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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Prevention & Care of Pediatric HIV Infection in Ouagadougou, Burkina Faso: Knowledge, Attitudes & Practices of the Caregivers

Background

The paediatric Human Immunodeficiency Virus (HIV) epidemic still progresses because of operational challenges in implementing prevention of mother-to-child HIV transmission (PMCT) programs. We assessed the knowledge, attitudes and practices (KAP) of children’s caregivers regarding mother-to-child transmission (MTCT) of HIV, paediatric HIV infection, early infant diagnosis (EID), and paediatric antiretroviral treatment in Ouagadougou, Burkina Faso.

Methods

We undertook a qualitative survey in the four public hospitals managing HIV exposed or infected children, in Ouagadougou in 2011. A sociologist used a semi-structured questionnaire to interview caregivers of children less than 5 years old attending the paediatrics wards on their KAP. Study participants were divided into four groups as follows:

those who did not yet know their children’s HIV infection status, those who were waiting for their children’s HIV test results, those who were waiting for antiretroviral treatment, and those who were already on antiretroviral treatment.

Results

A total of 37 caregivers were interviewed. The mean age was 32.5 years, and 29 (78 %) were mothers. Twenty seven (73 %) caregivers had primary or higher level of education, and 15 (40 %) described their occupation as “housewife”. Overall, 36 (97 %) of caregivers knew that the main route of HIV transmission for infants was through MTCT and 14 (38 %) specified that it occurred during pregnancy or delivery. Five percent thought that MTCT of HIV occurred during conception. PMTCT interventions could help prevent infant HIV infection according to 32 (87 %) caregivers. Thirty five percent of caregivers stated EID as a prevention strategy. Fifty-four percent of the participants believed that replacement feeding option would prevent MTCT of HIV; 24 (65 %) stated that they would prefer medical practitioners seek caregivers’ consent before carrying out any HIV-test for their child, and that caregivers’ consent was not compulsory before antiretroviral treatment. All caregivers thought that it was necessary to treat HIV-infected children, although they did not know what interventions could be done.

Conclusions

This study highlighted the low level of caregivers’ knowledge on paediatric HIV prevention and care in Ouagadougou. Awareness programs targeting caregivers need to be strengthened in order to improve the uptake of HIV early infant diagnosis and care.

Caregivers’ knowledge, attitudes and perceptions in Ouagadougou, Burkina Faso, 2011

	Total N = 37 100 %	Group 1 N = 11 100 %	Group 2 N = 4 100 %	Group 3 N = 5 100 %	Group 4 N = 17 100 %	Groups 1 + 2 + 3 N = 20 100 %	P-value (Group 1 + 2 + 3 vs Group 4)
Caregiver’s knowledge of existing interventions to prevent MTCT of HIV
Yes	30 (81)	7 (64)	4 (100)	3 (60)	16 (94)	14 (70)	0.16
No	1 (3)	0 (0)	0 (0)	1 (20)	0 (0)	1 (5)
No response	6 (16)	4 (36)	0 (0)	1 (20)	1 (6)	5 (25)
Caregiver’s knowledge regarding existing methods of infant HIV diagnosis
Yes	32 (86)	8 (73)	4 (100)	5 (100)	15 (88)	17 (85)	0.77
No	5 (14)	3 (27)	0 (0)	0 (0)	2 (12)	3 (15)
Caregiver’s knowledge regarding existing treatment of HIV-infected infants
Yes	37 (100)	11 (100)	4 (100)	5 (100)	17 (100)		Not applicable
No	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)
Caregiver’s attitude regarding the practice of their child systematic HIV testing
For	31 (84)	11 (100)	3 (75)	4 (80)	13 (76)	18 (90)	0.26
Against	6 (16)	0 (0)	1 (25)	1 (20)	4 (24)	2 (10)
Caregiver’s attitude regarding the antiretroviral treatment of HIV-infected children
For	37 (100)	11 (100)	4 (100)	5 (100)	17 (100)	20 (100)	Not applicable
Against	0 (0)	0 (0)	0 (0)	0 (0.0)	0 (0.0)	0 (0)
Parent’s consent needed for child HIV-test
Yes	24 (65)	8 (73)	3 (75)	4 (80)	9 (53)	15 (75)	0.16
No	13 (35)	3 (27)	1 (25)	1 (20)	8 (47)	5 (25)
Parent’s consent needed for child treatment
Yes	11 (30)	6 (55)	0 (0)	1 (20)	4 (24)	7 (35)	0.25
No	24 (65)	4 (36)	3 (75)	4 (80)	13 (76)	11 (55)
No response	2 (5)	1 (9)	1 (25)	0 (0)	0 (0)	2 (10)

Group 1: caregivers of HIV-infected child currently treated with antiretroviral therapy

Group 2: caregivers of HIV-infected child not yet initiated on antiretroviral therapy

Group 3: caregivers waiting for their child’s HIV post-test result

Group 4: caregivers attending paediatric ward, with an unknown HIV child status

Vs versus

Full article at:   http://goo.gl/1Dwg43

By:  Malik Coulibaly, Elisabeth Thio, Caroline Yonaba, Sylvie Ouédraogo, Nicolas Meda, Fla Kouéta, Désiré Lucien Dahourou, Angèle Kalmogho, Mady Gansonré, Diarra Yé, Ludovic Kam, Valériane Leroy, and for the MONOD Study Group*

Projet MONOD, ANRS 12206, Centre de Recherche Internationale pour la Santé, 09 BP 168 Ouagadougou, Burkina Faso

Centre Muraz, Bobo Dioulasso, Burkina Faso

CHU Charles De Gaules, Service de Pédiatrie médicale, Ouagadougou, Burkina Faso

CHU Yalgado Ouédraogo, Service de Pédiatrie, Ouagadougou, Burkina Faso

Inserm U1219, Institut de Santé Publique, Epidémiologie et Développement, Université de Bordeaux, Bordeaux, France

Inserm U1027 Université Paul Sabatier, Toulouse 3, Toulouse, France

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Barriers to Cervical Cancer Screening in Burkina Faso: Needs for Patient and Professional Education

Cervical cancer is among the leading causes of cancer deaths for women in low-income African countries, such as Burkina Faso. Given that cervical cancer is a preventable disease through early detection and vaccination, this study aimed at understanding the barriers to cervical cancer early detection in Ouagadougou, the capital city of Burkina Faso. 

Women seeking screening and treatment for cervical cancer during the period of May-August 2014, at the Yalgado Ouedraogo University Hospital, were interviewed about their knowledge, attitudes, and practices toward cervical cancer. Interview questions elicited information about sociodemographic of participants, history of screening, knowledge of cervical cancer, and attitudes toward cervical screening. Scores were assigned to responses of questions and knowledge, and tertitles of distributions were used for comparison. 

A multivariate logistic regression was performed to predict cervical screening. Study participants were relatively young (37.5 ± 10.7 years) and predominately resident of urban areas (83.8 %), and over half had no or less than high school education. 

• Over 90 % of participants had heard about cervical cancer, 
• and about 55 % of them had intermediate-level knowledge of the disease, its screening, and/or risk factors. 
• Knowledge level was lower among rural than urban residents. 

Predictors of screening included 

• higher level of education, 
• older age, 
• higher socioeconomic standard, 
• urban residence, 
• encouragement for screening by a health care worker, 
• and employment. 

Low awareness and socioeconomic barriers lead to underutilization of screening services of women. Motivation and education by healthcare workers are important factors for increasing screening rates. Organized patient and professional education programs in gynecologic services are warranted for improving screening in Burkina Faso and other low-resource countries in Africa.

Via: http://ht.ly/Sqwfl  Purchase full article at: http://ht.ly/SqwlW 

By: Compaore S1, Ouedraogo CM, Koanda S, Haynatzki G, Chamberlain RM, Soliman AS.

• 1Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE, 68198, USA.

Structural Determinants of Health among Women Who Started Selling Sex as Minors in Burkina Faso

Data were drawn from cross-sectional studies of adult female sex workers (FSW) recruited through respondent-driven sampling in Ouagadougou and Bobo-Dioulasso, Burkina Faso.

Of study participants, 27.8% reported selling sex as a minor, ranging from 24.4% in Bobo-Dioulasso to 31.2% in Ouagadougou. 

• In Ouagadougou, early initiates were more than twice as likely to report someone ever forced them to have sex. 
• In Bobo-Dioulasso, those who started as minors were more likely to report someone ever tortured them. 
• In both cities, early initiates were more likely to not use a condom with a client if offered more money. 
• In Ouagadougou, women who had started selling sex at a young age were half as likely to have been tested for HIV more than once ever. 
• In Bobo-Dioulasso, early initiates were less likely to attend HIV-related talks or meetings.

A substantial proportion of FSW in Burkina Faso started selling sex as minors. The findings show that there are heightened vulnerabilities associated with selling sex below age 18 years, including physical and sexual violence, client-related barriers to condom use, and lower access to HIV-related services.

Via: http://ht.ly/SqvyE  Full PDF Article:  http://ow.ly/d/3Kg6 

By: Grosso AL1, Ketende S, Dam K, Papworth E, Ouedraogo HG, Ky-Zerbo O, Baral S.

• 1*Department of Epidemiology, Johns Hopkins University, Baltimore, MD; †Institut de Recherche en Sciences en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso; and ‡Programme d'Appui au Monde Associatif et Communautaire (PAMAC), Ouagadougou, Burkina Faso.

HIV Prevention & Care Services for Female Sex Workers: Efficacy of a Targeted Community-Based Intervention in Burkina Faso

Although interventions to control HIV among high-risk groups such as female sex workers (FSW) are highly recommended in Africa, the contents and efficacy of these interventions are unclear. We therefore designed a comprehensive dedicated intervention targeting young FSW and assessed its impact on HIV incidence in Burkina Faso.

The 321 HIV-uninfected FSW enrolled in the cohort completed 409 person-years of follow-up. No participant seroconverted for HIV during the study (0/409 person-years), whereas the expected modelled number of HIV infections were 5.05/409 person-years (95% CI, 5.01–5.08) or 1.23 infections per 100 person-years (p=0.005). This null incidence was related to a reduction in the number of regular partners and regular clients, and by an increase in consistent condom use with casual clients and with regular clients.

Combining peer-based prevention and care within the same setting markedly reduced the HIV incidence among young FSW in Burkina Faso, through reduced risky behaviours.

Table 1

Baseline participant characteristics and comparison with potentially eligible female sex workers who missed their enrolment visit in Ouagadougou

	Enrolled N=321	Eligible but not enrolled N=118
	n (%) or median [IQR]	N (%) or median [IQR]	p
Socio-demographic characteristics
Age (years)	21 [19–23]	20 [19–23]	0.42
Marital status (married or cohabiting)	109 (34)	31 (26)	0.13
Sex work status			<0.001
Professional	121 (38)	23 (20)
Non-professional	200 (62)	94 (80)
Education			0.29
None	87 (27)	32 (27)
1–6 years (primary)	145 (45)	45 (38)
≥7 years (secondary or superior)	89 (28)	41 (35)
Median monthly income (€)	91 [53–149]	63 [38–114]	<0.001
Sex work is the main income source	211 (66)	60 (51)	0.003
Drug and alcohol consumption
Druga consumption	14 (4)	–	–
Any alcohol consumption	202 (63)	68 (58)	0.37
Previous HIV-testing	231 (72)	74 (63)	0.06
Child desire	67 (21)	25 (21)	1.00
Sexual behaviours
Age of sex debut (years)	16 [15–18]	17 [15–18]	0.04
Duration of sex work (years)	1 [0.1–3.0]	1 [0.0–2.0]	<0.001
Number of casual clients (previous week)	2 [1–3]	1 [1–1]	0.01
>1 regular clients (last month)	136 (42)	27 (23)	<0.001
>1 regular partner (last month)	59 (19)	21 (18)	0.88
>1 previous pregnancy	93 (29)	22 (19)	0.03
Always condom use with casual clients	273 (95)	86 (93)	0.45
Always condom use with regular clients	150 (77)	31 (70)	0.43
Always condom use with regular partner	128 (50)	59 (56)	0.29
Vaginal infections
Vaginal candidiasis	36 (13)	15 (16)	0.38
Bacterial vaginosis	37 (13)	12 (13)	0.73
STI
Trichomoniasis vaginalis	8 (3)	3 (4)	1.00
HSV-2 infection	91 (28)	–	–

aInclude cannabis, volatile solvents, hallucinogens and amphetamines.

Via:   http://ht.ly/SquL9

By: Isidore T Traore,§,1 Nicolas Meda,1,2 Noelie M Hema,3 Djeneba Ouedraogo,3 Felicien Some,3 Roselyne Some,3 Josiane Niessougou,3 Anselme Sanon,1 Issouf Konate,1 Philippe Van De Perre,4,5 Philippe Mayaud,6 and Nicolas Nagot4,5

²Department of Public Health, Centre Muraz, Bobo-Dioulasso, Burkina Faso, West Africa

³Centre of International Research for Health, University of Ouagadougou, Ouagadougou, Burkina Faso, West Africa

⁴UMR 1058, INSERM/University of Montpellier/EFS, Montpellier, France

⁵CHRU Montpellier, Montpellier, France

⁶

1Department of Clinical Research, Centre Muraz, Bobo-Dioulasso, Burkina Faso, West Africa

2Department of Public Health, Centre Muraz, Bobo-Dioulasso, Burkina Faso, West Africa
3Centre of International Research for Health, University of Ouagadougou, Ouagadougou, Burkina Faso, West Africa
4UMR 1058, INSERM/University of Montpellier/EFS, Montpellier, France
5CHRU Montpellier, Montpellier, France
6Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK

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1Department of Clinical Research, Centre Muraz, Bobo-Dioulasso, Burkina Faso, West Africa