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For the implementation of the REDD+ mechanism, the UNFCCC, through decision 12/CP17, invites countries to develop certain tools to estimate reference emission levels for forests. With this in mind, reference emission and absorption levels were estimated in five protected areas in Benin. To achieve this, two different datasets were used, namely: in situ data from the field collection campaign carried out in 2018, especially from the national forest inventory of 2007 and land use data from 2000 to 2018. In accordance with the 2006 IPCC Good Practice Guidance on Greenhouse Gas Inventories, the calculation of historical emissions from deforestation and degradation is done by multiplying Activity Data (AD) by Emission Factors (EF). The analysis of the results shows that at the national level, the annual deforestation rate in protected areas is 0.34% (2091 ha/year), compared to 1.09% (3153 ha/year) for the annual degradation rate. Overall, carbon emissions amount to 166.65 Mt.eq-CO2/ha, or 16.67 Mt.eq-CO2/ha/year, compared to baseline removals of about 1.14 Mt.eq-CO2/ha, or 0.11 Mt.eq-CO2/ha/year in the protected areas covered by this research. Annual emissions of 0.67 Mt.eq-CO2/ha/year from methane are also noted, compared to 0.056 Mt.eq-CO2/ha/year from nitrous oxide. Therefore, It is clear that actions to mitigate GHG emissions must be undertaken directly in Benin’s protected areas in order to strengthen forest carbon stocks.

International audience; Alcohol use disorders (AUD) is a major public health concern. General practitioners (GP) must play a key role in identifying this disorder and offering appropriate interventions. The authors conducted a survey among French GP in the Provence – Alpes – Côte-d’Azur (PACA) region to better understand their practices regarding AUD. Random sampling was used to enrol 101 GP in a 15-minute survey. A Computer-Assisted Telephone Interview exploring demographic and professional characteristics was conducted using a questionnaire. One third (31.7%) of the participants systematically addressed alcohol use with their patients whereas six (5.9%) never addressed it. Logistic regression analyses showed that after adjustment for the number of AUD patients followed up (odds ratio [OR] = 1.92; 95% confidence interval [CI] [1.19, 3.08]) and GP interest in addiction medicine (5.41 [2.17, 13.40]), GP who systematically screened patients for AUD were more likely to accept controlled drinking as a therapeutic goal (5.41 [2.17, 13.33]), and to perceive patient denial of AUD as a major barrier to care (1.39 [0.60, 3.22]). GP providing care for AUD were more likely to monitor tobacco cessation (9.08 [2.60, 31.64]) and to prescribe opioid maintenance treatment (7.35 [2.52, 21.41]). Alcohol screening is insufficient in general practice in France. Providing updated guidelines is essential to foster experience in this field among GP.

International audience; BACKGROUND:Coffee intake has been shown to modulate both the effect of ethanol on serum GGT activities in some alcohol consumers and the risk of alcoholic cirrhosis in some patients with chronic diseases. This study aimed to analyze the impact of coffee intake and alcohol consumption on advanced liver fibrosis (ALF) in HIV-HCV co-infected patients.METHODS:ANRS CO13-HEPAVIH is a French, nationwide, multicenter cohort of HIV-HCV-co-infected patients. Sociodemographic, behavioral, and clinical data including alcohol and coffee consumption were prospectively collected using annual self-administered questionnaires during five years of follow-up. Mixed logistic regression models were performed, relating coffee intake and alcohol consumption to ALF.RESULTS:1019 patients were included. At the last available visit, 5.8% reported high-risk alcohol consumption, 27.4% reported high coffee intake and 14.5% had ALF. Compared with patients with low coffee intake and high-risk alcohol consumption, patients with low coffee intake and low-risk alcohol consumption had a lower risk of ALF (aOR (95% CI) 0.24 (0.12⁻0.50)). In addition, patients with high coffee intake had a lower risk of ALF than the reference group (0.14 (0.03⁻0.64) in high-risk alcohol drinkers and 0.11 (0.05⁻0.25) in low-risk alcohol drinkers).CONCLUSIONS:High coffee intake was associated with a low risk of liver fibrosis even in HIV-HCV co-infected patients with high-risk alcohol consumption.

Objectives: Despite free access to antiretroviral therapy (ART) from 1996 onward, and treatment for all people living with HIV (PLWHIV) from 2013, mortality in Brazil has not homogeneously decreased. We investigated to what extent delayed ART, hepatitis coinfections and sociodemographic factors predict all-cause mortality in Brazilian PLWHIV. Design: We included PLWHIV at least 18 years, with complete CD4(+) cell count data, followed up between 2007 and 2015 in Brazil. Methods: After multiple imputation, an extended Cox model helped estimate the effects of fixed and time-varying covariates on mortality. Results: The study population (n = 411 028) were mainly male (61%), white (55%), 40 years or less (61%), heterosexually HIV infected (71%), living in the Southeast region (48%) and had basic education (79%). Hepatitis C virus and hepatitis B virus coinfection prevalences were 2.5 and 1.4%, respectively. During a 4-year median follow-up, 61 630 deaths occurred and themortality rate was 3.45 (95% confidence interval: 3.42-3.47) per 100 person-years. Older age, male sex, non-white ethnicity, illiteracy/basic education and living outside the Southeast and Central-West regions were independently associated with increased mortality. The main modifiable predictors of mortality were delayed ART (i.e. CD4(+) cell count

Background Men who have sex with men (MSM) using preexposure prophylaxis (PrEP) are at risk for sexually transmitted infections (STIs). Therefore, PrEP services should include regular screening for Chlamydia trachomatis(CT) and Neisseria gonorrhoeae(NG) at urethra, anorectum, and pharynx. However, financial and logistic challenges arise in low-resource settings. We assessed a new STI sample pooling method using the GeneXpert instrument among MSM initiating PrEP in West Africa. Methods Urine, anorectal, and pharyngeal samples were pooled per individual for analysis. In case of an invalid result only (strategy 1) or a positive result of the pool (strategy 2), samples were analyzed individually to identify the infection's biological location. The results of 2 different pooling strategies were compared against the individual results obtained by a criterion standard. Results We found a prevalence of 14.5% for chlamydia and 11.5% for gonorrhea, with a predominance of infections being extragenital (77.6%). The majority of infections were asymptomatic (88.2%). The pooling strategy 1, had a sensitivity, specificity and agreement for CT of 95.4%, 98.7%, and 0.93, respectively; and 92.3%, 99.2%, and 0.93 for pooling strategy 2. For NG, these figures were 88.9%, 97.7%, and 0.85 for strategy 1, and 88.9%, 96.7%, and 0.81 for strategy 2. Conclusions West African MSM have a high prevalence of extragenital and asymptomatic STIs. The GeneXpert method provides an opportunity to move from syndromic toward etiological STI diagnosis in low-income countries, as the platform is available in African countries for tuberculosis testing. Pooling will reduce costs of triple site testing.

Background: In West Africa, few HIV services target men who have sex with men (MSM). In 2015, the interventional cohort CohMSM started offering a community-based prevention package for MSM. Participants expressed interest in pre-exposure prophylaxis (PrEP) and their eligibility was demonstrated. In 2017, PrEP was added to services already offered as part of a new program, CohMSM-PrEP, which recruited CohMSM participants and new participants. We aimed to determine whether the introduction of PrEP as an additional prevention tool influenced the type of participant signing up for CohMSM-PrEP. Methods: CohMSM-PrEP recruited HIV-negative MSM in community-based clinics in Mali, Cote d'Ivoire, Burkina Faso, and Togo. Quarterly follow-up included free clinical examinations, PrEP, HIV/sexually transmitted infection screening, peer education, condoms, and lubricants. Sociobehavioral data were collected every 3 months using face-to-face questionnaires. Our outcome was participant type: new participants vs CohMSM participants. Logistic regression was performed to identify the factors associated with being a new participant. Results: Of the 524 MSM included in CohMSM-PrEP, 41% were new participants. After adjustment, multivariate analysis showed they were more socioeconomically disadvantaged with financial insecurity, social isolation-including isolation within the MSM community-and riskier sexual practices. Conclusion: The introduction of PrEP as an additional prevention tool and the use of peer-based outreach services over time influenced the type of participant signing up for a community-based HIV prevention cohort in West Africa. Adding these elements to existing interventions in Sub-Saharan Africa could be the key to reaching MSM marginalized from HIV prevention and care programs.

The level of CO2 emissions generated by deforestation was estimated in the middle Sota catchment. To achieve this, in situ surveys and remote sensing data (SPOT5 and SPOT 7) were used to estimate activity data and CO2 emission factors from deforestation. In accordance with the IPCC guidelines on good practice in greenhouse gas inventory, the calculation of historical emissions from deforestation is done by multiplying activity data (DA) by emission factors (FE). Thus the annual rate of net deforestation is 2.03% (or 2,669.89 ha/year), while the net degradation is estimated at 0.19%/year (or 253.23 ha/year). Net deforestation is estimated at 465.46 ha/year (or 1.01%) in protected areas, while it amounts to 2,204.74 ha/year (or 2.59%/year) in the terrors. Overall, the basin has a total emission factor of 11,080.45 t CO2/ha while historical emissions due to deforestation amount to about 295.87 Mt CO2/ha or 29.58 Mt CO2/ha/year. In protected areas, annual emissions are estimated at 1.14 Mt CO2/ha, while soils emit up to 19.04 Mt CO2/ha/year. This study provided a better understanding of the spatial variability of CO2 emissions between land use types, thus providing arguments for fully meeting REDD+ objectives., L'estimation du niveau d'émission de CO2 dues à la déforestation a été faite dans le bassin moyen de la Sota. Pour y parvenir, les données relevées in situ et les données de télédétection (SPOT5 et SPOT 7) ont été utilisés pour estimer les données d'activité et les facteurs d'émission du CO2 issus de la déforestation. En accord avec les lignes directrices du GIEC sur les bonnes pratiques en matière d'inventaire des gaz à effet de serre, le calcul des émissions historiques issues de la déforestation est fait en multipliant les données d'activité (DA) par les facteurs d'émission (FE). Ainsi le taux annuel de déforestation nette est de 2,03 % (soit 2 669,89 ha/an), alors que la dégradation nette est évaluée à 0,19 %/an (soit 253,23 ha/an). La déforestation nette est évaluée à 465,46 ha/an (soit 1,01 %) dans les aires protégées, alors qu'elle s'élève à 2 204,74 ha/an (soit 2,59 %/an) dans les terroirs. Globalement, le bassin dispose d'un facteur d'émission total de 11 080,45 t.éq-CO2/ha alors que les émissions historiques dues à la déforestation s'élèvent à environ 295,87 Mt.éq-CO2/ha soit 29,58 Mt.éq-CO2/ha/an. Dans les aires protégées, les émissions annuelles sont estimées à 1,14 Mt.éq-CO2/ha, alors que les terroirs émettent jusqu'à 19,04 Mt.éq-CO2/ha/an. Cette étude a rendu davantage compte de la variabilité spatiale des émissions de CO2 entre les types d'affectation des terres donnant ainsi des arguments pour répondre pleinement aux objectifs du REDD+.