title: Oral health and HIV infection among female sex workers in Abidjan, Côte d'Ivoire.
abstract: BACKGROUND
  Worldwide, female sex workers (FSW) represent a vulnerable population for oral diseases due to many risk factors including HIV infection and drug abuse. In sub-Saharan Africa, little is known about the burden of oral diseases and their determinants in vulnerable populations. The aim of the study was to estimate the prevalence and associated factors of oral diseases among FSW.
  
  
  METHODS
  A cross sectional study was conducted among FSW who attended a dedicated non-profit clinic in Abidjan, Côte d'Ivoire from June to August 2013. Data about the presence of dental caries, periodontitis and oral-mucosal lesions were collected by a dentist during an oral examination. Behavioural information related to oral hygiene habits as well as tobacco and alcohol consumption were collected through a standardized questionnaire. Information related to HIV infection including HIV diagnosis, last known CD4 count and antiretroviral therapy were documented through a medical chart review. Logistic regression models were used to identify factors associated with oral diseases.
  
  
  RESULTS
  A total of 249 FSW with a median age of 29 years, [Inter Quartile Range (IQR) = 23-36] and a median duration of sex work of 24 months [IQR 9-60]) were included. Current tobacco use and hazardous alcohol use were reported in 21.7 % and 19.7 % of FSW, respectively. The estimated prevalence of HIV infection was 33.7 % [95 % confidence interval (CI); 27.8 - 39.6]) and 82.1 % of HIV-infected FSW were on antiretroviral therapy . The prevalence of dental caries, periodontitis and oral-mucosal lesions were 62.3 % [95 % CI 55.5 - 67.5], 14.5 % [95 % CI 10.2 - 18.9] and 8.2 % [95 % CI 4.8 - 11.5], respectively. In multivariate analysis, periodontitis, oral-mucosal lesions and HIV infection were associated with odds ratio of 2.6 [95 % CI, 1.2-5.8]) and 50.0 [95 % CI; 6.4-384.6].
  
  
  CONCLUSIONS
  This study showed a high prevalence of oral diseases among FSW in Abidjan. HIV infection was common and significantly associated with periodontal diseases and oral-mucosal lesions. There is a need to integrate regular screening and treatment of oral lesions into the medical follow-up of FSW along with strategies for HIV prevention.
authors.affiliation: Programme PACCI, CHU Treichville, Site de Recherche ANRS, Abidjan, Côte d'Ivoire. nouaman_et_vie@yahoo.fr.
authors.forename: Marcellin N
authors.initials: MN
authors.lastname: Nouaman
authors.affiliation: UFR Odonto-Stomatologie, Université Félix Houphouët Boigny, 18 BP 1954, Abidjan 18, Côte d'Ivoire. ead_dm@yahoo.fr.
authors.forename: David G
authors.initials: DG
authors.lastname: Meless
authors.affiliation: Programme PACCI, CHU Treichville, Site de Recherche ANRS, Abidjan, Côte d'Ivoire. ahuatchi@gmail.com.|Département de Dermatologie et Infectiologie, UFR des Sciences Médicales, Université Félix Houphouët Boigny, Abidjan, Côte d'Ivoire. ahuatchi@gmail.com.
authors.forename: Patrick A
authors.initials: PA
authors.lastname: Coffie
authors.affiliation: Université Bordeaux, ISPED, Centre INSERM U897- Epidémiologie-Biostatistique, F-33000, Bordeaux, France. elise.arrive@isped.u-bordeaux2.fr.|INSERM, ISPED, Centre INSERM U897- Epidémiologie-Biostatistique, F-33000, Bordeaux, France. elise.arrive@isped.u-bordeaux2.fr.
authors.forename: Elise
authors.initials: E
authors.lastname: Arrivé
authors.affiliation: Programme PACCI, CHU Treichville, Site de Recherche ANRS, Abidjan, Côte d'Ivoire. boris.tchounga@yahoo.fr.|Université Bordeaux, ISPED, Centre INSERM U897- Epidémiologie-Biostatistique, F-33000, Bordeaux, France. boris.tchounga@yahoo.fr.|INSERM, ISPED, Centre INSERM U897- Epidémiologie-Biostatistique, F-33000, Bordeaux, France. boris.tchounga@yahoo.fr.
authors.forename: Boris K
authors.initials: BK
authors.lastname: Tchounga
authors.affiliation: Programme PACCI, CHU Treichville, Site de Recherche ANRS, Abidjan, Côte d'Ivoire. didier.ekouevi@gmail.com.|Université Bordeaux, ISPED, Centre INSERM U897- Epidémiologie-Biostatistique, F-33000, Bordeaux, France. didier.ekouevi@gmail.com.|INSERM, ISPED, Centre INSERM U897- Epidémiologie-Biostatistique, F-33000, Bordeaux, France. didier.ekouevi@gmail.com.|Département de santé publique, Faculté des Sciences de la santé, Université de Lomé, Lomé, Togo. didier.ekouevi@gmail.com.
authors.forename: Didier K
authors.initials: DK
authors.lastname: Ekouévi
authors.affiliation: Clinique de Confiance, Abidjan, Côte d'Ivoire. anomacamille@yahoo.fr.
authors.forename: Camille
authors.initials: C
authors.lastname: Anoma
authors.affiliation: Département de Dermatologie et Infectiologie, UFR des Sciences Médicales, Université Félix Houphouët Boigny, Abidjan, Côte d'Ivoire. speholie@afnet.net.
authors.forename: Serge P
authors.initials: SP
authors.lastname: Eholié
authors.affiliation: Université Bordeaux, ISPED, Centre INSERM U897- Epidémiologie-Biostatistique, F-33000, Bordeaux, France. francois.dabis@isped.u-bordeaux2.fr.|INSERM, ISPED, Centre INSERM U897- Epidémiologie-Biostatistique, F-33000, Bordeaux, France. francois.dabis@isped.u-bordeaux2.fr.
authors.forename: François
authors.initials: F
authors.lastname: Dabis
authors.affiliation: Université Bordeaux, ISPED, Centre INSERM U897- Epidémiologie-Biostatistique, F-33000, Bordeaux, France. antoine.jaquet@isped.u-bordeaux2.fr.|INSERM, ISPED, Centre INSERM U897- Epidémiologie-Biostatistique, F-33000, Bordeaux, France. antoine.jaquet@isped.u-bordeaux2.fr.
authors.forename: Antoine
authors.initials: A
authors.lastname: Jaquet
mesh_terms: D000328:Adult; D018791:CD4 Lymphocyte Count; D007560:Cote d'Ivoire; D003731:Dental Caries; D005260:Female; D015658:HIV Infections / Q000453:epidemiology; D006801:Humans; D009059:Mouth Diseases / Q000453:epidemiology; D016017:Odds Ratio; D009909:Oral Health; D015995:Prevalence; D012307:Risk Factors; D060386:Sex Workers