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Collection : Collection Points de repères, Contient une table des matières, Avec mode texte

Collection : Collection Points de repères, Contient une table des matières, Avec mode texte

Introduction The universal test‐and‐treat (UTT) strategy aims to maximize population viral suppression (PVS), that is, the proportion of all people living with HIV (PLHIV) on antiretroviral treatment (ART) and virally suppressed, with the goal of reducing HIV transmission at the population level. This article explores the extent to which temporal changes in PVS explain the observed lack of association between universal treatment and cumulative HIV incidence seen in the ANRS 12249 TasP trial conducted in rural South Africa. Methods The TasP cluster‐randomized trial (2012 to 2016) implemented six‐monthly repeat home‐based HIV counselling and testing (RHBCT) and referral of PLHIV to local HIV clinics in 2 × 11 clusters opened sequentially. ART was initiated according to national guidelines in control clusters and regardless of CD4 count in intervention clusters. We measured residency status, HIV status, and HIV care status for each participant on a daily basis. PVS was computed per cluster among all resident PLHIV (≥16, including those not in care) at cluster opening and daily thereafter. We used a mixed linear model to explore time patterns in PVS, adjusting for sociodemographic changes at the cluster level. Results 8563 PLHIV were followed. During the course of the trial, PVS increased significantly in both arms (23.5% to 46.2% in intervention, +22.8, p < 0.001; 26.0% to 44.6% in control, +18.6, p < 0.001). That increase was similar in both arms (p = 0.514). In the final adjusted model, PVS increase was most associated with increased RHBCT and the implementation of local trial clinics (measured by time since cluster opening). Contextual changes (measured by calendar time) also contributed slightly. The effect of universal ART (trial arm) was positive but limited. Conclusions PVS was improved significantly but similarly in both trial arms, explaining partly the null effect observed in terms of cumulative HIV incidence between arms. The PVS gains due to changes in ART‐

En 1994, une enquête par questionnaire postal a été conduite auprès d’échantillons de médecins (N = 742), de soignants (N = 3 696) et de directeurs (N = 469) exerçant dans des services pour personnes âgées des hôpitaux publics. L’étude portait sur les carrières, les conditions et les relations de travail, les attentes, les besoins de formation.Les conditions de travail des soignants, notamment la gestion du temps et des horaires de travail et l’organisation interne des équipes, apparaissent sous un jour beaucoup moins défavorable que ce qui est souvent avancé. Néanmoins, l’articulation entre l’équipe paramédicale et les médecins semble insuffisante et conduit à une organisation cloisonnée qui peut porter préjudice à la qualité des prises en charge.La nécessité de placer la personne âgée au centre de l’organisation des services et du travail se dégage comme un objectif consensuel des diverses catégories interrogées. Les manques de personnel sont vus comme portant non sur les soins de base et les soins techniques mais sur l’écoute, la relation, le soutien et la distraction des personnes âgées qui relèveraient de professions encore très peu représentées parmi le personnel des services de gériatrie.Tous les groupes interrogés formulent des attentes très fortes de formation aux dimensions psychologiques de la prise en charge et aux soins palliatifs. Malgré la richesse de leur activité professionnelle, chaque catégorie souffre d’un manque de reconnaissance dans le milieu hospitalier., In 1994 a survey was carried out by means of a questionnaire sent through the post to doctors (N=742), nursing staff (N=3,696) and directors (N=469) working in geriatric wards in public hospitals. The study covered careers, working conditions, working relations, expectations, and training needs.Working conditions of nursing staff, especially management of time and working hours as well as internal team organisation appeared in a far more favourable light than usually presented. Nevertheless coordination between paramedical teams and doctors appeared as insufficient and led to a compartmentalization which seems detrimental to the quality of care.There was a consensus accross professional groups that the main aim was for elderly patients to be the focus point in the organising of the various activities and of the tasks to be carried out. Lack of personnel was considered to be detrimental to awareness, contact, support and entertainment of elderly patients rather than to basic and technical treatment. Such qualified staff are still few and far between in geriatric wards.All the groups have high expectations regarding psychological training and palliative care training when taking on patients. Despite having a fulfilling professional activity each group suffered from a lack of recognition within the hospital context.

Background. New drug use patterns may increase the risk of human immunodeficiency virus and hepatitis infections. In France, new injection patterns among youths with diverse social backgrounds have emerged, which may explain the persistently high rates of hepatitis C virus infection. This study explores factors associated with injection risk behaviours at first injection among users who began injecting in the post-2000 era. Methods. A cross-sectional study was conducted on the Internet from October 2010 to March 2011, through an online questionnaire. Multivariate logistic regression identified the independent correlates of needle sharing and equipment (cooker/cotton filter) sharing. Results. Among the 262 respondents (mean age 25 years), 65% were male. Both risk behaviours were positively associated with initiation before 18 years of age (aOR 3.7 CI 95% 1.3–10.6 and aOR 3.0 CI 95% 1.3–7.0) and being injected by another person (aOR 3.1 CI 95% 1.0–9.9 and aOR 3.0 CI 95% 1.3–7.1). Initiation at a party was an independent correlate of equipment sharing (aOR 2.6 95% CI 1.0–6.8). Conclusions. Results suggest a need for innovative harm reduction programmes targeting a variety of settings and populations, including youths and diverse party scenes. Education of current injectors to protect both themselves and those they might initiate into injection is critically important.

Background: Monitoring of emerging modes of drug consumption in France has identified new patterns of injection among youths with diverse social backgrounds, which may explain the persistence of high rates of hepatitis C virus infection. The circumstances surrounding the first injection have been poorly documented in the group of heavy drug users and in the context of the French opioid substitution treatment (OST) policy that provides expanded access to high-dosage buprenorphine (BHD). Methods: An Internet survey (Priminject) was conducted from October 2010 to March 2011 with French drug users. Four time periods were compared based on critical dates throughout the implementation of the Harm Reduction Policy in France. Results: Compared with drug users who injected for the first time prior to 1995, the aspects of drug use for users who recently injected for the first time were as follows: (1) experimentation with miscellaneous drugs before the first injection; (2) an older age at the time of first injection; (3) heroin as the drug of choice for an individual’s first injection, notwithstanding the increased usage of stimulant drugs; (4) BHD did not appear to be a pathway to injection; and (5) an increased number of users who injected their first time alone, without the help or presence of another individual. Conclusion: The PrimInject study showed that there is a group of injection drug users that is larger than the group of injection drug users observed in previous studies; therefore, it is necessary to diversify programs to reach the entire spectrum of high-risk users.

Les équipes mobiles de soins palliatifs sont des nouvelles structures chargées d’aider par des conseils les médecins et les infirmières des services hospitaliers dans leur travail auprès des personnes en fin de vie. A partir de l’observation d’une telle équipe, cet article* s’attache à décrire son éthique quotidienne, une éthique dont l’axe principal est la sollicitude. Celle-ci se décline sur deux modes : comme pratique quotidienne et comme ressource discursive. En effet, d’une part, la sollicitude est, pour l’équipe mobile, une valeur emblématique qui s’exprime par des pratiques. D’autre part, l’équipe ayant deux objectifs de travail parfois incompatibles (aider les services et soulager les malades), ses membres peuvent se trouver devant des dilemmes moraux. Dans ce cas, la sollicitude apparaît non plus comme une pratique clinique mais comme une ressource discursive, lors de réunions d’équipe souvent animées., DAILY ETHICS OF A HOSPITAL PALLIATIVE CARE MOBILE UNIT. Mobile palliative care units are new structures set up to advise hospital doctors and nurses in the course of their work with patients at the end of life. The article is based on the observations of such a unit and sets out to describe its daily ethics which mainly revolve around solicitude. This solicitude is twofold: both in daily practice and in as a basic source of reflection. For a mobile unit, solicitude is an emblem which their practice expresses. However, the unit staff have working aims which are sometimes incompatible (to help staff as well as to relieve patients), and they are then faced with a moral dilemma. In such cases, solicitude no longer appears as a clinical practice but as a basic source of relection during unit meetings which are often lively.