Evaluation of near point‐of‐care viral load implementation in public health facilities across seven countries in sub‐Saharan Africa

IntroductionIn many low‐ and middle‐income countries, HIV viral load (VL) testing occurs at centralized laboratories and time‐to‐result‐delivery is lengthy, preventing timely monitoring of HIV treatment adherence. Near point‐of‐care (POC) devices, which are placed within health facility laboratories rather than clinics themselves (i.e. “true” POC), can offer VL in conjunction with centralized laboratories to expedite clinical decision making and improve outcomes, especially for patients at high risk of treatment failure. We assessed impacts of near‐POC VL testing on result receipt and clinical action in public sector programmes in Cameroon, Democratic Republic of Congo, Kenya, Malawi, Senegal, Tanzania and Zimbabwe.MethodsRoutine health data were collected retrospectively after introducing near‐POC VL testing at 57 public sector health facilities (2017 to 2019, country‐dependent). Where possible, key indicators were compared to data from patients receiving centralized laboratory testing using hazard ratios and the Somers’ D test.ResultsData were collected from 6795 tests conducted on near‐POC and 17614 tests on centralized laboratory‐based platforms. Thirty‐one percent (2062/6694) of near‐POC tests were conducted for high‐risk populations: pregnant and breastfeeding women, children and those with suspected failure. Compared to conventional testing, near‐POC improved the median time from sample collection to return of results to patient [six vs. sixty‐eight days, effect size: −32.2%; 95% CI: −41.0% to −23.4%] and to clinical action for individuals with an elevated HIV VL [three vs. fourty‐nine days, effect size: −35.4%; 95% CI: −46.0% to −24.8%]. Near‐POC VL results were two times more likely to be returned to the patient within 90 days compared to centralized tests [50% (1781/3594) vs. 27% (4172/15271); aHR: 2.22, 95% CI: 2.05 to 2.39]. Thirty‐seven percent (340/925) of patients with an elevated near‐POC HIV VL result had documented clinical follow‐up actions within 30 days compared to 7% (167/2276) for centralized testing.ConclusionsNear‐POC VL testing enabled rapid test result delivery for high‐risk populations and led to significant improvements in the timeliness of patient result receipt compared to centralized testing. While there was some improvement in time‐to‐clinical action with near‐POC VL testing, major gaps remained. Strengthening of systems supporting the utilization of results for patient management are needed to truly capitalize on the benefits of decentralized testing.     

Aspects cliniques et pronostiques des cancers du sein triple négatifs à l’unité de sénologie du CHU Le-Dantec de Dakar

Objectives

To determine the epidemiological and clinical characteristics, prognosis, and therapeutic modalities of triple negative breast cancer.

Patients and methods

It is a retrospective observational study of all cases of breast cancer with hormone receptors and HER-2 negative followed between April 2009 and March 2012. The following were studied: the sociodemographic characteristics of patients, the diagnostic features of triple negative breast cancer, and therapeutic modalities and outcome of followed cases. Data were entered and analyzed using SPSS software, version 19.0.

Results

Twenty-two patients were included. The rate was 33.8% of all breast cancers and 5.7% of breast pathologies recorded during the study period. The average age of patients was 45.4 years. The majority (63.6%) had less than 50 years. A proportion of 59.1% were premenopausal. The mean gravidity was 4 and mean parity 3.6. The mean delay for consultation was 11.1 months. The discovery of a breast mass was the reason for consultation in almost all cases (95.5%). Cancer was locally advanced in 86.3% of cases. Axillary lymph node involvement was present in 68.1% of patients. In 27.3% of cases, there were already secondary locations at the time of diagnosis. Infiltrating ductal carcinoma accounted for 86.4% of histological types. We found 68.2% of grade 3 tumors. In 59% of patients, the initial treatment was neoadjuvant chemotherapy. A clinical response was obtained in 61% of cases. Surgery in all cases was a mastectomy according to Patey-modified technique followed by axillary dissection. Three patients received radiotherapy. The mean time to recurrence was 16.9 months. This recurrence was observed in 27% of cases. The median overall survival was 25 months (from 21.1 to 28.8, CI 95%), and the median survival for metastatic patients was 16.5 months. The survival rate at 5 years was 41%.

Conclusion

This series shows a high frequency of triple negative breast cancer. These tumors are very aggressive with a very poor prognosis. In view of these results, collaboration with research teams in developed countries is needed to better identify triple negative breast cancer in Africa to improve prognosis.     

Creation of a therapeutic digestive endoscopy suite in Senegal: renovation, training and university certification. Results of a Belgian-Senegalese inter-university project

Therapeutic digestive endoscopy did not exist in sub-Saharan Africa before 2005. However, the prevalence of digestive diseases that could potentially benefit from basic endoscopic treatment is very high in this region. Portal hypertension with variceal bleeding and severe dysphagia associated with benign or malignant upper gastrointestinal tract diseases are prominent in these countries. The aim of the Project described in this report was to create a digestive endoscopy facility in Dakar (Senegal, West Africa), that would also provide local training in therapeutic endoscopy to doctors and nurses and facilitate regional autonomy with the opening of a University Certification in Gastroenterology. It took about 10 years to achieve these targets - 5 years to prepare realistic aims that took into account local needs, available local resources, and funding, and 4 years for the Project itself (2005-2009). At the present time, Senegalese colleagues and nurses are autonomous for basic therapeutic procedures in the upper and lower gastrointestinal tract. Two years after the end of funding, the rate of therapeutic activity has increased from 0% in 2005 to 12 % of digestive endoscopic activity in 2011. Key points of success were preparation, confidence of medical personnel, university involvement, shared funding, local multidisciplinary training, and facilitation of autonomy. Belgian healthcare workers were present on-site in Dakar for a total of about 6 months over the 4-year Project period, with an annual budget of less than € 80000. The Project has enabled an efficient North-South collaboration with a minimal budget, which has changed the healthcare provision of digestive endoscopy in Senegal, and has also provided autonomy, and facilitated the development of South-South cooperation.     

The kinetics of apical cicatrization. An experimental study apropos of 25 cases with radiologic imaging]

The conventional usage of endo-canalar antiseptic of Rockle's type (SEPTODONT Laboratory) and the application of a standard protocol during two seances have shown: a 68% successful rate of healing at six months post therapeutic follow up, the diameter decrease of radiological images of peri-apical lesions, more than 80% in relative value; for about 20 teeth drawned lots (in a prospective study). This reduction of 33% at least at the maxillary and 50% at the mandible may be a reliable indicator for an endodontic surgical decision or fixed prosthetic rehabilitation report since the third month (especially peri-apical lesions of more than five millimetres of diameter). The respect of the security apical-limit of the root canal filling is fundamental. The second Senegalese (Dakar) serial will permit us to evaluate the use of calcium hydroxide in mediate and prolonged canalar disinfection.     

Evaluation of staff performance and material resources for integrated schistosomiasis control in northern Senegal

BACKGROUND: A project to improve integrated control of schistosomiasis in the primary health care system of northern Senegal was implemented from February 1995 until September 1999, shortly after a Schistosoma mansoni outbreak. The activities included additional training of doctors and nurses in symptom-based treatment and making praziquantel (PZQ) available for an affordable price. OBJECTIVE: To investigate staff performance and the availability and costs of diagnostic materials and PZQ at the end of this intervention project. METHODS: We performed structured interviews with staff from 55 health care facilities in five districts. RESULTS: Respondents from 23 health care facilities reported both S. haematobium and S. mansoni in the coverage area, 32 reported only S. haematobium and three only S. mansoni. The average cost to patients for consultation, diagnosis, treatment and transportation to a referral health care facility was approximately 1.60 Euro. Fifty-seven per cent of the health care facilities with reported S. haematobium in the coverage area treated patients presenting with haematuria on symptoms; 56% of the health care facilities with reported S. mansoni in the coverage area treated patients presenting with blood in stool on symptoms. Thirteen per cent performed a diagnostic test for patients presenting with haematuria and 12% for patients presenting with blood in stool. The remainder, approximately one-third of the health care facilities, referred their patients to another facility for a diagnostic test. Implementation of symptom-based treatment in all health care facilities will reduce the total costs by 0.43 Euro (29%) for patients infected with S. haematobium and 0.78 Euro (46%) for patients infected with S. mansoni. Of the 53 health care facilities with schistosomiasis in their area, 37 had PZQ in stock of which 33 (88%) sold PZQ for the recommended retail price of 0.15 Euro per tablet (or 0.60 Euro per course of four tablets) or lower. CONCLUSION: Four years after the start of the intervention project, patients presenting with schistosomiasis related symptoms can generally expect proper diagnosis and treatment at all levels of the health care system in Northern Senegal, either at the initial visited health care facility or after referral. However, a further reduction of the total costs of treatment is still possible by a better implementation of symptom-based treatment and further reduction of the costs of PZQ.