Management of HIV children psychological conditions in resource-constraints settings: what can be gained? Authors F. Odjo, A. Azondekon, I. Adeyandju, A.M. Monzorgui, A. Keitchion, A. Sagui, A. Toudonou, R. Akpoli, S. Ogou, E. Homawoo, J. Sehonou, A. Gnangnon Presenting Author Alain AZONDEKON, MD, MPH Care unit for Children Exposed or Infected by HIV (CUCEIH) Military Teaching Hospital Cotonou, BENIN International AIDS Conference, Mexico City, Wednesday 6th August, 2008. WEAD0104

Introduction Psychological disorders in children infected by HIV are less documented in resource-limited setting Psychosocial or Psychological care? A psychologist? Or Conselor, Social workers? Nurses or Physician Management of these disorders in children and their care is a challenge in resources constraint setting because it is a very “ambitious” to afford psychologists in Health Care centers Is there a need to introduce psychological management in the minimum package of HIV children’s care Our aims Outcomes in implementing a psychological care program in a resources-constraint setting And what we gained!

Setting Pediatric service in a Military Teaching hospital Care program to HIV children since 1997 ART Program in 2002 Cumulative patients under HAART 124 (as of June 2008) Human resources: Pediatrician, Nurses, social worker(adult)

Description: Joint Initiative Benin Armed Forces Health Services and GlaxoSmithKline Foundation (France) Psychological unit have been set up August 2005 A clinical psychologist Psychological tests such projective methods Rorschach, Children Apperceptions Test, Thematic Apperception Test Materials for drawing Others: sofa, armchair, dolls Specific Standardized forms Database (Desktop)

Psychologist’s office

Dolls and drawing materials

CUCEIH organization Psychological Section File First visit Follow up Internal Referring External Referring Infected Exposed Reception Medical Section Psychological Section Therapeutic Education Section Social and Nutritional Support Section Community Care OPTIMA-Benin Fathers, Mothers or others relatives Care Adults Psycho-Social Care Unit 7 7

Psychological care program Psychological consultation is given to children their parents As well to caregivers or others relatives involved into children care Children and his family are followed at weekly basis for a month, and 2 times monthly for a trimester and once a trimester When psychologically stable. Follow up for those in bad psychological conditions is twice a week for a month, twice a month until patient is stable

What do we really gained?

Psychological conditions and Management From 2005 to 2007 97 children prospectively monitored HIV children has been psychologically followed ages from 5 months to 15 years, were seen; 51.6% were female 42 had psychological disorders such depression and anxiety, 50% were female Psychological care Behavioural therapy Systemic therapy and advice providing Most of disorders disappeared after 2 months of psychological care, but these disorders improved rapidly when their caregivers had no psychological troubles

Programmatic level (1) Is there a need to afford a psychologist 30% of psychological disorders of HIV children were missed by Healthcare workers compare to the Psychologist F. ODJO, A. AZONDEKON, F HINSON et al, Le volet psychologique de l’enfant et de son entourage dans le contexte du VIH: Peut il être mieux appréhendé par les agents de santé ? 1ères Journées scientifiques du VIH/SIDA au Bénin, Novembre 2007 (communication orale) Integration to minimum package of care Continuum of care Therapeutic education Interaction between patient education and therapeutic education F. ODJO, A. TOUDONOU, A. AZONDEKON et al, L’Education Thérapeutique peut elle avoir un retentissement sur l’équilibre psychologique du patient ? Revue Santé et Développement N°187, 2007 Home visits Be part of home visits team if needed

Programmatic level (2) Medical care Training Psychological referring when patients are in severe health conditions Before switching or changing drugs F. ODJO, A. AZONDEKON, A. TOUDONOU et al, Psychological consequences of drugs stock out: the case during Viracept recall due to contamination by toxic chemical, in resource-limiting setting, 2nd INTEREST Workshop, Dakar(Senegal), May 2008, abstract number: 42 Training Participation to national guidelines of HIV Children care Curriculum of training to healthcare workers Research agenda (ongoing study) Comparative study on psychological care needs of negative versus positive mothers Psychological impact on home visits Disclosing HIV status to HIV children

Collaboration with Universities

Conclusion Psychological Management of HIV Children is easy to do in resource-constraints setting Organized integrated Need of adequate human resource (At the best by a psychologist) Facility and logistics Promoting psychological research is the best strategy to face HIV children At Patients, health care workers, program prospective

Acknowledgments Contact: ipilina2000@yahoo.fr Benin Armed Forces Health Services Laurianne BEAUVAIS Michele BARZACH Emilie HOMAWOO Dominique ROBEZ-MASSON Evelyne AKINOCHO Anne BEUGNY Claudie PINOSA Contact: ipilina2000@yahoo.fr