Siblings testing during Prevention of Mother To Child Transmission...

Presented at the 2nd International Workshop on HIV Pediatrics

16-17 July 2010, Vienna Austria

Siblings testing during Prevention of Mother To Child Transmission (PMTCT) process: what could be

children benefits

E. Senou1, A. Azondekon1, A. Sagui1, A. Keitchion1, I. Adeyanju3

T. Bognon1, L. Beauvais4

T. Ndihokubwayo5, T. Anagonou2

1Military Teaching Hospital, Pediatrics, Cotonou, Benin, 2Benin Armed Forces Health Services, Cotonou, Benin, 3MEDECO, Cotonou, Benin, 4GlaxoSmithKline Foundation, Paris, France, 5UNICEF

Benin, Cotonou, Benin

Oral presentation O_19, 2nd International Workshop on HIV Pediatrics, July 16-17, 2010, Vienna - AUSTRIA



Introduction• Access to care and treatment

– Prevention, diagnosis(testing) and Care to infected children

• Testing: WHO recommendations– PMTCT plus: siblings, father and other relatives

• Our purpose to focus on testing for siblings of newborn followed during PMTCT process



Situation in Benin 1• Total population: 8 millions in 2009

• Prevalence rate as of 2007: 1,7%

• ANC coverage: 32% (2006) to 66% (2009)

• Proportion of women accessing to PMTCT: 28% (2006) to 70% (2009)

• Monoprophylaxie: 70%

• Lost to PMTCT rate: 43%

• 32% of Children in need of HAART are treated



Situation in Benin 2

• In Benin, 13% of women visited ART site within the year following PMTCT interventions (Adeyandju et al, 4th French HIV/AIDS Conference 2007)

• Numbers of infected children are missed for testing and care program



Objectives

• General– To describe outcomes of the strategy used for

testing siblings of newborn followed during PMTCT, in a resource-limited settings

• Specific– Percentage of women with children to be tested– HIV prevalence among siblings– Impact of involving socio-education and human

services in siblings testing



Care Unit for Children Exposed or Infected by HIV – CUCEIH

Military Teaching Hospital

• One of the first pediatric ART site

• Located at Military Teaching Hospital

• Established in 1997 with ARV delivery in 2002 and PMTCT intervention in 2000

• Social, education and human services from 2007– Pediatric social and preventive department

• Family-centered services

• Developing excellence in pediatric care to HIV Children



Pediatric Department – Military Teaching Hospital

Conference roomChild Examination office



CUCEIH at MTH: a global overview

Reception Infected

ExposedMedical Section

File

First visit

Follow up

Internal Referring

External Referring

Psychological Psychological SectionSection

Therapeutic Education Section

Community Care

OPTIMA-Benin

Fathers, Mothers or other relatives in Care

Social and Nutritional Support Section

Adults Psycho-Social Care Unit



Pediatric Social and Preventive Department• Therapeutic Education

• Social worker office for pediatrics

• Psychology

• Nutritional demonstration Unit

• Community Support services

Waiting roomHealth education office





Psychology

Pediatric Social worker Office

Nutritional support



Community office at CUCEIH/MTH

Community Support integrated

OPTIMA base

at Akpakpa PK5

« OPTIMA-BENIN is doing everything for children that is impossible at hospital»

« Only for Children, and their parents if their children are the primary beneficiaries»

Mediation LTFU reduction

Income generative activities

Community pharmacy

Schooling support

Capacity building for Life

Support group Nutrition





Methods 1• From 2004 to 2009, for every baby followed at

the Care Unit for Children Exposed or Infected to HIV(CUCEIH), siblings testing was undertaken if there is any

• From the second visit, and through health education program for PMTCT, siblings testing was suggested– As well, through social, psychological and

community services (from late 2006)

• The process is done continuously until, parents accept to bring the children to CUCEIH until Index baby reached 24 months



Methods 2• Gynaecologic and obstetrical history is

collected as well as number of children died and their age at death

• HIV antibody test was done by rapid tests (determine and Bioline) and confirmation by ELISA

• Statistical analysis– Breakdown period

• Period A: 2004 to 2006• Period B: 2007 and 2009

– Chi squarre, Mann-Withney and Kaplan-Meier curves



Results



Mothers characteristics

• 179 mothers were received with their babies

• 63% (113 mothers) had at least one childalive, other than the one brought for PMTCT follow up– 71 of them (63%) with History of miscarriage,

stillbirth or death child

• Median number of siblings was 2 (1 to 5 children)– 18% had more than 3 children



Children Characteristics• 221 children were identified

– Median age 4 years (13 months - 14 years)– 92 (42.6%) were in Period A

• 188 (85%) were tested– 77% for Period A vs 90.1% for Period B, p=0.01*– 123 (65.4%) with Mothers with history of

miscarriage, stilbirth or child death

• Time to bring children for testing• Median time: 6 months (1 to 23 months)

– 11 months (1 to 23 months) for Period A– 2 months (1 to 17 months) for Period B

• p=0.00, Mann-Whitney*



Time to bring children for testing

time (months)

2520151050

1,0

,8

,6

,4

,2

0,0

period

B

A

Log rank, p=0.00



Testing results• 39 of 188 tested (20.7%) were HIV positive

• Effect of history of miscarriage, stillbirth and child birth– 26% in children with history of Miscarriage, stillbirth or child

death for their mother– vs 11% with no history (p=0.01)*

• Period– 22.5% of Children in Period A vs 19.6% in Period B, p>0.05

• HAART eligibility• 17 of 39 (43.6%) were eligible to HAART according to

National Guidelines– 56.2% (9 of 16) were eligible for Period A– vs 30.4% (7 of 23) for Period B, p=0.10



What about “Not tested”children

• We did not test 33 children(14.9%)

• 22.8% for Period A vs 9.3% for Period B, p=0.01*

• Reasons– parent refusal (12 children)– fear from their mothers (7 children)– children tested before (14 children)



CascadeMothers Received for babies PMTCT follow up (179)

Mothers with at least one other child alive (113)

Children not tested (33)

Children to be tested (221)Mothers with no other child (69)

Children tested (188)

HIV positive children (39)

Infected Children in need of HAART (17)

43.6%

20.7%

Already tested (14)

Parent refusal (12)

Fear of mother (07)



Discussion

• Siblings testing is worthy– Improving access to care and treatment– Contribution to 9.2% of HIV children at

CUCEIH/MTH

• What are challenges now in testing siblings?– Should fathers be involved into this process!

– Should this begin since the maternity?



Conclusion

• A particular look has to be taken to siblings during PMTCT process since the benefits are great

• This strategy should be used as a keyelement in improving access to care and treatment for Children

• As well, health educator, social worker and psychologist should be also involved



Acknowledgments • French Cooperation

– GIP-ESTHER– Hôpital d’Enfants

Armand Trousseau

Waiting hall

Benin Armed Forces Health Services

Albert Gnangnon

Annicette Toudonou, Estelle Juré

Rock Akpoli

Laurianne Beauvais

Tharcienne Ndihokubwayo

Emilie Homawoo

Evelyne Akinocho

DHAPP San Diego

IDI Makere University

Siblings testing during Prevention of Mother To Child Transmission...

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