En dépit d’une riposte planétaire développée depuis un quart de siècle, l’infection à VIH/sida continue de toucher de plus en plus de personnes, même si par ailleurs un déclin est relevé dans plusieurs pays. L’Afrique subsaharienne demeure son territoire privilégié avec plus des deux tiers des contaminations et des décès. Le Burkina Faso présente une évolution favorable avec une diminution du taux d’infection estimé, dans la population des 15-49 ans, à 7,17 % en 1997 et à 1,6 % en 2007. Mais la maladie aurait emporté 12 000 personnes en 2005 et 9 200 en 2006, en relation avec les niveaux d’infection des années 1990 et les difficultés d’accès aux traitements. En effet, bien que la thérapie antirétrovirale existe et que son accessibilité s’améliore au fil du temps, on estime que les besoins sont loin d’être couverts : seulement 17 263 personnes sous ARV dans 76 structures de soins pour plus de 46 000 besoins de traitements estimés. Vivre avec le VIH et accéder aux traitements est facteur de déstabilisation pour les individus. Cette déstabilisation a plusieurs expressions : elle peut être sociale, économique et/ou spatiale. L’analyse enseigne que, malgré les progrès et les champs d’action des structures publiques, privées, auxquelles s’ajoutent les structures communautaires agréées, les disparités spatiales sont encore grandes pour la prise en charge thérapeutique des personnes vivant avec le VIH. Partant de là, et en fonction des accessibilités aux traitements, on observe chez les personnes vivant avec le VIH des itinéraires thérapeutiques différenciés, facteurs de nouvelles territorialités. Celles-ci révèlent non seulement des logiques personnelles mais encore les logiques spatiales et sociales des acteurs du soin, illustrant pour partie le fonctionnement du territoire national. Des enquêtes réalisées auprès des personnes sous traitement permettent de mettre en évidence ces territorialités et les processus de territorialisation / Despite a global response developed over the past quarter century, HIV / AIDS continues to affect more and more people, even if further decline is observed in several countries. Sub- Saharan Africa remains his preferred territory with more than two thirds of infections and deaths. The Burkina Faso has a favorable trend with a decrease in the rate of infection found in the population of 15-49 years, to 7.17% in 1997 and 1.6% in 2007. But the disease would have prevailed 12 000 in 2005 to 9 200 in 2006, in connection with infection levels of the 1990s and the difficulties of access to treatment. Indeed, although antiretroviral therapy exists and that its accessibility improves over time, it is estimated that the needs are far from being covered only 17 263 people on ARVs in 76 care facilities for more than 46 000 needs treatment estimated. Living with HIV and access to treatment is destabilizing factor for individuals. This destabilization has several expressions: it can be social, economic and / or space. The analysis shows that, despite progress, public organizations, private, plus the structures approved does not cover needs and that the disparities are even larger space. From there, depending on accessibility to treatment, there is among people living with HIV differentiated therapeutic routes, new factors territoriality. They reveal not only logical but also personal space logic and social care players, illustrating in part the functioning of the national territory. Surveys conducted among people under treatment can highlight these territoriality and regionalization processes

Made available in DSpace on 2016-12-23T13:56:02Z (GMT). No. of bitstreams: 1 dissertacao em pdf.pdf: 3843489 bytes, checksum: cf2e697dbd0b8d0de2ae9be8b74192c6 (MD5) Previous issue date: 2008-03-27 / Even with the advances that have allowed a better understanding of pathogenesis, epidemiology and prevention of infection, approximately 33.2 million people worldwide are suffering from HIV / AIDS. The HIV / AIDS is considered a pandemic, causing a major demographic impact due to the devastating infection among young adults. According to the Organization of the United Nations fighting AIDS (UNAIDS), despite a reduction in the overall number of new infections, this index is still very high, and the sexually transmission still the more frequent form of HIV infection. In order to interrupt transmission efficiently an accurate and fast diagnosis is pivotal. The great majority of diagnostic methods for HIV are based in the detection of antibodies specific to different proteins of the virus or the detection of its genetic material. Therefore delay in obtaining accurate results affects negatively prevention and treatment strategies. In the present study, we examined the effectiveness and cost of a rapid test (Rapid Check) as an alternative method in the serological diagnosis workflow for HIV infection. Three hundred and eight serum samples sent to LACEN-ES between October 2006 and May 2007 were analyzed. Both the Rapid Check and the prototype Tri-line depicted a high degree of concordance (98.97%) compared to other tests used for diagnosis of HIV infection at the LACEN-ES. In parallel, from 16 samples with results considered as "inconclusive" by the normal workflow due to absence or low reactivity of anti-gp41, only 3 out of these 16 were still considered inconclusive after using the Rapid Check. In addition to its efficiency, when cost were considered, rapid tests had the lowest cost/test, and required the shortest time to provide a final result (less than 15 minutes) not requiring additional equipment, accessories or specific infrastructure. Therefore, we believe that rapid tests with performance equal to or greater than the Rapid Check could be used as an alternative method at the Immunofluorescence, thus promoting a reduction in the cost and time of release of results. / Mesmo com os avanços que permitiram uma melhor compreensão da patogênese, epidemiologia e prevenção da infecção, cerca de 33,2 milhões de pessoas no mundo são portadoras de HIV/AIDS. A infecção pelo HIV/AIDS é considerada uma pandemia, causando um importante impacto demográfico, devido à infecção devastadora de adultos jovens. Segundo Organização das Nações Unidas para combate a AIDS (UNAIDS) apesar de uma redução no número global de novas infecções, este índice ainda é muito elevado, sendo a transmissão sexual a forma de contágio mais freqüente. Para que a cadeia de transmissão seja interrompida eficientemente é necessário que o diagnóstico dos casos seja preciso e rápido. Os métodos de diagnóstico para o HIV se baseiam, em sua maioria, na detecção de anticorpos específicos para as diferentes proteínas do vírus ou na detecção de seu material genético. Portanto o atraso na obtenção dos resultados afeta negativamente os programas de prevenção e tratamento. Neste estudo, foram analisados a efetividade e o custo da utilização de um teste rápido (Rapid Check) como método alternativo no fluxograma de diagnóstico sorológico da infecção pelo HIV. Para isso, foram analisadas 308 amostras de soro encaminhadas para o LACEN-ES entre outubro de 2006 e maio de 2007. Tanto o Rapid Check quanto o protótipo Tri-line apresentaram alto grau de concordância (98,97%) quando comparados a outros testes utilizados para o diagnóstico da infecção pelo HIV no LACEN-ES. Paralelamente, das 16 amostras com resultados considerados como inconclusivos pelo fluxograma normal, devido a ausência ou baixa reatividade de anticorpos anti-gp41, apenas em 3 delas o Rapid Check foi incapaz de produzir um resultado conclusivo. Paralelamente à eficiência, ao se considerar o custo, os testes rápidos apresentam custo inferior aos demais métodos, além de necessitarem de um tempo de execução menor (15 minutos) e não necessitarem de equipamentos, acessórios e infra-estrutura específica adicionais. Portanto, acreditamos que testes rápidos com a performance igual ou superior a do Rapid Check poderiam ser utilizados como método alternativo junto à Imunofluorescência, promovendo assim uma redução no custo e no prazo de liberação de resultados.