Comparison of HIV-positive women with children and without children accessing HIV care and treatment in the IeDEA Central Africa cohort.

Globally, women comprise half of all people living with HIV, but in sub-Saharan Africa, women are disproportionately affected. Data were obtained from 8419 HIV-infected women at enrollment into 10 HIV treatment programs in Cameroon, Burundi, and the Democratic Republic of the Congo as part of the Central Africa region of the International Epidemiological Database to Evaluate AIDS. We used chi-squared tests to determine if distributions between women with children differed from those without children, in regards to socio-demographic, behavioral and clinical characteristics. Logistic regression was used to determine if motherhood was associated with medication adherence. Of 8419 women, 81.7% had living children. The majority entered care through voluntary testing, and very few entered care through prevention of mother-to-child transmission programs. Women with children were older and more likely to be widowed, more likely to have no formal education and less likely to have attended university than those without children (p<0.05). Women without children were more likely to live in a home with electricity and potable water (p<0.05). There was no difference in adherence between these groups. However, women older than 50 years, those who reported no drug, tobacco, or alcohol use, and those with higher levels of formal education were more likely to report adherence along with those who had been on treatment for more than two years (p<0.05). As women account for a substantial proportion of HIV cases in sub-Saharan Africa, a broader understanding of their characteristics will inform testing, treatment, and support services. Though we did not find differences in adherence between women with children and those without children, we were able to identify other characteristics that may affect adherence. Further inquiry into the nuances of women living with HIV in sub-Saharan Africa is necessary to further understand their needs.

Diagnostic des dysplasies cervicales associees a l'infection VIH : perte d'efficacite de la cytologie conventionnelle

Problematique : l'absence d'un programme national de depistage du cancer du col uterin en Republique Democratique du Congo ne permet pas de prendre en charge efficacement cette pathologie dont le risque est de surcroit amplifie par l'infection a VIH. Le choix des techniques diagnostiques se pose de facon critique surtout en condition de faibles ressources ou se trouvent la plupart des pays subsahariens. Objectifs de la recherche : Evaluer ; d'une part; les qualites diagnostiques des frottis conventionnels (FC); facilement realisable en conditions de faibles ressources comparativement aux frottis en couche mince (FCM) pris comme reference; et d'autre part; l'influence de l'infection par le VIH sur les performances de ces techniques diagnostiques. Methodologie : Les examens cytopathologiques cervicaux ont ete realises sur 128 patientes VIH et 132 patientes VIH+ consentantes selectionnees dans deux centres de depistage volontaire de VIH a Kinshasa. Le consentement eclaire etait obtenu apres conseil et explication sur l'interet de cet examen pour la femme en activite sexuelle. Resultats : Les lesions dysplasiques de haut grade et les cancers du col uterin (CCU) etaient 10;3 fois plus frequentes chez les sujets VIH+ comparativement aux sujets VIH- (Odds ration=10;3 ; IC95=3;7 a 31;1). La sensibilite; la specificite; les valeurs predilectives positive et negative; et l'efficacite diagnostique des FC etaient respectivement de 66; 7; 98;2; 87;6; 89;4pour les sujets VIH+ contre 80;0; 100; 100;0; 99;2et 99;2pour les sujets VIH-. Le risque de faux negatif comparativement aux risque de faux positifs etait significativement plus eleve chez le sujets VIH+ (x2 de Mc; Nemar = 10;3 ; p = 0;001) que chez les sujets VIH- (x2 de Mc; Nemar = 0 ; p = 1). Conclusion : La sensibilite; l'efficacite diagnostique des FC; d'une part; le taux de concordance (Kappa entre les FC et les FCM; d'autre part; etaient effondrees en presence de l'infection par le VIH; occasionnant un taux eleves de faux negatifs et une faible valeur predilective negative; probablement du fait de l'intensification des reactions inflammatoires. La frequence des examens de controle devrait etre plus rapprochee en cas d'infection a VIH