Transcript Powerpoint

Ministry of Health and
the fight against AIDS
Ministry of Justice,
Co-infections TB/HIV in prison
Côte d’Ivoire Case study
Doctor J-M MASUMBUKO
ESTHER Coordinator in Côte d’ivoire
24 July 2014
www.aids2014.org
20th IAC, Melbourne, Australia
Introduction
• Cote d’Ivoire : the most affected country in West Africa :
– HIV 3,7%
• MACA = 5.000 prison inmates / 50% of prison population
• HIV in MACA 5,5%
Men : 4,6 %
Women : 14,1 %
• Before 2008: Management of HIV in Prison almost non
existent
• PROJET MACA/CHU BORDEAUX 2008 (ESTHER)
• Extension of the support 22/33 with aid of Global Fund
(Sub recipient of National AIDS program)
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Key Features of prison situation
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Limited medical care
Overpopulation (200-300%)
High mortality rate
lack of hygiene / Cholera Epidemic 2012
Drug and alcohol dependence
Homosexuality, sex workers
poor diet / BERI-BERI cases
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Strategy to fight HIV-TB in prisons (1)
Provide screening to all (inmates and staff)
TB
- screening at arrival
- Externalise sputum analysis
 HIV
- offer of testing on arrival
- Biological assesment if HIV+
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Strategy to fight HIV-TB in prisons (2)
Provide treatment and Care to all
 TB
- Isolation of TB patients and contact tracing
- DOTS
 HIV
- initiation of treatment and follow-up
according to the national protocol
Adequate and sufficient food with dietary
supplements
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Strategy to fight HIV-TB in prisons (3)
• Advocate for Health and rights in Prisons:
• Design a model of intervention replicable
in all prisons
• Respect confidentiality and rights
• Contribute to the writing and validation of
the first « National Recommendations for
Health in Prisons »
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Support of TB patients in Prisons in
2013 (National Program)
• 22/33 prisons offered support to TB patients
Screening
New cases
TPM +
all forms
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22 Prisons
MACA
54
29
85
51
HIV – 2013 Results
(8 prisons : MACA + 7/ Projet ESTHER/GF)
18.000 inmates offered HIV testing
Take up rate : 76%
HIV infection Rate:
Men: 2,92%
Women : 10%
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TB among HIV pts in 12 prisons
1st quarter 2014 (ESTHER/GF)
35
30
Abidjan: 6%
25
20
15
Bouaké: 67%
Man: 9%
10
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VIH+
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VIH et TB
TB Treatment centre within MACA
• A treatment and care center and a
reference center for other prisons
• Should be replicated in all regions
• 2013 Results :
– New cases of TB: 24
– TB (extra pulmonary) : 08
– TB patients tested HIV+ : 07 (22%)
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Key Challenges (1)
• Lack of Health Services in prisons
• Lack of qualified health personnel
• Poor Diet
• Overpopulation
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Key Challenges (2)
• No prevention tools and policy for
HIV / STI
• Difficulty of patient follow up on
release
• Poor data on Drug-Résistance
ESTHER/ANRS Study on multi-drug
resistant TB (Starting Nov. 2014)
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Conclusions (1)
 Screening
TB /HIV in Prisons : a major
Public health priority
 Need
for better health services and
qualified personnel
 Comprehensive
patient management
critical for reduction of drug resistance and
transmission
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Conclusions (2)
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Additional financial resources required
 Projet
ESTHER = Advocating for Health in
Prisons ; Finalisation and political
validation of the first National
Recommendation of Health in Prisons
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Thanks
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Ministry of Health - Cote d’Ivoire
Justice Ministry – Cote d’Ivoire
National HIV Program / Global Fund
Cote d’Ivoire/France Hospital partnerships
Prisons staff
Community consellors
NGO’s involved in pris on project
Prison inmates
ESTHER
Jeanne D’Arc Ouattara
Sidaction
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The MACA TEAM
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