Expérience précoce de la réponse à la pandémie à Syndrome Respiratoire Aigu Sévère à Corona Virus SARS-COV 2 appelé aussi Corona Virus Disease 19 (COVID-19) aux Cliniques Universitaires de Kinshasa: Early experience of response to Severe Acute Respiratory Syndrome-Coranovirus-2 (SARS-COV-2) pandemic at Kinshasa university hospital

The Democratic Republic of Congo (DRC) declared the first case of Coronavirus infection disease (COVID-19) on March 10, 2020. Ever since then, assessment in terms of management and care outcomes for COVID-19 patients has not yet been formally established. Since, the number of patients has been increasing; however, there has been no formal guideline for COVID-19 patient management. This paper provides an overview of the experience of the overall management of COVID-19 at the Kinshasa University Hospital (KUH), between March and the end of April 2020. Clinical data of 49 patients from surronding municipalities, including 61% of males, are presented in this report. Patients were young (median age 34 years). At admission, 20.4% of patients were at advanced stage and 6.1% at severe stage, and almost all of them have been using self-medication prior to admission at the hospital. The lethality rate was 10.2%. In almost all the cases (8 cases out of 10), death occurred within the first 24 hours following the admission. The response to COVID-19 was set up after a few twists and turns. With the support of a few partners and the government, we are seeing an improvement in the management of COVID-19 at the KUH. Delayed referral, self-medication and stigma are among the factors that influenced the disease severity and contributed to the high mortaly we have observed. La République démocratique du Congo (RDC) a déclaré le premier cas de la maladie à Coronavirus (COVID-19) le 10 mars 2020. Depuis lors, l’évaluation de la prise en charge et de l’issue vitale des patients suivis n’ont pas encore été formellement rapportées. Le présent article donne un aperçu de l’expérience de la prise en charge globale de la COVID-19 aux Cliniques Universitaires de Kinshasa, entre mars et fin avril 2020. Quarante-neuf (âge médian 34 ans, sexe masculin 61%, habitant les communes environnantes) ont été inclus. Près d’un tiers des patients étaient admis aux stades critiques (20,4%) ou sévère (6,1%) recourant souvent à l’automédication. Le taux de létalité a été 10,2% des cas. Le décès était survenu endéans les 24 premières heures dans la quasi-totalité des cas (8 cas/10 patients). Les patients sont très jeunes. La riposte à la pandémie a été d’installation lente, renforcée progressivement par l’appui des partenaires traditionnels et du gouvernement central. L’impact de ces interventions a contribué à une amélioration de la prise en charge de la COVID-19 aux CUK. La référence tardive, mais aussi l’autoprise en charge à domicile, corollaires à la stigmatisation communautaire seraient une explication plausible au nombre élévé de décès enregistrés dans cette institution

Cryptococcosis in the Democratic Republic of Congo from 1953 to 2021: A systematic review and meta-analysis

Contexte La cryptococcose est l’une des infections opportunistes les plus courantes et les plus incriminées dans la morbidité et mortalité associées à l'infection par le VIH. Dans sa forme neuro-méningée, la cryptococcose est responsable de 15% de décès au cours du VIH dans le monde. Elle est principalement causée par le complexe d’espèces Cryptococcus neoformans/ C. gattii. En République démocratique du Congo (RDC), l'infection par le VIH reste un problème menaçant, ce, dans un environnement de santé publique fragile et précaire. Objectifs La présente revue systématique examine les aspects cliniques et biologiques de la cryptococcose en RDC, et en estime le fardeau dans la population séropositive immunodéprimée à haut risque d’infections opportunistes. Méthodes En utilisant les directives PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis), nous avons recherché dans les bases de données en ligne et dans la littérature grise des publications disponibles sur la cryptococcose et Cryptococcus spp. en RDC. Les études ont été considérées sans aucune restriction linguistique et une méta-analyse a été réalisée pour estimer les données regroupées et les intervalles de confiance correspondants (IC) à 95%. Le fardeau de la cryptococcose neuro-méningée (CNM) a ensuite été estimé sur la base de (1) la prévalence moyenne de la CNM dans la population à VIH et (2) du nombre d’adultes vivant avec le VIH en RDC tel qu’estimé par ONUSIDA en 2020, tout en ne considérant que la population à haut risque. Bien que les personnes vivant avec le VIH (PVVIH) considérées dans la présente étude soient celles qui connaissent leur statut VIH, les critères de haut risque appliqués ici sont : le taux de CD4 < 200 cellules/µL, l'absence du traitement antirétroviral (ARV), l'échec du traitement ARV et la perte de vue dans le suivi. Résultats Au total, 30 articles de recherche ont été inclus dans la présente revue. Ils ont globalement inclus 1.018 patients atteints de cryptococcose, dont 80,8% avec une forme neuro-méningée et majoritairement immunodéprimés par le VIH/SIDA (97,6%). La prévalence moyenne de la CNM a été estimée à 9,63% (IC 95% : [5,99 - 14,07]), infectant principalement des patients de sexe féminin (51,7%), mariés (52%) et d'un âge médian de 35 (28 - 41) ans. Le taux médian de CD4 des patients était de 161 (98-499) cellules/µL et le procédé diagnostique le plus utilisé était la coloration directe à l'encre de Chine (264 sur 357). Plus d'un patient sur deux (52,7%) sont décédés parmi les patients traités. Le traitement de la cryptococcose a consisté principalement en une monothérapie au fluconazole (80,6 %). Par ailleurs, nous estimons qu'environ 9.265 (IC 95 % : 5.763 – 13.537) PVVIH ont été atteintes de CNM en 2020, parmi lesquelles 4.883 (IC 95 % : 3.037 – 7.134) seraient décédées la même année. Dans l’ensemble, en RDC, 74 isolats de Cryptococcus spp. ont été isolés et caractérisés, dont 82,4% de Cryptococcus neoformans, exclusivement de sérotype A et de types moléculaires VNI et VNII ; et 17,6% de Cryptococcus gattii, exclusivement de sérotype B et de type moléculaire VGI. Il est par ailleurs est noté que la plupart de ces types moléculaires ont également été isolés dans les pays voisins de la RDC. Conclusions Au fil des années, en RDC, la cryptococcose est restée fréquente avec un taux de mortalité inacceptablement élevé. En 2020, le nombre de PVVIH infectées et décédées de suite de la cryptococcose démontre son lourd fardeau chez les PVVIH congolaises. Recommandations Il est donc important d'améliorer la lutte contre le VIH-Sida en implémentant, effectivement, la stratégie test and treat et en encourageant le dépistage volontaire, notamment par les populations-clés. La mise en place d'un programme national de lutte contre les mycoses peut soutenir ces effortsCryptococcose chez les personnes vivant avec le VIH à Kinshasa : contribution à l'étude épidémiologique et moléculaire3. Good health and well-bein

Tests diagnostiques de l’infection à Coronavirus (COVID-19) : des atouts et des limites: Diagnosis testing for Coronavirus infection disease (COVID 19): Assets and limits

The world is going through a serious health crisis due to the COVID 19 pandemic. Although little is known about COVID-19, we have observed an increased interhuman transmission of etiological agent SARS-Cov-2 and we assume that each new cases of COVID-19 get at least two or three news persons infected. Therefore, the test for detection of the infection should be much implemented as an efficient strategy to fight against the COVID 19 pandemic. The COVID-19 diagnostic tests are an essential tool for assessing the pandemic. This review paper will discuss the advantages and limitations of the diagnosis tests for COVID 19. There are 2 categories of tests: those that directly detect the virus or its component, and those that search for the antibodies generated by the virus infection. The&nbsp;real time Reverse transcriptase Polymerase chain reaction (test rt-RT-PCR)&nbsp;remains the gold standard for the diagnosis of COVID-19. Its sensitivity on the nasopharynx swab seems high, though false negative cases can occur, with an average of 30% of cases. Serological test detect specific antibodies against SARS-COV-2. They help identify individuals that have been infected by the virus, those healed and that have acquired immunity against the virus. They are diagnosis orientation tests of COVID-19. Until now, none of these tests are 100% reliable, but they are used by a qualified collaborating medical staff. They can help identify the majority of the infected and immunized individuals. Le monde entier fait face à une crise sanitaire sans précédent due à la pandémie de maladie à virus SARS-COV-2 alias COVID-19. Malgré les connaissances très incomplètes sur la COVID-19, on a constaté une contagiosité interhumaine élevée au début de la pandémie actuelle, et on estime que chaque nouveau cas de COVID-19 infecte en moyenne deux à trois personnes. En conséquence, la stratégie de lutte contre la pandémie à COVID-19 qui ébranle nos sociétés passe nécessairement par une intensification des tests de détection de l’infection. Ces tests diagnostiques de la COVID-19 sont un outil essentiel pour suivre la propagation de la pandémie. Ainsi, l’objectif de la présente revue de la littérature est d’aborder le diagnostic de l’infection à Coronavirus (COVID-19) en s’attardant sur les tests de diagnostic, leurs atouts et leurs limites. Il y a deux catégories de test : ceux qui recherchent la présence directe du virus ou de ses fragments, et ceux qui recherchent les anticorps résultant de l’infection par le virus du COVID-19. Le test real time –Reverse Transcriptase –Polymerase chain reaction (rt-RT-PCR) reste le gold standard pour le diagnostic de la COVID-19. Sa sensibilité sur les écouvillons nasopharyngés semble élevée, mais des faux négatifs peuvent se produire, avec une fréquence incertaine (environ 30% des cas). Les tests sérologiques détectent les anticorps spécifiques du SARS-CoV-2. Ils permettent l’identification des individus qui ont été infectés par le virus, se sont rétablis, et ont développé, en théorie, une réponse immunitaire efficace contre le virus. Ils constituent des tests d’orientation diagnostique de la COVID-19. A ce jour, aucun de ces tests n’est fiable à 100 %, mais, utilisés par un personnel médical qualifié et en combinaison, ils permettent l’identification de la majorité des individus infectés et immunisés

Longitudinal analysis of sociodemographic, clinical and therapeutic factors of HIV-infected individuals in Kinshasa at antiretroviral therapy initiation during 2006-2017.

peer reviewedBACKGROUND: The benefits of antiretroviral therapy (ART) underpin the recommendations for the early detection of HIV infection and ART initiation. Late initiation (LI) of antiretroviral therapy compromises the benefits of ART both individually and in the community. Indeed, it promotes the transmission of infection and higher HIV-related morbidity and mortality with complicated and costly clinical management. This study aims to analyze the evolutionary trends in the median CD4 count, the median time to initiation of ART, the proportion of patients with advanced HIV disease at the initiation of ART between 2006 and 2017 and their factors. METHODS AND FINDINGS: HIV-positive adults (≥ 16 years old) who initiated ART between January 1, 2006 and December 31, 2017 in 25 HIV care facilities in Kinshasa, the capital of DRC, were eligible. The data were processed anonymously. LI is defined as CD4≤350 cells/μl and/or WHO clinical stage III or IV and advanced HIV disease (AHD), as CD4≤200 cells/μl and/or stage WHO clinic IV. Factors associated with advanced HIV disease at ART initiation were analyzed, irrespective of year of enrollment in HIV care, using logistic regression models. A total of 7278 patients (55% admitted after 2013) with an average age of 40.9 years were included. The majority were composed of women (71%), highly educated women (68%) and married or widowed women (61%). The median CD4 was 213 cells/μl, 76.7% of patients had CD4≤350 cells/μl, 46.1% had CD4≤200 cells/μl, and 59% of patients were at WHO clinical stages 3 or 4. Men had a more advanced clinical stage (p <0.046) and immunosuppression (p<0.0007) than women. Overall, 70% of patients started ART late, and 25% had AHD. Between 2006 and 2017, the median CD4 count increased from 190 cells/μl to 331 cells/μl (p<0.0001), and the proportions of patients with LI and AHD decreased from 76% to 47% (p< 0.0001) and from 18.7% to 8.9% (p<0.0001), respectively. The median time to initiation of ART after screening for HIV infection decreased from 40 to zero months (p<0.0001), and the proportion of time to initiation of ART in the month increased from 39 to 93.3% (p<0.0001) in the same period. The probability of LI of ART was higher in married couples (OR: 1.7; 95% CI: 1.3-2.3) (p<0.0007) and lower in patients with higher education (OR: 0.74; 95% CI: 0.64-0.86) (p<0.0001). CONCLUSION: Despite increasingly rapid treatment, the proportions of LI and AHD remain high. New approaches to early detection, the first condition for early ART and a key to ending the HIV epidemic, such as home and work HIV testing, HIV self-testing and screening at the point of service, must be implemented

Surveillance des décès aux Cliniques Universitaires de Kinshasa (RDC) : la COVID-19 a-t-elle entraîné une surmortalité ? Monitoring of deaths at the Kinshasa University Hospital: has COVID-19 resulted in increase of mortality?

Context and objectives. The extent of COVID-19 impact on overall in-hospital mortality is controversial. The objectives of the study were to compare the number of deaths in the first semesters of 2018, 2019 and 2020; determine the proportion of COVID-19 cases and identify the factors associated with COVID-19 among the deaths recorded at the morgue of the Kinshasa University Hospital (KUH).&nbsp;Methods. We collected death certificates registered at the KUH morgue. The diagnosis of COVID-19 was confirmed using RT-PCR in all suspected subjects (from March 2020), including those who have arrived dead. Pearson’s khi-square, Student’s t-test, and logistic regression were used as statistical tests.&nbsp;Results. The number of deaths recorded in the first semester of 2019 (868 cases) was higher than in 2020 (768 cases) and 2018 (744 cases). In 2020, 45 deaths related to COVID-19 (6.0%) were reported. The risk of COVID-19 depended on the period (month of June 2020, OR: 5.69; p = 0.002), sex (female, 0R: 0.42; p = 0.024) and age (one additional year of age, OR: 1.02; p = 0.009).&nbsp;Conclusion: COVID-19 did not lead to excess intra-hospital mortality in the first semester of 2020. The proportion of the disease among deceased patients was more marked in June 2020 and the risk increased with age, especially in men. Contexte et objectifs. L’ampleur de la COVID-19 sur la mortalité intra-hospitalière globale suscite des controverses. Les objectifs de l’étude étaient de comparer le nombre de décès lors des premiers semestres de 2018, 2019 et 2020 ; déterminer la proportion des cas de COVID-19 et identifier les facteurs associés à la COVID-19 parmi les décès enregistrés à la morgue des Cliniques Universitaires de Kinshasa (CUK).&nbsp;Méthodes. Nous avons colligé les certificats des décès enregistrés à la morgue des CUK. La COVID-19 a été recherchée par la RT-PCR chez tous les sujets suspects y compris les arrivés morts (à partir de mars 2020). Le Khi carré de Pearson, le test t de Student et la régression logistique ont été utilisés comme tests statistiques.&nbsp;Résultats. Le nombre de décès enregistrés au premier semestre 2019 (868 cas) était plus élevé qu’en 2020 (768 cas) et 2018 (744 cas). En 2020, on a rapporté 45 décès liés à la COVID-19 (6,0 %). Le risque d’avoir la COVID-19 dépendait de la période (mois de juin 2020, OR : 5,69 ; p = 0,002), du sexe (femme, 0R : 0,42 ; p = 0,024) et de l’âge (une année d’âge supplémentaire, OR : 1,02 ; p = 0,009).&nbsp;Conclusion. La COVID-19 n’a pas entraîné de surmortalité intra-hospitalière au premier semestre de l’année 2020. La proportion de la maladie parmi les patients décédés était plus marquée au mois de juin 2020 et le risque augmentait avec l’âge, particulièrement chez les hommes

Retention in care and predictors of attrition among HIV-infected patients who started antiretroviral therapy in Kinshasa, DRC, before and after the implementation of the ‘treat-all’ strategy

peer reviewedThe retention of patients in care is a key pillar of the continuum of HIV care. It has been suggested that the implementation of a “treat-all” strategy may favor attrition (death or lost to follow-up, as opposed to retention), specifically in the subgroup of asymptomatic people living with HIV (PLWH) with high CD4 counts. Attrition in HIV care could mitigate the success of universal antiretroviral therapy (ART) in resource-limited settings. We performed a retrospective study of PLWH at least 15 years old initiating ART in 85 HIV care centers in Kinshasa, Democratic Republic of Congo (DRC), between 2010 and 2019, with the objective of measuring attrition and to define factors associated with it. Sociodemographic and clinical characteristics recorded at ART initiation included sex, age, weight, height, WHO HIV stage, pregnancy, baseline CD4 cell count, start date of ART, and baseline and last ART regimen. Attrition was defined as death or loss to follow-up (LTFU). LTFU was defined as “not presenting to an HIV care center for at least 180 days after the date of a last missed visit, without a notification of death or transfer”. Kaplan–Meier curves were used to present attrition data, and mixed effects Cox regression models determined factors associated with attrition. The results compared were before and after the implementation of the “treat-all” strategy. A total of 15,762 PLWH were included in the study. Overall, retention in HIV care was 83% at twelve months and 77% after two years of follow-up. The risk of attrition increased with advanced HIV disease and the size of the HIV care center. Time to ART initiation greater than seven days after diagnosis and Cotrimoxazole prophylaxis was associated with a reduced risk of attrition. The implementation of the “treat-all” strategy modified the clinical characteristics of PLWH toward higher CD4 cell counts and a greater proportion of patients at WHO stages I and II at treatment initiation. Initiation of ART after the implementation of the ‘treat all” strategy was associated with higher attrition (p<0.0001) and higher LTFU (p<0.0001). Attrition has remained high in recent years. The implementation of the “treat-all” strategy was associated with higher attrition and LTFU in our study. Interventions to improve early and ongoing commitment to care are needed, with specific attention to high-risk groups to improve ART coverage and limit HIV transmission

Factors associated with acceptability of HIV self-testing (HIVST) among university students in a Peri-Urban area of the Democratic Republic of Congo (DRC)

Introduction:&nbsp;this paper examines the acceptability of HIV self-testing (HIVST) by students in a university in the DRC and identifies factors associated with uptake of HIVST. Methods:&nbsp;a cross-sectional study was conducted with a sample of 290 students from Kikwit University. Data were summarized using proportions and predictions of acceptability of HIVST by logistic regression. Results:&nbsp;the average age of students was 22.5 years, with the majority of the students being male (57%). Just over half the students sampled, reported being sexually active (51.8%). One hundred and sixty four (75%) reported that they had one sexual partner and fifty-six (25%) two or more sexual partners in the past year. Sixty-six percent had used condoms during their last sexual encounter. The acceptability of HIVST was high (81.4%) and 66.1% of students stated that they would confirm the self-test at a local health facility. The knowledge about the importance of the self-test (OR 5.02; 95% CI:1.33-18.88; p=0.017), the perception that counseling pre and post-test were important (OR 2.91; 95% CI:1.63-5.19; p &lt; 0.0001) and the willingness to realize the test with a partner (OR 2.46; 95% CI:1.43-4.23; p=0.034) were factors associated with HIVST. Conclusion:&nbsp;the acceptability of HIVST was high and therefore its implementation is feasible in our country. However, prior to implementation, additional factors such as cost; access of HIVST; false reassurance of the test; missed early infections in the window period, limited counseling and linkage to care options, need to be considered

Progressive phasing out of baseline CD4+ cell count testing for people living with HIV in Kinshasa, Democratic Republic of the Congo.

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Progressive phasing out of baseline CD4+ cell count testing for people living with HIV in Kinshasa, Democratic Republic of the Congo

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Decrease in late presentation for HIV care in Kinshasa, DRC, 2006-2020.

peer reviewedINTRODUCTION: Late presentation for HIV care is a well-described issue for the success of ART outcomes and the cause of higher morbidity, mortality and further transmission. Monitoring the level of late presentation and understanding the factors associated with it would help to tailor screening and information strategies for better efficiency. We performed a retrospective cohort study in Kinshasa, the capital of the DRC. The studied population included HIV-positive adults newly enrolled in HIV care between January 2006 and June 2020 at 25 HIV urban care facilities. Patient information collected at presentation for HIV care included age, sex, WHO clinical stage and screening context. We used 2 definitions of late presentation: the WHO definition of advanced HIV disease (WHO stage 3/4 or CD4 cell count < 200 cells/mm(3)) and a more inclusive definition (WHO stage 3/4 or CD4 cell count < 350 cells/mm(3)). RESULTS: A total of 10,137 HIV-infected individuals were included in the analysis. The median age was 40 years; 68% were female. A total of 45.9% or 47.5% of the patients were late presenters, depending on the definition used. The percentage of patients with late presentation (defined as WHO stage 3/4 or CD4 cell count < 350 cells/mm(3)) decreased during recent years, from 70.7% in 2013 to 46.5% in 2017 and 23.4% in 2020. Age was associated with a significantly higher risk of LP (p < 0.0001). We did not observe any impact of sex. CONCLUSIONS: The frequency of late presentation for care is decreasing in Kinshasa, DRC. Efforts have to be continued. In particular, the issue of late diagnosis in older individuals should be addressed