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: 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: 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: 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: 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 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

Acceptabilité de la récupération nutritionnelle ambulatoire chez les enfants de sept ans et plus infectés par le VIH suivis dans douze sites de prise en charge au Sénégal

Malnutrition is a recurrent disease in Africa, particularly affecting children and adolescents living with HIV. Senegal was one of the first African countries to implement a national program for access to antiretrovirals (ISAARV) from 1997. Nevertheless, as in most countries, pediatric in relation to that of adults. Malnutrition and HIV infection interact and increase the risk of child morbidity and mortality. However, international recommendations have focused on the management of malnutrition among children under five years of age. There are few guidelines for nutritional recovery in children over five years of age and adolescents infected with HIV.It was in this context that the Snac's study was set up to evaluate the effectiveness and acceptability of ambulatory nutrition recovery through the administration of Ready-to-Use Foods ) in HIV-infected children and adolescents in 12 treatment sites in Dakar and Senegal. The objective of this thesis is to evaluate, within the framework of this study 1 / the acceptability of an innovative information system for children and parents for participation in research 2 / the acceptability of the recovery intervention nutritional status in children and adolescents and to identify factors and barriers to acceptability 3 / the acceptability of the intervention among the caregivers involved in the study.Three surveys were conducted during the Snac's project at the two sites in Dakar and the ten regional sites for children, parents / caregivers and health professionals. Interviews with children on successful or unsuccessful treatment of malnutrition and with parents were conducted by focus group. They included 112 children at the time of inclusion and 71 children at the time of study exit. Individual interviews were held with 30 healthcare professionals. The quantitative data were processed with SAS and qualitative data using the Dedoose ™ software.Results: The Standardized Information System for Research (dsir) had the advantage of standardizing and making participants' information easily understandable. It was enjoyed by children / teenagers, and by parents / guardians. 68% of parents / guardians and 58% of children / adolescents, correctly answered at least 7/8 questions. The notion that was least well understood by parents / guardians and children / adolescents was the right to leave the study, with respective rates of correct answers of 54% and 36% respectively. The Acceptability Survey identified three determinants that may represent an obstacle to adherence of children / adolescents to ambulatory ape-based nutritional management: ape disgust, adverse effects, and the duration of the waiting period before the consultation. Interviews with healthcare teams highlighted the difficulties encountered in the management of pediatric HIV. The analyzes showed a good acceptability of the intervention, but an uncertainty as to the possibility of perpetuating it at the end of the project.This work allowed us to experiment with the implementation of the desire, which is interesting even if it needs to be improved. It made it possible to describe the difficulties and the stakes of the management of the pediatric hiv infection in particular in the region, which constitute the environment of the interventions of nutritional recovery. The results of this study show that the ambulatory nutritional recovery device is acceptable to the main actors (children / adolescents, parents / caregivers and healthcare teams), but that its sustainability is only possible with the support and commitment health authorities, the establishment of a regular supply in ape and adequate financial and financial support.La malnutrition est une pathologie récurrente en Afrique, qui touche particulièrement les enfants et adolescents vivant avec le VIH. Le Sénégal a été l’un des premiers pays africains à mettre en œuvre un programme national d’accès aux antirétroviraux à partir de 1998. Néanmoins, comme dans la majorité des pays, la prise en charge pédiatrique a connu un retard par rapport à celle des adultes. La malnutrition et l’infection à VIH agissent en interaction et aggravent le risque de morbidité et de mortalité des enfants. Pour autant, les recommandations internationales se sont surtout intéressées à la prise en charge de la malnutrition chez les enfants de moins de cinq ans. Il existe peu de directives concernant les modalités de récupération nutritionnelle chez les enfants de plus de cinq ans et les adolescents infectés par le VIH.C’est dans ce contexte qu’a été mise en place l’étude Snac’s qui avait pour objectif d’évaluer l’efficacité et l’acceptabilité de la récupération nutritionnelle ambulatoire par l’administration d’Aliments prêts à l’emploi (APE) chez les enfants et adolescents infectés par le vih dans 12 sites de prise en charge à Dakar et dans les régions du Sénégal. Cette thèse a pour objectif d’évaluer, dans le cadre de cette étude 1/l’acceptabilité d’un dispositif innovant d’information des enfants et des parents pour la participation à la recherche 2/ l’acceptabilité de l’intervention de récupération nutritionnelle chez les enfants et adolescents et d’identifier les facteurs et obstacles à cette acceptabilité 3/ l’acceptabilité de l’intervention chez les soignants impliqués dans l’étude.Trois enquêtes ont été menées au cours du projet Snac’s, dans les deux sites de Dakar et les dix sites régionaux auprès des enfants, des parents/tuteurs et des professionnels de santé. Les entretiens avec les enfants en succès ou en échec de traitement de la malnutrition et avec les parents se sont déroulés par focus group. Ils ont concerné 112 enfants au moment de l’inclusion et 71 enfants au moment de la sortie de l’étude. Des entretiens individuels ont concerné 30 professionnels de santé.Le Dispositif standardisé d’information à la recherche (dsir) avait pour intérêt de standardiser et rendre facilement compréhensible l’information des participants. Il a été apprécié par les enfants/adolescents, et par les parents/tuteurs. 68 % des parents/tuteurs et 58 % des enfants/adolescents, ont répondu correctement à au moins 7/8 questions. La notion qui a été la moins bien comprise par les parents/tuteurs et les enfants/adolescents était le droit de quitter l’étude, avec des taux respectifs de réponses correctes de 54 % et 36 %. L’enquête sur l’acceptabilité à permis d’identifier trois déterminants qui peuvent représenter un obstacle à l’adhésion des enfants/adolescents à une prise en charge nutritionnelle ambulatoire à base d’ape : le dégoût des ape, les effets secondaires et la durée de l’attente avant la consultation. Les entretiens avec les équipes soignantes ont mis en évidence les difficultés rencontrées dans la prise en charge du VIH pédiatrique. Les analyses ont montré une bonne acceptabilité de l’intervention, mais une incertitude quant à la possibilité de la pérenniser à la fin du projet.Ce travail a permis d’expérimenter la mise en place du dsir, qui s’avère intéressant même s’il demande à être amélioré. Il a permis de décrire les difficultés et les enjeux de la prise en charge de l’infection à vih pédiatrique notamment en région, qui constituent l’environnement des interventions de récupération nutritionnelle. Les résultats de cette étude montrent que le dispositif de récupération nutritionnelle ambulatoire est acceptable par les principaux acteurs (enfants/adolescents, parents/tuteurs et équipes soignantes), mais que sa pérennisation n’est envisageable qu’avec l’appui et l’engagement des autorités sanitaires, la mise en place d’un approvisionnement régulier en ape et d’un accompagnement, notamment financier, adéquat

Acceptability and feasability of outpatient nutritional rehabilitation among HIV-infected children and adolescents in Senegal

La malnutrition est une pathologie récurrente en Afrique, qui touche particulièrement les enfants et adolescents vivant avec le VIH. Le Sénégal a été l’un des premiers pays africains à mettre en œuvre un programme national d’accès aux antirétroviraux à partir de 1998. Néanmoins, comme dans la majorité des pays, la prise en charge pédiatrique a connu un retard par rapport à celle des adultes. La malnutrition et l’infection à VIH agissent en interaction et aggravent le risque de morbidité et de mortalité des enfants. Pour autant, les recommandations internationales se sont surtout intéressées à la prise en charge de la malnutrition chez les enfants de moins de cinq ans. Il existe peu de directives concernant les modalités de récupération nutritionnelle chez les enfants de plus de cinq ans et les adolescents infectés par le VIH.C’est dans ce contexte qu’a été mise en place l’étude Snac’s qui avait pour objectif d’évaluer l’efficacité et l’acceptabilité de la récupération nutritionnelle ambulatoire par l’administration d’Aliments prêts à l’emploi (APE) chez les enfants et adolescents infectés par le vih dans 12 sites de prise en charge à Dakar et dans les régions du Sénégal. Cette thèse a pour objectif d’évaluer, dans le cadre de cette étude 1/l’acceptabilité d’un dispositif innovant d’information des enfants et des parents pour la participation à la recherche 2/ l’acceptabilité de l’intervention de récupération nutritionnelle chez les enfants et adolescents et d’identifier les facteurs et obstacles à cette acceptabilité 3/ l’acceptabilité de l’intervention chez les soignants impliqués dans l’étude.Trois enquêtes ont été menées au cours du projet Snac’s, dans les deux sites de Dakar et les dix sites régionaux auprès des enfants, des parents/tuteurs et des professionnels de santé. Les entretiens avec les enfants en succès ou en échec de traitement de la malnutrition et avec les parents se sont déroulés par focus group. Ils ont concerné 112 enfants au moment de l’inclusion et 71 enfants au moment de la sortie de l’étude. Des entretiens individuels ont concerné 30 professionnels de santé.Le Dispositif standardisé d’information à la recherche (dsir) avait pour intérêt de standardiser et rendre facilement compréhensible l’information des participants. Il a été apprécié par les enfants/adolescents, et par les parents/tuteurs. 68 % des parents/tuteurs et 58 % des enfants/adolescents, ont répondu correctement à au moins 7/8 questions. La notion qui a été la moins bien comprise par les parents/tuteurs et les enfants/adolescents était le droit de quitter l’étude, avec des taux respectifs de réponses correctes de 54 % et 36 %. L’enquête sur l’acceptabilité à permis d’identifier trois déterminants qui peuvent représenter un obstacle à l’adhésion des enfants/adolescents à une prise en charge nutritionnelle ambulatoire à base d’ape : le dégoût des ape, les effets secondaires et la durée de l’attente avant la consultation. Les entretiens avec les équipes soignantes ont mis en évidence les difficultés rencontrées dans la prise en charge du VIH pédiatrique. Les analyses ont montré une bonne acceptabilité de l’intervention, mais une incertitude quant à la possibilité de la pérenniser à la fin du projet.Ce travail a permis d’expérimenter la mise en place du dsir, qui s’avère intéressant même s’il demande à être amélioré. Il a permis de décrire les difficultés et les enjeux de la prise en charge de l’infection à vih pédiatrique notamment en région, qui constituent l’environnement des interventions de récupération nutritionnelle. Les résultats de cette étude montrent que le dispositif de récupération nutritionnelle ambulatoire est acceptable par les principaux acteurs (enfants/adolescents, parents/tuteurs et équipes soignantes), mais que sa pérennisation n’est envisageable qu’avec l’appui et l’engagement des autorités sanitaires, la mise en place d’un approvisionnement régulier en ape et d’un accompagnement, notamment financier, adéquat.Malnutrition is a recurrent disease in Africa, particularly affecting children and adolescents living with HIV. Senegal was one of the first African countries to implement a national program for access to antiretrovirals (ISAARV) from 1997. Nevertheless, as in most countries, pediatric in relation to that of adults. Malnutrition and HIV infection interact and increase the risk of child morbidity and mortality. However, international recommendations have focused on the management of malnutrition among children under five years of age. There are few guidelines for nutritional recovery in children over five years of age and adolescents infected with HIV.It was in this context that the Snac's study was set up to evaluate the effectiveness and acceptability of ambulatory nutrition recovery through the administration of Ready-to-Use Foods ) in HIV-infected children and adolescents in 12 treatment sites in Dakar and Senegal. The objective of this thesis is to evaluate, within the framework of this study 1 / the acceptability of an innovative information system for children and parents for participation in research 2 / the acceptability of the recovery intervention nutritional status in children and adolescents and to identify factors and barriers to acceptability 3 / the acceptability of the intervention among the caregivers involved in the study.Three surveys were conducted during the Snac's project at the two sites in Dakar and the ten regional sites for children, parents / caregivers and health professionals. Interviews with children on successful or unsuccessful treatment of malnutrition and with parents were conducted by focus group. They included 112 children at the time of inclusion and 71 children at the time of study exit. Individual interviews were held with 30 healthcare professionals. The quantitative data were processed with SAS and qualitative data using the Dedoose ™ software.Results: The Standardized Information System for Research (dsir) had the advantage of standardizing and making participants' information easily understandable. It was enjoyed by children / teenagers, and by parents / guardians. 68% of parents / guardians and 58% of children / adolescents, correctly answered at least 7/8 questions. The notion that was least well understood by parents / guardians and children / adolescents was the right to leave the study, with respective rates of correct answers of 54% and 36% respectively. The Acceptability Survey identified three determinants that may represent an obstacle to adherence of children / adolescents to ambulatory ape-based nutritional management: ape disgust, adverse effects, and the duration of the waiting period before the consultation. Interviews with healthcare teams highlighted the difficulties encountered in the management of pediatric HIV. The analyzes showed a good acceptability of the intervention, but an uncertainty as to the possibility of perpetuating it at the end of the project.This work allowed us to experiment with the implementation of the desire, which is interesting even if it needs to be improved. It made it possible to describe the difficulties and the stakes of the management of the pediatric hiv infection in particular in the region, which constitute the environment of the interventions of nutritional recovery. The results of this study show that the ambulatory nutritional recovery device is acceptable to the main actors (children / adolescents, parents / caregivers and healthcare teams), but that its sustainability is only possible with the support and commitment health authorities, the establishment of a regular supply in ape and adequate financial and financial support

Isabelle Defourny & Yves Martin-Prével: Face à Face

Recueillie par Madina Querre et Marie Varloteaux Isabelle Defourny “ID”, Médecin, Directrice des Opérations à Médecin Sans Frontières (MSF) depuis le mois d’aout 2015, auparavant elle était Directrice des Opérations chez ALIMA. Yves Martin-Prével “YMP”, Médecin-épidémiologiste, Directeur de Recherche  à Institut de Recherche pour le développement (IRD), spécialisé dans la nutrition dans les  pays du Sud. Lorsque l’on parle de malnutrition le premier réflexe c’est de l’associer à la faim… Y..

Editorial

Julien Vignikin, Indigestion I. Collection particulière© Archive musée Drapper. Photo Olivier Gallaud, 2014 La situation de crise contemporaine, dont un des enjeux majeurs est l’accès du plus grand nombre à la nourriture, tant en terme de quantité que de qualité, oriente le choix de consacrer notre treizième numéro de Face à Face. Regards sur la santé aux malnutritions dans les pays du Nord et du Sud. Il s’articule autour des questions de dénutrition, de sous-alimentation, de surpoids et d’ob..

Improving the informed consent process among HIV‐infected undisclosed minors participating in a biomedical research: insights from the multicentre nutritional SNACS study in Senegal

International audienceObjectives: Providing research information in a manner accessible to minors participating in biomedical research is a major challenge. Guidance is dramatically lacking regarding best practices for seeking informed consent among undisclosed minors enrolled in HIV‐related research. We implemented an improved informed consent process (IICP) and identified factors associated with understanding of the information presented to HIV‐infected minors prior to their enrolment in a study.Methods: We enrolled study participants attending 12 paediatric HIV clinics in Senegal. Children ≥7 years were provided with standardised research information using the IICP, which involves viewing a video and taking part in extended group discussions. Understanding was assessed by seven basic questions scored 1 or 2 points, with a maximum score of 11 points. A score of 9 or more points was defined as satisfactory understanding. Factors associated with understanding were identified using a stepwise logistic regression model.Results: Overall, 112 children, with a median age of 12.9 years (IQR: 10.2–15.0), participated in the IICP, of whom 37% were HIV disclosed. 71% achieved a satisfactory understanding score and all gave consent to participate in the research. HIV‐disclosed children were more likely to demonstrate satisfactory understanding than undisclosed children (aOR = 3.2, 95% CI: 1.1–9.6). Age, study setting and education level were not associated with satisfactory understanding.Conclusion: These findings provide practical guidance for the development of improved and friendly informed consent processes in research involving minors. The implementation of the paediatric HIV research agenda will require a standardised and operational definition of informed consent, integrating the issue of HIV disclosure

Adherence to ready-to-use food and acceptability of outpatient nutritional therapy in HIV-infected undernourished Senegalese adolescents: research-based recommendations for routine care

International audienceBackground: Ready-to-use food (RUF) is increasingly used for nutritional therapy in HIV-infected individuals. However, practical guidance advising nutrition care to HIV-infected adolescents is lacking, so that little is known about the acceptability of such therapy in this vulnerable population. This study assesses the overall acceptability and perception of a RUF-based therapy and risk factors associated with sub-optimal RUF intake in HIV-infected undernourished adolescents in Senegal.Methods: Participants 5 to 18 years of age with acute malnutrition were enrolled in 12 HIV clinics in Senegal. Participants were provided with imported RUF, according to WHO prescription weight- and age-bands (2009), until recovery or for a maximum of 9-12 months. Malnutrition and recovery were defined according to WHO growth standards. Adherence was assessed fortnightly by self-reported RUF intake over the period. Sub-optimal RUF intake was defined as when consumption of the RUF provision was < 50%. RUF therapy acceptability and perceptions were assessed using a structured questionnaire at week 2 and focus group discussions (FGDs) at the end of the study. Factors associated with sub-optimal RUF intake at week 2 were identified using a stepwise logistic regression model.Results: We enrolled 173 participants, with a median age of 12.5 years (Interquartile range: 9.5-14.9), of whom 61% recovered from malnutrition within the study period. Median follow-up duration was 66 days (21-224). RUF consumption was stable, varying between 64 and 57% of the RUF provided, throughout the follow-up. At week 2, sub-optimal RUF intake was observed in 31% of participants. Dislike of the taste of RUF (aOR = 5.0, 95% CI: 2.0-12.3), HIV non-disclosure (5.1, 1.9-13.9) and food insecurity (2.8, 1.1-7.2) were the major risk factors associated with sub-optimal RUF intake at week 2. FGDs showed that the need to hide from others to avoid sharing and undesirable effects were other constraints on RUF feeding.Conclusions: This study revealed several factors reducing the acceptability and adherence to RUF therapy based on WHO guidelines in HIV-infected adolescents. Tailoring prescription guidance and empowering young patients in their care are crucial levers for improving the acceptability of RUF-based therapy in routine care

Cost-Utility Analysis of a Dolutegravir-Based Versus Low-Dose Efavirenz-Based Regimen for the Initial Treatment of HIV-Infected Patients in Cameroon (NAMSAL ANRS 12313 Trial)

International audienceObjectives: Evidence comparing the economic and patient values of the World Health Organization's preferred (dolutegravir 50 mg [DTG]-based) and alternative (low-dose [400 mg] efavirenz [EFV400]-based) first-line antiretroviral regimens is limited. We compared patient-reported outcomes (PROs), costs, and the cost-utility of DTG- versus EFV400-based regimens in treatment-naive HIV-1 adults in the randomised NAMSAL ANRS 12313 trial in Yaoundé, Cameroon.Methods:We used clinical data, PROs, and health resource use data collected in the trial’s first 96 weeks (2016–2019). Quality-adjusted life-years (QALYs) were computed using utility scores obtained from the 12-item Short Form (SF-12) generic health scale. Other PROs included perceived symptoms, depression, anxiety, and stress. In the 96-week base-case analysis, we estimated the unadjusted and multivariate-adjusted (1) mean costs (in US$, 2016 values) and QALYs/patient, (2) incremental costs and QALYs/patient, and (3) net health benefit (NHB). Outcomes were extrapolated over 5 and 10 years. Uncertainty was assessed using the cost-effectiveness acceptability curve and scenario and cost-effective price threshold analyses