Références bibliographiques

Abo Yao, Altman Mathias, Bekelynck Anne, Dahourou Désiré, Simo Fotso Arlette, Godin Zélie, Kadio Kadidiatou, Larmarange Joseph, Sondo Apoline et Valentin Louis (2020) Connaissances, attitudes et pratiques liées à la pandémie COVID-19 des médecins au Burkina Faso, Policy brief (1), Ouagadougou : Aphro-Cov, 6 p. https://aphro-cov.com/ressources_liste/connaissances-attitudes-et-pratiques-liees-a-la-pandemie-covid-19-des-medecins-au-burkina-faso/.

Résumé : CAP-CoV-BF : une enquête nationale réalisées auprès des médecins au Burkina Faso Le personnel de santé se trouve au cœur du dispositif élaboré dans le cadre de la réponse à l’épidémie de COVID-19, à la fois en tant qu’acteur essentiel du dispositif de réponse à l’épidémie, et en tant que premières personnes exposées et victimes. Il est ainsi essentiel de s’assurer de la compréhension de cette maladie (symptômes, modes de transmission, mesures de prévention, etc.) et de l’acceptabilité et de l’adaptation des médecins du Burkina Faso face aux mesures de santé publique préconisées. Cela permettra d’identifier les difficultés et les barrières qu’ils rencontrent afin d’adopter les mesures de protection adéquates, proposer des interventions adaptées pour les surmonter et prioriser les messages qui leur sont destinés. L’objectif principal de cette étude est de fournir aux acteurs nationaux impliqués dans la gestion de la crise des données probantes régulières et représentatives à l’échelle nationale sur les connaissances, attitudes et pratiques des médecins au Burkina Faso. Une enquête quantitative transversale par téléphone a été mise en place, menée auprès d’un échantillon représentatif de 166 médecins sur l’ensemble du territoire. Elle sera répétée trois fois à intervalles réguliers. Ce document “Policy Brief” (téléchargeable au lien ci-dessous) présente de façon synthétique les résultats de l’analyse de la 1ère vague d’appels réalisée en Septembre 2020.

Abo et al. - 2020 - Connaissances, attitudes et pratiques liées à la p.pdf 824 kio

Ante-Testard Pearl Anne, Benmarhnia Tarik, Bekelynck Anne, Baggaley Rachel, Ouattara Eric, Temime Laura et Jean Kévin (2020) « Temporal trends in socioeconomic inequalities in HIV testing: an analysis of cross-sectional surveys from 16 sub-Saharan African countries », The Lancet Global Health, 8 (6) (juin), p. e808-e818. DOI : 10.1016/S2214-109X(20)30108-X. https://linkinghub.elsevier.com/retrieve/pii/S2214109X2030108X.

Résumé : Overall increases in the uptake of HIV testing in the past two decades might hide discrepancies across socioeconomic groups. We used data from population-based surveys done in sub-Saharan Africa to quantify socioeconomic inequalities in uptake of HIV testing, and to establish trends in testing uptake in the past two decades. Methods We analysed data from 16 countries in sub-Saharan Africa where at least one Demographic and Health Survey was done before and after 2008. We assessed the country-specific and sex-specific proportions of participants who had undergone HIV testing in the previous 12 months across wealth and education groups, and quantified socioeconomic inequalities with both the relative and slope indices of inequalities. We assessed time trends in inequalities, and calculated mean results across countries with random-effects meta-analyses. Findings We analysed data for 537 784 participants aged 15-59 years (most aged 15-49 years) from 32 surveys done between 2003 and 2016 (16 before 2008, and 16 after 2008) in Cameroon, Cote d'Ivoire, DR Congo, Ethiopia, Guinea, Kenya, Lesotho, Liberia, Malawi, Mali, Niger, Rwanda, Sierra Leone, Tanzania, Zambia, and Zimbabwe. A higher proportion of female participants than male participants reported uptake of HIV testing in the previous 12 months in five of 16 countries in the pre-2008 surveys, and in 14 of 16 countries in the post-2008 surveys. After 2008, in the overall sample, the wealthiest female participants were 2.77 (95% CI 1.42-5.40) times more likely to report HIV testing in the previous 12 months than were the poorest female participants, whereas the richest male participants were 3.55 (1.85-6.81) times more likely to report HIV testing than in the poorest male participants. The mean absolute difference in uptake of HIV testing between the richest and poorest participants was 11.1 (95% CI 4.6-17.5) percentage points in female participants and 15.1 (9.6-20.6) in male participants. Over time (ie, when pre-2008 and post-2008 data were compared), socioeconomic inequalities in the uptake of HIV testing in the previous 12 months decreased in male and female participants, whereas absolute inequalities remained similar in female participants and increased in male participants. Interpretation Although relative socioeconomic inequalities in uptake of HIV testing in sub-Saharan Africa has decreased, absolute inequalities have persisted or increased. Greater priority should be given to socioeconomic equity in assessments of HIV-testing programmes. Copyright (C) 2020 The Author(s). Published by Elsevier Ltd.

Assoumou Nelly, Bekelynck Anne, Carillon Séverine, Kouadio Alexis, Ouantchi Honoré, Doumbia Mohamed, Larmarange Joseph et Kone Mariatou (2020) « Organisation du financement du dépistage du VIH à base communautaire en Côte d'Ivoire : une recherche d'efficience potentiellement contre-productive ? » (poster), présenté à INTEREST 2020, online. http://interestworkshop.org/.

Résumé : Contexte: Depuis le début des années 2010, le President’s Emergency Plan for AIDS Relief (Pepfar) et le Fonds mondial de lutte contre le VIH/ sida, la tuberculose et le paludisme, ont accentué leurs stratégies d’efficience basées sur la gestion axée sur les résultats (GAR). L’objectif ici est d’analyser les effets de ces stratégies sur la mise en oeuvre locale des activités, à travers l’exemple du dépistage du VIH à base communautaire. Matériels et Méthodes: L’étude a été menée en 2015 et 2016 dans trois districts sanitaires de la Côte d’Ivoire. Une cartographie des acteurs impliqués dans le dépistage à base communautaire et des entretiens semi-directifs ont été réalisés auprès de dix-huit membres des ONG dites «communautaires» : coordonnateurs de projet (8), chargés de suivi et évaluation (5), superviseur des activités (1), conseillers communautaires (4). Résultats: Les deux bailleurs mettent en place des systèmes de financement qui se déclinent sous forme de chaines à plusieurs maillons d’acteurs (bailleurs, organisations intermédiaires, ONG communautaires), de trois niveaux pour le Pepfar à quatre ou cinq pour le Fonds mondial. A chaque niveau, des comptes rendus et validations des données mensuelles, trimestrielles et annuelles sont exigées comme conditions de décaissements des fonds. Leur caractère chronophage, conjugué au manque de ressources humaines et/ou techniques des ONG communautaires génèrent d’importants retards. Au final, sur une année, seuls huit à neuf mois (sur douze) sont généralement consacrés à la mise en oeuvre effective des activités de dépistage ; et chaque mois, seules deux semaines (sur quatre) y sont dédiées. Conclusion: Tandis que les bailleurs de fonds portent une attention croissante à l’obtention de données précises et actualisées dans le but d’améliorer l’efficience de leurs stratégies, celles-ci produisent des effets contre-productifs, qui tendent à nuire à la mise en oeuvre effective des activités. Un juste équilibre entre mise en oeuvre et suivi et évaluation est ainsi à trouver, en fonction des capacités humaines et techniques des acteurs.

Bekelynck Anne et Larmarange Joseph (2020) « PEPFAR’s 3.0 HIV testing policy in Côte d'Ivoire reveals fragmentation, acceleration and disconnection », Aidspan, 376, avril 1. https://www.aidspan.org/gfo_article/pepfar%E2%80%99s-30-hiv-testing-policy-c%C3%B4te-divoire-reveals-fragmentation-acceleration-and.

Bekelynck Anne et Larmarange Joseph (2020) « La politique de dépistage du VIH de Pepfar 3.0 en Côte d'Ivoire (2014 à 2018) : fragmentation, accélération et déconnexion », Aidspan, 96, février 28. https://www.aidspan.org/fr/node/5224.

Boye Sokhna, Bouaré Seydou, Ky-Zerbo Odette, Rouveau Nicolas, Simo Fotso Arlette, d'Elbée Marc, Silhol Romain, Keita Adbelaye, Bekelynck Anne, Desclaux Alice, Larmarange Joseph, Pourette Dolorès et ATLAS Team (2020) « Challenges of HIV self-tests distribution for index testing in a context where HIV status disclosure is low: preliminary experience of the ATLAS project in Bamako, Mali » (poster PED1255), présenté à 23rd AIDS International Conference, San Francisco (virtual). https://cattendee.abstractsonline.com/meeting/9289/Presentation/2271.

Résumé : BACKGROUND: In Côte d''Ivoire, Mali and Senegal, ATLAS project has introduced HIV self-testing (HIVST) as an index testing strategy, distributing HIVST kits to people living with HIV (PLHIV) during consultations for secondary distribution to their partners. Here, we present preliminary results of an ethnographic survey conducted in one HIV clinic in Bamako, Mali, where most HIV patients have not disclosed their HIV status to their partner(s), notably for women for fear of jeopardizing their relationships. In such a context, how non-disclosure affect the distribution of HIVST kits? METHODS: The study was conducted from September 25 to November 27, 2019, and included individual interviews with 8 health workers; 591 observations of medical consultations; and 7 observations of patient groups discussions led by peer educators. RESULTS: Three principal barriers to HIVST distribution for index testing were identified. (1) Reluctance of PLHIV to offer HIVST to partners to whom they have not (yet) disclosed their status and desire to learn tactics for offering testing without disclosing their HIV status. (2) Near-universal hesitancy among health workers to offer HIVST to persons who, they believe, have not disclosed their HIV status to their partner(s). (3) Absence of strategies, among health workers, to support discussion of status disclosure with PLHIV. In the rare cases where HIVST was offered to a PLHIV whose partner did not know their status, either the PLHIV declined the offer or the provider left it to the patient to find a way to deliver the HIVST without disclosing his/her status. CONCLUSIONS: HIV self-testing distribution could serve as an opportunity for PLHIV to disclose their HIV status to partners. The continuing reluctance of PLHIV to heed advice to share their status and promote secondary HIV self-testing distribution highlights the structural factors (social inequalities and stigma) that limit awareness of HIV status and that favour the persistence of the epidemic.

Inghels Maxime, Kouassi Arsène Kra, Niangoran Serge, Bekelynck Anne, Carillon Séverine, Sika Lazare, Danel Christine, Kone Mariatou, Desgrées du Loû Annabel et Larmarange Joseph (2020) « Cascade of Provider-Initiated Human Immunodeficiency Virus Testing and Counselling at Specific Life Events (Pregnancy, Sexually Transmitted Infections, Marriage) in Côte dʼIvoire: », Sexually Transmitted Diseases, 47 (1) (janvier), p. 54-61. DOI : 10.1097/OLQ.0000000000001084. http://Insights.ovid.com/crossref?an=00007435-202001000-00012.

Résumé : BACKGROUND: Despite the implementation of Provider Initiated Testing and Counselling (PITC) in 2009, PITC coverage remains low in Cote d'Ivoire. The purpose of this study is to determine whether an human immunodeficiency virus (HIV) test was offered and performed at specific life events where PITC is recommended by national guidelines. METHODS: In 2017, a cross-sectional telephone survey was conducted among a representative sample of 3,867 adults from the general population in Côte d'Ivoire. The occurrences of the following events over the past 5 years were documented: pregnancy (event A) or partner's pregnancy (event B) of the last child, sexually transmitted infection (event C) and marriage (event D). For each of these events, participants were asked (i) if they consulted a health care professional, (ii) if they were offered an HIV test during that consultation and (iii) if they accepted it. RESULTS: Consulting a health care provider was reported by 94.9%, 58.3%, 70.3% and 19.1% of those who reported events A, B, C and D respectively. In case of medical consultations following events A, B, C and D, respectively 70.1%, 33.1%, 28.1%, and 78.8% of individuals were offered an HIV test. The testing acceptance was high regardless of the event. Overall, testing coverage was 63.7%, 16.9%, 13.4% and 14.5% for events A, B, C and D respectively. CONCLUSIONS: Increasing HIV testing coverage in Côte d'Ivoire requires (i) facilitating attendance to health services in case of sexually transmitted infections, marriage and pregnancy-for men-and (ii) strengthening routine testing offer on these occasions.

Inghels Maxime, Kouassi Arsène Kra, Niangoran Serge, Bekelynck Anne, Carillon Séverine, Sika Lazare, Danel Christine, Koné Mariatou, Desgrées du Loû Annabel, Larmarange Joseph et ANRS 12323 DOD-CI Study Group (2020) « Pratiques et facteurs associés au dépistage récent du VIH en population générale, Côte d’Ivoire. Résultats de l’étude ANRS 12323 DOD-CI », Bulletin De La Societe De Pathologie Exotique (1990), 113 (5) (décembre 28), p. 268-277. DOI : 10.3166/bspe-2021-0154. https://bspe.revuesonline.com/article.jsp?articleId=42002.

Résumé : With 2.9% of HIV prevalence in the general population, Côte d'Ivoire is one of the countries most affected by the HIV epidemic in West Africa. In this country, only 63% of people infected with HIV are aware of their status. A cross-sectional phone survey was conducted with a representative sample of 3,867 individuals to describe the practices and factors associated with a recent HIV testing (≤ 1 year) in Côte d'Ivoire. Data relative to the last done HIV test as well as the socio-demographic characteristics, sexual behavior, access to information, perceptions, capacities and autonomy as well as social and geographical environment of the participants were collected. Logistical regression models were used to identify the associated factors with a recent HIV test (≤ 1 year). Lack of information is one of the main barriers to HIV testing (only 60% of individuals know a place to get tested). For men, despite the fact that HIV testing is free of charge, poor economic conditions seem to be a barrier to testing. The social environment, including peer influence, also appears to have an effect on testing among men. For women, testing is associated with their perceptions of HIV exposure. There is a need to rethink the current HIV testing communication in Côte d'Ivoire and to identify economic or social incentives to remove access barriers to HIV testing.

Mots-clés : Africa, Western, Afrique subsaharienne, Cote d'Ivoire, Côte d’Ivoire, Cross-Sectional Studies, Dépistage, Enquête téléphonique, Female, HIV Infections, HIV Testing, Humans, Male, Population générale, Sexual Behavior, VIH.

Inghels Maxime, Kouassi Arsène Kra, Niangoran Serge, Bekelynck Anne, Carillon Séverine, Sika Lazare, Danel Christine, Kone Mariatou, Desgrees du Lou Annabel, Larmarange Joseph et for the ANRS 12323 DOD-CI Study Group (2020) « Practices and Obstacles to Provider-Initiated HIV Testing and Counseling (PITC) Among Healthcare Providers in Côte d’Ivoire », AIDS and Behavior (mai 24). DOI : 10.1007/s10461-020-02923-0. https://doi.org/10.1007/s10461-020-02923-0.

Résumé : Practices of Provider-Initiated HIV Testing and Counseling (PITC) remains suboptimal in Côte d’Ivoire. The aim of this survey was to identify the practices and obstacles to PITC among healthcare professionals in Côte d'Ivoire. A nationally representative cross-sectional survey was conducted in 2018 by telephone among three separate samples of midwives, nurses and physicians practicing in Côte d'Ivoire. The number of HIV tests proposed during consultation in the month preceding the survey was collected for each professional. Factors associated with the number of proposed tests were identified through ordinal logistic regression models. A total of 298 midwives, 308 nurses and 289 physicians were interviewed. Midwives proposed the test more frequently, followed by nurses and physicians. Among midwives, a higher number of proposed tests was associated with the perception that HIV testing does not require specific consent compared to other diseases (aOR 4.00 [95% CI 1.37–14.29]). Among nurses, having received HIV training and the presence of community HIV counselors were associated with a higher number of proposed tests (aOR 2.01 [1.31–3.09] and aOR 1.75 [1.14–2.70], respectively). For physicians, the presence of a voluntary testing center was associated with a higher number of proposed tests (aOR 1.69 [1.01–2.86]). PITC practices and barriers differed across professions. Beyond improving environmental opportunities such as dedicated staff or services, strengthening the motivations and capabilities of healthcare professionals to propose testing could improve PITC coverage.

Inghels Maxime, Kouassi Arsène Kra, Niangoran Serge, Bekelynck Anne, Carillon Séverine, Sika Lazare, Koné Mariatou, Danel Christine, Desgrées du Loû Annabel et Larmarange Joseph (2020) « Perceptions, préférences et recours aux offres communautaires de dépistage du VIH chez les hommes ayant des relations sexuelles avec d’autres hommes (HSH) en Côte d’Ivoire » (communication orale (session SPD1), présenté à AFRAVIH 2020, Dakar. http://www.afravih2020.org/.

Résumé : Objectifs Depuis la fin des années 2000, se sont développées des offres de dépistage dédiées à destination des HSH. Portées par des ONG communautaires et favorisées par la formation de pairs éducateurs à la réalisation de tests rapides, ce dépistage communautaire serait plus adapté pour atteindre cette population. Mais qu’en est-il du point de vue des intéressés eux-mêmes ? Matériels et Méthodes Une enquête par téléphone de type Respondent driven sampling (RDS) auprès de 518 HSH a été réalisée en 2018 en Côte d’Ivoire. Le questionnaire portait, entre autres, sur la connaissance, la pratique, la satisfaction et les préférences concernant les offres de dépistage dédiées aux HSH. Résultats Seule la moitié des enquêtés (47 %) ont déclaré connaître un lieu de dépistage dédié aux HSH. Parmi ceux-ci, 79 % en avaient déjà fréquenté un. Ces derniers ont rapporté avoir été bien accueillis, s’être sentis en confiance, que la confidentialité avait été respectée et 95 % ont déclaré qu’ils y retourneraient. En termes de préférences, 37 % des enquêtés ont déclaré préférer les lieux de dépistage indifférenciés (c.-à-d. accueillant tout type de patient), 34 % les lieux communautaires et 29 % sans préférence. Ceux préférant le dépistage communautaire mentionnaient une meilleure écoute et s’y sentir plus en confiance, notamment du fait de la présence d’autres HSH. À l’inverse, ceux préférant une offre généraliste mentionnaient le manque de discrétion et d’anonymat des offres communautaires et vouloir éviter le regard des autres. Les hommes les plus éloignés du « milieu HSH », se définissant comme bisexuels/hétérosexuels, attirés principalement par des femmes, ne connaissant pas une association HSH ou n’ayant pas dévoilé leur homosexualité ont plus tendance à préférer un lieu généraliste. Conclusion Si le dépistage communautaire est bien adapté aux HSH qui y ont recours, le maintien d’une offre de dépistage indifférenciée reste essentiel.

Inghels Maxime, Kouassi Arsène Kra, Niangoran Serge, Bekelynck Anne, Carillon Séverine, Sika Lazare, Koné Mariatou, Danel Christine, Desgrées du Loû Annabel et Larmarange Joseph (2020) « Perceptions, preferences and access to community-based HIV testing services among Men who have Sex with Men (MSM) in Côte d'Ivoire » (communication orale (présentation orale de poster), présenté à INTEREST 2020, online. http://interestworkshop.org/.

Résumé : Background: Dedicated HIV testing settings have been developed for Men who have Sex with Men (MSM) since the end of the 2000s. These facilities are supported by community-based NGOs and promoted by peer educators, who are trained in the use of rapid HIV tests. As such, this community-based HIV-testing should be adapted to reach the MSM populations. However, little is known about the direct MSM’ point of view regarding such community-based services. Materials and methods: A respondent-driven sampling telephone survey of 518 MSM was conducted in 2018 in Côte d'Ivoire. The questionnaire examined knowledge, practice, satisfaction, and preferences regarding MSM-community-based HIV testing services. Results: Only half of the respondents (47%) reported knowing a community-based HIV testing site dedicated to MSM. Of these, 79% had already attended one. They reported that they were welcomed, that they felt confident, that confidentiality was respected, and 95% said they would return to one of these sites. In terms of preferences, 37% of respondents said they preferred undifferentiated HIV testing sites (i.e., “all patients” or “general population” HIV testing sites), 34% preferred community-based sites, and 29% had no preference. Those who preferred community-based HIV testing reported better listening and feeling more confident, particularly because of the presence of other MSM. Conversely, those preferring undifferentiated HIV testing sites mentioned the lack of discretion and anonymity of community-based sites and wanting to avoid the gaze of others. They feared to be recognized by other patients in a context where they want to keep secret their sexual preferences. Men who were furthest away from the MSM community, defining themselves as bisexual/heterosexual, attracted primarily to women, not knowing a dedicated MSM NGO, or not having disclosed their homo/bisexuality to one member of their family were more likely to prefer undifferentiated HIV testing sites. Conclusion: Community-based HIV testing is well suited for MSM who identify as homosexual and those close to the MSM community while maintaining undifferentiated HIV testing is essential for others. Both types of activities need to be maintained and developed. It is also crucial that healthcare professionals in undifferentiated HIV testing sites are properly trained in non-judgemental reception of people with diverse sexual practices and identities.

Kouadio Brou Alexis, Carillon Séverine, Bekelynck Anne, Assi Adjoa Nelly Assoumou, Danel Christine, Ouantchi Honoré, Doumbia Mohamed, Koné Mariatou, Larmarange Joseph et Équipe projet DOD-CI ANRS 12323 (2020) « Outreach strategies of HIV testing in Côte d’Ivoire: Community providers under pressure », Sante Publique, 32 (1) (juin 29), p. 103-111. DOI : 10.3917/spub.201.0103. https://www.cairn-int.info/journal-sante-publique-2020-1-page-103.htm.

Résumé : Background: Outreach HIV testing strategies have significantly contributed to the increase in the number of people knowing their HIV status in sub-Saharan Africa. This article analyzes the articulation of donor and field constraints on the implementation of outreach HIV testing strategies in Côte d’Ivoire.Methods: Qualitative research was conducted in three health districts (Man, Cocody-Bingerville and Aboisso) in Côte d’Ivoire in 2015-2016, through in-depth interviews with community providers, local leaders and people tested and through observation of outreach HIV testing activities.Results: Implementing organizations feel “under pressure” to meet donors’ objectives that are deemed unattainable, as well as the lack of training and funding. As a result, providers do not observe systematically the rules of the “three Cs” (counselling, informed consent, confidentiality), and propose testing to individuals who are “off-target” (in terms of locations and populations).Discussion: Implementing NGOs experience two types of constraints those resulting from the functioning of international aid (inadequate funding compared to actual costs, objectives too high, the important chain of intermediaries) and those related to the local context (spaces not adapted to guarantee confidentiality and the professional activity of target populations).Conclusion: The pressure that is exerted at different levels on implementing NGOs is detrimental to the quality of HIV testing. It is now essential to develop a more qualitative approach in defining strategies and evaluation criteria.

Snapshot (source)

Kouadio Brou Alexis, Carillon Séverine, Bekelynck Anne, Assoumou Assi Adjoa Nelly, Danel Christine, Ouantchi Honoré, Doumbia Mohamed, Koné Mariatou, Larmarange Joseph et Équipe projet DOD-CI ANRS (2020) « Dépistage du VIH hors les murs en Côte d’Ivoire : des prestataires communautaires sous pression », Santé Publique, 32 (1), p. 103. DOI : 10.3917/spub.201.0103. http://www.cairn.info/revue-sante-publique-2020-1-page-103.htm?ref=doi.

Résumé : Background: Outreach HIV testing strategies have significantly contributed to the increase in the number of people knowing their HIV status in sub-Saharan Africa. This article analyzes the articulation of donor and field constraints on the implementation of outreach HIV testing strategies in Cote d'lvoire. Methods: Qualitative research was conducted in three health districts (Man, Cocody-Bingerville and Aboisso) in Cote d'lvoire in 2015-2016, through in-depth interviews with community providers, local leaders and people tested and through observation of outreach HIV testing activities. Results: Implementing organizations feel "under pressure" to meet donors' objectives that are deemed unattainable, as well as the lack of training and funding. As a result, providers do not observe systematically the rules of the "three Cs" (counselling, informed consent, confidentiality), and propose testing to individuals who are "off-target" (in terms of locations and populations). Discussion: Implementing NGOs experience two types of constraints those resulting from the functioning of international aid (inadequate funding compared to actual costs, objectives too high, the important chain of intermediaries) and those related to the local context (spaces not adapted to guarantee confidentiality and the professional activity of target populations). Conclusion: The pressure that is exerted at different levels on implementing NGOs is detrimental to the quality of HIV testing. It is now essential to develop a more qualitative approach in defining strategies and evaluation criteria.

Niangoran Serge, Inghels Maxime, Kouassi Arsène Kra, Bekelynck Anne, Carillon Séverine, Sika Lazare, Danel Christine, Koné Mariatou et Larmarange Joseph (2020) « Physicians' knowledge of Hepatitis B and C in Côte d'Ivoire » (poster), présenté à INTEREST 2020, online. http://interestworkshop.org/.

Résumé : Background: Viral hepatitis is a major public health problem in Côte d'Ivoire, with a prevalence of 8% to 10% for hepatitis B and 1% for hepatitis C. Research indicates that there is a lack of awareness of hepatitis in the general population; however, there remains little evidence concerning physician’s knowledge of the virus. We, thus, investigate physician’s knowledge on viral hepatitis B and C, which can be the first condition for screening and treatment. Materials and methods: In 2018, we conducted a cross-sectional Knowledge, Attitudes and Practices (KAP) telephone survey on a random sample of physicians working in health facilities in Côte d'Ivoire. Data collected included an assessment of knowledge about viral hepatitis B and C and their personal attitudes towards hepatitis screening and vaccination. We created a knowledge score based on 14 variables (screening test variables, HBV viral load variables, treatment indications variables, treatment availability and associated costs variables) and identified the associated factors using a multivariate Poisson model. Results: Among the 542 physicians contacted, 316 physicians participated in the survey (58%). The vast majority of doctors spontaneously cited cirrhosis (79%) and liver cancer (77%) as the main complications of viral hepatitis. Screening modalities were also well known. Knowledge of modes of transmission and prevention were uneven : blood transmission 88%, sexual 78%, saliva 27%, during pregnancy or childbirth 20%. Physicians' knowledge of the prevalence of hepatitis B and hepatitis C in the population remains very limited (32% indicates between 5% and 15% for HBV while 33% indicates less than 5% for HCV) In terms of treatment, less than half knew the conditions for initiating hepatitis B treatment (42%) or the existence of curative treatment for hepatitis C (34%). Similarly, few knew the cost of associated treatments or tests (23%), such as HBV viral load (17%). A higher knowledge score was associated with having a close relative infected by viral hepatitis (RR=1.09 [1.00 – 1.19], p=0.052), receiving training on viral hepatitis (RR=1.16 [1.04 – 1.29], p=0,008) and testing for any viral hepatitis (RR=1.16 [1.04 – 1.29], p=0.008). Conclusion: The fight against viral hepatitis requires the involvement of physicians. Findings suggest that many physicians are in need of ongoing training on prevention and treatment of viral hepatitis.

Niangoran Serge, Inghels Maxime, Kouassi Arsène Kra, Bekelynck Anne, Carillon Séverine, Sika Lazare, Koné Mariatou, Desgrées du Loû Annabel et Larmarange Joseph (2020) « Connaissances des médecins sur les hépatites virales B et C en Côte d’Ivoire et facteurs associés » (poster PL189), présenté à AFRAVIH 2020, Dakar. http://www.afravih2020.org/.

Résumé : Objectifs Avec une prévalence de 8% à 10% pour l’hépatite B et de 1% pour l’hépatite C, les hépatites virales constituent un problème de santé publique majeur en Côte d’Ivoire. Alors que ces infections sont mal connues en population générale, qu’en est-il des médecins ? Matériels et Méthodes Une enquête transversale par téléphone a été réalisée en 2018 auprès d’un échantillon aléatoire de 316 médecins exerçant dans des structures de santé en Côte d’Ivoire. Le questionnaire administré portait notamment sur l’évaluation des connaissances sur les hépatites virales B et C ainsi que leurs attitudes personnelles face au dépistage et à la vaccination. Un score de connaissance a été créé à partir de 14 variables (figure) et les facteurs associés ont été mesurés à l’aide d’un modèle multivarié de Poisson. Résultats La grande majorité des médecins citent spontanément la cirrhose et le cancer du foie comme principales complications des hépatites virales. Les modalités de dépistage sont également bien connues. Les connaissances en termes de modes de transmission et de moyens de prévention sont inégales, tandis qu’un tiers a une idée des prévalences des hépatites B et C en Côte d’Ivoire. En matière de prise en charge, moins de la moitié connaît les indications de traitement pour l’hépatite B ou l’existence d’un traitement curatif pour l’hépatite C (figure). De même, peu connaissent les coûts des traitements ou des examens comme la charge virale VHB. Le score de connaissances varie selon le type de structure, le sexe, le fait de connaître un proche porteur d’une hépatite virale, le fait qu’une ONG intervienne ou non dans la structure de santé, avoir suivi une formation sur les hépatites virales et le fait de s’être soi-même fait dépister. Conclusion La lutte contre les hépatites virales passe nécessairement par une implication accrue de l’ensemble des médecins, et notamment par des formations continues à la prévention et à la prise en charge qui doivent être développées.

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