1. 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, WEAD0104

2. 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!

3. 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)

4. 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)

5. Psychologist’s office

6. Dolls and drawing materials

7. 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

8. 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

9. What do we really gained?

10. 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

11. 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

12. 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

13. Collaboration with Universities

14. 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

15. 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: