Abidjan, Ivory Coast

Abidjan Graduate School

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Abidjan, Ivory Coast

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Tchounga B.K.,French Institute of Health and Medical Research | Coffie P.A.,Abidjan Graduate School | Bado G.,Hopital de Jour | Minga A.,Center Medical Of Suivi Of Donneurs Of Sang Cnts Primo Ci | And 6 more authors.
Journal of the International AIDS Society | Year: 2014

Introduction: West Africa is characterized by the circulation of HIV-1 and HIV-2. The laboratory diagnosis of these two infections as well as the choice of a first-line antiretroviral therapy (ART) is challenging, considering the limited access to second-line regimens. This study aimed at confirming the classification of HIV-2 and HIV-1&2 dually reactive patients followed up in the HIV-2 cohort of the West African Database to evaluate AIDS collaboration. Method: A cross-sectional survey was conducted from March to December 2012 in Burkina Faso, Côte d'Ivoire and Mali among patients classified as HIV-2 or HIV-1&2 dually reactive according to the national HIV testing algorithms. A 5-ml blood sample was collected from each patient and tested in a single reference laboratory in Côte d'Ivoire (CeDReS, Abidjan) with two immunoenzymatic tests: ImmunoCombII® (HIV-1&2 ImmunoComb BiSpot - Alere) and an in-house ELISA test, approved by the French National AIDS and hepatitis Research Agency (ANRS). Results: A total of 547 patients were included; 57% of them were initially classified as HIV-2 and 43% as HIV-1&2 dually reactive. Half of the patients had CD4 ≥500 cells/mm3 and 68.6% were on ART. Of the 312 patients initially classified as HIV-2, 267 (85.7%) were confirmed as HIV-2 with ImmunoCombII® and in-house ELISA while 16 (5.1%) and 9 (2.9%) were reclassified as HIV-1 and HIV-1&2, respectively (Kappa = 0.69; p < 0.001). Among the 235 patients initially classified as HIV-1&2 dually reactive, only 54 (23.0%) were confirmed as dually reactive with ImmunoCombII® and in-house ELISA, while 103 (43.8%) and 33 (14.0%) were reclassified as HIV-1 and HIV-2 mono-infected, respectively (kappa = 0.70; p < 0.001). Overall, 300 samples (54.8%) were concordantly classified as HIV-2, 63 (11.5%) as HIV-1&2 dually reactive and 119 (21.8%) as HIV-1 (kappa = 0.79; p < 0.001). The two tests gave discordant results for 65 samples (11.9%). Conclusions: Patients with HIV-2 mono-infection are correctly discriminated by the national algorithms used in West African countries. HIV-1&2 dually reactive patients should be systematically investigated, with a standardized algorithm using more accurate tests, before initiating ART as at least 4 out of 10 of them could initiate an effective first-line ART for HIV-1 and optimize their second-line treatment options. © 2014 Tchounga BK et al; licensee International AIDS Society.


PubMed | Abidjan Graduate School, University Paris Diderot, Hopital de Jour, Service des Maladies Infectieuses et Tropicales and 5 more.
Type: Journal Article | Journal: PloS one | Year: 2015

Plasma HIV-1 RNA monitoring is one of the standard tests for the management of HIV-1 infection. While HIV-1 RNA can be quantified using several commercial tests, no test has been commercialized for HIV-2 RNA quantification. We studied the relationship between plasma HIV-2 viral load (VL) and CD4 count in West African patients who were either receiving antiretroviral therapy (ART) or treatment-nave.A cross sectional survey was conducted among HIV-2-infected individuals followed in three countries in West Africa from March to December 2012. All HIV-2 infected-patients who attended one of the participating clinics were proposed a plasma HIV-2 viral load measurement. HIV-2 RNA was quantified using the new ultrasensitive in-house real-time PCR assay with a detection threshold of 10 copies/ mL (cps/mL).A total of 351 HIV-2-infected individuals participated in this study, of whom 131 (37.3%) were treatment nave and 220 (62.7%) had initiated ART. Among treatment-nave patients, 60 (46.5%) had undetectable plasma HIV-2 viral load (<10 cps/mL), it was detectable between 10-100 cps/mL in 35.8%, between 100-1000 cps/mL in 11.7% and >1000 cps/mL in 6.0% of the patients. Most of the treatment-nave patients (70.2%) had CD4-T cell count 500 cells/mm3 and 43 (46.7%) of these patients had a detectable VL (10 cps/mL). Among the 220 patients receiving ART, the median CD4-T cell count rose from 231 to 393 cells/mm3 (IQR [259-561]) after a median follow-up duration of 38 months and 145 (66.0%) patients had CD4-T cell count 500 cells/mm3 with a median viral load of 10 cps/mL (IQR [10-33]). Seventy five (34.0%) patients had CD4-T cell count 500 cells/mm3, among them 14 (18.7%) had a VL between 10-100 cps/mL and 2 (2.6%) had VL >100 cps/mL.This study suggests that the combination of CD4-T cell count and ultrasensitive HIV-2 viral load quantification with a threshold of 10 cps/mL, could improve ART initiation among treatment nave HIV-2-infected patients and the monitoring of ART response among patients receiving treatment.


Messou E.,French Institute of Health and Medical Research | Chaix M.-L.,University of Paris Descartes | Gabillard D.,French Institute of Health and Medical Research | Minga A.,French Institute of Health and Medical Research | And 8 more authors.
Journal of Acquired Immune Deficiency Syndromes | Year: 2011

Background: Adherence is a strong determinant of viral suppression with antiretroviral therapy (ART) but measuring it is challenging. Medication delivery can be measured accurately in settings with computerized prescription databases. We studied the association between medication possession ratio (MPR), virologic suppression, and resistance to ART in Côte d'Ivoire. Methods: We conducted a prospective cohort study of HIV-1-infected adults initiating ART in 3 clinics using computerized monitoring systems. Patients had viral load (VL) tests at month 6 (M6) and month 12 (M12) after ART initiation and genotype tests if VL was detectable (300 copies/mL). MPR was defined as the number of daily doses of antiretroviral drug actually provided divided by the total number of follow-up days since ART initiation. Results: Overall, 1573 patients started ART with stavudine/zidovudine plus lamivudine plus nevirapine/efavirenz. At M6 and M12, 996 and 942 patients were in active follow-up; 20% (M6) and 25% (M12) of patients had detectable VL, including 7% (M6) and 11% (M12) with 1 resistance mutation. Among patients with MPR of 95%, 80%-94%, 65%-79%, 50%-64%, and <50% at M12, the proportion with detectable VL [resistance] was 9% [4%], 17% [7%], 45% [24%], 67% [31%], and 85% [37%]. Among patients with 1 mutation at M12, 86% were resistant to lamivudine/emtricitabine and/or nevirapine/efavirenz but not to other drugs. Conclusions: MPR was strongly associated with virologic outcomes. Half of those with detectable VL at M12 had no resistance mutations. MPR should be used at M6 to identify patients who might benefit from early interventions to reinforce adherence. © 2011 Lippincott Williams & Wilkins.


Beauliere A.,French Institute of Health and Medical Research | Toure S.,Abidjan Graduate School | Alexandre P.,Johns Hopkins University | Kone K.,Institute Pedagogique National Of Lenseignement Technique Et Professionnelle Ipnetp | And 8 more authors.
PLoS ONE | Year: 2010

Background: Large HIV care programs frequently subsidize antiretroviral (ARV) drugs and CD4 tests, but patients must often pay for other health-related drugs and services. We estimated the financial burden of health care for households with HIV infected adults taking antiretroviral therapy (ART) in Cô te d'Ivoire. Methodology/Principal Findings: We conducted a cross-sectional survey. After obtaining informed consent, we interviewed HIV-infected adults taking ART who had consecutively attended one of 18 HIV care facilities in Abidjan. We collected information on socioeconomic and medical characteristics. The main economic indicators were household capacity-to-pay (overall expenses minus food expenses), and health care expenditures. The primary outcome was the percentage of households confronted with catastrophic health expenditures (health expenditures were defined as catastrophic if they were greater than or equal to 40% of the capacity-to-pay). We recruited 1,190 adults. Median CD4 count was 187/mm3, median time on ART was 14 months, and 72% of subjects were women. Mean household capacity-to-pay was $213.7/month, mean health expenditures were $24.3/month, and 12.3% of households faced catastrophic health expenditures. Of the health expenditures, 75.3% were for the study subject (ARV drugs and CD4 tests, 24.6%; morbidity events diagnosis and treatment, 50.1%; transportation to HIV care centres, 25.3%) and 24.7% were for other household members. When we stratified by most recent CD4 count, morbidity events related expenses were significantly lower when subjects had higher CD4 counts. Conclusions/Significance: Many households in Cô te d'Ivoire face catastrophic health expenditures that are not attributable to ARV drugs or routine follow-up tests. Innovative schemes should be developed to help HIV-infected patients on ART face the cost of morbidity events. © Beaulière et al.


Coffie P.A.,University of Bordeaux Segalen | Kanhon S.K.,Abidjan Graduate School | Toure H.,University of Bordeaux Segalen | Ettiegne-Traore V.,Programme National de Prise en Charge des Personnes Vivant Avec le VIH | And 4 more authors.
Journal of Acquired Immune Deficiency Syndromes | Year: 2011

Background: Single-dose nevirapine (NVP) is the simplest antiretroviral regimen for the prevention of mother-to-child HIV transmission (PMTCT) in resource-limited settings. We evaluated NVP coverage among HIV-infected delivering women in Côte d'Ivoire. Methods: A cross-sectional survey of mother-infant pairs was conducted between November 2007 and September 2008 in 10 randomly selected facilities providing delivery services in the country. All sites used at least NVP for PMTCT. Anonymous HIV test and blood collection for NVP concentration measurement were performed in labor wards. NVP coverage was defined as the proportion of maternal and infant NVP intake confirmed by cord blood chromatography and direct observation. Results: A total of 9953 deliveries were enrolled. Median maternal age was 25 years, and the median number of antenatal care (ANC) visits was 3. Of the 9747 women (97.9%) who made at least 1 ANC visit, 5880 (60.3%) received an HIV test proposal, 5135 (87.3%) accepted it, and 251 (4.9%) were diagnosed HIV infected; 176 of them (70.1%) received antiretroviral prophylaxis according to the medical record. Using anonymous cord blood surveillance, HIV prevalence was 5.9% (570 of 9646), maternal NVP coverage was 24.3% (138 of 570), and maternal and infant NVP coverage was 17.9% (102 of 570). In multivariate analysis, maternal NVP coverage was associated with 2-3 ANC visits [adjusted odds ratio (aOR): 2.61; 95% confidence interval (CI): 1.27 to 5.39] or 4 ANC visits (aOR: 3.84; 95% CI: 1.86 to 7.90) (ref. ≤1), and giving birth in clinic of first ANC visit (aOR: 2.21; 95% CI: 1.43 to 3.40). Conclusions: Maternal and infant NVP coverage was low irrespective of the method. Anonymous cord blood surveillance is more reliable for documenting PMTCT coverage. Copyright © 2011 by Lippincott Williams & Wilkins.


Oga M.A.,Programme PACCI | Ndondoki C.,University of Bordeaux Segalen | Brou H.,Programme PACCI | Salmon A.,Programme PACCI | And 4 more authors.
Journal of Acquired Immune Deficiency Syndromes | Year: 2011

Objective: We assessed attitudes and practices of health care workers (HCWs) toward HIV counselling and testing (CT) routinely offered to infants in health facilities in Abidjan, Côte d'Ivoire. Methods We performed a cross-sectional survey inquiring on systematic HIV CT offered to children aged 6-26 weeks attending postnatal care for either immunization or pediatric care and to their parents in 4 community health centres rolling-out access to antiretroviral therapy. Data were collected using standardized anonymous self-questionnaires directed to all HCWs involved. Results: One-hundred five HCWs were interviewed in 2008: 30% were social workers, 27% physicians, 24% nurses and 19% laboratory technicians. Among immunization staff (n = 45), none trained in child CT versus 26% in pediatric services (n = 60, P < 0001). Almost all staff believed that it is important to offer HIV screening services to children and the best place could be during pediatric consultations. In their daily work, 22% of immunization staff and 48% of pediatric care staff had already been dealing with early HIV CT (P = 0.01). Facing a child suspected to be HIV infected, only 54% of providers in pediatrics and 71% in immunization would offer CT to all family members (P = 0.01). Conclusions: In Abidjan, although HCWs were generally in favour of pediatric HIV screening, very few had received specific training to do so. Deleguation of CT to the primary care level could improve coverage of CT services. It is urgent to train HCWs to promote early infant HIV diagnosis to improve earlier access to antiretroviral therapy in West African HIV-infected children. Copyright © 2011 by Lippincott Williams & Wilkins.


PubMed | CNRS The Institute of Chemistry and Processes for Energy, Environment and Health and Abidjan Graduate School
Type: | Journal: The Science of the total environment | Year: 2017

Sustainable water management remains a global concern to meet the food needs of industrial and agricultural activities. Therefore, pollution abatement techniques, cheap and environmentally, are highly desired and recommended. The present review is devoted to the origin and the toxicity of nitrogen-containing organic compounds in water. The progress made in removing these pollutants, in recent years, is addressed. However, a prominent place is given to the photocatalytic degradation process using the TiO


Diabetic ketoacidosis still appears as a real concern in Africa due both to its high prevalence and mortality rates. In addition we must emphasize its uncommon presentation as it is also reported in adult patients. Ten years ago, we settled a special management program in order to lower that high mortality rate. Our cross-sectional study aimed to report the results of that program. The prevalence rate of ketoacidosis was high as we identified 737 (30.7%) cases from 2, 400 diabetic patients included in the study. As we could not assess blood body ketones, ketoacidosis diagnosis was based only on urine ones and blood sugar rate above 300 mg/dl. We reported mild condition in 75.5% of our patients. Elsewhere, diabetic condition was unknown in 49.3% of patients. In this latter group, ketosis-prone atypical diabetes was reported in 164 subjects, accounting for 22.3% of ketoacidosis cases. Probably due to continuous insulin infusion, our mortality rate was as low as 5.1%. We outline both malaria as a triggering factor of ketoacidosis (33% of infections) and mixed (ketotic and hyperosmolar) cases reported in 60% of our patients. Obviously, therapeutic education still remains the cornerstone of diabetic ketoacidosis prevention. © 2014 - Elsevier Masson SAS - Tous droits réservés.


Ndondoki C.,French Institute of Health and Medical Research | Brou H.,Programme PACCI | Timite-Konan M.,Abidjan Graduate School | Oga M.,Programme PACCI | And 4 more authors.
PLoS ONE | Year: 2013

Background:Universal HIV pediatric screening offered at postnatal points of care (PPOC) is an entry point for early infant diagnosis (EID). We assessed the parents' acceptability of this approach in Abidjan, Côte d'Ivoire.Methods:In this cross-sectional study, trained counselors offered systematic HIV screening to all children aged 6-26 weeks attending PPOC in three community health centers with existing access to HAART during 2008, as well as their parents/caregivers. HIV-testing acceptability was measured for parents and children; rapid HIV tests were used for parents. Both parents' consent was required according to the Ivorian Ethical Committee to perform a HIV test on HIV-exposed children. Free HIV care was offered to those who were diagnosed HIV-infected.Findings:We provided 3,013 HIV tests for infants and their 2,986 mothers. While 1,731 mothers (58%) accepted the principle of EID, only 447 infants had formal parental consent 15%; 95% confidence interval (CI): [14%-16%]. Overall, 1,817 mothers (61%) accepted to test for HIV, of whom 81 were HIV-infected (4.5%; 95% CI: [3.5%-5.4%]). Among the 81 HIV-exposed children, 42 (52%) had provided parental consent and were tested: five were HIV-infected (11.9%; 95% CI: [2.1%-21.7%]). Only 46 fathers (2%) came to diagnose their child. Parental acceptance of EID was strongly correlated with prenatal self-reported HIV status: HIV-infected mothers were six times more likely to provide EID parental acceptance than mothers reporting unknown or negative prenatal HIV status (aOR: 5.9; 95% CI: [3.3-10.6], p = 0.0001).Conclusions:Although the principle of EID was moderately accepted by mothers, fathers' acceptance rate remained very low. Routine HIV screening of all infants was inefficient for EID at a community level in Abidjan in 2008. Our results suggest the need of focusing on increasing the PMTCT coverage, involving fathers and tracing children issued from PMTCT programs in low HIV prevalence countries. © 2013 Ndondoki et al.


Abrogoua D.P.,Abidjan Graduate School | Kablan B.J.,Laboratoire Of Pharmacie Clinique | Thierry Kamenan B.A.,Abidjan Graduate School | Aulagner G.,Service Pharmaceutique Hopital Louis Pradel | And 2 more authors.
Patient Preference and Adherence | Year: 2012

Objective: The aim of this study was to quantify, by modeling, the impact of significant predictors on CD4 cell response during antiretroviral therapy in a resource-limited setting. Methods: Modeling was used to determine which antiretroviral therapy response predictors (baseline CD4 cell count, clinical state, age, and adherence) significantly influence immunological response in terms of CD4 cell gain compared to a reference value at different periods of monitoring. Results: At 6 months, CD4 cell response was significantly influenced by baseline CD4 count alone. The probability of no increase in CD4 cells was 2.6 higher in patients with a baseline CD4 cell count of ≥200/mm3. At 12 months, CD4 cell response was significantly influenced by both baseline CD4 cell count and adherence. The probability of no increase in CD4 cells was three times higher in patients with a baseline CD4 cell count of ≥200/mm3 and 0.15 times lower with adherent patients. At 18 months, CD4 cell response was also significantly influenced by both baseline CD4 cell count and adherence. The probability of no increase in CD4 cells was 5.1 times higher in patients with a baseline CD4 cell count of ≥200/mm3 and 0.28 times lower with adherent patients. At 24 months, optimal CD4 cell response was significantly influenced by adherence alone. Adherence increased the probability (by 5.8) of an optimal increase in CD4 cells. Age and baseline clinical state had no significant influence on immunological response. Conclusion: The relationship between adherence and CD4 cell response was the most significant compared to that of baseline CD4 cell count. Counseling before initiation of treatment and educational therapy during follow-up must always help to strengthen adherence and optimize the efficiency of antiretroviral therapy in a resource-limited setting. © 2012 Abrogoua et al, publisher and licensee Dove Medical Press Ltd.

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