Morbidity and mortality in HIV-infected children on antiretroviral therapy in Togo.

the aim of this study was to evaluate the mortality and morbidity of HIV-infected children on highly active antiretroviral treatment (HAART) in Togo. this is a retrospective study of HIV-infected children on HAART in the 25 largest centers of HIV/AIDS care in Togo. the study included 1861 children (sex-ratio=0.99). Among them, 35.6 % were in WHO clinical stages 3 or 4 at the beginning of HAART. The most common opportunistic infections were coughing and pneumonia (37.1 %), gastroenteritis (11.3 %), various bacterial infections (10.4 %), and pruritus (10.4 %). The incidence of death was estimated at 4.5 per 100 person-years. Mortality was highest during the first year of antiretroviral therapy. The survival rate at 12 months of ART was 92.6 %. Children who began HAART at WHO clinical stage 4 had a significantly lower survival rate than the others (P<0.0001). The presence of a side effect of HAART (P=0.041), and hospitalization (P<0.001) were significantly associated with death in these children. although the new recommendations for medical care require early initiation of HAART, the improved performance of programs to prevent maternal-infant transmission remains crucial in reducing morbidity and mortality of children on HAART in Togo.

HIV prevalence and behavioral studies among female sex workers in Togo in 2015.

The purpose of this study is to determine the seroprevalence of HIVamong female sex workers (FSWs) and to document the behavior in this target population four years after the last study and possibly readjust these interventions. We conducted from March 27 to April 4, 2015 a crosssectional study of 1197 FSWs. Behavior data were collected by interviewer-administered questionnaires. The FSWs were then subjected to blood tests to measure the prevalence of HIV. The average age of respondents FSWs was 28 years and 20% had their first sexual intercourse before 15 years old. Overall, 48% of the FSWs received between 1 and 7 customers per working day. The majority of FSWs (90%) had consistently used condoms during their last week of work. HIV seroprevalence was 11.7% for FSWs. HIV prevalence was higher in FSWs living in Lomé, the capital city, (13.4%) than those living in the Kara region, in the North of the country (2%), P < 0.0001. The results of this study show the positive behavioral change in FSWs with a stabilization of HIV prevalence in this group after four years.

Barriers to tuberculosis care delivery among miners and their families in South Africa: an ethnographic study.

SETTING: South African miners suffer the highest tuberculosis (TB) rates in the world. Current efforts to stem the epidemic are insufficient. Historical legacies and persistent disease burden demand innovative approaches to reshape health care delivery to better serve this population. OBJECTIVE: To characterize social and behavioral health determinants for successful TB care delivery and treatment from the perspective of miners/ex-miners, health care workers and policy makers/managers. DESIGN: We conducted applied ethnography with 30 miners/ex-miners, 13 family/community members, 14 health care providers, and 47 local policy makers/managers in South Africa. RESULTS: Miners/ex-miners felt health care delivery systems failed to meet their needs. Many had experienced unnecessary physical and psychological harm due to limited health education about TB, minimal engagement in their own care, lack of trust in providers, and a system that did not value their experience. Stigma and fear associated with TB result in denial of symptoms and delays in care seeking. Health care providers and policy makers/managers felt discouraged by system constraints in providing optimal care. CONCLUSION: Our findings describe long-term effects of perpetual TB misinformation and stigma resulting from fear and disempowerment among miners and their families/communities. To reduce the TB burden, there is an urgent need to co-design a care delivery system with miners to better meet their needs.

[Evaluation of antiretroviral treatment in a cohort of 1,620 HIV-infected patients in Togo]. / Évaluation du traitement antirétroviral de 1 620 personnes infectées par le VIH au Togo.

PURPOSE: The purpose of this study was to evaluate the efficacy of antiretroviral treatment for HIV-infected patients in Togo. PATIENTS AND METHOD: This retrospective study covered the period from January 2001 to January 2009 and included all HIV-infected patients who received antiretroviral therapy for at least 12 months. RESULTS: The study included 1,620 of the 8,901 patients (18.2%) treated with antiretroviral therapy. Mean patient age was 34.8 ± 11.4 years and the male/female sex-ratio was 0.4. When treatment began, the mean CD4+ T lymphocyte count was 143/mm(3) and mean patient weight was 53.3 kg. Overall, 263 of the 1,620 subjects (16.2%) had opportunistic infections before starting antiretroviral treatment. The most frequently used antiretroviral combination was stavudine/lamivudine/nevirapine (91.7%). The compliance rate for the first 12 months was 89.6%, and the antiretroviral regimen was changed in 5.9% of cases. After 36 months, mean weight gain was 8.8 kg and the mean increase in the CD4(+) T lymphocyte count was 265 cells/mm(3). The number of opportunistic infections decreased from 263 cases at the beginning of antiretroviral treatment to 9 after three years of treatment. During follow-up, 258 deaths were recorded, for a cumulative case fatality rate of 15.9%. The most common side effects were cutaneous toxicity and anemia in the short term and neurological toxicity, lipodystrophy and hepatotoxicity over the long term. DISCUSSION: This study confirms the efficacy of antiretroviral treatment of HIV-infected patients in Togo. These findings should encourage policy-makers to work toward universal access to antiretroviral treatment for people living with HIV.

Causes of mortality associated with HIV/AIDS in health-care facilities in Togo: a six-month prospective study.

In order to determine the rate and the different causes of mortality associated with HIV/AIDS in health-care facilities we conducted a prospective study between 1 April and 30 September 2010 in the six health regions of Togo. We rationalized the choice of the healthcare facilities in order to cover the entire national territory. During the study period, 24,054 patients were hospitalized. HIV serology was positive in 1065 (18.2%) of the 5865 tested patients. Of the 24,054 patients, we recorded 2551 deaths (10.6%), including 309 HIV-infected patients (5.2%). The mortality rate associated with HIV/AIDS was 1.3% of the total number of inpatients and 5.3% of the number of patients tested for HIV. The mortality rate among HIV-infected patients was 29%. The causes of death in patients infected with HIV/AIDS were mainly anaemia and cerebral toxoplasmosis. This study shows that mortality associated with HIV/AIDS in health-care facilities in Togo remains relatively high.

[Biological profile of adult patients infected with HIV at initiation of antiretroviral therapy in Togo]. / Profil biologique des patients adultes infectés par le VIH à l'initiation du traitement antirétroviral au Togo.

OBJECTIVE: The study's objective was to determine the CD4 count and laboratory abnormalities in adults infected with HIV at initiation of antiretroviral therapy (ART) in Togo. METHODS: A retrospective and descriptive study was made of all patients on HAART in 2009 in Togo. RESULTS: A total of 5106 patients were included with a median age of 35 years. 68.6% were female patients. HIV1 infection was predominant (97.5%). The mean CD4) count at treatment initiation was 134 cells/µl. Among these patients, 22.1% had a CD4 count below 50 cells/µl and 73.8% had a CD4 count below 200 cells/µl. The median hemoglobin level was 10.4 g/dl. Transaminase level was elevated (grade 1 and above) in 55.9% of patients for AST, and in 29.8% of patients for ALT. Mean serum creatinine was 9.6 ± 5 mg/l. CONCLUSION: Initiation of ART is late in Togo, consequently a significant proportion of patients present with severe immunosuppression on initiation of treatment. Improving strategies for mass screening should increase the number of patients treated early to better meet WHO 2009 recommendations.

[Knowledge, attitudes and practices about prevention of mother to child transmission of HIV (PMTCT) among pregnant women in antenatal clinic at 2010 in Togo]. / Connaissances, attitudes et pratiques en matière de prévention de la transmission mère-enfant du VIH chez la femme enceinte vue en consultation prénatale en 2010 au Togo.

PURPOSE: The purpose of this study carried out among pregnant women in antenatal clinics in Togo was to evaluate knowledge, attitudes and practices related to prevention of mother-to-child transmission of HIV (PMTCT). METHODS: A qualitative cross-sectional study was conducted in 22 antenatal clinics. Data were collected by interviewing all pregnant women examined from January 18th to February 4th, 2010. RESULTS: A consecutive series of 210 pregnant women was compiled. The women identified sexual relations (93.8%), objects soiled with blood (80.5%) and transmission from mother to child (27.1%) as routes of HIV transmission. A large majority (77.1%) agreed that unprotected sexual relations raised the risk of HIV transmission to the child and most (61%) expressed willingness to use condoms during pregnancy or breastfeeding, A high percentage (68.1%) believed that contamination during pregnancy increased the risk of HIV transmission to the child, and 61% knew that the risk of HIV transmission to the child was higher for mixed breastfeeding than for exclusive breastfeeding. The acceptance rate for HIV testing was 92.4%. The percentage of women who never used condoms (male or female) was 51% and the percentage considering that HIV-positive woman should not have children was 29.5%. CONCLUSION: The results of this study indicate that pregnant women in Togo have fairly good knowledge about HIV/AIDS. Attitudes towards PMTCT were generally positive but some behaviors such as condom use still require improvement.