Missed Opportunities of Inclusion of HIV-Infected Children to Initiate Antiretroviral Treatment Before the Age of Two in West Africa, 2011 to 2013

INTRODUCTION:

The World Health Organization (WHO) 2010 guidelines recommended to treat all HIV-infected children less than two years of age. We described the inclusion process and its correlates of HIV-infected children initiated on early antiretroviral therapy (EART) at less than two years of age in Abidjan, Côte d'Ivoire, and Ouagadougou, Burkina Faso.

METHODS:

All children with HIV-1 infection confirmed with a DNA PCR test of a blood sample, aged less than two years, living at a distance less than two hours from the centres and whose parents (or mother if she was the only legal guardian or the legal caregiver if parents were not alive) agreed to participate in the MONOD ANRS 12206 project were included in a cohort to receive EART based on lopinavir/r. We used logistic regression to identify correlates of inclusion.

RESULTS:

Among the 217 children screened and referred to the MONOD centres, 161 (74%) were included and initiated on EART. The main reasons of non-inclusion were fear of father's refusal (48%), mortality (24%), false-positive HIV infection test (16%) and other ineligibility reasons (12%). Having previously disclosed the child's and mother's HIV status to the father (adjusted odds ratio (aOR): 3.20; 95% confidence interval (95% CI): 1.55 to 6.69) and being older than 12 months (aOR: 2.05; 95% CI: 1.02 to 4.12) were correlates of EART initiation. At EART initiation, the median age was 13.5 months, 70% had reached WHO Stage 3/4 and 57% had a severe immune deficiency.

CONCLUSIONS:

Fear of stigmatization by the father and early competing mortality were the major reasons for missed opportunities of EART initiation. There is an urgent need to involve fathers in the care of their HIV-exposed children and to promote early infant diagnosis to improve their future access to EART and survival.

Below:  Cohort profile ofthe ANRS 12206 MONOD study, Abidjan, Ouagadougou, May 2011 to February 2013

Full article at:   http://goo.gl/ILmMTv

By:  Dahourou DL1,2,3, Amorissani-Folquet M4,5, Coulibaly M1,2, Avit-Edi D4, Meda N1,6,7, Timite-Konan M8, Arendt V9, Ye D7,10, Amani-Bosse C4, Salamon R2,Lepage P11, Leroy V12; Monod Anrs 12206 Study Group.

• 1MONOD Project, ANRS 12206, Centre de Recherche Internationale pour la Santé, Ouagadougou, Burkina Faso.
• 2Inserm, U1219, Institut de Santé Publique, Epidémiologie et Développement, University of Bordeaux, Bordeaux, France.
• 3Centre Muraz, Bobo-Dioulasso, Burkina Faso; ddahourou@gmail.com; ddahourou@gmail.com.
• 4PACCI Programme, Site ANRS, Projet Monod, Abidjan, Côte d'Ivoire.
• 5Pediatric Department, CHU of Cocody, Abidjan, Côte d'Ivoire.
• 6Centre Muraz, Bobo-Dioulasso, Burkina Faso.
• 7University of Ouagadougou, Ouagadougou, Burkina Faso.
• 8Pediatric Department, Centre Hospitalier Universitaire (CHU) de Yopougon, Abidjan, Côte d'Ivoire.
• 9Department of Infection and Immunity, Luxembourg Institute of Health, Luxembourg.
• 10Pediatric Department, CHU Charles de Gaulle, Ouagadougou, Burkina Faso.
• 11Pediatric Department, Hôpital Universitaire des Enfants de la Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium.
• 12Inserm, U1027, Université Toulouse, Toulouse, France. 
• J Int AIDS Soc. 2016 Mar 23;19(1):20601. doi: 10.7448/IAS.19.1.20601.

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Prevalence and Factors Associated with HIV and Tuberculosis in People Who Use Drugs in Abidjan, Ivory Coast

Highlights

• Smoking is the main way of cocaine and heroin consumption in Abidjan, Ivory Coast.
• People who use drugs in Abidjan can be considered at high risk of HIV, due to sexual transmission in women, sex workers, and men having sex with men using drugs.
• Social vulnerability is a major factor of illness in people who use drugs in Abidjan, with particularly high rates of active pulmonary TB associated with living conditions.

Abstract

Background

The number of people who use drugs (PWUD) has dramatically increased in West Africa over the last 15 years, but targeted interventions are falling behind, notably because of the lack of awareness of the health needs of PWUD. We aimed to assess prevalence and factors associated with HIV and other infections in PWUD in Abidjan, Ivory Coast, one of the countries most affected by HIV in Western Africa.

Methods

We used respondent-driven-sampling to obtain a representative sample of heroin or cocaine/crack users aged 18 years or more. Socio-behavioral data were obtained by face-to-face questionnaires. Blood samples were collected and tested for HIV. Two sputa were obtained in tuberculosis (TB) symptomatic participants for acid-fast-bacilli (AFB) smear testing. After a descriptive analysis, crude prevalence were calculated, then weighted to take account of the sampling method. Factors associated with HIV and TB were studied using adjusted log-binomial regression. Population size was estimated by capture-recapture.

Results

450 PWUD were recruited in May 2014. The mean age was 33.5 years; 10.9% were women. Smoking was the main mode of consumption, ever injecting was reported by 12.7% of the participants (3.6% in the past month). Sex work was reported by 15.8% of the PWUD (13.7% of the men), and 10.2% of the men reported sexual relationships with other men (MSM). We found a weighted prevalence of 9.5% for HIV. Women were 3.4 times more likely to be infected than men. Among men, being a sex worker (SW) (adjusted OR 2.9 [95CI 1.06-7.98]) or MSM (adjusted OR 11.5 [95CI 4.22-31.42]) were the main factors associated with HIV infection in adjusted analysis. Injection was not associated with HIV. TB weighted prevalence was 1.8%, associated with poor living arrangements in adjusted analysis. We estimated that 3521; 95CI 3049–3993 PWUD live in Abidjan.

Conclusion

PWUD in Abidjan are at high risk of HIV due to sexual transmission, especially in women, SW and MSM who also use drugs. Interventions should be developed to improve HIV prevention and linkage to care in these specific populations. More generally, improving the health of PWUD involves a broader reflection on the living environment and access to health care of slum residents in large African cities.

Purchase full article at:   http://goo.gl/vQo1be

By:  Julie Bouscaillou, Jérome Evanno, Myrtille Prouté, André Inwolé, Mathieu Kabran, Thierry N’Guessan, Samedi Djé-Bi, Souleymane Sidibé, Marguerite Thiam-Niangoin, Roger Nguessan Badou, Pascale Blanchetière, Niklas Luhmann

julie.bouscaillou@medecinsdumonde.net

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Scale-up of HIV Viral Load Monitoring — Seven Sub-Saharan African Countries

To achieve global targets for universal treatment set forth by the Joint United Nations Programme on human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) (UNAIDS), viral load monitoring for HIV-infected persons receiving antiretroviral therapy (ART) must become the standard of care in low- and middle-income countries (LMIC) (1). CDC and other U.S. government agencies, as part of the President's Emergency Plan for AIDS Relief, are supporting multiple countries in sub-Saharan Africa to change from the use of CD4 cell counts for monitoring of clinical response to ART to the use of viral load monitoring, which is the standard of care in developed countries. Viral load monitoring is the preferred method for immunologic monitoring because it enables earlier and more accurate detection of treatment failure before immunologic decline. This report highlights the initial successes and challenges of viral load monitoring in seven countries that have chosen to scale up viral load testing as a national monitoring strategy for patients on ART in response to World Health Organization (WHO) recommendations. Countries initiating viral load scale-up in 2014 observed increases in coverage after scale-up, and countries initiating in 2015 are anticipating similar trends. However, in six of the seven countries, viral load testing coverage in 2015 remained below target levels. Inefficient specimen transport, need for training, delays in procurement and distribution, and limited financial resources to support scale-up hindered progress. Country commitment and effective partnerships are essential to address the financial, operational, technical, and policy challenges of the rising demand for viral load monitoring.

In 2014, UNAIDS launched "90-90-90" goals to increase to 90% by 2020 the proportion of persons living with HIV infection who know their status, the proportion of persons living with HIV infection receiving ART, and the proportion of persons living with HIV infection on ART who have achieved viral suppression (defined as HIV RNA concentration below the threshold needed for detection on a viral load assay) (1). Increasing viral load monitoring for ART patients will require lowering costs associated with viral load testing and improving access in LMIC. A global diagnostic access initiative was launched in 2014 by UNAIDS, which challenged the global community to work with manufacturers to provide reasonably priced viral load testing, reducing the price of test kits to as low as $10 per test (2)....

Read at:  http://goo.gl/9sDm3X  By:  https://twitter.com/cdcmmwr

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Lower Levels of Antiretroviral Therapy Enrollment among Men with HIV Compared with Women — 12 Countries, 2002–2013

Equitable access to antiretroviral therapy (ART) for men and women with human immunodeficiency virus (HIV) infection is a principle endorsed by most countries and funding bodies, including the U.S. President's Emergency Plan for AIDS (acquired immunodeficiency syndrome) Relief (PEPFAR) (1). To evaluate gender equity in ART access among adults (defined for this report as persons aged ≥15 years), 765,087 adult ART patient medical records from 12 countries in five geographicregions* were analyzed to estimate the ratio of women to men among new ART enrollees for each calendar year during 2002–2013. 

This annual ratio was compared with estimates from the Joint United Nations Programme on HIV/AIDS (UNAIDS)^† of the ratio of HIV-infected adult women to men in the general population. In all 10 African countries and Haiti, the most recent estimates of the ratio of adult women to men among new ART enrollees significantly exceeded the UNAIDS estimates for the female-to-male ratio among HIV-infected adults by 23%–83%. In six African countries and Haiti, the ratio of women to men among new adult ART enrollees increased more sharply over time than the estimated UNAIDS female-to-male ratio among adults with HIV in the general population. Increased ART coverage among men is needed to decrease their morbidity and mortality and to reduce HIV incidence among their sexual partners. 

Reaching more men with HIV testing and linkage-to-care services and adoption of test-and-treat ART eligibility guidelines (i.e., regular testing of adults, and offering treatment to all infected persons with ART, regardless of CD4 cell test results) could reduce gender inequity in ART coverage.

Full article at:  http://goo.gl/ppLdvz  

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Children Living with HIV-Infected Adults: Estimates for 23 Countries in Sub-Saharan Africa

Background

In sub-Saharan Africa many children live in extreme poverty and experience a burden of illness and disease that is disproportionately high. The emergence of HIV and AIDS has only exacerbated long-standing challenges to improving children’s health in the region, with recent cohorts experiencing pediatric AIDS and high levels of orphan status, situations which are monitored globally and receive much policy and research attention. Children’s health, however, can be affected also by living with HIV-infected adults, through associated exposure to infectious diseases and the diversion of household resources away from them. While long recognized, far less research has focused on characterizing this distinct and vulnerable population of HIV-affected children.

Methods

Using Demographic and Health Survey data from 23 countries collected between 2003 and 2011, we estimate the percentage of children living in a household with at least one HIV-infected adult. We assess overlaps with orphan status and investigate the relationship between children and the adults who are infected in their households.

Results

The population of children living in a household with at least one HIV-infected adult is substantial where HIV prevalence is high; in Southern Africa, the percentage exceeded 10% in all countries and reached as high as 36%. This population is largely distinct from the orphan population. Among children living in households with tested, HIV-infected adults, most live with parents, often mothers, who are infected; nonetheless, in most countries over 20% live in households with at least one infected adult who is not a parent.

Conclusion

Until new infections contract significantly, improvements in HIV/AIDS treatment suggest that the population of children living with HIV-infected adults will remain substantial. It is vital to on-going efforts to reduce childhood morbidity and mortality to consider whether current care and outreach sufficiently address the distinct vulnerabilities of these children.

Below: Co-residence of Children 0–17 with HIV-infected Adults and Adult HIV Prevalence (15–49), by Country

Below:  Among Children 0–17 Living with at Least One HIV-infected Adult, Percent Living with HIV-infected Mothers, Fathers, and Others, by Country

Full article at:  http://goo.gl/IAtHln

By:  

Susan E. Short

Department of Sociology and Population Studies and Training Center, Brown University, Providence, RI, United States of America

Rachel E. Goldberg

Department of Sociology, University of California Irvine, Irvine, CA, United States of America

 

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Exploring Risk Behaviors & Vulnerability for HIV among Men Who Have Sex with Men in Abidjan, Cote d'Ivoire: Poor Knowledge, Homophobia & Sexual Violence

Men who have sex with men (MSM) are at high risk of HIV. Few data are available on MSM and HIV-related risk behaviors in West Africa. We aimed to describe risk behaviors and vulnerability among MSM in Abidjan, Cote d'Ivoire. 

We conducted a cross-sectional respondent-driven sampling survey with 601 MSM in 2011-2012. Sociodemographic and behavioural data as well as data related to emotional state and stigma were collected. Population estimates with 95% confidence intervals were produced. Survey weighted logistic regression was used to assess factors associated with inconsistent condom use in the prior 12 months. 

Most MSM were 24 years of age or younger (63.9%) and had attained at least primary education (84.4%). HIV risk behaviors such as low condom and water-based lubricant use, high numbers of male and female sex partners, and sex work were frequently reported as well as verbal, physical and sexual abuse. Inconsistent condom use during anal sex with a male partner in the prior 12 months was reported by 66.0% of the MSM and was positively associated with history of forced sex, alcohol consumption, having a regular partner and a casual partner, having bought sex, and self-perception of low HIV risk. MSM in Abidjan exhibit multiple and frequent HIV-related risk behaviors. 

To address those behaviours, a combination of individual but also structural interventions will be needed given the context of stigma, homophobia and violence.

Table 1

Sociodemographic characteristics, emotional state, history of abuse and other descriptives of MSM in Abidjan (N = 601).

Variables	Unweighteda % (n)	Weightedb % (95% CI)
Sociodemographic characteristics and self-reported STD symptoms
Age (median 23, range 18–51)
18–24	59.1 (355)	63.9 (57.2–70.5)
25–29	25.8 (155)	23.8 (18.5–29.4)
30–34	9.1 (55)	8.7 (5.1–12.1)
35–39	3.8 (23)	2.8 (1.2–5.5)
40+	2.2 (13)	0.8 (0.1–1.7)
Nationality
Ivoirian	95.0 (571)	95.0 (92.9–97.2)
Other	5.0 (30)	5.0 (2.8–7.2)
Marital status
Never married	91.5 (550)	92.4 (89.5–95.3)
Married	0.8 (5)	0.9 (0.0–2.3)
Divorced, separated, widow	0.3 (2)	0.2 (0.0–0.7)
Married or cohabitating with a woman	2.7 (16)	2.9 (1.2–4.7)
Cohabitating with a man	4.7 (28)	3.6 (1.7–5.7)
Highest education level started
Never been to school	5.8 (35)	6.3 (3.5–8.8)
Primary	7.0 (42)	9.3 (5.8–13.1)
Secondary	55.9 (336)	59.6 (54.3–66.7)
Post-secondary	31.3 (188)	24.8 (19.1–29.7)
Work status
Unemployed	14.5 (87)	17.5 (12.5–22.2)
Student	40.4 (243)	40.6 (34.7–46.6)
Shopkeeper, retailer, hotel worker	18.6 (112)	14.5 (10.8–19.2)
Laborer, driver, artist	15.0 (90)	17.2 (12.4–22.7)
Clerical, professional	5.1 (31)	4.6 (2.4–6.9)
Sex workers	0.7 (4)	0.1 (0.0–0.3)
Other	5.7 (34)	5.5 (3.2–8.2)
Sexual identity
Homosexual	43.9 (264)	40.2 (34.7–46.4)
Bisexual	54.4 (327)	57.6 (51.4–62.8)
Heterosexual	1.4 (8)	1.8 (0.5–3.9)
Don't know	0.3 (2)	0.4 (0.0–1.5)
Age at first sex with a man
≤10	5.6 (31)	6.0 (2.9–9.4)
11–15	21.7 (121)	18.6 (14.4–24.2)
16–20	54.2 (302)	50.2 (43.2–56.8)
21–25	12.9 (72)	17.4 (11.8–22.8)
26–30	5.0 (28)	6.8 (3.5–11.0)
>31	0.6 (3)	1.1 (0.0–2.9)
Self-reported STD symptoms in the past 12 months	19.0 (114)	19.2 (14.5–24.0)
Emotional state and history of abuse
Dominant feeling related to whole life in general
Positive feeling	46.0 (276)	44.1 (38.7–50.8)
Ambivalent feeling	13.8 (83)	11.5 (8.3–14.7)
Negative feeling	40.2 (241)	44.3 (38.0–50.1)
PHQ-2 Screen for depression in the past 2 weeks
Screen not depressed	74.7 (447)	74.3 (69.9–78.8)
Screen depressed	25.3 (151)	25.7 (21.2–30.1)
History of harassment or abuse because of MSM status	44.9 (270)	38.5 (32.4–43.6)
History of verbal harassment (threats, insults) because of MSM status	40.9 (246)	33.0 (27.5–37.9)
History of emotional abuse (isolation, exclusion) because of MSM status	9.5 (57)	6.3 (3.9–8.9)
History of physical abuse because of MSM status	13.8 (83)	8.5 (5.5–11.4)
History of forced sex	24.5 (147)	21.4 (16.6–26.0)
Alcohol and drug use
Alcohol use in the past 30 days
Never	27.4 (165)	32.4 (26.0–38.3)
Once a week or less	49.1 (295)	18.4 (14.5–22.9)
More than once a week	23.1 (139)	49.1 (43.4–55.6)
Non-intravenous drug use in the past 12 months	9.3 (56)	9.6 (6.2–13.5)
Exposure to HIV interventions
HIV test in the past 12 months	37.9 (228)	32.1 (26.6–37.0)
Had had an education session with a NGO or a health agent in the past 12 months (not related to HIV testing)	48.1 (289)	39.9 (34.4–45.5)

a. Unweighted: sample proportions.

b. Weighted: population proportions.

Full article at: http://goo.gl/z25NKz

By: Josephine Aho,1,* Avi Hakim,2 Bea Vuylsteke,1 Gisèle Semde,3 Honorat G. Gbais,4 Mamadou Diarrassouba,5Marguerite Thiam,6 and Marie Laga1

¹Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium

²Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America

³Family Health International 360, Kinshasa, Democratic Republic of Congo

⁴Family Health International 360, Abidjan, Cote d′Ivoire

⁵Centers for Disease Control and Prevention, Abidjan, Cote d′Ivoire

⁶Program for Highly Vulnerable Populations, Ministry of Health and Fight against AIDS, Abidjan, Cote d′Ivoire

Rollins School of Public Health, United States of America

* E-mail: ac.oohay@ohaesoj

  

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