Digital Health in Francophone Sub-Saharan Africa: Catching Up!

Digital health has the potential to strengthen health systems and empower patients to prevent ill health and manage their own care. To confirm this potential, however, it is urgent to shift from pilot studies to the implementation of programs at a sufficient scale, with interoperable solutions and integrated into the national health system, while respecting human rights. It is also important to plan for studies to demonstrate the impact and produce the necessary evidence. Francophone sub-Saharan Africa can catch up in this area.

[HIV treatment by ARV in resource-poor francophone countries]. / Le traitement du VIH par les antirétroviraux dans les pays francophones à ressources limitées.

At the last United Nations General Assembly, an ambitious target has been set for HIV treatment: ending AIDS as a public health threat by 2030. This article proposes to review the situation of HIV treatment in francophone limited resources settings and the challenges faced by those countries. It also proposes innovative actions that should be set up urgently to increase ART coverage towards scaling up.

Review of policy and status of implementation of collaborative HIV-TB activities in 23 high-burden countries.

Issuance of national policy guidance is a critical step to ensure quality HIV-TB (human immunodeficiency virus-tuberculosis) coordination and programme implementation. From the database of the Joint United Nations Programme on HIV/AIDS (UNAIDS), we reviewed 62 national HIV and TB guidelines from 23 high-burden countries for recommendations on HIV testing for TB patients, criteria for initiating antiretroviral therapy (ART) and the Three I's for HIV/TB (isoniazid preventive treatment [IPT], intensified TB case finding and TB infection control). We used UNAIDS country-level programme data to determine the status of implementation of existing guidance. Of the 23 countries representing 89% of the global HIV-TB burden, Brazil recommends ART irrespective of CD4 count for all people living with HIV, and four (17%) countries recommend ART at the World Health Organization (WHO) 2013 guidelines level of CD4 count â©¿500 cells/mm(3) for asymptomatic persons. Nineteen (83%) countries are consistent with WHO 2013 guidelines and recommend ART for HIV-positive TB patients irrespective of CD4 count. IPT is recommended by 16 (70%) countries, representing 67% of the HIV-TB burden; 12 recommend symptom-based screening alone for IPT initiation. Guidelines from 15 (65%) countries with 79% of the world's HIV-TB burden include recommendations on HIV testing and counselling for TB patients. Although uptake of ART, HIV testing for TB patients, TB screening for people living with HIV and IPT have increased significantly, progress is still limited in many countries. There is considerable variance in the timing and content of national policies compared with WHO guidelines. Missed opportunities to implement new scientific evidence and delayed adaptation of existing WHO guidance remains a key challenge for many countries.

[Prevalence of urogenital mycoplasma infection in women infected with HIV in Bangui (Central African Republic)]. / Prévalence de l'infection par mycoplasmes urogénitaux chez la femme atteinte par le VIH à Bangui (République Centrafricaine).

Urogenital mycoplasma (UGM) infections have often been reported in HIV patients. Little is known about UGM colonization and infection. We assessed the level of UGM colonization and infection in a cohort of HIV-positive women living in Bangui, Central African Republic. We studied 146 women of child-bearing age, some of whom were pregnant. All were HIV-positive but asymptomatic and attended one of the urban health centers and the National Center for Sexually Transmitted Diseases in Bangui in April or May 1995. Colonization was defined as an endocervical mycoplasma concentration of less than 10(4) color change units per milliliter (CCU/ml) and infection was defined as an endocervical mycoplasma concentration of at least 10(4) CCU/ml. 58 of the 146 HIV-positive women were pregnant (group A). Group B comprised the other 88 women who were not pregnant. The mean age of the women in group A was 22.7 years (range: 15 to 41) and that for the women in group B was 25.8 years (range: 17 to 40). 134 of the 146 women were carrying one or both of the two types of UGM. There were 53 (91.4%) cases in group A and 81 (92%) in group B. Overall, 40% of the women were colonized and 51.4% were infected. UGM infections frequently affect HIV-positive pregnant women in Bangui. Our results suggest that women should be screened for UGM as well as for other sexually transmitted diseases, to improve the care of HIV-infected women attending antenatal clinics in developing countries.