1. www.aids2014.org Co-infections TB/HIV in prison Côte d’Ivoire Case study Doctor J-M MASUMBUKO ESTHER Coordinator in Côte d’ivoire 24 July 2014 20 th IAC, Melbourne, Australia Ministry of Justice, Ministry of Health and the fight against AIDS

2. www.aids2014.org Introduction Cote d’Ivoire : the most affected country in West Africa : –HIV 3,7% MACA = 5.000 prison inmates / 50% of prison population HIV in MACA 5,5% Men : 4,6 % Women : 14,1 % Before 2008: Management of HIV in Prison almost non existent PROJET MACA/CHU BORDEAUX 2008 (ESTHER) Extension of the support 22/33 with aid of Global Fund (Sub recipient of National AIDS program)

3. www.aids2014.org Key Features of prison situation Limited medical care Overpopulation (200-300%) High mortality rate lack of hygiene / Cholera Epidemic 2012 Drug and alcohol dependence Homosexuality, sex workers poor diet / BERI-BERI cases

4. www.aids2014.org

5. Strategy to fight HIV-TB in prisons (1) Provide screening to all (inmates and staff)  TB - screening at arrival -Externalise sputum analysis  HIV - offer of testing on arrival -Biological assesment if HIV+

6. www.aids2014.org Strategy to fight HIV-TB in prisons (2) Provide treatment and Care to all  TB - Isolation of TB patients and contact tracing -DOTS  HIV -initiation of treatment and follow-up according to the national protocol Adequate and sufficient food with dietary supplements

7. www.aids2014.org Strategy to fight HIV-TB in prisons (3) Advocate for Health and rights in Prisons: Design a model of intervention replicable in all prisons Respect confidentiality and rights Contribute to the writing and validation of the first « National Recommendations for Health in Prisons »

8. www.aids2014.org 22/33 prisons offered support to TB patients Support of TB patients in Prisons in 2013 (National Program) Screening22 Prisons MACA New cases TPM + 5429 all forms8551

9. www.aids2014.org HIV – 2013 Results (8 prisons : MACA + 7/ Projet ESTHER/GF) 9 18.000 inmates offered HIV testing Take up rate : 76% HIV infection Rate: Men: 2,92% Women : 10%

10. www.aids2014.org TB among HIV pts in 12 prisons 1 st quarter 2014 (ESTHER/GF)

11. www.aids2014.org TB Treatment centre within MACA A treatment and care center and a reference center for other prisons Should be replicated in all regions 2013 Results : –New cases of TB: 24 –TB (extra pulmonary) : 08 – TB patients tested HIV+ : 07 (22%)

12. www.aids2014.org Key Challenges (1) Lack of Health Services in prisons Lack of qualified health personnel Poor Diet Overpopulation

13. www.aids2014.org Key Challenges (2) No prevention tools and policy for HIV / STI Difficulty of patient follow up on release Poor data on Drug-Résistance ESTHER/ANRS Study on multi-drug resistant TB (Starting Nov. 2014)

14. www.aids2014.org Conclusions (1) Screening TB /HIV in Prisons : a major Public health priority Need for better health services and qualified personnel Comprehensive patient management critical for reduction of drug resistance and transmission

15. www.aids2014.org Conclusions (2) Additional financial resources required Projet ESTHER = Advocating for Health in Prisons ; Finalisation and political validation of the first National Recommendation of Health in Prisons

16. www.aids2014.org Thanks Ministry of Health - Cote d’Ivoire Justice Ministry – Cote d’Ivoire National HIV Program / Global Fund Cote d’Ivoire/France Hospital partnerships Prisons staff Community consellors NGO’s involved in pris on project Prison inmates ESTHER Jeanne D’Arc Ouattara Sidaction

17. www.aids2014.org The MACA TEAM