Adherence to anti-retroviral drugs in pregnant and lactating HIV Positive women in Brazzaville

Background: Anti-retroviral drugs reduce morbidity and mortality due to HIV and prevent transmission  from mother to child. But compliance on anti-retroviral treatment is an essential element for the success of therapeutic goals.Objective: To assess the level of compliance of anti-retroviral treatment in pregnant and lactating HIV women and identify factors of non-compliance in Brazzaville.Design: An analytical and transversal study conducted in three specialised centres from March to June 2014.Setting: Three support centres for HIV patients in Brazzaville, Republic of Congo.Subjects: It had interested pregnant and lactating HIV women and having given consent. The variables studied were: socio-demographic, related to treatment and linked to the health system. Five statistic tests were used: Yates’ chi², Fisher, Student, Kruskal-Wallis and Bartlett.Results: One hundred and thirty patients were included, the mean age was 32 years, 92.3% had good education level, and 72.3% lived as couple. The adherence to antiretroviral treatment within seven days before the survey was 77.7%. Factors significantly influencing non-adherence were: ignorance of HIV status by the partner (RR = 2.10 (1.12 - 3.92)), traditional treatment (RR = 1.77 (0.92 - 3.41), forgetfulness to take drugs (RR = 5.10 (2.07 - 12.55), and discomfort with side effects (RR = 2.12 (1.13 - 3.95).Conclusion: Several factors influence the non-adherence of anti-retroviral treatment. Improving   compliance with treatment requires multi-sectoral participation

Pratique de la mesure ambulatoire de la pression artérielle à Brazzaville (Congo): données préliminaires

Introduction: évaluer l'apport de la MAPA dans la prise en charge de l'hypertension artérielle à Brazzaville.Méthodes: cette étude transversale descriptive a été menée à Brazzaville entre janvier 2011 et décembre 2013 (soit 36 mois). Elle a inclus une série consécutive de 1040 patients ayant bénéficié d'une Mesure Ambulatoire de la Pression Artérielle. Nous avons utilisé le TONOPORT V et le logiciel Cardiosoft 6.51 de GE Health Care, respectivement pour l'enregistrement et l'analyse des données. Les seuils fixés sur les moyennes de 24H étaient une PA < 130/80 mmHg pour les patients contrôlés, et une PA > 130/80 mmHg pour la confirmation de l'HTA.Résultats: il s'agissait de 573 hommes (55%) et de 467 femmes (45%), âgés en moyenne de 51,7 ± 10,6 ans (extrêmes: 22 et 89 ans). L'indication de la MAPA était à visée thérapeutique dans 627 cas (60,3%), à visée diagnostique dans 410 cas (39,4%), et dans trois cas une suspicion d'effet « blouse blanche ». Dans l'indication à visée diagnostique, l'HTA était confirmée dans 303 cas (74%). La moyenne nycthémérale était de 139 ± 12 mmHg pour la PAS et 89,7 ± 9,6 mmHg pour la PAD; 141,2 ± 13,9 mmHg de PAS et 92,4 ± 10,0 mmHg de PAD en période diurne ; 131,1 ± 13,5 mmHg de PAS et 80,7 ± 9,9 mmHg de PAD en période nocturne. Dans l'indication à visée thérapeutique, l'HTA était contrôlée chez 220 patients (35%). La moyenne nycthémérale était de 139 ± 14 mmHg pour la PAS et 88,1 ± 10 mmHg pour la PAD. Les moyennes diurnes et nocturnes étaient respectivement de 140,7 ± 14,0 mmHg et 133,1 ± 16,2 mmHg pour la PAS, 90,3 ± 10,5 et 81,1 ± 10,9 mmHg pour la PAD. Le protocole antihypertenseur utilisé était une monothérapie dans 126 cas (22%), une bithérapie dans 270 cas (47%), une trithérapie dans 149 cas (26%), une quadrithérapie et plus dans 29 cas (5%). Conclusion: cette étude préliminaire a montré l'importance de la MAPA comme outil de diagnostic et d'évaluation thérapeutique. Son utilisation rationnelle dans notre contexte permettrait d'améliorer la prise en charge des patients hypertendus

Rates of untreated, treated, and controlled hypertension and relationships between blood pressure with other cardiovascular risk factors in Brazzaville (Republic of the Congo): May Measurement Month 2017-Sub-Saharan Africa.

Hypertension (HT) is a growing burden worldwide, leading to over 10 million deaths each year. In Brazzaville, the prevalence of HT was 32.5% in 2004. The mortality for stroke in 2008 and heart failure in 2013 were, respectively, 24% and 20.2%. May Measurement Month (MMM) is a global initiative initiated by the International Society of Hypertension aimed at raising awareness of HT and to act as a temporary solution to the lack of screening programmes worldwide. An opportunistic cross-sectional survey of volunteers aged ≥18 was carried out in May 2017. Blood pressure (BP) measurement, the definition of HT and statistical analysis followed the standard MMM protocol. The screening was carried out in Brazzaville, and the screening sites were distributed in different districts of the city in public places and health facilities. A total of 3842 individuals were screened during MMM17. After multiple imputations, 1576 (41.0%) had HT. About 956 (29.7%) individuals not receiving anti-hypertensive medication, were hypertensive. Four hundred and nine (66.0%) individuals receiving anti-hypertensive medication, had uncontrolled BP. Systolic and diastolic BPs after adjustment for age and sex differed significantly in association with use of anti-hypertensive medication (P < 0.0001), previous stroke (P = 0.001 for systolic), and waist circumference (P < 0.0001). MMM17 was the largest BP screening campaign undertaken in Congo. Almost one-third of screenees had untreated HT, and two-thirds of treated hypertensives were not well controlled. These results suggest that opportunistic screening can identify significant numbers with raised BP