1. 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

2. 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

3. 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
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Cecilia Ferreyra - MSF - Implementing systematic HIV testing in a nutritional programme in Niger

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

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