Teses / dissertações sobre o tema "Risques professionnels – Épidémiologie"
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Duclos, Jean-Claude. "Du bruit, de la surdité et de l'information : aspects physiologiques et psychophysiologiques". Lyon 1, 1986. http://www.theses.fr/1986LYO10038.
Texto completo da fonteChaneliere, Marc. "La sécurité du patient en soins primaires : éléments conceptuels, épidémiologie, interventions auprès des professionnels de santé". Thesis, Lyon, 2017. http://www.theses.fr/2017LYSE1015/document.
Texto completo da fontePrimary care is for patients the first level of contact with the healthcare system, providing answers in 90% of the health-related issues. Patient safety incidents (PSI) are common, reducing quality and safety of care. This work deals with patient safety in primary care. In a first part, this work considers the terminology and epidemiology related to PSI in primary care (through ECOGEN and ESPRIT studies). In a second part, the concept of patient safety culture is discussed, as well as its assessment with professionals or medical students. An international literature review and the translation of a survey for medical students are exposed. In a third part, three examples of risk management elements deployed in primary care are introduced: morbidity and mortality reviews, a PSI reporting system for general practitioners, and a tool for root cause analysis dedicated to primary care (CADYA)
Lopes, Julie. "Analyse du risque radio-induit de décès chez les professionnels de santé exposés aux rayonnements ionisants". Electronic Thesis or Diss., université Paris-Saclay, 2023. http://www.theses.fr/2023UPASR020.
Texto completo da fonteAbstract: Studies of workers exposed to ionizing radiation enable the characterization of health effects resulting from chronic low-dose exposure. Although extensive research has been carried out on the subject, there are still uncertainties surrounding the quantification of these effects. To date, medical workers represents the largest group of workers occupationally exposed to artificial sources of ionizing radiation. Their subsequent risk of various pathologies is therefore an important subject of study. Nevertheless, the conclusions of these studies are uncertain and debated, particularly regarding the risk of developing tumors of the central nervous system (CNS).Based on literature reviews supported by meta-analyses and on statistical analyses of data collected as part of the epidemiological follow-up of the ORICAMs (Occupational Radiation Induced Cancer in Medical staff) cohort, this thesis aims to improve knowledge of the effects of ionizing radiation on health in the context of low-dose exposure.A mortality analysis was carried out on the ORICAMs cohort, including 164 015 medical workers occupationally exposed to ionizing radiation in France, presenting at least one dosimetric record between 2002 and 2012. Mortality was significantly lower in the ORICAMs cohort than in the general population. However, these results based on a comparative analysis with national rates may be influenced by the healthy worker effect, and do not allow to conclude on the existence or not of a potential relationship between occupational exposure and the risk of death. To address this issue, a case-control study nested within the ORICAMs cohort was set up, including 33 cases and 160 controls. However, conditional logistic regression analyses showed no dose-response relationship between occupational exposure to ionizing radiation and death from CNS tumors. An extension of the cohort follow-up and the inclusion of the case-control study in the international BECOME project will increase the statistical power of the analyses, allowing the assessment of the long-term effects of chronic exposure to low doses of ionizing radiation
Mével, Hermine. "Contribution à l’amélioration des connaissances sur les asthmes en relation avec le travail". Thesis, Université de Lorraine, 2019. http://www.theses.fr/2019LORR0119/document.
Texto completo da fonteWork-related asthma (WRA) includes work aggravation of preexisting asthma (WEA) and new-onset asthma induced by occupational exposure (OA). Making an accurate diagnosis of WRA is important, the condition having significant health consequences and substantial socio-economic impacts. The first part is based on a literature review including data on prevalence, risk factors and diagnosis procedures of WRA. The issues in diagnosing WRA are also discussed, as well as the use of airway inflammation markers (FeNO levels and sputum eosinophils). The second part shows an analysis of epidemiological data in 417 apprentices in baking, pastry-cooking and hairdressing, which are populations at risk of OA. Mixed-effect models were applied and showed that the degree of sensitization was related to bronchial hyperresponsiveness (BHR) and FeNO levels. Compared to non-sensitized subjects, FeNO levels were 83% higher (p>0,01) in highly sensitized subjects and 30% higher (p<0,01) in weakly sensitized subjects. The third part describes the protocol of a field study aiming to collect new data on clinical, epidemiological and economical aspects of WRA. It focuses especially on the design of tools and decision algorithms, such as a screening questionnaire, and more advanced questionnaires on control, quality of life, expositions and socio-economic consequences, and a peak-flow journal. Screening results show that a substantial number of workers declare asthma-like respiratory symptoms, some of which being possibly related to work. Despite the importance of WRA diagnosis, diagnostic procedures are still being discussed. Although the apprentice study showed an association between airway inflammation markers (FeNO levels) and atopy markers (prick-tests), their use in the diagnostic procedure is still under discussion. Diagnostic procedures that could be used in populations at work are also subject to think about, in particular in epidemiological study, with the difficulty of differentiating OA from WEA. Thus, in the ARPEIGE study, a screening questionnaire was useful to collect data on asthma-like respiratory symptoms. Nevertheless, few screened workers agreed to go further and fill in the peak flow journal. Similarly, in the literature asthma and COPD screening campaigns using spirometry seemed difficult to implement. There is a lack of strategies that would enable a more accurate screening of WRA
Fendler, Julie. "Approches hiérarchiques bayésiennes pour l'estimation d'un risque sanitaire induit par l'exposome professionnel (co-expositions radiologiques à faibles doses sujettes à des erreurs de mesure) : Application à la cohorte française des mineurs d'uranium". Electronic Thesis or Diss., université Paris-Saclay, 2024. http://www.theses.fr/2024UPASR019.
Texto completo da fonteThe population of uranium miners is a reference population for studying the health effects of chronic exposure to various sources of ionising radiation (IR): radon, gamma rays and uranium dust. However, two statistical problems arise in these studies: 1) the miners' exposures measures are error-prone; 2) the exposures to the three sources of IR are highly correlated. In radiation epidemiology, measurement errors in exposures are often ignored and health risks are estimated source by source, ignoring the synergistic or antagonistic effects of simultaneous exposures. The aim of this work, which is divided into two parts, is to promote the use of hierarchical Bayesian models to address the two problems raised above. All the statistical methods proposed in this work are applied to estimate a health risk from survival data in the French cohort of uranium miners.A model is proposed for estimating a health risk while considering complex measurement errors on radon exposures. These measurement errors depend on the miner's workplace and its work habits which change little over time. These errors are therefore spatially and temporally correlated. They are also heteroscedastic: their variances decrease over time as methods for assessing radon exposure improve. The proposed models are used account for measurement errors in radon exposure when estimating the risk of death by lung cancer, kidney cancer, brain and central nervous system cancer and leukaemia. The correction of the measurement errors and the estimation of the health risk are carried out simultaneously so that the estimation of the risk coefficient account for the uncertainty in the exposures. An MCMC algorithm was implemented in Python 3.8 to infer the model within a Bayesian framework. A simulations study is then carried out to estimate the impact of model misspecification on risk estimates.The three exposures to IRs are considered simultaneously when assessing a health risk by using profil regressions mixture (PRM) models. These models are used to create groups of miners with similar exposure profiles and similar health risks. As before, the inference of groups and the estimation of health risk are carried out simultaneously so that the uncertainty in the grouping is accounted in the estimation of risk. The number of groups in the model is infinite, but only a finite number of groups are non-empty. This assumption, which implies that the number of model parameters is infinite, introduces a difficulty in inferring the model. In addition, the output of the inference algorithm cannot be interpreted directly: post-processing must be carried out in order to form the different groups of individuals. While the choice of post-processing used has an impact on the grouping of individuals, there are only few guidelines on this in the scientific literature. This work proposes a Python implementation of a time-efficient MCMC algorithm for inferring PRM models. This algorithm is used to estimate the risk of death from lung cancer in the French cohort of uranium miners associated with simultaneous exposure to radon, gamma rays and uranium dust. Finally, a simulation study is carried out to compare different post-treatment procedures and provide guidelines on their use
Guseva, Canu Irina. "Etude épidémiologique des travailleurs exposés au risque d'incorporation d'uranium". Phd thesis, Université Pierre et Marie Curie - Paris VI, 2008. http://tel.archives-ouvertes.fr/tel-00812524.
Texto completo da fonteGonzalez, Maria. "Evaluation des expositions professionnelles dans les études épidémiologiques". Université Louis Pasteur (Strasbourg) (1971-2008), 2006. https://publication-theses.unistra.fr/public/theses_doctorat/2006/GONZALEZ_Maria_2006.pdf.
Texto completo da fonteNisse, Catherine. "Facteurs de risque professionnels et environnementaux des syndromes myélodysplasiques et des leucémies myéloïdes chroniques : deux études cas témoins dans le Nord-Pas-de-Calais". Lille 2, 2004. http://www.theses.fr/2004LIL2S043.
Texto completo da fonteIn order to assess the relationship between occupational and environmental risk factors of Myelodysplastic syndromes (MDS) and Chronic Myeloid Leukaemias (CML), we performed 2 case-control studies. Incident cases and sex and age-matched controls of the general population gave data on their occupational exposures and hobby activities by interview. Exposure assessment was reviewed by a group of experts. The study on 204 SMD and 204 controls shows relationship between MDS and smoking habits, life near an industrial plant, gardening, occupations such as health professionals, technical and sales representatives, machine operators, agricultural workers, textile workers, exposure to oil, ammonia, solvents, pesticides and other agricultural hazards. No relation between the exposures studied and a specific cytogenetic abnormality was observed. The study on 110 LMC cases and 440 controls does not show any relation with smoking, life near a nuclear power plant or under a High voltage power line. Cases used to live more often near an industrial plant and had more often occupations exposing to chemicals : labourer, spinning worker, printer or photographer, housekeeper, draughtsperson and were more often exposed to formaldehyde, paints, acids, pesticides, solvents
Berleur-Aubert, Marie-Pierre. "Etude épidémiologique de la fréquence des avortements spontanés en relation avec l'exposition professionnelle paternelle au benzène". Paris 5, 1992. http://www.theses.fr/1992PA05P054.
Texto completo da fonteMoisan, Frédéric. "Prévalence et facteurs de risque professionnels de la maladie de Parkinson parmi les affiliés à la Mutualité Sociale Agricole". Phd thesis, Université Paris Sud - Paris XI, 2011. http://tel.archives-ouvertes.fr/tel-00703143.
Texto completo da fonteLemarchand, Clémentine. "Facteurs de risque de cancers hormono-dépendants en population agricole au sein de la cohorte agriculture et cancer". Caen, 2015. http://www.theses.fr/2015CAEN3159.
Texto completo da fonteAgriculture is an occupational environment which expose to a large range of agents (pesticides, dust…), frequently associated with occurrence of several diseases. Only pesticides have been often studied but the role of specific pesticides remains poorly documented especially in France, first pesticide consumer among European countries. The aim of the thesis was to identify the determinants related to hormone-related cancers. This project relies on the data of the cohort AGRICAN involving more than 180 000 subjects. More than 11 000 cancer cases have been identified by regular linkage with cancer registries (2538 prostate cancers and 1087 breast cancers). Apart from tobacco-related cancers with a lower incidence, some cancers were more frequent in the cohort (prostate, non-Hodgkin lymphoma, multiple myeloma, skin melanoma and lip cancers). Insecticide applicators on cattle, mainly those with the largest number of animals, pesticide applicators on specific crops (fruit growing, cereals, potatoes and tobacco) and specially those who do not wear protective gloves, people performing reentry tasks in those same sectors had a greater prostate cancer risk. Potential exposure to organochlorine insecticides (estimated using the crop-exposure matrix PESTIMAT) also increased prostate cancer risk. Although female farmers had an overall decreased risk of breast cancer, peas and vegetables growers had an increased risk. Results seem different according to menopausal status
Le, Goff Jérémie. "Risque de cancer en milieu agricole : apport de la mesure des adduits à l'ADN leucocytaire pour l'évaluation de l'impact génotoxique de l'exposition professionnelle à des pesticides". Caen, 2004. http://www.theses.fr/2004CAEN4035.
Texto completo da fonteLoyant, Véronique. "Apport d'une approche biologique en population à l'étude des facteurs de risque[s] professionnels et environnementaux des tumeurs primitives du système nerveux central de l'adulte". Caen, 2005. http://www.theses.fr/2005CAEN4062.
Texto completo da fonteAetiology of primary central nervous system tumours is widely unknown and data in France are poor. A case control study (CEREPHY) was done in the Gironde department in France between 1999 and 2001. A significant increased risk of brain tumours was found among subjects with the highest level of occupational exposure to pesticides. Spectrum of TP53 mutations can reflect exposure to environmental carcinogens in some cancers. We screened TP53 mutations by DHPLC and sequencing in brain tumours of the 30 patients of the CEREPHY study occupationally exposed to pesticides and/or to organic solvents. Three mutations have been detected, what is similar to the number expected calculated from literature data. In order to study the influence of a predisposing genetic context on the association between pesticide exposure and brain tumours, we conducted a stratified analysis on the existence of a first degree relative family history of cancer from the CEREPHY study data. Results suggest that individuals with a first degree relative family history of cancer would be at higher risk to develop a brain cancer when they are occupationally exposed to pesticides, compared to individuals without such a family history. In order to continue to study the risk factors of central nervous system tumours and of influence of a predisposing genetic context, we are carrying on a multicentric population-based case control study (CERENAT) with buccal cells collection in France for a two year period in each of the four participating departments. Cases were eligible since January 2004 in the Calvados and Manche departments, june 2004 in the Gironde department and july 2004 in the Hérault department
Mattei, Francesca. "Rôle de l'exposition professionnelle aux solvants organiques dans le risque du cancer du poumon : analyse multidimensionnelle de l'étude ICARE". Thesis, Université Paris-Saclay (ComUE), 2015. http://www.theses.fr/2015SACLS061/document.
Texto completo da fonteContext: The principal risk factor for lung cancer is by far tobacco smoke, however occupational exposures deserve a special interest because they are the 2nd main etiology of this cancer. Little information is currently available on the relationship between lung cancer risk and occupational exposure to solvents that are widely used in several industries. Certain jobs such as painters, who are particularly exposed to solvents, are known to be at increased risk of lung cancer, but the causative agent is still unknown or unproven.Objectives: The aim of the present work was the evaluation of the role of occupational exposure to different organic solvents on lung cancer risk. Initially we studied the effect of occupational exposure to chlorinated solvents; then the analysis integrated exposure to two other solvent families, namely fuels and petroleum solvents and oxygenated solvents, always taking into account the main risk factors for lung cancer, including cigarette smoking and occupational exposure to asbestos.Population and methods: This work was based on a large population-based case-control study, ICARE. Detailed data on the lifelong occupation was collected. A total of 2,926 cases of lung cancer (2,276 men and 650 women) and 3,555 controls (2,780 men and 775 women) were included. Exposure to solvents was assessed by job exposure matrices, developed separately for each substance by industrial hygienists. In addition, exposure to certain solvents was directly reported by subjects in the questionnaire. First we followed a classical statistical regression analysis approach to investigate the role of chlorinated solvents. In the analysis that included three families of solvents, we followed a multidimensional complex methodological approach. Bayesian profile regression method enabled us to overcome traditional analysis limits due to high multicollinearity between solvents.Results and conclusions: The analysis focused on chlorinated solvents suggested an association between lung cancer and occupational exposure to perchloroethylene (PCE), especially in women. While, no association with lung cancer risk could be demonstrated in the second analysis, incorporating the three families of solvents (chlorinated, petroleum and oxygenated). However, as we had increased the specificity of exposure definition, PCE was not included in the studied solvents anymore, preventing us from confirming or denying the association suggested above. Although solvents were not associated with lung cancer, we identified two groups of subjects whose risk of lung cancer was higher than the average. In particular, one of these groups included a high concentration of painters, however our analysis does not advocate the role of solvents to explain this excess. Despite the lack of association between solvent exposure and risk of lung cancer, the Bayesian approach allowed us to analyze the effect of joint exposure to a relatively large number of substances, which is a fairly common situation in occupational exposures. Thanks to this innovative method, our intention is now to look at the role of joint exposure to substances recognized as carcinogenic for the lung such as asbestos, silica dust and diesel engine exhaust, that are frequently found for instance in construction industry
Bensefa-Colas, Lynda. "Analyse des dermatoses professionnelles au sein du réseau national de vigilance et de prévention des pathologies professionnelles (RNV3P) : distribution, tendances et situations professionnelles à risque". Thesis, Sorbonne Paris Cité, 2015. http://www.theses.fr/2015USPCB155.
Texto completo da fonteBackground: In Europe, occupational skin disease is one of the major causes of work-related diseases, among them occupational contact dermatitis (OCD) accounts for 80% of all cases of OSD reported, but data about sectors and agents at risk remains sparse. Objectives: 1) to study OCD trends in terms of industrial activities and main causal agents, 2) to describe industrial sectors or occupations at risk of OCD. Method: Data were collected from the French National Network of Occupational Disease Surveillance and Prevention (RNV3P) during 2001-2010 period, based on the 32 French Occupational and Environmental Disease Consultation Centres. All allergic contact dermatitis (ACD), irritative contact dermatitis (ICD) and contact urticaria (CU) probably or certainly work-related were included in the study. Trends were examined (i) on annual crude numbers of OCD and (ii) on reported odds-ratios of OCD calculated using logistic regression models. Results: 5990 OCD cases were included and concerned more frequently young age classes among women and older age classes among men. Industrial sectors more commonly involved in OCD concerned in decreasing order: health and social work activities, personal service activities, construction, metal industry, public administrations, other business activities, retail trade and repair of motor vehicles, and hotels and restaurants. According to trend analysis of OCD cases, cosmetics (including soaps and fragrances) and biocides increased significantly in health and social work activities; hairdressing products and cosmetics (mainly soaps) in personal service activities (including primarily hairdressers). In construction sector, ACD due to epoxy resins increased during the study period and concomitantly, ICD attributed to cement did not decrease underlying the lack of prevention in this sector at risk. ACD due to metals increased in other business activities mainly occupied by cleaning staff. We showed a rise of ACD due to isothiazolinone compounds whatever the sector. Besides, we have shown the impact of regulatory measures or prevention campaign on OCD: (i) a significant reduction by almost half in the occurrence of ACD attributed to chromate in cement which coincides with the implementation of the European Cement directive and we obtained similar results to a study based on the UK EPIDERM network; (ii) the effectiveness of latex exposure prevention measures for health care workers since half of 2000s and (iii) the wide use of disinfection with an alcohol-based solution in health and social work activity followed by a significant reduction of ICD due to iterative handwashing with soap. Conclusion: RNV3P data allowed to highlight causal agents involved in sectors most at risk of OCD. These results might help intervention policy in health and safety at work and allergy prevention. They also showed the effectiveness of preventative intervention on OCD, suggesting that RNV3P reporting scheme is useful in France to evaluate intervention policy in health and safety at work
Amigou, Alicia. "Etude des facteurs de risque des leucémies de l'enfant". Phd thesis, Université Paris Sud - Paris XI, 2013. http://tel.archives-ouvertes.fr/tel-00954463.
Texto completo da fonteVilleneuve, Sara. "Professions, expositions professionnelles aux solvants et cancer du sein analyse de deux études épidémiologiques sur les cancers du sein chez l'homme et chez la femme". Phd thesis, Université Paris Sud - Paris XI, 2011. http://tel.archives-ouvertes.fr/tel-00639294.
Texto completo da fontePaget-Bailly, Sophie. "Facteurs de risque professionnels des cancers des voies aéro-digestives supérieures : Synthèse des données épidémiologiques et analyse d’une étude cas-témoins, l’étude Icare". Thesis, Paris 11, 2012. http://www.theses.fr/2012PA11T061/document.
Texto completo da fonteBackground: There is sufficient evidence that asbestos causes laryngeal cancer, but overall the role of occupational exposures in the etiology of head and neck cancer (HNC) remains largely unknown. Although several studies have reported associations between occupational exposures and HNC, it is difficult to draw firm conclusions. Objectives: (1) To summarize available epidemiologic data on occupational exposures and cancers of the oral cavity (OC), pharynx and larynx (the most frequent HNC); (2) using data from a large case-control study, to identify occupations and industries with an increased risk of HNC, then to investigate the role of some suspected occupational exposures (asbestos, mineral wools (MW), cement dust, silica). Methods: (1) A literature research and a series of meta-analyses were performed. (2) The Icare study is a French population-based case-control study including 2415 HNC cases and 3555 controls. Complete and detailed occupational histories were collected. Analyses by job title were conducted. Job exposure matrices, developed by the Occupational Health Department of the French Institute for Public Health Surveillance (InVS), were used to assess lifetime occupational exposure to asbestos, MW, cement dust and silica. Results: Significantly increased meta-relative risks (meta-RR) were obtained considering laryngeal cancer and exposures to polycyclic aromatic hydrocarbons (PAH), engine exhausts, working in the textile industry and the rubber industry, and for cancer of the OC and pharynx and exposures to asbestos, PAH and engine exhausts. Significantly increased risks were found for several jobs and industries, some of them entailing exposures to agents for which meta-RR were increased. Analyses for specific occupational exposures confirmed the association between asbestos and laryngeal cancer and showed an association with the risk of oral cavity and pharyngeal cancer. An association with exposure to cement dust was also suggested. The results did not support an association between HNC risk and exposure to MW or silica. Conclusion: This work emphasizes the role of occupational exposures in HNC. Overall, our results suggest associations between HNC and exposure to asbestos, PAH, cement dust, and work in the rubber industry
Rachet, Bernard. "Étude internationale de cohorte sur les risques de cancer parmi les personnels des laboratoires de recherche biomédicale et agronomique : résultats et développements méthodologiques sur les effets de latence et dose-réponse". Lyon 1, 2000. http://www.theses.fr/2000LYO1T054.
Texto completo da fonteMaugard, Charlotte. "Analyse des données massives de source assurantielle de la Mutualité Sociale Agricole, pour la surveillance en santé au travail des travailleurs agricoles en France". Thesis, Université Grenoble Alpes (ComUE), 2019. http://www.theses.fr/2019GREAS035.
Texto completo da fonteIntroduction: Health surveillance and vigilance (identification of new risks in particular) represent a major challenge in the field of occupational health. In addition to classical epidemiological studies, the systematic analysis, without a priori, of data collected routinely could be an asset for the early detection of diseases related to work. In this context, the social protection scheme dedicated to French agricultural workers, known as “Mutualité Sociale Agricole” (MSA), wanted to develop its vigilance activity by exploiting its medico-administrative data, used for the reimbursement of health expenditures. In partnership with the French Agency for Food, Environmental and Occupational Health & Safety (ANSES), a data mining project has been set up in which this thesis work fits. The aim of the thesis is, more precisely, to test, without any prior assumptions, the existence of associations between agricultural activities and pathologies recognized as long-term disease (LTD).Method: The work presented was conducted on self-employed population (heads of farms or enterprises) affiliated to the MSA. It relied on the one hand on a contributors’ database which includes, at the individual level, information about occupational activities, demographic and socio-economic characteristics, and on the other hand, on a medico-administrative database with declarations of long-term diseases (LTD) and associated information like ICD-10 diseases. Thanks to the agreement of the French Data Protection Authority (CNIL), a unique identifier was created so that, for the first time, these administrative and medico-administrative data could be merged and restructured to allow the application of models. Logistic regression models were performed, adapting variable selection for each LTD and using cross-validation to limit over-fitting of models. Several methods have been tested to better take into account potential confounders. These different models were evaluated via robustness measures and applied at two-level of precision for pathology (LTD and ICD-10). The statistical associations between each combination of occupational activity and LTD were characterized by p-values, corrected for multiple tests, and odds ratio.Results: Data management allowed us to consider a population of 899 212 self-employed affiliated between 2006 and 2016. Among them, it was possible to identify 100 706 individuals with at least one declaration of LTD over the observation period. The applied methodology revealed 54 statistically significant associations between an occupational activity and an LTD, making it possible to capture already known or suspected health determinants but also to generate interesting hypotheses. After adjusting for confounding factors, the agricultural sectors most associated with LTD, among the self-employed, are viticulture, timber exploitations, landscaping and gardening or reforestation.Discussion: This thesis provides a first demonstration of the feasibility and relevance of the systematic analysis of data collected routinely for insurance purposes, concerning the overall agricultural population, to search for health risks associated with occupational activities. The statistical "signals" thus highlighted will then be investigated by a group of experts from different scientific and occupational fields. Other models should be tested like survival models. This approach may thus be a valuable tool contributing to the health surveillance system dedicated to agricultural workers
Aho, Joséphine. "Prévention du VIH chez les femmes travailleuses du sexe de Conakry, République de Guinée : conseil dépistage volontaire, comportements à risque et infections sexuellement transmissibles". Thèse, 2010. http://hdl.handle.net/1866/5276.
Texto completo da fonteBackground: Female sex workers (FSW) constitute the population most at risk for HIV infection in many countries of Sub-Saharan Africa. Several interventions have been implemented in this population to reduce the risk of infection. These interventions include the promotion of condom use and the screening and treatment of sexually transmitted infections (STI). However, some components are poorly represented among the interventions offered to FSW. Voluntary counselling and testing could be a useful intervention of primary and secondary prevention for this population but the acceptability of this intervention by FSW is little-known. In addition, in terms of surveillance of the epidemics, the evaluation of the validity of self-reported condom use is important as this indicator is frequently used in population surveys. More information is also needed about the importance of the desire for children in using inconsistently condoms with the main non-paying regular partner. Finally, the prevalence of STIs such as HPV-16 and the combined impact of sociodemographic, behavioural and preventive factors on HIV/STIs infection in this population need to be assessed. Objectives: The objectives of this thesis are 1) to measure the acceptability and the consequences of voluntary HIV counselling and testing among FSW in Conakry, Guinea; 2) to assess the validity of self-report condom use in this population through a biological indicator of semen, the prostate specific antigen (PSA); 3) to measure condom use with clients and non-client partners of FSW and to study the importance of the desire for children in inconsistent condom use with the main regular non-client partner and 4) to measure the prevalence of STIs and HIV and the socio-demographic, behavioural and preventive factors related to these infection outcomes. Methodology: We conducted a longitudinal study in the city of Conakry, Guinea among 421 FSW recruited in three health centers adapted for FSW. A longitudinal mixed design allowed for quantitative and qualitative data collections at baseline and one year later. Biological screening tests for STIs and HIV were performed. Results: The first article presented in this thesis showed that the acceptability of voluntary counselling and testing is high among FSW. The acceptance rate of testing, the return rate for results and disclosure of HIV status were close to 100%. This acceptability seemed to be the result of a high risk perception of HIV infection and of social pressure on FSW by the sex work stakeholders to undergo testing and to disclose their serostatus. Negatives consequences to VCT were rare. The second paper showed that self-reported recent condom use had a very low sensitivity when compared to the gold standard. Thus, most women in whom the PSA was found did not report any recent unprotected intercourse. The discrepancy between self-reported recent condom use and the presence of PSA was associated with a perceived high risk of HIV infection. The third section showed that while condom use was very common with clients, it was much less with non-client regular partners. The desire for pregnancy among SW contributed significantly to inconsistent condom use with this type of sexual partner. Socio-demographic characteristics, behavioural factors and co-infection with other STIs were associated with the presence of STIs and HIV, which were common despite all the interventions that were conducted in this population. Conclusion: In conclusion, HIV prevention among FSW is a challenge requiring the development of integrated strategies that take into account the commercial context in which these interventions are implemented but also FSW’s childbearing aspirations.
Kalau, Mutej Jean-Marie. "Étude des déterminants socio-familiaux associés aux comportements sexuels à risque des adolescents de Lubumbashi : Une contribution à la théorie socio-psychologique de la santé". Phd thesis, 2013. http://tel.archives-ouvertes.fr/tel-00862001.
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