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Follow-up Order for Women in the Process of Proceeding with Antiretroviral Treatment at the CHU de Brazzaville: Prevalence and Associated Factors

Ossibi Ibara BR*, Bintsene Mpika Gickelle, Adoua Doukaga T, Bouambo G, Potokoué Mpia NSB, Balekouzou A, Ekat M, Angonga Pabota E, Bendet P, Itoua C, Iloki H

Faculty of Health Sciences, Marien Ngouabi University, Brazzaville, Congo

Abstract: Objective. Determine the prevalence of follow-up stops at women in order to stay at the CHU of Brazzaville and identify the associated factors. Patients and method. Transversal study, with a descriptive and analytical view of spatients immunodepressed by the VIH, having stopped the follow-up for at least one month in the Brazzaville CHU Infectious Diseases Service during the January 2019 period in June 2021. Results: A total of 110 patients were admitted (25.9%) with an average age of 33.2 ± 9.1 years, single women (51.8%), students (n = 29; 26.4%), Nullipares (n = 82; 29.1%), having a maternity leave ((n = 41; 37.8%). They had several sexual partners (n = 43; 39.1%) and were infected by VIH1 (98, 2%). The prolonged fever (n = 42; 38.2%) and chronic diarrhea (n = 22; 20%) were the main reasons for consultation. They were classified OMS 3 (n = 54; 49.1 %) and had as opportunistic infections tuberculosis (n = 41; 37.3%) and toxoplasmosis (n = 25; 22.7%). The CD4 was <200 / mm3 (n = 52; 53.6%) and the VIH was discovery in hospitalization (n = 59; 53.6%). The TARV was made of TDF + FTC + EFV (n = 51; 46.4%) and DTG + 3TC + TDF (n = 7; 6.4%). Secondary effects were cauchemars (n = 66; 60%), diarrhea (55, 43,6) and factors associated with treatment arrest were distance dispensation ARV domicile> 5 km (p = 0.04), the stage of the OMS3 (p = 0.02), the troubles of sommeil (p = 0, 001). Conclusion: Prevalence of follow-up stops among women in the process of proceeding with antiretroviral treatment is relatively high and this, in line with several factors in particular, the toxicity of antiretroviral molecules, the elimination of the drug dispensing site and also the advanced immunosuppression with its correlation of opportunistic infections in particular tuberculosis.

Keywords: follow-up arrest, women in procrastination age, prevalence, associated factors, Brazzaville

Received March 08, 2022; Revised April 11, 2022; Accepted April 18, 2022

Citation: Ossibi Ibara BR, Bintsene Mpika Gickelle, Adoua Doukaga T, Bouambo G, Potokoué Mpia NSB, Balekouzou A, Ekat M, Angonga Pabota E, Bendet P, Itoua C, Iloki H, Follow-up Order for Women in the Process of Proceeding with Antiretroviral Treatment at the CHU de Brazzaville: Prevalence and Associated Factors. American Journal of Infectious Diseases and Microbiology, 10 (2). 83-87. January 2022. doi:10.12691/ajidm-10-2-4

1. Introduction

According to the OMS, we are known in the world, Nearly 14 million women infected with VIH of which the age varies between 15 and 49 years, which has to correlate the rate of transmission of the VIH at children under 15 years of age in sub-Saharan Africa [1]. In Senegal, the hospital frequency women in procrastination infected by the VIH in 2008 was 85% and this in line with the socio-cultural and economic factors own to this population category [2]. In the Congo, few have studied the problem of VIH infection at the woman in the process of procrastination reflects on the situation in the pediatric environment of where interest in this work which had for objective general the determination of the prevalence of infection in VIH at the young woman in the process of procrastination in the CHU of Brazzaville and the identification of various associated factors.

2. Patients and Method

It is a transversal study, with a descriptive and analytical view of women's medical records in the process of finding infected by the VIH which is the type to receive is an antiretroviral treatment, part of the active file of living people with the VIH of the Infectious Diseases Service at the CHU of Brazzaville during the period of the January 1, 2019 to June 30, 2021 is a period of 30 months. The advicentement libre en éclairé et été obtenu chez to all the patients who would have liked to have stopped the TARV for a while at least 4 weeks. The epidemiological, clinical, diagnostic, therapeutic and evolutionary variables have been studied.

The data were collected on the basis of a pre-developed survey sheet, and analyzed using EPI software. Info 3.3.1 with the determination of qualitative and quantitative variables from statistical tests according to their applicability criteria. For all tests, the significance level was set at <0.05.

2.1. Operational Definition

Female in procrastination age: any woman whose age ranges from 15 to 49 years.

Follow-up stop: woman having voluntarily stopped the TARV for at least 4 weeks

2.2. Abbreviations

TARV: antiretroviral treatment

FAP: Woman of childbearing age.

3. Results

Out of a total of 110 patients were admitted (25.9% of admissions) with an average age of 33.2 ± 9.1 years, celibates (51.8%),free union (n = 20; 18.2%), students / students (n = 29; 26.4%), Nulliparous (n = 82; 29.1%), having a maternity leave (n = 41; 37.8%).One child died (n = 21; 65.6%). They reside in town (n = 67; 60.9%) and had multiple sexual partners (n = 43; 39.1%) then infected by VIH1 (98.2%).There was a lack of knowledge about the VIH (n = 38; 34.5%).Prolonged fever (n = 42; 38.2%) and chronic diarrhea (n = 22; 20%) were the main reasons for consultation. They were ranked OMS 3 (n = 54; 49.1%) and were asopportunistic infections with tuberculosis (n = 41; 37.3%) and toxoplasmosis (n = 25; 22.7%) and cryptococcosis (n = 17; 15.5%). Two opportunistic infections were associated with 36 cases (32.7%). The CD4 was <200 / mm3 (n = 52; 53.6%) and the VIH was found in hospitalization (n = 59; 53.6%) and when a health balance (n = 28; 25.5%). The TARV was made of TDF + FTC + EFV (n = 51; 46.4%) and DTG + 3TC + TDF (n = 7; 6.4%).Women find complex treatment in 81 cases (73.6%).Secondary effects principals were Nightmares (n = 66; 60%), diarrhea (55, 43,6) and the factors associated with the arrest of treatment was the distance dispensation ARV domicile> 5 km (p = 0.04), the stage of the OMS 3 (p = 0.02), the sleep disorders (p = 0, 001).

Table 1. Different aspects related to taking charge

Figure 1. Matrimonial situation of the FAP loss of sight

Table 2. Factors associated with the FAP follow-up arrest under TARV

4. Discussion

The study presents some biases in relation to its retrospective nature on the reliability and validity of information collected in the past, and the absence of a comparative group. However, this study helped to lift the veil on the current situation of therapeutic arrests of women in the process of procuring in the service of infectious diseases of the CHU of Brazzaville.

The prevalence of follow-up arrests among women in the age of procrastination is elevated and this, in line with the infection of VIH infection in our regions. It is relatively higher than the one found in Senegal and along the coast by Sondo Ouédraogo and Soro respectively [2,3]. Decentralized personnel management strategiesnnes living with the VIH already effective in Africa of the West, justifies in part these differences observed. The most represented age group was the same between 30 and 39 years old. This result is similar to the one obtained in Senegal and Guyane française [2,4]. They are always a sexually active population category as notified in the literature. Nearly half of the cases, the women had a secondary education level and were students in 26,4% of cases. It would appear that the level of instruction influences the follow-up to compliance with VIH infection [5]. More of the women of the age to procure infected by the VIH were of men. It's a categoryie population with a low economic level, as well as vulnerable women vis-à-vis job seekers and external pressures on sexuality. These data are in conformity with those published by UNU-Sida in its annual report of 2019 [1]. The improvement of living conditions and especially the budget of the household in Africa and in particular in the Congo could minimize the rate of contamination in this population category. At the moment of the knowledge of their status as sero Logically, women in procrastination age did not have children in 29.1% of cases. Some among them, declare to have the desire to proceed in more than half of the cases (63%). The lack of infants at the time of VIH infection diagnosis is a fact as having a negative influence on the psychological component of these young women in the process of procuring the need for support in this category of population [1,6]. A study conducted in Abidjan informant on the VIH and choice of procreation, allowed to observe a voluntary reduction of the condition of individuals who were infected by the VIH, to avoid giving birth to a child who may be infected, or who may be find orphan in a few years later [7]. Women in the process of procreation have a level of knowledge on the VIH bad in 34.5% of cases. These levels of knowledge are similar to those found in the same service by Ossibi Ibara and collaborators [8]. Returning consultation deadlines in the present study are classics in the African environment [9]. In fact, the cultural considerations of the disease at VIH-Sida modify the itinerary of taking care of infected patients who consult traditionally before resorting to a health structure. The late recourse to justifiable care structures criticizes the state of alteration of the general state of patients in admission to a Long-term fever and diarrhea as notified in the literature. Pulmonary tuberculosis, cerebral toxoplasmosis, as well as neuromenovar cryptococcosis have been the main opportunistic infections found in women as they progress through TARV. These opportunistic infections that classify Sida are the reflection of late, classic consultations in our regions. Tuberculosis is causing the first-ever infection in the Brazzaville CHU Infectious Diseases Service notified by Ossibi Ibara and collaborators [10]. In a non-negligible proportion (33% of cases) it was found in patients with two associated opportunistic infections and three in 21% of cases. These associations are the reflection of an immunodeficiency advanced online with late consultations notified in Côte d'Ivoire and Senegal [3,9].

The type 1 VIH was the most frequently found pathogen (98.2%) among women in procrastination age and this in relation to the data found in the literature and published by the UNU-Sida [1]. The mean time of diagnosis of VIH infection was long. In addition to patient mortality, VIH infection diagnosis was found in hospitalization (53.6%), in an advanced immunodeficiency context and in 25.5% of cases on the occasion of a balance of health. These data are in disagreement with the new strategies of the UN-Sida which would have meant that 90% of people with a positive attitude knew their serological status in order to be treated quickly [1].

The average CD4 counts were low and in 53.6% of cases the number of CD4 cells <to 200 was found. The viral charge was not available in the quasi-totality of the patients. When it was realized, it retrieved the average numbers of 302933 copies / ml, evidence of an intense replication of the virus in the organism.

The average time to initiate antiretroviral treatment after the VIH infection diagnosis at the woman in age to progress long term. This length of time is similar to that observed in most African series [3,8,9]. Several factors justify this therapeutic delay. In effect, the majority of patients are diagnosed at the advanced stage of immunodeficiency with their corollary, the appearance of opportunistic infections of which most are pathologies of immune restoration such as tuberculosis and cryptococcosis [11]. It is recommended in the current strategy of UNU-SIDA, on the global takeover of people living with the VIH, to scan and treat these quickly patients all in favor of the opportunistic infection. The general and nutritional status of certain patients also constitutes a barrier to the implementation of antiretroviral treatment. Aussi, while consent to treatment is not freely obtained from the patient, it is difficult to start a treatment of a chronic disease whose observance is the only gage of success. All these difficulties are reported in the literature [8,9,10]. When they were treated, the most patients receive the association Ténofovir, Emtricitabine and Efavirenz in combined form in 46.4% of cases, follow-up of those associating zidovudine, Lamuvidine and Nevirapine in 40.9% of cases. The new guidelines of the World Organization for Health, adapted in each country by the national programs of the fight against Sida, position the inhibitors of integration (in association with other molecules) in the first intention, in particular the dolotegravir to the dose of 50 mg in the absence of tuberculosis and double dose if necessary. This new molecule has just been incorporated into the guidelines of the National Fighting Program against the Side of the Congo as recommended by the OSS justifying the fact that, in only 6.4%, women of all ages have access to this molecule [12,13]. In 74% of cases, the FAP assesses the TARV complex and compares it with catch schedules (52.7%), the undesirable effects (68.2%).Summer troubles (58%) and nightmares (60%) were cited as uncontrollable constraints and secondary effects. It is judicial to take into account all these effects in the prescription of TARV or at least to treat patients before the start of treatment as recommended by the WHO [1].

The average duration of hospitalization was long. Evolution has been unfavorable in the vast majority of cases. We recorded a loss of weight or a therapeutic arrest in 67.3% of cases. Several factors have been linked to the therapeutic arrest. While the distance separating the home from the provision of antiretroviral molecules exceeded 6 km, there was a significant (p = 0.004) possibility of stopping the TARV. In Africa, several authors had been notified as predictive factors of status during treatment antiretroviral, the separation distance domicile - CDT> 6 km, the advanced immunodeficiency and the bad level of knowledge of the disease [8,13,14,15,16,17]. It is imperative to decentralize the charge of PvVIH through the creation of ARV support and dispensation centers in health care districts and trainings in order to minimize the risk of treatment stoppage. The current strategies of the World Health Organization require what antiretroviral treatment to prescribe for the first time in a naïve patient is well tolerated, easily administered, reduced to number of compressed, preferably at a fixed dose of where the position of the dultégravir with primary intention in replacing the effavirenz [1,13,18]. It is urgent that the national fight program against the Sida continue to strengthen the plea for the position of the Dolutégravir with the first intention in the antiretroviral treatment at the youth and adults.

5. Conclusion

The prevalence of follow-up arrests in women in the process of proceeding with antiretroviral treatment is relatively high and this, in line with several factors in particular, the toxicity of antiretroviral molecules, the elimination of the drug dispensation site and also the increase with its corollary the appearance of opportunistic infections especially the toxoplasmosis. It is important to evaluate the global charge of VIH infection in this population category in the measure where, moreover, the women infected by VIH express the desire to found a family and to have children saved from VIH.

Conflict of Interest

The authors do not signal a conflict of interest in link with the present study.

References

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