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BackgroundThe use of mobile technology in health care (mobile health [mHealth]) could be an innovative way to improve health care, especially for increasing retention in HIV care and adherence to treatment. However, there is a scarcity of studies on mHealth among people living with HIV (PLHIV) in West and Central Africa. ObjectiveThe aim of this study was to assess the acceptability of an mHealth intervention among PLHIV in three countries of West Africa. MethodsA cross-sectional study among PLHIV was conducted in 2017 in three francophone West African countries: Côte d’Ivoire, Burkina Faso, and Togo. PLHIV followed in the six preselected HIV treatment and care centers, completed a standardized questionnaire on mobile phone possession, acceptability of mobile phone for HIV care and treatment, preference of mobile phone services, and phone sharing. Descriptive statistics and logistic regression were used to describe variables and assess factors associated with mHealth acceptability. ResultsA total of 1131 PLHIV—643 from Côte d’Ivoire, 239 from Togo, and 249 from Burkina Faso—participated in the study. Median age was 44 years, and 76.1% were women (n=861). Almost all participants owned a mobile phone (n=1107, 97.9%), and 12.6% (n=140) shared phones with a third party. Acceptability of mHealth was 98.8%, with the majority indicating their preference for both phone calls and text messages. Factors associated with mHealth acceptability were having a primary school education or no education (adjusted odds ratio=7.15, 95% CI 5.05-10.12; P

: INTRODUCTION: To eliminate cervical cancer (CC), access to and quality of prevention and care services must be monitored, particularly for women living with HIV (WLHIV). We assessed implementation practices in HIV clinics across sub‐Saharan Africa (SSA) to identify gaps in the care cascade and used aggregated patient data to populate cascades for WLHIV attending HIV clinics. METHODS: Our facility‐based survey was administered between November 2020 and July 2021 in 30 HIV clinics across SSA that participate in the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium. We performed a qualitative site‐level assessment of CC prevention and care services and analysed data from routine care of WLHIV in SSA. RESULTS: Human papillomavirus (HPV) vaccination was offered in 33% of sites. Referral for CC diagnosis (42%) and treatment (70%) was common, but not free at about 50% of sites. Most sites had electronic health information systems (90%), but data to inform indicators to monitor global targets for CC elimination in WLHIV were not routinely collected in these sites. Data were collected routinely in only 36% of sites that offered HPV vaccination, 33% of sites that offered cervical screening and 20% of sites that offered pre‐cancer and CC treatment. CONCLUSIONS: Though CC prevention and care services have long been available in some HIV clinics across SSA, patient and programme monitoring need to be improved. Countries should consider leveraging their existing health information systems and use monitoring tools provided by the World Health Organization to improve CC prevention programmes and access, and to track their progress towards the goal of eliminating CC., INTRODUCTION The World Health Organization (WHO) seeks to eliminate cervical cancer (CC) within this century, and has defined the “90‐70‐90” targets it expects countries to reach by 2030: 90% of [...]

As human papillomavirus (HPV) immunisation and HPV‐based cervical cancer (CC) screening programmes expand across sub‐Saharan Africa, we investigated the potential impact of human immunodeficiency virus (HIV) status on high‐risk (HR)‐HPV distribution among women with CC in Côte d'Ivoire. From July 2018 to June 2020, paraffin‐embedded CC specimens diagnosed in Abidjan, Côte d'Ivoire were systematically collected and tested for HR‐HPV DNA. Type‐specific HR‐HPV prevalence was compared according to HIV status. Of the 170 CC specimens analysed (median age 52 years, interquartile range: [43.0‐60.0]), 43 (25.3%) were from women living with HIV (WLHIV) with a median CD4 count of 526 [373‐833] cells/mm3 and 86% were on antiretroviral therapy (ART). The overall HR‐HPV prevalence was 89.4% [95% CI: 84.7‐94.1]. All were single HR‐HPV infections with no differences according to HIV status (P =.8). Among HR‐HPV‐positive CC specimens, the most prevalent HR‐HPV types were HPV16 (57.2%), HPV18 (19.7%), HPV45 (8.6%) and HPV35 (4.6%), with no significant differences according to HIV status. Altogether, infection with HPV16/18 accounted for 71.1% [95% CI: 55.9‐86.2] of CC cases in WLHIV vs 78.9% [95% CI: 71.3‐86.5] in women without HIV (P =.3). The study confirms the major role of HPV16/18 in CC in Côte d'Ivoire and should support a regional scale‐up of HPV16/18 vaccination programmes regardless of HIV status. However, vaccines targeting additional HR‐HPV types, including HPV45 and HPV35, could further decrease future CC incidence in Côte d'Ivoire, both for WLHIV and women without HIV. [ABSTRACT FROM AUTHOR]

Objective: To assess the impact of HIV on access to invasive cervical cancer (ICC) care and overall survival (OS) in a time of universal access to antiretroviral therapy (ART). Methods: A cohort of women prospectively diagnosed with ICC was consecutively recruited from 2018 to 2020 in public/private cancer centers in Côte d'Ivoire. Follow‐up data were collected through facility‐ and phone‐based approaches. Logistic and Cox regression models allowed analysis of factors associated with access to cancer care and OS, respectively. Results: Overall, 294 women with ICC aged 50 years (interquartile range [IQR] 43–60) were enrolled, including 21.4% of women living with HIV (WLHIV), 87% being on ART. An advanced ICC clinical stage (III–IV) was less frequent in WLHIV (63.5% vs. 77.1% in HIV‐uninfected women; P = 0.029). Cancer care was initiated in 124 (42.2%) women (54.0% in WLHIV; 39.0% in HIV‐uninfected; P = 0.030). Factors independently associated with access to cancer care were International Federation of Gynecology and Obstetrics (FIGO) stage I–II (adjusted odds ratio [aOR] 3.58, 95% CI 2.01–6.38) and no treatment by traditional healers prior to ICC diagnosis (aOR 3.69, 95% CI 1.96–6.96). The 2‐year OS was 37.9% (95% CI 30.0–47.9). HIV status was not predictive of mortality (adjusted hazard ratio [aHR] 0.98, 95% CI 0.60–1.69). An advanced clinical stage was the only measured predictor of death (aHR 1.59, 95% CI 1.02–2.47). Conclusion: In a time of universal access to ART, HIV infection was not associated with OS among women with ICC in Côte d'Ivoire. Higher access to cancer care in WLHIV might be mediated by enhanced access to ICC screening services, supporting the need to expand these services to other types of healthcare facilities. Synopsis: Access to cancer care was higher in women living with HIV, probably mediated by early cancer diagnosis. However, while HIV status did not impact mortality, late stages did have an impact on mortality. [ABSTRACT FROM AUTHOR]

Non‐Hodgkin lymphomas (NHL) are underestimated causes of cancer in West Africa where chronic viral hepatitis and HIV are endemic. While the association with HIV infection has already been characterized, limited information is available on the association between chronic viral hepatitis and NHL in sub‐Saharan Africa. A case‐control study was conducted in referral hospitals of Abidjan (Cote d'Ivoire) and Dakar (Senegal). Cases of NHL were matched with controls on age, gender and participating site. The diagnosis of NHL relied on local pathological examination completed with immunohistochemistry. HIV, HBV and HCV serology tests were systematically performed. A conditional logistic regression model estimated the associations by the Odds Ratio (OR) with their 95% confidence interval (CI). A total of 117 NHL cases (Abidjan n = 97, Dakar n = 20) and their 234 matched controls were enrolled. Cases were predominantly men (68.4%) and had a median age of 50 years (IQR 37‐57). While Diffuse Large B‐cell lymphoma were the most reported morphological type (n = 35) among mature B‐cell NHL, the proportion mature T‐cell NHL (30%) was high. The prevalence figures of HBV, HCV and HIV infection were 12.8%, 7.7% and 14.5%, respectively among cases of NHL. In multivariate analysis, HBV, HCV and HIV were independently associated with NHL with OR of 2.23 (CI 1.05‐4.75), 4.82 (CI 1.52‐15.29) and 3.32 (CI 1.54‐7.16), respectively. Chronic viral hepatitis B and C were significantly associated with NHL in West Africa. Timely preventive measures against HBV infection and access to curative anti‐HCV treatment might prevent a significant number of NHL. What's new? While hepatitis B virus (HBV) infection is positively associated with non‐Hodgkin lymphoma (NHL) in some regions of the world, whether HBV increases risk of NHL remains uncertain. In this case‐control study based on data from referral hospitals in sub‐Saharan Africa, the authors describe a significant association between HBV infection and NHL. In West Africa, NHL was significantly associated with chronic infection with HBV and hepatitis C virus (HCV). The findings suggest that the implementation of measures to prevent HBV infection, along with efforts to ensure access to anti‐HCV treatments, could greatly reduce NHL in settings with high HBV prevalence. [ABSTRACT FROM AUTHOR]

Background: Cervical cancer prevention strategies recommend human papilloma virus (HPV) vaccination for female adolescents prior to their sexual debut. While HIV is a major risk factor for HPV infection in women of childbearing age, its prevalence among HIV-infected adolescent female is mostly unknown. This study aimed to describe the HPV prevalence and correlates among perinatally HIV-infected adolescent females prior to HPV immunisation.Methods: A cross-sectional survey was conducted from January to June 2016, in the four major paediatric HIV clinics of Abidjan, Côte d'Ivoire. All HIV-infected females aged 11-16 years were approached to participate in the study. A questionnaire assessing sexual behaviours and genital hygiene practices was administered to participants completed with a systematic vaginal swab collection. HPV genotyping was performed using the Anyplex II HPV28 Detection (Seegene). A logistic regression analysis was performed to identify factors associated with the presence of HPV infection. HPV immunisation was proposed free of charge to all participants.Results: A total of 250 participants were included, with a median age of 13 years (IQR 11-14). Among them, 237 (94.8%) were on antiretroviral treatment with a median CD4 count of 660 (IQR 439-914) cells/mm3. The overall prevalence of at least one HPV was 3.6% (95% CI 1.6 to 6.7) and the prevalence of at least one carcinogenic HPV was 2.8% (95% CI 0.7 to 4.8). Vaginal cleansing was reported by 75 (30%) of participants, with a median age at initiation of 12 years (IQR 10-13). Sexual activity was self-reported by 12 (4.8%) participants with a median age at sexual debut of 11 years (IQR 10-14). HPV infection was associated with vaginal cleansing (adjusted OR=7.0 (95% CI 1.4 to 31.6)).Conclusion: The reported low prevalence of carcinogenic HPV infections supports the appropriateness of HPV immunisation in this population. The reported association between cleansing practices and HPV infection deserves further prospective longitudinal studies. [ABSTRACT FROM AUTHOR]

Background: Of women with cervical cancer (CC) and HIV, 85% live in sub-Saharan Africa, where 21% of all CC cases are attributable to HIV infection. We aimed to generate internationally acceptable facility-based indicators to monitor and guide scale up of CC prevention and care services offered on-site or off-site by HIV clinics., Methods: We reviewed the literature and extracted relevant indicators, grouping them into domains along the CC control continuum. From February 2021 to March 2022, we conducted a three-round, online Delphi process to reach consensus on indicators. We invited 106 experts to participate. Through an anonymous, iterative process, participants adapted the indicators to their context (round 1), then rated them for 5 criteria on a 5-point Likert-type scale (rounds 2 and 3) and then ranked their importance (round 3)., Results: We reviewed 39 policies from 21 African countries and 7 from international organizations; 72 experts from 15 sub-Saharan Africa countries or international organizations participated in our Delphi process. Response rates were 34% in round 1, 40% in round 2, and 44% in round 3. Experts reached consensus for 17 indicators in the following domains: primary prevention (human papillomavirus prevention, n = 2), secondary prevention (screening, triage, treatment of precancerous lesions, n = 11), tertiary prevention (CC diagnosis and care, n = 2), and long-term impact of the program and linkage to HIV service (n = 2)., Conclusion: We recommend that HIV clinics that offer CC control services in sub-Saharan Africa implement the 17 indicators stepwise and adapt them to context to improve monitoring along the CC control cascade., Competing Interests: S.L.A. received the Swiss Government Excellence Scholarship, No 2019.0741. The remaining authors have no funding or conflicts of interest to disclose., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)