2. Testing brothers and sisters of a newborn (NB) followed in Prevention of Mother To Child Transmission (PMTCT) setting: used strategies and advantages in an African socio-cultural environment. Oral presentation; 18 TH ICASA, Nov 29 – Dec 04 2015; Hararé, Zimbabwé Logbo Parsifal 1, Dokponou Hugues 2, Tchegbessi Armandine 2, Gomadanou Eric 2, Padonou Jijoho 1, Azondekon Alain 1,2 1 University of Porto-Novo, Faculty of Medicine, Porto-Novo, Benin, 2 Military Teaching Hospital, Pediatrics, Cotonou, Benin

3. INTRODUCTION (1) WHO recommendations: PMTCT + testing siblings / father / other relatives Important gap in testing HIV positive children 50% mortality at < 2 years within HIV infected children if no treatment Early ART = 76% mortality reduction (Violari, 2008)

4. INTRODUCTION (2) Siblings HIV positive mothers Hospital: (sickness: malnutrition, TBC…) Adult’s Consultation Community Pregnancy Delivery PMTCT New-Born

5. SITUATION IN BENIN (2014) Total population: 10 millions HIV Prevalence rate : 1,2% HIV prevalence within pregnant woman: 1,9% Gap in testing HIV positive pregnant women: 5% Gap in PMTCT services accessing within tested HIV positive pregnant women : 38% MTCT prevalence: 7,62% Gap in HIV positive children under prophylaxis : 74%

6. OBJECTIVES General ─Describe how to integrate Social and Human sciences in a resource-limited setting in order to improve care to siblings with high HIV infection risk, in PMTCT process Specific ─Identify how this sciences can improve access for testing this possibly infected siblings ─Determine impact of integrating these sciences for early testing in siblings

7. CARE UNIT FOR CHILDREN EXPOSED OR INFECTED BY HIV (CUCEIH) - MILITARY TEACHING HOSPITAL (MTH) Established in 1997 ARV delivery since 2002 / PMTCT interventions since 2000 Human and social sciences services from 2007  social and preventive Pediatric department ─Family-centered services

8. PEDIATRIC DEPARTMENT - MTH Reception Infected Exposed Medical Section Psychological Section Therapeutic Education Section Community Care OPTIMA-Benin Fathers, Mothers or other relatives in Care Social and Nutritional Support Section Adults Psycho- Social Care Unit File First visit Follow up Internal Referring External Referring

9. CUCEIH - MTH Examination officeConference room Research and care Department

10. CUCEIH - MTH Waiting room Social and Preventive Pediatric Department Health education office

11. Nutritional support Social worker office Psychology office CUCEIH - MTH

12. Community Support MediationLTFU reduction Income generative activities Community pharmacy Schooling support Capacity building for Life Support group Nutrition Community support office at CUCEIH/MTH OPTIMA base at Akpakpa PK5 « OPTIMA-BENIN is doing everything for children that is impossible at hospital»

13. METHODS

14. Period A : 2004 - 2006Period B : 2007 - 2009 Human and social Sciences integrated No Human and Social sciences Systematic siblings testing suggested From PMTCT 2 nd visit, continuously until parents accepted Systematic siblings testing suggested From PMTCT 2 nd visit, continuously until parents accepted 14

15. Gynecologic and obstetrical past history were collected: miscarriage, stillborn, dead children with ages at death. Testing: Rapid tests (Determine and Bioline) were firstly used, then ELISA for confirmation Chi2 and Mann-Whitney’s tests were respectively used for proportions and medians comparison.

16. RESULTS

17. MOTHERS’ CHARACTERISTICS 179 mothers were received 63% (113 mothers) had at least one child alive ─ Median siblings size was 2 (1 to 5 children) ─ 18% had more than 3 children ─ 63% (71) of them with History of miscarriage, stillbirth or child death

18. CHILDREN CHARACTERISTICS 221 children were registered ─Median age 4 years (13 months - 14 years) ─42.6% (92) were in Period A 85% (188) were tested ─77% in Period A vs 90.1% in Period B, p=0.01* Time to bring children for testing Median time: 6 months (1 to 23 months) ─11 months (1 to 23 months) for Period A ─2 months (1 to 17 months) for Period B p=0.00, Mann- Whitney

19. TIME TO BRING CHILDREN FOR TESTING Log rank, p=0.00 2 No Human and social science 8 Involving Human and social science

20. TESTING RESULTS (1) 39 of 188 tested (20.7%) were HIV positive Effect of history of miscarriage, stillbirth and child death ─26% in children had their mother with history of Miscarriage, stillbirth or child death ─vs 11% with no history (p=0.01)*

21. 39 of 188 tested (20.7%) were HIV positive Effect of history of miscarriage, stillbirth and child death ─26% in children had their mother with history of Miscarriage, stillbirth or child death ─vs 11% with no history (p=0.01)* TESTING RESULTS (2)

22. Period ─22.5% of Children in Period A vs 19.6% in Period B, p>0.05 HAART eligibility 17 of 39 (43.6%) were eligible according to National Guidelines ─56.2% (9 of 16) in Period A vs 30.4% (7 of 23) in Period B, p=0.10 TESTING RESULTS (3)

23. WHAT ABOUT “NOT TESTED” CHILDREN We did not test 33 children (14.9%)  22.8% in Period A vs 9.3% in Period B p=0.01*  Reasons  children tested before (14 children)  parent refusal (12 children)  fear from mothers (7 children)

24. DISCUSSION

25. MESSAGE TAKE HOME MESSAGE Siblings testing is worthy ─Improving access to care and treatment ─Human and social sciences should always be integrated to improve accessing siblings as well as testing them early Early HIV diagnosis = Early ART = Increase HIV Child Survival

26. CHALLENGE Siblings HIV positive mothers Hospital: (sickness: malnutrition, TBC…) Adult’s Consultation Community (NGO, CBO) Pregnancy Delivery PMTCT New-Born Birth Interval ~ 9 Months DELAY FOR TESTING

27. CONCLUSION A particular look has to be taken to siblings during PMTCT As well, Health educator, Social Worker and Psychologist should be also involved This strategy should be used as a key element ─Improve access to care and treatment for Children

28. ACKNWOLEDGEMENTS Benin Arm Forces Health Services Pediatric Department Med-Colonel Alain AZONDEKON Tanguy BOGNON University of Porto-Novo Prof Jijoho PADONOU Raïssa CHAFFA