ICAP News - June 2009

Risk Reduction Program Implemented for Injecting Drug Users in Zanzibar

An innovative program led by a partnership of the Zanzibar government, non-governmental, and community-based organizations, is working to reduce HIV prevalence among the island’s more than 4,000 estimated injecting drug users.

One-quarter of Zanzibar’s injecting drug users are estimated to be HIV infected. In addition, injecting drug users account for nearly half of all HIV patients enrolled in care and treatment programs in Zanzibar.

The United for Risk Reduction and HIV/AIDS Prevention (URRAP) program focuses on educating injecting drug users about HIV prevention, including HIV testing and safe injecting practices, and linking these individuals to HIV services. Other goals include increasing awareness of injecting drug use and building the capacity of partners to implement effective HIV prevention programs.

In support of URRAP, ICAP has been working with HIV service sites to train clinicians about substance use and the management of HIV and sexually transmitted infections. ICAP is also supporting peer educator programs comprised of former drug users who are in recovery.

Since March 2009, URRAP has provided outreach to 6,420 individuals. In addition, since June 2008, training programs have been held for 46 healthcare providers, 80 peer educators, and 14 counselors.

“The strength of this program is the combined commitment of the partners to help one of the most marginalized populations at risk for HIV infection,” said Amy Cunningham, ICAP-Tanzania country director.

Primary implementing partners for URRAP include the Zanzibar Youth Education, Environment and Development Support Association; Zanzibar Association of Information Against Drug Abuse and Alcohol; and the Zanzibar Youth Forum.

Photo caption: Peer educators play vital roles in linking injecting drug users to HIV services in Zanzibar.

For more about ICAP Tanzania, visit here.

Labor and Maternity Wards Provide Opportunities for Delivering HIV Counseling and Testing to Male Partners of HIV-Positive Pregnant Women in Ethiopia

Male partner testing represents one of the biggest challenges to successful engagement of men in prevention of mother-to-child transmission (PMTCT) programs and prevention of HIV transmission in discordant couples. While men rarely accompany their partners on antenatal care visits, they are often present during labor and delivery. Recognizing this opportunity, ICAP-supported Nekemte Regional Hospital in Oromiya, Ethiopia, piloted an innovative provider-initiated HIV counseling and testing program in its labor and maternity ward.

Between Nov. 1, 2007 and July 31, 2008, a total of 1,709 women presented in labor, of whom more than three-quarters were unaware of their HIV status. Nearly all of these untested women and greater than one third of their male partners received HIV tests in the maternity ward. A total of 49 HIV-infected individuals were identified, of whom 20 were male partners. Among those who tested positive, 90 percent of the women and their partners were linked to HIV care and treatment at the HIV clinic at Nekemte Hospital.

“This approach of providing routine opt-out HIV counseling and testing for male partners accompanying women during labor may serve as a successful strategy to increase male involvement in PMTCT and identify HIV-infected men who may benefit from HIV care and antiretroviral therapy,” said ICAP-Ethiopia Regional PMTCT/Pediatric Advisor Yimenu Wondale. “It also offers opportunities for prevention efforts in identified discordant couples and engaging family members in supporting adherence to care.”

For more about ICAP Ethiopia, visit here.

Isoniazid Preventive Therapy Used for Childhood Contacts of Adults with Tuberculosis in Rwanda

In 2008, 4.4 percent of the 7,841 cases of tuberculosis (TB) in Rwanda occurred in children less than five years old. To reduce TB incidence in children, ICAP has been supporting the Ministry of Health in the expanded use of isoniazid preventive therapy (IPT).

A focus of this effort has been the revision of Rwanda’s national TB program guidelines and training materials to include a chapter on pediatric TB, contact tracing, and IPT. TB recording and reporting tools have also been updated to include information about IPT.

From 2006 to 2008, the number of children receiving IPT in 30 districts in the
country rose from 815 to 1,355. Among those children, approximately 15 percent had an HIV-positive parent. Children on IPT with an HIV-positive parent were offered HIV counseling and testing and enrolled in HIV care, if indicated.

Rwanda’s model for IPT implementation uses contact tracing through actively asking individuals with smear-positive pulmonary TB about their contacts and conducting home visits. Children identified as contacts are evaluated with a symptom screen and a physical examination. IPT is initiated for six months if the children are free of TB signs and symptoms or have had active TB excluded.

“National implementation of IPT for childhood contacts of adults with TB is feasible,” said ICAP Monitoring and Evaluation Director Veronicah Mugisha. “Nevertheless, additional evaluation is needed of the impact on childhood morbidity and mortality from TB.”

ICAP in Rwanda is supported by U.S. Centers for Disease Control and Prevention under the President’s Emergency Plan for AIDS Relief.

For more about ICAP Rwanda, visit here.

Microfinance Organization Links Clients to HIV Services in Rural Nigeria

In 2005, John Dada, director of the community-based Fantsuam Foundation in rural Kafanchan, Nigeria, started noticing that more clients were delinquent on their microfinance loan payments. Dada learned that they were using their loans to pay for HIV-related health care costs or funerals of loved ones who had died of AIDS.

“The problem that we were facing was enormous,” recalled Dada. “So many of our clients were dying of AIDS.”

Dada realized that the survival of the foundation itself depended on keeping its clients and their family members alive and healthy. In 2006, the organization began partnering with ICAP to provide a variety of HIV services, including HIV counseling and testing and home-based care, as well as services for orphans and vulnerable children.

In 2007, Baye Sunday lost his wife to HIV/AIDS and later learned that he too was HIV positive. As a client of the Fantsuam Foundation, he was referred to care and treatment at ICAP-supported General Hospital Kafanchan and provided with home-based care. The foundation also assisted him with employment and nutritional support for his children.

“Without this support, I would have lost my children as well,” said Sunday. “I am now very confident of my future.”

In addition to referring individuals who test HIV positive to care and treatment at General Hospital Kafanchan, Fantsuam Foundation plays a vital role in raising awareness about HIV and safer sex through public education. The organization also provides psychosocial and nutritional support to clients and their families.

“We have been able to stay open because of ICAP’s support,” said Dada. “HIV-related deaths have dropped substantially and overall quality of life has improved for people in the communities we serve.”

Photo caption: The Fantsuam Foundation provides lunch daily to Baba Sunday (center), son of client Baye Sunday. At left is John Dada, director of the foundation.

For more about ICAP Nigeria, visit here.

Zambia Hospital Identifies More than 3,000 Children Testing HIV Antibody Positive after Implementing Routine Opt-Out Testing

More than 3,000 hospitalized children tested HIV positive over an 18-month period after implementation of routine opt-out HIV testing at ICAP-supported University Teaching Hospital in Lusaka, Zambia, according to a study published in the June on-line edition of the Journal of Acquired Immune Deficiency Syndromes.

Diagnosis of HIV infection represents one of the biggest barriers to increasing the number of infants and children enrolled in HIV care and initiated on antiretroviral therapy (ART), especially in resource-limited settings. Infants are at high risk of early death without early diagnosis and treatment.

In Zambia, approximately 28,000 HIV-infected infants are born each year. In addition, one-quarter of women obtaining antenatal services in Lusaka are estimated to be HIV infected.

In January 2006, University Teaching Hospital implemented routine HIV counseling and testing for all hospitalized pediatric patients. HIV DNA polymerase chain reaction (PCR) was also introduced for early infant diagnosis.

During the period examined, HIV counseling and testing was offered to 15,670 children of unknown HIV status admitted to the hospital. Of those, 13,239 received counseling and 11,571 were tested. Nearly one-third of those tested were found to be HIV infected. Approximately 70 percent of those testing HIV-antibody positive were less than 18 months of age and nearly two-thirds of the infants tested with DNA PCR were determined to be HIV infected. In addition, the proportion of counseled children who were tested increased each quarter from 76 percent in January to March 2006 to 88 percent in April to June 2007.

“This work has now become a model for routine HIV testing of hospitalized pediatric patients and is being encouraged throughout Zambia,” said Chipepo Kankasa, MD, of the University Teaching Hospital Department of Pediatrics and one of the study’s lead authors.

University Teaching Hospital serves as Zambia’s national reference hospital and is home to the Pediatric Center of Excellence, which provides comprehensive care for HIV-exposed and HIV-infected children and training and dissemination of pediatric HIV expertise. The center is supported through a collaboration among the Zambian Ministry of Health, the U.S. Centers for Disease Control and Prevention, and ICAP.

For more about ICAP Zambia, visit here.