Profil comparatif et évolutif des personnes infectées par le virus de l’immunodéficience humaine traitées aux antirétroviraux à Kinshasa, République Démocratique du Congo

Introduction: a trithérapie (ARV) introduite en R.D.Congo en 1996, a permis l´amélioration substantielle de la qualité de vie des PVVIH et a réduit la morbimortalité liée au sida en R.D. Congo. L'objectif de cette étude est de présenter le profil épidémiologique comparatif, clinique, ainsi que l'évolution anthropométrique des PVVIH sous ARV à Kinshasa. Méthodes: étude de cohorte sur 438 PVVIH, de 18 ans et plus, suivies entre mai 2010 à 2011 à Amo Congo à Kinshasa. Une comparaison a été faite entre les patients suivis pendant un an et ceux perdus de vue. Le Chi carré de Mc Nemar et l'analyse de variance pour mesures répétées ont été appliqués pour étudier l'évolution. Résultats: près 12 mois de suivi, 11,4% de patients ont été perdus de vue. Parmi eux, on observait des proportions significativement plus élevées de personnes de niveau socioéconomique bas, d'indice de masse corporelle (IMC) bas, présentant de l'anorexie, des affections opportunistes. Les proportions de patients aux stades OMS 3 & 4 et naïfs étaient également significativement plus élevées et la durée sous ARV plus courte. Les gains moyens des paramètres anthropométriques au 12ème mois, étaient importants : de 3,6 [3,2 - 4,0] kg pour le poids, 1,8 (1,4 - 2,3) cm pour le périmètre abdominal, 0,9 (0,8 - 1,2) cm pour le périmètre brachial, 1,4 (1,2 - 1,5) kg/m2 pour l'IMC. La proportion de patients avec un IMC <18,5 kg/m2 a significativement plus baissé entre l'admission et le 12ème mois parmi les patients sans stomatite que parmi ceux avec stomatite. L'IMC moyen évoluait significativement différemment entre l'admission et le 12ème mois selon l'âge et la taille de ménage. Conclusion: les facteurs fragilisant la rétention des patients sous antirétroviraux et une évolution progressive de l'état nutritionnel ont été observés

Factors associated with HIV voluntary disclosure of people living with HIV to their steady sexual partner in the Democratic Republic of the Congo: results from a community-based participatory research

Introduction: HIV disclosure to a steady sexual partner (SSP) is important both in preventing HIV transmission and improving the quality of life of people living with HIV (PLHIV). “Its determinants have been poorly investigated in the Democratic Republic of the Congo.” The study objective was to determine factors independently associated with voluntary disclosure to one's SSP in PLHIV receiving services from a Congolese community-based organization (CBO). Methods: a community-based participatory research was performed and 300 PLHIV were interviewed by members of the CBO, using a standardized questionnaire. A multivariate logistic regression was used to determine the variables independently associated with disclosure. Results: in this sample, 79 of the 127 participants (62%) included in the analysis declared having voluntarily disclosed their serostatus to their SSP. Declaring to be in a relationship (Odds Ratio (95% Confidence Interval): 4.2 (1.4-12.6)), having tested for HIV because of symptoms (2.5 (1.0-6.4)), having taken the test on one's own initiative (3.2 (1.3-8.0)), having felt sympathy and indifference from people when disclosing (6.0 (1.4-26.9) and 5.0 (1.1-22.8), respectively) as well as having a higher score of the "regular discussion about daily life with HIV" index (1.7 (1.1-2.5)) were significantly associated with disclosure to one's SSP. Conclusion: several individual and contextual factors were associated with voluntary disclosure to SSP in this study, highlighting the complex nature of the disclosure process. Interventions encouraging disclosure should be designed "so as to adapt to one's personal life with HIV as well as psychosocial environment"

Older Adults Accessing HIV Care and Treatment and Adherence in the IeDEA Central Africa Cohort

Background. Very little is known about older adults accessing HIV care in sub-Saharan Africa. Materials and Methods. Data were obtained from 18,839 HIV-positive adults at 10 treatment programs in Burundi, Cameroon, and the Democratic Republic of Congo. We compared characteristics of those aged 50+ with those aged 18–49 using chi-square tests. Logistic regression was used to determine if age was associated with medication adherence. Results. 15% of adults were 50+ years. Those aged 50+ were more evenly distributed between women and men (56% versus 44%) as compared to those aged 18–49 (71% versus 29%) and were more likely to be hypertensive (8% versus 3%) (P < 0.05). Those aged 50+ were more likely to be adherent to their medications than those aged 18–49 (P < 0.001). Adults who were not heavy drinkers reported better adherence as compared to those who reported drinking three or more alcoholic beverages per day (P < 0.001). Conclusions. Older adults differed from their younger counterparts in terms of medication adherence, sociodemographic, behavioral, and clinical characteristics

Adult HIV care resources, management practices and patient characteristics in the Phase 1 IeDEA Central Africa cohort

Introduction: Despite recent advances in the management of HIV infection and increased access to treatment, prevention, care and support, the HIV/AIDS epidemic continues to be a major global health problem, with sub-Saharan Africa suffering by far the greatest humanitarian, demographic and socio-economic burden of the epidemic. Information on HIV/AIDS clinical care and established cohorts&#x2019; characteristics in the Central Africa region are sparse. Methods: A survey of clinical care resources, management practices and patient characteristics was undertaken among 12 adult HIV care sites in four countries of the International Epidemiologic Databases to Evaluate AIDS Central Africa (IeDEA-CA) Phase 1 regional network in October 2009. These facilities served predominantly urban populations and offered primary care in the Democratic Republic of Congo (DRC; six sites), secondary care in Rwanda (two sites) and tertiary care in Cameroon (three sites) and Burundi (one site). Results: Despite some variation in facility characteristics, sites reported high levels of monitoring resources, including electronic databases, as well as linkages to prevention of mother-to-child HIV transmission programs. At the time of the survey, there were 21,599 HIV-positive adults (median age=37 years) enrolled in the clinical cohort. Though two-thirds were women, few adults (6.5%) entered HIV care through prevention of mother-to-child transmission services, whereas 55% of the cohort entered care through voluntary counselling and testing. Two-thirds of patients at sites in Cameroon and DRC were in WHO Stage III and IV at baseline, whereas nearly all patients in the Rwanda facilities with clinical stage information available were in Stage I and II. WHO criteria were used for antiretroviral therapy initiation. The most common treatment regimen was stavudine/lamivudine/nevirapine (64%), followed by zidovudine/lamivudine/nevirapine (19%). Conclusions: Our findings demonstrate the feasibility of establishing large clinical cohorts of HIV-positive individuals in a relatively short amount of time in spite of challenges experienced by clinics in resource-limited settings such as those in this region. Country differences in the cohort&#x0027;s site and patient characteristics were noted. This information sets the stage for the development of research initiatives and additional programs to enhance adult HIV care and treatment in Central Africa

Vulnerability factors for malnutrition among people living with HIV under antiretroviral treatment in an outpatient clinic: Kinshasa, Democratic Republic of Congo

Background Significant progress has been made in the fight against HIV/AIDS across the world. However, in sub-Saharan countries, there remain numerous obstacles to achieving treatment goals. The aim of this study was to identify factors underlying vulnerability to malnutrition among people living with HIV (PLWHIV) under antiretroviral treatment (ART) in resource-limited settings. Methods A cross-sectional study was carried out in May 2010 in Kinshasa, the capital of the Democratic Republic of Congo. Baseline characteristics of PLWHIV were analyzed, and statistical analyses were performed in order to compare proportions of low weight, low mid-upper arm circumference, and low body mass index. Further analyses were performed to compare means of anthropometric characteristics according to sociodemographic, socioeconomic, and clinical characteristics. Multiple regression analyses were used to assess vulnerability determinants for malnutrition following adjustment. Results We identified specific sociodemographic characteristics, socioeconomic level and clinical characteristics (i.e. autonomous activity, appetite, asthenia level, and HIV clinical stage) that were significantly associated with malnutrition in PLWHIV. Conclusions Determining factors underlying vulnerability to malnutrition may be helpful to health providers in poor income settings for more effectively target patient interventions. © 2013 Polish AIDS Research Society.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Impact of Moringa oleifera lam. Leaf powder supplementation versus nutritional counseling on the body mass index and immune response of HIV patients on antiretroviral therapy: A single-blind randomized control trial

Background: To achieve effective antiretroviral therapy (ART) outcomes, adherence to an antiretroviral regimen and a good immunometabolic response are essential. Food insecurity can act as a real barrier to adherence to both of these factors. Many people living with human immunodeficiency virus (PLHIV) treated with ART in the Democratic Republic of the Congo (DRC) are faced with nutritional challenges. A significant proportion are affected by under nutrition, which frequently leads to therapeutic failure. Some HIV care facilities recommend supplementation with Moringa oleifera (M.O.) Lam. leaf powder to combat marginal and major nutritional deficiencies. This study aims to assess the impact of M.O. Lam. leaf powder supplementation compared to nutritional counseling on the nutritional and immune status of PLHIV treated with ART. Methods: A single-blind randomized control trial was carried out from May to September 2013 at an outpatient clinic for HIV-infected patients in Kinshasa (DRC). Sixty adult patients who were at stable HIV/AIDS clinical staging 2, 3 or 4 according to the World Health Organization (WHO), and were undergoing ART were recruited. After random allocation, 30 patients in the Moringa intervention group (MG) received the M.O. Lam. leaf powder daily over 6 months, and 30 in the control group (CG) received nutritional counseling over the same period. Changes in the body mass index (BMI) were measured monthly and biological parameters were measured upon admission and at the end of the study for the patients in both groups. Results: The two study groups were similar in terms of long-term nutritional exposure, sociodemographic, socioeconomic, clinical, and biological features. At 6 months follow-up, patients in the MG exhibited a significantly greater increase in BMI and albumin levels than those in the CG. The interaction between the sociodemographic, clinical, and biological characteristics of patients in the two groups was not significant, with the exception of professional activity. Conclusions: Under medical supervision, M.O. Lam. leaf powder supplementation may represent a readily available and effective local solution to improve the nutritional intake and nutritional status of PLHIV undergoing ART. Trial registration: The study was retrospectively registered in the Pan African Clinical Trial Registry on 15 May 2015, no. PACTR201505001076143.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Vulnerability factors for malnutrition among people living with HIV under antiretroviral treatment in an outpatient clinic: Kinshasa, Democratic Republic of Congo

AbstractBackgroundSignificant progress has been made in the fight against HIV/AIDS across the world. However, in sub-Saharan countries, there remain numerous obstacles to achieving treatment goals. The aim of this study was to identify factors underlying vulnerability to malnutrition among people living with HIV (PLWHIV) under antiretroviral treatment (ART) in resource-limited settings.MethodsA cross-sectional study was carried out in May 2010 in Kinshasa, the capital of the Democratic Republic of Congo. Baseline characteristics of PLWHIV were analyzed, and statistical analyses were performed in order to compare proportions of low weight, low mid-upper arm circumference, and low body mass index. Further analyses were performed to compare means of anthropometric characteristics according to sociodemographic, socioeconomic, and clinical characteristics. Multiple regression analyses were used to assess vulnerability determinants for malnutrition following adjustment.ResultsWe identified specific sociodemographic characteristics, socioeconomic level and clinical characteristics (i.e. autonomous activity, appetite, asthenia level, and HIV clinical stage) that were significantly associated with malnutrition in PLWHIV.ConclusionsDetermining factors underlying vulnerability to malnutrition may be helpful to health providers in poor income settings for more effectively target patient interventions.info:eu-repo/semantics/publishe

Profil comparatif et évolutif des personnes infectées par le virus de l'immunodéficience humaine traitées aux antirétroviraux à Kinshasa, République Démocratique du Congo.

info:eu-repo/semantics/publishe

Proportion of patients discontinuing from the AmoCongo ART program over time.

<p>Proportion of patients discontinuing from the AmoCongo ART program over time.</p