Preussianone, a New Flavanone-Chromone Biflavonoid from Garcinia preussii Engl.

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Individual and healthcare supply-related barriers to treatment initiation in HIV-positive patients enrolled in the Cameroonian antiretroviral treatment access programme

International audienceIncreasing demand for antiretroviral treatment (ART) together with a reduction in international funding during the last decade may jeopardize access to ART. Using data from a cross-sectional survey conducted in 2014 in 19 HIV services in the Centre and Littoral regions in Cameroon, we investigated the role of healthcare supply-related factors in time to ART initiation in HIV-positive patients eligible for ART at HIV diagnosis. HIV service profiles were built using cluster analysis. Factors associated with time to ART initiation were identified using a multilevel Cox model. The study population included 847 HIV-positive patients (women 72%, median age: 39 years). Median (interquartile range) time to ART initiation was 1.6 (0.5-4.3) months. Four HIV service profiles were identified: (1) small services with a limited staff practising partial task-shifting (n = 4); (2) experienced and well-equipped services practising task-shifting and involving HIV community-based organizations (n = 5); (3) small services with limited resources and activities (n = 6); (4) small services providing a large range of activities using task-shifting and involving HIV community-based organizations (n = 4). The multivariable model showed that HIV-positive patients over 39 years old [hazard ratio: 1.26 (95% confidence interval) (1.09-1.45), P = 0.002], those with disease symptoms [1.21 (1.04-1.41), P = 0.015] and those with hepatitis B co-infection [2.31 (1.15-4.66), P = 0.019] were all more likely to initiate ART early. However, patients in the first profile were less likely to initiate ART early [0.80 (0.65-0.99), P = 0.049] than those in the second profile, as were patients in the third profile [association only significant at the 10% level; 0.86 (0.72-1.02), P = 0.090]. Our findings provide a better understanding of the role played by healthcare supply-related factors in ART initiation. In HIV services with limited capacity, task-shifting and support from community-based organizations may improve treatment access. Additional funding is required to relieve healthcare supply-related barriers and achieve the goal of universal ART access

Use and cultural significance of Raphia palms

The genus Raphia (Palmae / Arecaceae) contains 22 species and represents a major multiuse resource across tropical Africa and Madagascar. Raphia species provide goods that range from food to construction material and medicine. Its species play a vital cultural role in African societies. Despite its importance, the taxonomy, ecology, and ethnobotany of this genus remain poorly understood. Here, we review the multiplicity of uses, products and cultural importance of Raphia species across its distribution. We provide a near exhaustive list of all products derived from Raphia species, classified by species and major use categories. We record nearly 100 different uses, traded and commercialized at local, regional, and national levels. Most species have several uses. Raphia wine is the most important product, followed by grubs and fiber extraction. Our review improves our understanding of the uses and cultural importance of Raphia species. If Raphia resources are managed responsibly, they will contribute to alleviate poverty, fight against hunger and conserve tropical biodiversity, especially in Africa