Viral load testing

Viral load testing has been available since February 2007 at the National HIV/TB Reference Laboratory at the Hôpital Lamordé.
Since this activity began, a total of 838 patients have been tested for viral load. This includes 355 patients who had been receiving ARV treatment > 6 months and 198 (23.6%) who were detectable.

More complete data are available for one prescription center (CTA de Niamey): a total of 263 viral load tests were performed in patients treated for more than 6 months. The viral load was undetectable in 150 (57%) of these patients at a threshold of 400 copies and 65 (24.7%) had values between 40 and 400 cp/ml. This latter result is being confirmed by a second sample, because they are probably false positives (probable contamination of the technique). Overall, only 39 (14.8%) patients were defi nitely detectable and switched to second line therapy. At the end of 2007, 21 patients were receiving second line therapy. A more detailed analysis will be performed on the entire list of active patients once it’s been updated..

Pharmacy

The national recommendations for fi rst line treatment were updated during a technical medical committee meeting in March 2007. This meeting was supported by Solthis, and discussed the new recommendations published by WHO proposing that D4T gradually be abandoned because of its long term side effects. As a result, tritherapy including AZT is more and more frequently the first-line treatment for newly included patients. A recent analysis of a cohort since the beginning of follow-up in October 2004 showed that 96% of patients had received a fi rst line regimen including 2NRTI+1NNRTI, d4T/3TC/NVP in 85% of cases.

The management and distribution of drugs is the main blocking point for patient treatment. As a result Solthis hired a pharmacist specialised in HIV/AIDS to join the team in 2007 to provide overall support for pharmaceutical distribution channels. This request for pharmaceutical technical support was made by the CISLS and its two major sponsors: the World Fund and the World Bank. Besides occasionally purchasing certain drugs to avoid having patients run out, this support also allowed Solthis to « manage emergencies » from one prescription center to another, quantify national needs, draft reference terms
for the team in charge of managing drugs and perform missions to evaluate pharmacies and prescription centers in the fi eld. Technical pharmaceutical assistance was set up by (UNAIDS/UNICEF) in November 2007. In 2008, technical support from Solthis in this area will be complementary to that provided by this new partner.

Opportunistic infections and tuberculosis

To improve diagnostic and therapeutic management of opportunistic infections, Solthis evaluated the diagnostic capacities of the laboratories. This helped identify the difficulties encountered (material and human) and to suggest actions for improving these capacities. The existing situation on tuberculosis was
also investigated which will be the basis for our activities on HIV/TB co-infection in 2008.

The person in charge of Compliance and Therapeutic Education, Hadiza Baoua, supports and coordinates therapeutic educators in the prescription centers, whether they are members of associations or healthcare personnel. She participates in the medical staff meetings with the therapeutic educators at the prescription sites in Niamey as well as in the discussion groups at the Center for Outpatient Treatment and the Anonymous, Voluntary Testing Center.

In 2007 we were able to:
● update the therapeutic education follow-up file
● Train 12 new therapeutic educators in Maradi (8 members of the regional hospital and 4 members of MSF)

Françoise Aebérhard, psychologist at the Hôpital de la Pitié Salpétrière in Paris participated in a second support mission to Zinder to help fi nalise an integrated patient management group (CPECG) - an initiative which was proposed during her first mission in 2006.

During this second visit the CPECG was evaluated, the INAARV healthcare personnel in Zinder was helped with psychological support of HIV-positive patients and an evaluation of this activity was performed in Niamey, in particular at the National Hospital.

A group for integrated patient management (3 social workers, 1 psychologist for patients living with HIV) was created in April 2007 at the National Hospital at Zinder. This group is in charge of welcoming, supporting and accompanying HIV-positive patients who request assistance at the hospital. This is a pilot project which could be duplicated in other structures if the experience is a positive one.

A food support project for HIV-positive patients receiving treatment was set up in association with the Ministry of Health and the World Food Program for the period between April 2006 and December 2007.

This support is provided based on two criteria:

Medical criteria : WHO clinical stage 3 and 4 and/or level CD4<200/mm3

Social criteria : No fixed revenue (salary)

It is provided for 6 months directly from prescription centers (each center has a store which can distribute food based on a family ration system), by associative partners (NGO Mieux Vivre avec le Sida at the National Hospital in Niamey, Espoir Niger at the National Hospital in Lamordé, and Lafi a Matassa at the Regional Hospital Center Poudrière).  The program also supports frienship meals organized by NGOs and patient associations.

On December 31, 2007, the Program for Food Aid to patients living with HIV/AIDS at the National Hospital in Niamey (NHN), of the NHL of the CHP and of the HNZ included 586 recipients (63% women) and 4,473 beneficiaries (with 51% women and 18% children under 5 years old).

Solthis has also asked the Lasdel (Laboratory for study and research on local dynamics and social development) -- in particular a team of researchers directed by Jean-Pierre Olivier de Sardan -- to perform a socio-anthropological analysis of the project. This study and the discussions that ensued were particularly interesting, as they identified the elements of the program that needed to be improved upon (information provided to the patient, the need to recruit stockroom assistants, continuous correction of other problems, etc).