RESUMO
Context: In 2022, four severe cases of Hantavirus pulmonary syndrome (HPS) were reported in patients from informal settlements around Cayenne, the main city in French Guiana. Regional Health Agency (RHA) was commissioned by the French Public Health Agency to estimate the seroprevalence of Hantavirus infections in the neighborhoods of confirmed cases of HPS. RHA then commissioned the French Red Cross (FRC) mobile public health team, providing support in environmental health issues to the population living in informal settlements by health mediators, to facilitate the investigation. The objective of this study was to describe the health mediators' activities set up to improve the efficiency of the investigation. Methods: The health mediators' team was specifically trained by virologist and infectiologist specialized in HPS. They helped the investigating team and health workers at various steps of the investigation. These interventions are then described in the results section. Results: The investigation took place between Nov. 2022 and March 2023 in three neighborhoods. During the pre-investigation activities, the mediators raised awareness about HPS of 343 people, among whom 319 (93%) planned to participate in the investigation. Altogether, 274 people finally participated in the investigation, including, i.e., 30.8% of the estimated population living in the three concerned settlements. The global proportion of patients with positive IgG anti-Hantavirus was 5.1%. The health mediators team supported the following steps: preliminary meetings and training modules, identification of resource persons, field visits and awareness and information campaigns (pre-investigation); on field data collection in informal settlements (per-investigation) and communication of individual results, public feedback meeting (post-investigation). Discussion/Conclusion: The involvement of mediators was probably a factor in the success of the public health response to socially vulnerable people living in the investigated neighborhoods. The preliminary prevention activities helped to raise awareness of the health risk and to enroll participants. Health mediation and outreach activities seem relevant tools of epidemiological field investigations in diseases affecting inhabitants of informal settlements.
Assuntos
Síndrome Pulmonar por Hantavirus , Humanos , Guiana Francesa/epidemiologia , Masculino , Feminino , Estudos Soroepidemiológicos , Adulto , Síndrome Pulmonar por Hantavirus/epidemiologia , Infecções por Hantavirus/epidemiologia , Orthohantavírus , Pessoa de Meia-Idade , Saúde PúblicaRESUMO
In French Guiana, 4.5-5.0% of HIV-infected persons experienced an incarceration between 2007 and 2013. A cross-sectional survey was performed to describe the epidemiology and treatment outcomes of a population of HIV-infected inmates in French Guiana. The study population was patients released between 1/2007 and 12/2013, after >30 days of incarceration (n = 147). A secondary objective aimed to identify its main specificities, relative to both the general inmate population and the nonincarcerated HIV population. The socioeconomic situation of HIV-infected inmates was particularly precarious, relative to other detainees: 58.1% had never attended school (versus 5.5%, p < 0.01), 31.0% were homeless (versus 8.5%, p < 0.01), 63.9% were repeat offenders (versus 46.6%, p < 0.01), 33.3% were crack cocaine users (versus 9.8-12%, p < 0.01). The frequency of hypertension and chronic B hepatitis was also higher. Only 50.3% of inmates were on antiretroviral therapy (ART) versus 92.6% in the hospital HIV population (p < 0.001). Among untreated patients, 15.1% refused ART. Among those treated, 81.3% were virologically suppressed. Although comparisons were biased, HIV-positive inmates had more psychosocial vulnerabilities than the general inmate population. Despite ART availability and excellent treatment outcomes, undertreatment was a fact not completely explained by patient refusal. HIV-infected inmates should benefit from increased attention by health care and social workers.