Profil épidémiologique de l’infection à VIH au cours d’une campagne de sensibilisation à Yaoundé au Cameroun

Introduction: L'objectif de ce travail était de déterminer le profil épidémiologique de l'infection à VIH/SIDA au cours d'une campagne de sensibilisation à Yaoundé au Cameroun. Méthodes: Après avoir obtenu le consentement éclairé des participants, le dépistage de l'infection par le VIH a été effectué selon l'algorithme de dépistage en série de l'Organisation Mondiale de la Santé (OMS). En outre, un questionnaire socio-comportemental a été proposé à chaque participant. Résultats: Au total, 911 personnes ont été dépistées. La prévalence de l'infection par le VIH était de 2.6%. Elle était 3 fois plus élevée parmi les femmes (RC=3.22, IC (1.26 - 8.18). Les prévalences les plus élevées ont été observées chez les personnes de plus de 45 ans (p=0.01), les personnes sans emploi (p<0.001) et les veufs/veuves (p=0.02). Plus de 80% des participants trouvaient le test de dépistage nécessaire et 76,2% l'avaient déjà effectué au moins une fois auparavant. Il s'agissait principalement de femmes (p=0.02), d'étudiants (p<0.001) et des personnes âgées de 25 à 34 ans (p<0.001). Les personnes séropositives avaient moins tendance à retirer leur résultat (p=0.01). Conclusion: Il apparait urgent d'intensifier les campagnes de dépistage de l'infection par le VIH en ciblant davantage des groupes particuliers tels que les élèves, les personnes âgées et les veufs/veuves, tout en recherchant les facteurs pouvant favoriser la propagation de l'infection dans ces groupes.Key words: Dépistage du VIH, prévalence, profil épidémiologique, campagne de sensibilisatio

Séroprévalence et facteurs associés au VIH et aux hépatites virales B et C dans la ville de Bafoussam au Cameroun

Introduction: L'objectif de ce travail était de déterminer la séroprévalence et les facteurs associés au VIH et aux hépatites virales B et C dans laville de Bafoussam au Cameroun. Méthodes: Il s'agissait d'une étude descriptive et analytique réalisée de février 2012 à Juin 2012 dans la ville de Bafoussam au Cameroun. Pour cette étude, nous avons obtenu une clairance éthique.Résultats: Au total, 982 personnes ont été dépistées pour le VIH et les hépatites virales B et C. Les femmes représentaient 56,3% des personnes dépistées. La tranche d'âge la plus représentée était celle des 20 à 24 ans. L'âge médian était de 34,5 ans. Les prévalences du VIH, de l'AgHBs, et de l'Ac anti HCV étaient respectivement de 6,0%, 4,1%, et 0,4%. La prévalence du VIH était 2 fois plus élevée parmi les femmes que les hommes avec 8,1% contre 3,5% (p=0,01). Les prévalences les plus élevées ont été observées chez les personnes de 30 à 34 ans, 40 à 44 ans avec 15,0% et 11,5% (p=0,01), les personnes sans emploi avec 11,1% (p<0,001) et les personnes en union libre avec 17,9% (p=0,000). La  prévalence du VIH n'était pas directement liée aux comportements et pratiques sexuels de la population de l'étude. On enregistrait une  prévalence élevée de 29,3% chez les individus ayant déclaré avoir au moins une infection sexuellement transmissible (p=0,000). Conclusion: Il apparait urgent de mettre en place des stratégies de prévention contre le VIH, les hépatites virales et les facteurs associés au Cameroun

Evaluation of the single platform Muse® Auto CD4/CD4 % system in Cameroon

Background: according to who revised guidelines for scaling up antiretroviral therapy (ART) in adults and children living in resource-limited settings, there is an urgent need for laboratory monitoring, including the numeration of CD4 T cells.Objective: the study compared the muse® auto CD4/CD4% System for CD4 t cell enumeration in absolute counts and in percentages, to the Guava® AutoD4/CD4% System.Design: This was a prospective study using adults, adolescents, children and infant’s samples.Setting: The Centre International de Diagnostic Medical (CIDM), Yaounde, a research laboratory devoted to HIV screening and monitoring affiliated to the University of Yaounde I.Subjects: K3-EDTA-blood samples from 111 patients (77 adults, 12 adolescents, 18 children and 4 infants) were collected and tested. All participants signed an informed consent form whereas the guardian and parent of children signed the assent form.Results: the absolute CD4 t lymphocyte counts as well as the percentage CD4 lymphocyte of the Muse® AutoCD4/CD4% and GuavaAutoCD4/CD4% Systems, were highly correlated with an interclass correlation coefficient of 0.997 (95%CI: 0.996-0.998) and 0.991 (95% CI: 0.987-0.994) respectively. The Bland-Altman analysis limits of agreement were -5.79 cells/μl (95%CI: [-97.77; 86.19]) for the absolute CD4 T lymphocyte counts and -1.93 (95%CI: [-7.29; – 3.43]) for CD4 T lymphocyte percentage. The numbers of outliers were similar (6/111=5.41%) both for CD4 T lymphocyte counts and percentage. In addition, Cohen’s Kappa ranged from 0.95 to 1 according to CD4 T lymphocyte counts thresholds (p<0.001), showing agreement between both methods. Conclusion: this study demonstrates that the muse™ auto CD4/CD4% system constitutes a promising system for CD4 t cell counting comparable to existing reference methods, and should facilitate wider access to CD4 T cell enumeration for adults and children with HIV infection living in resource-limited countries

Distribution épidémiologique de l’infection à VIH chez les femmes enceintes dans les dix régions du Cameroun et implications stratégiques pour les programmes de prévention

Introduction: le Cameroun se situe dans un contexte d'épidémie  généralisée du VIH. La sous-population des femmes enceintes, facilementaccessible au sein de la population générale, représente une cible  robante pour mener la surveillance du VIH et estimer l'évolution épidémiologique. L'objectif de notre étude était d'évaluer la distribution épidémiologique du VIH chez les femmes enceintes.Méthodes: étude transversale menée en 2012 chez 6521 femmes  enceintes (49,3% âgées de 15-24 ans) en première consultation prénatale (CPN1) dans 60 sites des 10 régions Camerounaises. L'algorithme en série a été utilisé pour le sérodiagnostic du VIH.Résultats: la prévalence du VIH était de 7,8% (508/6521), avec une  différence non significative (p=0,297) entre milieu rural (7,4%) et milieu urbain (8,1%). En zone rurale, cette prévalence variait de 0,7% à  l'Extrême-Nord à 11,8% au Sud. Cependant, en zone urbaine elle variait de 4% à l'Ouest à 11,1% au Sud-Ouest. Suivant l'âge, la prévalence était plus élevée (11,3%) chez les femmes de 35-39 ans. Suivant le niveau de scolarisation, la prévalence du VIH était plus faible (4,4%) chez celles non-scolarisées, et plus élevée (9,3%) chez celles ayant un niveau  primaire. Selon la profession, l'infection était plus élevée chez les  coiffeuses (15,5%), secrétaires (14,8%), commerçantes (12,9%) et  institutrices/enseignantes (10,8%). Conclusion: la prévalence du VIH reste élevée chez les femmes enceintes au Cameroun, sans distinction entre milieux rural et urbain. Les stratégies de prévention devraient s'orienter préférentiellement chez les femmes enceintes âgées, celles du niveau d'instruction primaire, et celles du  secteur des petites et moyennes entreprises

Mapping subnational HIV mortality in six Latin American countries with incomplete vital registration systems

Background: Human immunodeficiency virus (HIV) remains a public health priority in Latin America. While the burden of HIV is historically concentrated in urban areas and high-risk groups, subnational estimates that cover multiple countries and years are missing. This paucity is partially due to incomplete vital registration (VR) systems and statistical challenges related to estimating mortality rates in areas with low numbers of HIV deaths. In this analysis, we address this gap and provide novel estimates of the HIV mortality rate and the number of HIV deaths by age group, sex, and municipality in Brazil, Colombia, Costa Rica, Ecuador, Guatemala, and Mexico. Methods: We performed an ecological study using VR data ranging from 2000 to 2017, dependent on individual country data availability. We modeled HIV mortality using a Bayesian spatially explicit mixed-effects regression model that incorporates prior information on VR completeness. We calibrated our results to the Global Burden of Disease Study 2017. Results: All countries displayed over a 40-fold difference in HIV mortality between municipalities with the highest and lowest age-standardized HIV mortality rate in the last year of study for men, and over a 20-fold difference for women. Despite decreases in national HIV mortality in all countries—apart from Ecuador—across the period of study, we found broad variation in relative changes in HIV mortality at the municipality level and increasing relative inequality over time in all countries. In all six countries included in this analysis, 50% or more HIV deaths were concentrated in fewer than 10% of municipalities in the latest year of study. In addition, national age patterns reflected shifts in mortality to older age groups—the median age group among decedents ranged from 30 to 45 years of age at the municipality level in Brazil, Colombia, and Mexico in 2017. Conclusions: Our subnational estimates of HIV mortality revealed significant spatial variation and diverging local trends in HIV mortality over time and by age. This analysis provides a framework for incorporating data and uncertainty from incomplete VR systems and can help guide more geographically precise public health intervention to support HIV-related care and reduce HIV-related deaths

Global, regional, and national sex-specific burden and control of the HIV epidemic, 1990–2019, for 204 countries and territories: the Global Burden of Diseases Study 2019

Background: The sustainable development goals (SDGs) aim to end HIV/AIDS as a public health threat by 2030. Understanding the current state of the HIV epidemic and its change over time is essential to this effort. This study assesses the current sex-specific HIV burden in 204 countries and territories and measures progress in the control of the epidemic. Methods: To estimate age-specific and sex-specific trends in 48 of 204 countries, we extended the Estimation and Projection Package Age-Sex Model to also implement the spectrum paediatric model. We used this model in cases where age and sex specific HIV-seroprevalence surveys and antenatal care-clinic sentinel surveillance data were available. For the remaining 156 of 204 locations, we developed a cohort-incidence bias adjustment to derive incidence as a function of cause-of-death data from vital registration systems. The incidence was input to a custom Spectrum model. To assess progress, we measured the percentage change in incident cases and deaths between 2010 and 2019 (threshold >75% decline), the ratio of incident cases to number of people living with HIV (incidence-to-prevalence ratio threshold <0·03), and the ratio of incident cases to deaths (incidence-to-mortality ratio threshold <1·0). Findings: In 2019, there were 36·8 million (95% uncertainty interval [UI] 35·1–38·9) people living with HIV worldwide. There were 0·84 males (95% UI 0·78–0·91) per female living with HIV in 2019, 0·99 male infections (0·91–1·10) for every female infection, and 1·02 male deaths (0·95–1·10) per female death. Global progress in incident cases and deaths between 2010 and 2019 was driven by sub-Saharan Africa (with a 28·52% decrease in incident cases, 95% UI 19·58–35·43, and a 39·66% decrease in deaths, 36·49–42·36). Elsewhere, the incidence remained stable or increased, whereas deaths generally decreased. In 2019, the global incidence-to-prevalence ratio was 0·05 (95% UI 0·05–0·06) and the global incidence-to-mortality ratio was 1·94 (1·76–2·12). No regions met suggested thresholds for progress. Interpretation: Sub-Saharan Africa had both the highest HIV burden and the greatest progress between 1990 and 2019. The number of incident cases and deaths in males and females approached parity in 2019, although there remained more females with HIV than males with HIV. Globally, the HIV epidemic is far from the UNAIDS benchmarks on progress metrics. Funding: The Bill & Melinda Gates Foundation, the National Institute of Mental Health of the US National Institutes of Health (NIH), and the National Institute on Aging of the NIH

Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990–2019 : a systematic analysis for the Global Burden of Disease Study 2019

Background: Achieving universal health coverage (UHC) involves all people receiving the health services they need, of high quality, without experiencing financial hardship. Making progress towards UHC is a policy priority for both countries and global institutions, as highlighted by the agenda of the UN Sustainable Development Goals (SDGs) and WHO's Thirteenth General Programme of Work (GPW13). Measuring effective coverage at the health-system level is important for understanding whether health services are aligned with countries' health profiles and are of sufficient quality to produce health gains for populations of all ages. Methods: Based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we assessed UHC effective coverage for 204 countries and territories from 1990 to 2019. Drawing from a measurement framework developed through WHO's GPW13 consultation, we mapped 23 effective coverage indicators to a matrix representing health service types (eg, promotion, prevention, and treatment) and five population-age groups spanning from reproductive and newborn to older adults (>= 65 years). Effective coverage indicators were based on intervention coverage or outcome-based measures such as mortality-to-incidence ratios to approximate access to quality care; outcome-based measures were transformed to values on a scale of 0-100 based on the 2.5th and 97.5th percentile of location-year values. We constructed the UHC effective coverage index by weighting each effective coverage indicator relative to its associated potential health gains, as measured by disability-adjusted life-years for each location-year and population-age group. For three tests of validity (content, known-groups, and convergent), UHC effective coverage index performance was generally better than that of other UHC service coverage indices from WHO (ie, the current metric for SDG indicator 3.8.1 on UHC service coverage), the World Bank, and GBD 2017. We quantified frontiers of UHC effective coverage performance on the basis of pooled health spending per capita, representing UHC effective coverage index levels achieved in 2019 relative to country-level government health spending, prepaid private expenditures, and development assistance for health. To assess current trajectories towards the GPW13 UHC billion target-1 billion more people benefiting from UHC by 2023-we estimated additional population equivalents with UHC effective coverage from 2018 to 2023. Findings: Globally, performance on the UHC effective coverage index improved from 45.8 (95% uncertainty interval 44.2-47.5) in 1990 to 60.3 (58.7-61.9) in 2019, yet country-level UHC effective coverage in 2019 still spanned from 95 or higher in Japan and Iceland to lower than 25 in Somalia and the Central African Republic. Since 2010, sub-Saharan Africa showed accelerated gains on the UHC effective coverage index (at an average increase of 2.6% [1.9-3.3] per year up to 2019); by contrast, most other GBD super-regions had slowed rates of progress in 2010-2019 relative to 1990-2010. Many countries showed lagging performance on effective coverage indicators for non-communicable diseases relative to those for communicable diseases and maternal and child health, despite non-communicable diseases accounting for a greater proportion of potential health gains in 2019, suggesting that many health systems are not keeping pace with the rising non-communicable disease burden and associated population health needs. In 2019, the UHC effective coverage index was associated with pooled health spending per capita (r=0.79), although countries across the development spectrum had much lower UHC effective coverage than is potentially achievable relative to their health spending. Under maximum efficiency of translating health spending into UHC effective coverage performance, countries would need to reach $1398 pooled health spending per capita (US$ adjusted for purchasing power parity) in order to achieve 80 on the UHC effective coverage index. From 2018 to 2023, an estimated 388.9 million (358.6-421.3) more population equivalents would have UHC effective coverage, falling well short of the GPW13 target of 1 billion more people benefiting from UHC during this time. Current projections point to an estimated 3.1 billion (3.0-3.2) population equivalents still lacking UHC effective coverage in 2023, with nearly a third (968.1 million [903.5-1040.3]) residing in south Asia. Interpretation: The present study demonstrates the utility of measuring effective coverage and its role in supporting improved health outcomes for all people-the ultimate goal of UHC and its achievement. Global ambitions to accelerate progress on UHC service coverage are increasingly unlikely unless concerted action on non-communicable diseases occurs and countries can better translate health spending into improved performance. Focusing on effective coverage and accounting for the world's evolving health needs lays the groundwork for better understanding how close-or how far-all populations are in benefiting from UHC

Prevalence, years lived with disability, and trends in anaemia burden by severity and cause, 1990–2021: findings from the Global Burden of Disease Study 2021

Background: Anaemia is a major health problem worldwide. Global estimates of anaemia burden are crucial for developing appropriate interventions to meet current international targets for disease mitigation. We describe the prevalence, years lived with disability, and trends of anaemia and its underlying causes in 204 countries and territories. Methods: We estimated population-level distributions of haemoglobin concentration by age and sex for each location from 1990 to 2021. We then calculated anaemia burden by severity and associated years lived with disability (YLDs). With data on prevalence of the causes of anaemia and associated cause-specific shifts in haemoglobin concentrations, we modelled the proportion of anaemia attributed to 37 underlying causes for all locations, years, and demographics in the Global Burden of Disease Study 2021. Findings: In 2021, the global prevalence of anaemia across all ages was 24·3% (95% uncertainty interval [UI] 23·9–24·7), corresponding to 1·92 billion (1·89–1·95) prevalent cases, compared with a prevalence of 28·2% (27·8–28·5) and 1·50 billion (1·48–1·52) prevalent cases in 1990. Large variations were observed in anaemia burden by age, sex, and geography, with children younger than 5 years, women, and countries in sub-Saharan Africa and south Asia being particularly affected. Anaemia caused 52·0 million (35·1–75·1) YLDs in 2021, and the YLD rate due to anaemia declined with increasing Socio-demographic Index. The most common causes of anaemia YLDs in 2021 were dietary iron deficiency (cause-specific anaemia YLD rate per 100 000 population: 422·4 [95% UI 286·1–612·9]), haemoglobinopathies and haemolytic anaemias (89·0 [58·2–123·7]), and other neglected tropical diseases (36·3 [24·4–52·8]), collectively accounting for 84·7% (84·1–85·2) of anaemia YLDs. Interpretation: Anaemia remains a substantial global health challenge, with persistent disparities according to age, sex, and geography. Estimates of cause-specific anaemia burden can be used to design locally relevant health interventions aimed at improving anaemia management and prevention. Funding: Bill & Melinda Gates Foundation

Mapping inequalities in exclusive breastfeeding in low- and middle-income countries, 2000–2018

Abstract: Exclusive breastfeeding (EBF)—giving infants only breast-milk for the first 6 months of life—is a component of optimal breastfeeding practices effective in preventing child morbidity and mortality. EBF practices are known to vary by population and comparable subnational estimates of prevalence and progress across low- and middle-income countries (LMICs) are required for planning policy and interventions. Here we present a geospatial analysis of EBF prevalence estimates from 2000 to 2018 across 94 LMICs mapped to policy-relevant administrative units (for example, districts), quantify subnational inequalities and their changes over time, and estimate probabilities of meeting the World Health Organization’s Global Nutrition Target (WHO GNT) of ≥70% EBF prevalence by 2030. While six LMICs are projected to meet the WHO GNT of ≥70% EBF prevalence at a national scale, only three are predicted to meet the target in all their district-level units by 2030

Subnational mapping of HIV incidence and mortality among individuals aged 15–49 years in sub-Saharan Africa, 2000–18 : a modelling study

Background: High-resolution estimates of HIV burden across space and time provide an important tool for tracking and monitoring the progress of prevention and control efforts and assist with improving the precision and efficiency of targeting efforts. We aimed to assess HIV incidence and HIV mortality for all second-level administrative units across sub-Saharan Africa. Methods: In this modelling study, we developed a framework that used the geographically specific HIV prevalence data collected in seroprevalence surveys and antenatal care clinics to train a model that estimates HIV incidence and mortality among individuals aged 15–49 years. We used a model-based geostatistical framework to estimate HIV prevalence at the second administrative level in 44 countries in sub-Saharan Africa for 2000–18 and sought data on the number of individuals on antiretroviral therapy (ART) by second-level administrative unit. We then modified the Estimation and Projection Package (EPP) to use these HIV prevalence and treatment estimates to estimate HIV incidence and mortality by second-level administrative unit. Findings: The estimates suggest substantial variation in HIV incidence and mortality rates both between and within countries in sub-Saharan Africa, with 15 countries having a ten-times or greater difference in estimated HIV incidence between the second-level administrative units with the lowest and highest estimated incidence levels. Across all 44 countries in 2018, HIV incidence ranged from 2 ·8 (95% uncertainty interval 2·1–3·8) in Mauritania to 1585·9 (1369·4–1824·8) cases per 100 000 people in Lesotho and HIV mortality ranged from 0·8 (0·7–0·9) in Mauritania to 676· 5 (513· 6–888·0) deaths per 100 000 people in Lesotho. Variation in both incidence and mortality was substantially greater at the subnational level than at the national level and the highest estimated rates were accordingly higher. Among second-level administrative units, Guijá District, Gaza Province, Mozambique, had the highest estimated HIV incidence (4661·7 [2544·8–8120·3]) cases per 100000 people in 2018 and Inhassunge District, Zambezia Province, Mozambique, had the highest estimated HIV mortality rate (1163·0 [679·0–1866·8]) deaths per 100 000 people. Further, the rate of reduction in HIV incidence and mortality from 2000 to 2018, as well as the ratio of new infections to the number of people living with HIV was highly variable. Although most second-level administrative units had declines in the number of new cases (3316 [81· 1%] of 4087 units) and number of deaths (3325 [81·4%]), nearly all appeared well short of the targeted 75% reduction in new cases and deaths between 2010 and 2020. Interpretation: Our estimates suggest that most second-level administrative units in sub-Saharan Africa are falling short of the targeted 75% reduction in new cases and deaths by 2020, which is further compounded by substantial within-country variability. These estimates will help decision makers and programme implementers expand access to ART and better target health resources to higher burden subnational areas