Comparison of Target Volumes in Hepatocellular Carcinoma Delineated using Standard Method and Bolus Tracking Method

Comparison of Target Volumes in Hepatocellular Carcinoma Delineated using Standard Method and Bolus Tracking Method

Editorial

‘Target delineation in radiation oncology is the most important step of treatment [1]. Usually, contrast CT scan is done to delineate the target. Target volume may be different at different phases of scan after contrast. The differential volume in different phases after contrast infusion (Arterial, Veinous, Portal phase) may be responsible for either increase or decrease or even miss a part of the tumour which may have impact on clinical outcome. After contrast infusion, there is a time lag for the appropriate contrast material to reach the tumour tissue before it is washed out through the veins [2]. Appropriate timing of the scan is critical for optimal image quality, enhancement of the lesion and appropriate delineation of the target [3]. In ‘standard’ contrast CT scan, there is a ‘fixed’ time interval between the infusion and imaging scan. However, the ‘time lag’ or the time required to reach the tumour or target depends upon various patient related factors, such as

a. Blood Pressure,

b. Heart rate,

c. Status of cardiac contractility (ejection fraction),

d. Patient position and

e. Height of the patient.

There is a need to individualize the ‘lag time’ between the infusion of contrast and scan. ‘Bolus tracking’ is a contrast CT scan method which is individualized to improve the image quality and hence delineation of the target [4]. In the present study, ‘bolus tracking’ was evaluated for primary liver tumours. In primary liver tumour, appropriate contrast imaging is critical to delineate the target. Contrast enhancing lesion volume in arterial, venous and portal phase may differ with timing of imaging after contrast infusion, and the target volume will be different or even miss the actual target in inappropriately timed scan. ‘Bolus tracking’ may help for appropriate phase imaging and proper delineation of the target. Breathing pattern and imaging in realtion to breathing cycle (eg- end of expiration) may also influence target volume. The bolus tracking method and standard CT simulation method work-flow is mentioned in Figure 1.

Standard technique: During CT simulation for SBRT for primary liver tumour (Hepatocellular carcinoma), usually a contrast CT scan is taken for target volume delineation. An 80 mL of contrast is given using 20 G cannula with a flow rate of 2.5 to 3mL per second. The scans are taken after fixed arbitrary time delays, arterial phase is taken 2 seconds, portal phase 12 seconds and venous phase 15 seconds delay time after contrast injection. Images taken in different phases are used for target delineation. Bolus tracking during multiphase contrast CT scan is often used in diagnostic radiology, mostly for liver tumours to enhance the visibility of tumours. However, in planning CT simulation, bolus tracking method is not usually applied. In high dose per fraction short course treatment (stereotactic radiosurgery) for primary liver tumours we considered triphasic CT simulation using ‘bolus’ tracking for appropriate delineation of target volume. Bolus tracking technique: CT scans were acquired using 4D CT simulator GE OPTIMA 580WRT with 16 slice large bore size of 80 cm and flat couch [5].

Figure 1: Schematic presentation of conventional CT simulation & simulation with ‘bolus tracking’ in primary liver tumours.

Initially 80 mL of contrast is injected using 18 G cannula at a flow rate of 4 mL per second. The slice thickness used is 1.25 mm. ‘Bolus’ tracker or Smart Prep RX is placed at descending aorta (Figure 2). Bolus tracking software trigerred scans of liver were taken at 5 seconds, 15 seconds and 30 seconds following aortic enhancement corresponding to aortic, portal and venous enhancement phases of liver (Figure 3). These scans were initiated at the end of exhale. Arterial phase was initiated (triggered) when the contrast reaches the bolus tracker. Triggering of arterial phase was done by bolus tracker and predifined Houndsfield unit. Veinous phase and portal phase was initiated at 15 sec and 30 sec after triggering of the scan. Bolus tracking mainly help in appropriate time (when the contrast reaches the bolus tracking region, defined by Hounds field unit change) for triggering the scan. Bolus tracking was well tolerated by our patients. The tumor enhancement and portal vein thrombus was appropriately visualized with bolus tracking.

Figure 2: Pictorial presentation of standard simulation and bolus tracking simulation method.

Figure 3: Comparison of target visualization with and without bolus tracking.

Target volume was better defined in arterial and portal phases after bolus tracking when compared to non-bolus tracked conventional contrast CT simulation scans (Figure 3). Imaging of liver is always facinating. Even in early CT scan era there was a concept of using contrast in phased manner to improve the contrast between liver parenchyma and tumour tissue [6,7]. Different dynamic scans use differential time gap between contrast infusion and scanning. Apart from the differential time gap, contrast flow rate and amount of contrast influence the image quality. Radiological diagnosis of the lesions were done mostly by the enhancement pattern in different phases and the architecture of the lesion. ‘Multiphasic’ CT scan for diagnosis of liver tumours are in use for last few decades. Multiphasic CT scan utilise the differential time gap between contrast infusion and image acquisition in arterial, venous or portal phase. Hepatic lesions are better visible in specific sequences, such as liver metastasis in arterial phase, primary liver tumour in venous phase and portal vein thrmobosis in portal phase. Liver parenchyma also uptake contrast. Differential contrast uptake between normal liver parenchyma and tumour defines the target volume.

Appropriately timed image acquisition after contrast infusion helps in defining the tumour appropriately. Bolus tracking helps in triggering of image acquisition at appropirate time and hence helps in appropriate deliniation of target. Bolus tracking nullifies the patient related factors (ejection fraction, heart rate, blood pressure etc) influencing the flow rate of blood and contrast. Bolus tracking need 4D CT scan with ‘Bolus tracker’ or ‘Smart PreRX’ software to track the bolus, trigger the scan when the bolus (contrast) reaches the descending aorta and is not routinely used for radiation therapy planning in liver tumours. In radiation oncology, contouring done in contrast CT scan. Imaging at different phase in different tumours will provide appropriate anatomical information. ‘Bolus tracking’ with appropriate imaging will provide us appropriate phase information and contouring of the target. Bolus tracking have shown significant concordance in appropriate tumour volume delineation in pancreatic tumour [8]. In stereotactic radiosurgery, appropriate delineation of target is critical as there is no clinical target volume (CTV) and set up margins (PTV) are minimal [1].

Bolus tracking will improve the accuracy of tumour volume delineation and may reduce geographical miss as well as marginal recurrences. In summary, radiation oncologists consistently preferred arterial phase for better target volume delineation and portal venous phase for delineation of tumor thrombus in portal vein. ‘Bolus tracking’ method of contrast CT scan for tumour delineation provides appropriate target definition. In our experience with thirty-six primary liver tumours treated with ‘bolus tracking’ method during CT simulation have given appropriate deliniation of target. Our first two patients where target volume was compared with non-bolus and bolus tracking methods as well, there was a definitive better visualization of target volume with bolus tracking. Hence, in our institute bolus tracking is considered for all primary liver tumours. From our institutional experience we recommend bolus tracking with arterial phase for hepato cellular tumor delineation and portal venous phase for portal vein tumor thrombus delineation.

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Cimarron Taro Xanthosoma Cubense (Schott) Schott: Endemic Cuban Species in Situ Conserved

Cimarron Taro Xanthosoma Cubense (Schott) Schott: Endemic Cuban Species in Situ Conserved

Introduction

Specimens of cimarron taro (X. cubens) were collected in missions organized by INIVIT during the years 1989-1991 (Sánchez 1995) throughout the national territory and, in spite of several attempts, it was always possible its ex situ conservation (under field conditions) for short periods of time (up to three months maximum). After this time, the plants died as an indication of non-adaptation. For these reasons, the in-situ variant has been the priority to consider in the conservation of this important Cuban genetic resource. On the other hand, the main limitations to ensure an adequate conservation of genetic diversity in crops, such as taro are associated with the limited knowledge available on their taxonomy, as well as its life habits, its morphological and genetic characteristics. Taking into account also that despite this condition of endemism, cimarron taro is little known in Cuba and that have been presented in a general way, levels of genetic erosion in the ecosystems as a result of current and evident changes in the climate, it has been necessary to identify in situ specimens of this species, characterize it and encourage its conservation in its own habitat, not only because of its genetic interest, but also because of the need to study its potential for possible uses. All of the above constitute objectives of this work.

Materials and Methods

To identify in situ specimens of the species, previous reports by Sánchez et al. [1] who found specimens in the eastern Cuban region during plant collection missions organized by the INIVIT / IBPGR, as well as previous studies by Arias (1994) regarding the location and distribution of X. cubense in the Cuban national territory.

A collection mission was organized to Sierra de Cubitas, province of Camagüey, as one of these places previously referred to as sites with a natural and wild presence of the species. Once in the place, Paso de los Paredones, an exhaustive exploration of the area was carried out with the Chief of the Protected Area. A training action was also carried out with the workers of this Area in order to sensitize the personnel in charge of the maintenance and conservation of the flora of the place about the value of this plant species, and the importance of its conservation in that privileged geographical area for its vegetation. The genetic material found was characterized in the same place with the use of the list of descriptors for the genus Xanthoma [2,3].

A strategy was proposed for the in-situ conservation of X. cubense in the explored area, in accordance with the requirements of the species and the requirements of Limones – Tuabaquey Protected Area, Camagüey.

The appearance of possible damages caused by pests or abiotic factors was evaluated, as well as the presence of inflorescences in natural conditions that allowed to assess their genetic potentialities. It was also inquired about consumption habits, other uses or preferences.

Results and Discussion

A map is shown where the area sampled in this work is reflected, and references of the material studied (Figures 1 & 2). This location was also reported by Sánchez et al. & Arias [1].

Figure 1: Geographic location found for Xanthosoma cubense (Schott) Schott in the province of Camagüey, Cuba.

Figure 2: The plants died as an indication of nonadaptation.

Central Cuba

Camagüey: Sierra de Cubitas, Hoyo de Bonet, April 25, 1984, /. Bisse, J. Gutiérrez, K.F. Günther, F.K. Meyer, Β. Mory, C. Sánchez, R. Rankin et. Arias n. 53923 (HAJB); Sierra de Cubitas, Hoyo de Bonet, October 9, 1985, R. Oviedo n. 59654 (HAJB); Sierra de Najasa, Loma de Santa Águeda, July 12, 1986, Ε. Méndez and J. Rodríguez s.n. (HAJB) [4]. The present work allowed to identify specimens in the wild natural state of the species X. cubense in Sierra de Cubitas, belonging to the Protected Area Limones - Tuabaquey, Camagüey, conserved in situ in the Paso de los Paredones in the front and after the obelisk dedicated to the General Manuel de Quesada and Loynaz. A population of 26 plants in different stages was observed, only two adults that grow on a leached red Ferralitic soil. It is important to point out that since 1990, when it was collected there [1], specimens can be seen growing in the same place, that is to say, the right part of Paso de los Paredones coexisting with a type of fern. In this area a humid climate predominates where, practically, the sun´s rays do not reach.

The fact that it is still in places where it was found in 1992 [1] and in 1994 (Arias, 1994) indicates that there has not been genetic erosion of the species, although a limited number of specimens are observed in the area. Even though consumption habits, other uses or preferences are not reported, it is important to consider that the fact of being an endemic Cuban wild species, in which no damage is observed by pests that emit inflorescence [1], among other qualities, make it a potentially valuable genetic resource for the Program of Genetic Breeding of Aroids in Cuba.

Characterization

After the geographical location and the identification of X. cubense specimens, a morphological characterization of five of them was carried out with the application of the List of descriptors for Xanthosoma spp. (IBPGR, 1989), modified by Milián (2008). According to Arias (1994), Xanthosoma cubense was the first species of this genus described in Cuba. León (1946) reports two endemic species for Cuba: Xanthosoma cubense (A. Rich.) Schott and Xanthosoma clarense León [5]. However, Arias (1994), after a careful review of the existing literature on the genus and herbarium material from Cuba deposited in several herbaria, has highlighted that both species should be considered as belonging to a single taxon (X. cubense), whose interpretation has been the cause of some taxonomic errors. It belongs to the family Araceae and it is wild in all Cuban provinces, in humid places, at the foot of the calcareous mountains and among the rocks. In some places they call it ¨malanguilla¨. Its leaves are lobadas - pedadas. Subsequently, prior coordination with the Flora and Fauna Company, Limones Protected Area - Tuabaquey, Camagüey, a strategy was organized to guarantee the preservation of this valuable germplasm, through the in-situ modality of conservation of genetic resources [6].

Strategy

a) Train the staff

b) Mark plots identifying the place where the plant population is.

The conservation of biodiversity is strategic to satisfy the growing current and future demands of the world population. A strategy of this nature has as essential objectives, to conserve the variability of a species and to provide the breeders, the raw material for the selection programs.

Conclusion

a) The conservation of biodiversity in general, and in particular of the X. cubense species, is strategic to satisfy the demands of the world population.

b) The in-situ germplasm conservation variant responds to the need to guarantee the plant genetic heritage.

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Biomedical Engineering and Prehospital Emergencies: Binomial of the Future

Biomedical Engineering and Prehospital Emergencies: Binomial of the Future

Opinion

Biomedical engineering is a relatively new science in the academic field. Its development has allowed to introduce cuttingedge technology in medical applications with different purposes and unsuspected results. In this opinion article, we will focus on its application, present and future, in the field of prehospital created for it, in order to assess, diagnose and treat the patient clinically during their transfer to the useful hospital center [1]. In Medicine and Nursing Degrees [2,3] biotechnology was introduced, especially through clinical simulation. The high-fidelity mannequins with physiological response are a clear exponent. They are used both for the acquisition of students of both basic and advanced skills, as well as training when working in multidisciplinary teams. In a second phase [4] these same mannequins are used for a first evaluation of the students before their clinical practices thanks to the approach of clinical cases. Currently, holograms [5] and other technological means are used to study in depth the physiology and physiopathology, as well as the anatomy, of the human body.

The postgraduate training of health personnel working in emergency medical services has the following objectives: first, to provide individual, specialized training in the field of emergency; Another aim is the continuous training of health teams, and a third objective would be to form high-performance teams [6]. For this, not only do we have the clinical simulation, we also have augmented virtual reality, immersive virtual reality, CAVE’s, [7] etc. That they give us a great methodological variety for the learning of the emergency team students in different situations or in different cases of seriousness, the student can repeat as many times as he wishes until he has acquired skills, non-technical skills or simply having the immersive experience in the emergency field. For this, it is necessary to and medical emergency situations teams with engineers and health specialists about teaching and medical emergency situations. Teams that complement each other and mark the difference, in a transdisciplinary way, between current and future training. At the moment we live a very productive moment in this sense. It innovates in products present in ambulances, such as the “Smart BenchTM”, [8] platform that allows to know the real weight of any patient, facilitating the calculation of pharmaceutical doses, fluids, etc. reducing human error or devices traditionally anchored to the hospital environment, such as the CT scanner housed inside an ambulance to detect stroke immediately and effectively, thanks to the technical advances of biomedical engineering [9]. Many other examples could be cited. The most important one is to provide the mobile units with technical means to be able to obtain the traceability of the decisions made during the emergency to increase the safety of our patients and thus their survival. In conclusion, to affirm that health professionals and engineers of different specialties enrich health care when we join in R + D + i projects in transdisciplinary teams.

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Sociocultural Factors Associated with the S Éroprévalence of Infection HIV in Kenge, DRC (January 2015-June 2016)

Sociocultural Factors Associated with the S Éroprévalence of Infection HIV in Kenge, DRC (January 2015-June 2016)

Introduction

HIV infection is one of the most deadly cosmopolitan diseases. Today, it is a major scourge that affects human capital and its magnitude and consequences have a negative impact on all development sectors (UNAIDS, 2005). With more than 35 million deaths to date, HIV continues to be a major global public health problem (WHO, 2017). According to the WHO report [1], 36.7 million people s worldwide are infected with HIV, of which approximately 70% live in sub-Saharan Africa. Infection damages families slows growth and robs countries of valuable skills (Koffi Annan, 2004). Despite diligent past 30 years in the sought-e since its discovery these days, its particularly deadly pathogenicity explains all the dynamics of control strategies developed around the world [2]. In Eastern Europe, Central Asia, the Middle East, North Africa and many parts of Asia and Latin America, drug use is the leading cause of new HIV infections [3-5]. In several regions, a substantial portion of the NEW infections is due to the fact that the collection of blood and transfusions are in bad conditions and the use of contaminated needles [6]. In its report on the situation of HIV / AIDS in the world, UNAIDS (2008) accredits DHS data -2008 situating the national prevalence of DR Congo in the range of 1.2 to 1.5% [7]. The national seroprevalence of the DRC is therefore one of the lowest in the region.

In contrast, the serosurveillance report in 2011 indicates a prevalence of 1.1 % in the general population (UNAIDS and WHO, 2013). The HIV / AIDS epidemic in the DRC has remained relatively stable over the last 5 years (MINISANTE, 2010) [8]. Data from sentinel sites show that the HIV / AIDS epidemic is widespread in the DRC. Current trends i n diqu ent that this epidemic ruralized (4.6% in rural areas compa 4.2% in urban areas) is “juvénilise” and feminization (sex ratio: 1.3), especially in railway stations, seaports, mining areas and border posts (Balangaliza, 2007). HIV affects an impressive number of people and access to antiretrovirals (ARVs) is very limited yet considered as the only effective treatment that can significantly improve the quality and length of life of people living with HIV [9]. Over one million people are HIV positive in the DRC and the estimated rate of e patients at an ARV coverage to 14%. This coverage rate is among the lowest in the world, and significantly lower than neighboring countries [10]. Similarly, the treatment of Prévention of Transmission of HIV M era in Enfant (PMCT) n is available only for 1% of women infected with HIV, which is extremely low compared to neighboring countries (UNAIDS, 2015) [8].

In addition, a very large majority of people affected by HIV / AIDS in the DRC do not know their HIV status. Low screening is explained by the lack of VCT / PITC in several health facilities and supplies inadéqua t test s HIV. Other factors influence this low population screening, including stigma, discrimination, fear of being rejected by relatives, shame or lack of available ARV treatment. (UNAIDS 2015). In 2016, HIV prevalence in Kwango was around 0.3% of the general population, among the which has the nearly 92% were on ART (MOH 2016). In those days, then what is the dan t in this evolving of HIV / AIDS infection in the town of Kenge? And, what socio c ulturels can we associate it? This is what is striving to answer this study aimed to determine the socio-cultural factors that expli nt prevalence of HIV / AIDS infection in the town of Kenge, as the s plane s sociodemographic than educational. It is s pécifiquement enumerate the population who carried out the screening test, dégag st the positives are, and then catégoris st infected subjects by age, sex, place of residence, religion, language group, perception and knowledge. Second, the study may infer socio demographic and educational factors s associated with sero prevalence of HIV / AIDS infection in Kenge City from January 2015 to June 2016.

Literature Paper

The distribution of S IDA around the world is, as many studies suggest, very disproportionate. Such disproportion is seen as a logical consequence of the often-singular situations that prevail in each country. An analysis of the different available data reveals many geographical trends (MINI PLAN, 2007). The latter depend considerably on several determining factors among which, access to prevention and screening services, the context of precariousness of life, promiscuity, the precocity of sexual intercourse and other sexual practices such as the multi-sexual partnership, population mobility, state of security in the country, common awareness practices, availability of drugs [11]. It has been observed that since the introduction of ARVs, the seropositivity no longer appears to patients, their families, their relatives or caregivers, as a declaration of death even though the prevalence is higher among men than women. (PNMLS, 2012). This suggests that antiretrovirals are a real breakthrough in the fight against HIV / AIDS, as they turn a oncedeadly disease into a potentially chronic disease [11]. With regard to the lifestyle conducted, other available data confirm a close link between certain manias and HIV infection. Paid sex and alcohol use, for example, have a significant exposure to this infection [12].

It is now accepted that men who have paid sex are more likely to be physically abusive towards their partners, to have a high number of partners, to consume heavily and to violate. Data from the DHS reconfirm this correlation of Violences between Partenaires in times (VPI) and alcohol consumption (Harvard Unversity, 2006). Awareness plays a role in improving knowledge about this pandemic. In Southern Africa, for example, it is documented that when awareness-raising activities on gender and AIDS accompany the implementation of microfinance projects for 12 months, two years later, a higher level of knowledge about HIV is identified. and HIV testing, increased condom uses with non-marital partners, 55% reduction in physical and sexual violence between intimate partners (UNDP-DRC, 2010). These advances constitute a revolution that is not only medical. It is also the basis of a real change in the popular perceptions of AIDS (Olivier, 2006). Like education, education also has a lot to do with advances in HIV / AIDS testing and care. The risk of contraction of AIDS is related to the level of education [13]. Well integrated, all the benefits gained should lead to a decline in prevalence. According to estimates, HIV / AIDS is ranked as the fourth leading cause of death in the world with 39.5 (CI 34.1 - 47.1) million HIV carriers. In 2006, new infections occurred at about 4.3 million (IC 3.6- 6.6) and deaths were estimated at 2.9 million (IC 2.5 - 3.5) [14].

For all available sources, sub-Saharan Africa is the region most affected by the epidemic and HIV is the main cause of death in this region, which is estimated to have been recorded in the same year 2.8 (IC 2.4 - 3.2) million new infections [14]. In 2006, Mali, with a population estimated at 12,250,019 inhabitants, had an estimated seroprevalence of 1.3% with 1.1% among men and 1.5% among women [15]. Counted among the most affected countries, DR Congo presents different tables, changing according to whether one is east or west and from one year to another. By dividing the Democratic Republic of Congo into two large “West” and “East” zones, populations in the regions and provinces in the east of the country are twice as prevalent as those in the West. the exception of Kinshasa [16]. In the east of the country, the mortality of infected women is twice as high as among western women (Benjamin, 2009). Rape and sexual violence fostered by widespread insecurity are the basis of this high prevalence in Part Est. There is also reason to fear that the same situation will reoccur in the center of the country faced with the same insecurity. These factors are amplified by widespread poverty in some settings and socio-cultural barriers. (PNMLS, 2012). Estimated at 4% for the entire period from 2003 to 2011, this prevalence dropped to 3.4% of the 974,304 PHAs, of whom 439,137 were eligible for ART in 2012, reaching 1.1 in 2013 [17] (UNAIDS, 2013).

Materials and Methods

Description of the mi Place of Study

This field study conducted in the city of Kenge’s neck u r s the period of th January 2015 to June 2016. The city has an e population depress 300.000 divided into 15 districts [18]. It is to evenue capital Province Kwango when decentralization held in the Democratic Republic of Congo n th, 2016. The town of Kenge is located at 5° S latitude, 17° East longitude, and at an average elevation of 555 m above the sea surface [19]. Its climate is humid tropical. The city is entirely on plateaux intersected by valleys, and sometimes, hills between the rivers Wamba in the west and Bakali in the east. The Kenge soil is sandy Karoo-Kalahari type. Its vegetation consists essentially of grassy savannahs, woodlands and forest galleries found along the rivers. The city is connected to the rest of the country mainly by the National Road N° 1, Kinshasa-Kikwit.

Sampling and Technique Collection of Donations

This study was essentially descriptive retrospective based on a survey supported by the literature review and a structured interview to identify HIV-positive people during the research period. The sample in this study was simple random probabilistic. Its size was calculated by the Fisher formula and s’ is raised to 655 people who carried out the voluntary testing. Data collection was done in the structures CDV / DCIP Kenge during the period from e Janver 2015 at Y oun 2016. The enquêt century were made on appointments, obtained prior ment before d or r the interview with the heads of structures under investigation.

Selection Criteria: The following subjects were included in the study sample:

(i) living in the town of Kenge;

(ii) have been consulted in the CDV / DCIP structures during the period of our study; and

(iii) have been tested positive for HIV.

Criteria for Exclusion

Was excluded from the sample, any person having voluntarily refused to participate in the study or having been absent during the investigations.

S Technical Data Analysis

The analyzes were mainly based on descriptive statistics. The data has been tabulated to facilitate the calculation of frequencies. The trends were identified for using the following formulas:

[Equation 1]

Or,

f = Relative frequency

FO = Frequency observed

FA = Expected frequency

[Equation 2]

Or,

p = Prevalence

x = Number of positive cs

N = Total number of cases identified

The chi-square statistic (chi2 or X2) was used to test the null hypothesis that there was no significant relationship between the expected distribution of seroprevalence (E) and observed that e o f presumed socio-psychological factors influence the seroprevalence (O). Thus, the century following assumptions have been testing e e s:

a) H0: E ≠ O, there is a significant difference ent r e distributions of E and O

b) H1 E = O, There ‘a a u cu not significant difference between the E and W of distributions

From an analytical point of view, the chi-square statistic (Khi2 or X2) is represented by the following formula (Equation 3 ):

[Equation 3]

Where,

Ei, the ith expected number of seropositive patients

Oj, the jth observed effective da ns distribution alleged socioeconomic factors explain seroprevalence

ddl, the degree of freedom (equal to nk)

n, the total number of the sample

k, the number of estimated parameters (equal to the number of factors)

p, the signi fi cation rate (equal to the probability of failure of Ho)

The chi-square (Khi2) statistic was tested at the 5% significance level (p = 0.05) using SPSS 12.0 and MS Excel 2010 computer software.

Results of Analysis

Analysis of Socio - Demographic Characteristics of Respondents

The results of u Table 1 reveal that the 655 people tested for HIV, 293 were cases of e male (44.7%) and 362 were of a female (55.3%). The prevalence of infection e u s HIV is eventually raised to 2.9%, 19 times out of 655 (Table 1). L HIV prevalence by age brackets was 2.4% for the 6 th century to 14 years and 3.4% for those 4 years plus 1. The at rs categories recorded no active cases of HIV infection (Table 2). The results in Table 3 reveal that out of a total of 19 subjects, 13 cases were detected at the General Hospital VCT. of Reference (HGR) of Kenge (68%) 4 cases detected at the CDV of the CS de la Barrière (21%); and 2 cases detected at the CDV of CS Mgr. Jean-Gaspard Mudiso / Dream of Kenge (11%) (Table 3). Table 4 indicates that the majority of cases were screened in 2015 (16 cases, 84%); only 3 cases were in 2016 (16%) (Table 4). The distribution of respondents according to the mid place of origin shows a high concentration of subjects carrying the HIV virus in Congo neighborhoods, Kikwit and Bakali / SAS. Indeed, the district of Congo had more cases of HIV positive than the others (with 6 cases, 31.6%) followed by Kikwit and Bakali / SAS (with respectively 5 cases, or 26.3%). The Masikita district recorded 2 cases (10.5%) and the EPOM district shone with a very low HIV prevalence of 5.3% (only 1 case) (Table 5).

Table 1: Sex Distribution of HIV-Tested People.

Source: Author’s (201 7).

Table 2: Distribution of people tested for HIV by age group.

Source: Authors (2017).

Table 3: Distribution of people tested for HIV by age group.

Source: Authors (2017).

Table 4: Seroprevalence by year of screening.

Seroprevalence by year of screening.

Table 5: Seroprevalence according to the place of residence of the respondents.

Source: Authors (2017).

Analysis of Socio- Educational Factors Related to Seroprevalence

The social factors educational not a positive influence on seroprevalence. As an illustration, Table 6 indicated that the Pelende (31.5%), Mbala (20.4%), Suku (18%), Yaka (13%) and Hungani (7.1%) are the largest language groups in the surveyed population, followed by Luba ( 2 , 8 %) , Swahili (2.6%) and Ngala (0.9%). The other language groups represent only 3.6% of the surveyed population (Table 6). On the 655 interviewed subjects, more than 235 were from religion Protestant e (36%), followed by the Catholics (24.2%), kimbanguists (18.2%) , de nonbelievers (8.3%), musulmans (6.6%), and 34 Other topics are coming from various religious onfessions c (or 5, 2%) (Table 7). Report with the perception of respondents are HIV infection, information collected e a u T able 8 shows that 303 655 subjects perceive HIV as a disease ronique ch incurable (46.2%) ; 252 subjects ( 38.4% ) consider it a disease of lovers; close to 100 Topics on the 655 said that all of my exposed to the risk of HIV infecté (15.2%), and; a very small proportion pens é to e nvoutement (0.2%) (Table 8).

Table 6: Sociolinguistic characteristics of the respondents.

Source: Authors (2017).

Table 7: C ra ct i s ticks sociore the igieux investigations.

Source: Authors (2017).

Table 8: Perception of respondents of HIV infection.

Source: Authors (2017).

Concerning modes of transmission, the Table 9 reveals that jets 465 susur 655 asserted u have some knowledge of HIV transmission (71%) against 190 quido contains have not ent at all (29%). En effet, on the s 465 people who knew the mode of transmission, 1 86 cited the sexual mode ( 39.9% ) ; 25.4% the blood mode (either 1 1 8 subjects ); Parental m ode was cited by 93 people ( 19.9% ); 69465 people cited both the sexual way and the s anguin mode ( ie 14.9% ) (Table 9). As for the prevention methods , Table 10 indicates that 465 people sister recognized the corrective t use condoms s c As effective means of AIDS prevention (26.1%); 8 5 pe r PERSONS (18.3%) have spoken ed the integration of prevention of HIV transmission from mother to child activities (PMTCT); 28 subjects targeted the s ecurity transfusion (6%), and; 29 subjects indicated the personal use of objects ranchants t (or 6.3%). Very little o u nt re conn early detection of HIV as a strategy for prevention against the infection HIV (14 people of 465, or 3%). Cepuring 142 4 65 be 32% cited both condoms use and PMTCT; 14 people, silo 3% cited the first three modes. S Only 4.5% of respondents (n it 21 people out of 4 65) cited’re all c m odes (Table 10).

Table 9: Knowledge of respondents on the mode of transmission of HIV / AIDS.

Source: Authors (2017).

Table 10: Knowledge of the respondents on how prevention of HIV / AIDS.

Source: Authors (2017).

Finally, inferential statistics is detected s relationships strongly negative and significant between c,es socio-educational factors retain and seroprevalence; but l e s factors socioethnic n ‘had no influence on the prevalence (Table 11). The board 11 shows that the perception of HIV infection (Kh2 = 17.79 , df = 4 ; p = 0.00) and the fact to know the modes of transmission of AIDS (K h2 = 19.43, df = 4 ; p = 0.00) and its prevention (Kh² = 58.60, df = 8; p = 0.00) avai t a pleasant effect on the seroprevalence. But that there is no relationship between Vait has seroprevalence and all social and ethnic factors cited investigated by the s and r that could positively affects, including membership religi honest (Kh2 = 0.37; df = 6, p = 0, 88 5) and lingu i sti that ( Kh2 = 11.51 , ddl = 9; p = 0, 1 2 3 ). So, possession of accurate information on a transmission and prevention of HIV / AIDS it will be the pillar of any strategy that fight against this scourge of the 2s century.

Table 11: Factors associated socio educational e d seroprevalence at Kenge.

Source: Authors (2017).

Discussion of Results

Discussion on the S Socio - Demographic Characteristics of the Respondents

This study conducted in the city of Kenge during the period of th from January 2015 to June 2016 revealed a general HIV prevalence in the order of 2.9%. When s even from a sample greatly reduced, c es s results indicate that seroprevalence of the city of Kenge is much higher, compared with the national average of 1.1% set by the Sero-Surveillance Report of UNAIDS (2011) and WHO (2011). Indeed, the sister more than 150,000 inhabitants that includes the town of Kenge, only 655 people (0.43%) are on the e s se detected in the selected FOV. This very low enrollment rate in HIV / AIDS testing proves to the satisfaction of the population’s low willingness to know its HIV-positive status. These results corroborate those of Barrere (2016) who, in his study of ‘’ knowledge, attitudes and behavior vis-à-vis STI / AIDS ‘’ found that in Cameroon only 5% of women and 7% men have performed an HIV test and received the results the last 12 months. This low screening rate can also be explained by the low number of HIV diagnoses [20,21].

This study also showed that HIV prevalence was 1.7% for men and 3.8% for women. Several studies have confirmed the e fact that women are increasingly expos ed and now constitute nearly half of the 37.2 million adults (15 to 49) living with HIV in the world. The SSA is the hardest hit region in the world, with nearly 60% of female adults living with HIV, or 13.3 million cases [12,22]. The results of the EDS-2008 relayed by PNMLS (2008) also confirmed the fact that women are significantly affected by the AIDS epidemic than men. This high rate of infection among young women and adolescent girls can be explained by the “sugar daddies” phenomenon, where older men barter gifts and money for unprotected sex, as is the case in Africa. South (WHO, 2016). This situation is also observed in the town of Kenge. Indeed, the distribution of HIV positive has shown that e only old patient s over 14 years, those females and living in Congo neighborhoods, Kikwit and Bakali / SAS, located on the National No. 1 were the most affected. No cases were detected in slices of lower age century at age 5, while s age bracket from 6 to 14 years and more than 14 years o nt recorded respectively es prevalence s of the order of 2.4 and 3.4 %. This is precisely justified risk factor for the best- known HIV transmission, including intensive sexual activity.

The latter increases from the age of 15 when young people do not have enough knowledge about HIV prevention [21]. The survey on mortality, the morbidity and the use of services (EMMUS-V) directed e by the Ministry of Public Health and Population (MSPP) in Haiti in 2012 has dice showed that 2.2 % of people tested for 15-49 years are infected with HIV [22]. This r UTCOME deemed significant lies less in what the u i found in the city of Ke n g e in 2016. Infection in children aged 6-14 may be partly attributed to transfusions and injections made without respect for protection standards. Moreover, the absence infection nd year tranche of age inf e higher in a year some t be consécuti ve integration of the transmission of HIV from mother to child prevention activities ( PMTCT) , in line with UNAIDS guidance , which advocates a triple zero goal: Zero new infections due to HIV; Zero discrimination nt , and ; Zero cases of death due to HIV. As for the origin of the detected event, the present e study demonstrated that the highest proportion is observed Neighborhood Congo (with 31, 6%), followed consecutively of Kikwit neighborhoods and Bakali / SAS (26.3 % each). T ll these neighborhoods are located on the National No. 1 where the o n observes migratory flows and intense commercial activity s. There re are several places of ease, of enjoyment e t food supply. These include bars, hotels, restaurants, shops and e s markets, without forgetting the central parking Kenge, commonly called "B back".

That which exposes the population to risk behavior likely s to foster the spread of HIV / AIDS. Its n ‘ est therefore not surprising to see the s district s Device Masikita et EPOM 10.5 and 5.3% of the cases detected shine with a very low prevalence, estimated at respectively. Analysis t e mp orelle the pr e valence of HIV / AIDS shows that 16 out of 19 positive cases were te te TROUBLE- ed in 2015 (84.2%) against 3 cases in 1 st half of 2016 (ie 15.7%). Although the study focused on the first half of the year, the various studies currently show a downward trend in HIV infection worldwide. Between 2000 and 2016, the number of new infections fell by 39% and that of HIV-related deaths fell by a third, with 13.1 million lives saved thanks to x Antiretroviral Treatments (ART). That Equals Does reflects the considerable efforts made by the national fight against HIV programs, with the support of civil society and various development partners (WHO, 2017). The awareness is so important in the implementation of art programs of fight against HIV / AIDS.

SDiscussion on Socio- Educational Factors Associated with HIV / AIDS

L has awareness r e po s e mainly on socio -ethniques and educational conditioning the thinking e t s e behavior of the general population. These factors include religion and the language or ethnic group, as well as instruction on HIV transmission and prevention training. In general, religion and ethnicity s have often if g nificatifs in determining seroprevalence and in the s studies conducted entirely under other skies [23-25]. But these factors had no particular significance for the explanation of seroprevalence in the Kenge Health Zone. Hence the acceptance of the null hypothesis which establishes a clear difference between socio-ethnic factors and seroprevalence. In fact, predominantly Protestant (36%), Catholic s (24.2%), Kimbanguists (1 8.2%), Muslims and nonbelievers (8.3%), the respondents were either associated to PLHIV, as the l es that are leu rs tribes or native languages. knowledge of respondents on the transmission or prevention of HIV / AIDS and seroprevalence. Sawadogo (2007) concluded t alo r However, there was no particularly significant reason for not accepting the alternative hypothesis that there was not a significant difference between s that e the inadequate knowledge of the channels of HIV transmission appears to be a factor aggravating seroprevalence following non u sing the services VCT ( VCT ).

This inadequate knowledge shines clearly in the way in which people PERC oiv e n t HIV. Many of the respondents are of the opinion that the V IH is a chronic disease i ncurable (46.2%), while others consider it a disease of love ( 38.4% ) or that everyone is supposed to be exposed to the risk of i nfect ion HIV ( 15.2% ) , or that it is a flow (0.2%) . And even though 71% claim to know the modes of transmission of HIV, 2 9% do not know at all. Only 39.9%, 25.4% and 14.9% have respectively cited s exe as m ode main transmission of this infection, followed by m blood ode e t of fashion s sexual and s anguin both. Yet Z Igani (2004) found in his study that only sexual intercourse is the most connue of all the es investigated s (99%). Regarding the prevention, Zigani (2004) reveals that condom es tl is the tactic most famous ed es respondents (respectively 56% and 70% of e ow l ‘ have re known). However, only 26.1% of the subjects in our sample have recognized the correct use of condoms sc A s effective means of prevention of HIV. D ‘ at t r e s, in this case 18.3% have p ense the treatment Prévention of Transmission of HIV M era in Enfant (PMCT) ; 32% cited both condom use and PMTCT , and; 6% respectively p ense to the s transfusion ecurity and personal use objects t ranchants. Only a very few have re conn u early detection of HIV how prevention strategy against infection with HIV (3%).

Conclusion

This study you are carrying on the sociocultural factors associated with the prevalence of HIV / AIDS in the city of Kenge has established a rate of 2.9% rate considered higher than PNMLS which sets national prevalence at 1.1%. The age of more than 14 years, female gender and neighborhoods urbanized, or cosmopolitans were the most affected s. Thus, Congo, Kikwit and Bakali / SAS districts, located along the N° 1 national road, have been the are knowledge of the population about modes of transmission and prevention of HIV infection. The most affected since they sheltered e nt several places of ‘aisanc e and re enjoyment, making the following e to significant emigration and to sexual activity in t ensive. This seroprevalence seems to be aggravated by the nonuse of voluntary counseling and testing (VCT) services, due to the insufficiency of the socio- ethnic and educational factors that condition the thinking and behavior of the population in general. such as religion, language group and ethnicity, cannot face r among the determinants of prevalence of HIV / AIDS infection in the town of Kenge [26-38].

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