RESUMEN
In view of the worldwide epidemic processes that require and result in simultaneous research in several countries and in an increasingly more structured scientific community, especially in countries of Global South, it is essential to establish partnerships between researchers, policy-makers, local supervisors, and communities in both the North and the South. The objectives of this essay are to: 1) present the context and issues linked to research in the framework of a North-South partnership; 2) describe the development of appropriate responses to improve consideration of ethical aspects; and 3) discuss the current role of young researchers in this era of multiple partnerships and share the observations and thoughts of PhD students in one research unit.
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Investigación sobre Servicios de Salud/ética , Cooperación Internacional , África del Sur del Sahara , Conducta Cooperativa , Francia , Salud Global/ética , HumanosRESUMEN
Immune abnormalities have been described in some individuals with autism spectrum disorders (ASDs) as well as their family members. However, few studies have directly investigated the role of prenatal cytokine and chemokine profiles on neurodevelopmental outcomes in humans. In the current study, we characterized mid-gestational serum profiles of 22 cytokines and chemokines in mothers of children with ASD (N=415), developmental delay (DD) without ASD (N=188), and general population (GP) controls (N=428) using a bead-based multiplex technology. The ASD group was further divided into those with intellectual disabilities (developmental/cognitive and adaptive composite score<70) (ASD+ID, N=184) and those without (composite score⩾70) (ASD-noID, N=201). Levels of cytokines and chemokines were compared between groups using multivariate logistic regression analyses, adjusting for maternal age, ethnicity, birth country and weight, as well as infant gender, birth year and birth month. Mothers of children with ASD+ID had significantly elevated mid-gestational levels of numerous cytokines and chemokines, such as granulocyte macrophage colony-stimulating factor, interferon-γ, interleukin-1α (IL-1α) and IL-6, compared with mothers of children with either ASD-noID, those with DD, or GP controls. Conversely, mothers of children with either ASD-noID or with DD had significantly lower levels of the chemokines IL-8 and monocyte chemotactic protein-1 compared with mothers of GP controls. This observed immunologic distinction between mothers of children with ASD+ID from mothers of children with ASD-noID or DD suggests that the intellectual disability associated with ASD might be etiologically distinct from DD without ASD. These findings contribute to the ongoing efforts toward identification of early biological markers specific to subphenotypes of ASD.
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Trastorno Autístico/etiología , Quimiocinas/efectos adversos , Citocinas/efectos adversos , Adulto , Trastorno del Espectro Autista/epidemiología , Trastorno del Espectro Autista/etiología , Trastorno Autístico/complicaciones , Estudios de Casos y Controles , Quimiocinas/sangre , Niño , Desarrollo Infantil , Trastornos Generalizados del Desarrollo Infantil/epidemiología , Trastornos Generalizados del Desarrollo Infantil/etiología , Preescolar , Citocinas/sangre , Discapacidades del Desarrollo/complicaciones , Femenino , Humanos , Lactante , Discapacidad Intelectual/etiología , Masculino , Madres , Embarazo , Efectos Tardíos de la Exposición Prenatal/patologíaRESUMEN
Maternal pregnancy levels of the inflammatory marker C-reactive protein (CRP) has been previously associated with autism spectrum disorder (ASD) in the offspring. We conducted a population-based nested case-control study with 500 children with ASD, 235 with developmental delay (DD) and 580 general population (GP) controls to further investigate whether elevated CRP during pregnancy increases the risk of ASD. Maternal CRP concentration was measured in archived serum collected during 15-19 weeks of pregnancy and genome-wide single-nucleotide polymorphism (SNP) data were generated. The levels of CRP were compared between ASD vs GP and DD vs GP. The genetic associations with CRP were assessed via linear regression. Maternal CRP levels in mid-pregnancy were lower in mothers of ASD compared with controls. The maternal CRP levels in the upper third and fourth quartiles were associated with a 45 and 44% decreased risk of ASD, respectively. Two SNPs at the CRP locus showed strong association with CRP levels but they were not associated with ASD. No difference was found between maternal CRP levels of DD and controls. The reasons for the lower levels of CRP in mothers of ASD are not known with certainty but may be related to alterations in the immune response to infectious agents. The biological mechanisms underlying this association remain to be clarified.
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Trastorno del Espectro Autista/epidemiología , Proteína C-Reactiva/análisis , Madres , Adulto , California/epidemiología , Estudios de Casos y Controles , Femenino , Humanos , Lactante , Masculino , Embarazo , Segundo Trimestre del Embarazo , Riesgo , Adulto JovenRESUMEN
UNLABELLED: Delayed care-seeking occurs when a person who received a positive HIV serology test result does not immediately seek medical treatment for this HIV infection. It has serious consequences for patient survival. This study aims to analyze the factors leading to delayed care-seeking in this circumstance. METHODOLOGY: Applying a qualitative approach, we conducted individual interviews and focus groups in 9 community-based organizations of people living with HIV and AIDS in Burkina Faso. In total, 112 people including 70 HIV-positive patients, 30 healthcare providers, and 12 people leaving the laboratory after an HIV test, were interviewed. A thematic content analysis identified the factors that delayed care-seeking. RESULTS: Several factors explain the delay in seeking care. The weight of the negative representations of HIV and AIDS, its impact on those diagnosed with them, and fear of stigmatization (especially by family members) are major factors in delayed care. The poor quality of pre- and post-test counseling is another factor. This study also shows that financial barriers remain important in this delay. CONCLUSION: These findings suggest that earlier HIV care may be possible through efforts to reduce stigma, removal of financial barriers, and improvement of the quality of pre- and post-test counseling in mobile-device strategies and during large-scale testing campaigns.
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Seropositividad para VIH , Aceptación de la Atención de Salud , Adulto , Burkina Faso , Estudios Transversales , Femenino , Seropositividad para VIH/terapia , Humanos , Masculino , Aceptación de la Atención de Salud/psicología , Aceptación de la Atención de Salud/estadística & datos numéricos , Factores de Tiempo , Adulto JovenRESUMEN
OBJECTIVES: Increasing the rate of people who know their HIV status is imperative, particularly in sub Saharan Africa, and this requires an assessment of strategies for increasing the utilization of testing services. This article discusses the relevance, feasibility, and effectiveness of national screening campaigns conducted between 2006 and 2010 in Burkina Faso. METHODOLOGY: An analysis of all data regarding testing uptake from 2006 to 2010 was conducted, along with interviews of key participants in the process. RESULTS: The results show that the 8 screening campaigns led to HIV testing of 487,727 people, that is, 50% of the total number of people tested and 24.6 % of HIV+ people diagnosed during this period. Campaigns succeeded in testing populations that are difficult to reach (especially young people), at a low cost. CONCLUSIONS: This strategy is relevant and useful for identifying HIV+ people. Its utility for HIV prevention campaigns requires further study. Campaigns are effective and cost-effective even in this country with a low disease prevalence. These results underline the importance of the synergy between community-based organizations and health services in the provision of counseling and testing.
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Infecciones por VIH/diagnóstico , Infecciones por VIH/tratamiento farmacológico , Promoción de la Salud , Accesibilidad a los Servicios de Salud , Tamizaje Masivo , Adolescente , Adulto , Burkina Faso , Estudios de Factibilidad , Femenino , Infecciones por VIH/prevención & control , Humanos , Masculino , Adulto JovenRESUMEN
Full Title:Le conseil post-test encourage-t-il les PVVIH a partager leur statut serologique? Pratiques et suggestions des conseillers au Burkina Faso (Does post-test counseling support PLHIV in disclosing their HIV status? Practices and propositions by counselors in Burkina Faso)Le partage du resultat du test VIH est; selon les normes; aborde lors du counseling post-test. Cependant; alors que les obstacles au partage d'un resultat VIH positif sont attestes; la litterature reste peu abondante sur la maniere dont les directives sont appliquees sur le terrain. L'objectif de cet article est d'examiner les pratiques de conseil concernant le partage du resultat avec l'entourage rapportees par les clients et les prestataires du conseil et test VIH (CTV) au Burkina Faso. Une enquete transversale a ete conduite en milieu urbain et en milieu rural en 2008. Un questionnaire integrant des questions semi-ouvertes a ete utilise. Un nombre total de 542 personnes qui ont realise le test depuis 2007 et 111 prestataires de services de conseil et test VIH ont ete interviewes. Les donnees ont ete analysees sur SPSS 12. Seulement 29des personnes testees declarent que le theme du partage du resultat avec l'entourage a ete discute avec elles lors du counseling post-test. Ce resultat s'explique par les incertitudes et les inquietudes des prestataires sur la maniere de partager et sur les risques de consequences defavorables du partage. Des strategies sont developpees par les prestataires pour soutenir les personnes dont la seropositivite a ete depistee a partager cette information avec l'entourage mais ils reconnaissent que ces actions sont insuffisantes. Les suggestions des prestataires pour ameliorer la situation incluent la lutte contre la stigmatisation vis-a-vis des personnes vivant avec le VIH; le renforcement des competences des prestataires et l'adoption de textes juridiques pour rendre obligatoire le partage du resultat avec le partenaire. En conclusion; l'etude a identifie plusieurs pistes pour ameliorer les pratiques de conseil concernant le partage des resultats au Burkina Faso. Ces observations pourraient avoir une portee globale pour la region Afrique
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Infecciones por VIH , Personal de Salud , Difusión de la Información , Rol del Médico , Guía de Práctica Clínica , Pruebas SerológicasRESUMEN
The aim of this study was to assess antenatal transmission of hepatitis B virus in a context of moderate prevalence of HIV in Burkina Faso. Among 360 counselled pregnant women for HIV and HBV testing, 307 were voluntarily enrolled at their last antenatal clinic at the university hospital, in Ouagadougou. Blood samples were collected from all the 307 mothers and tested for HBsAg, HBeAg and antibodies to HIV Blood samples were collected from 313 newborns in the 24 hours after birth and screened for HBV Data from mothers and newborns were collected and analysed using the EPI Info 2002 software. Values for p < 0.05 were considered statistically significant. HBsAg were found in 35 (11.4%) mothers, including 7 with HBeAg and 6 co-infected by both HIV and HBV. Seven babies born to 13 carrier mothers for HBsAg and HBeAg had HBsAg versus 6 born to 22 HBsAg carrier mothers HBeAg-negative. HBsAg was detected in 4 babies born to 6 HIV/HBV co-infected mothers versus 9 born to 29 mothers with HBsAg and HIV-negative. HIV infection, HBeAg and mothers excision were significantly associated with mother-to-child transmission (MTCT) of HBV (p < 0.02). HBV antenatal transmission was important in Ouagadougou and it occurred 2.5 folds more from HIV coinfected mothers than in HIV-negative mothers to newborns. These results showed the need of the implementation of national programme for HBV screening and immunisation in Burkina Faso.
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Enfermedades Fetales/epidemiología , Infecciones por VIH/transmisión , Hepatitis B/transmisión , Transmisión Vertical de Enfermedad Infecciosa/estadística & datos numéricos , Intercambio Materno-Fetal , Complicaciones Infecciosas del Embarazo/epidemiología , Adolescente , Adulto , Burkina Faso/epidemiología , Comorbilidad , Femenino , Enfermedades Fetales/etiología , Enfermedades Fetales/virología , Anticuerpos Anti-VIH/sangre , Infecciones por VIH/embriología , Infecciones por VIH/epidemiología , Seroprevalencia de VIH , Hepatitis B/embriología , Hepatitis B/epidemiología , Anticuerpos contra la Hepatitis B/sangre , Antígenos de Superficie de la Hepatitis B/sangre , Antígenos e de la Hepatitis B/sangre , Humanos , Recién Nacido , Masculino , Persona de Mediana Edad , Embarazo , Complicaciones Infecciosas del Embarazo/virología , Factores Socioeconómicos , Adulto JovenRESUMEN
BACKGROUND: To assess sexually-transmitted infections (STIs) quality of care, syndromic approach acceptability and applicability by patients and health workers in Burkina Faso. METHOD: Three approaches were used: simulated patients method to assess quality of STIs care, patients interview and focus discussion with health workers to assess syndromic approach acceptability and applicability. RESULTS: Sixty-two anonymous visits were made in 17 Bobo-Dioulasso primary care clinics. Overall, history taking were assessed in 77.4% of visits, 47% patients were physically examined. Women (71%) were examined more frequently than men (41%) (P=0.01), 42% of patients were not examined in an isolated room. Medication was prescribed for 87.1% of the patients but only 37.5% of the treatments were applied according to national recommendations. Counselling was poor concerning critical messages regarding risk of HIV transmission, STI prevention. Patients and health workers found the syndromic approach acceptable and applicable, but the question of sexual behaviour was considered difficult to address. CONCLUSION: Quality of STIs care is poor in Burkna Faso. Staff training must emphasize interpersonal communication and motivation, with introduction of a sexually-transmitted infection syndrome package consisting of drugs and condoms in order to improve syndromic case management.
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Calidad de la Atención de Salud , Enfermedades de Transmisión Sexual/terapia , Algoritmos , Burkina Faso , Consejo , Femenino , Infecciones por VIH/diagnóstico , Infecciones por VIH/prevención & control , Infecciones por VIH/transmisión , Humanos , Entrevistas como Asunto , Masculino , Educación del Paciente como Asunto , Examen Físico , Factores de Riesgo , Factores Sexuales , Enfermedades de Transmisión Sexual/diagnóstico , Enfermedades de Transmisión Sexual/tratamiento farmacológico , Enfermedades de Transmisión Sexual/prevención & controlRESUMEN
Nowadays technics for Helicobacter pylori detection in stools like culture, and PCR, are expensive and difficult to perform. The aim of this study was to evaluate ELISA test efficacy for detection of H. Pylori antigens in stools comparing this results with standarized technics like histology (Giemsa), ureasa test and UBT C 14. 26 patients were evaluated in this study, ages between 15-75 with upper gastrointestinal symptoms; all of them required gastroduodenal endoscopy, status H. Pylori was determined with methods upon mentioned. 24 hours after endoscopy H. Pylori antigens in stools with the technique Premier Platinum Htsa, Elisa were determined. The detection of H. Pylori antigens in stools accurately identified active H. Pylori infection. The performance characteristics of this non-invasive method was similar in sensibility and specificity to conventional tests (AU)
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Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Antígenos Bacterianos/análisis , Heces/microbiología , Infecciones por Helicobacter/diagnóstico , Helicobacter pylori/inmunología , Técnicas para Inmunoenzimas/métodos , Ensayo de Inmunoadsorción Enzimática/normas , Sensibilidad y EspecificidadRESUMEN
Nowadays technics for Helicobacter pylori detection in stools like culture, and PCR, are expensive and difficult to perform. The aim of this study was to evaluate ELISA test efficacy for detection of H. Pylori antigens in stools comparing this results with standarized technics like histology (Giemsa), ureasa test and UBT C 14. 26 patients were evaluated in this study, ages between 15-75 with upper gastrointestinal symptoms; all of them required gastroduodenal endoscopy, status H. Pylori was determined with methods upon mentioned. 24 hours after endoscopy H. Pylori antigens in stools with the technique Premier Platinum Htsa, Elisa were determined. The detection of H. Pylori antigens in stools accurately identified active H. Pylori infection. The performance characteristics of this non-invasive method was similar in sensibility and specificity to conventional tests
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Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Antígenos Bacterianos , Heces , Infecciones por Helicobacter , Helicobacter pylori , Técnicas para Inmunoenzimas , Ensayo de Inmunoadsorción Enzimática , Sensibilidad y EspecificidadRESUMEN
OBJECTIVE: To define the role of virtual gastroscopy (VG) in the detection of elevated lesions comparing its results with conventional endoscopy (CE) as the gold standard method. MATERIALS AND METHODS: Between December 2000 and July 2001, 19 patients were evaluated. The age ranged between 41 and 72 (mean 58.8 years old). VG and CE were performed in all the patients during the same week. VG were carried out with a multislice CT scanner (Mx 8000, Marconi Medical Systems). The technical parameters used were 3 mm with slices and 1.5 mm reconstruction intervals. The acquisition time was 22 seconds. Images were sent to a workstation (MxView, Marconi Medical Systems) where they were reprocessed in three different ways: 1) Bidimensionally 2) Tridimensionally 3) Virtual Endoscopy Findings of VG were compared with CE. RESULTS: VG detected 39 lesions, whereas CE detected 40 lesions. There were 39 true-positive findings, 2 true-negative findings, 0 false-positive findings and 1 false-negative findings. The Sensitivity (Se) was 97.5%; Specificity (Sp) was 100%, positive predictive value 100% and Negative predictive value 66%. CONCLUSIONS: VG is a new non-invasive method with high Se and Sp in the detection of elevated lesions. The actual role of VG consist in identification of gastric lesions and possibility to diagnose gastric disease.
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Gastroscopía/métodos , Procesamiento de Imagen Asistido por Computador , Gastropatías/diagnóstico , Adulto , Anciano , Humanos , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Sensibilidad y Especificidad , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVE: To define the role of virtual gastroscopy (VG) in the detection of elevated lesions comparing its results with conventional endoscopy (CE) as the gold standard method. MATERIALS AND METHODS: Between December 2000 and July 2001, 19 patients were evaluated. The age ranged between 41 and 72 (mean 58.8 years old). VG and CE were performed in all the patients during the same week. VG were carried out with a multislice CT scanner (Mx 8000, Marconi Medical Systems). The technical parameters used were 3 mm with slices and 1.5 mm reconstruction intervals. The acquisition time was 22 seconds. Images were sent to a workstation (MxView, Marconi Medical Systems) where they were reprocessed in three different ways: 1) Bidimensionally 2) Tridimensionally 3) Virtual Endoscopy Findings of VG were compared with CE. RESULTS: VG detected 39 lesions, whereas CE detected 40 lesions. There were 39 true-positive findings, 2 true-negative findings, 0 false-positive findings and 1 false-negative findings. The Sensitivity (Se) was 97.5%; Specificity (Sp) was 100%, positive predictive value 100% and Negative predictive value 66%. CONCLUSIONS: VG is a new non-invasive method with high Se and Sp in the detection of elevated lesions. The actual role of VG consist in identification of gastric lesions and possibility to diagnose gastric disease (AU)
Asunto(s)
Estudio Comparativo , Humanos , Adulto , Persona de Mediana Edad , Anciano , Procesamiento de Imagen Asistido por Computador , Tomografía Computarizada por Rayos X , Gastroscopía/métodos , Gastropatías/diagnóstico , Sensibilidad y Especificidad , Valor Predictivo de las PruebasRESUMEN
OBJECTIVE: To define the role of virtual gastroscopy (VG) in the detection of elevated lesions comparing its results with conventional endoscopy (CE) as the gold standard method. MATERIALS AND METHODS: Between December 2000 and July 2001, 19 patients were evaluated. The age ranged between 41 and 72 (mean 58.8 years old). VG and CE were performed in all the patients during the same week. VG were carried out with a multislice CT scanner (Mx 8000, Marconi Medical Systems). The technical parameters used were 3 mm with slices and 1.5 mm reconstruction intervals. The acquisition time was 22 seconds. Images were sent to a workstation (MxView, Marconi Medical Systems) where they were reprocessed in three different ways: 1) Bidimensionally 2) Tridimensionally 3) Virtual Endoscopy Findings of VG were compared with CE. RESULTS: VG detected 39 lesions, whereas CE detected 40 lesions. There were 39 true-positive findings, 2 true-negative findings, 0 false-positive findings and 1 false-negative findings. The Sensitivity (Se) was 97.5%; Specificity (Sp) was 100%, positive predictive value 100% and Negative predictive value 66%. CONCLUSIONS: VG is a new non-invasive method with high Se and Sp in the detection of elevated lesions. The actual role of VG consist in identification of gastric lesions and possibility to diagnose gastric disease
Asunto(s)
Humanos , Adulto , Persona de Mediana Edad , Gastroscopía , Procesamiento de Imagen Asistido por Computador , Sensibilidad y Especificidad , Gastropatías , Tomografía Computarizada por Rayos X , Valor Predictivo de las PruebasRESUMEN
Nowadays technics for Helicobacter pylori detection in stools like culture, and PCR, are expensive and difficult to perform. The aim of this study was to evaluate ELISA test efficacy for detection of H. Pylori antigens in stools comparing this results with standarized technics like histology (Giemsa), ureasa test and UBT C 14. 26 patients were evaluated in this study, ages between 15-75 with upper gastrointestinal symptoms; all of them required gastroduodenal endoscopy, status H. Pylori was determined with methods upon mentioned. 24 hours after endoscopy H. Pylori antigens in stools with the technique Premier Platinum Htsa, Elisa were determined. The detection of H. Pylori antigens in stools accurately identified active H. Pylori infection. The performance characteristics of this non-invasive method was similar in sensibility and specificity to conventional tests.
Asunto(s)
Antígenos Bacterianos/análisis , Heces/microbiología , Infecciones por Helicobacter/diagnóstico , Helicobacter pylori/inmunología , Técnicas para Inmunoenzimas/métodos , Adolescente , Adulto , Anciano , Ensayo de Inmunoadsorción Enzimática/normas , Femenino , Humanos , Masculino , Persona de Mediana Edad , Sensibilidad y EspecificidadRESUMEN
OBJECTIVE: To define the role of virtual gastroscopy (VG) in the detection of elevated lesions comparing its results with conventional endoscopy (CE) as the gold standard method. MATERIALS AND METHODS: Between December 2000 and July 2001, 19 patients were evaluated. The age ranged between 41 and 72 (mean 58.8 years old). VG and CE were performed in all the patients during the same week. VG were carried out with a multislice CT scanner (Mx 8000, Marconi Medical Systems). The technical parameters used were 3 mm with slices and 1.5 mm reconstruction intervals. The acquisition time was 22 seconds. Images were sent to a workstation (MxView, Marconi Medical Systems) where they were reprocessed in three different ways: 1) Bidimensionally 2) Tridimensionally 3) Virtual Endoscopy Findings of VG were compared with CE. RESULTS: VG detected 39 lesions, whereas CE detected 40 lesions. There were 39 true-positive findings, 2 true-negative findings, 0 false-positive findings and 1 false-negative findings. The Sensitivity (Se) was 97.5
; Specificity (Sp) was 100
, positive predictive value 100
and Negative predictive value 66
. CONCLUSIONS: VG is a new non-invasive method with high Se and Sp in the detection of elevated lesions. The actual role of VG consist in identification of gastric lesions and possibility to diagnose gastric disease.
RESUMEN
Nowadays technics for Helicobacter pylori detection in stools like culture, and PCR, are expensive and difficult to perform. The aim of this study was to evaluate ELISA test efficacy for detection of H. Pylori antigens in stools comparing this results with standarized technics like histology (Giemsa), ureasa test and UBT C 14. 26 patients were evaluated in this study, ages between 15-75 with upper gastrointestinal symptoms; all of them required gastroduodenal endoscopy, status H. Pylori was determined with methods upon mentioned. 24 hours after endoscopy H. Pylori antigens in stools with the technique Premier Platinum Htsa, Elisa were determined. The detection of H. Pylori antigens in stools accurately identified active H. Pylori infection. The performance characteristics of this non-invasive method was similar in sensibility and specificity to conventional tests.
RESUMEN
BACKGROUND: In the context of the DITRAME-ANRS 049 research program that evaluated interventions aimed at reducing mother-to-child transmission of HIV (MTCT) in Bobo-Dioulasso (Burkina Faso), Voluntary HIV counseling and testing (VCT) services were established for pregnant women. HIV-infected women were advised to disclose their HIV serostatus to their male partners who were also offered VCT, to use condoms to reduce sexual transmission, and to choose an effective contraception method to avoid unwanted pregnancies. This study aimed at assessing how HIV test results were shared with male sexual partners, the level of use of modern contraceptive methods, and the pregnancy incidence among these women informed of the risks surrounding sexual and reproductive health during HIV infection. METHODS: From 1995 to 1999, a quarterly prospective follow-up of a cohort of HIV-positive women. RESULTS: Overall, 306 HIV-positive women were monitored over an average period of 13.5 months following childbirth, accounting for a total of 389 person-years. The mean age at enrollment in the cohort was 25.1 (standard deviation, 5.2 years). In all, 18% of women informed their partners, 8% used condoms at each instance of sexual intercourse to avoid HIV transmission, and 39% started using hormonal contraception. A total of 48 pregnancies occurred after HIV infection was diagnosed, an incidence of 12.3 pregnancies per 100 person-years. Pregnancy incidence was 4 per 100 person-years in the first year of monitoring and this rose significantly to 18 per 100 person-years in the third year. The only predictor of the occurrence of a pregnancy after HIV diagnosis was the poor outcome of the previous pregnancy (stillbirth, infant death). Severe immunodeficiency and change in marital status were the only factors that prevented the occurrence of a pregnancy after HIV diagnosis. CONCLUSION: Our study shows a poor rate of HIV test sharing and a poor use of contraceptive methods despite regular advice and counseling. Pregnancy incidence remained comparable with the pregnancy rate in the general population. To improve this situation, approaches for involving husbands or partners in VCT and prevention of MTCT interventions should be developed, evaluated, and implemented.
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Infecciones por VIH/epidemiología , Seropositividad para VIH/epidemiología , Índice de Embarazo , Conducta Sexual/estadística & datos numéricos , Burkina Faso/epidemiología , Estudios de Cohortes , Condones/estadística & datos numéricos , Conducta Anticonceptiva/estadística & datos numéricos , Femenino , Humanos , Embarazo , Resultado del Embarazo/epidemiologíaRESUMEN
The objectives of this study were to monitor the trends of the HIV epidemic between 1995 and 1999 among pregnant women in Bobo-Dioulasso, the second largest town of Burkina Faso, and to discuss the possible effect of preventive interventions (condom availability) on sexual transmission of HIV in this context. Age-specific trends in HIV prevalence obtained from sentinel surveillance programme were analysed. Among antenatal clinic attendees, HIV prevalence was 7.5% (n=401) in 1995, 10% (n=200) in 1996, 7.6% (n=448) in 1997, 8.4% (n=642) in 1998 and 5.3% (n=716) in 1999 without demonstrated temporal trend (P=0.12). The average number of condoms available per person (aged 15-49 years) per year increased from 0.6 in 1992 to 5.7 in 1995 and 6.0 in 1999. Anonymous surveys are less subject to selection bias and suggest a stabilization of the HIV prevalence around 7.3% in Bobo-Dioulasso. Distribution of condoms could explain at least, partly, this stabilization of the HIV epidemic.
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Infecciones por VIH/epidemiología , Adolescente , Adulto , África/epidemiología , Condones/estadística & datos numéricos , Femenino , Infecciones por VIH/prevención & control , Encuestas Epidemiológicas , Humanos , Persona de Mediana Edad , Embarazo , Prevalencia , Vigilancia de GuardiaRESUMEN
BACKGROUND: Given the relationship between HIV infection and fertility, antenatal clinic-based HIV prevalence may not provide a good estimate of the community HIV prevalence. The objective of this work was to evaluate the impact of HIV infection on fertility among women attending antenatal clinics in Bobo-Dioulasso (Burkina Faso), and to discuss possible implications on HIV sentinel surveillance. METHODS: In the context of a phase II/III clinical trial of a short course of Zidovudine during pregnancy (DITRAME - ANRS 049 trial) we consecutively proposed voluntary counselling and HIV testing (VCT) to 1349 women aged at least 18 years, carrying a pregnancy of 7 months or less and living in Bobo-Dioulasso. During pre-test counselling session, a standardised questionnaire was administered to collect detailed information regarding socio-demographic characteristics and obstetrical history. Blood samples were then taken and tested for HIV after written informed consent. RESULTS: Mean age (+/- standard deviation) at first sexual intercourse was similar among HIV-infected (HIV+) (16.7+/- 2; n=83) and HIV-negative (HIV-) women (16.9+/- 2; n=1336). However, HIV+ women aged 25 years and above had, on the average fewer pregnancies (3.8+/- 1.5; n=37) than HIV- women (5.0+/- 2.3; n=567), p<0.01. Similarly, these HIV+ women had, on average, less live births (2.8+/- 1.3; n=35) than HIV- ones (3.7+/- 2.1; n=555), p=0.02. Other sexual and obstetrical characteristics such as maternal age, proportion of primigravidae, stillbirths or spontaneous abortions were comparable between HIV+ and HIV- women. CONCLUSIONS: Our data suggest that the level of fertility of HIV+ women aged 25 years and above is significantly lower than for HIV- women. Therefore, HIV+ women in this age group are likely to be under-represented among antenatal clinic attendees. These findings suggest adjusting antenatal clinic-based HIV sentinel surveillance data for age and fertility in order to derive a good estimate of the community HIV prevalence.