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Implementing a test and treat programme in a rural conflict-affected area of South Sudan Cecilia Ferreyra Arellano, Vicente Descalzo Jorro, Elena Grandio,

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Presentation on theme: "Implementing a test and treat programme in a rural conflict-affected area of South Sudan Cecilia Ferreyra Arellano, Vicente Descalzo Jorro, Elena Grandio,"— Presentation transcript:

1 Implementing a test and treat programme in a rural conflict-affected area of South Sudan
Cecilia Ferreyra Arellano, Vicente Descalzo Jorro, Elena Grandio, Augusto Llosa, Johana Vanpeteghen MSF, Yambio, South Sudan 1

2 Introduction: Context
South Sudan: Independent in 2011. Civil war since December 2013, with important ethnic component. Northern-eastern part of the country is the region most affected by conflict. In 2015 clashes spread to Western Equatoria (local militia against national army) Vicente Descalzo Jorro. MSF. Implementing a test and treat programme in a rural conflict-affected area of South Sudan 2

3 MSF (Operational Centre Barcelona)
Introduction: Context South Sudan: Independent in 2011. Civil war since December 2013, with important ethnic component. Northern-eastern part of the country is the region most affected by conflict. In 2015 clashes spread to Western Equatoria (local militia against national army) MSF (Operational Centre Barcelona) Vicente Descalzo Jorro. MSF. Implementing a test and treat programme in a rural conflict-affected area of South Sudan 3

4 Introduction: HIV situation
HIV adult prevalence: 2.7% (6.8% in Western Equatoria) Centralised HIV counselling and testing (HCT) services. Antiretroviral therapy (ART) only accessible at district hospital level. Vicente Descalzo Jorro. MSF. Implementing a test and treat programme in a rural conflict-affected area of South Sudan

5 Introduction: HIV situation
HIV adult prevalence: 2.7% (6.8% in Western Equatoria) Centralised HIV counselling and testing (HCT) services. Antiretroviral therapy (ART) only accessible at district hospital level. Pilot Project: Test and Treat OBJECTIVES Bring HCT and ART closer to the communities Implement early ART initiation Assess the feasibility and acceptability of this intervention Vicente Descalzo Jorro. MSF. Implementing a test and treat programme in a rural conflict-affected area of South Sudan

6 Methods: Location Western Equatoria State Rural Areas of Yambio County
By User:Ivan25 (Source Map) via Wikimedia Commons Western Equatoria State Rural Areas of Yambio County 3 Payams Total population estimated at people Map data © 2016 Google Vicente Descalzo Jorro. MSF. Implementing a test and treat programme in a rural conflict-affected area of South Sudan

7 Methods: Activities Images by Teresa Sánchez Ravina (MSF) Vicente Descalzo Jorro. MSF. Implementing a test and treat programme in a rural conflict-affected area of South Sudan

8 Methods: Activities Images by Teresa Sánchez Ravina (MSF) Vicente Descalzo Jorro. MSF. Implementing a test and treat programme in a rural conflict-affected area of South Sudan

9 Methods: Activities Images by Teresa Sánchez Ravina (MSF) Vicente Descalzo Jorro. MSF. Implementing a test and treat programme in a rural conflict-affected area of South Sudan

10 Methods: Activities Images by Teresa Sánchez Ravina (MSF) Vicente Descalzo Jorro. MSF. Implementing a test and treat programme in a rural conflict-affected area of South Sudan

11 Methods: Activities Images by Teresa Sánchez Ravina (MSF) Vicente Descalzo Jorro. MSF. Implementing a test and treat programme in a rural conflict-affected area of South Sudan

12 Methods: Activities Images by Teresa Sánchez Ravina (MSF) Vicente Descalzo Jorro. MSF. Implementing a test and treat programme in a rural conflict-affected area of South Sudan

13 Methods: Contingency Plan
Vicente Descalzo Jorro. MSF. Implementing a test and treat programme in a rural conflict-affected area of South Sudan

14 Methods: Contingency Plan
Provision of phone number Contingency Stock Vicente Descalzo Jorro. MSF. Implementing a test and treat programme in a rural conflict-affected area of South Sudan

15 Methods: Contingency Plan
Community Health Workers (CHWs) refill drugs of patients if restriction of movements Provision of phone number Contingency Stock Vicente Descalzo Jorro. MSF. Implementing a test and treat programme in a rural conflict-affected area of South Sudan

16 Methods: Contingency Plan
Community Health Workers (CHWs) refill drugs of patients if restriction of movements Provision of phone number Contingency Stock Distribution of Run-away-bags (3 months’ ARVs) through CHWs Vicente Descalzo Jorro. MSF. Implementing a test and treat programme in a rural conflict-affected area of South Sudan

17 Methods: Contingency Plan
Community Health Workers (CHWs) refill drugs of patients if restriction of movements Donation to District Hospital Handover files and register Provision of phone number Contingency Stock Distribution of Run-away-bags (3 months’ ARVs) through CHWs Vicente Descalzo Jorro. MSF. Implementing a test and treat programme in a rural conflict-affected area of South Sudan

18 Methods: Data Analysis of program data for the first 6 months of the project: July to December 2015. Data on acceptability of the services: uptake on HCT and ART initiation. Data on patient outcomes: retention in care. Lab: CD4 count and Viral Load at baseline and follow up after ART initiation. This study was approved by the MSF and the South Sudan Ministry of Health Ethics Review Boards Vicente Descalzo Jorro. MSF. Implementing a test and treat programme in a rural conflict-affected area of South Sudan

19 Results Tested 5262 people HIV Positive 178 (3.4%)
ART Initiation 146 (82%) CD4 < 500 cells/mm3 79 (54%) Vicente Descalzo Jorro. MSF. Implementing a test and treat programme in a rural conflict-affected area of South Sudan

20 Outcomes Contingency Plan
Map data © 2016 Google Vicente Descalzo Jorro. MSF. Implementing a test and treat programme in a rural conflict-affected area of South Sudan

21 Map data © 2016 Google Vicente Descalzo Jorro. MSF. Implementing a test and treat programme in a rural conflict-affected area of South Sudan

22 Sep 15 Map data © 2016 Google Vicente Descalzo Jorro. MSF. Implementing a test and treat programme in a rural conflict-affected area of South Sudan

23 Sep 15 Map data © 2016 Google Vicente Descalzo Jorro. MSF. Implementing a test and treat programme in a rural conflict-affected area of South Sudan

24 21 patients in no-go area, CHWs kept 19 (90%) on follow up and drug refill.
Sep 15 Map data © 2016 Google Vicente Descalzo Jorro. MSF. Implementing a test and treat programme in a rural conflict-affected area of South Sudan

25 Dec 15 21 patients in no-go area, CHWs kept 19 (90%) on follow up and drug refill. Sep 15 Map data © 2016 Google Vicente Descalzo Jorro. MSF. Implementing a test and treat programme in a rural conflict-affected area of South Sudan

26 Distribution of Run-away-bags to 25 of 29 patients with appointment that week (86%).
Dec 15 21 patients in no-go area, CHWs kept 19 (90%) on follow up and drug refill. Sep 15 Map data © 2016 Google Vicente Descalzo Jorro. MSF. Implementing a test and treat programme in a rural conflict-affected area of South Sudan

27 Dec 15 Distribution of Run-away-bags to 25 of 29 patients with appointment that week (86%). Dec 15 Dec 15 21 patients in no-go area, CHWs kept 19 (90%) on follow up and drug refill. Sep 15 Map data © 2016 Google Vicente Descalzo Jorro. MSF. Implementing a test and treat programme in a rural conflict-affected area of South Sudan

28 Drug distribution to 51 of 56 patients needing refill (91%)
Dec 15 Distribution of Run-away-bags to 25 of 29 patients with appointment that week (86%). Drug distribution to 51 of 56 patients needing refill (91%) Dec 15 Dec 15 21 patients in no-go area, CHWs kept 19 (90%) on follow up and drug refill. Sep 15 Map data © 2016 Google Vicente Descalzo Jorro. MSF. Implementing a test and treat programme in a rural conflict-affected area of South Sudan

29 Conclusions High level of acceptance of the intervention in the community (HCT and ART initiation) Good outcomes in the implementation of contingency plan, but security situation is still a big limitation. Short period for analysis of patient outcomes. Need for longer evaluation, including level of virological suppression. Guide for further MSF interventions focused on conflict settings with weak/non-existent HIV services. Vicente Descalzo Jorro. MSF. Implementing a test and treat programme in a rural conflict-affected area of South Sudan

30 Acknowledgements Thanks to all the people that make Test and Treat possible, especially the staff on the field and the communities of Yambio Images by Teresa Sánchez Ravina (MSF) Vicente Descalzo Jorro. MSF. Implementing a test and treat programme in a rural conflict-affected area of South Sudan

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