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Co-infections TB/HIV in prison Côte d’Ivoire Case study

Doctor J-M MASUMBUKO ESTHER Coordinator in Côte d’ivoire

24 July 2014 20th IAC, Melbourne, Australia

Ministry of Justice,Ministry of Health and the fight against AIDS

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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

• 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 protocolAdequate 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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• 22/33 prisons offered support to TB patients

Support of TB patients in Prisons in 2013 (National Program)

Screening 22 Prisons MACA

New cases TPM +

54 29

all forms 85 51

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HIV – 2013 Results (8 prisons : MACA + 7/ Projet ESTHER/GF)

9

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)

ABIDJAN

TIASSALE

DIMBO

KRO

BOUAKE

MAN

SOUBRE

SASSANDRA

DABOU

TOUM

ODI

BONGO

UANOU

ABENGOURO

U

BONDO

UKOU

0

5

10

15

20

25

30

35

VIH+ VIH et TB

Abidjan: 6%

Bouaké: 67%

Man: 9%

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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)

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• 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