui a eu pour cadre le service de médecine interne du CNHU-HKM de Cotonou. L'étude a couvert une période 91 mois allant du 1er janvier 2010 au 31 août 2017. Les variables étudiées étaient les caractéristiques sociodémographiques, cliniques et biologiques au moment du diagnostic de connectivite. Résultats : 18 patients ont été inclus sur les 2219 patients suivis pendant la période d'étude soit une fréquence hospitalière de 0,8%. Le sex ratio était de 0,26 et l'âge moyen de 35,3±11,5 ans. Les connectivites identifiées au cours de la période d'étude étaient principalement le Lupus érythéma-teux systémique (77,8%), les connectivites indifférenciées (11,1%) et la sclérodermie (5,6%). Les manifestations cliniques étaient dominées par les manifestations ostéo-articulaires (77,8%), cutanéo-muqueuses (61,1%) et hématologiques (55,6%). Le profil immunologique des patients était dominé par les antiRNP, les antiSm, anti-SSA et antinucléosome. Conclusion : les connectivites sont peu fréquentes en Médecine interne au Bénin et sont majoritaire-ment représentées par le lupus. Des études multicentriques sont nécessaires afin de déterminer un panorama plus représentatif


Asunto(s)
Benin , Medicina Interna , Pacientes , Enfermedades Indiferenciadas del Tejido Conectivo/diagnóstico
12.
Pan Afr Med J ; 30: 180, 2018.
Artículo en Francés | MEDLINE | ID: mdl-30455809

RESUMEN

INTRODUCTION: The prevalence of hepatitis B is very variable across geographic areas and seems to be influenced by HIV infection. This study aims to evaluate the impact of serologic HIV status on the overall prevalence of hepatitis B in a Hospital in Parakou, Benin. METHODS: We conducted a cross-sectional study of adults aged 18 years old and over hospitalized in the Departmental University Hospital Center in Parakou between May 2011 and June 2012. The diagnosis of hepatitis B was made on the basis of rapid HBsAg tests while the diagnosis of HIV was made on the basis of rapid HIV tests using venous blood samples. Data were analyzed using EpiInfo software. Multivariate logistic regression model was implemented to investigate factors associated with hepatitis B. RESULTS: Out of 1516 subjects included, 744 were HIV seropositive. The average age was 31.3 + 11.1 years and 65.1% were women. The prevalence rate of hepatitis B in the whole sample was 13.9% [CI95:12.2%-15.7%]. This prevalence was higher in HIV seropositive subjects (16.9% vs 10.9%; p < 0.0006), however there was not a more significant difference in multivariate analysis, except for the group of subjects from Borgou/Alibori (p < 0.02). A consistent association was observed between age group 24-44 years (p < 0.03), male sex (p < 0.01), primary school education (p < 0.02) and a high prevalence of hepatitis B. CONCLUSION: The prevalence of hepatitis B was higher in HIV seropositive subjects. This was influenced by age, sex, education level and geographical origin.


Asunto(s)
Infecciones por VIH/epidemiología , Antígenos de Superficie de la Hepatitis B/sangre , Hepatitis B Crónica/epidemiología , Adolescente , Adulto , Factores de Edad , Benin/epidemiología , Estudios Transversales , Femenino , Infecciones por VIH/diagnóstico , Hepatitis B Crónica/diagnóstico , Hospitales Universitarios , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Prevalencia , Factores de Riesgo , Estudios Seroepidemiológicos , Factores Sexuales , Adulto Joven
13.
PLoS One ; 12(2): e0171384, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28182705

RESUMEN

OBJECTIVE: Xpert MTB/RIF is recommended by the World Health Organization (WHO) as the initial tuberculosis (TB) diagnostic test in individuals suspected of HIV-associated TB. We sought to evaluate field implementation of Xpert among a cohort of HIV/TB co-infected individuals, including availability, utilization and outcomes. DESIGN: Observational cohort study (patient-level data) and cross-sectional study (site-level Xpert availability data). METHODS: Data were collected at 30 participating International epidemiologic Databases to Evaluate AIDS (IeDEA) sites in 18 countries from January 2012-January 2016. All patients were HIV-infected and diagnosed with TB, either bacteriologically or clinically, and followed until a determination of TB treatment outcome. We used multivariable modified Poisson regression to estimate adjusted relative risk (RR) and 95% confidence intervals for unfavorable TB treatment outcomes. RESULTS: Most sites (63%) had access to Xpert, either in the clinic (13%), in the same facility (20%) or offsite (30%). Among 2722 HIV/TB patients included, median age was 35.4 years and 41% were female; BMI and CD4 count were low. Overall, most patients (76%) received at least one TB test; 45% were positive. Only 4% of all patients were tested using Xpert: 64% were Xpert-positive, 13% showed rifampicin (RIF) resistance and 30% were extrapulmonary (EPTB) or both pulmonary-EPTB. Treatment outcomes were mostly favorable (77%) and we found little association between Xpert use and an unfavorable TB treatment outcome (RR 1.25, 95%CI: 0.83, 1.90). CONCLUSIONS: In this cohort, Xpert utilization was low even though the majority of sites had access to the test. Our findings show the need for expanded implementation and further research exploring barriers to use in low-resource settings.


Asunto(s)
Infecciones por VIH/complicaciones , Tuberculosis Resistente a Múltiples Medicamentos/complicaciones , Tuberculosis Resistente a Múltiples Medicamentos/diagnóstico , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Síndrome de Inmunodeficiencia Adquirida/epidemiología , Adulto , Estudios de Cohortes , Coinfección/diagnóstico , Coinfección/epidemiología , Estudios Transversales , Bases de Datos Factuales , Femenino , Infecciones por VIH/diagnóstico , Infecciones por VIH/epidemiología , VIH-1 , Humanos , Internacionalidad , Masculino , Tuberculosis Resistente a Múltiples Medicamentos/epidemiología
14.
Am J Trop Med Hyg ; 93(2): 287-92, 2015 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-26101276

RESUMEN

We investigated the circulating plasma levels of Th1- (Interleukin-2 [IL-2], tumor necrosis factor-α [TNF-α], interferon-gamma [IFN-γ]) and Th2-type (IL-4, IL-5, IL-10) cytokines in human immunodeficiency virus (HIV)-infected pregnant women living in a malaria-endemic area. We analyzed samples from 200 pregnant women included in the prevention of pregnancy-associated malaria in HIV-infected women: cotrimoxazole prophylaxis versus mefloquine (PACOME) clinical trial who were followed until delivery. Cytokine concentrations were measured by flow cytometry-based multiplex bead array. Significantly elevated levels of IL-10 and lower levels of TNF-α were observed at delivery compared with inclusion (P = 0.005). At inclusion, the presence of circulating IFN-γ, a higher CD4(+) T cell count and having initiated intermittent preventive treatment of malaria with sulfadoxine pyrimethamine (SP-IPTp) were all associated with a lower likelihood of Plasmodium falciparum infection. At delivery, the inverse relationship between the presence of infection and circulating IFN-γ persisted, although there was a positive association between the likelihood of infection and the presence of circulating TNF-α. Initiation of antiretroviral therapy was associated with elevated IL-5 production. Consistent with our own and others' observations in HIV seronegative subjects, this study shows circulating IL-10 to be a marker of infection with P. falciparum during pregnancy even in HIV-infected women, although plasma IFN-γ may be a marker of anti-malarial protection in such women.


Asunto(s)
Infecciones por VIH/sangre , Malaria Falciparum/sangre , Complicaciones Infecciosas del Embarazo/sangre , Complicaciones Infecciosas del Embarazo/virología , Complicaciones Parasitarias del Embarazo/sangre , Adulto , Antimaláricos/uso terapéutico , Benin/epidemiología , Combinación de Medicamentos , Femenino , Infecciones por VIH/complicaciones , Humanos , Interleucina-10/sangre , Interleucina-2/sangre , Interleucina-4/sangre , Interleucina-5/sangre , Malaria Falciparum/complicaciones , Malaria Falciparum/tratamiento farmacológico , Embarazo , Complicaciones Parasitarias del Embarazo/tratamiento farmacológico , Estudios Prospectivos , Pirimetamina/uso terapéutico , Sulfadoxina/uso terapéutico , Combinación Trimetoprim y Sulfametoxazol/uso terapéutico , Factor de Necrosis Tumoral alfa/sangre , Adulto Joven
16.
BMC Infect Dis ; 15: 176, 2015 Apr 09.
Artículo en Inglés | MEDLINE | ID: mdl-25885859

RESUMEN

BACKGROUND: The causes of severe morbidity in health facilities implementing Antiretroviral Treatment (ART) programmes are poorly documented in sub-Saharan Africa. We aimed to describe severe morbidity among HIV-infected patients after ART initiation, based on data from an active surveillance system established within a network of specialized care facilities in West African cities. METHODS: Within the International epidemiological Database to Evaluate AIDS (IeDEA)--West Africa collaboration, we conducted a prospective, multicenter data collection that involved two facilities in Abidjan, Côte d'Ivoire and one in Cotonou, Benin. Among HIV-infected adults receiving ART, events were recorded using a standardized form. A simple case-definition of severe morbidity (death, hospitalization, fever>38°5C, Karnofsky index<70%) was used at any patient contact point. Then a physician confirmed and classified the event as WHO stage 3 or 4 according to the WHO clinical classification or as degree 3 or 4 of the ANRS scale. RESULTS: From December 2009 to December 2011, 978 adults (71% women, median age 39 years) presented with 1449 severe events. The main diagnoses were: non-AIDS-defining infections (33%), AIDS-defining illnesses (33%), suspected adverse drug reactions (7%), other illnesses (4%) and syndromic diagnoses (16%). The most common specific diagnoses were: malaria (25%), pneumonia (13%) and tuberculosis (8%). The diagnoses were reported as syndromic in one out of five events recorded during this study. CONCLUSIONS: This study highlights the ongoing importance of conventional infectious diseases among severe morbid events occurring in patients on ART in ambulatory HIV care facilities in West Africa. Meanwhile, additional studies are needed due to the undiagnosed aspect of severe morbidity in substantial proportion.


Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/epidemiología , Infecciones por VIH/epidemiología , Malaria/epidemiología , Neumonía/epidemiología , Tuberculosis/epidemiología , Adulto , Instituciones de Atención Ambulatoria , Fármacos Anti-VIH/uso terapéutico , Benin/epidemiología , Conducta Cooperativa , Côte d'Ivoire/epidemiología , Recolección de Datos , Bases de Datos Factuales , Femenino , Fiebre/epidemiología , Infecciones por VIH/tratamiento farmacológico , Hospitalización/estadística & datos numéricos , Humanos , Estado de Ejecución de Karnofsky , Masculino , Persona de Mediana Edad , Morbilidad , Estudios Prospectivos , Índice de Severidad de la Enfermedad
17.
Int J Epidemiol ; 44(1): 251-63, 2015 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-25859596

RESUMEN

BACKGROUND: Even among HIV-infected patients who fully suppress plasma HIV RNA replication on antiretroviral therapy, genetic (e.g. CCL3L1 copy number), viral (e.g. tropism) and environmental (e.g. chronic exposure to microbial antigens) factors influence CD4 recovery. These factors differ markedly around the world and therefore the expected CD4 recovery during HIV RNA suppression may differ globally. METHODS: We evaluated HIV-infected adults from North America, West Africa, East Africa, Southern Africa and Asia starting non-nucleoside reverse transcriptase inhibitorbased regimens containing efavirenz or nevirapine, who achieved at least one HIV RNA level <500/ml in the first year of therapy and observed CD4 changes during HIV RNA suppression. We used a piecewise linear regression to estimate the influence of region of residence on CD4 recovery, adjusting for socio-demographic and clinical characteristics. We observed 28 217 patients from 105 cohorts over 37 825 person-years. RESULTS: After adjustment, patients from East Africa showed diminished CD4 recovery as compared with other regions. Three years after antiretroviral therapy initiation, the mean CD4 count for a prototypical patient with a pre-therapy CD4 count of 150/ml was 529/ml [95% confidence interval (CI): 517­541] in North America, 494/ml (95% CI: 429­559) in West Africa, 515/ml (95% CI: 508­522) in Southern Africa, 503/ml (95% CI: 478­528) in Asia and 437/ml (95% CI: 425­449) in East Africa. CONCLUSIONS: CD4 recovery during HIV RNA suppression is diminished in East Africa as compared with other regions of the world, and observed differences are large enough to potentially influence clinical outcomes. Epidemiological analyses on a global scale can identify macroscopic effects unobservable at the clinical, national or individual regional level.


Asunto(s)
Fármacos Anti-VIH/inmunología , Fármacos Anti-VIH/uso terapéutico , Recuento de Linfocito CD4/estadística & datos numéricos , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/inmunología , Adulto , África/epidemiología , Alquinos , Fármacos Anti-VIH/administración & dosificación , Asia/epidemiología , Benzoxazinas/inmunología , Benzoxazinas/uso terapéutico , Ciclopropanos , Quimioterapia Combinada , Femenino , Humanos , Masculino , Nevirapina/inmunología , Nevirapina/uso terapéutico , América del Norte/epidemiología , ARN Viral , Replicación Viral/efectos de los fármacos , Replicación Viral/inmunología
18.
PLoS One ; 9(7): e102643, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-25047804

RESUMEN

BACKGROUND: A comprehensive, HIV prevention programme (Projet Sida1/2/3) was implemented among female sex workers (FSWs) in Cotonou, Benin, in 1993 following which condom use among FSWs increased threefold between 1993 and 2008 while FSW HIV prevalence declined from 53.3% to 30.4%. OBJECTIVE: Estimate the potential impact of the intervention on HIV prevalence/incidence in FSWs, clients and the general population in Cotonou, Benin. METHODS AND FINDINGS: A transmission dynamics model parameterised with setting-specific bio-behavioural data was used within a Bayesian framework to fit the model and simulate HIV transmission in the high and low-risk population of Cotonou and to estimate HIV incidence and infections averted by SIDA1/2/3. Our model results suggest that prior to SIDA1/2/3 commercial sex had contributed directly or indirectly to 93% (84-98%) of all cumulative infections and that the observed decline in FSWs HIV prevalence was more consistent with the self-reported post-intervention increase in condom use by FSWs than a counterfactual assuming no change in condom use after 1993 (CF-1). Compared to the counterfactual (CF-1), the increase in condom use may have prevented 62% (52-71%) of new HIV infections among FSWs between 1993 and 2008 and 33% (20-46%) in the overall population. CONCLUSIONS: Our analysis provides plausible evidence that the post-intervention increase in condom use during commercial sex significantly reduced HIV prevalence and incidence among FSWs and general population. Sex worker interventions can be effective even in medium HIV prevalence epidemics and need to be sustained over the long-term.


Asunto(s)
Condones , Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control , Trabajadores Sexuales , Adolescente , Adulto , Teorema de Bayes , Benin/epidemiología , Femenino , Infecciones por VIH/transmisión , Humanos , Masculino , Persona de Mediana Edad , Sexo Seguro , Trabajo Sexual , Adulto Joven
19.
Malar J ; 13: 255, 2014 Jul 04.
Artículo en Inglés | MEDLINE | ID: mdl-24996807

RESUMEN

BACKGROUND: Malaria and HIV are two major causes of morbidity and mortality among pregnant women in sub-Saharan Africa. Foetal and neonatal outcomes of this co-infection have been extensively studied. However, little is known about maternal morbidity due to clinical malaria in pregnancy, especially malaria-related fever, in the era of generalized access to antiretroviral therapy and anti-malarial preventive strategies. METHODS: A cohort study was conducted in order to estimate the incidence rate and to determine the factors associated with malaria-related fever, as well as the maternal morbidity attributable to malaria in a high-transmission setting of South Benin among HIV-infected pregnant women. Four-hundred and thirty-two women who participated in a randomized trial testing strategies to prevent malaria in pregnancy were included and followed until delivery, with at least three scheduled visits during pregnancy. Confirmed malaria-related fever was defined as axillary temperature >37.5°C and a concomitant, positive, thick blood smear or rapid diagnostic test for Plasmodium falciparum. Suspected malaria-related fever was defined as an axillary temperature >37.5°C and the concomitant administration of an anti-malarial treatment in the absence of parasitological investigation. RESULTS: Incidence rate for confirmed malaria-related fever was of 127.9 per 1,000 person-year (PY) (95% confidence interval (CI): 77.4-211.2). In multivariate analysis, CD4 lymphocytes (Relative Risk (RR) for a 50 cells/mm3 variation = 0.82; CI: 0.71-0.96), antiretroviral treatment started before inclusion (RR = 0.34; CI: 0.12-0.98) and history of symptomatic malaria in early pregnancy (RR = 7.10; CI: 2.35-22.49) were associated with the incidence of confirmed or suspected malaria-related fever. More than a half of participants with parasitaemia were symptomatic, with fever being the most common symptom. The crude fraction of febrile episodes attributable to malaria was estimated at 91%. CONCLUSIONS: This work highlights that malaria is responsible for a substantial morbidity in HIV-infected pregnant women, with cellular immunodepression as a major determinant, and establishes the possible advantage offered by the early initiation of antiretroviral treatment. TRIAL REGISTRATION: PACOME Study has been registered under the number NCT00970879.


Asunto(s)
Infecciones por VIH/complicaciones , Malaria Falciparum/epidemiología , Complicaciones Infecciosas del Embarazo/epidemiología , Adulto , Benin/epidemiología , Estudios de Cohortes , Femenino , Humanos , Incidencia , Embarazo , Estudios Prospectivos , Adulto Joven
20.
J Acquir Immune Defic Syndr ; 65(2): 198-206, 2014 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-24220287

RESUMEN

BACKGROUND: Malaria during pregnancy has serious consequences that are worsened by HIV infection. Malaria preventive measures for HIV-infected pregnant women include cotrimoxazole (CTX) prophylaxis given to prevent HIV-related opportunistic infections and also protective against malaria, or intermittent preventive treatment (IPTp) with an antimalarial drug. Here, we present the first study evaluating CTX efficacy versus mefloquine (MQ)-IPTp, alone and in combination, in HIV-infected pregnant women. METHODS: We conducted 2 randomized, open-label, noninferiority trials in Benin. In the CTX-mandatory trial, HIV-infected women with CD4 counts of <350 per cubic millimeter received CTX either alone or with MQ-IPTp (N = 292). In the CTX-not-mandatory trial (CD4 count >350/mm), CTX was compared with MQ-IPTp (N = 140). In both the trials, the primary end point was microscopic placental parasitemia. RESULTS: At delivery, 1 woman in each CTX-alone treatment group exhibited placental parasitemia, versus no women in the groups receiving MQ. CTX alone demonstrated noninferiority in the CTX-mandatory trial. However, polymerase chain reaction-detected placental parasitemia was markedly reduced in the CTX + MQ group compared with CTX alone (0/105 vs. 5/103, P = 0.03). Because of insufficient recruitment in the CTX-not-mandatory trial, noninferiority could not be conclusively assessed. Dizziness and vomiting of moderate intensity were reported by 34%-37% of women receiving MQ in both the trials, versus 0%-3% in CTX groups (P < 0.0001). No serious adverse events related to these drugs were found. CONCLUSIONS: CTX alone provided adequate protection against malaria in HIV-infected pregnant women, although MQ-IPTp showed higher efficacy against placental infection. Although more frequently associated with dizziness and vomiting, MQ-IPTp may be an effective alternative given concerns about parasite resistance to CTX.


Asunto(s)
Antimaláricos/administración & dosificación , Quimioprevención/métodos , Infecciones por VIH/complicaciones , Malaria/prevención & control , Mefloquina/administración & dosificación , Complicaciones Parasitarias del Embarazo/prevención & control , Combinación Trimetoprim y Sulfametoxazol/administración & dosificación , Adulto , Antimaláricos/efectos adversos , Benin , Quimioprevención/efectos adversos , Mareo/inducido químicamente , Mareo/epidemiología , Quimioterapia Combinada/efectos adversos , Quimioterapia Combinada/métodos , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/epidemiología , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/patología , Femenino , Humanos , Lactante , Recién Nacido , Mefloquina/efectos adversos , Parasitemia/prevención & control , Embarazo , Resultado del Tratamiento , Combinación Trimetoprim y Sulfametoxazol/efectos adversos , Adulto Joven
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