[Assessment of compliance with ARV treatment in Africa]. / Bilan de quelques études sur l'observance aux ARV en Afrique.

This study was conducted in health facilities in the capitals of five sub-Saharan African countries (Cotonou, Benin; Bangui, Central African Republic; Libreville, Gabon; Yaoundé, Cameroon; and Casablanca, Morocco). The purpose was to investigate factors promoting and impeding compliance with antiretroviral therapy (ART) and cotrimoxazole (CTX) prophylaxis in adult patients. Patients were interviewed immediately after follow-up examination to identify the problems that they encountered and the solutions that they proposed to improve compliance. Compliance was assessed based on three measurement modalities, i.e. skipping medication during the four days prior to attendance, counting the number of remaining tablets, and attendance assiduity. Compliance scores varied according to measurement modality from 65% to 90%. All patients underlined the impact of treatment on their daily life and the difficulty of following the prescribed regimen properly. Impeding factors for compliance were treatment-related hunger, lack of information, out-of-pocket expenses (including laboratory tests, transportation, and loss of income), side effects, long waiting time at the treatment centers, and fear stigma and discrimination. Efforts to increase access to treatment can only be successful if accompanied by measures to promote compliance.

Bilan de quelques etudes sur l'observance aux ARV en Afrique

L'article rapporte les resultats d'une etude realisee dans cinq capitales d'Afrique subsaharienne (Bangui; Casablanca. Cotonou; Libreville et Yaounde) pour etudier les facteurs limitant ou favorisant l'observance au traitement par ARV et/ou cotrimoxazole en prophylaxie primaire. Les patients adultes etaient interroges a la sortie de la consultation de suivi sur les problemes et les solutions qu'ils proposaient pour y remedier. L' observance etait mesuree par une question sur un saut de prise dans les 4 jours precedents; le comptage des comprimes restant et la regularite aux rendez-vous. Le taux d'observance varie de 65 a 90selon les lieux et la methode de mesure. Tous les patients ont souligne l'impact du traitement sur leur vie quotidienne et les difficultes pour suivre correctement les prescriptions. Les problemes qui minorent l'observance sont l'alimentation; le manque d'info rm ations; les couts annexes (incluant examens biologiques; transports; pertes de revenus); les effets secondaires; les longs temps d'attente; la stigmatisation et les discriminations. Au total; les efforts pour augmenter le nombre de patients traites ne pourront pas etre efficaces sans accroitre parallelement les moyens d'aide a l'observance

Acute renal failure as initial presentation of visceral leishmaniasis in an HIV-1-infected patient.

We report the case of an HIV-infected patient who presented with acute renal failure due to visceral leishmaniasis (VL). Although renal failure is the leading cause of death in dogs, the natural reservoir of Leishmania infantum, renal involvement is usually absent in human VL. However, L. infantum can be considered a cause of renal failure in HIV-infected patients.