Pratique du dépistage du cancer du col au Service des Maladies infectieuses et tropicales, Abidjan

le dépistage systématique du cancer du col de l’utérus chez les femmes  infectées par le Vih est recommandé par l’oMS et effectif en Côte d’ivoire depuis 2009. l’objectif était de partager l’expérience de cette pratique en routine chez les femmes infectées par le Vih suivies dans un service  d’infectiologie à abidjan. il s’est agit d’une étude rétrospective des dossiers de patientes âgées de 25 à 65 ans, infectées par le Vih, suivies au SMiT entre 2010 et 2014. la technique d’inspection visuelle à l’acide acétique (iVa) a été utilisée pour le dépistage. les données socio-démographiques, cliniques et thérapeutiques recueillies ont été analysées à l’aide des logiciels excel 2007 et STaTa version 13.0. le test statistique utilisé pour comparer les pourcentages était le khi deux ou le test exact de Fischer. les différences observées ont été considérées comme significatives en dessous de 5 %. la variable d’intérêt était la réalisation d’au moins un test iVa en routine. Selon le résultat du test iVa, le profil clinique et immunovirologique des patientes a été analysé en précisant la conduite à tenir selon  l’indication. enfin la poursuite du dépistage a été notifiée dans le temps spécifiquement chez les femmes négatives au test initial. entre 2010 et 2014, 4 368 femmes infectées par le Vih étaient éligibles au dépistage du cancer du col. Parmi elles, 301 femmes (6,9 %) en ont bénéficié. l’âge médian était de 38 ans [25 - 58 ans]. la médiane des Cd4 au bilan de suivi lors du test iVa était de 291 cellules/mm3 [2 – 1 876 cellules/mm3]. le dépistage était positif pour 24 femmes (8 %) et selon les indications, 6 femmes étaient éligibles à la cryothérapie (26 %), 6 à la résection à l’anse diathermique (26 %) et 10 à la réalisation d’un frottis cervico-vaginal, pour une suspicion de cancer invasif (44 %). les patientes positives au test iVa étaient relativement plus jeune (35 vs 38 ans ; p = 0,03). aucun contrôle ultérieur n’a été effectué chez 90 % (n = 249) de celles qui ont eu un test iVa négatif au premier dépistage. le dépistage systématique est peu réalisé en routine au cours du suivi des femmes Vih. les défis  opérationnels doivent être relevés pour une optimisation des soins en afrique.Mots-clés : dépistage, cancer invasif du col, prévention, Vih, abidjan. Routine screening for cervical cancer in hiV-infected women is  recommended by the who and has been effective in Côte d’ivoire since 2009. The aim was to share the experience of this practice routinely in women infected hiV followed in an infectious disease service in abidjan. This was a retrospective study of hiVinfected women aged 25 to 65, followed at SMiT between 2010 and 2014. The technique of visual inspection with acetic acid (iVa) was used for screening. The socio-demographic, clinical and therapeutic data collected were analyzed using excel 2007 and STaTa version 13.0 software. The statistical test used to compare the percentages was the chi-square or the exact Fischer test. The observed differences were considered significant below 5%. The main variable of interest was the  completion of at least one routine iVa test. according to the result of the  iVa test, the clinical and immunovirological profile of the patients was analyzed by specifying the action to be taken according to the indication. Finally, continuation of screening was notified in time specifically in women who were negative in the initial test. Between 2010 and 2014, 4368 women with hiV were eligible for cervical cancer screening. of these, 301 women (6.9%) benefited. The median age was 38 [25-58]. The median Cd4 at follow-up in the iVa test was 291 cells / mm3 [2 - 1876 cells / mm3]. Screening was positive for 24 women (8%) and, according to the  indications, 6 women were eligible for cryotherapy (26%), 6 for diathermic  loop resection (26%) and 10 for smears. cervicovaginal, for a suspected invasive cancer (44%). iVa-positive patients were relatively younger (35 vs. 38 years, p = 0.03). no subsequent control was performed in 90% (n = 249) of those who had an iVa negative test at first screening. Routine  screening is rarely performed routinely during hiV follow-up. operational challenges need to be addressed to optimize care in africa.Keywords: screening, invasive cervical cancer, prevention, hiV, abidjan.

Implementation of tuberculosis intensive case finding, isoniazid preventive therapy, and infection control ("Three I's") and HIV-tuberculosis service integration in lower income countries

Setting: World Health Organization advocates for integration of HIV-tuberculosis (TB) services and recommends intensive case finding (ICF), isoniazid preventive therapy (IPT), and infection control ("Three I's") for TB prevention and control among persons living with HIV. Objective: To assess the implementation of the "Three I's" of TB-control at HIV treatment sites in lower income countries. Design: Survey conducted between March-July, 2012 at 47 sites in 26 countries: 6 (13%) Asia Pacific, 7 (15%), Caribbean, Central and South America, 5 (10%) Central Africa, 8 (17%) East Africa, 14 (30%) Southern Africa, and 7 (15%) West Africa. Results: ICF using symptom-based screening was performed at 38% of sites; 45% of sites used symptom-screening plus additional diagnostics. IPT at enrollment or ART initiation was implemented in only 17% of sites, with 9% of sites providing IPT to tuberculin-skin-test positive patients. Infection control measures varied: 62% of sites separated smear-positive patients, and healthcare workers used masks at 57% of sites. Only 12 (26%) sites integrated HIV-TB services. Integration was not associated with implementation of TB prevention measures except for IPT provision at enrollment (42% integrated vs. 9% nonintegrated; p = 0.03). Conclusions: Implementation of TB screening, IPT provision, and infection control measures was low and variable across regional HIV treatment sites, regardless of integration status

Detection and management of drug-resistant tuberculosis in HIV-infected patients in lower-income countries

SETTING: Drug resistance threatens tuberculosis (TB) control, particularly among human immunodeficiency virus (HIV) infected persons. OBJECTIVE: To describe practices in the prevention and management of drug-resistant TB under antiretroviral therapy (ART) programs in lower-income countries. DESIGN: We used online questionnaires to collect program-level data on 47 ART programs in Southern Africa (n =14), East Africa (n = 8), West Africa (n = 7), Central Africa (n = 5), Latin America (n = 7) and the Asia-Pacific (n=6 programs) in 2012. Patient-level data were collected on 1002 adult TB patients seen at 40 of the participating ART programs. RESULTS: Phenotypic drug susceptibility testing (DST) was available in 36 (77%) ART programs, but was only used for 22% of all TB patients. Molecular DST was available in 33 (70%) programs and was used in 23% of all TB patients. Twenty ART programs (43%) provided directly observed therapy (DOT) during the entire course of treatment, 16 (34%) during the intensive phase only, and 11 (23%) did not follow DOT. Fourteen (30%) ART programs reported no access to second-line anti-tuberculosis regimens; 18 (38%) reported TB drug shortages. CONCLUSIONS: Capacity to diagnose and treat drugresistant TB was limited across ART programs in lowerincome countries. DOT was not always implemented and drug supplies were regularly interrupted, which may contribute to the global emergence of drug resistance