Aids

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Effect of Cell Age and Membrane Rigidity on Red Blood Cell Shape in Capillary Flow

Blood flow in the microcirculatory system is crucially affected by intrinsic red blood cell (RBC) properties, such as their deformability. In the smallest vessels of this network, RBCs adapt their shapes to the flow conditions. Although it is known that the age of RBCs modifies their physical properties, such as increased cytosol viscosity and altered viscoelastic membrane properties, the evolution of their shape-adapting abilities during senescence remains unclear. In this study, we investigated the effect of RBC properties on the microcapillary in vitro flow behavior and their characteristic shapes in microfluidic channels. For this, we fractioned RBCs from healthy donors according to their age. Moreover, the membranes of fresh RBCs were chemically rigidified using diamide to study the effect of isolated graded-membrane rigidity. Our results show that a fraction of stable, asymmetric, off-centered slipper-like cells at high velocities decreases with increasing age or diamide concentration. However, while old cells form an enhanced number of stable symmetric croissants at the channel centerline, this shape class is suppressed for purely rigidified cells with diamide. Our study provides further knowledge about the distinct effects of age-related changes of intrinsic cell properties on the single-cell flow behavior of RBCs in confined flows due to inter-cellular age-related cell heterogeneity

BMJ Open

To describe sexual and reproductive health (SRH) needs of female sex workers (FSWs) to inform the future implementation of pre-exposure prophylaxis (PrEP) for HIV prevention in this population. The ANRS 12361 PrEP-CI cross-sectional and mixed-methods study was designed and implemented with two community-based organisations in Côte d'Ivoire. A convenience sample of 1000 FSWs aged ≥18, not known as HIV-positive, completed a standardised questionnaire assessing sociodemographic characteristics, sexual practices, use of community health services and a priori acceptability of PrEP. Twenty-two indepth interviews and eight focus group discussions were also conducted to document FSWs' risky practices and sexual behaviours, experiences with violence and discrimination, attitudes regarding HIV and sexually transmitted infections (STIs), and barriers to SRH services. Although 87% described consistent condom use with clients, more than 22% declared accepting condomless sexual intercourse for a large sum of money. Furthermore, condom use with their steady partner and knowledge of their partner's HIV status were low despite their acknowledged concurrent sexual partnerships. While inconsistent condom use exposed FSWs to STIs and undesired pregnancies, the prevalence of contraceptive strategies other than condoms was low (39%) due to fear of contraception causing sterility. FSWs faced obstacles to accessing SRH care and preferred advice from their peers or self-medication. Despite adoption of preventive behaviour in most cases, FSWs are still highly exposed to HIV. Furthermore, FSWs seem to face several barriers to accessing SRH. Implementing PrEP among FSWs in West Africa, such as in Côte d'Ivoire, constitutes an opportunity to consider the regular follow-up of HIV-negative FSWs. PrEP initiation should not condition access to SRH services; conversely, SRH services could be a way to attract FSWs into HIV prevention. Our results highlight the importance of developing a people-focused approach that integrates all SRH needs when transitioning from PrEP efficacy trials to implementation

Effect of Cell Age and Membrane Rigidity on Red Blood Cell Shape in Capillary Flow

peer reviewedBlood flow in the microcirculatory system is crucially affected by intrinsic red blood cell (RBC) properties, such as their deformability. In the smallest vessels of this network, RBCs adapt their shapes to the flow conditions. Although it is known that the age of RBCs modifies their physical properties, such as increased cytosol viscosity and altered viscoelastic membrane properties, the evolution of their shape-adapting abilities during senescence remains unclear. In this study, we investigated the effect of RBC properties on the microcapillary in vitro flow behavior and their characteristic shapes in microfluidic channels. For this, we fractioned RBCs from healthy donors according to their age. Moreover, the membranes of fresh RBCs were chemically rigidified using diamide to study the effect of isolated graded-membrane rigidity. Our results show that a fraction of stable, asymmetric, off-centered slipper-like cells at high velocities decreases with increasing age or diamide concentration. However, while old cells form an enhanced number of stable symmetric croissants at the channel centerline, this shape class is suppressed for purely rigidified cells with diamide. Our study provides further knowledge about the distinct effects of age-related changes of intrinsic cell properties on the single-cell flow behavior of RBCs in confined flows due to inter-cellular age-related cell heterogeneity

Retards à l'initiation de la PrEP orale chez les travailleuses du sexe en Côte d'Ivoire (projet ANRS 12381 PRINCESSE)

International audienceObjectifsDécrire les retards et obstacles à l’initiation de la prophylaxie pre-exposition (PrEP) orale des travailleuses du sexe (TS) en Côte d’Ivoire.Matériels et MéthodesLe projet ANRS 12381 PRINCESSE est une cohorte interventionnelle mono-bras, dont les inclusions ont débuté le 26/11/2019, qui vise à évaluer la mise en oeuvre d’une offre de soins globale et communautaire auprès des TS de ≥18 ans dans la région de San Pedro. Il s’organise autour d’une clinique mobile se déplaçant sur 10 sites prostitutionnels (chaque site étant visité toutes les deux semaines) et d’une clinique fixe. La PrEP est proposée à toutes les TS VIH- ; l’initiation est possible après vérification du taux de créatinine (déterminé via un bilan biologique ; résultats valables un mois). L’analyse présentée se limite aux TS VIH- et séronégatives au virus de l’hépatite B (AgHBs-) incluses jusqu’au 30/09/21, et décrit ce qu’il s’est passé entre l’intérêt exprimé pour la PrEP et la prescription de la PrEP (ou la fin de suivi). La probabilité d’initiation de la PrEP après avoir exprimé son intérêt est décrite via une courbe de Kaplan-Meier censurée au 23/11/21 (une analyse censurée à la date de dernière visite a aussi été conduite).RésultatsParmi les 362 TS étaient incluses dans la cohorte PRINCESSE, 302 étaient VIH-/AgHBs-. Sur les 296 TS à qui la PrEP a été présentée (95,2% à l’inclusion), 292 se sont déclarées intéressées (99,7% le jour même). Parmi elles, 192 (65,8% des TS intéressées) ont reçu une prescription de PrEP : 18 le jour même de l’intérêt exprimé (le bilan biologique ayant été réalisé lors d’une précédente visite), 148 lors de la visite suivante (délai médian depuis l’intérêt : 3 semaines [Intervalle Inter-Quartile : 2-6]) et 26 lors d’une visite ultérieure (délai médian : 20 semaines [9-36], soit parce qu’elles n’étaient temporairement plus intéressées (n=3), soit parce qu’elles sont revenues tardivement). Au final, la probabilité deprescription de la PrEP après avoir exprimé son intérêt est de 39,0% à 1 mois et de 56,6% à 3 mois (en censurant sur la date de dernière visite, ces proportions sont respectivement de 50,7% et 74,6%). Parmi les 100 TS qui n’ont pas initié la PrEP malgré un intérêt exprimé, 68 n’ont jamais été revues dans le projet ; parmi les 32 TS qui sont revenues à au moins une deuxième visite suivant leur intérêt pour la PrEP, 4 ont déclaré ne plus être intéressées par la PrEP (délai médian depuis l’intérêt : 12 semaines [10-19]), 1 a été dépistée VIH+ (délai de 2 semaines) et 27 sont revenues plus d’un mois après (leur bilan biologique n’était plus valable).ConclusionMalgré un fort intérêt exprimé pour la PrEP, son initiation reste sous-optimale parmi les TS de PRINCESSE. Les premières analyses exploratoires et discussions avec les équipes terrain suggèrent plusieurs obstacles (mobilité des TS, intérêt mal perçu pour la PrEP, lourdeur du suivi, fidélité des sorties de la clinique mobile), et confirment la nécessité de trouver des solutions adaptées pour rendre la PrEP effective chez les TS

Evaluation des connaissances des etudiants sur la gestion des déchets biomédicaux solides au Centre De Consultations et de Traitements Odonto-Stomatologiques (CCTOS) du Centre Hospitalier Universitaire de Cocody, Abidjan, Cote D’ivoire : Evaluation des connaissances des etudiants sur la gestion des déchets biomédicaux solides au Centre De Consultations et de Traitements Odonto-Stomatologiques (CCTOS) du Centre Hospitalier Universitaire de Cocody, Abidjan, Cote D’ivoire

Introduction Les déchets biomédicaux sont les déchets issus d’activités de diagnostic, de suivi et de traitement préventif, curatif ou palliatif dans les domaines de la médecine humaine et vétérinaire. L’objectif de cette étude était de décrire le niveau de connaissance des étudiants cliniciens du Centre de Consultations et de Traitements Odonto-Stomatologiques (CCTOS) sur la gestion des déchets médicaux solides.Méthodes Il s’agit d’une étude transversale descriptive. L’évaluation a concerné les connaissances des étudiants de l’Unité de Formation et de Recherche Odonto-Stomatologique (UFROS) sur la gestion des déchets biomédicaux solides au CCTOS.Résultats La population d’étude était constituée de 44 étudiants. Le sexe masculin était le plus représentatif avec un pourcentage de 70,5 %. Du point de vue de la formation, 68,2 % des étudiants n’avaient jamais reçu de formation en gestion des déchets biomédicaux. En ce qui concerne la connaissance, la majorité des étudiants (56,8%) ne connaissaient pas avec exactitude la définition de déchet biomédical. Les différentes étapes de la filière d’élimination n’étaient pas connues chez 52,3% des étudiants. Les résultats concernant le tri à la source de production, ont montré que pour 79,6% des étudiants, le praticien ne devrait pas faire de tri.Conclusion Il ressort de cette étude un déficit général du niveau de connaissance des étudiants en matière de gestion des déchets biomédicaux. Cela requiert un besoin d’amélioration de leur niveau de formation en matière de gestion des déchets biomédicaux. Ceci passe par l’intensification des cours de gestion des déchets biomédicaux en formation initiale des étudiants cliniciens. Introduction Biomedical waste is waste from diagnostic, monitoring and preventive, curative or palliative treatment activities in the fields of human and veterinary medicine. The objective of this study was to describe the level of knowledge of student clinicians at the Centre de Consultations et de Treatments Odonto-Stomatologiques (CCTOS) on the management of solid medical waste.Methods This is a descriptive cross-sectional study. The evaluation concerned the knowledge of the students of the Odonto-Stomatological Training and Research Unit (UFROS) on the management of solid biomedical waste at the CCTOS.Results The study population consisted of 44 students. The male gender was the most representative with a percentage of 70.5%. From a training perspective, 68.2% of the students had never received training in biomedical waste management. In terms of knowledge, the majority of students (56.8%) did not know the exact definition of biomedical waste. The different stages of the disposal process were not known by 52.3% of the students. The results concerning the sorting at the source of production, showed that for 79.6% of the students, the practitioner should not sort.Conclusion This study shows a general deficit in the level of knowledge of students in biomedical waste management. This calls for a need to improve their level of training in biomedical waste management. This requires the intensification of biomedical waste management courses in the initial training of clinical students

Trends in HIV Testing, the Treatment Cascade, and HIV Incidence among Men Who Have Sex with Men in Africa: A Systematic Review and Meta-Regression Analysis

Background Gay, bisexual, and other men who have sex with men (MSM) are disproportionately affected by HIV. In Africa, MSM face structural barriers to HIV prevention and treatment including socio-economic disadvantages, stigma, and criminalization that increase their vulnerability to HIV acquisition and transmission and undermine progress towards ending AIDS. This systematic review explores progress towards increases in HIV testing, improving engagement in the HIV treatment cascade, and HIV incidence reductions among MSM in Africa. Methods We searched Embase, Medline, Global Health, Scopus, and Web of Science from January 1980-March 2022 for cross-sectional and longitudinal studies reporting HIV testing, knowledge of status, care, antiretroviral therapy (ART) use, viral suppression, and/or HIV incidence among MSM in Africa. We pooled surveys using Bayesian generalized linear mixed-effects models, used meta-regression to assess time trends, and compared HIV incidence estimates among MSM with those of all men. Findings Of 8,992 articles identified, we included 148 unique studies published from 2005-2022. HIV testing increased over time in Central/Western and Eastern Africa and in 2020, we estimate that 88% (95% credible interval (CrI) 57-97%) of MSM had tested in the past 12 months, but 66% (19-94%) of MSM living with HIV knew their HIV status, although this is probably underestimated given non-disclosure. Current ART use increased over time in Central/Western (ORyear=1.4, 95%CrI 1.1-2.0, N=8) and Eastern/Southern Africa (ORyear=1.4, 1.0-1.8, N=17) and in 2020 we estimate that 75% (18-98%) of MSM living with HIV in Africa were currently on ART. Nevertheless, we did not find strong evidence viral suppression increased, and in 2020 we estimate that only 62% (12-95%) of MSM living with HIV were virally suppressed. HIV incidence among MSM did not decrease over time (IRRyear=1.0, 0.7-1.3, N=38) and remained high in 2020 (5.4 per 100 person-years, 0.9-33.9) and substantially higher (27-150 times higher) than among all men. Interpretation No decreases in HIV incidence have been observed among MSM in Africa over time, despite some increases in HIV testing and ART use. Achieving the UNAIDS 95-95-95 targets for diagnosis, treatment, and viral suppression equitably for all requires renewed focus on this key population. Combination interventions for MSM are urgently required to reduce disparities in HIV incidence and tackle the social, structural, and behavioural factors that make MSM vulnerable to HIV acquisition. Funding US National Institutes of Health, UK Medical Research Council, Canadian Institutes of Health Research, Fonds de Recherche du Quebec - Sante