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

HIV Prevention , treatment and care for IDUs in Senegal : An innovative ESTHER partnership. Dr Gilles Raguin , on behalf of ESTHER Senegal , IAS, 2012. Universal access to HIV prevention , treatment and care for IDUs is a priority.

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

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  1. HIV Prevention, treatment and care for IDUs in Senegal: An innovative ESTHER partnership Dr Gilles Raguin, on behalf of ESTHER Senegal, IAS, 2012

  2. Universalaccess to HIV prevention, treatment and care for IDUsis a priority • Package of intervention well defined and efficacy demonstrated • Needle exchange programs • Opioid substitution treatments (OST) • Volontary counseling and testing (VCT) • Antiretroviral Treatment (ART) • Prevention and treatment of STI • Condom distribution programs • Information, Education and Communication (IEC) • Vaccination, diagnosis and treatment of hepatitis • Prevention, 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

  3. HIV and IDU in Africa: a neglectedepidemic No data in most countries Kenya: 36 % S Africa: 12 % Nigeria: 5.5 % Tanzania :42 % Zanzibar: 16% Mathers, Lancet 2008

  4. An OperationnalResearch 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

  5. 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

  6. 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)

  7. 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).

  8. 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

  9. Thirdstep: 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

  10. Thirdstep: 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)

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

  12. 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

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