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Objectives In terms of HIV infection, western and central Africa is the second most affected region world-wide, and the gap between the regional figures for the testing and treatment cascade and the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 targets is particularly worrying. We assessed the prevalence of virological suppression in patients routinely treated in 19 hospitals in Cameroon. Methods A cross-sectional survey was performed in adult patients receiving antiretroviral therapy (ART) in the Centre and Littoral regions. The prevalences of virological suppression (mL) were compared among all 19 hospitals using the chi(2) test. Potential individual and health care-related determinants of virological suppression were assessed using multivariate logistic regression models. Results A total of 1700 patients (74% women; median age 41 years; median time on ART 3.7 years) were included in the study. The prevalence of virological suppression was 82.4% overall (95% confidence interval 80.5-84.2%). It ranged from 57.1 to 97.4% according to the individual hospital (P < 0.001). After adjustment, virological suppression was associated with age, CD4 cell count at ART initiation, disclosure of HIV status to family members, interruption of ART for more than two consecutive days, and location of patient's residence and hospital (rural/urban). These factors did not explain the heterogeneity of virological suppression between the study hospitals (P < 0.001). Conclusions The overall prevalence of virological suppression was reassuring. Nevertheless, the heterogeneity of virological suppression among hospitals highlights that, in addition to programme-level data, health facility-level data are crucial in order to tailor the national AIDS programme's interventions with a view to achieving the third UNAIDS 90 target.

Au cours des 40 dernières années, la récurrence d'épidémies dues à des agents infectieux connus ou nouveaux (sida, virus de la grippe aviaire, du SRAS, Ebola...) a généré une prise de conscience accrue des interconnexions entre santés humaine, animale et environnementale, et de l'effet des changements globaux sur ces interactions. À l'image des émergences dans d'autres domaines scientifiques, des courants de pensée, des stratégies et des pratiques reposant sur des approches systémiques, ici dans le champ de la santé, ont ainsi vu le jour. Ce 25ème dossier d'Agropolis fait le point sur les multiples compétences et sur les approches systémiques en santé développées par la communauté scientifique active en région Occitanie. Avec une masse critique de recherche en sciences médicales, sciences agronomiques et vétérinaires, sciences écologiques et environnementales et sciences sociales, cette communauté constitue en effet un terreau favorable au développement et au rayonnement de telles approches et à l'opérationnalisation de concepts et de méthodes originaux. Loin de prétendre à l'exhaustivité, ce dossier offre un panorama des approches intégrées en santé menées par les équipes scientifiques implantées en Occitanie, et dans les régions d'outre-mer lorsque ces équipes ont une tutelle en Occitanie. Il présente de multiples exemples, illustrant les partenariats mis en oeuvre en France et dans le monde. Sont ici prises en compte également les questions de santé liées à notre alimentation et à notre façon de la produire. Au total, ce ne sont pas moins de 66 unités de recherche auxquelles il est fait référence tout au long de ce dossier, illustrant la diversité, la complémentarité et la portée pour la région et, au-delà, pour le monde des travaux scientifiques originaux développés.

Over the last 40 years, the recurrence of epidemics resulting from known or new infectious agents (AIDS, avian influenza, SARS, Ebola, etc.) has sharply raised awareness about the interconnections between human health and the health of animals and the environment, as well as the effects of global changes on these interactions. In line with the emerging trends in other scientific fields, systemic thinking, strategies and practices have gained ground in the area of health. In this 25th dossier d'Agropolis, we offer an overview of the expertise of the scientific community in the French region of Occitanie in the manifold areas of health and of the systemic approaches being developed. Bringing together a critical mass of research in medicine, agronomy, veterinary science and ecological, environmental and social science, this diverse community is fertile terrain for adopting an integrated approach to health and developing innovative concepts and methods. While far from exhaustive, this report provides illustrative examples of research undertaken by scientific teams in the region alongside partners in France, its overseas territories, and around the world. All aspects affecting health are considered: not only human and animal health, but plant health, the environment, and issues linked to diet and food production. No less than 66 research units are cited in this report, illustrating the diversity and complementarity of the scientific work being carried out from this hub of integrated health research.

Background. With the increasing frequency and impact of Ebola virus disease (EVD) outbreaks illustrated by recent epidemics, a good understanding of the extent of viral persistance or ribonucleic acid (RNA) detection in body fluids from survivors is urgently needed. Methods. Ebola viral RNA shedding was studied with molecular assays in semen (n = 1368), urine (n = 1875), cervicovaginal fluid (n = 549), saliva (n = 900), breast milk (n = 168), and feces (n = 558) from EVD survivors in Guinea (PostEbogui cohort, n = 802) at a regular base period until 40 months after inclusion. Results. Twenty-seven of 277 (9.8%) male survivors tested positive for Ebola RNA in at least 1 semen sample. The probability of remaining positive for Ebola RNA in semen was estimated at 93.02% and 60.12% after 3 and 6 months. Viral RNA in semen was more frequent in patients with eye pain (P = .036), joint pain (P = .047), and higher antibody levels to Ebola virus antigens (nucleoprotein [P = .001], glycoprotein [P = .05], and viral protein-40 [P = .05]). Ebola RNA was only rarely detected in the following body fluids from EVD survivors: saliva (1 of 454), urine (2 of 593), breast milk (2 of 168), cervicovaginal secretions (0 of 273), and feces (0 of 330). Ribonucleic acid was detected in breast milk 1 month after delivery but 500 days after discharge of Ebola treatment unit (ETU) in 1 woman who became pregnant 7 months after discharge from the ETU. Conclusions. The frequency and potential long-term presence of viral RNA in semen confirmed that systematic prevention measures in male survivors are required. Our observation in breast milk suggests that our knowledge on viral reservoir in immune-privileged sites and its impact are still incomplete.

Background The prevalence of Ebola virus infection among people who have been in contact with patients with Ebola virus disease remains unclear, but is essential to understand the dynamics of transmission. This study aimed to identify risk factors for seropositivity and to estimate the prevalence of Ebola virus infection in unvaccinated contact persons. Methods In this retrospective, cross-sectional observational study, we recruited individuals between May 12, 2016, and Sept 8, 2017, who had been in physical contact with a patient with Ebola virus disease, from four medical centres in Guinea (Conakry, Macenta, N'zerekore, and Forecariah). Contact persons had to be 7 years or older and not diagnosed with Ebola virus disease. Participants were selected through the Postebogui survivors' cohort. We collected self-reported information on exposure and occurrence of symptoms after exposure using a questionnaire, and tested antibody response against glycoprotein, nucleoprotein, and 40-kDa viral protein of Zaire Ebola virus by taking a blood sample. The prevalence of Ebola virus infection was estimated with a latent class model. Findings 1721 contact persons were interviewed and given blood tests, 331 of whom reported a history of vaccination so were excluded, resulting in a study population of 1390. Symptoms were reported by 216 (16%) contact persons. The median age of participants was 26 years (range 7-88) and 682 (49%) were male. Seropositivity was identified in 18 (8.33%, 95% CI 5.01-12.80) of 216 paucisymptomatic contact persons and 39 (3.32%, 5.01-12.80) of 1174 (2-4) asymptomatic individuals (p=0.0021). Seropositivity increased with participation in burial rituals (adjusted odds ratio [aOR] 2.30, 95% CI 1.21-4.17; p=0.0079) and exposure to blood or vomit (aOR 2.15, 1.23-3.91; p=0.0090). Frequency of Ebola virus infection varied from 3.06% (95% CI 1.84-5.05) in asymptomatic contact persons who did not participate in burial rituals to 5.98% (2.81-8.18) in those who did, and from 7.17% (3.94-9.09) in paucisymptomatic contact persons who did not participate in burial rituals to 17.16% (12.42-22.31) among those who did. Interpretation This study provides a new assessment of the prevalence of Ebola virus infection among contact persons according to exposure, provides evidence for the occurrence of paucisymptomatic cases, and reinforces the importance of closely monitoring at-risk contact persons.

Les maladies infectieuses émergentes sont récurrentes et représentent un enjeu de sécurité sanitaire planétaire. Le continent africain est particulièrement exposé aux risques infectieux épidémiques à cause du nombre d'agents infectieux qui y circulent, en particulier dans la faune, mais aussi de par des facteurs sociaux et environnementaux qui favorisent leur diffusion épidémique. Les épidémies à virus Ebola en Afrique de l'Ouest en 2014 et celles en République démocratique du Congo (RDC) ayant débuté en 2018 ont été l'occasion de mettre au point et de déployer de nouvelles techniques diagnostiques pour des laboratoires en Guinée et en RDC. Ces outils ont permis d'identifier rapidement l'agent infectieux, de retracer en temps réel les chaînes de contamination pour intervenir efficacement et développer un outil sérologique fiable permettant un diagnostic différentiel. Aujourd'hui, des structures équipées et fonctionnelles existent en Guinée et en RDC pour répondre aux risques d'émergence épidémique, pilotées par des chercheurs guinéens et congolais formés à des niveaux de compétence élevés et bénéficiant d'expérience et de connaissance de terrain unique.

Second-line therapy randomized trials with lopinavir/ritonavir question the value of resistance testing to guide nucleoside reverse transcriptase inhibitor (NRTI) selection. In this study, we investigated the association between baseline drug resistance and treatment outcome after 104 weeks of second-line therapy with NRTIs and either darunavir/ritonavir or lopinavir/ritonavir in West-central Africa. We did an observational analysis of data from 387 individuals in a randomized, open-label 2LADY trial in Burkina Faso, Cameroon, and Senegal. We modeled the association between RTI drug resistance mutations (DRMs) and virological failure (VF) (viral load [VL] 1) in their prescribed second-line regimen. The average number of DRMs by drug class, the proportion of individuals by GSS category, and the duration of first-line therapy were not associated with VF (p>.05). High VL at switch was the only consistent prognostic factor for VF after multivariate adjustment (p