User satisfaction with family planning services in government health centres in the Congo

Patient satisfaction is considered an indicator of quality of care. This study aimed to assess the degree of clients‘ satisfaction with family planning (FP) services in government health centers in Congo. A cross-sectional study was conducted. A total of 635 clients nested in 27 health facilities were included in the analysis. Satisfaction was defined as "having a good perception of provider technical skills, being satisfied with the service organization and having a general positive appreciation of FP services. Statistical analyses were performed using SPSS v15. Among 635 clients, 57% perceived lack of technical competence in providers, 88% perceived good organization in FP services and 77% declared having general positive appreciation of FP services. Global level of client satisfaction was 42%. In conclusion client satisfaction with FP service was low and strengthening health workers technical competence is crucial. But, as the quality is multidimensional, other aspects especially significant funding investment and quality-assurance interventions must be taken into account.Keywords: family planning, services, user satisfaction, Cong

Research protocol: essential stage of research process guaranteeing validity of results

La recherche scientifique est une activité obligatoire à tout enseignant à l’université. Nous avons réalisé ce travail de synthèse en apportant des innovations dans les composantes d’un protocole de recherche. Le but de notre travail est de rappeler aux chercheurs de tous les domaines, la démarche à suivre pour rédiger un bon projet de recherche encore appelé protocole de recherche. Un protocole de recherche complet doit contenir les onze composantes suivantes : le titre ; l’introduction ; la problématique ; l’hypothèse ; les objectifs ; les généralités ; la méthode ; le calendrier ; le budget ; la bibliographie et la mention des liens d’intérêt. La méthode d’étude est la partie essentielle du protocole de recherche. En conclusion, tout chercheur doit maîtriser la procédure d’élaboration d’un protocole de recherche lui permettant d’aboutir à des résultats valides et de publier des articles scientifiques de bonne qualité.Scientific research is a compulsory activity for every university teacher. We realized this synthetic work by bringing innovations in research protocol components. The purpose of our work is to remind the searchers in all domains, the approach to be followed to draft a good research project also called research protocol. A complete research protocol has to include the eleven following components: title, introduction, problem, hypothesis, objectives, majorities, method, timetable, budget, bibliography and conflict of interests. The method of study is an essential part of the research protocol. As a conclusion, we can say every searcher should know and be able to elaborate a research protocol in order to obtain valid results and to publish quality scientific articles

Adherence as a Predictor of Sexual Behaviors in People Living with HIV/AIDS during the First Year of Antiretroviral Therapy in Rural Cameroon: Data from Stratall ANRS 12110/ESTHER Trial

Objective: This study aims to investigate the time pattern of inconsistence condom use (ICU) during the first year of antiretroviral therapy (ART) and its relationship with treatment adherence in naive HIV-infected adult patients. ' Methods: Data collection was nested within a longitudinal trial on HIV treatment. ICU was defined as reporting to have "never", "sometimes" or "nearly always" used condoms with one's main or casual partner(s) - either HIV-negative or of unknown HIV status in the three previous months. Adherence was defined as taking 100% of their ART prescribed doses in the 4 days before the visit and "not having interrupted treatment", even once, for more than two consecutive days during the 4 previous weeks. Mixed logistic regression was used to study the relationship between adherence and ICU. Results: Among the 459 patients enrolled, 212 (46%) during 334 visits reported to have had sexual intercourse at least once with their partner(s) - either HIV-negative or of unknown HIV status-during the first 12 months of ART. The proportion of ICU was 76%, 50% and 59% at month 0 (M0), month 6 (M6) and month 12 (M12), while 60% and 66% of patients were ART-adherent at M6 and M12, respectively. After adjustment for the frequency of sexual activity, type of sexual partner(s), perceived social class and desire for a child, patients adherent to ART were less likely to report ICU when compared with baseline (AOR [95% CI]: 0.38 [0.19-0.76]; P = 0.006). Conclusions: Adherence to ART is associated with a lower risk of ICU but this result needs to be interpreted carefully. As adherence behaviors are not only determined by problems with the healthcare systems but also by social barriers encountered by patients in their daily life, counseling should not only be ART adherence-centered but also patient-centered, including sexual risk minimization and psychosocial support

Impact des traitements antirétroviraux sur le risque de transmission sexuelle du VIH en Afrique Subsaharienne : le cas du Cameroun

Approfondir les connaissances sur l'évolution et les facteurs associés aux comportements sexuels chez les PVVIH exposées aux traitements antirétroviraux en Afrique subsaharienne. Données collectées dans le cadre d'un essai randomisé conduit dans neuf hôpitaux de district ruraux au Cameroun. 459 PVVIH éligibles au traitement inclus et suivis sur 24 mois. Régression logistique à effets mixtes utilisée pour analyser les facteurs associés aux différentes variables réponses étudiées.La proportion des patients sexuellement actifs augmente de 32% à l'inclusion à 56% après 24 mois de traitement. Une augmentation supplémentaire du temps depuis l'initiation du traitement de 6 mois augmente de 30% de la probabilité de déclarer une activité sexuelle sous ARV. Proportion des patients ayant des comportements sexuels à risque (CSR) baisse significativement de 76% à l'inclusion à 66% au 24e mois, les patients obervants au traitement étaient moins susceptibles de rapporter les CSR. La proportion des patients susceptibles de transmettre le VIH par voie sexuelle (STVIH) baisse de 76% à l'inclusion à 27% après 24 mois de traitement ARV. Une augmentation du temps depuis l'initiation du traitement de 6 mois réduit de 66% la STVIH. Mes travaux montrent un impact positif des ARV sur l'activité sexuelle des PVVIH, les CSR et la STVIH, suggérant un effet positif de l'exposition des PVVIH aux traitements ARV sur la prévention de la transmission sexuelle du VIH. Mais, le risque potentiel de transmission du VIH persiste nécessitant le renforcement des interventions de réduction des risques dans les programmes d'accès aux ARV.To evaluate the evolution and factors associated with sexual behavior among PLWHA exposed to antiretroviral therapy in sub-Saharan Africa. Data collected as part of a randomized trial conducted in nine rural district hospitals in Cameroon. 459 PLWHA eligible for treatment included and followed for 24 months. Mixed effects logistic regression used to analyze factors associated with different response variables studied. Proportion of patients sexually active increased from 32% at baseline to 56% after 24 months of treatment. An additional 6 months increase of the time since initiation of treatment increase in 30% the probability of reporting sexual activity. Proportion of patients with sexual risk behavior (SRB) decreased significantly from 76% at baseline to 66% at 24 months and patient obervants to treatment were less likely to report CSR. Proportion of patients likely to transmit HIV through sexual intercourse (STVIH) decrease from 76% at baseline to 27% after 24 months of HAART. Analyses shown that increasing in 6 months of time since initiation of treatment reduced STVIH by 66%. My dissertation show a positive impact of ART on sexual activity, CSR and STVIH among PLWHA, suggesting a positive effect of exposure to HAART on the prevention of sexual transmission of HIV. However, the potential risk of transmission of HIV persists requiring strengthening risk reduction interventions in HAART access programs

Susceptibility to transmitting HIV in patients initiating antiretroviral therapy in rural district hospitals in Cameroon (Stratall ANRS 12110/ESTHER Trial).

OBJECTIVES: Using cohort data nested in a randomized trial conducted in Cameroon, this study aimed to investigate time trends and predictors of the susceptibility to transmitting HIV during the first 24 months of treatment. METHODS: The outcome, susceptibility to transmitting HIV, was defined as reporting inconsistent condom use and experiencing incomplete virological suppression. Mixed logistic regressions were performed to identify predictors of this outcome among 250 patients reporting to have had sexual relationships either with HIV-negative or unknown HIV status partner(s). RESULTS: Despite an initial decrease from 76% at M0 to 50% at M6, the rate of inconsistent condom use significantly increased from M12 (59%) to M24 (66%) (p = 0.017). However, the proportion of patients susceptible to transmitting HIV significantly decreased over follow-up from 76% at M0, to 50% at M6, 31% at M12 and 27% at M24 (p<0.001). After controlling for age, gender and intervention group, we found that perceiving healthcare staff's readiness to listen as poor (adjusted odds ratios (AOR) [95% Confidence Interval (CI)] = 1.87 [1.01-3.46]), reporting to have sexual relationships more than once per week (AOR [95%CI] = 2.52 [1.29-4.93]), having more than one sexual partner (AOR [95%CI] = 2.53 [1.21-5.30]) and desiring a/another child (AOR [95%CI] = 2.07 [1.10-3.87]) were all associated with a higher risk of being susceptible to transmitting HIV. Conversely, time since ART initiation (AOR [95%CI] = 0.66 [0.53-0.83] for an extra 6 months and ART adherence (AOR [95%CI] = 0.33 [0.15-0.72]) were significantly associated with a lower risk of being susceptible to transmitting HIV. CONCLUSIONS: The decrease observed in the susceptibility to transmitting HIV suggests that fear of behavioural disinhibition should not be a barrier to universal access to ART. However, developing adequate preventive interventions matching patients' expectations -like the desire to have children- and strengthening healthcare staff's counselling skills are urgently needed to maximize the impact of ART in slowing the HIV epidemic

Factors associated with inconsistent condom use among HIV-infected patients reporting sex with a main or casual partner(s) - either HIV negative or of unknown status during the first year of antiretroviral therapy in Cameroon: univariate and multivariate analyses using mixed-effect logistic models (212 patients, 344 visits).

<p>OR  =  crude odds ratio, AOR  =  adjusted odds ratio, IQR: interquartile range,</p>*<p>included in multivariate analysis,</p>a<p>during the previous 12 months,</p>b<p>consumption of three big bottles and/or six glasses of alcoholic beverages or more on any one occasion,</p>c<p>level 1 or 2 on a ten-point scale <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0036118#pone.0036118-SinghManoux1" target="_blank">[15]</a>,</p>d<p>score range 0–60, higher values denote more depressive symptoms <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0036118#pone.0036118-Radloff1" target="_blank">[17]</a>.</p

Factors associated with the susceptibility to transmitting HIV during the first 24 months of antiretroviral therapy in Cameroon: univariate and multivariate analyses using mixed-effects logistic models (Stratall ANRS 12110/ESTHER trial, 250 patients, 473 visits).

<p>OR = odds ratio; AOR = adjusted odds ratio; IQR = interquartile range; CLIN = clinical monitoring alone; LAB = clinical and laboratory monitoring.</p><p>^aOR per 10-year increase;</p>b<p>Level 1 or 2 on a ten-point scale;</p>c<p>Level 1 to 5 on a 6-point visual scale;</p>d<p>CES-D score>16.</p><p>+OR per one-symptom addition,</p><p>++OR for an extra 6 months on ART.</p

Time trend of the proportion of patients with incomplete virological suppression (defined as having had a least one detectable viral load (≥40 copies/ml) during the previous 6 months) over the first 24 months (Stratall ANRS 12110/ESTHER trial, 250 patients, 473 visits).

<p>Time trend of the proportion of patients with incomplete virological suppression (defined as having had a least one detectable viral load (≥40 copies/ml) during the previous 6 months) over the first 24 months (Stratall ANRS 12110/ESTHER trial, 250 patients, 473 visits).</p

Cross tabulation between incomplete virological suppression (defined as having had at least one detectable viral load (≥40 copies/ml) during the previous 6 months) and inconsistent condom use at each follow up time point (Stratall ANRS 12110/ESTHER trial, 250 patients, 473 visits).

<p>ICU = Inconsistent condom use; VL = Viral Load.</p>*<p>As viral load suppression was not defined at M0, figures reported at M0 are related to No. (%) of patients having an undetectable Viral Load (HIV RNA <40copies/ml).</p>**<p>As viral load suppression was not defined at M0, figures reported at M0 are related to No. (%) of patients having a detectable Viral Load (HIV RNA≥40copies/ml).</p