Solthis has been active in Mali since 2003. Initially approached by the Mali's Ministry of Health to guide it through development of quality care in the Ségou region, Solthis is now supporting the decentralization in progress throughout the country as it battles hepatitis, tuberculosis, malaria and HIV/AIDS.
Mali has one of the world's highest infant mortality rates at 128 deaths per 1,000 children. Pediatric care therefore is a priority for the country.
Malaria is the leading cause of death for all pathologies combined in Mali. This disease alone accounts for more than 30% of medical consultations in the country. Children under age 5 are the most vulnerable.
Hepatitis B poses a major public health problem, especially because it is transmitted in most cases from mother to child and during early childhood. A recent study reported an incidence of 15%.
The literature shows that tuberculosis is often an opportunistic disease in HIV patients and that HIV aggravates the disease's progress. Mali's national protocol therefore recommends automatically providing HIV advice to all tuberculosis patients or suspects. However, management of TB/HIV co-infection remains poor.
Solthis' operational context in Mali
Partners: Ministry of Health and Public Hygiene, and its regional units, SE/HCNLS
Areas of operation: Ségou, Bamako, Mopti
29 sites supported
Focus of operations: HIV/AIDS, hepatitis, tuberculosis, mother-child health, sexual and reproductive health
After being approached by the Ministry of Health to guide it through development of quality care in the Ségou region, Solthis is now supporting the current decentralization initiative throughout the country.
2009: Start of second phase of our operation. Following the phase-out of onsite medical support in the Ségou area, Solthis is providing upgraded support in the Mopti and Bamako areas. In the Ségou area, Solthis is developing Education for Health activities.
2012-2013: Declining security situation. Solthis is continuing its activities to maintain delivery of care to patients treated at supported sites.
2014: The security and institutional crisis has had an uneven impact on Solthis' program in Mali. Staff movements in the Mopti area have had to be limited strictly to the city of Mopti in the first three quarters.
Train and mentor health professionals for treatment of seropositive patients and sound management of supplies.
Support regional authorities to monitor decentralization.
HIV screening in care settings
Raise awareness of decision makers and train caregiving staff to generalize the automatic offer of HIV screening to patients at risk of infection.
Improve screening of key populations in Ségou (seasonal workers, sex workers, men having sexual relations with men) and their access to care.
Awareness-raising and battling stigmatization
Awareness-raising and communication initiatives promoting screening, in the media, schools, and with populations at risk of infection (seasonal workers, sex workers, men having sexual relations with men)
Actions to battle stigmatization of people living with HIV by opinion leaders (clerics, journalists) and in health centers
Introduce early screening of children exposed to HIV by PCR/DBS in Mopti
Train paramedics to improve care for pregnant women.
Introduction of a health information system
Improve management of health information to avoid a rise in lost patients (no-shows for last appointment) and a break in HIV products.
Ensure continuous availability of inventory, and track/assess consumables to align orders with needs as much as possible.
Improved biological and virological monitoring
Train biologists to use the viral load monitor.
Provide technical and financial support to upgrade molecular biology technology in laboratories.
Mentor staff on compilation, quality control, analysis and interpretation of CD4 and viral load results.
Conduct research on preventing mother-to-child transmission of the hepatitis B virus.
Solthis’ address in Mali
Mali – Bamako Rue 189 – Porte 372 Korofina Nord BP 3062
“Managing Risk in Fragile States: Putting Health First!
Optimising the Efficiency of the Global Fund's Grants”
This evidence-based report is the result of a work over several months, including 4 missions (Guinea, Mali, Niger and Sierra Leone) and interviews with 140 stakeholders. Through this work, we identified bottlenecks in the implementation of the Global Fund's grants in the field, showing that the Global Fund's Risk Management Policy is not well-adapted to fragile states. The additional safeguard measures which have been put in place by the Secretariat after the investigations of the Office of the Inspector General were meant to mitigate the financial risks and to reassure donors. However, experiences in challenging operating environments clearly show that these measures are mainly focused on financial risks and have caused significant malfunctions that jeopardise both the impact and the sustainability of the programmes. In order to make progress and to cope with the challenges specific to fragile states, we think it is now time for the Board members and the donors of the Global Fund to opt for an ambitious and innovative policy, which would put financial risk at its proper place: behind risks to public health. The main recommendations we are addressing in the report aim to place the public health risk at the centre of the mechanism, by:
Improving the balance between the analysis and the management of the different risks.
Simplifying and clarifying the control procedures: limit the number of contractors and the levels of validation.
Defining indicators or objectives for terminating additional safeguard measures to encourage appropriation and capacity building.
Investigating the possibility of an increased presence of the Global Fund in the field, by missions of several weeks or several months.
Adapting the indicators and procedures of performance-based funding and accountability measures to fragile states.
Prof. C. Katlama, Prof. G. Brücker et S. Calmettes
On the occasion of its General Assembly, Solthis held Wednesday, July 6 at the Pitié-Salpêtrière, the 4th day meeting. Teams Solthis and partners in the field were present, especially from Mali, Guinea, Niger and Haiti. The presentations are available below on this page.
HIV testing: a challenge?
Y. Yazdanpanah, F. Huber, R. Tubiana, M. Idé
At the "Test and Treat", screening is an important theme in African contexts, as in Western countries. Also, the first workshop of the Scientific Day Solthis it was dedicated, moderated by Dr. M. Ide (Niger) and Dr. R. Tubiana (Paris). In his introduction, Dr. F. Huber (Solthis) presented the technical aspects of "rapid tests" raising the question of the limits of these tests, and the problem of lack of due process and the frequent inability to meet the temperature conditions recommended by the suppliers. This presentation was followed by a review of different screening strategies and the historical evolution of paradigms: the screening called "voluntary" to "provider-initiated testing for carers" as advocated by WHO and the various authorities health. Aspects of "cost effectiveness" of screening were then analyzed by Prof. Y. Yazdanpanah (Tourcoing). Dr. F. Lamontagne (Solthis Guinea) and Prof. M. Cisse (Guinea) have supported these statements by the West African experiences Solthis on screening in the care environment "opt out". If this type of screening "at the initiative of the caregiver" has made great advances in PMTCT or in tuberculosis centers, much remains to be done in other departments of medicine, where a high proportion of patients is not detected, not supported. Mobilization on this issue is more strategic than ever.
Despite the investment of Solthis on supply issues (ARV, all health products ...), stock-outs, especially for ARVs, are still common in the field and directly threaten the health of patients. The session dedicated to these issues was conducted by two doctors Dr. B. Diallo (Mali) and Dr. PM Girard (Paris). E. Guillard (Solthis Pharmacy Manager) said the overall functioning of the supply before presenting the main causes that lead to situations of stockouts. The threat of disruption of Guinea in February 2011 was taken as an example to highlight the failures at different levels of decision making. Teams in the field of pharmacy Solthis and their partners then described their daily actions, emphasizing the mode of intervention or Solthis tools developed together, such as coordinating groups and committees for monitoring supplies, tables edge compilation, analysis, alerting, quantification tools ... Finally, J. Langlois (Sidaction) and F. Foguito (TAW), representing civil society, concluded the session by the role of associations to fight against breakage, and more widely to improve the quality of care.
Prof. V. Calvez (Pitié-Salpêtrière, Paris) presented the situation of primary resistance throughout the world, before recalling the consequences attributable to virological choice of first-line treatments. He raised the problem of low genetic barrier of molecules commonly used in countries with limited resources (especially NNRTIs), especially when access to viral load is small or nonexistent.
This session, moderated by Prof. M. Cisse (Guinea) and Dr. G. Breton (Paris), addressed the issue of retention of patient care in the circuit, through various initiatives. After a general introduction of G. Lurton (Solthis), Dr. M. Ide (National Hospital of Niamey) lamented the difficulties of long-term monitoring of HIV patients in Niger, based on the experiences of ambulatory treatment center and day hospital in Niamey. The experience of Medecins du Monde, supporting marginalized populations in integrated centers in Asia, was reported by Dr. N. Luhman. Finally, Dr. Claude Pean, Haitian Institute Pereo Fame, introduced the operation of the center of Port-au-Prince, who has built an international program based on improving the encrypted performance.
The prevention of mother-to-child transmission of HIV in Mali: HIV-positive pregnant women and loss to follow-up in the Segou region (Mali)Author(s) : T. Mutel, A. Akondé, A. Doumbia, D. Coulibaly Traore, M. Diarra, F. Maiga, B. Coulibaly, L. Pizarro, F. Perez
The Scientific Days of Mali experts have gathered several members of the Working Group Solthis: Christine Katlama, Roland Tubiana and Gilles Brucker. Solthis co-organized the National Day which brought together over 300 Malian professionals involved in the fight against HIV. For Solthis and its partners, it was an opportunity to present the results of the management and discuss immunological and therapeutic advances.
Evolution de la prise en charge du VIH à Ségou entre 2003 et 2009 Author(s) : L. Diakité, D. Katilé, , N. Diallo, A. Doumbia, MS. Koné, B. Coulibaly, A. Sidibé, Y. Coulibaly, A. Akondé, G. Lurton, F. Huber Download the presentationEvaluation de la mise en place du dépistage et de la prise en charge du VIH au centre antituberculeux Carrière, à Conakry (Guinée) Author(s) : LM. Camara, B. Bah, D. Touré, P. Kourouma, L. Hajouji, C. Katlama, F. Huber, O. Sow Download the presentationDélégation de la prescription des antirétroviraux aux paramédicaux dans la PTME à Ségou (Mali) Author(s) :A. Doumbia, A. Sidibé, AT. Traoré, A. Akondé, F.Z.T. Sangaré, DC. Traoré, M. Maiga, AM. Soumaré, F.D. Cissé, SD. Naman, G. Lurton, C. Katlama, F. Huber Download the presentationCharge virale en routine dans un pays à ressources limitées : le cas du Niger Author(s) : Dr Hanki, H. Yahayé, S. Mamadou, I. Aboubacar, R. Ali Maazou, I. Dillé, C. Dézé, S. Diallo, F. Huber, M. Amadou, F. Maïga Download the presentationL'épidémiologie des perdus de vue dans les programmes VIH/SIDA Author(s) : E. Poulet, M. Pujades-Rodriguez Download the presentationL'approche anthropologique des ruptures de suivi médical des personnes vivant avec le VIH : l'exemple de Kayes (Mali) Author(s) : S. Carillon, V. Petit Download the presentationLes patients sous ARV perdus de vue : l'expérience de l'ONG WALE Author(s) : D. KatiléDownload the presentation
Level of viral load and antiretroviral resistance after 6 months of non-nucleoside reverse transcriptase inhibitor first-line treatment in HIV-1-infected children in Mali
Author(s) : D. Germanaud, A. Derache, M. Traoré, Y. Madec, S. Touré, F. Dicko, H. Coulibaly, M. Traoré, M. Sylla, V. Calvez, AG. Marcelin Journal : Journal of Antimicrobial Chemotherapy - 2010 Jan;65(1):118-24
Solthis, GIP Esther and the Point G Hospital, organized the seminar "resistance" on 10 and 11 December 2009 in Bamako. More than fifty doctors and biologists from all over the country attended this training on viral load and resistance to ARVs patients living with HIV / AIDS. Several clinical cases were presented by the Malian and discussed with national medical authorities, also attended by experts from the Pitie-Salpetriere Hospital in Paris: Professor Christine Katlama, Prof. Vincent Calvez, Dr. Anne Genevieve Marcelin and Dr. Roland Tubiana .
Over a hundred people came to attend the Scientific Solthis Day on June 26. Players on the field of SOLTHIS, France or Paris, they met for the highlight of the association. Also, many distinguished guests were present: representatives of national and international institutions, the Global Fund, civil society actors ... Today, all teams SOLTHIS wishes to thank those who were able to attend this day to the quality of exchanges, the wealth of information and their demonstrated interest in our actions. Scientific Day of Solthis is also an opportunity to give voice to field to present the projects implemented and to share their thoughts on the challenges of HIV disease. See you in 2010!
Proceedings of the Round TableWhat future for international funding of HIV programs?
In the current economic crisis and crisis funding, SOLTHIS wanted to set up a reflection on this vast subject. The roundtable, chaired by Professor Gilles Brucker, gave rise to two questions, firstly that of continuous funding for the fight against HIV and the effectiveness of such funding. This debate was thus the occasion for Prof. Patrice Debré, new Ambassador in charge of the fight against HIV AIDS, to outline the challenges and the strategy it intends to introduce. Dr. Florence Veber, Assistant Director for Health and Human Development (MFA) has expressed his current thinking on innovative financing and recalled in place of the fight against HIV in health policy. Representatives of civil society were also at the table. Marie-Alexia Delerue, of Action for Global Health, called for a mobilization of governments for development of new sources of funding in addition to their official development assistance. As for Khalil Elouardighi, Coalition of More, he warned of the serious short-term decline in funding from the Global Fund, particularly for patients néceisstant treatment of second and third line.
Prof. Patrice Debré: Patients and international partnerships
Prof. Patrice Debré is the new Ambassador in charge of the fight against HIV / AIDS and infectious diseases.There is also a co-founder of Solthis.
Professor Debre presented the characteristics of the epidemic: 33 million people infected with HIV, 2.7 million new infections per year, two million deaths 75% in Saharan Africa. A disease that affects both women that man ... In countries é low or middle income, the access to ARVs is limited: only 31% of global demand for ARVs are covered. .. HIV was the illness that led to the concept of "Global Health" to emerge, this awareness of global health has led to considerable social and political commitments for which new resources and new funds were needed .
Then, the Ambassador outlined the contribution e franéaise the fight against pandemics based financing channels in 2007:
- For HIV: 363 million euros, 20 million for bilateral (AFD, Esther, ... AT MFA) and 26 million for Research (ANRS, IRD, CNRS ...).
- For malaria: 100 million for multilateral and bilateral for zero.
- For TB: 31 million for multilateral and bilateral 3 million for.
Finally, Professor Debré expressed challenges in the fight against HIV at international level:
1. Harmonization of the Governance of International Health
2. Cooperation among the multilateral organizations
3. Complementarity between the bilateral and the multilateral
4. European dimension
5. Support in general
6. Integrated approach between basic and clinical research, opening e other areas such as agronomy
7. Multiplication of innovative financing
Dr. Florence Veber is currently in charge of the Sub-Directorate of Health and Human Development of the Ministry of Foreign Affairs and European.
Dr. Florence Veber presented the new organizational structure of Ministry of Foreign Affairs and European set up to be in phase with the emergence of global issues like climate change or pandemics. She outlined the three main directions:
1. Administrative direction
2. Diplomatic lead (geographical division)
3. Overall direction of globalization development, partnerships and development.
This new direction is divided into four sub-directorates including the Directorate of global public goods including climate, natural resources (forests and water), food security and health and human development. Led by Dr. Veber, this sub-directorate deals with issues of health but also education, employability, gender equality, migration, demography and social protection. To date, this sub-department is particularly sought for the monitoring of commitments in the multilateral franéais since 75% of the budget of the health cooperation through multilateral channels. She is in charge of policy definitions, the Operational being managed by AFD (Franéaise Development Agency). Moreover, the strategy of cooperation policy for health should be reviewed to the end of 2009 with the participation of stakeholders. This new team wants to offer stakeholders greater access and transparency to the data field to promote shared approaches among other NGOs and the Ministry. Dr. Veber has shared his thoughts of two topics:
1. Consequences of funding for HIV / AIDS on strengthening health systems?
2. Efficiency and use of innovative financing in health?
Marie-Alexia Delerue: Health Care Financing
Marie-Alexia Delerue is responsible for advocacy at Medecins du Monde, a member of the NGO network European Action for Global Health.
Marie-Alexia Delerue presented the evolution of financing Development assistance for health:
- International: 4-fold increase between 1990 and 2007;
- At European level: 58% increase from 2001 e 2007;
- In France: 4-fold increase between 2000 and 2007;
- Sources: Public sources of funds, but increasingly the private / philanthropic (26.7% of total international aid health in 2007);
- Channels: increased multilateral channel (GFATM, GAVI). If this international movement, ed through increased international funding, has achieved considerable progress in terms of health (reduction of child mortality, increasing the number of patients having access to ARVs ...), we find that health issues in the South are immense: the eight Millennium Development Goals (MDGs), who increased the least are those for e health. Funding and predictability are still insufficient. In the current economic crisis, health indicators are threatened. The WB report on the global crisis provides that if any international response is urgently adopted to support developing countries, approximately 200 000 e 400 000 children under 5 years and more will lose their lives each year. It is therefore fondammental that donors meet their financial commitments in favor of health. Today, NGOs are calling on international donors and governments in the South:
- Putting health at the heart of development policies (for developing countries, have 15% of their health budget e)
- Respect the commitments made by donors in the framework of the G8
- Promote the strengthening of health systems
- Develop new funding sources, including quickly implement the tax on currency transactions, which could bring in $ 40 billion by annnée and would therefore make a real difference in terms of scale of development finance and accelerate the progress of health indicators. Innovative financing must be additional e the official development assistance and truly predictable.
Les perdus de vue de la région de Ségou, au Mali Author(s) : G. LurtonDownload the presentationPrise en charge transfrontalière des PVAVS : le point de vue du soignant Author(s) : S. DialloDownload the presentationMigrations transfrontalières en Afrique de l'Ouest : le regard des sciences sociales Author(s) : S. TchiombianoDownload the presentationContinuum des soins et politique d'accès aux traitements des IST/VIH/SIDA dans les cinq pays du Corridor Abidjan-Lagos Author(s) : J. KoffiDownload the presentationLa PEC transfrontalière des PVVIH : recommandations Author(s) : S. DialloDownload the presentationQuestions posées et enjeux de l'adoption d'une loi spécifique sur le VIH/sida : le cas du Niger Author(s) : S. TchiombianoDownload the presentation
HIV/AIDS care and follow-up on a national scale in low resource settings: experience of the Niger Initiative on Antiretroviral Access (INAARV), NigerAuthor(s) : M. Ide, Y. Madec, M. Boubacar, E. Adehossi, C. Dezé, GM. Lawal, O. Amadou, S. Diallo, C. Pizzocolo, IA. Touré, S. Mamadou, C. Katlama and the National Technical Committee Download the presentationPilot cell comprehensive care: a multidisciplinary service orientation and listening PHAs, NigerAuthor(s) : A. Alzouma, C. Dezé, B. Sabo, M. Bako, S. Maman, I. Mourtala, M. Goundara, F. Djermakoye, M. Ide, F. Aeberhard Download the presentationThe impact of prior recourse to traditional medicine on the out-of-pocket expenditure of HIV/AIDS patients in NigerAuthor(s): S. Walker, S. Tchiombiano, A. Maiga, R. Hassane, M. Idé, AH. Souna, V. Bignon, O. Weil, L. Pizarro Download the presentationIncidence and risk factor for tuberculosis (TB) in HIV patients on ART, Niger Author(s): A. Foucher, Y. Madec, S. Diallo, Z. Thiousso, I. Dillé, S. Gambo, HA. Souna, A. Oumarou, A. Manou, GM. Laoual, Al. Touré, C. Pizzocolo, L. Pizarro, A. Fontanet Download the presentationDecentralized access to triple therapy and viral load monitoring in West Africa (Mali)Author(s) : A. Akondé, Y. Madec, AB. Dicko, I. Haidarra, I. Katile, B. Diarra, M. Kye, A. Doumbia, C. Pizzocolo, C. Katlama and the Segou Medical Technical Committee Download the presentationA method of HAART decentralization in rural areas: Solthis' experience in Segou (Mali)Author(s) : P. Teisseire, A. Akondé, C. Pizzocolo, S. Calmettes, S. Dalglish, N. Bodo, L. Pizarro Download the presentationPrevention of mother-to-child transmission of HIV (PMTCT) in a rural setting : the experience of the Segou region in MaliAuthor(s) : CD. Traoré, A.akondé, T. Samake, T. Traoré, Y. Coulibaly, O. Coulibaly, A. Sidibé, D. Germanaud, Z. Traoré, A. Maiga, AG. Marcelin, C. Pizzocolo, C. Katlama and the Segou Medical Technical Committee Download the presentationAppraisal of treatment modification in HIV patient follow-up in the region of Segou (Mali)Author(s) : J. Landier, A. Akondé, C. Pizzocolo, I. Haidara, M. Drabo, L. Pizarro, A. Fontanet, C. Katlama, Y. Madec Download the presentationEtude virologique chez des sujets VIH-1 suivis à MadagascarAuthor(s) : F. Lamontagne, S. Andriantsimietry, ML. Chaix, JP. Viard, M. Randria, J. Nely, S. Randriamampionona, C. Aguilar, S. Royer, C. Pizzocolo, LR. Razanakolona, C. Rouzioux Download the presentation
International AIDS Conference – Mexico City, August 2008
HIV-infected children in the context of the Niger Initiative on Antiretroviral Access (INAARV), Niger (West Africa)Author(s) : R. Abdoulaye-Mamadou, I. Adehossi, Y. Madec, C. Dezé, W. Alkassoum, M. Mahamane, I. Daouda, M. Amadou, D. Germanaud, C. Pizzocolo, S. Mamadou, C. Katlama and the National Technical Pediatric Committee Download the presentationLooking for lost to follow-up patients: experiences of Segou (Mali)Author(s) : G. Lurton, A. Akondé, Y. Madec, P. Teisseire, T. Traore, B. Touré, D. Cissé, C. Koumaré, C. Pizzocolo, L. Pizarro, C. Katlama, and the Segou Medical Technical Committee Download the presentation
Les perdus de vue dans la file active de la région de Ségou
Author(s) : AG. Marcelin, B. Jarrousse, A. Derache, M. Ba, ML. Dakouo, A. Doumbia, I. Haidara, A. Maïga, G. Carcelain, G. Peytavin, C. Katlama, V. Calvez Journal : Aids - 2007, 12;21(17):2341-3
L’impact de la situation socio-économique sur la réussite de la prise en charge pour les patients vivants avec le VIH/Sida et l’effet de l’identité d’être malade de Sida sur la pauvreté – Travail suite à une enquête de terrain au Mali.
Evaluation d'un programme d'accès décentralisé aux antirétroviraux au Mali Author(s) : AB. Dicko, MH. Maiga, A. Akondé, Y. Madec, C. Pizzocolo, le Comité thérapeutique de Ségou et le groupe de travail Solthis Download the posterMise en place de la numération des lymphocytes T CD4+ par cytométrie de flux et suivi immunitaire des patients sous traitement antirétroviral à Ségou (Mali) Author(s) : A. Maiga, B. Jarrousse, I. Haidara, L. Tegna, G. Carcelain, B. Autran, C. Katlama, le comité thérapeutique de Ségou et le groupe de travail Solthis Download the posterEvaluation des enfants de moins de 5 ans nés de mères séropositives incluses dans l'INAARV Author(s) : R. Abdoulaye-Mamadou, G.M. Lawal, A. Soumana, A. Gali-Yaroh, I. Adéossi, A. Harakoye, A. Diatta, M. Idé, Saïdou, C. Dézé, le comité médical technique du Niger et le groupe de travail Solthis Download the poster
Evolution of genetic diversity and drug resistance mutations in HIV-1 among untreated patients from Mali between 2005 and 2006
Author(s) : A. Derache, Al. Maiga, O. Traoré, A. Akondé, M. Cissé, B. Jarrousse, V. Koita, B. Diarra, G. Carcelain, F. Barin, C. Pizzocolo, L. Pizarro, C. Katlama, V. Calvez, AG. Marcelin Journal : Journal of Antimicrobial Chemotherapy - Sep;62(3):456-63
Solthis: evaluation of a decentralized program for access to ARV in Ségou (Mali)Author(s) : B. Jarrousse, A. Doumbia, M. Ba, E. Klement, L. Tegna, B. Diarra Sonou, Z. Traore, D. Traore, B. Touré, S. Tchiombiano, B. Dembélé, C. Tétrel, A. Maïga, G. Carcelain, AG. Marcelin, B. Autran, C. Katlama
Pour un accès gratuit et décentralisé aux antirétroviraux en Afrique subsaharienne : l'expérience de Solthis dans la région de Ségou, au MaliAuthor(s) : E. Klement, Z. Traoré, B. Jarrousse, L. Tegna, C. Tétrel, C. Katlama