Telephone peer recruitment and interviewing during a respondent-driven sampling (RDS) survey: feasibility and field experience from the first phone-based RDS survey among men who have sex with men in Côte d’Ivoire

Background Many respondent-driven sampling (RDS) methodologies have been employed to investigate hard-to-reach populations; however, these methodologies present some limits. We describe a minimally investigated RDS methodology in which peer recruitment and interviewing are phone-based. The feasibility of the methodology, field experiences, validity of RDS assumptions and characteristics of the sample obtained are discussed. Methods We conducted a phone-based RDS survey among men who have sex with men (MSM) aged 18 or above and living in Côte d’Ivoire. Eight initial MSM across Côte d’Ivoire were selected. Participants were asked to call a hotline to be registered and interviewed by phone. After the participants completed the questionnaire, they were asked to recruit a maximum of 3 MSM from their acquaintances. Results During the 9 months of the survey, 576 individuals called the hotline, and 518 MSM completed the questionnaire. The median delay between the invitation to participate and the completion of the questionnaire by peer-recruited MSM was 4 days [IQR: 1–12]. The recruitment process was not constant, with high variation in the number of people who called the hotline during the survey period. RDS chain convergence to equilibrium was reached within 6 waves for most of the selected variables. For the network size estimation assumption, participants who incorrectly estimated their network size were observed. Regarding the sample obtained, MSM were recruited from all the regions of Côte d’Ivoire with frequent interregional recruitment; 23.5% of MSM were recruited by someone who does not live in the same region. Compared to the MSM who participated in two other surveys in Côte d’Ivoire, the MSM in our sample were less likely to know about an MSM non-governmental organisation. However, MSM aged 30 years old and above and those with a low level of education were underrepresented in our sample. Conclusion We show that phone-based RDS surveys among MSM are feasible in the context of sub-Saharan Africa. Compared to other classical RDS survey methodologies, the phone-based RDS methodology seems to reduce selection bias based on geography and proximity with the MSM community. However, similar to other methodologies, phone-based RDS fails to reach older and less-educated MSM

Preferences and access to community-based HIV testing sites among men who have sex with men (MSM) in Côte d'Ivoire.

OBJECTIVE Measuring access and preferences to Men who have Sex with Men focused community-based HIV testing sites (MSM-CBTS) in Côte d'Ivoire. DESIGN A respondent-driven sampling telephone survey. SETTING National survey conducted in 2018 in Côte d'Ivoire. PARTICIPANTS 518 MSM aged over 18 years old. PRIMARY AND SECONDARY OUTCOME MEASURES Knowledge, practices, satisfaction and preferences regarding MSM-CBTS. Factors associated with MSM-CTBS access or knowledge and with HIV testing venue preferences were examined. RESULTS Only half of the respondents (47%) reported knowing of an MSM-CBTS. Of these, 79% had already attended one. Both knowing of and ever visiting an MSM-CBTS were significantly associated with a higher number of HIV tests performed in the past 12 months and having disclosed sexual orientation to one family member.In terms of preferences, 37% of respondents said they preferred undifferentiated HIV testing sites (ie, 'all patients' HIV testing sites), 34% preferred MSM-CBTS and 29% had no preference.Those who reported being sexually attracted to women, being bisexual and those who did not know an MSM non-governmental organisation were less likely to prefer MSM-CBTS. MSM who preferred undifferentiated HIV testing sites mentioned the lack of discretion and anonymity of community-based sites and the desire to avoid the gaze of others. CONCLUSION Community-based HIV testing is well suited for MSM who identify as homosexual and those close to the MSM community, while maintaining undifferentiated HIV testing is essential for others. Both types of activities need to be maintained and developed. Healthcare professionals in undifferentiated HIV testing sites need to be properly trained in the non-judgemental reception of MSM

PLoS One

BACKGROUND: Cardiovascular diseases (CVD) are the leading causes of death in the world, mainly occurring in low-and-middle income countries. The aim of this study was to estimate the prevalence of hypertension and other cardiovascular risk factors among university students at a National Polytechnic Institute in Côte d'Ivoire. METHODS: A cross-sectional study was conducted among students of the National Polytechnic Institute of Côte d'Ivoire. Sample was selected using a non-probabilistic convenient sampling method. Anthropometric measurements, blood pressure and capillary blood glucose were measured. A logistic regression model allowed to determine factors associated with hypertension. RESULTS: A total of 2,030 students, 79.7% males and 20.3% females, with a median age of 20 years (IQR = [19-22]) participated in the study. On hypertension knowledge, 96.9% (n = 1,968) of students reported having heard of hypertension; salty foods were reported by more than a third as a cause of hypertension (n = 734; 37.3%), while 114 (5.8%) and 157 (8.0%) selected tobacco and alcohol as causes of hypertension, respectively. The overall prevalence of hypertension was 6.0%, higher in males (6.8%) compared to females (2.7%) (p < 0.001). As for CVD risk factors, 148 (7.3%) were overweight or obese; 44.0% of males and 36.6% of females reported alcohol consumption. In multivariate analysis, being a female (OR = 4.16; CI 95% = [1.96-9.09]; p<0.001), being 25 years old and older (OR = 3.34; CI 95% = [2.01-5.55]; p = 0.001), tobacco use (OR = 2.65; CI 95% = [1.41-4.96]; p = 0.002), being overweight or obese (OR = 3.75; CI 95% = [2.13-6.59]; p<0,001) and having abnormal waist circumference (OR = 6.24; CI 95% = [1.99-19.51]; p = 0.002) were significantly associated with high blood pressure. CONCLUSION: CVD risk factors are prominent among young adults in Côte d'Ivoire. Appropriate behavioural health interventions promoting a healthy lifestyle for young adults should be urgently implemented for CVD burden reduction

Contemp Clin Trials Commun

Ensuring the quality of data is essential for the credibility of a multicenter clinical trial. Centralized Statistical Monitoring (CSM) of data allows the detection of a center in which the distribution of a specific variable is atypical compared to other centers. The ideal CSM method should allow early detection of problem and therefore involve the fewest possible participants. We simulated clinical trials and compared the performance of four CSM methods (Student, Hatayama, Desmet, Distance) to detect whether the distribution of a quantitative variable was atypical in one center in relation to the others, with different numbers of participants and different mean deviation amplitudes. The Student and Hatayama methods had good sensitivity but poor specificity, which disqualifies them for practical use in CSM. The Desmet and Distance methods had very high specificity for detecting all the mean deviations tested (including small values) but low sensitivity with mean deviations less than 50%. Although the Student and Hatayama methods are more sensitive, their low specificity would lead to too many alerts being triggered, which would result in additional unnecessary control work to ensure data quality. The Desmet and Distance methods have low sensitivity when the deviation from the mean is low, suggesting that the CSM should be used alongside other conventional monitoring procedures rather than replacing them. However, they have excellent specificity, which suggests they can be applied routinely, since using them takes up no time at central level and does not cause any unnecessary workload in investigating centers

Missed opportunities for HIV testing among newly diagnosed HIV-infected adults in Abidjan, Côte d'Ivoire.

HIV testing is crucial for starting ART earlier in HIV-infected people. We describe Missed Opportunities (MO) for HIV testing among adults newly diagnosed with HIV in Abidjan, Côte d'Ivoire.Between april,2nd 2013 and april 1st 2014, a cross-sectional study was conducted among all adults newly diagnosed (< 1year) for HIV at the Blood Donors Medical Center of Abidjan with face to face questionnaire. An MO for HIV testing was defined as a medical consultation for a clinical indicator (e.g. symptoms, hospitalization, and pregnancy) or a non-clinical indicator (e.g. high-risk sexual behavior, HIV-infected partner) potentially related to an HIV infection but did not lead to HIV test proposal by a health care professional.Of the 341 patients who attended the center suring this period, 273 (157 women and 116 men) were included in this analysis. 130 (47.6%) reported at least one medical consultation for an indicator relevant for a test proposal between 1 month and five years prior to their diagnosis. Among them, 92 (77.3%) experienced at least one MO for testing. The 273 included patients reported a total of 216 indicators; 146 (67.6%) were reported without test proposal and thus were MO. Hospitalization, extreme lose of weight, chronic or repeat fever and herpes zoster were the indicators with the largest number of MO. While 66 (24.2%) patients experienced non-clinical indicators relevant to risk of HIV infection, only 11 (4.0%) mentioned it to a health professional.MO for HIV testing are frequent, even in situations for which testing is clearly recommended. Better train healthcare professionals and creating new opportunities of testing inside and, outside of medical settings are crucial to improve HIV control

Cascade of provider-initiated HIV testing and counselling at specific life events (pregnancy, STIs, marriage plan) in Côte d’Ivoire

AimIn Côte d’Ivoire, only 57.8% of women and 37.0% of men have been HIV-tested at least once, which is insufficient to control the epidemic. The objective of this study is to describe at a population level if an HIV test was offered and performed at specific life-events where provider-initiated HIV testing is recommended.Method/IssueA cross-sectional telephone survey was conducted in 2017 among a representative sample of 3 867 individuals from the general population in Côte d’Ivoire. For each individual, the occurrence of the following events over the past 5 years was documented: birth of a child, Sexually Transmitted Infections—STIs, marriage. For each of these events, they were asked (i) if they have consulted a health professional, (ii) if they were offered an HIV test during that consultation and (iii) if they accepted it. The factors associated with each of these three steps were analyzed in separate logistic regression models stratified by type of event.Results/CommentsWhile 63.7% of women were HIV-tested during their last pregnancy, only 16.9% of men were tested during their partner’s last pregnancy and this proportion fell to 13.4% for people with an STI and 14.5% for people who got married. These levels of HIV testing were mainly driven by a lack of medical consultation (except for pregnant women) and a lack of testing proposal (except for pre-marital check-up). Testing acceptability was high.DiscussionImproving HIV testing coverage in Côte d’Ivoire requires (i) facilitating attendance to health services in case of STIs, marriage plans and pregnancy—for men—and (ii) strengthening routine testing proposal during these occasions

Physicians' knowledge of Hepatitis B and C in Côte d'Ivoire : the emergency need to intensify the training of health worker in the context of a generalized epidemic

International audienceBackground: Viral hepatitis is a major public health problem in Côte d'Ivoire, with a prevalence of 8% to 10% for hepatitis B and 1% for hepatitis C. Research indicates that there is a lack of awareness of hepatitis in the general population; however, there remains little evidence concerning physician’s knowledge of the virus. We, thus, investigate physician’s knowledge on viral hepatitis B and C, which can be the first condition for screening and treatment.Materials and methods: In 2018, we conducted a cross-sectional Knowledge, Attitudes and Practices (KAP) telephone survey on a random sample of physicians working in health facilities in Côte d'Ivoire. Data collected included an assessment of knowledge about viral hepatitis B and C and their personal attitudes towards hepatitis screening and vaccination. We created a knowledge score based on 14 variables (screening test variables, HBV viral load variables, treatment indications variables, treatment availability and associated costs variables) and identified the associated factors using a multivariate Poisson model.Results: Among the 542 physicians contacted, 316 physicians participated in the survey (58%). The vast majority of doctors spontaneously cited cirrhosis (79%) and liver cancer (77%) as the main complications of viral hepatitis. Screening modalities were also well known. Knowledge of modes of transmission and prevention were uneven : blood transmission 88%, sexual 78%, saliva 27%, during pregnancy or childbirth 20%. Physicians' knowledge of the prevalence of hepatitis B and hepatitis C in the population remains very limited (32% indicates between 5% and 15% for HBV while 33% indicates less than 5% for HCV) In terms of treatment, less than half knew the conditions for initiating hepatitis B treatment (42%) or the existence of curative treatment for hepatitis C (34%). Similarly, few knew the cost of associated treatments or tests (23%), such as HBV viral load (17%). A higher knowledge score was associated with having a close relative infected by viral hepatitis (RR=1.09 [1.00 – 1.19], p=0.052), receiving training on viral hepatitis (RR=1.16 [1.04 – 1.29], p=0,008) and testing for any viral hepatitis (RR=1.16 [1.04 – 1.29], p=0.008).Conclusion: The fight against viral hepatitis requires the involvement of physicians. Findings suggest that many physicians are in need of ongoing training on prevention and treatment of viral hepatitis

Disclosure of HIV positive status : gender differences within the TEMPRANO trial participants, Côte d'Ivoire - ANRS 12239

For people living with HIV, disclosure of HIV status is an important challenge : informed friends or family members can be supportive, or on the contrary can stigmatise the HIV-positive person. We aimed to compare HIV status disclosure among men and women, since gender relationships create different opportunities and difficulties for both sexes. The study was conducted among HIV-positive adults enrolled in the TEMPRANO randomized trial in Côte d'Ivoire, which aims to compare very early antiretroviral treatment versus treatment initiation as per WHO current guidelines. All participants in this trial were asked questions on HIV status disclosure after 24 months of follow- up. Univariate and multivariate analyses were performed to compare disclosure patterns among men and women, disclosure to people living inside and/or outside the household, and in particular to the spouse or regular partner, and to identify the factors associated with disclosure. HIV status disclosure was frequent (more than 80%) among HIV patients, with no difference between men and women (p=0.45). For both, the regular partner was the most frequent confidant. But patterns of disclosure were different : men more frequently disclosed to a regular partner than women (74.1% vs 64.9%, p=0.004), because they were more likely to live with a regular partner (58.6% of men vs 35.8% of women). Men and women living with a regular partner reported similar levels of disclosure to the spouse (82.1% for men and 82.4% for women). Women disclosed more often than men to their children, siblings and mother. For both, the confidants were more often women (sisters, mother) than men (brothers, father). Our study shows that differences in the living conditions of men and women living with HIV and differences in gender roles induce gendered differences in HIV disclosure that should be considered in the care of the patient

A native arbuscular mycorrhizal fungus inoculant outcompetes an exotic commercial species under two contrasting yam field conditions

This study aimed to assess the performance of an indigenous arbuscular mycorrhizal fungus (AMF) inoculant isolated from yam rhizosphere on yam (Dioscorea rotundata Poir.) growth and yield in field conditions. For this purpose, a factorial experiment was carried out in two contrasting agricultural soils located in Duokro and INPHB in Yamoussoukro, Côte d’Ivoire. The Duokro soil was neutral sandy loam with high nutrient content and an established AMF community dominated by Glomeraceae whereas the INP-HB soil was acidic sand with low nutrient content and codominance of Glomeraceae and Paraglomeraceae. The inoculation treatments were two native AMF species, namely Rhizophagus irregularis (Blaszk., Wubet, Renker & Buscot) isolated from yam rhizosphere and Acaulospora colombiana (Spain & N.C. Schenck) isolated from cassava rhizosphere, applied singly or together, and Rhizophagus intraradices (N.C. Schenck & G.S. Sm.), an exotic commercial species. Mycorrhizal colonization frequencies of inoculated yam plants were substantially higher at Duokro than INP-HB. As consequence, all the growth and yield parameters measured were higher at Duokro than at INP-HB. Plants inoculated with the native inoculant R. irregularis had the highest mycorrhizal frequencies, the best growth and tuber production at both sites. Moreover, the exotic commercial inoculant was outcompeted by the native inoculants. R. irregularis appeared therefore to be a good candidate for commercialization as an inoculant for yam crops

Disclosure of HIV positive status : gender differences within the TEMPRANO trial participants, Côte d'Ivoire - ANRS 12239

For people living with HIV, disclosure of HIV status is an important challenge : informed friends or family members can be supportive, or on the contrary can stigmatise the HIV-positive person. We aimed to compare HIV status disclosure among men and women, since gender relationships create different opportunities and difficulties for both sexes. The study was conducted among HIV-positive adults enrolled in the TEMPRANO randomized trial in Côte d'Ivoire, which aims to compare very early antiretroviral treatment versus treatment initiation as per WHO current guidelines. All participants in this trial were asked questions on HIV status disclosure after 24 months of follow- up. Univariate and multivariate analyses were performed to compare disclosure patterns among men and women, disclosure to people living inside and/or outside the household, and in particular to the spouse or regular partner, and to identify the factors associated with disclosure. HIV status disclosure was frequent (more than 80%) among HIV patients, with no difference between men and women (p=0.45). For both, the regular partner was the most frequent confidant. But patterns of disclosure were different : men more frequently disclosed to a regular partner than women (74.1% vs 64.9%, p=0.004), because they were more likely to live with a regular partner (58.6% of men vs 35.8% of women). Men and women living with a regular partner reported similar levels of disclosure to the spouse (82.1% for men and 82.4% for women). Women disclosed more often than men to their children, siblings and mother. For both, the confidants were more often women (sisters, mother) than men (brothers, father). Our study shows that differences in the living conditions of men and women living with HIV and differences in gender roles induce gendered differences in HIV disclosure that should be considered in the care of the patient