Introduction:Vaccination is one of the responses to the ongoing global COVID-19 pandemic. However, it has also sparked controversy, hesitation, and infodemics worldwide. Gabon began vaccinating its population in July 2021. Our study aims to describe the motivations, knowledge, and levels of acceptance of volunteers. Methods:We conducted a descriptive, cross-sectional, "knowledge, attitudes, and practices" study from May 2021 to January 2022 (eight months) at the only COVID-19 vaccination center in Makokou, in Gabon's Eastern Health Region. Volunteers were included during the vaccination process and responded to a questionnaire during a face-to-face interview. We studied their sociodemographic profile, knowledge of the disease and the vaccine, and perceptions and experiences of accessibility. Results:A total of 303 people between 18 and 71 years old, were included in the study. Subjects aged 30 to 40 years old represented 39.6% (n = 120) of those included. The sex ratio was 2.7. Eighty-six point seven percent of participants were of Gabonese nationality, and the median length of stay in the city of Makokou was six years (IQR: 2-15). The most represented professions were health workers (17.8%, n = 54), followed by defense and security forces (15.8%, n = 48), who were the main targets of the program. Forty-two point five percent (n = 129) of participants reported being influenced in their decision to get vaccinated. Globally, 72.6% (n = 220) thought that vaccination was a constraint, either for health reasons (n = 128, 58.2%) or for greater freedom of movement (n = 109, 49.5%). The main sources of information were the media (n = 237, 78.2%) and medical personnel (n = 168, 55.4%). Motivation was associated with compulsion (OR = 2.2), knowledge of certain symptoms (OR = 0.4), perception of the disease as serious (OR = 0.2), and positive media influence (OR = 0.4). Accessibility was associated with previous infection (OR = 11) or employer coercion (OR = 0.2). Conclusion:The decision to get vaccinated against COVID-19 was greatly influenced by the media and socio-professional constraints. Given that access to the vaccine was considered easy, motivation should have been the pursuit of better health.
Introduction:ABO blood typing relies on two complementary tests: the red blood cell test (Beth-Vincent) and the serum test (Simonin-Michon). Concordance between these tests is essential for transfusion safety. Persistent discrepancies, though rare, are critical and require thorough investigation. Methods and case presentation:Thirteen patients (aged 6-73) were examined for persistent ABO discordance. We performed parallel Beth-Vincent and Simonin tests. In the event of discordance, we triple washed the red blood cells in saline solution. Auto-, allo-, and ABO controls were systematically performed. The clinical contexts included trauma, anemia, and preoperative and prenatal assessments. Most patients had no history of previous transfusion. Most cases presented a positive auto control, suggesting the presence of autoantibodies, and/or a positive AB control, indicating polyagglutinability. Discrepancies mainly concerned conflicts between direct and inverse ABO phenotypes (AB/O, A/O, and B/O). These results demonstrate the value of controls in guiding diagnosis and the need for complementary approaches. Conclusion:This series illustrates the decision-making algorithm proposed for cases with persistent discrepancies between red blood cell and serum tests during ABO blood typing.
Introduction:Hemorrhagic syndrome accounts for a significant proportion of the mortality and morbidity associated with snakebites in sub-Saharan Africa. Hyperfibrinolysis, which has been reported in some cases, suggests the potential benefit of antifibrinolytics; however, these have been little studied in this context. This study aimed to evaluate the effectiveness of combining tranexamic acid and antivenom in treating hemorrhagic syndrome and coagulopathy associated with Echis ocellatus (West African Carpet Viper) envenomation. Materials and methods:Patients presenting with hemorrhagic syndrome due to envenomation were prospectively included at the Saint Jean de Dieu Hospital in Tanguiéta, Benin. Patients were randomized into two groups: one receiving antivenom and tranexamic acid (SAV + AT) and one receiving only antivenom (SAV). All patients received two vials of InoserpTM PAN-AFRICA antivenom upon admission. The SAV + AT group received 1 g of tranexamic acid over 30 minutes, followed by an additional 1 g over 8 hours. The occurrence of bleeding and the results of blood coagulation tests (whole blood clotting test or WBCT) were recorded at 2, 4, 6, 8, 12, 24, 48, and 72 hours after the initial antivenom administration. Antivenom administration was repeated if bleeding occurred at any of these times. The INR (International Normalized Ratio) was measured at six and twelve hours. Tolerance was assessed at 1, 2, 4, 6, 8, 12, 24, 48, and 72 hours. Plasma creatinine was measured at 24 and 72 hours. Results:Twenty-five patients were included: Twelve patients were in the SAV + AT group, and thirteen patients were in the SAV group. Six patients in the SAV + AT group and five patients in the SAV group experienced persistent or recurrent bleeding (p = 0.695). There was no significant difference in WBCT at different time points between the two groups, nor in INR at 6 and 12 hours. There were no adverse effects suggesting intolerance to tranexamic acid (e.g., ocular abnormality, convulsions, or thrombosis), and plasma creatinine levels did not differ significantly between the two groups. Conclusion:Systematic use of tranexamic acid showed no benefit for hemorrhagic syndrome and coagulopathy associated with E. ocellatus in Benin. Therefore, the indications for this adjunctive treatment need to be clarified.
Objectives:This study aims to present the epidemiological and clinical characteristics of snakebites treated in Kindia, Guinea, between 2015 and 2019. Materials and methods:We conducted a retrospective descriptive study covering the period from January 2015 to December 2019. The study included all patient records for envenomation from snakebites at the Institut de Recherche en Biologie Appliquée de Guinée in Kindia. Results:A total of 1,420 snakebites were recorded, including 1,008 envenomations (male-to-female ratio = 1.2), over a 60-month period. Most patients (76.9%) came from rural areas and were primarily involved in agriculture and livestock farming. In 85.4% of cases, the bites were to the lower limbs. Viper syndrome was predominant, and 98.5% of patients received antivenom with a 95.9% cure rate. Conclusion:The results of this study demonstrate that snakebite envenomation are common and have a 2.5% case-fatality rate. These results suggest the need for greater consideration of snakebites in Guinea's health policy.
Introduction:Thanks to the effectiveness of antiretroviral treatment (ART), more and more people in Africa are aging with HIV. In Senegal, 34% of people living with HIV (PLHIV) who received ART were 50 years of age or older in 2022. As people age, their medical, psychological, and social needs gradually change and increase. This article presents the results of an anthropological study that aimed to describe and analyze the living conditions and care of PLHIV aged 70 and over in urban areas, in relation to the health and social context. Materials and methods:The ethnographic study was conducted from 2022 to 2023 in the Dakar metropolitan area. The study focused on 31 older people living with HIV (OPLHIV), including 14 women, with an average age of 72 (maximum age 90). The median duration of ART was 16 years (maximum: 22 years). Six family caregivers, four community mediators, one nurse, and five doctors (including a geriatrician) were also interviewed, as well as the main national officials responsible for the fight against AIDS. Results:The OPLHIV who were interviewed reported habituation to HIV and demonstrated excellent adherence to ART. However, persistent social stigma surrounding HIV continues to affect their daily lives, leading to various forms of self-exclusion and strategies to keep their illness secret. Medically, they are all in virological remission; however, they face multiple comorbidities and functional disabilities that lead to increased healthcare costs. Economic insecurity and inadequate social protection systems lead to increased dependence on loved ones. Families are the main providers of care. However, the attention given to the elderly depends on the nature and quality of the relationships they have built throughout their lives. Conclusion:This research contributes to anthropology's analysis of healthcare systems and their capacity to care for specific populations. From a public health perspective, the findings of this analysis call for health facilities, community stakeholders, and health authorities to consider the unique health and social needs of OPLHIV to enable them to age with dignity.
Introduction:Idiopathic intracranial hypertension (IIH) typically affects young, obese women. This condition is rarely described in sub-Saharan African countries. This study reports on the clinical and evolutionary characteristics of patients diagnosed with IIH in Niamey, Niger. Materials and methods:We retrospectively analyzed observations of eight patients diagnosed with IIH in the neurology department of the Niamey General Reference Hospital between June 1, 2021, and May 31, 2023. Results:All patients presented with headaches and subacute bilateral visual acuity loss. Their median age was 29.5 years. Their median body mass index (BMI) was 30.75 kg/m² (interquartile range [IQR]: 26-32). Fundus examinations revealed bilateral papilledema in all patients. The median cerebrospinal fluid pressure upon opening was 30 cm H₂O (interquartile range [IQR]: 28.35 to 35). Brain and vascular imaging were normal. All patients completely recovered their vision and experienced normalization of the fundus under acetazolamide treatment, after which treatment was discontinued. Six months after discontinuing acetazolamide, one patient relapsed, necessitating the reintroduction of long-term treatment. Conclusion:Intracranial hypertension (IIH) is a rare neurological disorder that usually affects young, obese women, but its incidence is increasing due to the obesity epidemic. This is the first series of Nigerien cases of IIH.
Background and objectives:The participation of healthy volunteers is essential for many clinical studies. However, their situation differs from that of patients, yet they are not subject to specific ethical recommendations. Unlike patients, healthy volunteers are not seeking treatment. They are exposed to the uncertainties of a clinical trial and face with an unfavorable risk/ benefit ratio. The VoIREthics charter, published by Inserm and its partners, outlines the protection principles that should protect healthy volunteers participating in clinical research. However, these principles are essentially based on Western morality and may therefore conflict with non-Western moral codes. The discussion presented here highlights the difficulties that may arise during clinical research depending on the cultural, legislative and regulatory context. Method:The VolREthics charter's recommendations were examined based on the principles of autonomy, beneficence and justice. This examination was conducted in light of literature and personal experience, to illustrate the differences in perception that may exist between Western and non-Western societies. Results and discussion:A person's place in society can limit their free will. In some societies, individual autonomy is replaced by dependence on the community. The perception of the benefit/risk balance must relate to the scale of the community, not the individual. In traditional medicine, therapeutic efficacy does not result from treatment alone, and therapeutic risk is not understood in the same way as in Western medicine. Furthermore, healthy volunteers must reflect the diversity of the population. If they are selected through a community consensus, the inclusion criteria cannot escape the investigator's or sponsor's control. Conclusion:The principles set out in the VolREthics charter must be contextualized to ensure acceptance by the study stakeholders and to avoid conflict with local practices. Rather than applying recommendations that are difficult to adapt to all contexts systematically, it is essential to discuss their local relevance point by point to ensure the well-being of clinical trial participants and their adherence to the research protocol.
Introduction:The prevalence of imported schistosomiasis among unaccompanied minor migrants (UMMs) in France is not well understood. Methodology:From December 2023 to February 2024, we screened UMMs for schistosomiasis, in addition to tuberculosis screening, at our Alpes-Maritimes Tuberculosis Control Center. We offered serological screening (Western Blot) to all UMMs from sub-Saharan Africa (SSA). If the result was positive, we offered a parasitological examination of urine and stool samples. Results:During these three months, we screened 187 UMMs from SSA. Serology was positive for 116 of them (62%). The median age was 16 years, and the sex ratio (male to female) was 6.9. Parasitological tests were performed on 58 (50%) of the 116 UMMs with positive serology results. Schistosome eggs were found in 24 of them. Fourteen UMMs had Schistosoma mansoni eggs in their stools, nine had S. haematobium eggs in their urine, and one had both S. mansoni and S. haematobium. Five UMMs had hematuria (due to S. haematobium) at the time of the study. The prevalence of schistosomiasis was at least 12.5% (24 out of 187). Discussion/Conclusion:Schistosomiasis is common among UMMs, with asymptomatic cases being the most prevalent.
Objective:The detection of tuberculosis in an apparently isolated location, such as the sternocleidomastoid muscle, is exceptional. It can be mistaken for a cervical tumor. This report presents a case with its diagnostic and therapeutic particularities. Observation:An immunocompetent patient presented with right anterolateral cervical swelling, which was suggestive of a thyroid tumor. Paraclinical investigations revealed tuberculosis of the right sternocleidomastoid muscle and a latent homolateral pulmonary focus. The patient responded well to medical treatment. Conclusion:Muscular tuberculosis in the cervical region can mimic a cervical tumor.
Introduction:Rhino-orbito-cerebral mucormycosis is the most common clinical form of mucormycosis. The most common underlying condition associated with this form is diabetes, especially in cases of glycemic imbalance. Observation:This report concerns a 13-year-old girl with type 1 diabetes who was admitted for ketoacidosis. Clinical and radiological examinations revealed progressive orbital cellulitis (Chandler stage II, then V). Despite initiating antibiotic and antifungal treatment, there was no improvement. Surgery was performed to remove necrotic tissue, and mycological and anatomopathological examinations confirmed the diagnosis of mucormycosis. The patient was successfully treated with liposomal amphotericin B for two months. Discussion/Conclusion:Although this infection is rare, it should always be suspected in cases of facial cellulitis, especially in patients with poorly controlled diabetes, to ensure rapid and effective treatment.
Introduction:New species of Borrelia, Rickettsia, and Anaplasma have recently been detected in ticks in French Guiana. Additionally, a new species of Anaplasma was discovered in a human. Specific genovariants of Anaplasma and Ehrlichia have also been identified in the Amazonian forest of French Guiana, indicating a specific sylvatic cycle. Case presentation:We present the case of a patient who experienced fever, myalgia, rash, and inoculation eschars following dozens of tick bites while hiking in the Amazon rainforest. Laboratory results showed lymphopenia, neutrophilia, hepatic cytolysis and cholestasis, and a C-reactive protein level of 78 mg/L. Serology tests for HIV, hepatitis A, B, C, and E; cytomegalovirus; syphilis; and Q fever were negative. NS1 antigen, dengue, and leptospirosis PCR tests were also negative. A skin biopsy of an ulcerated papule on the leg revealed a polymorphic dermal inflammatory infiltrate with intramacrophagic Gram-negative bacilli. Blood PCR for Anaplasma phagocytophilum, Borrelia, Rickettsia, and Babesia were negative. Serology tests were negative for Rickettsia conorii and R. typhi, but positive for A. phagocytophilum, with weakly positive IgM and positive IgG. Serological results were confirmed by controlled sample. The patient improved with doxycycline treatment. Discussion and conclusion:Novel species of Anaplasma and Ehrlichia have been detected in the Amazon rainforest of French Guiana. These novel genovariants differ from other species in the Northern Hemisphere and are difficult to diagnose with molecular tools not designed to detect pathogens differing from known species. While not proven by molecular biology, this case may represent an anaplasmosis or another infection from the Rickettsiales group. This highlights that little is known about the potential for tick-borne diseases in French Guiana. In this context, recommendations for vector control should extend to ticks as well.
Introduction:Human brucellosis is a prevalent zoonotic disease in Tunisia, especially in rural areas with significant livestock activity. The disease can manifest as localized or systemic forms, and its clinical presentation is highly polymorphic. Here, we present three cases that illustrate this clinical diversity. Observation 1:A 69-year-old diabetic man living in a rural area presented with a painful cervical swelling. Computed tomography revealed cervical cellulitis and pyomyositis. Culture of the pus from the cellulitis yielded positive results for Brucella spp., and the patient was treated with doxycycline and rifampicin for six weeks, along with surgical drainage. The outcome was favorable. Observation 2:A 48-year-old male intravenous drug user was hospitalized due to a prolonged fever associated with a heart murmur. Echocardiography revealed tricuspid vegetation measuring 34×24 mm and moderate tricuspid regurgitation. A blood culture revealed Brucella spp., and treatment consisted of a combination of antibiotics, including doxycycline and rifampicin, as well as valve surgery. The outcome was favorable with this combined treatment. Observation 3:A 50-year-old cirrhotic patient was admitted with febrile hepatic encephalopathy that did not improve with empirical antibiotic therapy. Blood cultures isolated Brucella spp., and appropriate treatment led to a marked clinical improvement. Conclusion:Human brucellosis presents with a variety of clinical manifestations that complicate its diagnosis. In Tunisia, clinical vigilance is essential for the early diagnosis and appropriate management of the disease, particularly in at-risk patients. Prospective studies are needed to better define treatment protocols, especially for complex forms of the disease.
Introduction:Although there has been a significant decline in tetanus cases thanks to vaccination, it remains a public health problem, particularly in developing countries. The epidemiology of tetanus in Tunisia has not been updated in over 20 years. Our study aims to examine the epidemiological, clinical, paraclinical, therapeutic, and evolutionary characteristics of patients with severe tetanus in intensive care. Materials and methods:This retrospective study was conducted in the multi-purpose intensive care unit at Habib Bourguiba University Hospital in Sfax. It spanned 19 years. We included all suspected cases of severe tetanus according to the WHO definition, which includes trismus and/or generalized contractures and/or paroxysms in an unvaccinated or poorly vaccinated patient. Results:Sixteen patients were included. The frequency was 0.84 cases per year, and the patients' average age was 61.6 ± 10.1 years. There was a predominance of males, with a sex ratio of 2.2. Half of the patients were manual laborers who worked in rural areas during the hot seasons. The most common symptom was a skin wound with traumatic inoculation in the lower limbs (10 patients), with 14 patients presenting with this symptom. None of the patients had been vaccinated. According to Ablett's classification, half of our patients had severe or very severe forms of the disease. All patients had generalized tetanus with trismus, neck stiffness, dysphagia, and generalized muscle contractures. Thirteen patients experienced paroxysms, and fourteen had dysautonomic disorders, the most common of which were tachycardia episodes (six patients). Fifteen patients required mechanical ventilation, with an average duration of 24.9 ± 15.8 days. The total length of stay was 29.7 ± 16.5 days, and five patients died during hospitalization. Conclusion:Despite advances in intensive care in Tunisia, tetanus remains a serious disease with high morbidity and mortality rates. Prevention is the most effective way to eradicate it.
Rationale:Malaria remains a significant public health concern in sub-Saharan Africa. To prevent the transmission of the disease, long-lasting insecticide-treated mosquito nets (LLINs) have been periodically distributed in Côte d'Ivoire. This study aims to determine the availability and utilization rate of LLINs in two National Malaria Control Program (NMCP) sentinel sites. A sentinel site is a location selected by the NMCP to ensure continuous, standardized malaria epidemiological, parasitological, and entomological surveillance. Materials and methods:A descriptive, cross-sectional survey was conducted from January to March of 2019. Two hundred heads of households were surveyed in urban (Camp Sea and Logokaha) and rural (Kassiapleu and Kaforo) areas in Man and Korhogo. These two sites have different malaria epidemiological contexts. Data were collected using questionnaires administered to household heads or their representatives at home. The questionnaires gathered information on the household heads' sociodemographic characteristics, their perceptions and knowledge of malaria risk, and their possession of and experience with using LLINs within their households. Results:In at least 70% of cases, households associated malaria transmission with mosquito bites. Additionally, 87% of respondents reported owning at least one LLIN, and 84% said they had used it the previous night. This usage rate exceeds the 80% recommended by the World Health Organization. Conclusion:This study shows that the surveyed populations have a good understanding of LLINs to protect themselves, regardless of the transmission context. However, some results suggest that health authorities could take measures to improve LLIN use among these populations.
Introduction and methods:While Ebola virus disease (EVD) remains a major threat, recent advances have led to the approval of several medical products, in particular the rVSVΔG-ZEBOV-GP vaccine (Ervebo) and two monoclonal antibody treatments, mAb114 (Ebanga) and REGN-EB3 (Inmazeb). However, their use in post-exposure prophylaxis (PEP) remains poorly documented. Our narrative review of the literature and guidelines aims to assess the potential of the rVSVΔG-ZEBOV-GP vaccine and monoclonal antibodies mAb114 and REGN-EB3 for PEP following high-risk exposure. Results:Very few studies have been conducted specifically to determine the efficacy of vaccines or monoclonal antibodies as PEP. Data from animals and humans suggest that the rVSVΔG-ZEBOV-GP vaccine offers only limited protection as PEP, although it may reduce the severity of EVD if it occurs. None of the 34 individuals who have received the vaccine as PEP to date have developed EVD. A retrospective case-control study suggests an efficacy of only 16% against the occurrence of EVD when the vaccine is administered during a period compatible with PEP. In contrast, the monoclonal antibodies mAb114 and REGN-EB3, due to their immediate action through passive immunisation, appear to confer higher protection against the onset of EVD after high-risk exposure, with 100% survival in animal models, although human clinical data remain scarce with only 23 cases of use reported in PEP and no occurrence of EVD. Discussion and conclusion:Access to monoclonal antibodies for community members following high-risk exposure should be ensured, while optimising risk assessment criteria. Further research, particularly on the interaction between vaccination and antibody administration, is essential to determine the most effective PEP strategies. Finally, an emergency stockpile of monoclonal antibodies and improved contact tracing are essential to strengthen the response to epidemics. Despite the limitations of current data, monoclonal antibodies should be considered a priority option for PEP after high-risk exposure.
Introduction:The most recent dengue epidemic in Burkina Faso in 2023 resulted in the highest morbidity and mortality rates in Africa. Neurological complications of dengue are associated with high mortality rates. This study investigated these complications in adults hospitalized at the Ouagadougou University Hospital during the 2023 dengue epidemic in Burkina Faso. Patients and methods:This cross-sectional, retrospective, descriptive, and analytical study examined confirmed cases of dengue fever in adults hospitalized from January 1 to December 31, 2023, at the University Hospitals of Ouagadougou. We analyzed the frequency of dengue fever-related neurological complications and the sociodemographic, clinical, paraclinical, and intra-hospital data of these patients. A bivariate analysis, followed by a multivariate study using multiple logistic regression, identified factors associated with in-hospital mortality. Results:A total of 1,057 patients were hospitalized with dengue fever in Ouagadougou's university hospitals during the epidemic period. Of these patients, 116 (11%) presented with neurological complications. The mean age of these patients was 47.6 years, and 51.7% were female. The most frequently found neurological clinical signs were impaired consciousness (84.5%), epileptic seizures (20.7%), and psycho-behavioral disorders (14.6%). The neurological complications encountered were encephalopathies (7.8%), probably dengue-related encephalitis (0.8%), strokes (0.7%), and Guillain-Barré syndrome (0.1%). The in-hospital mortality rate was 69% (80 patients), and acute renal failure was the only independent factor associated with it (OR = 3.49; p = 0.02). Conclusion:In Burkina Faso, the neurological complications of dengue are primarily multifactorial encephalopathies, which are associated with a high mortality rate. Screening patients with severe dengue early and admitting them to intensive care or resuscitation units (particularly those with neurological signs) would improve their prognosis.
Introduction:Neuromyelitis optica (NMO) is an inflammatory and demyelinating disease of the central nervous system (CNS) that typically progresses in episodes. The average age of onset is around 40 years old, though there are also pediatric forms. We present our first pediatric case and discuss its unique features. Clinical observation:An 8-year-old child was hospitalized in June 2023 due to motor deficits in all four limbs. In November 2021, she presented with a binocular decrease in visual acuity, followed by partial recovery. Eleven months later, she experienced a second, more severe episode without recovery. In May 2023, she presented with uncontrollable vomiting and a mild motor deficit in all four limbs. By June 2023, she reported significant asthenia, severe facial itching, and worsening motor deficits. Her EDSS score was estimated at 8. Ophthalmologically, she had an absence of light perception and optic atrophy on fundus examination. Testing confirmed seropositive NMO. Following corticosteroid therapy, she showed clinical improvement with an EDSS score of 5.5. Following a relapse on azathioprine, her condition remained stable on rituximab. Discussion:NMO accounts for 3 to 5% of all NMO cases in children and is often underdiagnosed. There is clinical and radiological heterogeneity in pediatric NMO. Misleading forms, such as area prostema syndrome (which is quite common in children), should not be overlooked. Basic treatments are based on immunosuppressants. Conclusion:NMO is a rare and little-known condition in sub-Saharan Africa, with flare-ups representing genuine therapeutic emergencies.
Tahiti or the "myth of Paradise", Bora Bora, "the Pearl of the Pacific". Who has never wanted to take a plane and come and land on the heavenly beaches of Polynesia, a French territory at the antipodes of mainland France lost in the middle of the Pacific? However, we do not imagine that 60% of Polynesians live below the metropolitan low-income threshold or that life expectancy is lower than that of the mainland due to the high prevalence of cardiovascular diseases with three quarters overweight population.In addition to non-transmissible metabolic diseases, various pathologies common to temperate countries present specificities in Polynesia, leading to sometimes different management and medical reasoning. Indeed, in Polynesia where the islands extend over an area of the size of Europe, delays in treatment are frequent and it can sometimes seem difficult to send sick patients back to their isolated island. Certain pathologies that were once common in France, such as acute rheumatic fever, are still prevalent there, while others, such as gout, are rarely seen elsewhere in terms of prevalence or severity. Even if the geographical distance has protected Polynesia from a number of tropical diseases including malaria or dangerous animals, this territory presents a range of varied infectious diseases including arboviruses, leptospirosis, tuberculosis and leprosy or angiostrongylosis. Skin infections are very common with their corollary of complications including endocarditis and osteoarticular infections. The sea, which is omnipresent, also poses certain dangers such as ciguatera poisoning and exposure to certain marine organisms.Care is provided according to current medical standards thanks to European-level resources allowing diagnostic and therapeutic possibilities that do not exist in other Pacific island states.The objective of this overview is to guide health care providers coming to or practicing in French Polynesia in their daily practice, but also practitioners taking care of people returning from Polynesia.
Introduction:Since the introduction of antiretroviral therapy for HIV in Burkina Faso, several treatment adherence support mechanisms have been implemented to improve outcomes and prevent resistance. Our study aimed to evaluate the knowledge and perceptions of people living with HIV (PLHIV) regarding these mechanisms in the Plateau-Central region. Methods:We conducted a descriptive study in the Plateau-Central region, which is one of the 13 regions of Burkina Faso. PLHIV were selected as they arrived for their follow-up visits. Information was collected through interviews using a standardized questionnaire. Adherence was calculated based on the participants' reports. Those who took all their medications in the month prior to the survey were considered adherent. Quantitative variables were calculated using the averages, and qualitative variables were calculated using proportions. Results:A total of 347 PLHIV were included in the study. Of these, 69% were women, with a mean age of 45.6 ± 12.2 years. The mean treatment follow-up duration was 8.6 ± 5 years. Eighty percent of individuals adhered to treatment (95% CI [75-84]). Nearly all PLHIV (99.7%) were aware of adherence support mechanisms. The most well-known mechanisms were six-month antiretroviral drug supplies (RAVI6M) (71%), discussion groups (69.9%), individual discussion (69.9%), and counseling (64.2%).The recently introduced community-based antiretroviral drug refilling program outside of health facilities was less well known (42.2%). The most commonly used measures were face-to-face discussion (64%), counseling (62%), and RAVI6M (61.7%). The most appreciated measures were the six-month supply of antiretroviral drugs (44.6%), drug counting (10.7%), and patient interview (10.1%). Conclusion:PLHIV are familiar with and appreciate adherence support measures. The most appreciated measure is six-monthly refills of ARV drugs. Community-based ARV supply policies should be encouraged.
