1 / 27

Pierre-Marie GIRARD, Hopital St Antoine & IMEA, Paris and ANRS Sénégal Site, for the

Injecting Drug Use and HIV, HCV infections in Dakar, Sénégal : From R esearch to Implementation , the UDSEN project. Pierre-Marie GIRARD, Hopital St Antoine & IMEA, Paris and ANRS Sénégal Site, for the UDSEN Study Group. Starting point - ICASA 2008, Dakar.

maxine
Download Presentation

Pierre-Marie GIRARD, Hopital St Antoine & IMEA, Paris and ANRS Sénégal Site, for the

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Injecting Drug Use and HIV, HCV infections in Dakar, Sénégal : FromResearch to Implementation, the UDSEN project Pierre-Marie GIRARD, Hopital St Antoine & IMEA, Paris and ANRS Sénégal Site, for the UDSEN Study Group

  2. Starting point - ICASA 2008, Dakar • A qualitative RapidAssessmentStudy(2004-2005) confirmed Injectable DrugsUse • The legal and social context of drugs use was repressive. • Very few care giversinvolvedin IDU . • =>PWID/PWUD = hiddenpopulations • Poor experience of HCW on drug use (« drugs » meanonly Cannabis) • Willingness of HIV experts and HCW to face this challenge (CNLS/SMI Fann/Saint Antoine Hospital /ANRS/IMEA /ESTHER). • => Implementation of an Operationnalresearchbased on a prevalence estimation of HIV/HCV/HBV by RespondentDrivenSampling (RDS) method

  3. Injection practices in Dakar, 2008

  4. UDSEN = « Usagers de Drogues Injectables au Sénégal » = « IDU in Dakar area » CEPIAD = « Centre de Prise en charge Integrée des Addictions à Dakar» 2008 2010 2011 2013 2014 2015

  5. UDSEN study: Objectives • To provide objective data on: • IDU prevalence and size of the population • Practices • HIV/HCV/HBV prevalence • HCW and Social Workers training • Advocacy for harmreduction programs • Advocacy for access to HAART in IDU

  6. Ethical Issues • Security & confidentiality for participants : • Setting of the survey in Clinical and Research center of Centre Hospitalier de Fann • Anonymous consent form • Intensive training of HCW and staff members on addictions issues and confidentiality • Amount of incentive: thesame as currentamount for clinicalstudies participation in the center • Care accessfor all the recrutees: • Prevention kits & counselling. • Access to tests results and care = 18-month duration for study preparation

  7. UDSEN study (ANRS 12243): methods (1) • Outreach program in the 4 previousmonths • Settings: All 4 departments of Dakar area. • Inclusion criteria: heroin and/or cocaine use in the previous 3 monthswhatever the use patterns (=IDU). • Size estimation by capture/recapture method : • Capture : cardboardtoken distribution at W-1 RDS survey • Recapture : participation to the RDS survey.

  8. UDSEN study (ANRS 12243): methods (2) • Recruitment of IDUsfor estimation of prevalence in the population: RespondentDrivenSampling (RDS) : 8 seeds representative of the diversity of the population. • RDS, social and behavioral questionnaires. • Biologicalassessment for HIV antibodies, HBV (HBs Ag and HBc Ab) and HCV (DBS). • Counselling and kit prevention

  9. UDSEN study : Main Results (April to July 2011) • Size estimation of IDU in Dakar area: 1324 (IC95%: 1281-1367). • RDS survey: • 625 individualswerepeer-recruited and 506included. • Non inclusion (N=119)

  10. Main characteristics of the participants (1) • predominantly male (n=434, 86%) • Median age: 43 year-old, women are younger (35 vs 44) • Most of them (n=356, 70%) were either single, divorced or widowed and lived with their parents (n=296, 59 %) • History of incarceration reported by 62 % • Median age of first heroin or cocaine or crack use: 27 year-old • 28% (n=140) have injecteddrugs at least once in their life

  11. Main characteristics of the participants (2) • Drugs use in the previous month: Heroïn 91%, Cannabis 64%, Cocaïne or Crack 63% , Alcohol 49%, Benzodiazepin 30%. • injection 14 %. • 13 % syringe sharing • Sharing: preparation water 27%, spoon 34%, cotton 27%. • Smoking: 86% (sharing of oral implements 60%) • Snorting: 49% (sharing of intra nasal implements 27% ) • At least one sexual intercourse for money or drug: 27%. • Sexual contacts in the previous 12 months • 80% • 46 % : multiple partners • 65% : often or alwaysunprotectedsex

  12. UDSEN study : Main Results (1) • Prevalences in the IDU population • HIV : 5.2% [IC95%(3.8-6.3)] • HBV (Hbs+ Ag) : 8.9% [IC95%(5.2-11.1)] • HCV (HCV Ab) : 23.3% [IC95% (21.2-25.2)]

  13. UDSEN study: Main results (2) HIV/HCV/HBV prevalence • HIV: • Injectors*vs Non-injectors: 9.4 % vs 2.5% • Womenvs Men: 13% vs 3% • HCV: • Injectorsvs Non-injectors: 39 % vs 18% No statisticdifferencein gender • HBV: AgHBs + : 8.9% • *injection at least once lifely

  14. Riskfactors for HIV and HCV • Riskfactors for HIV • Femalesex(OR = 4.9, 95%CI: 1.6 – 15.6) p= 0.007 • Past or actual injection (OR = 4.3, 95%CI: 1.7 – 10.7) p= 0.04 • Age (OR per year) (OR =1.1, 95%CI:1.004 – 1.1) p= 0.03 • Riskfactors for HCV • Past or current injection (OR = 2.7, 95%CI: 1.7 – 4.3) p= 0.0001 • To besingle, divorced or widowed (OR = 1.81, 95%CI: 1.08 – 3.04) p = 0.02 • Duration of relationship with study recruiter (OR per days)(OR = 1.001, 95CI: 1.0 – 1.002) p = 0.05 All results are generatedthroughmutivariateanalysis

  15. OUTREACH ACTIVITIES • Needle and Syringes programms (NSP)including collection of used injections materials • IEC withspecific communications tools • Feed back of the results of UDSEN study • HIV testing and counselling • Condoms programms • Information, prevention and treatment of STI • HAART accessaccording to the Senegale recommandations

  16. Quantitative assessment of OutreachActivities Sept 2011-Dec 2013 • 8396 contacts/talks/services including565« new » IDU (ie post UDSEN) • 419 IDU referred to clinics • 18619 syringes given and 10785used syringes collected (58%), • Distribution of 17564 condoms

  17. Needles & Syringes Program -«CRCF Cohort» 437 syr/PWID/year -Whole PWID of Dakar area 57s/PWID/an

  18. Post UDSEN study: High Fatality rate • 56 reportedDeaths (05/2011 – 12/2013) : • Meanage 43 yrs [ 25-60], • 50 % injectors • Causes of death: cardiac(2), accident(4), hepatitis (6), renalfailure (1), unknown (20), overdose/toxic (6), neurologic(1), TB (2), HIV (4) gastric (2), crime (1), surgery (1), cancer(1) malaria(2), seizures (2), lungdisease (1)

  19. Health and Social Centre for Drug Users CEPIAD (Centre de Prise en Charge Intégrée des Addictions de Dakar) Financial supports: GF/CNLS, Paris Municipality , ESTER, ONUDC, MSAS, CHNU Fann • In Hôpital Universitaire de Fann • Under auspices of CNLS • ConnectedwithClinicalResearch Center • Opening: end of 2014

  20. Benefits of UDSEN study • IDU defined as a key population in the 2011-2015 national program against HIV/AIDS. • Leverageeffect of the research on national and international fundings (UNODC, Mairie de Paris, FEI, Japanesecooperation). • July 2013: approval of the national multisectorial strategy against HIV infection and other co-morbidities among IDU and of its operational plan. • 2014: Opening of the center of integrated care for addictions with outreach, NSP and methadone programs in Fann Hospital (Dakar).

  21. Demonstration in the streets of Dakar & Workshop, June 2014

  22. Idrissa Ba, Annie Leprêtre, Abdalla Toufik, Papa Salif Sow, Maryvonne Maynart, Karine Lacombe, Coumba  Toure Kane, Gilles Raguin, Momar Gueye, Ibra Ndoye,

  23. Thanks for your attention

  24. Lambdin et al CID, July 2014

More Related