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To evaluate the performance of the cascade of activities for prevention of mother-to-child transmission (PMTCT) of human immunodeficiency virus (HIV) at the second immunization visit in Burkina Faso.In a cross-sectional study, we recruited mothers attending the second immunization visit for their infant in 20 health centres of Bobo-Dioulasso city, Burkina Faso over 12 months (2019-2020). We administered a short questionnaire to 14 176 mothers and performed HIV serological tests on mothers who had not been tested in the last 3 months. All mothers were asked about their attendance for antenatal care and HIV rapid testing. HIV-infected mothers were also asked about the timing of their HIV diagnosis, antiretroviral therapy, pre-exposure prophylaxis initiation at birth and infant diagnosis of HIV.Of 14 136 respondents, 13 738 (97.2%) had at least one HIV serological test in their lifetime. Of 13 078 mothers who were never tested or were HIV-negative, 12 454 (95.2%) were tested during or after their last pregnancy. Among HIV-infected mothers already aware of their status, 110/111 (99.1%) women were on antiretroviral therapy. Among HIV-exposed infants, 84/101 (83.2%) babies received 6 weeks of antiretroviral prophylaxis at birth and 58/110 (52.7%) had a blood sample collected for early infant diagnosis. Only two mothers received their child's test results at the time of the second immunization visit. Four mothers were newly diagnosed as HIV-positive during the study.Collecting data at the second immunization visit, a visit rarely missed by mothers, could be useful for identifying gaps in the PMTCT cascade in settings where mothers are difficult to reach, such as in low-income countries with intermediate or low HIV prevalence.Évaluer les performances de la cascade d'activités liées à la prévention d'une transmission de la mère à l'enfant (PTME) du virus de l'immunodéficience humaine (VIH) lors de la seconde visite de vaccination au Burkina Faso.Dans le cadre de notre étude transversale, nous avons recruté des mères se rendant à la seconde visite de vaccination de leur nourrisson dans 20 centres de santé de la ville de Bobo-Dioulasso (Burkina Faso) pendant 12 mois (2019–2020). Nous avons soumis un bref questionnaire à 14 176 mères et effectué un test sérologique de dépistage du VIH sur celles n’ayant pas été testées au cours des trois derniers mois. Toutes ont été interrogées sur leur participation aux soins prénatals et aux tests rapides de détection du VIH. Nous avons également demandé aux mères infectées par le VIH des informations sur la date du diagnostic, le traitement antirétroviral, le début de la prophylaxie avant exposition à la naissance et le dépistage du VIH chez le nourrisson.Sur un total de 14 136 participantes, 13 738 (97,2%) ont subi au moins un test sérologique de dépistage du VIH au cours de leur vie. Sur 13 078 mères jamais testées ou séronégatives, 12 454 (95,2%) ont été testées au cours ou à l'issue de leur dernière grossesse. Parmi les mères séropositives connaissant déjà leur statut, 110 sur 111 (99,1%) suivaient un traitement antirétroviral. Et parmi les nourrissons exposés au VIH, 84 sur 101 (83,2%) ont reçu une prophylaxie antirétrovirale durant les 6 semaines suivant leur naissance, tandis qu'un échantillon de sang a été prélevé chez 58 sur 110 (52,7%) afin de poser un diagnostic précoce. Seules deux mères avaient obtenu les résultats des tests de leur enfant au moment de la seconde visite de vaccination. Enfin, quatre mères ont été diagnostiquées séropositives pendant l'étude.Colliger des données lors de la seconde visite de vaccination, à laquelle les mères sont généralement présentes, pourrait s'avérer utile pour identifier les faiblesses dans la cascade d'activités liées à la PTME dans les régions où il est difficile d'entrer en contact avec les mères, notamment dans les pays à revenu faible où la prévalence du VIH est faible à modérée.Evaluar el rendimiento de la serie de actividades de prevención de la transmisión maternofilial (PTMF) del virus de la inmunodeficiencia humana (VIH) en la segunda visita de vacunación en Burkina Faso.En un estudio transversal, se reclutaron madres que asistían a la segunda visita de vacunación de su bebé en 20 centros sanitarios de la ciudad de Bobo-Dioulasso, Burkina Faso, durante 12 meses (2019-2020). Se realizó un breve cuestionario a 14 176 madres y se llevaron a cabo pruebas serológicas del VIH a las madres que no se habían hecho la prueba en los últimos 3 meses. Se preguntó a todas las madres sobre su asistencia a la atención prenatal y a la prueba rápida del VIH. También se preguntó a las madres infectadas por el VIH sobre el momento de su diagnóstico de VIH, el tratamiento antirretrovírico, el inicio de la profilaxis previa a la exposición en el momento del nacimiento y el diagnóstico de VIH en el bebé.De 14 136 encuestadas, 13 738 (97,2 %) se hicieron al menos una prueba serológica del VIH a lo largo de su vida. De las 13 078 madres que nunca se habían sometido a la prueba o no estaban infectadas por el VIH, 12 454 (95,2 %) se sometieron a la prueba durante o después de su último embarazo. Entre las madres infectadas por el VIH que ya conocían su estado, 110/111 (99,1 %) mujeres estaban en tratamiento antirretrovírico. Entre los bebés expuestos al VIH, 84/101 (83,2 %) recibieron 6 semanas de profilaxis antirretrovírica al nacer y a 58/110 (52,7 %) se les tomó una muestra de sangre para el diagnóstico temprano del bebé. Solo dos madres recibieron los resultados de las pruebas de sus hijos en el momento de la segunda visita de vacunación. Cuatro madres recibieron un diagnóstico reciente como infectadas por el VIH durante el estudio.La recopilación de datos en la segunda visita de vacunación, una visita a la que rara vez faltan las madres, podría ser útil para identificar las deficiencias del proceso de PTMF en lugares donde es difícil llegar a las madres, como en los países de bajos ingresos con una prevalencia intermedia o baja del VIH.تقييم أداء سلسلة الأنشطة للوقاية من انتقال فيروس نقص المناعة البشرية من الأم إلى الطفل (PMTCT) في زيارة التحصين الثانية في بوركينا فاصو.في دراسة مقطعية، قمنا بالاستعانة الأمهات اللاتي حضرن زيارة التحصين الثانية لأطفالهن الرضع في 20 مركزًا صحيًا في مدينة بوبو ديولاسو، بوركينا فاصو على مدى 12 شهرًا (2019-2020). قمنا بطرح استبيان قصير على 14176 من الأمهات، وإجراء اختبار مصلي لفيروس نقص المناعة البشرية للأمهات اللاتي لم يخضعن للاختبار خلال الشهور الثلاثة الأخيرة.. تم توجيه أسئلة لجميع الأمهات عن حضورهن لزيارات لرعاية السابقة للولادة، والاختبار السريع لفيروس نقص المناعة البشرية. كما سألنا الأمهات المصابات بفيروس نقص المناعة البشرية عن توقيت تشخيص إصابتهن بفيروس نقص المناعة البشرية، والعلاج المضاد للفيروسات القهقرية، والبدء في العلاج الوقائي قبل التعرض عند الولادة، وتشخيص فيروس نقص المناعة البشرية لدى الرضع.من بين 14136 مستجيبة، كان لدى 13738 (%97.2) اختبار مصلي واحد على الأقل لفيروس نقص المناعة البشرية في حياتهم. من بين 1378 من الأمهات اللاتي لم يتم اختبارهن، أو كن مصابات بفيروس نقص المناعة البشرية، تم اختبار 12454 (%95.2) أثناء الحمل الأخير، أو بعده. من بين الأمهات المصابات بفيروس نقص المناعة البشرية اللاتي كن يعرفن بالفعل حالتهن، كانت 110/111 (%99.1) من السيدات يتلقين العلاج المضاد للفيروسات القهقرية. من بين الرضع المعرضين لفيروس نقص المناعة البشرية، تلقى 84/101 (%83.2) من الأطفال 6 أسابيع من العلاج الوقائي بمضادات الفيروسات القهقرية عند الولادة، وحصل 58/110 (%52.7) على عينة دم تم جمعها من أجل التشخيص المبكر للرضع. حصلت اثنتان فقط من الأمهات على نتائج اختبار طفليهما في وقت زيارة التحصين الثانية. تم تشخيص أربع أمهات حديثًا على أنهن مصابات بفيروس نقص المناعة البشرية أثناء الدراسة.إن تجميع البيانات في زيارة التحصين الثانية، وهي زيارة نادراً ما تفوتها الأمهات، قد يكون مفيداً في تحديد الثغرات في سلسلة الوقاية من انتقال الفيروس من الأم إلى الطفل في الأوضاع التي يصعب فيها الوصول إلى الأمهات، كما هو الحال في الدول ذات الدخل المنخفض مع الانتشار المتوسط أو المنخفض لفيروس نقص المناعة البشرية.旨在评估布基纳法索第二次免疫接种中人类免疫缺陷病毒 (HIV) 母婴传播 (PMTCT) 各阶段预防活动的成效。.我们招募在 12 个月的期限内在布基纳法索博博-迪乌拉索市 20 个健康中心为其幼儿孩子进行第二次免疫接种的母亲参加一项横断面研究。我们对 14,176 名母亲进行了简短的问卷调查，并对在过去3个月内未进行检测的母亲进行了艾滋病毒血清检测。同时对于感染 HIV 的母亲,询问其 HIV 确诊时间、采用的抗逆转录病毒治疗、出生时开始的暴露前预防措施及婴儿的 HIV 诊断情况。.在 14 136 名受访者中,13 738 (97.2%) 名受访者至少在人生中某个阶段接受过一次 HIV 血清学检测。在从未接受过 HIV 检测或检测结果为阴性的 13 078 位母亲中,12 454 (95.2%) 位在其最近一次孕期期间或之后接受过检测。在感染 HIV 并且已了解其病情的母亲中,110/111 (99.1%) 位曾接受过抗逆转录病毒治疗。在存在 HIV 感染的婴儿中,84/101 (83.2%) 名婴儿在出生时接受过为期 6 周的抗逆转录病毒治疗,并且 58/110 (52.7%) 名婴儿进行了血样采集,以用于早期婴儿诊断。仅两位母亲在第二次免疫接种时收到了其孩子的检测结果。四位母亲在研究开展期间初次诊断为 HIV 阳性。.在第二次免疫接种(很少有母亲会错过这次接种)时采集数据,有助于确定婴儿母亲在获取诊断方面有困难地区(例如,存在较低或中等程度 HIV 患病率的低收入国家)PMTCT 各阶段之间存在的差距。.Оценить эффективность комплекса мероприятий по профилактике передачи вируса иммунодефицита человека (ВИЧ) от матери ребенку (ППМР), осуществляемых во время второго визита для проведения вакцинации в Буркина-Фасо.Для участия в кросс-секционном исследовании были отобраны матери, которые пришли на второй визит для проведения вакцинации своего ребенка в 20 медицинских центрах города Бобо-Диуласо, Буркина-Фасо, в течение 12 месяцев (2019–2020 гг.). Среди 14 176 матерей было проведено краткое анкетирование, а среди матерей, которые не были протестированы в течение последних 3 месяцев, также было проведено серологическое тестирование на ВИЧ. Всем матерям задавали вопросы о том, посещали ли они дородовое наблюдение и проходили ли экспресс-тестирование на ВИЧ. ВИЧ-инфицированных матерей также спрашивали о времени постановки диагноза ВИЧ, проведении антиретровирусной терапии, начале доконтактной профилактики при рождении и диагностике ВИЧ у детей грудного возраста.Из 14 136 респондентов 13 738 (97,2%) прошли хотя бы одно серологическое исследование на ВИЧ в течение жизни. Из 13 078 матерей, которые никогда не проходили тестирование или были ВИЧ-отрицательными, 12 454 (95,2%) прошли тестирование во время или после последней беременности. Среди ВИЧ-инфицированных матерей, уже знавших о своем статусе, 110 из 111 женщин (99,1%) проходили антиретровирусную терапию. Среди ВИЧ-инфицированных детей грудного возраста 84 из 101 ребенка (83,2%) провели 6-недельную антиретровирусную профилактику при рождении, а у 58 из 110 младенцев (52,7%) был взят образец крови для ранней диагностики. Только две матери получили результаты анализов своего ребенка во время второго визита для проведения вакцинации. В ходе исследования у четырех матерей был впервые установлен диагноз ВИЧ-инфекции.Сбор данных во время второго визита для проведения вакцинации, который редко пропускается матерями, может быть полезен для выявления пробелов в комплексе мероприятий по профилактике ППМР в условиях, когда сложно связаться с матерями, например в странах с низким уровнем дохода и средней или низкой распространенностью ВИЧ.

Post-natal HIV infection through breastfeeding remains a challenge in many low and middle-income countries, particularly due to non-availability of alternative infant feeding options and the suboptimal Prevention of Mother to Child Transmission of HIV-1 (PMTCT) cascade implementation and monitoring. The PROMISE-EPI study aims to address the latter by identifying HIV infected mothers during an almost never-missed visit for their infant, the second extended program on immunization visit at 6-8 weeks of age (EPI-2). The study is divided into 3 components inclusive of an open-label randomized controlled trial aiming to assess the efficacy of a responsive preventive intervention compared to routine intervention based on the national PMTCT guidelines for HIV-1 uninfected exposed breastfeeding infants. The preventive intervention includes: a) Point of care testing for early infant HIV diagnosis and maternal viral load; b) infant, single-drug Pre-Exposure Prophylaxis (PrEP) (lamivudine) if mothers are virally unsuppressed. The primary outcome is HIV-transmission rate from EPI-2 to 12 months. The study targets to screen 37,000 mother/infant pairs in Zambia and Burkina Faso to identify 2000 mother/infant pairs for the clinical trial. The study design and challenges faced during study implementation are described, including the COVID-19 pandemic and the amended HIV guidelines in Zambia in 2020 (triple-drug PrEP in HIV exposed infants guided by quarterly maternal viral load). The changes in the Zambian guidelines raised several questions including the equipoise of PrEP options, the standard of care-triple-drug (control arm in Zambia) versus the study-single-drug (intervention arm). Trial registration number (www.clinicaltrials.gov): NCT03869944. Submission category: Study Design, Statistical Design, Study Protocols.

OBJECTIVE: To assess the relationship between infant feeding practices and mortality by 18 months of age among children born to HIV-infected mothers in the Kesho Bora trial (Burkina-Faso Kenya and South Africa). METHODS: Enrolled HIV-infected women were counseled to choose between breastfeeding up to 6 months or replacement feeding from delivery. Multivariable Cox models were used to compare the infant mortality risks according to feeding practices over time defined as never breastfed weaned or still breastfed. The category still breastfed was disaggregated as exclusively predominantly or partially breastfed to compare modes of breastfeeding. The relationship between weaning and mortality was also assessed using marginal structural models to control for time-dependent confounders such as maternal or infant morbidity (reverse causality). RESULTS: Among 795 mothers 618 (77.7%) initiated breastfeeding. Mortality rates by 18 months among uninfected and infected children were 6 and 38% respectively. Never breastfed and weaned children were at greater risk of death compared with those still breastfed. Adjusted hazard ratios were 6.7 [95% confidence interval (CI)=2.5-17.9; P

Background. Antiretroviral (ARV) prophylaxis effectively reduces mother-to-child transmission of human immunodeficiency virus type 1 (HIV). However, it is unclear whether stopping ARVs after breastfeeding cessation affects maternal HIV disease progression. We assessed 18-24-month postpartum disease progression risk among women in a randomized trial assessing efficacy and safety of prophylactic maternal ARVs. Methods. From 2005 to 2008, HIV-infected pregnant women with CD4(+) counts of 200-500/mm(3) were randomized to receive either triple ARV (zidovudine, lamivudine, and lopinavir/ritonavir during pregnancy and breastfeeding) or AZT/sdNVP (zidovudine until delivery with single-dose nevirapine without postpartum prophylaxis). Maternal disease progression was defined as the combined endpoint of death, World Health Organization clinical stage 4 disease, or CD4(+) counts of

BACKGROUND: Breastfeeding is essential for child health and development in low-resource settings but carries a significant risk of transmission of HIV-1 especially in late stages of maternal disease. We aimed to assess the efficacy and safety of triple antiretroviral compared with zidovudine and single-dose nevirapine prophylaxis in pregnant women infected with HIV. METHODS: Pregnant women with WHO stage 1 2 or 3 HIV-1 infection who had CD4 cell counts of 200-500 cells per muL were enrolled at five study sites in Burkina Faso Kenya and South Africa to start study treatment at 28-36 weeks gestation. Women were randomly assigned (1:1) by a computer generated random sequence to either triple antiretroviral prophylaxis (a combination of 300 mg zidovudine 150 mg lamivudine and 400 mg lopinavir plus 100 mg ritonavir twice daily until cessation of breastfeeding to a maximum of 6.5 months post partum) or zidovudine and single-dose nevirapine (300 mg zidovudine twice daily until delivery and a dose of 600 mg zidovudine plus 200 mg nevirapine at the onset of labour and after a protocol amendment in December 2006 1 week post-partum zidovudine 300 mg twice daily and lamivudine 150 mg twice daily). All infants received a 0.6 mL dose of nevirapine at birth and from December 2006 4 mg/kg twice daily of zidovudine for 1 week after birth. Patients and investigators were not masked to treatment. The primary endpoints were HIV-free infant survival at 6 weeks and 12 months; HIV-free survival at 12 months in infants who were ever breastfed; AIDS-free survival in mothers at 18 months; and serious adverse events in mothers and babies. Analysis was by intention to treat. This trial is registered with Current Controlled Trials ISRCTN71468401. FINDINGS: From June 2005 to August 2008 882 women were enrolled 824 of whom were randomised and gave birth to 805 singleton or first liveborn infants. The cumulative rate of HIV transmission at 6 weeks was 3.3% (95% CI 1.9-5.6%) in the triple antiretroviral group compared with 5.0% (3.3-7.7%) in the zidovudine and single-dose nevirapine group and at 12 months was 5.4% (3.6-8.1%) in the triple antiretroviral group compared with 9.5% (7.0-12.9%) in the zidovudine and single-dose nevirapine group (p=0.029). The cumulative rate of HIV transmission or death at 12 months was 10.2% (95% CI 7.6-13.6%) in the triple antiretroviral group compared with 16.0% (12.7-20.0%) in the zidovudine and single-dose nevirapine group (p=0.017). In infants whose mothers declared they intended to breastfeed the cumulative rate of HIV transmission at 12 months was 5.6% (95% CI 3.4-8.9%) in the triple antiretroviral group compared with 10.7% (7.6-14.8%) in the zidovudine and single-dose nevirapine group (p=0.02). AIDS-free survival in mothers at 18 months will be reported in a different publication. The incidence of laboratory and clinical serious adverse events in both mothers and their babies was similar between groups. INTERPRETATION: Triple antiretroviral prophylaxis during pregnancy and breastfeeding is safe and reduces the risk of HIV transmission to infants. Revised WHO guidelines now recommend antiretroviral prophylaxis (either to the mother or to the baby) during breastfeeding if the mother is not already receiving antiretroviral treatment for her own health. FUNDING: Agence nationale de recherches sur le sida et les hepatites virales Department for International Development European and Developing Countries Clinical Trials Partnership Thrasher Research Fund Belgian Directorate General for International Cooperation Centers for Disease Control and Prevention Eunice Kennedy Shriver National Institute of Child Health and Human Development and UNDP/UNFPA/World Bank/WHO Special Programme of Research Development and Research Training in Human Reproduction. Copyright (c) 2011 Elsevier Ltd. All rights reserved.

To evaluate strategies to reduce HIV-1 transmission through breastfeeding, a multicentre study including a nested randomized controlled trial was implemented in five research sites in West, East and South Africa (The Kesho Bora Study). The aim was to optimize the use of antiretroviral (ARV) drugs during pregnancy, delivery and breastfeeding to prevent mother-to-child transmission of HIV-1 (PMTCT) and to preserve the health of the HIV-1-infected mother. The study included long-term ARV treatment for women with advanced disease, and short-course ARV prophylaxis stopped at delivery for women with early disease. Women with intermediate disease participated in a randomized controlled trial to compare safety and efficacy of triple-ARV prophylaxis prolonged during breastfeeding with short-course ARV prophylaxis stopped at delivery. Between January 2005 and August 2008 a total of 1140 women were enrolled. This paper describes the study design, interventions and protocol amendments introduced to adapt to evolving scientific knowledge, international guidelines and availability of ARV treatment. The paper highlights the successes and challenges during the conduct of the trial. The Kesho Bora Study included one of the few randomized controlled trials to assess safety and efficacy of ARV prophylaxis continued during breastfeeding and the only randomized trial to assess maternal prophylaxis started during pregnancy. The findings have been important for informing international and national guidelines on MTCT prevention in developing countries where, due to poverty, lack of reliable and affordable supply of replacement feed and stigma associated with HIV/AIDS, HIV-infected women have little or no option other than to breastfeed their infants. (ISRCTN71468401).

To assess the effectiveness and safety of antiretrovirals (ARVs) used for treatment or prophylaxis in a breastfeeding population of HIV-1-infected women (Burkina-Faso, Kenya, South Africa).HIV-1-infected pregnant women with200 CD4 cells per cubic millimeter or with World Health Organization stage 4 disease (cohort A) and asymptomatic women with500 CD4 cells per cubic millimeter (cohort B) were enrolled into 2 prospective cohorts. Women with 200-500 CD4 cells per cubic millimeter were enrolled in a parallel randomized trial. Women in cohort A initiated antiretroviral therapy. Women in cohort B received zidovudine from 34 to 36 weeks gestation until delivery, with single-dose nevirapine in labor (cohort B). All children received single-dose nevirapine.Of 248 women enrolled, 111 (cohort A) and 125 (cohort B) infants alive at 24 hours after birth were analyzed. Sixty-nine percent and 42% of women had undetectable viral load at delivery, respectively. Ten children in each cohort died. The 18-month cumulative incidences of HIV-1 infection were 7.5% (95% confidence interval: 3.8% to 14.5%) (cohort A) and 5.8% (2.8% to 11.8%) (cohort B). Sixty-one percent (cohort A) and 78% (cohort B) were breastfed for a median duration of 20 weeks. Four children in cohort A and only 1 in cohort B became HIV-1 infected after 6 weeks of age.Antiretroviral therapy initiated a median of 7 weeks before delivery in women with advanced HIV-1 disease was associated with a significant residual risk of HIV-1 transmission due to insufficient decrease in viral load by the time of delivery. Among women with500 CD4 cells per cubic millimeter, the risk of breast-milk transmission was very low despite lack of postnatal prophylaxis.

Rapid human immunodeficiency virus (HIV) antibody tests have been adopted into national guidelines for HIV testing in many countries in sub-Saharan Africa. One goal of HIV rapid testing is to minimize the occurrence of indeterminate results. From January 2005 to December 2007, plasma (or serum) samples from pregnant women in Bobo-Dioulasso (Burkina Faso, West Africa) were screened for HIV by using two rapid tests (the Determine HIV1/2 test [Abbott] and Genie II HIV-1/HIV-2 [Bio-Rad]) through a sequential algorithm prior to enrollment of HIV-1-infected women in a prevention of mother-to-child transmission (PMTCT) trial (WHO/ANRS 1289 Kesho Bora trial). Samples exhibiting indeterminate results (Determine positive and Genie II negative) were further tested with a fourth-generation HIV enzyme immunoassay (EIA) (Murex HIV Ag/Ab combination in 2005 and 2006 and Vironostika HIV Uni-Form II Ag/Ab in 2007). If positive, they were finally assessed for HIV-1 RNA (Generic HIV-1 RNA viral load assay; Biocentric). From a total of 44,653 samples tested, 597 (1.3%) showed indeterminate results. Of these, 367 could be analyzed by EIA. Only 15 (15/367, 4.1%) samples were found EIA reactive. Of these, 11 could be tested for HIV-1 RNA. All were HIV-1 RNA negative. In our clinical practice, pregnant women with such indeterminate results are now reassured during posttest counseling that they are very unlikely to be infected with HIV-1. As a consequence, such women with indeterminate results can reliably be considered negative when urgent clinical decisions (such as providing PMTCT prophylaxis) need to be taken.

Background: In the context of the DITRAME-ANRS 049 research program that evaluated interventions aimed at reducing mother-to-child transmission of HIV (MTCT) in Bobo-Dioulasso (Burkina Faso), Voluntary HIV counseling and testing (VCT) services were established for pregnant women. HIV-infected women were advised to disclose their HIV serostatus to their male partners who were also offered VCT, to use condoms to reduce sexual transmission, and to choose an effective contraception method to avoid unwanted pregnancies. This study aimed at assessing how HIV test results were shared with male sexual partners, the level of use of modern contraceptive methods, and the pregnancy incidence among these women informed of the risks surrounding sexual and reproductive health during HIV infection. Methods: From 1995 to 1999, a quarterly prospective follow-up of a cohort of HIV-positive women. Results: Overall, 306 HIV-positive women were monitored over an average period of 13.5 months following childbirth, accounting for a total of 389 person-years. The mean age at enrollment in the cohort was 25.1 (standard deviation, 5.2 years). In all, 18% of women informed their partners, 8% used condoms at each instance of sexual intercourse to avoid HIV transmission, and 39% started using hormonal contraception. A total of 48 pregnancies occurred after HIV infection was diagnosed, an incidence of 12.3 pregnancies per 100 person-years. Pregnancy incidence was 4 per 100 personyears in the first year of monitoring and this rose significantly to 18 per 100 person-years in the third year. The only predictor of the occurrence of a pregnancy after HIV diagnosis was the poor outcome of the previous pregnancy (stillbirth, infant death). Severe immunodeficiency and change in marital status were the only factors that prevented the occurrence of a pregnancy after HIV diagnosis. Conclusion: Our study shows a poor rate of HIV test sharing and a poor use of contraceptive methods despite regular advice and counseling. Pregnancy incidence remained comparable with the pregnancy rate in the general population. To improve this situation, approaches for involving husbands or partners in VCT and prevention of MTCT interventions should be developed, evaluated, and implemented.

In order to assess the human immunodeficiency virus (HIV) prevalence among teachers in Burkina Faso, we carried out a national survey in 336 primary and secondary schools from urban and rural areas. Among 2088 teachers who agreed to participate, 1498 (71.7%) provided urine for HIV testing. The crude prevalence of HIV among teachers was 2.8% (95% confidence interval [CI]: 2.0–3.6), with no difference between teachers from primary schools (2.9%, 95%CI: 2.1–4.0) and those from secondary schools (2.5%, 95%CI: 0.5–4.5). Age- and area-standardized HIV prevalence was 1.0% (95%CI: 0.4–1.2) in male teachers, 2.5 times lower than among men in the general population (as assessed from a concomitant Demographic Health Survey), and it was 3.5% (95%CI: 2.5–5.2) in female teachers, 1.7 times higher than in Demographic Health Survey women. This finding calls for the implementation of specific HIV prevention programmes in the education sector targeting women more specifically.

Voluntary counselling and testing (VCT) together with a safe sexual behaviour is an important preventive strategy in the control of HIV. Although Health care workers (HCWs) are critical in the response to HIV, little is known about VCT and high risk behaviours (HRB) among this group in West Africa. This study aims to assess the prevalence of VCT and HRB among HCWs in Burkina Faso., info:eu-repo/semantics/published

Background Since 1994, the French National Agency for Research on AIDS and Viral Hepatitis (ANRS) has funded research sites in resource-limited countries (RLCs). These sites implement research on human immunodeficiency virus (HIV) infection and Hepatitis C. In parallel, international regulations and recommendations for clinical trials have evolved and proliferated. However, little guidance exists on how these should be interpreted and applied within academic trials and in the context of RLCs. After developing a specific Ethical Charter for research in developing countries in 2002, ANRS developed a set of quality indicators (QIs) as a monitoring tool for assessing compliance to international guidelines. Purpose We describe here the development process, QIs adopted, and areas for improvement. Methods In 2008, a group of experts was convened that included a researcher representing each ANRS site (Cote d’Ivoire, Senegal, Cameroun, Burkina Faso, Egypt, and Cambodia). Our structuring interaction development process combined evidence and expert opinion in two nominal group meetings to identify (1) clinical trial processes involved, (2) issues specific to RLCs in terms of Good Clinical Practice (GCP) and the application of ethical recommendations, and (3) checklists of QIs adapted to clinical trials conducted in RLCs. Results The trial process reviewed and proposed for RLCs was mostly similar to the one produced in wealthier countries. The scheme generated by our work group added two further processes: ‘drug management’ and ‘biological investigations’. Specific issues regarding trial management in RLCs were therefore described for eight trial steps (1) protocol conception and seeking authorizations, (2) participant enrollment and follow-up, (3) site monitoring, (4) drug management, (5) biological investigations, (6) record management, (7) data management, and (8) site closeout. A total of 58 indicators were identified with at least one indicator for each trial process. Limitations Some trial activities require further consideration, that is, in the case of vulnerable participants (children, pregnant women). Proposed indicators are the result of expert consensus and reflect their experience in the HIV field. Relevance to existing trials and extrapolation to other fields must be assessed. Conclusions This innovative program allowed ANRS sites located in RLCs to share their GCP implementation experiences in order to build a list of relevant indicators for clinical trials. The next step is to collect data from ongoing HIV and hepatitis C trials in these settings and will assess the relevance of these indicators to document current quality of performance among trials in resource-limited settings.

Introduction. Voluntary HIV counselling and testing (VCT) is a key element of treatment and is essential for prevention of vertical HIV transmission. Little information is available on the uptake of VCT in Burkina Faso. This study aims to assess the prevalence of VCT in urban Burkina Faso, where the epidemic is still highly concentrated. Methods. We conducted a two-stage clustered population-based survey among 1,694 subjects living in Ouagadougou, Burkina Faso. After informed consent was obtained, a behavioural questionnaire was administered to participants. Results. Overall, 10.2% of individuals had used VCT, while 9% were women. Among women who had a child after the launch of the programme to prevent mother-to-child transmission (PMTCT), only 10.4% have been tested for HIV. Almost all participants (99.3%) were aware of HIV/AIDS, and 65% knew the main methods of prevention. In multivariate analysis, older age and being married and better educated were independent factors associated with VCT. Conclusions. Despite high public knowledge and awareness about HIV, VCT uptake was still very low and PMTCT coverage was poor. New strategies are required to increase VCT uptake in urban areas, in particular among the youngest age., info:eu-repo/semantics/published

Herpes simplex virus type 2 (HSV-2) infection enhances human immunodeficiency virus (HIV) susceptibility and may increase sexual transmission, but few data on HSV-2 prevalence are available from West Africa. The main objective of this study was to describe the prevalence and determinants of HSV-2 among adults in urban and rural Burkina Faso.We conducted (i) a 2-stage clustered population-based survey among adults aged 15 to 49 years in Ouagadougou (N = 883 women and 791 men), the capital city of Burkina Faso, and (ii) a cross-sectional study among attendees (N = 2018) of all 98 antenatal clinics from 4 provinces of the country. HSV-2 infection was diagnosed using a specific IgG2 enzyme-linked immunosorbent assay test (Kalon).The prevalence of HSV-2 among pregnant women was 18.0% (95% confidence interval (CI): 16.3%-19.7%), with a trend for lower rates in rural (17.3%; CI: 15.5%-19.2%) versus semiurban areas (21.4%; CI: 17.2%-26.2%) (P = 0.08), whereas the prevalence of HSV-2 was 23.7% (CI: 20.9%-26.6%) among women in Ouagadougou (N = 883), and 15.3% (CI: 12.9%-18.0%) among men (N = 791). Using multivariable logistic regression analysis among women, older age, being married, contraceptives, bacterial vaginosis (BV), and HIV infection were significantly associated with HSV-2 infection. Among men, only increased age and HIV were independently associated with HSV-2.The prevalence of HSV-2 infection was high among young women, including in rural areas, with a strong association with BV. Therefore, rural areas should not be neglected in prevention programs. New potent BV, hormonal contraceptives, and HSV control strategies may be helpful for HIV control.

International audience; Abstract: Background: Little information is available on the epidemiology of syphilis in West Africa, where this infection is routinely screened in antenatal clinics to prevent congenital infection. In order to inform control programmes, we estimated the burden of active syphilis among pregnant women and adults in Burkina Faso. Methods: This study enrolled 2136 pregnant women from 98 health care facilities and 1679 consenting women and men from the general population of Ouagadougou, the capital city. After a face-to-face interview on demographic characteristics, blood samples were collected and tested for syphilis. Active syphilis was defined by a dually positive result on RPR and TPHA tests. Results: The overall seroprevalence of active syphilis was 1.7% (95% confidence interval (CI)=1.3-2.2), with similar rates between women (1.2%, CI=0.7-2.3) and men (1.8%, CI=1.0-3.0) in Ouagadougou, and a trend for higher prevalence among pregnant women from semi-urban areas (2.2%, CI=1.0-4.5) compared with rural areas (1.7%, CI=1.2-2.4, p=0.06). The prevalence tended to be higher among women aged 20-24 (2.6%, CI=1.3-7.6) and men aged 30-34 (3.9%, CI=0.8-11.0) than at other ages. However, age, marital status, location and education were not associated with syphilis. Conclusion: The low prevalence of syphilis among pregnant women and the adult general population is very encouraging but should not challenge the amount of resources dedicated to STI and HIV prevention. Key words: Syphilis, urban, rural, prevalence, Burkina Faso