Dr Gilles Raguin, on behalf of ESTHER Senegal, IAS, 2012

HIV Prevention, treatment and care for IDUs in Senegal: An innovative ESTHER partnership

Universal access to HIV prevention, treatment and care for IDUs is a priority

Package of intervention well defined and efficacy demonstrated

Needle exchange programsOpioid substitution treatments (OST) Volontary counseling and testing (VCT)Antiretroviral Treatment (ART)Prevention and treatment of STICondom distribution programs Information, Education and Communication (IEC)Vaccination, diagnosis and treatment of hepatitisPrevention, diagnosis and treatment of TB

Source: WHO/UNODC/UNAIDS TECHNICAL GUIDE for countries to set targets for universal access to HIV prevention, treatment and care for injecting drug users

HIV and IDU in Africa: a neglected epidemic No data in most countriesKenya: 36 %S Africa: 12 %Nigeria: 5.5 %Tanzania :42 %Zanzibar: 16%

Mathers, Lancet 2008

An Operationnal Research programme on IDU in Dakar, Sénégal

(ANRS/CNLS/ESTHER/IMEA)

• To provide data on:– IDU prevalence and size of the population– Practices – HIV/HCV prevalence

• To Build capacities of HCW and CBOs• To Advocate and Act for access to HIV

prevention, treatment and care for IDUs

First step: the survey (Grant ANRS 12243)

• Population : IDUs, Dakar région• Inclusions : héroïn and/or cocaïne users <3 mths

(april to july 2011) • Location: CRCF, Hospital Fann, Dakar partner of

Hospital Saint Antoine, Paris, France• Methods: Respondent driven sampling (RDS),

506 inclusions• Biology : rapid tests for HIV, HBV, HCV on DBS

Results for HIV prevalence (n=506)• 22 IDU VIH+ = 4,3 % vs 0,7% in general

population• Injectors vs non injectors = 9,4 % vs 2,5%

(p=0.001)• Women vs men = 13% (9/69) vs 3% (13/437)

(p= 0,001)• Women injecting vs men injecting

= 21,1 % vs 7,5% (p= 0,0001)

Results for HCV prevalence

• 120 UDI HCV+ = 24 % vs < 1% in general population

• Injectors vs non injectors = 38,85 % vs 18% (p=0.000)

• Women vs men = 29% (20/69) vs 23% (100/437) (p=0,26, NS).

• Women injecting vs men injecting = 42,1 % vs 38,3% (NS).

Second step: capacity building• 2010 : Sensibilisation workshop on IDU and HR (30 HCW)• 2010 : Study tour in Morocco • 2011 : training course and diploma in France for Psychiatrist

team leader• 2011-2012 : study results at HIV/AIDS conferences • 2012 : 3 training sessions (HCW and CHW)• May 2012 : study tour in Morocco• Oct 2012 : training sessions, tutoring outreach activities,

national guidelines on IDU and HR

Third step: Advocate and Act• Regional workshops UNODC/ESTHER, Grand Bassam

(12/09 and 2010)• Regional ministerial Dakar Initiative (01/10)• Intégration of IDUs among vulnerable groups in the

Senegalese National strategic plan against HIVAIDS and allocation of specific funds (GF Round 9)

• Methadone registered on the list of essential drugs• Revision of law in process

Third step: Advocate and Act

• Access to care for recrutees• Outreach prevention activities 09/11• Needle exchange program 11/11• Opening of a Care center for Addictions in Fann hospital,

Dakar, in partnership with hospital Saint Antoine, APHP, Paris, funded by CLNS/GF, ESTHER, UNODC, City Council of Paris (planned for end of 2012)

ESTHER is a partner of the 2010-2014 UNODC regional programme for West africa

Acknowledgements

• CNLS: I Ndoye• Ministère de la Santé / DLSI / Bureau Santé Mentale: I Ba and

A Wade• CRCF et CTA: Pr PS Sow, M Maynart, N F Ngom Gueye• CHU Fann, Psychiatry: M Gueye • Hôpital Le Dantec (LBV): S Mboup, CT Kane, H Diop, O Ndiaye. • UNODC: M Molnar• ESTHER: S Perrot, A Toufik, K Diop• IRD: A Desclaux, C Desclaux• Hôpital Saint Antoine and IMEA: A Leprêtre, PM Girard