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Abstract: Objective: In developed countries, where the mother-to-child transmission rate of HIV is low (1 to 1,5%), a major medical concern is the safety of new therapies during pregnancy. Teratogenicity has been described with an NNRTI, efavirenz (Sustiva®), in animal model, regarding neural tube defects. Patients and methods: We have made a retrospective study of pregnancies starting with efavirenz with a special focus on fœtal and infant abnormalities. Results: Three abnormalities were notified no one linked to a neural tube defect. Discussion and conclusion: In the English literature published, although the prevalence of abnormalities in human is low (1,7%) during pregnancy, due to the potent teratogenicity, efavirenz is contraindicated in the first trimester and should be used with caution in women of childbearing potential. [Copyright &y& Elsevier]

Introduction/rationale: In 2006, the Senegalese government set up a health coverage programme for people aged 60 and over - the Plan Sésame - to provide free medical care in all the country's public health facilities. This scheme has been integrated into the Universal Health Coverage (CMU) promoted from 2013. The objective of the study was to describe and analyse the knowledge and representations of professionals and users about health coverage and the Plan Sésame, the use of the scheme by the elderly, to evaluate the amount of medical expenses incurred during a routine medical consultation for the monitoring of their illness (hypertension and diabetes), and to calculate the out-of-pocket expenses related to the consultation., Material and Methods: Study conducted between July 2020 and October 2021 in two public health facilities in Dakar. Mixed approach: 1/ qualitative study by semi-directive interviews, informal interviews, observations and field diary with 35 people selected according to a reasoned choice procedure with the aim of diversifying gender, age, social status, therapeutic itineraries for 23 people (including 12 women, ages between 60 and 85 years), and professional activities for 12 health actors; 2/ quantitative cross-sectional study by questionnaire of 225 people (including 141 women) aged 60 and over; we calculated the total cost of the consultation and associated prescriptions (complementary examinations and medicines) as well as the remaining medical expenses (out-of-pocket) and the cost of transporting patients. This is a descriptive exploratory study of a non-representative sample of the elderly population in Senegal., Results: The health professionals interviewed supported the principle of health coverage, but most of them had limited and sometimes imprecise knowledge of the existing schemes and the methods of access or the services covered. Their point of view about the consequences of the Plan Sésame on their practice reveals some contradictions: some complain about the increase in workload, the criticism is extended to all the free schemes which would have a negative impact on daily practice because of the increase in the number of consultations which would be linked to abuse by patients.The interviews highlight the heterogeneity of the knowledge of elderly people about the health coverage intended for them, even though the Plan Sésame has been in place for over ten years. The interviews clearly show that the use of the health coverage system by the elderly depends closely on the information they have and their ability to use it, both for women and men. There is a close link between the level of social integration of people and their use of health coverage: the most socially integrated people are those who know how to use CMU services best. The use of health coverage by the elderly appears to vary according to the individual.Although Plan Sésame is defined as part of a national strategy, its implementation varies according to the health structures and the periods; in the two study sites, the range of services covered by Plan Sésame is very limited, so the coverage provided by Plan Sésame is only partial: between 30 and 50% of the medical costs; the remaining cost of a consultation for elderly patients with hypertension and/or diabetes varies between 24,000 and 28,000 CFA francs.These amounts must be put into perspective with the resources available to people. Statistical studies published in 2021 report that in Senegal the average daily expenditure is 1,390 CFA francs/person/day; and that almost 38% of the population lives on 913 CFA francs/person/ day, which is the poverty line calculated in 2019. Thus, the average out-of-pocket expenses for a follow-up consultation for hypertension, diabetes or a combination of the two diseases represent 15 to 30 days of daily expenditure. While the vast majority of elderly people in Senegal do not have a retirement pension, health expenses are therefore borne by their relatives. Within households, medical expenditure for the elderly competes with basic needs, particularly food, which usually take up more than half of household resources. This indispensable family support places the elderly in a situation of total dependence., Conclusions: In 2021, Plan Sésame does not yet allow for completely free care for the elderly. However, its application, even partial, has resulted in a real reduction in health care costs for the elderly. Its use remains limited due to inconsistent application by most health structures. Its impact is insufficient in view of the amounts that users have to pay in a context of social and economic vulnerability. These observations reinforce the need to work on reducing the price of medical services and strengthening the UHC, in order to improve the equity and performance of the system, and to make it fully functional in all health structures., (Copyright © 2023 SFMTSI.)

Ebola virus disease (EVD) epidemic that spread in West Africa from the end of 2013 to early 2016 has reached more people than all past epidemics. Beyond care management of acute phase ill patients and measures for the control of the epidemic, the outcome of Ebola survivors became an important question as their number increased and raised new issues. A multidisciplinary prospective cohort of survivors in Guinea has been launched by IRD UMI 233 and Donka National Hospital, Conakry, Guinea, to assess the long-term clinical, psychological, sociological, immunological, and viral outcomes potentially related to EVD. This paper describes PostEboGui Programme, constraints and changes to the initial proposal, participants, first results, and new issues, 1 year after its start, in a descriptive and critical view. We started also to work on ethical aspects in the context of epidemics and of mass interventions with a risk of overinvestigation of patients.

While prolonged widowhood is unusual in Senegalese society, some women living with HIV receiving antiretroviral therapy for ten years remained widows. Are they maintained in this situation for refusing or being unable to remarry? To understand the conditions and the reasons for this lack of "matrimonial normalization", a qualitative interview study was conducted in Dakar with 31 widows. Their living conditions are mostly marked by economic difficulties, dependence on host families, and responsibilities visà-vis their children. They refuse to remarry, regret not being able to, or wish to without success, despite the existence locally of social forms of marital union that would respond to their situation. The refusal to disclose their HIV status combined with self-stigma prevent them from improving their condition. This form of social vulnerability that remains beyond the restoration of health is ignored by public policy and HIV/AIDS community based organizations claims. It should be acknowledged and considered for defending PLWAs' rights.

The sexual health of people who have been living with HIV (PLHIV) and who have been receiving ARV drug treatment for several years is still a virtually unexplored topic in Africa today. A study was conducted in Senegal on people who have been treated with ARVs for ten years. Half of those interviewed believe that their sexuality has deteriorated. HIV infection has become a chronic disease in which sexual dysfunction related to the disease or age is interpreted in the context of popular representations of HIV infection and those on sexuality defined by social norms.

The direct cost of medical care for HIV infection-excluding ARVs, viral load and CD4 counts-was assessed for patients who received ARV treatment in Senegal within the framework of the ANRS cohort 1215, between the third and tenth year of follow-up. The average annual direct cost was estimated at 120 /patient/year; this amount remained stable over the first ten years of treatment follow-up. Biological assessments for routine follow-up account for the majority of these costs (66%), followed by drugs (26%). Given the level of economic poverty facing by families, patients cannot bear such expenses over several years. However, these costs appear low enough to be covered by HIV-treatment programs or included in Universal Health Coverage systems.

By the end of 2013, 11 million PLHIV were taking ARVs in Africa; application of the WHO recommendation to initiate treatment earlier (at CD4 count of 500 cells/mm3 or less) should further increase this number. Currently, twothirds of patients in Africa have been on treatment for less than five years, and less than 10% have received treatment for eight years or more. Given the historical perspective is in its early stages, the long-term impact of ARV therapy is still unclear. This article reviews the knowledge gained over the period marking the first ten years of implementation of the universal access strategy (2003-2013) in Africa, through a review of the literature documenting the long-term consequence of ARV treatment, focusing on medical care for adults with an emphasis on the patient-centered approach. The goal is to understand the interrelationships between biological and social factors and individual and collective aspects that affect the lives of PLHIV and determine the impacts of ARV treatment over the long term. The biomedical and social factors are addressed successively, based on the most significant results. Key knowledge on the long-term outcomes for PLHIVon ARV treatment offers vital information on the necessary conditions and adaptations for care systems needed to ensure the benefits of treatment endure over time.

Background and Methodology: The delay in the diagnosis of HIV infection is a major obstacle to optimal care for this disease. To deal with this problem, we conducted this study among newly diagnosed HIV patients hospitalized in the Fann University Hospital Infectious Diseases Clinic in Dakar. The epidemiological, clinical, biological and outcome aspects are described and patient history reviewed. A qualitative socio-anthropological study was made to understand and describe the logic of the decision processes in the patient's search for treatment., Results: One hundred patients were included, with a mean age of 39.5+/-11.1 years and a sex-ratio: 1.08. The transmission was mainly heterosexual (90%), and chronic diarrhea (64%) and/or chronic cough (66%) were the principal symptoms leading to diagnosis. The mean delay before diagnosis was 5+/-4.27 months. The major opportunistic diseases were tuberculosis (44 cases) and infectious diarrhea (23 cases). Most patients were diagnosed at the AIDS stage (97%) and the death rate was 30% among hospitalized patients after admission. Sixty-eight percent of patients had consulted at least three times, generally a "traditional practitioner", at first and 43% had been hospitalized at least once. The qualitative investigation revealed that the "representation" or the "feeling of severity" of the disease were the principal justifications for consulting the "traditional practitioner" or the physician, respectively., Conclusion: Better information for health workers and global population is necessary for an earlier diagnosis of HIV infection in Dakar.

Objective: In developed countries, where the mother-to-child transmission rate of HIV is low (1 to 1,5%), a major medical concern is the safety of new therapies during pregnancy. Teratogenicity has been described with an NNRTI, efavirenz (Sustiva), in animal model, regarding neural tube defects., Patients and Methods: We have made a retrospective study of pregnancies starting with efavirenz with a special focus on foetal and infant abnormalities., Results: Three abnormalities were notified no one linked to a neural tube defect., Discussion and Conclusion: In the English literature published, although the prevalence of abnormalities in human is low (1,7%) during pregnancy, due to the potent teratogenicity, efavirenz is contraindicated in the first trimester and should be used with caution in women of childbearing potential.

The bio-clinical efficacy of ART in Africa has now been proven. In 2001, the resolution adopted by the UNGASS meeting confirms that "effective prevention, care and treatment strategies will require [...] a non-discriminatory access to [...] anti-retroviral therapies". Most of the programmes that give access to ART initiated in the sub-Saharan region in 1998 are based on the principle that the patients participate financially to the purchases of ART. Some countries (Côte d'Ivoire, Senegal, and Mali) subsidize ART medications to favour a better access. The financial contribution of patients is supposed to: 1/ translate patient support into government action; 2/ favour a closer therapeutic adherence; 3/ assure the access programmes sustainability. However, despite the subsidies provided by some states, the cost of medical treatment greatly exceeds the resources available to most of the sufferers. The analysis of ART access programmes, specifically in Senegal and Côte d'Ivoire, shows that: 1/ Patient support to government action does not need to be more demonstrated while general access to treatment is officially recognised and recommended by the United Nations. 2/ Patient involvement and better adherence have been noted with patients that receive free ART. 3/ Patient contribution represents less than 10% of the medication's purchasing cost, thus, the cost recovery is marginal and does not allow for sustainable ART access programmes. The cost charged to patients for ARV still represents a major obstacle for proper medical management. Care programmes in African countries should implement free access to ART as a priority.

In Burkina Faso, in rural Mossi areas, popular contemporary representations of the transmission of HIV from mother to child are based on the idea that "the disease is in the blood" and that the fetus is conceived by "mixing the blood" of its parents. Infection of the child is seen as inevitable and systematic and is believed to occur in utero. Maternal milk is thought to have the same potential for infection because "milk is blood" but its role in transmission is seen as secondary, with transmission occurring before birth. However, breast feeding is believed to be responsible for the transmission of the disease in two ways: 1) by infected women transmitting the illness to healthy children via their milk and 2) by healthy women becoming infected by breast feeding infants born to infected mothers. The belief that transmission is systematic and the fear that the child will contaminate others leads to the widely held view within the population that no care should be taken of children born to women with AIDS and that such children should be abandoned and left to die. These representations have recently developed in the population based on preexisting beliefs relating to the physiology and role of blood in the transmission of diseases and the health information that has been distributed. Health information messages are largely responsible for the representations described above. Indeed, the description of the modes of HIV transmission in such messages has been based on the simplified statement of the triad, sex, blood and mother-child, with no indication of the relative risks of transmission for each. Hence, this incomplete information, interpreted in terms of popular conceptions about contagion, has resulted in maximal probability being attributed to each of the listed modes of transmission. Health information messages are the principal means of communicating scientific information to the general population. The stakes associated with the quality and correctness of the information supplied are therefore very high. The notion of the risk of transmission and statement of the level of risk are essential to any explanation of the modes of transmission of HIV. These ideas cannot be neglected because they are essential to the correct understanding of transmission and to the logical management of individual risk.

This article is based on an ethnographical study carried out in 1996. It describes and analyzes the methods of medical and family management of HIV-positive and full-blown AIDS patients in the rural environment of Burkinabé. A number of recommendations are made. Biomedical management of these patients is almost non-existent (currently there is no serology or screening advice available at the dispensary). The patient is never informed of an AIDS diagnosis. The relations between the medical personnel and the patients are dominated by a sense of powerlessness and constant fear of infection. None of the traditional doctors of the region admits to treating AIDS although traditional medicine is used throughout the illness. Family management ranges from complete rejection of the patient to supportive but often misdirected care. It is determined by at least five elements: (1) the composition of the family unit and the nature of relations between the sick individual and the rest of the family, (2) the economic status of the patients, his family group and his parents, (3) the initial uncertainties of the diagnosis of the illness, (4) the fear of contagion and (5) the fear of gossip. Management of these patients would be improved by: (1) real access to counseling and screening, (2) the involvement of health workers in this activity and in the notification of the diagnosis to the peripheral medical organizations, (3) the education of the staff about the risks of contamination and care of the terminally ill, (4) reeducation of the public about the non-contagious nature of the sick by personal counseling given by health care professionals and (5) the material support of families. This is of vital importance but is difficult to achieve in the context of chronic poverty.