Assessment of dietary diversity and nutritional support for children living with HIV in the IeDEA pediatric West African cohort: a non-comparative, feasibility study

Abstract Background Nutritional care is not optimally integrated into pediatric HIV care in sub-Saharan Africa. We assessed the 6-month effect of a nutritional support provided to children living with HIV, followed in a multicentric cohort in West Africa. Methods In 2014-2016, a nutritional intervention was carried out for children living with HIV, aged under 10 years, receiving antiretroviral therapy (ART) or not, in five HIV pediatric cohorts, in Benin, Togo and Côte d’Ivoire. Weight deficiency was assessed using two definitions: wasting (Weight for Height Z-score [WHZ] for children<5 years old or Body-Mass-Index for Age [BAZ] for ≥5 years) and underweight (Weight for Age Z-score [WAZ]) (WHO child growth standards). Combining these indicators, three categories of nutritional support were defined: 1/ children with severe malnutrition (WAZ and/or WHZ/BAZ <-3 Standard Deviations [SD]) were supported with Ready-To-Use Therapeutic Food (RUTF), 2/ those with moderate malnutrition (WAZ and/or WHZ/BAZ = [-3;-2[ SD) were supported with fortified blended flours produced locally in each country, 3/ those non malnourished (WAZ and WHZ/BAZ ≥-2 SD) received nutritional counselling only. Children were followed monthly over 6 months. Dietary Diversity Score (DDS) using a 24h recall was measured at the first and last visit of the intervention. Results Overall, 326 children were included, 48% were girls. At baseline, 66% were aged 5-10 years, 91% were on ART, and 17% were severely immunodeficient (CD4 <250 cells/mL or CD4%<15). Twenty-nine (9%) were severely malnourished, 63 (19%) moderately malnourished and 234 (72%) non-malnourished. After 6 months, 9/29 (31%) and 31/63 (48%) recovered from severe and moderate malnutrition respectively. The median DDS was 8 (IQR 7-9) in Côte d’Ivoire and Togo, 6 (IQR 6-7) in Benin. Mean DDS was 4.3/9 (sd 1.2) at first visit, with a lower score in Benin, but with no difference between first and last visit (p=0.907), nor by intervention groups (p-value=0.767). Conclusions This intervention had a limited effect on nutritional recovery and dietary diversity improvement. Questions remain on determining appropriate nutritional products, in terms of adherence, proper use for families and adequate energy needs coverage for children living with HIV. Trial registration PACTR202001816232398, June 01, 2020, retrospectively registered.

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Financial burdens of HIV and chronic disease on people living with HIV in Côte d’Ivoire: A cross-sectional out-of-pocket expenditure study

PLoS ONE ◽

10.1371/journal.pone.0255074 ◽

2021 ◽

Vol 16 (7) ◽

pp. e0255074

Author(s):

Rachel D. Stelmach ◽

Miriam Rabkin ◽

Kouame Abo ◽

Irma Ahoba ◽

Mahena Gildas Anago ◽

...

Keyword(s):

Cote D'ivoire ◽

Côte D’Ivoire ◽

Direct Costs ◽

User Fees ◽

Hiv Care ◽

People Living With Hiv ◽

Convenience Sample ◽

Cote D’Ivoire ◽

Côte D'ivoire ◽

Living With Hiv

Background Although people living with HIV in Côte d’Ivoire receive antiretroviral therapy (ART) at no cost, other out-of-pocket (OOP) spending related to health can still create a barrier to care. Methods A convenience sample of 400 adults living with HIV for at least 1 year in Côte d’Ivoire completed a survey on their health spending for HIV and chronic non-communicable diseases (NCDs). In addition to descriptive statistics, we performed simple linear regression analyses with bootstrapped 95% confidence intervals. Findings 365 participants (91%) reported OOP spending for HIV care, with a median of $16/year (IQR 5–48). 34% of participants reported direct costs with a median of $2/year (IQR 1–41). No participants reported user fees for HIV services. 87% of participants reported indirect costs, with a median of $17/year (IQR 7–41). 102 participants (26%) reported at least 1 NCD. Of these, 80 (78%) reported OOP spending for NCD care, with a median of $50/year (IQR 6–107). 76 participants (95%) with both HIV and NCDs reported direct costs, and 48% reported paying user fees for NCD services. Participants had missed a median of 2 HIV appointments in the past year (IQR 2–3). Higher OOP costs were not associated with the number of HIV appointments missed. 21% of participants reported spending over 10% of household income on HIV and/or NCD care. Discussion and conclusions Despite the availability of free ART, most participants reported OOP spending. OOP costs were much higher for participants with co-morbid NCDs.

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Discrimination of people living with hiv/aids: a survey with dentists in Abidjan, Côte d’Ivoire

European Journal of Public Health ◽

10.1093/eurpub/ckz185.044 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

J C Guinan ◽

G D Meless ◽

A D Sangaré ◽

V Danho-Da ◽

B S Kouassi ◽

...

Keyword(s):

Hiv Infection ◽

Continuing Education ◽

Cote D'ivoire ◽

Côte D’Ivoire ◽

Hiv Transmission ◽

People Living With Hiv ◽

Cote D’Ivoire ◽

Côte D'ivoire ◽

Living With Hiv ◽

Lack Of Knowledge

Abstract Background Despite several decades of fighting HIV infection, discrimination against people living with this infection persists, even among health professionals. Understanding the determinants of discriminatory attitudes of dentists is a first step towards access to oral health care and improved care for people living with HIV (PLHIV). Objectives To analyse the determinants of discriminatory attitudes towards people living with HIV among dentists in Côte d’Ivoire. Methods A cross-sectional survey was conducted among dentists in Abidjan in 2016. In addition to socio-professional characteristics, a questionnaire collected information on their knowledge about HIV (transmission, hiv-related oral diseases) and their individual perception (fear of being contaminated, cross-contamination...). The chi2 test for independent sampling was used to identify factors associated with discriminatory attitudes (threshold α = 5%). Results A total of 120 dentists were interviewed: 61.3% from the public sector; 56.7% men; 54.2% in couple; 53.3% had participated in continuing education on HIV; 29.2% did not know HIV-related diseases and transmission modes and 69.2% reported fear of being infected during care; 44.2% reported informing staff of the patient’s HIV status. The proportion of dentists with discriminatory attitudes was estimated at 69.2%. The main associated factors were: female gender (p = 0.001), living in couple (p = 0.000), lack of knowledge of the risk of HIV transmission after a blood exposure accident (p = 0.000), the law protecting people living with HIV in Côte d’Ivoire (p = 0.009) and fear of being infected (p = 0.000). Conclusions The results of this study show that the determinants of discriminatory attitudes among dentists result from their lack of knowledge of the disease, justifying the need to strengthen their continuing education on HIV/AIDS infection. Key messages Dentists discrimination towards people living with HIV infection result from their lack of knowledge about the infection. It’s essential to strengthen their knowledge about HIV in order to improve access to care for people living with HIV.

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