65 research outputs found
BMJ Qual Saf
No full textOBJECTIVE: Patients living with HIV infection (PLWH) in sub-Saharan Africa face an important burden of treatment related to everything they do to take care of their health: doctor visits, tests, regular refills, travels, and so on. In this study, we involved PLWH in proposing ideas on how to decrease their burden of treatment and assessed to what extent these propositions could be implemented in care. METHODS: Adult PLWH recruited in three HIV care centres in Cote d'Ivoire participated in qualitative interviews starting with 'What do you believe are the most important things to change in your care to improve your burden of treatment?' Two independent investigators conducted a thematic analysis to identify and classify patients' propositions to decrease their burden of treatment. A group of experts involving patients, health professionals, hospital leaders and policymakers evaluated each patient proposition to assess its feasibility. RESULTS: Between February and April 2017, 326 participants shared 748 ideas to decrease their burden of treatment. These ideas were grouped into 59 unique patient propositions to improve their personal care and the organisation of their hospital or clinic and/or the health system. Experts considered that 27 (46%), 19 (32%) and 13 (22%) of patients' propositions were easy, moderate and difficult, respectively, to implement. A total of 118 (36%) participants offered at least one proposition considered easily implementable by our experts. CONCLUSION: Asking PLWH in sub-Saharan Africa about how their care could be improved led to identifying meaningful propositions. According to experts, half of the ideas identified could be implemented easily at low cost for minimally disruptive HIV care
Prognosis of patients with HIV-1 infection starting antiretroviral therapy in sub-Saharan Africa: a collaborative analysis of scale-up programmes
No full textBackground
Prognostic models have been developed for patients infected with HIV-1 who start combination antiretroviral therapy (ART) in high-income countries, but not for patients in sub-Saharan Africa. We developed two prognostic models to estimate the probability of death in patients starting ART in sub-Saharan Africa.
Methods
We analysed data for adult patients who started ART in four scale-up programmes in Côte d'Ivoire, South Africa, and Malawi from 2004 to 2007. Patients lost to follow-up in the first year were excluded. We used Weibull survival models to construct two prognostic models: one with CD4 cell count, clinical stage, bodyweight, age, and sex (CD4 count model); and one that replaced CD4 cell count with total lymphocyte count and severity of anaemia (total lymphocyte and haemoglobin model), because CD4 cell count is not routinely measured in many African ART programmes. Death from all causes in the first year of ART was the primary outcome.
Findings
912 (8·2%) of 11 153 patients died in the first year of ART. 822 patients were lost to follow-up and not included in the main analysis; 10 331 patients were analysed. Mortality was strongly associated with high baseline CD4 cell count (≥200 cells per μL vs <25; adjusted hazard ratio 0·21, 95% CI 0·17–0·27), WHO clinical stage (stages III–IV vs I–II; 3·45, 2·43–4·90), bodyweight (≥60 kg vs <45 kg; 0·23, 0·18–0·30), and anaemia status (none vs severe: 0·27, 0·20–0·36). Other independent risk factors for mortality were low total lymphocyte count, advanced age, and male sex. Probability of death at 1 year ranged from 0·9% (95% CI 0·6–1·4) to 52·5% (43·8–61·7) with the CD4 model, and from 0·9% (0·5–1·4) to 59·6% (48·2–71·4) with the total lymphocyte and haemoglobin model. Both models accurately predict early mortality in patients starting ART in sub-Saharan Africa compared with observed data.
Interpretation
Prognostic models should be used to counsel patients, plan health services, and predict outcomes for patients with HIV-1 infection in sub-Saharan Africa
Clinical deterioration during antituberculosis treatment in a high HIV-1 prevalence setting
No full textOrigin of the synergistic effect between TiO2 crystalline phases in the Ni/TiO2-catalyzed CO2 methanation reaction
No full textInternational audienceThe catalytic performances of TiO2-supported Ni catalysts for the methanation of CO2 have been investigated using different crystalline phases of TiO2 (rutile and anatase). The catalytic activity of Ni depends appreciably on the nature of the support. The rate for CO2 hydrogenation decreases in the order of 10Ni/TiO2-rutile ≫ 10Ni/TiO2-anatase. The use of a mixture of catalysts containing 70% 10Ni/TiO2-anatase + 30% 10Ni/TiO2-rutile allows for a significant increase of the reaction rate related to 100% 10Ni/TiO2-rutile. Importantly, it has been demonstrated that the two catalysts do not need to be in direct contact for the synergetic effect to occur. DRIFTS operando analysis during the methanation reaction shows that adsorbed CO accumulates on Ni/TiO2-anatase and not on Ni/TiO2-rutile, and that the role of the Ni/TiO2-rutile is to assist the hydrogenation of this adsorbed CO on the Ni/TiO2-anatase. Increased CO2 methanation is also observed by adding Ni-free TiO2-anatase to 10Ni/TiO2-rutile, indicating that COx hydrogenation can also occur on bare TiO2-anatase if activated hydrogen can be supplied by another source. H2-TPD analyses and catalytic tests performed after dilution of the catalysts have shown that hydrogen spillover (mediated by surface or gas-phase species) is at the origin of the synergy observed between the two catalysts for the Sabatier reaction
Hiv Aids (Auckl)
No full textBackground: Reporting mortality and lost to follow-up (LTFU) by age is essential as older HIV-positive patients might be at risk of long-term effects of living with HIV and/or taking antiretroviral therapy (ART). As age effects might not be linear and might impact HIV outcomes in the oldest more severely, people living with HIV (PLHIV) aged 50-59 years and PLHIV aged >60 years were considered separately. Setting: Seventeen adult HIV/AIDS clinics spread over nine countries in West Africa. Methods: Data were collected within the International Epidemiological Databases to Evaluate AIDS West Africa Collaboration. ART-naive PLHIV-1 adults aged >16 years initiating ART and attending >= 2 clinic visits were included (N=73,525). Age was divided into five groups: 16-29/30-39/40-49/50-59/>= 60 years. The age effect on mortality and LTFU was evaluated with Kaplan-Meier curves and multivariable Cox proportional hazard regressions. Results: At month 36, 5.9% of the patients had died and 47.3% were LTFU. Patients aged >= 60 (N=1,736) and between 50-59 years old (N=6,792) had an increased risk of death in the first 36 months on ART (adjusted hazard ratio=1.66; 95% CI: 1.36-2.03 and adjusted hazard ratio=1.31; 95% CI: 1.15-1.49, respectively; reference: = 60 years old tend to be more often LTFU. Condusion: The oldest PLHIV presented the poorest outcomes, suggesting that the PLHIV aged >50 years old should not be considered as a unique group irrespective of their age. Tailored programs focusing on improving the care services for older PLHIV in Sub-Saharan Africa are clearly needed to improve basic program outcomes
Prevalence and Risk Factors for Albuminuria among HIV Ivorian Children, Using the Dipstick Method
No full textDeterminants of Weight Evolution Among HIV-Positive Patients Initiating Antiretroviral Treatment in Low-Resource Settings.
No full textBACKGROUND
In resource-limited settings, clinical parameters, including body weight changes, are used to monitor clinical response. Therefore, we studied body weight changes in patients on antiretroviral treatment (ART) in different regions of the world.
METHODS
Data were extracted from the "International Epidemiologic Databases to Evaluate AIDS," a network of ART programmes that prospectively collects routine clinical data. Adults on ART from the Southern, East, West, and Central African and the Asia-Pacific regions were selected from the database if baseline data on body weight, gender, ART regimen, and CD4 count were available. Body weight change over the first 2 years and the probability of body weight loss in the second year were modeled using linear mixed models and logistic regression, respectively.
RESULTS
Data from 205,571 patients were analyzed. Mean adjusted body weight change in the first 12 months was higher in patients started on tenofovir and/or efavirenz; in patients from Central, West, and East Africa, in men, and in patients with a poorer clinical status. In the second year of ART, it was greater in patients initiated on tenofovir and/or nevirapine, and for patients not on stavudine, in women, in Southern Africa and in patients with a better clinical status at initiation. Stavudine in the initial regimen was associated with a lower mean adjusted body weight change and with weight loss in the second treatment year.
CONCLUSIONS
Different ART regimens have different effects on body weight change. Body weight loss after 1 year of treatment in patients on stavudine might be associated with lipoatrophy
Avoidable workload of care for patients living with HIV infection in Abidjan, Côte d’Ivoire: A cross-sectional study
No full textObjectivePeople living with HIV infection (PLWHIV) in Sub-Saharan Africa cope with an increasing workload of care (doctor visits, lab tests, medication management, refills, etc.) in a context of poor health service organization. We aimed to describe the workload of care for PLWHIV in Sub-Saharan Africa and assess to what extent simple adjustments in care organization could reduce this workload of care.MethodsAdult PLWHIV under antiretroviral treatment for at least 1 year were recruited in three centers (two public, one private) in Abidjan, Côte d’Ivoire. Using methods inspired from sociology, we precisely described all health-related activities (HRAs) performed by patients, in 1 month, in terms of time, money and opportunity costs. Then, we assessed the theoretical avoidable workload of care if patients’ visits and tests had been grouped on the same days.ResultsWe enrolled 476 PLWHIV in the study. Patients devoted 6.7 hours (SD = 6.3), on average, in HRAs per month and spent 5% (SD = 11) of their monthly revenue, on average, on health activities. However, we found great inter-patient heterogeneity in the mixture of activities performed (managing medications; dietary recommendations; visits, tests, support groups; administrative tasks; etc.) and their time allocation, temporal dispersion and opportunity costs (personal, familial, social or professional costs). For 22% of patients, grouping activities on the same days could reduce both time and cost requirements by 20%.ConclusionPLWHIV in Côte d’Ivoire have a heavy workload of care. Grouping visits and tests on the same days may be a simple and feasible way to reduce patients’ investment of time and money in their care.</div
Pregnancy Outcomes in Women Exposed to Efavirenz and Nevirapine: An Appraisal of the IeDEA West Africa and ANRS Databases, Abidjan, Côte d'Ivoire
No full textCharacteristics of people living with HIV infection (PLWHIV) in Abidjan, Côte d’Ivoire (n = 476).
No full textTotal number of co-morbidities exceeds 100% because a patient may have multiple comorbidities.</p
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