Practices and Obstacles to Provider-Initiated HIV Testing and Counseling (PITC) Among Healthcare Providers in Côte d’Ivoire

Practices of Provider-Initiated HIV Testing and Counseling (PITC) remains suboptimal in Côte d'Ivoire. The aim of this survey was to identify the practices and obstacles to PITC among healthcare professionals in Côte d'Ivoire. A nationally representative cross-sectional survey was conducted in 2018 by telephone among three separate samples of midwives, nurses and physicians practicing in Côte d'Ivoire. The number of HIV tests proposed during consultation in the month preceding the survey was collected for each professional. Factors associated with the number of proposed tests were identified through ordinal logistic regression models. A total of 298 midwives, 308 nurses and 289 physicians were interviewed. Midwives proposed the test more frequently, followed by nurses and physicians. Among midwives, a higher number of proposed tests was associated with the perception that HIV testing does not require specific consent compared to other diseases (aOR 4.00 [95% CI 1.37-14.29]). Among nurses, having received HIV training and the presence of community HIV counselors were associated with a higher number of proposed tests (aOR 2.01 [1.31-3.09] and aOR 1.75 [1.14-2.70], respectively). For physicians, the presence of a voluntary testing center was associated with a higher number of proposed tests (aOR 1.69 [1.01-2.86]). PITC practices and barriers differed across professions. Beyond improving environmental opportunities such as dedicated staff or services, strengthening the motivations and capabilities of healthcare professionals to propose testing could improve PITC coverage

Prevalence de l’infection a VIH chez les patients victimes d’un accident vasculaire cerebral au CHU Campus de Lome

Introduction: Le VIH/SIDA et son traitement antirétroviral sont associés à un risque élevé de maladies cardiovasculaires comme les accidents vasculaires cérébraux (AVC). L’objectif de cette étude était d’estimer la prévalence du VIH et d’identifier ses facteurs associés chez les patients hospitalisés pour un AVC.Méthode: Une étude transversale a été réalisée dans le service de neurologie du centre hospitalier universitaire Campus de Lomé au Togo, du 01 Août 2012 au 28 Février 2013. Tous les patients hospitalisés pour un AVC sur la base de données cliniques et de scannographie cérébrale ont été enrôlés. Une sérologie au VIH avec deux tests rapides en série a été réalisée, de même que des bilans biologiques et d’imagerie à la recherche de facteurs de risque cardiovasculaire. Une analyse de régression logistique a été réalisée pour identifier les facteurs associés à l’infection à VIH.Résultats: Au total 444 patients ont été enrôlés. L’âge médian était de 57ans (étendue interquartile de 47-68 ans) avec 53,6% de sujets de genre féminin. Parmi ces patients, le diagnostic d’AVC ischémique a été confirmé chez 309 (69,6%) patients et celui d’AVC hémorragique chez 135 (30,4%). La prévalence du VIH était de 8,1% (n=36) avec un intervalle de confiance (IC) à 95% (5,6-10,6%). Chez les patients séropositifs au VIH, 25 (69,4%) patients avaient fait un AVC ischémique et 11 (30,6%) patients avaient fait un AVC hémorragique. L’analyse de régression logistique avait montré que le type d’AVC n’était pas associé à l’infection à VIH avec un Odds Ratio de 0,85, IC à 95% (0,40-1,84).Conclusion: Cette première étude de séroprévalence au VIH réalisée chez les sujets hospitalisés pour un AVC montre une prévalence au VIH élevée comparativement à la prévalence nationale (2,9%). Les services de neurologie doivent continuer la prise en charge du VIH au sein de leur structure en faisant un dépistage systématique du VIH chez les patients ayant présenté un AVC.Mots clés: AVC, VIH, SIDA, Togo, Afrique noireEnglish Title: Prevalence of HIV infection among patients presenting with acute stroke at The Teaching Hospital Campus in Lome, TogoEnglish AbstractIntroduction: HIV / AIDS and its antiretroviral treatment are associated with a high risk of cardiovascular diseases such as stroke. The objective of this study was to estimate HIV prevalence and identify its associated factors among patients hospitalized for stroke.Method: A cross-sectional study was conducted in the Neurology ward at the Teaching Hospital “Campus” in Lome (Togo), from August 1st, 2012 to February 28th, 2013. All patients hospitalized for stroke, based on clinical symptoms and brain scan were enrolled. HIV serology was performed with two serial rapid tests and a third laboratory test when needed. Other cardiovascular risk factors, were investigated with more biological tests. Logistic regression analysis was performed to identify factors associated with HIV infection.Results: A total of 444 patients were enrolled, of which 53.6% were women and the median age of participants was 57 years (IQR [47-68]). Ischemic stroke was diagnosed in 309 (69.6%) patients and hemorrhagic stroke in 135 (30.4%) patients. HIV prevalence was 8.1% (n = 36) with a 95% confidence interval (CI) (5.6 - 10.6%). Among HIVpositive patients, 25 (69.4%) had an ischemic stroke and 11 (30.6%) had hemorrhagic stroke. Logistic regression analysis showed that the type of stroke was not associated with HIV infection (OR=0.85, 95% CI [0.40 to 1.84]).Conclusion: This first HIV seroprevalence study, conducted among patients hospitalized for stroke showed a higher prevalence compared to the national prevalence (2.9%). Neurology ward must continue the management of HIV within their structure by performing a routine HIV testing in patients admitted for stroke.Keywords: AVC, HIV, AIDS, Togo, black Afric

Sex Transm Dis

Background Despite the implementation of Provider Initiated Testing and Counselling (PITC) in 2009, PITC coverage remains low in Cote d'Ivoire. The purpose of this study is to determine whether an human immunodeficiency virus (HIV) test was offered and performed at specific life events where PITC is recommended by national guidelines. Methods In 2017, a cross-sectional telephone survey was conducted among a representative sample of 3,867 adults from the general population in Côte d'Ivoire. The occurrences of the following events over the past 5 years were documented: pregnancy (event A) or partner's pregnancy (event B) of the last child, sexually transmitted infection (event C) and marriage (event D). For each of these events, participants were asked (i) if they consulted a health care professional, (ii) if they were offered an HIV test during that consultation and (iii) if they accepted it. Results Consulting a health care provider was reported by 94.9%, 58.3%, 70.3% and 19.1% of those who reported events A, B, C and D respectively. In case of medical consultations following events A, B, C and D, respectively 70.1%, 33.1%, 28.1%, and 78.8% of individuals were offered an HIV test. The testing acceptance was high regardless of the event. Overall, testing coverage was 63.7%, 16.9%, 13.4% and 14.5% for events A, B, C and D respectively. Conclusions Increasing HIV testing coverage in Côte d'Ivoire requires (i) facilitating attendance to health services in case of sexually transmitted infections, marriage and pregnancy—for men—and (ii) strengthening routine testing offer on these occasions

Pepfar 3.0's HIV testing policy in Cote d'Ivoire (2014 to 2018) : fragmentation, acceleration and disconnection

Introduction HIV Testing and Counselling (HTC) remains a key challenge in achieving control of the HIV epidemic by 2030. In the early 2010s, the President's Emergency Plan for AIDS Relief (Pepfar) adopted targeted HTC strategies for populations and geographical areas most affected by HIV. We examine how Pepfar defined targeted HTC in Cote d'Ivoire, a country with a mixed HIV epidemic, after a decade of expanding HTC services. Methods We explored the evolution of HTC strategies through the Country Operational Plans (COP) of Pepfar during its phase 3.0, from COP 14 to COP 17 (October 2014 to September 2018) in Cote d'Ivoire. We conducted an analysis of the grey literature over the period 2014 to 2018 (Budget & Target Report, Strategic Direction Summary, Sustainability Index and Dashboard Summary, ). We also conducted a qualitative study in Cote d'Ivoire (2015 to 2018) using in-depth interviews with stakeholders in the AIDS public response: CDC/Pepfar (3), Ministry of Health (3), intermediary NGOs (7); and public meeting observations (14). Results Since the COP 14, Pepfar's HIV testing strategies have been characterized by significant variations in terms of numerical, geographical and population targets. While the aim of COP 14 and COP 15 seemed to be the improvement of testing efficacy in general and testing yield in particular, COP 16 and COP 17 prioritized accelerating progress towards the "first 90" (i.e. reducing the proportion of people living with HIV who are unaware of their HIV). A shift was observed in the definition of testing targets, with less focus on the inclusion of programmatic data and feedback from field actors, and greater emphasis on the use of models to estimate and disaggregate the targets by geographical units and sub-populations (even if the availability of data by this disaggregation was limited or uncertain); increasingly leading to gaps between targets and results. Conclusions These trials and tribulations question the real and long-term effectiveness of annually-revised, fragmented strategies, which widen an increasing disparity between the realities of the actors on the ground and the objectives set in Washington

Cascade of provider-initiated human immunodeficiency virus testing and counselling at specific life events (Pregnancy, sexually transmitted infections, marriage) in Cote d'Ivoire

Background Despite the implementation of Provider Initiated Testing and Counselling (PITC) in 2009, PITC coverage remains low in Cote d'Ivoire. The purpose of this study is to determine whether an human immunodeficiency virus (HIV) test was offered and performed at specific life events where PITC is recommended by national guidelines. Methods In 2017, a cross-sectional telephone survey was conducted among a representative sample of 3,867 adults from the general population in Cote d'Ivoire. The occurrences of the following events over the past 5 years were documented: pregnancy (event A) or partner's pregnancy (event B) of the last child, sexually transmitted infection (event C) and marriage (event D). For each of these events, participants were asked (i) if they consulted a health care professional, (ii) if they were offered an HIV test during that consultation and (iii) if they accepted it. Results Consulting a health care provider was reported by 94.9%, 58.3%, 70.3% and 19.1% of those who reported events A, B, C and D respectively. In case of medical consultations following events A, B, C and D, respectively 70.1%, 33.1%, 28.1%, and 78.8% of individuals were offered an HIV test. The testing acceptance was high regardless of the event. Overall, testing coverage was 63.7%, 16.9%, 13.4% and 14.5% for events A, B, C and D respectively. Conclusions Increasing HIV testing coverage in Cote d'Ivoire requires (i) facilitating attendance to health services in case of sexually transmitted infections, marriage and pregnancy-for men-and (ii) strengthening routine testing offer on these occasions

Coding human languages for long range communication in natural ecological environments: shouting, whistling and drumming

International audienceHuman languages represent very complex coding systems that can be decoded by the human brain after a long acquisition phase. In their acoustic form, human languages can be expressed through different natural speech types. Modal speech is the most common one but several other registers have evolved around the world to enable interlocutors to speak from far. This chapter first provides a large overview of the limits of modal speech for distance communication and lists the major acoustic constraints that interfere with spoken communications in rural outdoor settings. Next, it describes how speech has been naturally adapted to these constraints in different populations by transforming the sounds of spoken languages in shouted speech, whistled speech, or drummed speech. These three registers represent different ways of coding the same linguistic targets as modal speech. Their comparison in a wide variety of languages of the world highlights the great productive and perceptual flexibility of humans to transmit messages of linguistic attitude for telecommunication purposes in natural surroundings