Jointly conducted by IRD and INSERM, this research highlights the challenges of HIV management in Senegal.
Ndeye Fatou Ngom, researcher at TransVIHMI (Institut de Recherche pour le Développement).
Thesis defended in 2018 at the doctoral school École doctorale Sciences Chimiques et Biologiques pour la Santé (Montpellier ; 1992-....).
This research is the result of an international co-supervision between several partner institutions.
Referenced in the ABES/STAR network, this thesis meets the rigorous criteria of French higher education.
The fight against HIV in Senegal represents a major public health issue, with implications that go far beyond the medical framework. Indeed, the HIV/AIDS pandemic has repercussions on society as a whole, affecting economic, social, and cultural aspects. Despite significant advances in access to antiretroviral treatments (ART), the continuity of care and virological monitoring remain crucial challenges that require particular attention.
Research conducted by Ndeye Fatou Ngom, in collaboration with the Institute for Research and Development and INSERM, analyzes the evolution of HIV management over two decades in an Outpatient Treatment Center in Dakar. The results of this study are revealing: 69% of patients were eligible for treatment, but only 41% actually initiated ART. This situation raises fundamental questions about the effectiveness of public health programs and the barriers to accessing care.
Retention rates at 12, 24, and 36 months are 84%, 77%, and 73%, respectively. Although these figures are encouraging, they also reveal a concerning loss to follow-up, particularly among men and residents outside of Dakar. This raises questions about geographical and gender disparities in access to care. For example, men, who are often less inclined to seek help for health issues, may be less monitored, complicating the fight against HIV.
The availability of viral load testing is around 40%, which limits the ability to measure virological success. Indeed, virological success is 64% at 50 copies/ml, reaching 84% at 1000 copies/ml. These results highlight the need to improve the continuity of care and virological monitoring to achieve the ambitious goals of UNAIDS, which aims to end the HIV/AIDS epidemic by 2030.
It is imperative to explore solutions to overcome these obstacles. The provision of free ART, established in 2004, has increased the number of patients receiving treatment, but there are still gaps in implementation. For example, although treatment is free, indirect costs, such as transportation to care centers, can be a barrier for many patients, particularly those living in rural areas.
Policymakers must address the factors influencing patient retention and the availability of viral load tests. An integrated approach, involving community actors and public-private partnerships, could enhance the effectiveness of HIV programs. For instance, local awareness and education initiatives could help reduce the stigma associated with HIV, thereby encouraging more people to get tested and adhere to treatment.
In summary, this research underscores the need for concerted action to improve HIV management in Senegal. The challenges are numerous, but solutions exist. It is time to act to ensure equitable access to care and effective follow-up for patients living with HIV. This requires not only financial resources but also strong political commitment and mobilization of civil society.
It is essential to create an environment where people living with HIV feel supported and not stigmatized. By integrating mental health and psychosocial support services into HIV care, we can improve patients' quality of life and their adherence to treatment. Furthermore, ongoing training for healthcare professionals on best practices in HIV management is crucial to ensure quality care.
In conclusion, the fight against HIV in Senegal is a struggle that requires a long-term vision and a multidimensional approach. By uniting our efforts, mobilizing the necessary resources, and placing patients' needs at the heart of health policies, we can hope for a future where HIV is no longer a threat to public health.
Key Facts
- 69% : Proportion of patients eligible for antiretroviral treatment.
- 41% : Percentage of patients who initiated ART.
- 84% : Retention rate at 12 months.
- 64% : Virological success at 50 copies/ml.
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Sources and Access
Ndeye Fatou Ngom. Enjeux de la prise en charge thérapeutique du VIH au Sénegal. Médecine humaine et pathologie. Université Montpellier, 2018. Français. ⟨NNT : 2018MONTT098⟩. ⟨tel-02100064⟩