Suchergebnisse

Introduction The aim of this study was to assess the capacity of Burkina Faso's health services to care for road accident victims, from the crash site up to their recovery and rehabilitation. Methods We performed a situation analysis rooted in the literature findings, an overview of administrative documents, followed by the analysis of pre-hospital, hospital and post-hospital care. We also performed monitoring visits and interviewed a number of stakeholders, aiming to understand the current situation and identify the most important knowledge gaps, required for the development of policy and implementation of the holistic intervention plan. Results The study identified numerous and strong deficiencies across the total care of road accident victims management spectrum. The results suggest that a broad-scope intervention is needed, although even smaller-scale effects on elements of total care may yield improvements in specific areas. We also detected a substantial need for more primary studies that can provide relevant data for policy. Conclusion This study identified numerous problems, which need to be further explored and quantified, before a more systematic intervention can be applied across the country, aiming to reduce the negative health consequences of road accidents.

IntroductionGender differences in antiretroviral therapy (ART) outcomes are critical in sub‐Saharan Africa. We assessed the association between gender and virologic failure among adult patients treated in a public routine clinic (one of the largest in West Africa) in Burkina Faso.MethodsWe performed a case‐control study between July and October 2012 among patients who had received ART at the Bobo Dioulasso Day Care Unit. Patients were eligible if they were 15 years or older, positive for HIV‐1 or HIV‐1+2, and on first‐line ART for at least six months. Cases were all patients with two consecutive HIV loads >1000 copies/mL (Biocentric Generic or Abbott Real Time assays), or one HIV load >1000 copies/mL associated with immunologic or clinical failure criteria. Controls were all patients who only had HIV loads <300 copies/mL. The association between gender and virologic failure was assessed using a multivariate logistic regression, adjusted on age, level of education, baseline CD4+ T cell count, first and current antiretroviral regimens and time on ART.ResultsOf 2303 patients (74.2% women; median age: 40 years; median time on ART: 34 months), 172 had virologic failure and 2131 had virologic success. Among the former, 130 (75.6%) had confirmed virologic failure, 38 (22.1%) had viro‐immunologic failure, and four (2.3%) had viro‐clinical failure. The proportion of men was significantly higher among the cases than among the controls (37.2% vs. 24.9%; p<0.001). Compared to controls, cases were also younger, more immunodeficient at ART initiation, less likely to receive a protease inhibitor‐based antiretroviral regimen and had spent a longer period of time on ART. After adjustment, male gender remained strongly associated with virologic failure (odds ratio 2.52, 95% CI: 1.77–3.60; p<0.001).ConclusionsMen on ART appeared more vulnerable to virologic failure than women. Additional studies are needed to confirm the poorer prognosis of men in this setting and to determine the causes for their vulnerability in order to optimize HIV care. From now on, efforts should be made to support the adherence of men to ART in the African setting.