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Objective To describe sexual and reproductive health (SRH) needs of female sex workers (FSWs) to inform the future implementation of pre-exposure prophylaxis (PrEP) for HIV prevention in this population.Design and setting The ANRS 12361 PrEP-CI cross-sectional and mixed-methods study was designed and implemented with two community-based organisations in Côte d’Ivoire.Participants A convenience sample of 1000 FSWs aged ≥18, not known as HIV-positive, completed a standardised questionnaire assessing sociodemographic characteristics, sexual practices, use of community health services and a priori acceptability of PrEP. Twenty-two indepth interviews and eight focus group discussions were also conducted to document FSWs’ risky practices and sexual behaviours, experiences with violence and discrimination, attitudes regarding HIV and sexually transmitted infections (STIs), and barriers to SRH services.Results Although 87% described consistent condom use with clients, more than 22% declared accepting condomless sexual intercourse for a large sum of money. Furthermore, condom use with their steady partner and knowledge of their partner’s HIV status were low despite their acknowledged concurrent sexual partnerships. While inconsistent condom use exposed FSWs to STIs and undesired pregnancies, the prevalence of contraceptive strategies other than condoms was low (39%) due to fear of contraception causing sterility. FSWs faced obstacles to accessing SRH care and preferred advice from their peers or self-medication.Conclusions Despite adoption of preventive behaviour in most cases, FSWs are still highly exposed to HIV. Furthermore, FSWs seem to face several barriers to accessing SRH. Implementing PrEP among FSWs in West Africa, such as in Côte d’Ivoire, constitutes an opportunity to consider the regular follow-up of HIV-negative FSWs. PrEP initiation should not condition access to SRH services; conversely, SRH services could be a way to attract FSWs into HIV prevention. Our results highlight the importance of developing a people-focused approach that integrates all SRH needs when transitioning from PrEP efficacy trials to implementation.

: Introduction: HIV Testing and Counselling (HTC) remains a key challenge in achieving control of the HIV epidemic by 2030. In the early 2010s, the President's Emergency Plan for AIDS Relief (Pepfar) adopted targeted HTC strategies for populations and geographical areas most affected by HIV. We examine how Pepfar defined targeted HTC in Côte d'Ivoire, a country with a mixed HIV epidemic, after a decade of expanding HTC services. Methods: We explored the evolution of HTC strategies through the Country Operational Plans (COP) of Pepfar during its phase 3.0, from COP 14 to COP 17 (October 2014 to September 2018) in Côte d'Ivoire. We conducted an analysis of the grey literature over the period 2014 to 2018 (Budget & Target Report, Strategic Direction Summary, Sustainability Index and Dashboard Summary, https://data.pepfar.gov). We also conducted a qualitative study in Côte d'Ivoire (2015 to 2018) using in‐depth interviews with stakeholders in the AIDS public response: CDC/Pepfar (3), Ministry of Health (3), intermediary NGOs (7); and public meeting observations (14). Results: Since the COP 14, Pepfar's HIV testing strategies have been characterized by significant variations in terms of numerical, geographical and population targets. While the aim of COP 14 and COP 15 seemed to be the improvement of testing efficacy in general and testing yield in particular, COP 16 and COP 17 prioritized accelerating progress towards the “first 90” (i.e. reducing the proportion of people living with HIV who are unaware of their HIV). A shift was observed in the definition of testing targets, with less focus on the inclusion of programmatic data and feedback from field actors, and greater emphasis on the use of models to estimate and disaggregate the targets by geographical units and sub‐populations (even if the availability of data by this disaggregation was limited or uncertain); increasingly leading to gaps between targets and results. Conclusions: These trials and tribulations question the real and long‐term effectiveness of annually‐revised, fragmented strategies, which widen an increasing disparity between the realities of the actors on the ground and the objectives set in Washington., Introduction HIV Testing and Counselling (HTC) remains the first challenge in achieving control of the HIV epidemic by 2030. Despite significant progress, it was estimated that in 2017 only 75% [...]

Objective The 6 month assessment of the response to antiretroviral therapy (ART) is a critical step. In sub-Saharan Africa, few people have access to plasma viral-load measurement. We assessed the gain or loss in body mass index (BMI), alone or in combination with the gain or loss in CD4+ T-cell count (CD4), as a tool for predicting the response to ART. Methods In a cohort of 622 adults in Abidjan, Cote d&apos;Ivoire, we calculated the sensitivity, specificity and predictive values of BMI and CD4 for treatment success defined as viral-load undetectability (< 300 copies/ml) as gold standard. Findings After 6 months of ART, the median change in BMI was an increase of 1.0 kg/[m.sup.2] (interquartile range, IQR: 0.0-2.1), the median change in CD4 an increase of 148/[micro]l (IQR: 54-230) and 84% of patients reached viral-load undetectability. The distribution of change in BMI was similar among patients who reached undetectability and those who dial not (increases of 1.06 kg/[m.sup.2] versus 0.99 kg/[m.sup.2], P = 0.51). With larger changes in BMI, the specificity for treatment success increased but its sensitivity decreased and its positive predictive value was stable around 85%. AII results remained similar when combining changes in BMI with those in CD4 and when stratifying by groups of baseline BMI or CD4. Conclusion In settings where viral-load measurement is not available, a high BMI gain does not reflect virological success, even when combined with a high CD4 gain. In our population, most patients with detectable viral-load had probably adhered to the drug regimen sufficiently to reach significant gains in body mass and CD4 count but had adhered insufficiently to reach viral suppression. Resume Objectif L&apos;evaluation sur 6 mois de la reponse au traitement antiretroviral (ART) est une etape critique. En Afrique subsaharienne, peu de personnes ont acces a la mesure de la charge virale plasmatique. Nous avons evalue le gain ou la perte d&apos;indice de masse corporelle (IMC), isolement ou en association avec le gain ou la perte de cellules T CD4+ (CD4), en tant qu&apos;outils pour predire la reponse au traitement ART. Methodes Parmi une cohorte de 622 adultes d&apos;Abidjan, en Cote d&apos;lvoire, nous avons calcule la sensibilite, la specificite et les valeurs predictives de I&apos;IMC et des CD4 pour le succes du traitement, defini comme l&apos;impossibilite de detecter une charge virale (< 300 copies/ml), a titre normatif. Resultats Apres 6 mois de traitement ART, on obtenait comme valeur mediane de la variation de I&apos;IMC une augmentation de 1,0 kg/[m.sup.2] (intervalle interquartile, IIQ : 0,0-2,1) et comme mediane de la variation des CD4 une augmentation de 148/pl (IIQ : 54-230), ainsi qu&apos;une indetectabilite de la charge virale chez 84 % des patients. La distribution de la variation de I&apos;IMC etait similaire chez les patients ayant atteint I&apos;indetectabilite et chez ceux ne I&apos;ayant pas atteint (augmentation de 1,06 kg/[m.sup.2] au lieu de 0,99 kg/[m.sup.2], p < 0,51). Lorsque la variation de I&apos;IMC augmente, sa specificite a I&apos;egard du succes therapeutique diminue et sa valeur predictive positive reste stable autour de 85 %. Les resultats ne varient guere Iorsqu&apos;on combine les variations de I&apos;IMC, dans leur ensemble, et celles des CD4 et qu&apos;on opere une stratification par groupes d&apos;IMC ou de CD4 de depart. Conclusion Dans les situations ou I&apos;on ne dispose pas de mesure de la charge virale, un fort gain d&apos;IMC n&apos;implique pas un succes virologique, meme s&apos;il s&apos;accompagne d&apos;une importante elevation des CD4. Dans la population etudiee, la plupart des patients presentant une charge virale detectable avaient probablement respecte assez longtemps le schema therapeutique pour beneficier d&apos;augmentations notables de la masse corporelle et de la numeration des CD4, mais pas suffisamment pour atteindre la suppression virale. Resumen Objetivo La evaluacion a los 6 meses de la respuesta a la terapia antirretroviral (TAR) es una medida esencial, pero en el Africa subsahariana son muy pocas las personas con acceso a analisis de la carga viral en plasma. Evaluamos el aumento o disminucion del indice de masa corporal (IMC), aisladamente o en combinacion con el aumento o disminucion del recuento de linfocitos T CD4+ (CD4), como estrategia para predecir la respuesta a la TAR. Metodos En una cohorte de 622 adultos de Abidjan, Cote d&apos;lvoire, calculamos la sensibilidad, la especificidad y los valores predictivos del IMC y los niveles de CD4 como indicadores de la eficacia terapeutica, definida como una carga viral indetectable (< 300 copias/ml). Resultados A los 6 meses de iniciada la TAR, el IMC mediano habia aumentado en 1,0 kg/[m.sup.2] (intervalo intercuartilico, IIC: 0,0-2,1) y el nivel mediano de CD4, en 148/[micro]l (IIC: 54-230), y la carga viral habia pasado a ser indetectable en un 84% de los pacientes. La distribucion de la variacion del IMC fue similar en los pacientes que alcanzaron niveles indetectables y en los demas (aumento de 1,06 kg/[m.sup.2] frente a 0,99 kg/[m.sup.2], p = 0,51). Conforme aumentaba la variacion del IMC, la especificidad respecto de la eficacia terapeutica aumentaba, pero su sensibilidad disminuia, y su valor predictivo positivo se mantenia estable, en torno al 85%. Se obtenian siempre resultados similares al combinar distintos cambios del IMC y del recuento de CD4, asi como al estratificar los grupos en funcion de los valores basales de IMC o CD4. Conclusion En los entornos donde no es posible medir la carga viral, un gran aumento del IMC no refleja la eficacia virologica, aun cuando se combine con un incremento importante de los niveles de CD4. En la poblacion aqui estudiada, la mayoria de los pacientes con carga viral detectable probablemente habian seguido el tratamiento en la medida suficiente para conseguir aumentos importantes de la masa corporal y del recuento de CD4, pero no en la medida necesaria para lograr la supresion viral. [TEXT NOT REPRODUCIBLE IN ASCII.], Introduction International guidelines recommend that plasma viral load undetectability should be reached within the first 6 months of antiretroviral therapy (ART). (1) In patients with plasma viral load still detectable [...]

Objective To estimate the probability of reaching the criteria for starting highly active antiretroviral therapy (HAART) in a prospective cohort of adult HIV-1 seroconverters in Abidjan, Cote d&apos;Ivoire. Methods We recruited participants from HIV-positive donors at the blood bank of Abidjan for whom the delay since the estimated date of seroconversion (midpoint between last negative and first positive HIV-1 test) was [less than or equal to] 36 months. Participants were offered early trimethoprim-sulfamethoxazole (cotrimoxazole) prophylaxis, twice-yearly measurement of CD4 count and we made standardized records of morbidity. We used the Kaplan-Meier method to estimate the probability of reaching the criteria for starting HAART according to WHO 2006 guidelines. Findings 217 adults (77 women (35%)) were followed up during 668 person-years (PY). The most frequent diseases recorded were mild bacterial diseases (6.0 per 100 PY), malaria (3.61100 PY), herpes zoster (3.41100 PY), severe bacterial diseases (3.1/100 PY) and tuberculosis (2.1/100 PY). The probability of reaching the WHO 2006 criteria for HAART initiation was estimated at 0.09, 0. 16, 0.24, 0.36 and 0.44 at 1, 2, 3, 4 and 5 years, respectively. Conclusion Our data underline the incidence of the early HIV morbidity in an Ivorian adult population and provide support for HIV testing to be made more readily available and for early follow-up of HIV-infected adults in West Africa. Bulletin of the World Health Organization 2007;85:116-123. Resume Objectif Estimer la probabilite de remplir les criteres de mise en route d&apos;un traitement antiretroviral hautement actif (HAART) dans le cadre d&apos;une etude prospective portant sur une cohorte d&apos;adultes ayant subi une seroconversion au VIH-1, a Abidjan (Cote d&apos;lvoire). Methodes Nous avons recrute des sujets parmi les donneurs positifs pour le VIH d&apos;une banque de sang d&apos;Abidjan pour lesquels le delai ecoule depuis la date estimee de la seroconversion (date situee a mi-distance entre le dernier test negatif et le premier test positif pour le VIH-1) etait [less than or equal to] 36 mois. Nous avons propose a ces sujets un traitement prophylactique precoce par le trimethoprimesulfamethoxazole (cotrimoxazole) et une numeration deux fois par an des lymphocytes T CD4. Nous avons procede a un enregistrement normalise de la morbidite. Nous avons utilise la methode de Kaplan-Meier pour estimer la probabilite de remplir les criteres de mise en route d&apos;un traitement de type HAART selon les Directives OMS de 2006. Resultats 217 adultes, dont 77 femmes (35 %), ont ete suivis sur 668 personnes-ans. Les maladies les plus frequemment relevees chez eux etaient des affections bacteriennes benignes (6,0/100 personnes-ans), des paludismes (3,6/100 personnes-ans), des zonas (3,4/100 personnes-ans), des affections bacteriennes graves (3,1/100 personnes-ans) et des tuberculoses (2,1/100 personnes-ans). La probabilite de remplir les criteres 2006 de l&apos;OMS concernant la mise en route d&apos;un traitement HAART a ete estimee a 0,09 ; 0,16 ; 0,24 ; 0,36 et 0,44 respectivement pour les annees 1, 2, 3, 4 et 5. Conclusion Nos donnees font ressortir l&apos;incidence de la morbidite precoce liee au VIH parmi une population adulte ivoirienne et confirment la necessite de rendre plus accessible le depistage de ce virus et de pratiquer un suivi precoce des adultes seropositifs en Afrique de l&apos;Ouest. Resumen Objetivo Estimar la probabilidad de satisfacer los criterios para comenzar la terapia antirretroviral de gran actividad (TARGA) en una cohorte prospectiva de seroconvertidos para el VIH-I en el banco de sangre de Abidjan, Africa Occidental. Metodos Se invito a participar en la cohorte a todos los donantes de sangre en los que habian transcurrido [less than or equal to] 36 meses desde la fecha estimada de seroconversion (punto medio entre la ultima prueba negativa y la primera positiva para el VIH-1). El seguimiento incluyo la profilaxis temprana con cotrimoxazol, el recuento semestral de CD4 y la documentacion normalizada de la morbilidad. Mediante el metodo de Kaplan-Meier calculamos la probabilidad de cumplir los criterios para iniciar la TARGA de acuerdo con las directrices de la OMS de 2006. Resultados Se siguio la evolucion de 217 adultos (35% de mujeres) durante 668 anos-persona. Las dolencias mas frecuentes fueron enfermedades bacterianas leves (incidencia de 6,0 por 100 anos-persona [/100 AP]), malaria (3,6/100 AP), herpes zoster (3,4/100 AP), enfermedades bacterianas graves (3,1/100 AP) y tuberculosis (2,1/100 AP). La probabilidad de cumplir los criterios de la OMS de 2006 para comenzar la TARGA se estimo en 0,09, 0,16, 0,24, 0,36 y 0,44 a los uno, dos, tres, cuatro y cinco anos, respectivamente. Conclusion Estos datos destacan la incidencia de morbilidad precoz por VIH en una poblacion adulta de Africa Occidental y respaldan la idea de realizar un cribado temprano de la infeccion por VIH y un seguimiento temprano de los adultos infectados por el virus en esa parte de Africa., Une traduction en francais de ce resume figure a la fin d l'article. Al final del articulo se facilita una traduccion al espanol. Introduction Experts from the World Health Organization [...]

The 6-month efficacy and tolerance of an efavirenz-containing highly active antiretroviral therapy regimen in a large cohort of HIV-1-infected adults is presented. Considering the very high hepatic and cutaneous tolerance, efavirenz could be considered as a valuable first-line drug for women of childbearing age who agree to use contraception in sub-Saharan Africa, provided that the risk of teratogenicity should be closely monitored.