Evolution of Teaching Strategies in a French ODL University Course

ISBN: 978-0-9805950-2-4International audienceThe university course on statistical methods in health at the Bordeaux School of Public Health, University of Bordeaux, has been run as an Open and Distance Learning (ODL) program since 2004 on the basics of statistical reasoning in the health field. The course is mainly for professionals. In more than ten years, about 1,000 people have been trained with over a third coming from sub-Saharan Africa. The program aims to meet a growing demand for statistical training from professionals from the south whose mobility is limited. Each year a satisfaction survey is sent to students with a view to improving the program. Even though participation in the survey is anonymous and not compulsory, it is a valuable source of comments and ideas. These have led to innovative pedagogical practices such as “tutored exercises” with individual correction, the use of new statistical software, summary sheets and flipped classrooms. However, benchmarking of the program has shown that more could be done. Teaching strategies should evolve within the framework of distance learning in terms of content, form and interactivity. This article discusses the development of these new educational strategies from their inception as well as future projects

Do tests devised to detect recent HIV-1 infection provide reliable estimates of incidence in Africa?

International audienceThe objective of this study was to assess the performance of 4 biologic tests designed to detect recent HIV-1 infections in estimating incidence in West Africa (BED, Vironostika, Avidity, and IDE-V3). These tests were assessed on a panel of 135 samples from 79 HIV-1-positive regular blood donors from Abidjan, C?d'Ivoire, whose date of seroconversion was known (Agence Nationale de Recherches sur le SIDA et les H?tites Virales 1220 cohort). The 135 samples included 26 from recently infected patients (180 days), and 15 from patients with clinical AIDS. The performance of each assay in estimating HIV incidence was assessed through simulations. The modified commercial assays gave the best results for sensitivity (100% for both), and the IDE-V3 technique gave the best result for specificity (96.3%). In a context like Abidjan, with a 10% HIV-1 prevalence associated with a 1% annual incidence, the estimated test-specific annual incidence rates would be 1.2% (IDE-V3), 5.5% (Vironostika), 6.2% (BED), and 11.2% (Avidity). Most of the specimens falsely classified as incident cases were from patients infected for >180 days but <1 year. The authors conclude that none of the 4 methods could currently be used to estimate HIV-1 incidence routinely in C?d'Ivoire but that further adaptations might enhance their accuracy

Bacterial Pneumonia among HIV-Infected Patients: Decreased Risk After Tobacco Smoking Cessation. ANRS CO3 Aquitaine Cohort, 2000–2007

BACKGROUND: Bacterial pneumonia is still a substantial cause of morbidity and mortality in HIV-infected patients in the era of combination Antiretroviral Therapy. The benefit of tobacco withdrawal on the risk of bacterial pneumonia has not been quantified in such populations, exposed to other important risk factors such as HIV-related immunodeficiency. Our objective was to estimate the effect of tobacco smoking withdrawal on the risk of bacterial pneumonia among HIV-infected individuals. METHODOLOGY/PRINCIPAL FINDINGS: Patients of the ANRS CO3 Aquitaine Cohort with >or= two visits during 2000-2007 and without bacterial pneumonia at the first visit were included. Former smokers were patients who stopped smoking since >or= one year. We used Cox proportional hazards models adjusted on CD4+ lymphocytes (CD4), gender, age, HIV transmission category, antiretroviral therapy, cotrimoxazole prophylaxis, statin treatment, viral load and previous AIDS diagnosis. 135 cases of bacterial pneumonia were reported in 3336 patients, yielding an incidence of 12 per thousand patient-years. The adjusted hazard of bacterial pneumonia was lower in former smokers (Hazard Ratio (HR): 0.48; P = 0.02) and never smokers (HR: 0.50; P = 0.01) compared to current smokers. It was higher in patients with <200 CD4 cells/microL and in those with 200 to 349 CD4 cells/microL (HR: 2.98 and 1.98, respectively; both P<0.01), but not in those with 350 to 499 CD4 cells/microL (HR: 0.93; P = 0.79), compared to those with >or=500 CD4 cells/microL. The interaction between CD4 cell count and tobacco smoking status was not statistically significant. CONCLUSIONS/SIGNIFICANCE: Smoking cessation dramatically reduces the risk of bacterial pneumonia, whatever the level of immunodeficiency. Smoking cessation interventions should become a key element of the clinical management of HIV-infected individuals

PLoS One

Objectives Mental health is a largely neglected issue among in Sub-Saharan Africa, especially among key populations at risk for HIV. The aim of this study was to estimate the prevalence of psychological distress (PD) and to assess the factors associated among males who have sex with males (MSM), female sex workers (FSW) and drug users (DU) in Togo in 2017. Study design A cross-sectional bio-behavioral study was conducted in August and September 2017 using a respondent-driven sampling (RDS) method, in eight cities in Togo. Methods A standardized questionnaire was used to record sociodemographic characteristics and sexual behaviors. The Alcohol Use Disorders Identification Test (AUDIT) and a subset of questions from the Tobacco Questions for Survey were used to assess alcohol and tobacco consumption respectively. PD was assessed with the Kessler Psychological Distress Scale. A blood sample was taken to test for HIV. Descriptive statistics, univariable and multivariable ordinal regression models were used for analysis. Results A total of 2044 key populations including 449 DU, 952 FSW and 643 MSM with a median age of 25 years, interquartile range (IQR) [21–32] were recruited. The overall prevalence of mild PD among the three populations was 19.9% (95%CI = [18.3–21.8]) and was 19.2% (95%CI = [17.5–20.9]) for severe/moderate PD. HIV prevalence was 13.7% (95%CI = [12.2–15.2]). High age (≥ 25 years) [aOR = 1.24 (95% CI: 1.02–1.50)], being HIV positive [aOR = 1.80 (95% CI: 1.31–2.48)] and hazardous alcohol consumption [aOR = 1.52 (95% CI: 1.22–1.87)] were risk factors for PD. Secondary [aOR = 0.52 (95% CI: 0.42–0.64)] or higher [aOR = 0.46 (95% CI: 0.32–0.64)] education levels were protective factors associated with PD. FSW [OR = 0.55 (95% CI: 0.43–0.68)] and MSM [OR = 0.33 (95% CI: 0.24–0.44)] were less likely to report PD compared with DU. Conclusion and recommendations This is the first study conducted among a large, nationally representative sample of key populations in Togo. The prevalence of PD is high among these populations in Togo and was associated to HIV infection. The present study indicates that mental health care must be integrated within health programs in Togo with a special focus to key populations through interventions such as social support groups

HIV Status Disclosure and Retention in Care in HIV-Infected Adolescents on Antiretroviral Therapy (ART) in West Africa

We assessed the effect of HIV status disclosure on retention in care from initiation of antiretroviral therapy (ART) among HIV-infected children aged 10 years or more in Cote d'Ivoire, Mali and Sénégal.Multi-centre cohort study within five paediatric clinics participating in the IeDEA West Africa collaboration. HIV-infected patients were included in this study if they met the following inclusion criteria: aged 10-21 years while on ART; having initiated ART ≥ 200 days before the closure date of the clinic database; followed ≥ 15 days from ART initiation in clinics with ≥ 10 adolescents enrolled. Routine follow-up data were merged with those collected through a standardized ad hoc questionnaire on awareness of HIV status. Probability of retention (no death or loss-to-follow-up) was estimated with Kaplan-Meier method. Cox proportional hazard model with date of ART initiation as origin and a delayed entry at date of 10th birthday was used to identify factors associated with death or loss-to-follow-up.650 adolescents were available for this analysis. Characteristics at ART initiation were: median age of 10.4 years; median CD4 count of 224 cells/mm³ (47% with severe immunosuppression), 48% CDC stage C/WHO stage 3/4. The median follow-up on ART after the age of 10 was 23.3 months; 187 adolescents (28.8%) knew their HIV status. The overall probability of retention at 36 months after ART initiation was 74.6% (95% confidence interval [CI]: 70.5-79.0) and was higher for those disclosed compared to those not: adjusted hazard ratio for the risk of being death or loss-to-follow-up = 0.23 (95% CI: 0.13-0.39).About 2/3 of HIV-infected adolescents on ART were not aware of their HIV status in these ART clinics in West Africa but disclosed HIV status improved retention in care. The disclosure process should be thus systematically encouraged and organized in adolescent populations

Severe morbidity and mortality in untreated HIV-infected children in a paediatric care programme in Abidjan, Côte d'Ivoire, 2004-2009

<p>Abstract</p> <p>Background</p> <p>Clinical evolution of HIV-infected children who have not yet initiated antiretroviral treatment (ART) is poorly understood in Africa. We describe severe morbidity and mortality of untreated HIV-infected children.</p> <p>Methods</p> <p>All HIV-infected children enrolled from 2004-2009 in a prospective HIV programme in two health facilities in Abidjan, Côte d'Ivoire, were eligible from their time of inclusion. Risks of severe morbidity (the first clinical event leading to death or hospitalisation) and mortality were documented retrospectively and estimated using cumulative incidence functions. Associations with baseline characteristics were assessed by competing risk regression models between outcomes and antiretroviral initiation.</p> <p>Results</p> <p>405 children were included at a median age of 4.5 years; at baseline, 66.9% were receiving cotrimoxazole prophylaxis, and 27.7% met the 2006 WHO criteria for immunodeficiency by age. The risk of developing a severe morbid event was 14% (95%CI: 10.7 - 17.8) at 18 months; this risk was lower in children previously exposed to any prevention of mother-to-child-transmission (PMTCT) intervention (adjusted subdistribution hazard ratio [sHR]: 0.16, 95% CI: 0.04 - 0.71) versus those without known exposure. Cumulative mortality reached 5.5% (95%CI: 3.5 - 8.1) at 18 months. Mortality was associated with immunodeficiency (sHR: 6.02, 95% CI: 1.28-28.42).</p> <p>Conclusions</p> <p>Having benefited from early access to care minimizes the severe morbidity risk for children who acquire HIV. Despite the receipt of cotrimoxazole prophylaxis, the risk of severe morbidity and mortality remains high in untreated HIV-infected children. Such evidence adds arguments to promote earlier access to ART in HIV-infected children in Africa and improve care interventions in a context where treatment is still not available to all.</p

Estimation de l'incidence de l'infection par le VIH en Afrique (application à la Côte d'Ivoire)

L'épidémie de VIH/SIDA se répand de manière dramatique en Afrique subsaharienne. Connaître l'incidence de l'infection par le VIH (vitesse de production des nouvelles infections) est un enjeu majeur pour la surveillance de cette épidémie. L'objectif de ce mémoire est de proposer des outils performants pour estimer l'incidence du VIH dans le contexte africain. Nous développons une méthode pour l'estimer chez les femmes à partir de données de prévalence chez les femmes enceintes. Nous étudions également la performance sur des sujets africains des tests de détection d'infections récentes (TIR) développés dans des pays occidentaux. Nous montrons que notre méthode d'estimation permet d'estimer avec précision les tendances de l'incidence au cours du temps et par classe d'âge, mais qu'elle est moins performante pour les valeurs quantitatives. Nous montrons également que les TIRs ne sont pas adaptés pour estimer l'incidence du VIH en Afrique, et donnons des pistes de recherche pour les améliorer.The HIV/AIDS epidemic have been fast growing for more than two decades in Africa. It is a major issue for HIV surveillance to know the incidence of HIV infection (speed of acquisition of new infections). The objective of this work is to propose effective methods to estimate HIV incidence in the African context. We developped a method for estimating HIV incidence among women using serial HIV prevalence data from pregnant women, and studied the performance on African subjects of tests recent infections (TRI) developed among Caucasian. We showed that our method estimated correctly incidence time trends by age groups, but that quantitative values have to be interpreted with caution. We also showed that TRIs were not adapted to estimate HIV incidence in Africa and we gave several research leads to improve it.BORDEAUX2-BU Santé (330632101) / SudocSudocFranceF

Estimation de l'incidence de l'infection par le VIH en Afrique (application à la Côte d'Ivoire)

L'épidémie de VIH/SIDA se répand de manière dramatique en Afrique subsaharienne. Connaître l'incidence de l'infection par le VIH (vitesse de production des nouvelles infections) est un enjeu majeur pour la surveillance de cette épidémie. L'objectif de ce mémoire est de proposer des outils performants pour estimer l'incidence du VIH dans le contexte africain. Nous développons une méthode pour l'estimer chez les femmes à partir de données de prévalence chez les femmes enceintes. Nous étudions également la performance sur des sujets africains des tests de détection d'infections récentes (TIR) développés dans des pays occidentaux. Nous montrons que notre méthode d'estimation permet d'estimer avec précision les tendances de l'incidence au cours du temps et par classe d'âge, mais qu'elle est moins performante pour les valeurs quantitatives. Nous montrons également que les TIRs ne sont pas adaptés pour estimer l'incidence du VIH en Afrique, et donnons des pistes de recherche pour les améliorer.The HIV/AIDS epidemic have been fast growing for more than two decades in Africa. It is a major issue for HIV surveillance to know the incidence of HIV infection (speed of acquisition of new infections). The objective of this work is to propose effective methods to estimate HIV incidence in the African context. We developped a method for estimating HIV incidence among women using serial HIV prevalence data from pregnant women, and studied the performance on African subjects of tests recent infections (TRI) developed among Caucasian. We showed that our method estimated correctly incidence time trends by age groups, but that quantitative values have to be interpreted with caution. We also showed that TRIs were not adapted to estimate HIV incidence in Africa and we gave several research leads to improve it.BORDEAUX2-BU Santé (330632101) / SudocSudocFranceF

Estimation de la distribution des temps d'infection par le VIH à partir des données longitudinales de marqueurs virologiques de séroconversion

International audienceDepuis les années 1990, de nombreux travaux portent sur l'étude de l'évolution des anticorps anti-VIH menant à des tests permettant de distinguer les infections récentes des infections déjà bien établies à partir d'un seul échantillon de sérum. L'incidence peut alors être estimée à partir de la relation entre la prévalence, l'incidence et la durée de l'infection récente ("période fenêtre"). Cependant, de récents travaux ont montré les limites de cette approche dues essentiellement à une grande variabilité de la "période fenêtre". Nous proposons une approche alternative qui consiste à estimer la distribution du temps d'infection basée sur la valeur des marqueurs virologiques au moment où l'infection est découverte pour la première fois. Dans un premier temps, un modèle pour l'évolution des marqueurs est spécifié et estimé à partir de mesures répétées de marqueurs virologiques de séroconversion. Les paramètres du modèle sont estimés à partir des données d'une cohorte de patients inclus pendant la primo-infection. Dans un second temps, nous utilisons ce modèle pour estimer la distribution des temps d'infection pour les sujets nouvellement diagnostiqués VIH+ et reportés dans le système de surveillance des diagnostics VIH en France

Epidémiologie analytique de Salmonella enterica et Listeria monocytogenes en production primaire porcine (élevage hors-sol de type naisseur-engraisseur)

BORDEAUX2-BU Santé (330632101) / SudocSudocFranceF