Cecilia Ferreyra – MSF OCBA MSF UK Scientific Day 2017 Implementing systematic HIV testing in a nutritional programme in Niger Cecilia Ferreyra – MSF OCBA MSF UK Scientific Day 2017

Niger: Tahoua Region Madaoua District: 457,831 pop. MSF 2015 International Activity Report Cecilia Ferreyra - MSF - Implementing systematic HIV testing in a nutritional programme in Niger

Project Setting “This retrospective analysis met the criteria of the MSF Ethics Review Board for exemption from ethics review. Authorized by Jean François Saint-Sauver MSF OCBA” Muslim population Main killers malaria and malnutrition 2005: MSF OCBA opens a nutritional project: Inpatient therapeutic feeding centre (ITFC) Ambulatory therapeutic feeding centre (ATFC) and Care for hospitalized children <5 years ITFC: 2204 severe acute malnourished (SAM) children/year Hospitalization: 1514 admissions/year, mortality rate 5.4% Photo: Nuria Salse We confirm we have permission to use images from participants included in this presentation. Cecilia Ferreyra - MSF - Implementing systematic HIV testing in a nutritional programme in Niger

Project Setting National HIV prevalence: 0.5% 2013 MSF blood bank data: HIV prevalence 8% Hep B prevalence 12% Photo: Nuria Salse Cecilia Ferreyra - MSF - Implementing systematic HIV testing in a nutritional programme in Niger

High rates of HIV prevalence reported in malnourished children BACKGROUND High rates of HIV prevalence reported in malnourished children 2014 MSF recommends systematic HIV testing in nutritional centres Cecilia Ferreyra - MSF - Implementing systematic HIV testing in a nutritional programme in Niger

However…. BACKGROUND OBJECTIVE To describe the implementation model Lack of access to early infant diagnosis (EID) Lack of trained staff Poor supply of paediatric antiretroviral therapy (ART) formulations Difficult programmatic decision to tackle only children Fear of jeopardising nutritional activities STIGMA… OBJECTIVE To describe the implementation model To assess HIV prevalence among children admitted to the MSF ITFC Cecilia Ferreyra - MSF - Implementing systematic HIV testing in a nutritional programme in Niger

METHODS Flying HIV/TB Extra human resources Start reproductive health activities! Extra human resources Feb- March 2014: Training MOH and MSF staff Targeted HIV testing March 2014 March 2015 December 2014: # 127/3841 children tested (3.3% of total ITFC) # 9 (7%) HIV positive June 2015: Systematic HIV testing at ITFC Community sensitization & health promotion Dec 2016: 7449 children tested Drug and lab supply Flying HIV/TB

METHODS June 2015 – Dec 2016: 7652 children admitted at ITFC (425/month) 7% below 6 months 56% between 6 and 23 months 37% between 2 and 5 years old 7499 (98%) accepted HIV testing 52 (0.7%) HIV + 25 > 18 months Confirmed HIV+ 27 < 18 months went for DNA PCR 13 DNA PCR HIV + 7499 tested with rapid diagnostic test Cecilia Ferreyra - MSF - Implementing systematic HIV testing in a nutritional programme in Niger

NO DATA ON VIROLOGICAL SITUATION HIV CASCADE 38 children HIV + 32 (84%) start ART 28 (88%) under care 3 (9%) died 1 (3%) Lost to follow-up NO DATA ON VIROLOGICAL SITUATION Cecilia Ferreyra - MSF - Implementing systematic HIV testing in a nutritional programme in Niger

CHALLENGES Poor awareness about HIV Lack of trained staff No access to EID Nutrition and malaria main priorities Monitoring and evaluation (M&E) tools not available Cecilia Ferreyra - MSF - Implementing systematic HIV testing in a nutritional programme in Niger

LIMITATIONS Retrospective review with limited data No data segregation per age (> or < 18 months) No data on virological outcomes Cecilia Ferreyra - MSF - Implementing systematic HIV testing in a nutritional programme in Niger

CONCLUSIONS Implementation of “systematic” HIV testing in nutritional programmes is feasible Lower HIV prevalence than reported In settings with low HIV prevalence it might be worth starting to test mothers When it is a new activity it is recommended to reassess HIV situation after some time to review strategy It is URGENT to advocate for wider access to EID at point of care in these settings Cecilia Ferreyra - MSF - Implementing systematic HIV testing in a nutritional programme in Niger

Review data from all nutritional projects providing HIV care In Niger, change strategy to offer HIV test first to mothers Share this experience among similar projects for wider roll-out Improve/simplify package of HIV care for these settings Cecilia Ferreyra - MSF - Implementing systematic HIV testing in a nutritional programme in Niger

Acknowledgments Co-authors: Mercé Rocaspana, Boucabar Seydou, Carol Botger Patients and Staff from Madaoua Hospital Cecilia Ferreyra - MSF - Implementing systematic HIV testing in a Nutritional programme in Niger

Thanks for your attention…….. Photo: Nuria Salse