Lenteur de propagation de la COVID-19 en Afrique subsaharienne : réalité ou sommet de l’iceberg ? Cas de la République Démocratique du Congo

Monsieur l’Editeur. Après la Chine, l’Europe et les Etats Unis d’Amérique, l’Afrique Subsaharienne (ASS) connait, depuis mars 2020, l’épidémie à COVID-19. Avant l’arrivée de cette épidémie, l’Organisation Mondiale de la Santé (OMS) et les Experts en santé prédisaient tous une propagation fulgurante de la COVID-19 en ASS avec une mortalité sans précédent (1-3). Cette prédiction apocalyptique de l’impact de l’épidémie à COVID-19 en ASS était fondée sur la conjonction de plusieurs facteurs de vulnérabilité incluant, entre autres, la fragilité du système de santé et de l’économie, la promiscuité interindividuelle et la pauvreté extrême des populations vivant au jour le jour sans provisions, l’endémicité de certaines pathologies chroniques pouvant faire le lit de la COVID-19, telles que l’infection à VIH/SIDA, le paludisme, la drépanocytose, la malnutrition (4-8), l’accès limité à l’eau potable et aux médicaments essentiels, le déni de la maladie lié à un taux élevé d’analphabétisme et les échanges commerciaux intenses avec des pays asiatiques et européens, tels que la Chine, la France, la Belgique et l’Italie (1). Cependant, force est de constater qu’après 8 semaines d’épidémie, la propagation de l’infection à virus « SARS-CoV-2 » et la maladie COVID-19 subséquente ne semble pas corroborer les prévisions et les projections faites en référence à l’épidémie en cours dans les pays cités ci-dessus (2). La propagation de l’épidémie à COVID-19 dans les pays de l’ASS parait moins rapide et peu mortelle avec des différences notables entre les pays (9). En effet, selon le rapport de l’OMS du 2 mai 2020, le nombre de cas biologiquement confirmés et de décès était estimé, après 8 semaines d’épidémie, à 27,973 cas et 1,013, soit une létalité de 3,6 % (10) avec l’Afrique Sud portant le plus lourd fardeau de la COVID-19. Dear Editor, following China, European countries like France and Italy, and United States of America (USA), sub-Saharan African (SSA) countries are experiencing since March 2020 the epidemic of COVID-19. Before the occurrence of the epidemics, World Health Organization (WHO) Experts expected an exponential progression of COVID-19 with unprecedented number of deaths (1-3). Factors underlying this apocalyptic prediction included the weakness of health systems and economy, the high rate of illiteracy and poverty as well as the social promiscuity precluding the effective adoption of barriers measures against COVID-19 by communities most of which living with less than one USD, the coexistence of endemic diseases, such as malaria, tuberculosis, HIV/AIDS, malnutrition, sickle cell disease that can accelerate the development and progression of COVID-19 (4-8), and the intensive commercial exchanges between SSA countries and China as well as European countries like France and Italy (1). In face of this expected apocalyptic picture, WHO Experts urged SSA Governments to anticipate on the negative health, social and economic impact of COVID-19 by learning from the experience gained by China and other countries and thus prepare and organize the response against this epidemic (1-3). However, eight weeks (May 2020) after the start of the epidemics in SSA, the rate of progression of COVID-19 and subsequent mortality appear to not corroborate the expected apocalyptic prediction of WHO Experts in comparison with the picture seen in aforementioned countries (2). Indeed, the rate of progression of COVID-19 in SSA is low with fewer deaths compared to that of European and Asian countries as well as USA

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

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

peer reviewe

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

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

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

Human Immunodeficiency Virus Viral Load Monitoring and Rate of Virologic Suppression Among Patients Receiving Antiretroviral Therapy in Democratic Republic of the Congo, 2013-2020.

peer reviewedBACKGROUND: Antiretroviral therapy (ART) expansion and viral load as a treatment monitoring approach have increased the demand for viral load testing. Many hurdles affect the coverage, quality, and use of viral load results. Estimates of viral load monitoring and viral suppression rates are needed to assess the performance of ART programs and improve human immunodeficiency virus (HIV) management outcomes. METHODS: People with HIV (PWH) viral load monitoring data were routinely collected in 84 health facilities in Kinshasa, Democratic Republic of the Congo (DRC), between 2013 and 2020. The number of PWH under ART, the number of participants with at least 1 viral load test result, the rate of viral suppression (defined as ≤1000 HIV ribonucleic acid copies per mL), and the mean turnaround time from sample collection to release of viral load test results were collected together with clinical data. RESULTS: A total of 14 057 PWH were included in the analysis. People with HIV were mainly enrolled after the "test and treat" implementation. The patients were followed for a median period of 27 months. The proportion of PWH with at least 1 available viral load largely increased in recent years. The delay from sample collection to release of viral load test results decreased overtime, from 35 days in 2018 to 16 days in 2020. Pregnancy and advanced HIV disease were associated with a lower chance of viral suppression. CONCLUSIONS: There has been considerable success in increasing viral load access for all PWH under therapy in DRC. Nevertheless, viral load testing should be intensified with a particular effort to be made in groups at higher risk of viral failure

Epidemiological, clinical Characteristics and mortality of patients Infected with SARS-CoV-2 Admitted to Kinshasa University Hospital (KUH), the Democratic Republic of the Congo from March 24th, 2020, to January 30th, 2021: Two waves, two faces?

Context and objective: Like all epidemics, the COVID-19 pandemic occurs in several highly diverse waves. The objective of the present study was to&nbsp; compare the demographic and clinical characteristics and mortality of patients between the first and second waves of COVID-19. Methods: This was a historical follow-up study conducted at the Kinshasa University Hospital (KUH) between March 2020 and January 2021. We used&nbsp; the χ² test to compare proportions. Survival was described by the Kaplan Meier method. Cox regression was used to identify independent&nbsp; predictors of mortality. Results: A total of 411 COVID-19 patients were enrolled. Compared to wave 1 patients, wave 2 patients were significantly&nbsp; older (52.4 ±17.5 vs. 58.1 ±15.7; p=0.026). The death rate of patients in the first wave was higher than in the second wave (p=0.009). Survival was&nbsp; more reduced in the first wave compared with the second wave. Predictors of mortality present in both the first and second waves were respiratory&nbsp; distress and severe COVID-19 stage. Conclusion: The first wave was more lethal than the second wave with respiratory distress and severe COVID-19&nbsp; stage as independent predictors in both waves. Strengthening the health system and raising awareness of preventive measures including&nbsp; vaccination should continue to sustain gains.&nbsp; &nbsp; French title: Caractéristiques épidémiologiques, cliniques et mortalité des patients infectés par le SRAS-CoV-2 admis aux Cliniques Universitaires&nbsp; de Kinshasa, République démocratique du Congo du 24 mars 2020 au 30 janvier 2021 : Deux vagues, deux visages ? Contexte et objectif: Comme toutes les épidemies, la pandémie à COVID-19 sévit en plusieurs vagues très diversifiées. L’étude a comparé les&nbsp; caractéristiques démographiques et cliniques ainsi que la mortalité des patients entre la 1ère et la 2ème vague de COVID-19. Méthodes: Il s’agissait&nbsp; d’une étude de suivi historique réalisée aux Cliniques Universitaires de Kinshasa entre mars 2020 et janvier 2021. Le test de χ² a permis la&nbsp; comparaison des proportions, et la la survie a été étudiée par la méthode de Kaplan Meier. L’identification dess prédicteurs indépendants de la&nbsp; mortalité a été déterminée par la régression de Cox. Résultats: Des 411 patients enrôlés, ceux de la 2ème vague étaient beaucoup plus âgés ((58,1 ±15,7 vs 52,4 ±17,5 ; p=0,026). La 1ère vague a été&nbsp; plus meurtrière que la seconde (p=0,009). La survie était plus réduite dans la première vague par rapport à la seconde. Les facteurs prédictifs de&nbsp; mortalité présents à la fois dans la première et la deuxième vague étaient la détresse respiratoire et le stade COVID-19 sévère. Conclusion: La 1ère&nbsp; vague était plus meutrière que la 2ème avec comme prédicteurs indépendants la détresse respiratoire et le stade COVID-19 sévère dans les deux&nbsp; vagues. Le renforcement du système de santé et la sensibilisation sur les mésures préventives dont la vaccination devraient continuer à maintenir&nbsp; les gains