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Presented at the 2nd International Workshop on HIV Pediatrics
16-17 July 2010, Vienna Austria
Siblings testing during Prevention of Mother To Child Transmission (PMTCT) process: what could be
children benefits
E. Senou1, A. Azondekon1, A. Sagui1, A. Keitchion1, I. Adeyanju3
T. Bognon1, L. Beauvais4
T. Ndihokubwayo5, T. Anagonou2
1Military Teaching Hospital, Pediatrics, Cotonou, Benin, 2Benin Armed Forces Health Services, Cotonou, Benin, 3MEDECO, Cotonou, Benin, 4GlaxoSmithKline Foundation, Paris, France, 5UNICEF
Benin, Cotonou, Benin
Oral presentation O_19, 2nd International Workshop on HIV Pediatrics, July 16-17, 2010, Vienna - AUSTRIA
Presented at the 2nd International Workshop on HIV Pediatrics
16-17 July 2010, Vienna Austria
Introduction• Access to care and treatment
– Prevention, diagnosis(testing) and Care to infected children
• Testing: WHO recommendations– PMTCT plus: siblings, father and other relatives
• Our purpose to focus on testing for siblings of newborn followed during PMTCT process
Presented at the 2nd International Workshop on HIV Pediatrics
16-17 July 2010, Vienna Austria
Situation in Benin 1• Total population: 8 millions in 2009
• Prevalence rate as of 2007: 1,7%
• ANC coverage: 32% (2006) to 66% (2009)
• Proportion of women accessing to PMTCT: 28% (2006) to 70% (2009)
• Monoprophylaxie: 70%
• Lost to PMTCT rate: 43%
• 32% of Children in need of HAART are treated
Presented at the 2nd International Workshop on HIV Pediatrics
16-17 July 2010, Vienna Austria
Situation in Benin 2
• In Benin, 13% of women visited ART site within the year following PMTCT interventions (Adeyandju et al, 4th French HIV/AIDS Conference 2007)
• Numbers of infected children are missed for testing and care program
Presented at the 2nd International Workshop on HIV Pediatrics
16-17 July 2010, Vienna Austria
Objectives
• General– To describe outcomes of the strategy used for
testing siblings of newborn followed during PMTCT, in a resource-limited settings
• Specific– Percentage of women with children to be tested– HIV prevalence among siblings– Impact of involving socio-education and human
services in siblings testing
Presented at the 2nd International Workshop on HIV Pediatrics
16-17 July 2010, Vienna Austria
Care Unit for Children Exposed or Infected by HIV – CUCEIH
Military Teaching Hospital
• One of the first pediatric ART site
• Located at Military Teaching Hospital
• Established in 1997 with ARV delivery in 2002 and PMTCT intervention in 2000
• Social, education and human services from 2007– Pediatric social and preventive department
• Family-centered services
• Developing excellence in pediatric care to HIV Children
Presented at the 2nd International Workshop on HIV Pediatrics
16-17 July 2010, Vienna Austria
Pediatric Department – Military Teaching Hospital
Conference roomChild Examination office
Presented at the 2nd International Workshop on HIV Pediatrics
16-17 July 2010, Vienna Austria
CUCEIH at MTH: a global overview
Reception Infected
ExposedMedical Section
File
First visit
Follow up
Internal Referring
External Referring
Psychological Psychological SectionSection
Therapeutic Education Section
Community Care
OPTIMA-Benin
Fathers, Mothers or other relatives in Care
Social and Nutritional Support Section
Adults Psycho-Social Care Unit
Presented at the 2nd International Workshop on HIV Pediatrics
16-17 July 2010, Vienna Austria
Pediatric Social and Preventive Department• Therapeutic Education
• Social worker office for pediatrics
• Psychology
• Nutritional demonstration Unit
• Community Support services
Waiting roomHealth education office
Presented at the 2nd International Workshop on HIV Pediatrics
16-17 July 2010, Vienna Austria
Presented at the 2nd International Workshop on HIV Pediatrics
16-17 July 2010, Vienna Austria
Psychology
Pediatric Social worker Office
Nutritional support
Presented at the 2nd International Workshop on HIV Pediatrics
16-17 July 2010, Vienna Austria
Community office at CUCEIH/MTH
Community Support integrated
OPTIMA base
at Akpakpa PK5
« OPTIMA-BENIN is doing everything for children that is impossible at hospital»
« Only for Children, and their parents if their children are the primary beneficiaries»
Mediation LTFU reduction
Income generative activities
Community pharmacy
Schooling support
Capacity building for Life
Support group Nutrition
Presented at the 2nd International Workshop on HIV Pediatrics
16-17 July 2010, Vienna Austria
Presented at the 2nd International Workshop on HIV Pediatrics
16-17 July 2010, Vienna Austria
Methods 1• From 2004 to 2009, for every baby followed at
the Care Unit for Children Exposed or Infected to HIV(CUCEIH), siblings testing was undertaken if there is any
• From the second visit, and through health education program for PMTCT, siblings testing was suggested– As well, through social, psychological and
community services (from late 2006)
• The process is done continuously until, parents accept to bring the children to CUCEIH until Index baby reached 24 months
Presented at the 2nd International Workshop on HIV Pediatrics
16-17 July 2010, Vienna Austria
Methods 2• Gynaecologic and obstetrical history is
collected as well as number of children died and their age at death
• HIV antibody test was done by rapid tests (determine and Bioline) and confirmation by ELISA
• Statistical analysis– Breakdown period
• Period A: 2004 to 2006• Period B: 2007 and 2009
– Chi squarre, Mann-Withney and Kaplan-Meier curves
Presented at the 2nd International Workshop on HIV Pediatrics
16-17 July 2010, Vienna Austria
Results
Presented at the 2nd International Workshop on HIV Pediatrics
16-17 July 2010, Vienna Austria
Mothers characteristics
• 179 mothers were received with their babies
• 63% (113 mothers) had at least one childalive, other than the one brought for PMTCT follow up– 71 of them (63%) with History of miscarriage,
stillbirth or death child
• Median number of siblings was 2 (1 to 5 children)– 18% had more than 3 children
Presented at the 2nd International Workshop on HIV Pediatrics
16-17 July 2010, Vienna Austria
Children Characteristics• 221 children were identified
– Median age 4 years (13 months - 14 years)– 92 (42.6%) were in Period A
• 188 (85%) were tested– 77% for Period A vs 90.1% for Period B, p=0.01*– 123 (65.4%) with Mothers with history of
miscarriage, stilbirth or child death
• Time to bring children for testing• Median time: 6 months (1 to 23 months)
– 11 months (1 to 23 months) for Period A– 2 months (1 to 17 months) for Period B
• p=0.00, Mann-Whitney*
Presented at the 2nd International Workshop on HIV Pediatrics
16-17 July 2010, Vienna Austria
Time to bring children for testing
time (months)
2520151050
1,0
,8
,6
,4
,2
0,0
period
B
A
Log rank, p=0.00
Presented at the 2nd International Workshop on HIV Pediatrics
16-17 July 2010, Vienna Austria
Testing results• 39 of 188 tested (20.7%) were HIV positive
• Effect of history of miscarriage, stillbirth and child birth– 26% in children with history of Miscarriage, stillbirth or child
death for their mother– vs 11% with no history (p=0.01)*
• Period– 22.5% of Children in Period A vs 19.6% in Period B, p>0.05
• HAART eligibility• 17 of 39 (43.6%) were eligible to HAART according to
National Guidelines– 56.2% (9 of 16) were eligible for Period A– vs 30.4% (7 of 23) for Period B, p=0.10
Presented at the 2nd International Workshop on HIV Pediatrics
16-17 July 2010, Vienna Austria
What about “Not tested”children
• We did not test 33 children(14.9%)
• 22.8% for Period A vs 9.3% for Period B, p=0.01*
• Reasons– parent refusal (12 children)– fear from their mothers (7 children)– children tested before (14 children)
Presented at the 2nd International Workshop on HIV Pediatrics
16-17 July 2010, Vienna Austria
CascadeMothers Received for babies PMTCT follow up (179)
Mothers with at least one other child alive (113)
Children not tested (33)
Children to be tested (221)Mothers with no other child (69)
Children tested (188)
HIV positive children (39)
Infected Children in need of HAART (17)
43.6%
20.7%
Already tested (14)
Parent refusal (12)
Fear of mother (07)
Presented at the 2nd International Workshop on HIV Pediatrics
16-17 July 2010, Vienna Austria
Discussion
• Siblings testing is worthy– Improving access to care and treatment– Contribution to 9.2% of HIV children at
CUCEIH/MTH
• What are challenges now in testing siblings?– Should fathers be involved into this process!
– Should this begin since the maternity?
Presented at the 2nd International Workshop on HIV Pediatrics
16-17 July 2010, Vienna Austria
Conclusion
• A particular look has to be taken to siblings during PMTCT process since the benefits are great
• This strategy should be used as a keyelement in improving access to care and treatment for Children
• As well, health educator, social worker and psychologist should be also involved
Presented at the 2nd International Workshop on HIV Pediatrics
16-17 July 2010, Vienna Austria
Acknowledgments • French Cooperation
– GIP-ESTHER– Hôpital d’Enfants
Armand Trousseau
Waiting hall
Benin Armed Forces Health Services
Albert Gnangnon
Annicette Toudonou, Estelle Juré
Rock Akpoli
Laurianne Beauvais
Tharcienne Ndihokubwayo
Emilie Homawoo
Evelyne Akinocho
DHAPP San Diego
IDI Makere University