Bulletin d`informations 3

LA LETTRE
62, Boulevard Garibaldi
75015 Paris
01 53 17 51 50
www.esther.fr
Éditorial
N°47
Gilles Raguin
lEditorial
l The Lomé Appeal, a first step to-
wards recognition of the profession
of psychosocial counsellor/mediator
pages 2 et 3
lTraining for psychosocial counsel-
lors/mediators in Benin and Chad
pages 4 et 5
Zoom on the training guide
for paramedical personnel
l
page 6 et 7
lHospital
the APPS
hygiene: France supports
pages 8 et 9
lThird-line
treatments
in Mali, a new challenge
page 10
March 2012
2012 is an important year for ESTHER and for
many other HIV/AIDS organisations. The financial crisis and the difficulties encountered by
the Global Fund have wrought deeper changes
than it may seem.
« Value for money» has become the new mantra
of an international community whose agenda is
now efficiency, effectiveness and performance.
This is both worrying and reassuring: worrying because accounting considerations
cannot be allowed to dictate public health strategies, and reassuring because responders to the HIV epidemic and care providers for HIV-infected people have finally come to appreciate the importance of quality. Objectives are no longer purely
quantitative. The epidemic is complex, the treatment is complex, and to manage this
complexity we need more intelligent programmes, more operational research and
more innovation, both in care and prevention.
With our colleagues from the South, it is time to start thinking about the changes
that are needed and about how these changes should be implemented.
In this issue of the ESTHER newsletter, due out on the eve of the 6th Francophone
HIV conference, you will find examples of targeted, innovative and quality-focused
projects.
Promoting the new health profession of mediator or psychosocial counsellor has
become a priority for ESTHER. The first international seminar devoted to this profession was held in Lomé, Togo, in November 2011, and brought together psychosocial
counsellors supported by ESTHER from 12 different francophone African countries.
The Lomé Appeal was launched in the wake of this seminar: it calls upon governments, international organisations, partners and civil society to advocate for
official recognition of the profession of psychosocial counsellor.
A symposium, co-led by ESTHER and AIDES, will be held on the subject on
25th March 2012 at the HIV conference in Geneva, and Fidelia ODJO talks
to us here about how the profession is developing in Benin.
lDr Christophe Michon,
Other examples of targeted, innovative and quality-focused projects include the paramedic’s training guide jointly produced by RAF-VIH, IMEA and
ESTHER, the rollout of our new paediatric ESOPE software program for mother
and child monitoring and ESTHER support for the setting up of a third-line ARV
treatment cohort.
ESTHER’s new medical
and scientific Director
page 11
lESTHER invites you to the
6th Francophone HIV
conference (AFRAHIV
2012) in Geneva
I couldn’t end this editorial without telling you about the arrival of ESTHER’s
new medical and scientific director, Doctor Christophe Michon, known
to many of you already. We are delighted to welcome him to the team
where, with you, he will be working to improve the health of those
for whom ESTHER was created.
page 12
Gilles Raguin
The Lomé Appeal, a first step towards recognition of
the profession of psychosocial counsellor/mediator
For ESTHER, psychological and social support for people living with HIV/AIDS is a priority aspect of
care provision.
This support is provided by psychosocial counsellors (PSCs), also known as mediators, and in 15 of
ESTHER’s 18 partner countries, they are helping to improve the quality of care. In 15 of ESTHER’s 18
partner countries, they are helping to improve the quality of care. Since its inception in 2002, ESTHER
has helped train and/or support more than 500 psychosocial counsellors/mediators, mostly from community-based HIV/AIDS associations.
This pilot initiative is beginning to take off: in Benin and Chad, for example, the health authorities
have decided to recruit and train almost 700 psychosocial counsellors/mediators to work on the main
HIV/AIDS treatment sites.
However, in many partner countries psychological and social support is still not recognised as an integral and necessary component of care provision.
This is why ESTHER is supporting the psychosocial counsellors, support workers and mediators of Francophone West and Central Africa
who came together in Lomé on 21st and 22nd
November 2011 for the first-ever International
Mediation Days (Journées Internationales de la
Médiation – JIMED) and are now launching the
«Lomé Appeal».
In this document, they are calling on heads of
state and governments, the United Nations,
technical and financial partners and civil society to take action to obtain recognition of
the profession of PSC/mediator, its integration,
by means of a professional training curriculum, into national systems of care provision for
people infected and/or affected by HIV, and the
perpetuation and sustainability of this profession.
1st International Mediation Days Lomé November 2011
Lomé appeal of 22nd November 2011
We, psychosocial counsellors, support workers and
mediators of Francophone West and Central African
countries, meeting in Lomé on 21st and 22nd November
2011 at the initiative of ESTHER for the first International
Mediation Days (Journées Internationales de la Médiation – JIMED) in the wake of the international community’s commitment to eradicate the transmission of HIV
from mother to child :
• In view of the spread of the pandemic (for every 2
people who receive treatment, another 5 people are
newly infected) and the high proportion of people infected and/or affected by HIV in Sub-Saharan Africa,
• In view of the chronicity and complexity of the disease calling for both clinical care and psychological
and social support,
• In view of the shortage of skilled health care providers in low-resource countries,
• In view of the low rate of screening and treatment of
•
•
•
•
•
people infected with HIV,
In view of the low retention rates of patients in health
facilities,
In view of the limited accessibility of services and care
for vulnerable groups,
In view of the objective of universal access to treatment by 2015,
In view of the new international agenda following
the United Nations conference in New York in June
2011 and the objective of eradicating the transmission of HIV from mother to child by 2015,
Welcoming the commitment of the first ladies of African, Asian, Latin American and Caribbean countries,
at the opening of the UNAIDS meeting in New York,
to achieving zero new HIV infections among children
by 2015,
Welcoming the adoption on 8th June 2011 of the Political
La lettre ESTHER n°47 - March 2012
2
Declaration on HIV/AIDS: Intensifying our efforts to eliminate HIV/
AIDS,
In view of the adoption in October 2011 by the Pan-African Parliament of the Declaration of Commitment to actions for maternal,
child and newborns health development,
With due regard to the Bamako initiative and the appeal for action
made by the young leaders in Mali in April 2011,
Taking note of the declaration of the Heads of State in Abuja in April
2011 on HIV/AIDS and health financing,
In view of the importance of the role of counsellors and/or mediators
in the care of people infected and/or affected by HIV/AIDS,
In view of the insecure conditions in which we exercise our profession,
In view of the lack of recognition of the profession of mediator in
many partner countries,
Considering the need to obtain recognition for the function by means
of training resulting in a professional qualification,
Considering the need to upscale the training and recruitment of psychosocial support workers in order to reach all the objectives of HIV
care,
Considering the requirement to take into account the need to decentralise care for people infected by HIV,
Considering the usefulness of extending their competence to other
chronic pathologies such as diabetes and cancer,
We, PSC/mediators from Benin, Burkina Faso, Burundi, Cameroon,
Côte d’Ivoire, Mali, Morocco, Niger, Central African Republic, Senegal,
Chad and Togo, supported by ESTHER, are calling on:
1.
Heads of states and governments to:
• create a framework for training in the profession of psychosocial
counsellor/mediator and for the exercising of this profession,
• take measures to obtain the recognition and integration into national HIV care provision systems of the profession of PSC/mediator
through the development of a training curriculum resulting in a professional qualification,
• extend this profession to other chronic pathologies that affect the
population in low-resource countries, such as cancer and diabetes,
2. the United Nations system, and more particularly UNAIDS and its
co-sponsors to:
• advocate for the recognition of this profession by its member states,
• provide the support necessary for establishing frameworks for the
development of the profession of PSC/mediator,
• invite international organisations and initiatives, financial institutions and other partners to contribute their support and allocate
resources to psychosocial mediation and counselling programmes
• advocate for the recognition of this profession by other key players,
3. technical and financial partners to:
• support efforts to obtain the recognition, sustainability and perpetuation of this profession,
• mobilise financial and technical resources for reaching the objectives of this appeal
4. civil society and HIV response organisations to:
• speak out in support of actions for reaching the objectives of this
appeal;
• undertake their own actions at national level to obtain recognition
of this profession.
Lomé, 22nd November 2011
6th Francophone
HIV Conference (AFRAVIH 2012)
in Geneva - 25th March 2012
AIDES & ESTHER WORKSHOP
Mediator / psychosocial counsellor:
a new community health profession
to be recognised and incorporated
into HIV care and treatment services
Psychological and social support for people
living with HIV/AIDS is now a priority aspect
of care provision. This support is provided by
psychosocial counsellors (PSCs), also known
as mediators, and in 15 of ESTHER’s 18 partner
countries, these professionals are already helping to improve the quality of care.
Although this pilot initiative is beginning to
take off, in many partner countries the function of psychosocial counsellor, which is not
only based on technical competence, but also
on skills gained from hands-on experience, is
still not recognised as an integral and necessary component of care provision.
Can experiences conducted in the North be
reproduced elsewhere? At this symposium we
will be discussing the experiences of Aides in
France, Arcad Sida in Mali and ESTHER in 15
countries.
Programme:
1 – The «Lomé Appeal»: a first step towards international-level recognition: Mohamed Touré
(ESTHER).
2 – What terms of reference for a professional
training curriculum and for defining the profession of psychosocial counsellor? Example of
ARCAD Sida: Bintou Dembele (ARCAD).
3- The recognition of new community health
professions in the North: example of the action
undertaken by the association AIDES: Michaël
Goetz (AIDES).
4 – What action plans for obtaining recognition
of the profession of counsellor/mediator in the
South? Mamadou Dieng (ESTHER).
3
La formation des CPS/Médiateurs : Bénin/ Tchad
Interview
Oussoumdity HAOUA, PSC
Oussoumdity Haoua is a 45-year-old
divorced mother of six who discovered
she was HIV positive in September
2000 when giving birth.
In Chad, ESTHER is known for the quality of its mediation
training and has been chosen to identify, train, remunerate and follow up 180 psychosocial counsellors with the
aim of promoting psychological and social support for
people living with HIV throughout the country.
The project is funded by the Global Fund’s Round 8
whose principal recipient is UNAD
(Union Nationale des Associations
Diocésaines), with technical oversight
ensured by the Chadian Ministry of
Health, the Country Coordinating Mechanism (CCM) and the Chadian National AIDS Council.
180 psychosocial counsellors (PSC) have
been identified for training. The first training session was delivered in N’Djamena
and Moundou in February 2011for an initial group of 83 PSCs and provided basic
knowledge of the workings of the human
body, HIV/AIDS, medical treatment and
care for adults and the specific characteristics of treatment and care for children.
Trainees were also introduced to certain
aspects of psychosocial support, such as
how to conduct an interview, for example,
and worked on defining the place and
role of PSCs in HIV care provision in Chad.
This first session was followed by a 2nd and 3rd session in December 2011. These sessions focused on medical knowledge
(co-infections, opportunistic infections, mother and child care
and reproduction in sero-discordant couples), an explanation
of the health system and of where PSCs fit into the care pathway, and also included practical exercises and role-play on
the relationship between care-giver and care receiver.
The 83 trained PSCs have now been assigned to Chad’s 57 HIV
treatment centres where they have been well-accepted and
integrated into the care system.
La lettre ESTHER n°47 - March 2012
Since 2003 Oussoumdity has been an
active member of a self-help association for people living with HIV. IN fact,
she has always worked in a medical
environment. As a first aider with the
Red Cross she worked in a hospital
and then in a clinic in Cameroon where
she gave ante-natal counselling - a
subject she is particularly familiar with
as she is also a traditional birth attendant. With her self-help association, she
has become a peer educator informing
women about the importance of HIV
screening and has
also worked with
sex workers and
lorry drivers on HIV
prevention and the
use of condoms.
In Chad, Oussoumdity is known as
being the first woman to have spoken out publicly
about her sero-positivity. When she
heard that PSC/
mediators were to
be recruited and
trained, she didn’t
hesitate for a minute in applying.
In addition to the
medical knowledge
about HIV treatment she has acquired
through this training, she has also learnt
the importance of mediation and of the
relationship between caregiver and care
receiver.
She has since been very favourably impressed by the way the newly-trained
PSCs have been welcomed by care
teams who have told them just how
much they are needed.
Oussoumdity is now working in N’djamena’s main referral hospital (HGRN).
Information : Chad coordination team
[email protected]
4
In Benin, ESTHER has been selected to recruit, train, supervise and
remunerate almost 500 PMTCT
mediators (psychosocial counsellors) on all the country’s treatment sites.
ESTHER is the Global Fund’s subrecipient for this project.
The mediator project has succeeded
in putting in place a new system of
psychological and social support on
all the country’s treatment sites (including 300 PMTCT sites).
The first stage was launched at the
beginning of November 2011and
involved the training of 32 Beninese
trainers who then went on to train
186 mediators to work with HIV-infected adults and 300 female mediators for the PMTCT sites.
Once the training was completed in early February 2012,
the newly-trained mediators were assigned to treatment
sites according to patient numbers and needs.
This training activity for mediators was carried out in close
liaison with the National HIV/AIDS Programme, the Departmental Public Health Directorates and all the actors
involved in the follow-up and support of people infected
and/or affected by HIV/AIDS, especially associations and
prescribers in the care facilities. Six psychologists have
now been assigned to the administrative departments to
supervise the mediators.
Interview Fidelia ODJO,
Psychologist and mediator trainer
Fidelia OHJO, 32 years old, is an experienced psychologist with a Masters in
psychology from the Beninese university of Abomey-Calavi. She began her
career at Benin Military Training Hospital in the service of Lieutenant-Colonel
Alain Azondekon, Head of Paediatrics,
where she provided psychological care
and support for HIV-infected children
and their parents.
After a brief period with the association Plan-Benin where she worked with
child victims of the flooding, and after
studying for an IUD in Ouagadougou
(sub-regional medical and paramedical
Inter-University Diploma in «Training in
the comprehensive treatment and care
of people living with HIV in Sub-Saharan Africa»), she joined ESTHER’s mediator project.
Fidelia attended the initial training of
trainers course in November 2011 so
that she could go on to deliver training for the
selected mediators.
This mediator training was divided up into modules for revising medical knowledge and providing theory and practice on the relationship
between caregiver and care receiver (learning
how to conduct an interview and run a meeting, family mediation and working as part of a
network).
Some mediators who were already working on
the treatment sites have since been trained in
these new support methods and the same tools
are now being used on all the treatment sites in
Benin.
Fidelia Odio found the participants to be very
interested in the mediator training: they were
obviously very keen to learn and were full of
questions.
The newly-trained mediators are now starting
work on the treatment sites. As for Fidelia, she
is preparing to help the PMTCT mediators find
their feet in their new jobs. On some sites she
has already prepared the administrative and
care teams for their arrival, explaining where
these mediators fit into the care pathway and
about their role. The reaction from the hospital
teams has been very positive. They are very eager for their help, especially with tracking down
patients who have become lost to follow-up.
Fidelia will be the referral psychologist for the
department of Ouéme-Plateau and so will be
responsible for supervising the mediators on 34
sites.
Information: Benin coordination
[email protected]
5
Zoom on the training guide
for paramedical personnel
Training paramedical personnel in HIV management has become essential for supporting the decentralisation of access to care and coping with the increasing numbers of patients.
In conjunction with the IMEA [Institute of Medicine and Applied Epidemiology] and
the RAF-VIH [African HIV Training Network], and as part of a project for strengthening the capacities of paramedical personnel, ESTHER, a French bilateral health
cooperation agency, has published a training guide for paramedics entitled «Training paramedical personnel in HIV management in resource-limited countries».
This guide has been financed by the AFD (French Development Agency).
The scientific coordination of this training guide
for paramedical personnel was ensured by Professor Olivier Bouchaud and Dr Cheik Tidiane Ndour,
with input from HIV specialists from France and
a number of francophone African countries and
reference to existing documentation. It is specifically intended for nurses from francophone African countries who find themselves managing the
treatment and care of people living with HIV, possibly but not necessarily as part of a task-shifting
initiative.
It has two aims:
• It can be used as course support material for participants on various types of training programmes
in the French-speaking world (university, ESTHER
programmes and national programmes). It can
also be used by trainers as an aid to designing
these training programmes.
• It is also intended for use as a reference document
in the field.
The «Training paramedical personnel in HIV management in resource-limited countries» guide is
made up of 11 modules, each dealing with a different aspect of the competences required by paramedical personnel for managing HIV/AIDS.
Each module is set out in the same way: training
objectives, key points to remember and basic
knowledge, with the more complex concepts in
boxes headed «to find out more». There are also
evaluation tools in the form of quizzes and clinical
cases.
This guide will be updated to keep pace with
medical and scientific advances. It can be used
as a reference tool and be adapted to country
context.
The PDF version is available on ESTHER’s continuing education website: www.estherformation.fr
The first 10 modules aim to provide paramedical
personnel with what they need to know about HIV
management.
Module 11 is for helping trainers to design and run
a training course for paramedics.
La lettre ESTHER n°47 - March 2012
6
MODULE 1: Epidemiology and transmission of the HIV infection
In order to eradicate the epidemic, we need to be familiar with all the
different modes of transmission of the virus, as well as the risk factors and
the means of prevention. Epidemiological surveillance is also an essential
component in the fight against HIV/AIDS.
MODULE 2: Virology, immunology and the natural history
of HIV infection
Over the last 20 years, considerable progress has been made in diagnosing and treating HIV infection, mainly due to the development of ARV regimens and means for measuring the CD4 lymphocyte count and the viral load. It is important to understand how HIV reproduces and damages
the immune system, as well as the biological and clinical progression of
HIV infection in order to be able to provide better quality information to
the patients and monitor the way their infection develops with or without treatment.
MODULE 3: Testing and diagnosis of HIV infection
The testing and diagnosis of HIV infection are key components in the
fight against the disease, crucial both for individuals and the community.
In order for the testing and diagnosis of HIV infection to contribute effectively to the response to HIV/AIDS, it is essential to know what biological
tests are available, how to use them to obtain reliable results and to understand the importance of providing counselling.
MODULE 4: Diagnosis and treatment of opportunistic infections and HIV-related diseases.
HIV infection causes immunodeficiency leading to increased susceptibility to opportunistic infections. How can these infections be prevented
and how can the signs be recognised so that they can be treated as early
as possible? HIV infection favours the development or is most frequently
related to other diseases: the immunodeficiency linked to HIV helps induce cancer, HBV or HCV infections and malaria.
MODULE 5: ARV treatment of HIV in adults and adolescents
MODULE 9: PMTCT and the treatment of HIV infection in children
The transmission of HIV from mother to child (MCT) is a leading cause of AIDS in Africa. Its prevention (PMTCT) consists
first of all in encouraging future mothers to take the test by
explaining its importance for the health of their future child.
PMTCT in HIV positive pregnant women has three crucial
objectives: to convince the women to undergo treatment in
order to stay in good health, to prevent infection of the child
and to organise follow up of the child after birth. If, in spite of
everything, a child is born with HIV infection, early diagnosis
and treatment are critical for his/her future: without adapted
care, more than half of HIV-infected children die before the
age of 2, and only about 10% survive to the age of 10.
MODULE 10: Hospital hygiene, healthcare-related infections and the protection of care providers.
Improved access to care means the number of people living with HIV and being treated by care providers is on the
increase. Whether care includes invasive procedures (blood
samples, injections, drips or even surgery) or not, it is imperative to protect people living with HIV from the risk of healthcare-associated infections by respecting a certain number
of rules concerning hygiene and asepsis. Prevention is also
crucial for care personnel, for whom there is a risk of accidental exposure to blood and body fluids (AEB).
MODULE 11: Practical guidance for delivering
HIV training
To deliver training on HIV/AIDS healthcare professionals must
have the necessary pedagogical skills and not simply the ability to transmit information. These skills are based on simple
principles for enabling a trainer to progress in a logical order
from the needs analysis stage to the training stage through to
an evaluation of the training delivered.
ARVs are drugs for blocking the reproduction of HIV. In order to use them
correctly with HIV-infected patients, you need to know the objectives and
basic principles of the treatment, as well as the different drugs available
for prescription. You also need knowledge of when and how to begin
treatment, how to monitor it and how to adapt it in the event of undesirable side-effects or insufficient effectiveness.
MODULE 6: Pharmacy management and the dispensing
of HIV/AIDS medicines
The success of ARV and OI treatments depends not only on patient adherence, but also on the uninterrupted supply of medicines and the quality
of the therapeutic education given to patients when the prescriptions
are delivered. It is therefore essential to apply strict rules to pharmacy management so that patients can be regularly and reliably provided with
good-quality medicines, and to provide advice and support to ensure the
treatment is taken correctly.
MODULE 7: Support for people living with HIV
HIV management must be comprehensive. In other words, it should not
be limited to care, but should include support to the person to help them
manage their disease, its treatment and its consequences. It must also
be part of a continuum of care both within and outside the healthcare
environment.
Components of the support to be provided to HIV-infected patients include managing reactions to the announcement of seropositivity, psychological support, therapeutic education, nutrition education and economic or legal assistance. To be of sufficiently high quality, it must meet
a number of specific conditions with which it is important to be familiar.
MODULE 8: Prevention of HIV infection
The standard means of prevention, all of them complementary to each
other, are testing, changing at-risk behaviour by promoting the use of
condoms, PMTCT, ARV post-exposure prophylaxis and the prevention of
transmission through blood. In addition to these standard means, new
methods are being explored, including male circumcision, vaginal microbicides, pre-exposure ARV treatment and ARV treatment for reducing the
quantity of HIV circulating in the population.
6th Francophone HIV Conference (AFRAVIH 2012),
Geneva, 27th March
3.30-4pm: ESTHER stand
«Training paramedical personnel in HIV management
in resource-limited countries»
A training guide for paramedical personnel
Presentation of the guide followed by a signing and distribution session on ESTHER’s stand
7
Hospital hygiene:
France supports the APPS
The safety of patients and healthcare personnel is a major issue in all countries.
Every year, healthcare-associated infections affect more than 1.4 million
people. WHO’s patient safety programme is attempting to foster worldwide
collaboration in reducing the impact of infections related to health care procedures.
WHO’s African Partnerships for Patient Safety (APPS) initiative is part of this endeavour. Its objective is to develop close and sustainable partnerships between
European and African hospitals in order to create a network of “model” hospitals with regard to patient safety.
The APPS programme was initiated in 2008 with support from the United
Kingdom and involvement on the part of the Geneva University Hospitals
(HUG). The first partnerships were launched in six African countries in 2009:
•
Three English-speaking countries: Uganda, Ethiopia and Malawi, who
work with the NHS (National Health Service), the NPSA (National Patient Safety
Agency) and THET (Tropical Health and Education Trust), in an English cooperation set-up.
•
Three French-speaking countries: Mali, Cameroon and Senegal, who
work with the Geneva University Hospitals.
France became involved in the programme in 2011. The French Minister of Labour, Employment
and Health gave his support to the development and implementation of 3 hospital partnerships
in Burundi, Côte d’Ivoire and Niger. He mandated GIP ESTHER to pilot the French branch of the
programme, to be implemented by 3 of ESTHER’s hospital partners: Bordeaux University Hospital,
Rennes University Hospital and Ambroise Paré (Boulogne-Billancourt).
Zoom on a project developed between Bordeaux University Hospital and the Côte
d’Ivoire as part of the ESTHER-WHO partnership for patient safety
Interview: Hélène Boulestreau, hospital practitioner, Bordeaux
The partnership is between Bordeaux University Hospital, one of France’s 6 university hospital centres of
excellence, and 3 healthcare facilities in the Ivoirian capital, Abidjan : Port Bouet General Hospital which is
the referral hospital for the Port Bouet district, CEPREF, which is a referral outpatients centre set up by the
NGO ACONDA in the Yopougon district specialised in training and care for people infected with HIV/AIDS
and currently treating the largest number of HIV patients in West Africa (8000), and the Centre de Santé
Urbain Spécialisé (Specialised Urban Health Centre) in Abidjan’s central prison, MACA, which comes under
Yopougon district’s Departmental Division and provides care to the prison’s 2000 inmates (although this
figure that can sometimes rise to 5000).
Hélène Boulestreau is a hospital practitioner in Pellegrin Hospital’s Hospital Hygiene Service. She runs the APPS project with a
nurse from the same service and makes visits to the field. The
first step in getting this project off the ground was to carry out a
review of the existing situation in order to define its objectives.
In Port Bouet General Hospital, the APPS project’s objective is
to provide support to the organisation of its operating theatre
(which is new) and sterilisation services through the introduction of procedures for managing healthcare-associated risks
and through the provision of training for the medical personnel
working in these services. A training course is being set up for
the Ivoirian staff in Bordeaux; they will then use the experience
gained in France to develop protocols adapted to their own
hospital’s situation.
La lettre ESTHER n°47 - March 2012
8
Another example of hospital hygiene efforts in Côte d’Ivoire:
the Sassandra experience
Evolutions in hygiene best practices
at Sassandra General Hospital (SGH):
a study conducted before and after a
training course for healthcare personnel
They will put these good practices in place in Port Bouet Hospital with the help of mentoring visits from the same French
staff who trained them in Bordeaux, and indicators will be
identified for monitoring these practices.
CEPREF has already received a number of mentoring visits and
personnel from the Yopougon Outpatient Centre have also
been to Bordeaux for training. However, it is taking longer to
introduce good practices here than at Port Bouet as the staff
have a particularly heavy workload due to the number of patients in their care. Improvement is still needed in the maintenance of medical equipment (sterilisation), the maintenance
of premises and protection from infectious risks.
MACA is the 3rd biggest site with which Bordeaux is working.
Côte d’Ivoire is currently in a reconstruction phase following
the political events in 2011, and has managed to rehabilitate
the facilities that had been destroyed. Two billion CFA were
spent on rehabilitating MACA for its “tenants”. As part of the
project, an operational hospital hygiene team was put in
place. Motivation levels are high among the staff on the hygiene committee, and also among the paramedical staff. Here,
the APPS project focuses on the safety of the premises, hand
hygiene using pump-distributed hydro-alcoholic products,
staff safety and the asepsis of care.
The project also plans to support the DHP (the Ministry of
Health’s Public Hygiene Division) with the dissemination of
best practices for the prevention of healthcare-associated infection in all hospital facilities in the country (including other
“ESTHER” sites at Dabou and Sassandra). The Bordeaux team
will also offer support for setting up a diploma course in hospital hygiene, if technical and financial conditions allow.
Up until 2009, hygiene and safety measures were
little known in most of the healthcare facilities in
Côte d’Ivoire, including at Sassandra General Hospital.
The objective of this study is to show the impact of
an operational team’s activities on the training of
personnel and the implementation of hygiene and
safety activities.
Methods
A prospective and descriptive study was conducted
between June 2009 and June 2011 to show the evolution in hygiene practices among the 41 healthcare
workers at SGH, including cleaners who double up
as auxiliaries.
The different strategies adopted were:
• Training an operational hygiene team of five persons,
• Conducting an initial evaluation of hygiene practices through a self-administered questionnaire and
an observation study,
• Staff awareness-raising and training on hygiene
best practices,
• Introducing hygiene material into healthcare services,
• Providing monthly mentoring,
• Conducting a bi-annual evaluation of practices
using the initial questionnaire.
Results
Practices were evaluated amongst 8 doctors, 9
nurses, 4 mid-wives, 4 auxiliaries and 16 cleaners
before the training began. The results of the initial
evaluation showed 87% of poor hygiene practices
and 13% of best practices.
Two years after the start of the operational
team’s activities, a notable improvement can be
seen in the healthcare workers’ delivery of care.
51% wash their hands with a hydro-alcoholic solution, 93% sort waste, 75% wash their hands before
delivering care and 100% of them afterwards, 78%
wear gloves during the delivery of care, 100% use
retractable syringes and auto-blockers, 93% use
safety boxes correctly and 83% use 12° bleach,
amounting to a total of 80% of best practices.
Furthermore, 7% of incidents involving accidental
exposure to blood have been reported, compared
to none in the past.
Conclusion
Good hygiene practices have been successfully promoted at SGH, increasing from 13% to 80% in two
years. The challenge now lies in consolidating these
gains and extending them to the rest of the health
district.
Auteurs :
N’guessan KISSIEDOU, Adjoua ALLA YOBOUE, KouassiLOUKOU, Aya Viviane N’DRI, LéonceN’GBOCHO: Sassandra General Hospital
Agnès CHARVIER, Fabienne FAURE, Jean-Pierre BRU,
Hospital Centre, Annecy Region,
Christophe MICHON, Jean Marie MASUMBUKO, ESTHER.
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Third-line treatments in
Mali: a new challenge
Third-line antiretroviral treatment
for multi-resistant patients in Mali
It’s been more than a decade since antiretroviral therapy was first introduced in West Africa. Over 85% of
our patients are still on their first-line treatment regimen. Fewer than 15% of our patients are on a secondline regimen, and very few are on third-line therapy.
Third-line treatment regimens are expensive and not
yet accessible to patients in Africa. For that reason, we
decided to investigate the genotypic resistance profile of the patients starting third-line ARV treatment in
Mali.
Methods : Between March 2009 and October 2011,
we selected all patients in Mali who were in virological
failure on a second- line ARV regimen and who had no
treatment options according to resistance genotyping
carried out using the Viroseq technique.
Almoustapha Maiga is veryactively involved in ESTHER projects. After receiving his Doctor of Pharmacy degree from Bamako University, he completed his clinical research training at
René Descartes University, and earned a Masters 2 in Virology-Immunology at the Ecole Pratique des Hautes Etudes and
a PhD in Virology from the Ecole Doctorale “Complexité du Vivant” at the Pierre et Marie Curie University.
He is currently working as:
- Assistant Department Head of Gabriel Touré University Hospital’s Medical Analysis Laboratory in Bamako. This laboratory performs medical analyses for the hospital’s inpatients, for
outside patients, and for medical consultations.
- Head of the Malian Centre for Vaccine Development’s medical bacteriology laboratory since June 2011. This laboratory
handles research protocols on bacterial infections commonly
found in Mali, sets up clinical trials for vaccines and gets them
added to the Expanded Program on Immunisation (EPI) in
Mali.
- Head of the Molecular Epidemiology of HIV Antiretroviral Resistance Unit at the SEREFO Centre for Research and Training
on HIV/AIDS and TB at Bamako University. This laboratory sequences HIV. The work focuses on the molecular epidemiology
of HIV-1 resistance to antiretrovirals in the management of
HIV+ patients on antiretroviral therapy. The lab also performs
molecular phenotyping of the viral subtypes found in Mali.
Results : NWe found 19 patients multi-resistant to the
ARV drugs available in Mali. The median viral load (VL)
was 69,740 copies/mm3 and the median CD4 count
was 134/mm3 before starting treatment. Six patients
died, for a mortality rate of 31.5%. The prevalence of
resistance mutations to nucleoside reverse transcriptase inhibitors was M41L (37%), A67G/N (42%), M184V
(100%), T215F/Y (68%), K219E/Q (37%) and Q151M
(16%).
For the non-nucleoside reverse transcriptase inhibitors
the prevalence was K103N (32%), K101E/H/P (11%),
Y181C/I/V (37%) and H221Y (21%). For the protease inhibitors, it was L76V (42%), V82A/F/T/S (21%) and I84V
(37%).
There were other important mutations. All of the patients had resistance to the three classes of ARV drugs
available in Mali, and 38% had resistance to Etravirine.
We started these patients on a regimen including Darunavir and/or Etravirine, depending on the genotyping results.
Conclusion : Laboratory monitoring (viral load and
resistance genotyping) continues to be essential for
starting and following a third-line ARV regimen in
resource-limited countries.
The results of his work have been presented at international conferences, including ICASA in December 2011
and the 6th Francophone Conference on HIV/AIDS, held
in Geneva in March 2012.
La lettre ESTHER n°47 - March 2012
10
Dr. Christophe Michon,
ESTHER’s new Medical and Scientific Director
The 2000s
In 1999 Dr. Michon began working as a staff
physician in the Infectious Diseases department at Annecy hospital. He also spent a year
as assistant on the HIV team at Geneva University Hospital, in the department of Prof. Bernard Hirschel. While at Annecy, he set up the
hospital’s addiction treatment unit.
While doing his hospital work, he joined MSF
Switzerland as a technical advisor at a time
when pilot programmes on ARV access were
just getting started. He also served as an advisor to UNAIDS; he was working on treatment
when the first ARV guidelines came out, and
when ARVs were added to the list of essential
drugs.
Christophe Michon at the ANRS Ivory Coast Cooperation
Programme’s 15th annual Scientific Conference, Ivory
Coast, February 2012.
Christophe Michon, MD began his specialisation in infectious diseases in the 1980s, at a time when ID departments were in disarray over the advent of AIDS.
His first foray into ID was at the Bichat-Claude Bernard
University Hospital, where as assistant registrar in the
Infectious and Tropical Diseases department he helped
launch the first day hospital dedicated to HIV/AIDS care
and organise the first AIDS course for hospital physicians in France.
As the epidemic grew, AIDS care expanded from just
a few departments in Paris hospitals to the creation of
AIDS units in the city’s suburbs. In Colombes, where he
worked as a staff physician for 11 years (1988 -1999),
Dr. Michon helped open the ambulatory care facility
(Day Hospital) and was head of the specialised HIV
team.
During this period he developed the ESTHER
partnership based on a twinning between Annecy Hospital and the Sassandra Hospital in
the Ivory Coast. The HIV management component was started in 2003 and expanded in
2005, with rapid decentralisation from the reference centre, Sassandra Hospital, to eighteen
peripheral health centres.
In November 2008 Dr. Michon became an adviser on HIV care at the Directorate-General
for Health’s Sub-Directorate for Infection Prevention in Paris, a position that included acting
as technical secretary for the group of French
experts working on HIV treatment recommendations (the Yeni Report).
Dr. Michon is currently director of ESTHER’s
Medical and Scientific Department.
“Those were creative years in terms of the organisation of care. The HIV unit was part of Internal
Medicine; it was a time when palliative care and clinical research were growing, and everything had to
be built from scratch locally.” It was also at that time
that he embarked upon his first international experiences; after obtaining an MAS in Public Health,
Developing Countries in 1988, he served on missions in Algeria and Mauritania.
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An invitation from ESTHER …
On Sunday 25th March from 3.30 to 5pm in Room 4: Symposium organised by ESTHER and AIDES
u
Mediator /psychosocial counsellor: a new community health profession to
be recognised and incorporated into HIV care and treatment services.
u
On Tuesday 27th March, at 3.30pm
Distribution of the training guide: «Training paramedical personnel in HIV
management in resource-limited countries».
Meeting and signing session with the authors and publication coordinators
u And presentations by ESTHER’s partners every day at the 6th
Francophone HIV conference (AFRAVIH 2012)
18 oral presentations and 12 posters will be presented by ESTHER’s partners or concern an ESTHER programme.
u
COME AND FIND US ON THE ESTHER STAND (N° 4)
Every day:
-Demonstrations of the ESOPE software suite and the E-learning continuing
education site: www.estherformation.fr, and presentation of the new website
www.esther.fr
-Presentation of the training guide for paramedical personnel: «Training paramedical personnel in HIV management in resource-limited countries».
Find out more: www.esther.fr
Editorial Board
Farid Lamara, Nadine Legret, Florence Maclair, Pierre Mendiharat.
Design & copy
Nadine Legret
Photo credit : ESTHER
A space for discussion between partners from the North and South
The inclusion of
photos of people
should not be seen
an as indication
of their state of
health.
The use of all or
part of the document is authorised
provided
the source is acknowledged.
Contacts-reactions : [email protected]
La lettre ESTHER n°47 - March 2012
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