Conseil prénatal du VIH orienté vers le couple : faisabilité et effets sur la prévention du VIH au Cameroun

It is a little above 30 years that the first cases of AIDS resulting from HIV infection were described in the United States of America. This disease remains a public health problem worldwide, with a great social and economic impact. In 2012, it was reported that the disease had already caused over 25 million deaths, and yet every year, more than 70% of the 2.3 million new HIV infections occurred in Africa, where there are only 12% of the world’s population. In Africa, there is a peculiar evolution of this infection overtime. After nearly two decades of promoting the ABC programs (abstinence, be faithful, condoms); promotion of counseling and testing; or more recently, introduction of pre- and post-exposure prophylaxis, usage of antiretroviral therapy as treatment and prevention, the prevalence of HIV remained stable or decreased in the most at-risk populations but increased dramatically in the formerly low-risk populations. Recent data from South Africa, Botswana an Cameroon showed that the prevalence of HIV is twice as much in women as in men and was higher in the population age range of 30 to 45 years, which constitute the economic livelihood of the continent. Furthermore, in some countries like in Cameroon, HIV prevalence was reported to be higher in stable couples (married, prolonged cohabitation etc.). It therefore seems necessary to revise the actual strategies of HIV prevention to deal with the new facet of the HIV epidemic in the African context. This thesis, which is a reported experience from an operational research, presents the results of the evaluation of a new intervention so called couple-oriented HIV counseling (COC), built by using the health belief model. It is an enhanced HIV post-test counseling offered during prenatal HIV testing, in replacement of the classical HIV post-test counseling. The originality of this study was the quality of our study design with a good level of proof and the public health perspective of the new strategy. To realize the study, we adopted two methodological approaches. The first one, acting as a proof of concept, was a randomized trial, conducted in a reference structure in an urban area (ANRS 12127-Prenahtest trial), to evaluate the efficiency of the new COC intervention to improve prenatal HIV testing of male partners, couple counseling for HIV and spousal communication about. Besides the effects of the COC, we documented other conditions for the improvement of previously mentioned indicators. After the proof of concept phase, we realized a second stage which consisted of scaling-up of the new intervention, with implementation conditions very close to the field conditions to take into account the future needs of transferability in practical standard care conditions. The study design used for this phase was the before/ after study (SIMECAM – FGSK project). This type of study was chosen to take into account the organization of the health system with three categories of health facilities at the peripheral level (district hospitals, divisional medical centers and integrated health centers). It also took into account the ethical component resulting from the superiority of the new intervention of COC described in an urban area.Cette intervention a été construite par la méthode du « health belief model », en renforçant l’intervention de conseil post-test classiquement offerte au cours du dépistage prénatal du VIH, en prenant en compte le contexte conjugal de la femme. Une approche méthodologique en deux étapes a été adoptée. La première étape, encore appelée étape de preuve de concept, a consisté, à travers un essai d’intervention randomisé mené dans une structure de référence en zone urbaine (essai ANRS 12127- Prenahtest), à évaluer l’efficacité de la nouvelle intervention de COC pour améliorer le dépistage prénatal du VIH des partenaires, le conseil de couple de VIH, la communication conjugale autour du VIH. Outre les effets du COC, nous avons aussi documenté les autres facteurs associés à l’approche de couple de prévention du VIH. La deuxième étape a consisté en une phase de passage à l’échelle de la mise en oeuvre de l’intervention de COC, de façon à évaluer sa transférabilité dans la pratique des soins courants. A cet effet, une étude de type Avant/Après (le projet SIMECAM-FGSK) a été réalisée. Ce choix méthodologique a permis de prendre en compte l’architecture sanitaire du système de santé, en incluant le niveau périphérique qui comporte trois catégories de formations sanitaires (hôpital de district ; centre médical d’arrondissement ; centre de santé intégré). Il a aussi permis de prendre en compte les contraintes éthiques, liées à la connaissance de la supériorité de la nouvelle intervention de COC décrite en zone urbaine. Les résultats les plus importants de l’essai ANRS 12127/12236l en zone urbaine au Cameroun sont les suivants :- La réalisation d’un essai comparatif randomisé de puissance moyenne et sans biais majeur et qui a été bien mené jusqu’à la fin - La description de l’acceptabilité du conseil orienté vers le couple dans un contexte où la prévalence du VIH atteint les 12% ;- La description de l’efficacité du nouveau type de conseil orienté vers le couple pour améliorer en zone urbaine la fréquence du dépistage du VIH du partenaire jusqu’à atteindre 27% des femmes ayant reçu le COC (vs 16% pour les femmes du groupe classique) ; - La description de l’efficacité du nouveau type de conseil pour améliorer la fréquence du conseil et dépistage du VIH en couple autour de 13% des femmes ayant reçu le COC (vs 3% pour les femmes du groupe classique) ;- La description de l’efficacité du nouveau type de conseil pour améliorer la fréquence de la communication conjugale autour du VIH. En zone rurale, les principaux résultats préliminaires du projet SIMECAM-FGSK, après seulement six mois effectifs d’activités de passage à l’échelle sont : - Le taux de prévalence du VIH est de 20,5% ; - Le COC permet le dépistage du VIH de près de 18% des partenaires ; et ce dépistage est majoritairement effectué dans le cadre d’un conseil VIH en couple ; - Le taux de prévalence du VIH chez les partenaires est de 22% et 11,2% des couples sont sérodiscordants ; - Sur cinquante trois femmes dépistées positives pour le VIH, 94% ont bénéficié d’une prise en charge par les ARV pour la PTME, dont 28,3% suivant le protocole de l’option B+. Le travail réalisé dans le cadre de cette thèse a permis de montrer que les effets du COC sur l’approche de prévention du VIH en couple sont modestes mais réels. Les faibles proportions observées peuvent entre autres s’expliquer par un certain nombre de barrières individuelles (telles que la peur de découvrir son statut VIH en même temps que sa partenaire), de barrières programmatiques (telles que les délais d’attente et la qualité de l’accueil des hommes en prénatale), et des barrières culturelles (la considération de la prénatale comme un espace réservé aux femmes). Par ailleurs, il est important de relever un certain de limites au cours de ce travail de thèse. L’essai Prenahtest compte un taux de perdues de vue de près de 25%, ce qui ne permet pas d’exclure tous les biais

Effectiveness of Multidrug Antiretroviral Regimens to Prevent Mother-to-Child Transmission of HIV-1 in Routine Public Health Services in Cameroon

International audienceBACKGROUND: Multidrug antiretroviral (ARV) regimens including HAART and short-course dual antiretroviral (sc-dARV) regimens were introduced in 2004 to improve Prevention of Mother-to-Child Transmission (PMTCT) in Cameroon. We assessed the effectiveness of these regimens from 6-10 weeks and 12 months of age, respectively. METHODOLOGY/FINDINGS: We conducted a retrospective cohort study covering the period from October 2004 to March 2008 in a reference hospital in Cameroon. HIV-positive pregnant women with CD4 or = 37 weeks, women received sd-NVP during labour [regimen 4]. Infants received sd-NVP plus ZDV and 3TC for 7 days or 30 days. Early diagnosis (6-10 weeks) was done, using b-DNA and subsequently RT-PCR. We determined early MTCT rate and associated risk factors using logistic regression. The 12-month HIV-free survival was assessed using Cox regression. Among 418 mothers, 335 (80%) received multidrug ARV regimens (1, 2, and 3) and MTCT rate with multidrug regimens was 6.6% [95%CI: 4.3-9.6] at 6 weeks, without any significant difference between regimens. Duration of mother's ARV regimen < 4 weeks [OR = 4.7, 95%CI: 1.3-17.6], mother's CD4 < 350 cells/mm(3) [OR = 6.4, 95%CI: 1.8-22.5] and low birth weight [OR = 4.0, 95%CI: 1.4-11.3] were associated with early MTCT. By 12 months, mixed feeding [HR = 8.7, 95%CI: 3.6-20.6], prematurity [HR = 2.3, 95%CI: 1.2-4.3] and low birth weight were associated with children's risk of progressing to infection or death. CONCLUSIONS: Multidrug ARV regimens for PMTCT are feasible and effective in routine reference hospital. Early initiation of ARV during pregnancy and proper obstetrical care are essential to improve PMTCT

Integrating pediatric TB services into child healthcare services in Africa: study protocol for the INPUT cluster-randomized stepped wedge trial

Background Tuberculosis is among the top-10 causes of mortality in children with more than 1 million children suffering from TB disease annually worldwide. The main challenge in young children is the difficulty in establishing an accurate diagnosis of active TB. The INPUT study is a stepped-wedge cluster-randomized intervention study aiming to assess the effectiveness of integrating TB services into child healthcare services on TB diagnosis capacities in children under 5 years of age. Methods Two strategies will be compared: i) The standard of care, offering pediatric TB services based on national standard of care; ii) The intervention, with pediatric TB services integrated into child healthcare services: it consists of a package of training, supportive supervision, job aids, and logistical support to the integration of TB screening and diagnosis activities into pediatric services. The design is a cluster-randomized stepped-wedge of 12 study clusters in Cameroon and Kenya. The sites start enrolling participants under standard-of-care and will transition to the intervention at randomly assigned time points. We enroll children aged less than 5 years with a presumptive diagnosis of TB after obtaining caregiver written informed consent. The participants are followed through TB diagnosis and treatment, with clinical information prospectively abstracted from their medical records. The primary outcome is the proportion of TB cases diagnosed among children < 5 years old attending the child healthcare services. Secondary outcomes include: number of children screened for presumptive active TB; diagnosed; initiated on TB treatment; and completing treatment. We will also assess the cost-effectiveness of the intervention, its acceptability among health care providers and users, and fidelity of implementation. Discussion Study enrolments started in May 2019, enrolments will be completed in October 2020 and follow up will be completed by June 2021. The study findings will be disseminated to national, regional and international audiences and will inform innovative approaches to integration of TB screening, diagnosis, and treatment initiation into child health care services.publishedVersio

Chikungunya Virus, Cameroon, 2006

We report the isolation of chikungunya virus from a patient during an outbreak of a denguelike syndrome in Cameroon in 2006. The virus was phylogenetically grouped in the Democratic Republic of the Congo cluster, indicating a continuous circulation of a genetically similar chikungunya virus population during 6 years in Central Africa

Research priorities for accelerating the achievement of three 95 HIV goals in Cameroon: a consensus statement from the Cameroon HIV Research Forum (CAM-HERO)

Introduction:&nbsp;the Treat-All remains the globally endorsed approach to attain the 95-95-95 targets and end the AIDS pandemic by 2030, but requires some country-level contextualization. In Cameroon, the specific research agenda to inform strategies for improving HIV policy was yet to be defined. Methods:&nbsp;under the patronage of the Cameroon Ministry of health, researchers, policy makers, implementing partners, and clinicians from 13 institutions, used the Delphi method to arrive at a consensus of HIV research priorities. The process had five steps: 1) independent literature scan by 5 working groups; 2) review of the initial priority list; 3) appraisal of priorities list in a larger group; 4) refinement and consolidation by a consensus group; 5) rating of top research priorities. Results:&nbsp;five research priorities and corresponding research approaches, resulted from the process. These include: 1) effectiveness, safety and active toxicity monitoring of new and old antiretrovirals; 2) outcomes of Antiretroviral Therapy (ART) with focus in children and adolescents; 3) impact of HIV and ART on aging and major chronic diseases; 4) ART dispensation models and impact on adherence and retention; 5) evaluations of HIV treatment and prevention programs. Conclusion:&nbsp;the research priorities resulted from a consensus amongst a multidisciplinary team and were based on current data about the pandemic and science to prevent, treat, and ultimately cure HIV. These priorities highlighted critical areas of investigation with potential relevance for the country, funders, and regulatory bodies

Outcomes of the first meeting of the CAMEROON HIV RESEARCH FORUM (CAM-HERO)

Research is a vital component for the development of any country. In Cameroon, HIV Operational research is rapidly growing, however, it faces some intractable problems which can only be solved through an urgent, strategic, efficient, and collaborative approach involving key stakeholders. The Kribi meeting (09 and 10th&nbsp;December 2020) brought together under the auspices of the Ministry of Public Health leading HIV research organisations and connected HIV researchers and actors from different sectors. These actors disseminated and discussed recent research findings and worked out mechanisms to advance HIV research development, developed new ideas and identified priority research areas, with emphasis on translational research. The official launching and consolidation of Cam-HERO was a critical step and it is hoped that these synergistic efforts will catalyse attainment of the 95-95-95 goals in Cameroon

Couple-oriented prenatal HIV counseling for HIV primary prevention: an acceptability study

<p>Abstract</p> <p>Background</p> <p>A large proportion of the 2.5 million new adult HIV infections that occurred worldwide in 2007 were in stable couples. Feasible and acceptable strategies to improve HIV prevention in a conjugal context are scarce. In the preparatory phase of the ANRS 12127 Prenahtest multi-site HIV prevention trial, we assessed the acceptability of couple-oriented post-test HIV counseling (COC) and men's involvement within prenatal care services, among pregnant women, male partners and health care workers in Cameroon, Dominican Republic, Georgia and India.</p> <p>Methods</p> <p>Quantitative and qualitative research methods were used: direct observations of health services; in-depth interviews with women, men and health care workers; monitoring of the COC intervention and exit interviews with COC participants.</p> <p>Results</p> <p>In-depth interviews conducted with 92 key informants across the four sites indicated that men rarely participated in antenatal care (ANC) services, mainly because these are traditionally and programmatically a woman's domain. However men's involvement was reported to be acceptable and needed in order to improve ANC and HIV prevention services. COC was considered by the respondents to be a feasible and acceptable strategy to actively encourage men to participate in prenatal HIV counseling and testing and overall in reproductive health services.</p> <p>Conclusions</p> <p>One of the keys to men's involvement within prenatal HIV counseling and testing is the better understanding of couple relationships, attitudes and communication patterns between men and women, in terms of HIV and sexual and reproductive health; this conjugal context should be taken into account in the provision of quality prenatal HIV counseling, which aims at integrated PMTCT and primary prevention of HIV.</p

Evidence for an enhanced HIV/AIDS policy and care in Cameroon: proceedings of the second Cameroon HIV Research Forum (CAM-HERO) 2021

To achieve the Sustainable Development Goal of zero hunger, multi-sectoral strategies to improve nutrition are necessary. Building towards this goal, the food and agriculture sector must be considered when designing nutritional interventions. Nevertheless, most frameworks designed to guide nutritional interventions do not adequately capture opportunities for integrating nutrition interventions within the food and agriculture sector. This paper aims to highlight how deeply connected the food and agriculture sector is to underlying causes of malnutrition and identify opportunities to better integrate the food and agriculture sector and nutrition in low and middle income countries. In particular, this paper: (1) expands on the UNICEF conceptual framework for undernutrition to integrate the food and agriculture sector and nutrition outcomes, (2) identifies how nutritional outcomes and agriculture are linked in six important ways by defining evidence-based food and agriculture system components within these pathways: as a source of food, as a source of income, through food prices, women’s empowerment, women’s utilization of time, and women’s health and nutritional status, and (3) shows that the food and agriculture sector facilitates interventions through production, processing and consumption, as well as through farmer practices and behavior. Current frameworks used to guide nutrition interventions are designed from a health sector paradigm, leaving agricultural aspects not sufficiently leveraged. This paper concludes by proposing intervention opportunities to rectify the missed opportunities generated by this approach. Program design should consider the ways that the food and agriculture sector is linked to other critical sectors to comprehensively address malnutrition. This framework is designed to help the user to begin to identify intervention sites that may be considered when planning and implementing multi-sectoral nutrition program

Couple-oriented prenatal HIV counseling : feasibility and effects on HIV prevention in Cameroon

Cette intervention a été construite par la méthode du « health belief model », en renforçant l’intervention de conseil post-test classiquement offerte au cours du dépistage prénatal du VIH, en prenant en compte le contexte conjugal de la femme. Une approche méthodologique en deux étapes a été adoptée. La première étape, encore appelée étape de preuve de concept, a consisté, à travers un essai d’intervention randomisé mené dans une structure de référence en zone urbaine (essai ANRS 12127- Prenahtest), à évaluer l’efficacité de la nouvelle intervention de COC pour améliorer le dépistage prénatal du VIH des partenaires, le conseil de couple de VIH, la communication conjugale autour du VIH. Outre les effets du COC, nous avons aussi documenté les autres facteurs associés à l’approche de couple de prévention du VIH. La deuxième étape a consisté en une phase de passage à l’échelle de la mise en oeuvre de l’intervention de COC, de façon à évaluer sa transférabilité dans la pratique des soins courants. A cet effet, une étude de type Avant/Après (le projet SIMECAM-FGSK) a été réalisée. Ce choix méthodologique a permis de prendre en compte l’architecture sanitaire du système de santé, en incluant le niveau périphérique qui comporte trois catégories de formations sanitaires (hôpital de district ; centre médical d’arrondissement ; centre de santé intégré). Il a aussi permis de prendre en compte les contraintes éthiques, liées à la connaissance de la supériorité de la nouvelle intervention de COC décrite en zone urbaine. Les résultats les plus importants de l’essai ANRS 12127/12236l en zone urbaine au Cameroun sont les suivants :- La réalisation d’un essai comparatif randomisé de puissance moyenne et sans biais majeur et qui a été bien mené jusqu’à la fin - La description de l’acceptabilité du conseil orienté vers le couple dans un contexte où la prévalence du VIH atteint les 12% ;- La description de l’efficacité du nouveau type de conseil orienté vers le couple pour améliorer en zone urbaine la fréquence du dépistage du VIH du partenaire jusqu’à atteindre 27% des femmes ayant reçu le COC (vs 16% pour les femmes du groupe classique) ; - La description de l’efficacité du nouveau type de conseil pour améliorer la fréquence du conseil et dépistage du VIH en couple autour de 13% des femmes ayant reçu le COC (vs 3% pour les femmes du groupe classique) ;- La description de l’efficacité du nouveau type de conseil pour améliorer la fréquence de la communication conjugale autour du VIH. En zone rurale, les principaux résultats préliminaires du projet SIMECAM-FGSK, après seulement six mois effectifs d’activités de passage à l’échelle sont : - Le taux de prévalence du VIH est de 20,5% ; - Le COC permet le dépistage du VIH de près de 18% des partenaires ; et ce dépistage est majoritairement effectué dans le cadre d’un conseil VIH en couple ; - Le taux de prévalence du VIH chez les partenaires est de 22% et 11,2% des couples sont sérodiscordants ; - Sur cinquante trois femmes dépistées positives pour le VIH, 94% ont bénéficié d’une prise en charge par les ARV pour la PTME, dont 28,3% suivant le protocole de l’option B+. Le travail réalisé dans le cadre de cette thèse a permis de montrer que les effets du COC sur l’approche de prévention du VIH en couple sont modestes mais réels. Les faibles proportions observées peuvent entre autres s’expliquer par un certain nombre de barrières individuelles (telles que la peur de découvrir son statut VIH en même temps que sa partenaire), de barrières programmatiques (telles que les délais d’attente et la qualité de l’accueil des hommes en prénatale), et des barrières culturelles (la considération de la prénatale comme un espace réservé aux femmes). Par ailleurs, il est important de relever un certain de limites au cours de ce travail de thèse. L’essai Prenahtest compte un taux de perdues de vue de près de 25%, ce qui ne permet pas d’exclure tous les biais.It is a little above 30 years that the first cases of AIDS resulting from HIV infection were described in the United States of America. This disease remains a public health problem worldwide, with a great social and economic impact. In 2012, it was reported that the disease had already caused over 25 million deaths, and yet every year, more than 70% of the 2.3 million new HIV infections occurred in Africa, where there are only 12% of the world’s population. In Africa, there is a peculiar evolution of this infection overtime. After nearly two decades of promoting the ABC programs (abstinence, be faithful, condoms); promotion of counseling and testing; or more recently, introduction of pre- and post-exposure prophylaxis, usage of antiretroviral therapy as treatment and prevention, the prevalence of HIV remained stable or decreased in the most at-risk populations but increased dramatically in the formerly low-risk populations. Recent data from South Africa, Botswana an Cameroon showed that the prevalence of HIV is twice as much in women as in men and was higher in the population age range of 30 to 45 years, which constitute the economic livelihood of the continent. Furthermore, in some countries like in Cameroon, HIV prevalence was reported to be higher in stable couples (married, prolonged cohabitation etc.). It therefore seems necessary to revise the actual strategies of HIV prevention to deal with the new facet of the HIV epidemic in the African context. This thesis, which is a reported experience from an operational research, presents the results of the evaluation of a new intervention so called couple-oriented HIV counseling (COC), built by using the health belief model. It is an enhanced HIV post-test counseling offered during prenatal HIV testing, in replacement of the classical HIV post-test counseling. The originality of this study was the quality of our study design with a good level of proof and the public health perspective of the new strategy. To realize the study, we adopted two methodological approaches. The first one, acting as a proof of concept, was a randomized trial, conducted in a reference structure in an urban area (ANRS 12127-Prenahtest trial), to evaluate the efficiency of the new COC intervention to improve prenatal HIV testing of male partners, couple counseling for HIV and spousal communication about. Besides the effects of the COC, we documented other conditions for the improvement of previously mentioned indicators. After the proof of concept phase, we realized a second stage which consisted of scaling-up of the new intervention, with implementation conditions very close to the field conditions to take into account the future needs of transferability in practical standard care conditions. The study design used for this phase was the before/ after study (SIMECAM – FGSK project). This type of study was chosen to take into account the organization of the health system with three categories of health facilities at the peripheral level (district hospitals, divisional medical centers and integrated health centers). It also took into account the ethical component resulting from the superiority of the new intervention of COC described in an urban area

Changing attitudes towards HIV testing and treatment among three generations of men in Cameroon: a qualitative analysis using the Fogg Behavior Model

INTRODUCTION: Men are less likely than women to test for HIV and promptly initiate antiretroviral treatment, resulting in advanced HIV disease and increased mortality rates among them. METHODS: In-depth interviews were conducted with men and leaders in the west and central regions of Cameroon. Men were recruited from existing community groups and stratified by age: 21-30 years, 31-40 years, and 41 years and older. Community leaders were recommended by the community dialogue structure chairman. Interviews were conducted using a semi-structured guide in English or French, depending on the participant\u27s preference. Transcripts were coded in the MAXQDA v.12 software and analyzed using thematic analysis and by age group. The Fogg Behavior Model was used to gain a deeper understanding of the different perceptions across all age groups. RESULTS: Younger men (21-30 years) were generally more accepting of HIV testing, as it had become normative behavior. Although financial barriers could limit access, free testing was mentioned as a prompt to initiate HIV testing. The middle age men (31-40 years) had the most concerns about HIV testing interrupting their work day and recommended increasing testing locations and hours. The older men (41 + years) were the least motivated to get tested, citing worries about the impact on their social standing within the community. All age groups reported being motivated to begin treatment if they were found to be HIV-positive. Participants also provided insights regarding community HIV testing and treatment messaging. Younger and older men preferred to hear directly from qualified health professionals, but younger men noted that social media, radio, and TV could be utilized. Middle age men also identified TV and radio as effective mediums, if door-to-door messaging was not an option. CONCLUSIONS: The study highlights important considerations when planning future information-sharing activities for HIV testing and treatment. Since lived experiences differ across generations and societal roles continue to change, not only should the content of messages differ among the generations, but the means of communication must also be considered to ensure the messages are conveyed through a trusted source