Lutte contre l'épidémie de la fièvre hémorragique lassa dans la commune de Tchaourou au Bénin : rôle de l'action sur les déterminants sociaux de la santé et de l'autonomisation communautaire en 2018

International audienc

Decline in HIV prevalence among young men in the general population of Cotonou, Benin, 1998-2008

OBJECTIVE: To assess changes in the prevalence of HIV and other sexually transmitted infections, as well as in different proximal and distal factors related to HIV infection, in the general population of Cotonou between 1998 and 2008, while an intensive preventive intervention targeting the sex work milieu was ongoing. METHODS: A two-stage cluster sampling procedure was used to select the participants in each study. Subjects aged 15-49 who agreed to participate were interviewed and tested for HIV, syphilis, HSV-2, gonorrhoea and chlamydia. We used the Roa-Scott Chi-square test (proportions) and the Student's t test (means) for bivariate comparisons, and adjusted logistic regression models taking into account the cluster effect for multivariate analyses. RESULTS: HIV prevalence decreased significantly in men (3.4% in 1998 versus 2.0% in 2008, p = 0.048), especially in those aged 15-29 (3.0% to 0.5%, p = 0.002). Among men, the prevalence of gonorrhoea decreased significantly (1.1% to 0.3%, p = 0.046) while HSV-2 prevalence increased from 12.0% to 18.1% (p = 0.0003). The proportion of men who reported condom use at least once (29.3% to 61.0%, p<0.0001) and of those having attained a secondary educational level or more (17.1% to 61.3%, p<0.0001) also increased significantly. There was an overall decrease in the prevalence of syphilis (1.5% to 0.6%, p = 0.0003). CONCLUSION: This is the first population-based study reporting a significant decline in HIV prevalence among young men in an African setting where overall prevalence has never reached 5%. The decline occurred while preventive interventions targeting the sex work milieu were ongoing and the educational level was increasing

HIV prevention and treatment cascades among female sex workers in Benin, West Africa

Background & Objectives Benin has a long-standing history of HIV prevention programs aimed at female sex workers (FSWs). We used data from a national survey among FSWs (2017) to assess the prevention and care cascades in this population. Methods FSWs were recruited through cluster sampling of sex work sites. A questionnaire was administered, and HIV tested. HIV-positive participants were asked to provide dried-blood spots (DBS), tested for ARV and viral load. We assessed two prevention cascades (HIV testing and safer sex) and the treatment cascade, using a combination of self-reported and biological variables. Results Mean age of the 1086 FSWs was 30 years. Half of them were Beninese and two-thirds had a primary school education level or less. Almost all FSWs had ever heard of HIV/AIDS. 79.1% had ever been tested, and 84.1% of the latter had been tested in the last year. In the previous six months, 90.1% were exposed to prevention messages. Women exposed to any HIV prevention message reported a higher level of consistent condom use in the last month (69.0%) than those who were not (48.5%, p<0.0001). HIV prevalence was 7.7%. Among HIV-positive women, 60.6% knew their status; among those, 90.5% were on ARV and 81.8% of them had a suppressed viral load. Conclusions Despite long-standing HIV prevention programs for FSWs, the prevention indicators were often low. Linkage to care was good, viral suppression was sub-optimal, but knowledge of HIV-positive status was low. Exposing women to prevention messages is necessary, as to increase HIV testing

A mathematical model impact analysis of a real-life pre-exposure prophylaxis and treatment-as-prevention study among female sex workers in Cotonou, Benin

BACKGROUND: Daily pre-exposure prophylaxis (PrEP) and treatment-as-prevention (TasP) reduce HIV acquisition and transmission risk, respectively. A demonstration study (2015-2017) assessed TasP and PrEP feasibility among female sex workers (FSW) in Cotonou, Benin. SETTING: Cotonou, Benin METHODS:: We developed a compartmental HIV transmission model, featuring PrEP, and ART among the high-risk (FSW, clients) and low-risk populations, calibrated to historical epidemiological and demonstration study data, reflecting observed lower PrEP uptake, adherence and retention compared to TasP. We estimated the population-level impact of the two-year study and several twenty-year intervention scenarios, varying coverage and adherence independently and together. We report the percentage (median, 2.5th-97.5th percentile uncertainty interval (95%UI)) of HIV infections prevented comparing the intervention and counterfactual (2017 coverages: 0% PrEP, 49% ART) scenarios. RESULTS: The two-year study (2017 coverages: 9% PrEP, 83% ART) prevented an estimated 8% (95%UI 6-12) and 6% (3-10) infections among FSW over two and twenty years, respectively, compared to 7% (3-11) and 5% (2-9) overall. The PrEP and TasP arms prevented 0.4% (0.2-0.8) and 4.6% (2.2-8.7) infections overall over 20 years, respectively. Twenty-year PrEP and TasP scale-ups (2035 coverages: 47% PrEP, 88% ART) prevented 21% (17-26) and 17% (10-27) infections among FSW respectively, and 5% (3-10) and 17% (10-27) overall. Compared to TasP scale-up alone, PrEP and TasP combined scale-up prevented 1.9x and 1.2x more infections among FSW and overall, respectively. CONCLUSIONS: The modest demonstration study impact was modest, and mostly from TasP. Increasing PrEP adherence and coverage improves impact substantially among FSW, but little overall. We recommend TasP in prevention packages

Afri-Can Forum 2

CITATION: Mukudu, H., et al. 2016. Afri-Can Forum 2. BMC Infectious Diseases, 16:315, doi:10.1186/s12879-016-1466-6.The original publication is available at https://bmcinfectdis.biomedcentral.comENGLISH ABSTRACT: We are pleased to present peer reviewed forum proceedings of the 2nd synchronicity forum of GHRI/CHVIfunded Canadian and African HIV prevention and vaccine teams Forum objectives ∙GHRI-funded capacity building and HIV prevention research teams presented highlights of achievements ∙Teams discussed how to jointly build on achievements for sustainability ∙Provided an opportunity for inter-team collaboration, synchronize best approach to capacity building, mentoring of new researchers and building leadership ∙Provided opportunities for informal discussions and networking among the teams. ∙Teams learnt about recent advances in the area of African regulatory and ethics review process ∙The forum proceedings was a special supplement in an openaccess journal was producedhttps://bmcinfectdis.biomedcentral.com/articles/supplements/volume-16-supplement-2Publisher's versio