Mesure de l’efficacité et de l’observance du traitement antirétroviral chez des patients infectés par le VIH au Cameroun

Objective

The aim of the study was to identify the most useful clinical criteria to measure effectiveness and adherence to antiretroviral treatment in a rural area of Cameroon.

Patients and method

All patients under antiretroviral therapy followed for at least 3 months at the Tokombéré UPEC hospital were eligible. Therapeutic failure was defined according to clinical criteria including weight, Karnofsky's index, or occurrence of WHO stage IV conditions. The criteria for drug adherence were based on patient statement (drugs taken over the last 4 days) and pharmacy-controlled drug delivery. Patient sociodemographic characteristics were collected via a questionnaire.

Results

Fifty-six patients were included, most of whom were at AIDS stage on treatment initiation. The mean duration of antiretroviral therapy was 1 year. 21, 10, and 19% of patients were in therapeutic failure according to “weight”, “Karnofsky's index”, and “WHO stage IV”, respectively. Non-adherence was reported in 5% of patients according to the declarative method and 20% according to pharmacy controlled drug delivery. Weight modification during treatment was significantly correlated with the evolution of Karnofsky's index (p = 0.03). A significant correlation between therapeutic failure and non-observance was only found when using the weight criterion and the declarative method (p = 0.004).

Conclusion

The effectiveness and adherence to antiretroviral therapy can be evaluated by simple clinical criteria. Using these criteria can be recommended in rural areas until access to biological follow-up becomes available in developing countries.     

Méthode d’évaluation des pratiques professionnelles (EPP) au cours de l’antibiothérapie des pneumopathies aiguës communautaires

Introduction

Methods used for the assessment of professional practices must be dependable and reproducible. The aim of this study was to assess a method used in our hospital to assess antibiotic therapy for acute community-acquired pneumonia (CAP).

Method

In this study, a pharmacist and two infectious disease specialists retrospectively and independently evaluated the compliance to local antibiotic guidelines for 124 patients. The assessment tool was a Medical Appropriateness Index (MAI) (nine items). The kappa agreement index (K) among experts was calculated.

Results

The agreement among experts was poor for the initial antibiotic treatment (K = 0.16) and route of administration (K = 0.14), low for the duration of treatment (K = 0.34), and null for the dose and adjustment to 72 hours.

Conclusion

Differences between experts can be explained by the complexity of medical records, the number of items assessed, the complexity of the MAI, but also by the specialization and experience of experts. Thus, the assessment of CAP antibiotic therapy requires the use of appropriate methods targeting reliable criteria.     

L’hôpital de jour du CHU de Bobo Dioulasso : une structure de référence pour la prise en charge des patients infectés par le VIH au Burkina Faso

Objective

The goal of the study was to assess the activity of a multidisciplinary structure for HIV infected patients, two years after the opening of the day hospital.

Design

A retrospective observational study of the Bobo Dioulasso day-hospital was made using the ESOPE^® (Epiconcept, France) software.

Results

In 2002, 147 patients were followed in the Bobo Dioulasso university hospital, 27 (or 18.5 %) of whom were treated with antiretrovirals. Between 2005, opening of the day-hospital, and 2007, the total number of patients increased by 20 %. The number of patients on antiretrovirals rose from 47 to 70 % in the same time. The rate of patients with waved antiretroviral costs rose from 6 to 53 %. Three hundred and eighty-six patients died between 2002 and 2007. 1450 patients were lost to follow-up between 20002 and 2007.

Conclusions

Two years after its opening, the Bobo Dioulasso day-hospital manages one of the largest HIV cohort in sub-Saharan Africa and has become a reference structure in Burkina Faso. The analysis of this cohort was an opportunity to identify issues concerning HIV patient treatment in 2009.     

Déploiement d’un laboratoire mobile de biologie moléculaire face au défi A(H1N1) à Kaboul

Since October 2009, the fear of swine flu spread in Afghanistan and severe cases were observed among NATO soldiers. Two patients were hospitalized in an Intensive Care Unit. To face this new challenge, the French Health Service decided the deployment of a mobile RT-PCR laboratory molecular biology in the Kabul International Military Hospital. We describe the implementation of the mobile RT-PCR laboratory for the diagnosis of A(H1N1). The analysis of the first nasopharyngeal samples confirmed the presence of this virus in Afghanistan. The peak of positive cases was observed in mid-November 2009, and some cluster cases were observed among units deployed on the field.