1. David Leuenberger, Jean J. Hebelamou, Eric A. Bafende, David V. Sovogui, Stefan Strahm Centre Médical of Macenta, Mission Philafricaine, Macenta B.P. 214, Conakry 1, Guinea 05/12/2011 - ICASA 2011, Addis Ababa, Ethiopia Abstract number MOAC0705

2. Forest Region of Guinea Macenta

3. HIV in the Forest Region of Guinea  Adult HIV prevalence Guinea overall: ○ 1.3% (2009, WHO Global report) ○ 1.5% (2005, National demographic and health survey EDSG) Forest Region: ○ 1.7% (2005, EDSG) – 2.2.% for women 1)WHO Global Report 2010 2)Enquête démographique et de santé de la Guinée (EDSG). 2005; as cited in Comité régional de lutte contre le sida de N‘Zérékoré; Analyse de la situation et de la réponse aux IST/VIH en Guinée Forestière. 2009

4. Centre Médical, Macenta  Public-private partnership: owned jointly by the Ministry of Public Health and Hygiene (MSHP) of the Republic of Guinea and the faith-based NGO Mission Philafricaine (MPA)  Opened in 1981  Now a national referral centre for leprosy (including reconstructive surgery) and tuberculosis (including multidrug resistant TB)

5. HIV care at the Centre Médical  Increasingly confronted with the HIV epidemic in the 1990s  A formal counselling and testing centre (CTC) with trained national counsellors opened in April 2006  Linked to prevention campaigns led by the Mission Philafricaine  On-site medical HIV care (including antiretroviral therapy [ART]) became available from 2008  Current figures: on average 188 tests/month (27.3% positive) Octobre 2011: 15 new patients starting on ART – 168 active patients on 31/10/2011

6. HIV test at our CTC  Sequential use of two different rapid tests a negative first test is considered a negative result a positive first test is confirmed immediately by a second rapid test which also allows HIV-1/2 subtyping a positive first test with a negative second test is considered an indeterminate result  Includes same-day pre- and post-test counselling by trained counsellors  Both provider- and client-initiated testing

7. Objective  To determine the basic characteristics of the population of clients undergoing testing at our CTC  To determine the predictors of seropositivity among basic demographic (age, gender, marital status, geographical origin) and clinical (test category) data

8. Methods  Retrospective analysis of the CTC register April 2006 – May 2011 (7’258 consecutive clients) ○ variables: age, gender January – May 2011 (1’064 consecutive clients) ○ variables available: age, gender, geographical origin, marital status and testing category  Statistical analyses with XLSTAT software (Addinsoft)

9. Breakdown by age group and gender 7258 clients consecutively tested (April 2006 – May 2011) (details available for 7257 clients) % women overall: 47.3%

10. Seropositivity by age group and gender RR 6.64 (95% CI 4.31-9.64) RR 1.30 (95% CI 1.19-1.42) 7258 clients consecutively tested (April 2006 – May 2011) (details available for 7257 clients)

11. 7258 clients consecutively tested (April 2006 – May 2011) (details available for 7257 clients) RR 1.42 (95% CI 1.32-1.54) Seropositivity and gender

12. Marital status 1064 clients consecutively tested (January – May 2011)

13. Geographical origin 69.4 % 14.6% 14.6 % 10.8% 2.1% 3.1% 1064 clients consecutively tested (January – May 2011)

14. Reasons for undergoing testing 1064 clients consecutively tested (January – May 2011)

15. Predictors of seropositivity: Age Relative risk compared to the reference group (age group 5-14 years) 0-4 years 15-24 years 25-34 years 35-49 years 50+ years 4.69 (1.27 – 17.36) 0.76 (0.29 – 2.01) 3.64 (1.43 – 9.31) 4.76 (1.91 – 11.87) 2.02 (0.76 – 5.37)

16. Predictors of seropositivity: Geographical origin Relative risk compared to the reference group (Macenta district residents) Forest region (except Macenta) Upper Guinea Elsewhere in Guinea Abroad 3.78 (2.62 – 5.46) 0.94 (0.56 – 1.59) 4.77 (2.06 – 11.03) 4.49 (2.23 – 9.02)

17. Predictors of seropositivity: Marital status Relative risk compared to the reference group (singles) Married Widowed 6.39 (4.08 – 10.00) 14.43 (5.11 – 40.79)

18. Predictors of seropositivity: Reasons for undergoing testing Relative risk compared to the reference group (healthy volunteers) Diagnostic testing: Tuberculosis Diagnostic testing: other clinical reason 2.11 (1.01 – 4.40) 7.97 (4.99 – 2.71)

19. Conclusions  The population undergoing testing at our centre is complex and highly diverse For example, young (15-24 years) single healthy volunteers from Macenta have low seropositivity rates (0.3% for men, 2.8% for women) On the other hand, adult (25-49 years) married clients being tested for clinical reasons have very high seropositivity rates (men 39.3%, women 45.7%)  Women are more affected than men across all age groups  We found a set of factors linked to seropositivity in our population  Tuberculosis does not appear to be a strong risk factor for HIV infection in our test population

20. Recommendations  Further refining of data collection will help better characterization of the population undergoing testing  This will inform preventive as well as clinical services  There is a general need to increase test uptake in the district of Macenta

21. Acknowledgments - HIV care team at the Centre Médical, Dr Eric Bafende, Dr Jean Hébélamou, Dr Agathe Guilavogui, M David Vévé Sovogui, Mme Jeannette Guilavogui, Mme Esther Bavogui, Mme Bintou Sovogui - Dr Stefan Strahm and all the Mission Philafricaine collaborators - National HIV program and the Ministry of Health, Guinea - Solidarité Protestante, Médecins sans Frontières Belgium (main donors) - Dr Hubert Gantenbein, Switzerland and the Swiss Society for tropical and travel medicine (financial support for conference attendance)