Références bibliographiques

Inghels Maxime, Carillon Séverine, Desgrées du Loû Annabel et Larmarange Joseph (2020) « Effect of organizational models of provider-initiated testing and counseling (PITC) in health facilities on adult HIV testing coverage in sub-Saharan Africa », AIDS Care, 32 (2) (février 1), p. 163-169. DOI : 10.1080/09540121.2019.1626339. https://doi.org/10.1080/09540121.2019.1626339.

Résumé : The purpose of this paper is to identify which Provider-Initiated HIV Testing and Counseling (PITC) organizational models are the most efficient to maximize testing coverage. We conducted a systematic literature review to identify published articles that evaluated routine PITC programs implemented in adult health facilities in Sub-Saharan Africa. We considered only articles measuring PITC offer, PITC acceptability and PITC coverage. Adjusted meta-regression models were performed to measure the association between PITC offer, acceptability and coverage with PITC organizational model. A total of 30 articles were included in the meta-analysis. Overall, 85.4% [95%CI: 77.2–93.5] of patients were offered a test, and 87.1% [82.4–91.7] accepted the test resulting in a PITC coverage of 74.3% [66–82.6]. Four types of PITC organizational models were identified: PITC initiated and performed during the consultation (model A), PITC initiated before consultation (model B), PITC referred on-site (model C) and PITC referred off-site (model D). Compared to model A, model B had a similar coverage (aOR: 1.02 [0.82–1.26]). However, coverage was lower for model C (aOR: 0.81 [0.68–0.97]) and model D (aOR: 0.58 [0.44–0.77]). Initiating the testing process before or during medical consultation is recommended for maximizing testing coverage among patients.

Mots-clés : HIV testing, organizational models, Provider initiated testing and counseling, Sub-Saharan Africa, testing cover.

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.

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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