Publications des membres du Ceped

2019



  • Gosset Andréa, Protopopescu Camelia, Larmarange Joseph, Orne-Gliemann Joanna, McGrath Nuala, Pillay Deenan, Dabis François, Iwuji Collins et Boyer Sylvie (2019) « Retention in Care Trajectories of HIV-Positive Individuals Participating in a Universal Test-and-Treat Program in Rural South Africa (ANRS 12249 TasP Trial) », JAIDS Journal of Acquired Immune Deficiency Syndromes, 80 (4) (avril 1), p. 375. DOI : 10.1097/qai.0000000000001938. https://journals.lww.com/jaids/Fulltext/2019/04010/Retention_in_Care_Trajectories_of_HIV_Positive.2.aspx.
    Résumé : Objective: To study retention in care (RIC) trajectories and associated factors in patients eligible for antiretroviral therapy (ART) in a universal test-and-treat setting (TasP trial, South Africa, 2012–2016). Design: A cluster-randomized trial whereby individuals identified HIV positive after home-based testing were invited to initiate ART immediately (intervention) or following national guidelines (control). Methods: Exiting care was defined as ≥3 months late for a clinic appointment, transferring elsewhere, or death. Group-based trajectory modeling was performed to estimate RIC trajectories over 18 months and associated factors in 777 ART-eligible patients. Results: Four RIC trajectory groups were identified: (1) group 1 “remained” in care (reference, n = 554, 71.3%), (2) group 2 exited care then “returned” after [median (interquartile range)] 4 (3–9) months (n = 40, 5.2%), (3) group 3 “exited care rapidly” [after 4 (4–6) months, n = 98, 12.6%], and (4) group 4 “exited care later” [after 11 (9–13) months, n = 85, 10.9%]. Group 2 patients were less likely to have initiated ART within 1 month and more likely to be male, young (<29 years), without a regular partner, and to have a CD4 count >350 cells/mm3. Group 3 patients were more likely to be women without social support, newly diagnosed, young, and less likely to have initiated ART within 1 month. Group 4 patients were more likely to be newly diagnosed and aged 39 years or younger. Conclusions: High CD4 counts at care initiation were not associated with a higher risk of exiting care. Prompt ART initiation and special support for young and newly diagnosed patients with HIV are needed to maximize RIC.
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  • Larmarange Joseph, Diallo Mamadou H, McGrath Nuala, Iwuji Collins, Plazy Mélanie, Thiébaut Rodolphe, Tanser Frank, Bärnighausen Till, Orne-Gliemann Joanna, Pillay Deenan, Dabis François et ANRS 12249 TasP Study Group (2019) « Temporal trends of population viral suppression in the context of Universal Test and Treat: the ANRS 12249 TasP trial in rural South Africa », Journal of the International AIDS Society, 22 (10) (octobre 22), p. e25402. DOI : 10.1002/jia2.25402. https://onlinelibrary.wiley.com/doi/full/10.1002/jia2.25402.
    Résumé : Abstract Introduction The universal test-and-treat (UTT) strategy aims to maximize population viral suppression (PVS), that is, the proportion of all people living with HIV (PLHIV) on antiretroviral treatment (ART) and virally suppressed, with the goal of reducing HIV transmission at the population level. This article explores the extent to which temporal changes in PVS explain the observed lack of association between universal treatment and cumulative HIV incidence seen in the ANRS 12249 TasP trial conducted in rural South Africa. Methods The TasP cluster-randomized trial (2012 to 2016) implemented six-monthly repeat home-based HIV counselling and testing (RHBCT) and referral of PLHIV to local HIV clinics in 2 ? 11 clusters opened sequentially. ART was initiated according to national guidelines in control clusters and regardless of CD4 count in intervention clusters. We measured residency status, HIV status, and HIV care status for each participant on a daily basis. PVS was computed per cluster among all resident PLHIV (≥16, including those not in care) at cluster opening and daily thereafter. We used a mixed linear model to explore time patterns in PVS, adjusting for sociodemographic changes at the cluster level. Results 8563 PLHIV were followed. During the course of the trial, PVS increased significantly in both arms (23.5% to 46.2% in intervention, +22.8, p < 0.001; 26.0% to 44.6% in control, +18.6, p?
    Mots-clés : antiretroviral therapy, HIV, population health, retention in care, South Africa, sustained viral suppression.
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2009


  • Orne-Gliemann Joanna (2009) « Quelle place pour les hommes dans les programmes de prévention de la transmission mère-enfant du VIH ? Revue de la littérature et étude de cas dans les Pays en Développement », Autrepart, 4 (52). http://www.cairn.info/revue-autrepart-2009-4-p-113.htm.
    Résumé : La prévention de la transmission mère-enfant du VIH est une priorité de santé publique à l’échelle mondiale. Cette intervention biomédicale soulève des enjeux socioculturels liés à l’infection par le VIH et aux relations de couple. Mais la prise en compte des hommes dans cette prévention de la transmission du VIH à l’enfant est encore largement insuffisante. Ce papier présente tout d’abord une revue de la littérature sur l’implication des hommes dans la prévention de la transmission mère-enfant du VIH dans les pays à ressources limitées puis les résultats d’une enquête transversale et qualitative conduite dans le cadre d’un essai d’intervention dans quatre pays à ressources limitées.Les hommes jouent un rôle non négligeable sur l’acceptabilité et l’utilisation des services de prévention de la transmission mère-enfant du VIH. Néanmoins, la place accordée dans ces services aux hommes et prise par les hommes est faible. Ce manque d’implication s’explique notamment par la base conceptuelle et structurelle de la prévention de la transmission mère-enfant du VIH focalisée sur la mère et l’enfant, par le manque de communication au sein du couple et par les constructions sociales du rôle de l’homme dans la sphère reproductive. Il est plus que jamais nécessaire de documenter et de mettre en place une approche de la prévention de la transmission mère-enfant du VIH, et à fortiori de la prise en charge globale du VIH/SIDA, qui soit orientée vers le couple.
    Mots-clés : couple, hommes, prévention de la transmission mère-enfant du VIH, VIH, ⛔ No DOI found.
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