Why wash matters to people living with hiv
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Why WASH Matters to People Living With HIV. Joe Brown London School of Hygiene & Tropical Medicine Department of Disease Control Faculty of Infectious & Tropical Diseases [email protected] 25 July 2012. WASH importance to HIV. Quality of LIFE

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Why WASH Matters to People Living With HIV

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Why wash matters to people living with hiv

Why WASH Matters to People Living With HIV

Joe Brown

London School of Hygiene & Tropical Medicine

Department of Disease Control

Faculty of Infectious & Tropical Diseases

[email protected]

25 July 2012


Wash importance to hiv

WASH importance to HIV

  • Quality of LIFE

  • OIs related to WASH disproportionately affect People Living With HIV (PLHIV)

  • Stakes are higher for PLHIV: increased morbidity & mortality

  • Co-infections can lead to disease progression and early death as infections result from and increasea weakened immune status

  • Gut infections reduce ART uptake!


Why wash matters to people living with hiv

WHO GBD 2008, LMICs


Some common co infections that may be prevented or reduced with wash

Some common co-infections that may be prevented or reduced with WASH

  • Faecal-oral

    • Hepatitis A,E; viral diarrheas; Campylobacter; cholera; ETEC; Salmonella; Shigella; typhoid; paratyphoid; Crypto; Giardia; Amoebas; Toxoplasma gondiiand other opportunists

  • Water-washed

    • Trachoma; scabies; conjunctivitis; louse-borne infections

  • Soil helminths and tapeworms

    • Ascaris; hookworm; Taenia

  • Water-based

    • Cholera; Legionella; Leptospirosis; Schisto;

  • Insect vectors

    • Dengue, yllw fever, malaria, trypanosomiasis, filariasis, trachoma

  • Rodent borne

    • Leptospirosis; hantavirus, Tularemia


Wash control measures

WASH control measures

  • Improve water quality, water availability, hygiene

    • Hepatitis A,E; polio; viral diarrhoeas; Campylobacter; cholera; ETEC; Salmonella; Shigella; typoid; paratyphid; Crypto; Giardia; Amoebas; Toxoplasma gondiiand other opportunists

  • Improve water availability and hygiene

    • Trachoma; scabies; conjunctivitis; louse-borne infections

  • Sanitation, hygiene, treatment of excreta before re-use

    • Ascaris; hookworm; Taenia

  • Reduce contact with contaminated water, sanitation, treatment of excreta before re-use

    • Cholera; Legionella; Leptospirosis; Schisto; Guinea worm

  • Drainage, reducing breeding sites, insecticides/nets

    • Dengue, yllw fever, malaria, trypanosomiasis, filariasis, trachoma

  • Rodent control, hygiene measures

    • Leptospirosis; hantavirus, tularemia


Children with hiv

Children with HIV

  • Children who are HIV+ are at much greater risk of hospitalization, long-term illness, and death as a result of WASH-related infections

  • Children who are HIV+, as well as those who are HIV- but cared for by mothers that are HIV+, are at greater risk of poor nutritional status and health which can be caused or aggravated by enteric infection (Filteau 2009)


Art and diarrhea

ART and diarrhea

  • Diarrheal disease and intestinal infection may cause individuals on antiretroviral therapy (ART) not to absorb therapeutic dosages of the medication (Isaac 2008, Brantley 2003, Bushen 2004).

  • Implications for PMTCT, PREP, PEP, long-term disease progression and survival


Prevention of mother to child transmission pmtct

Prevention of Mother-to-Child Transmission (PMTCT)

  • Healthier moms are less likely to transmit the virus to children through breastfeeding

    • Healthier moms are less likely to pass other infections to baby, also

  • Gut infections in babies may increase the risk of HIV infection by compromising the integrity of the intestinal wall, making it easier for the HIV virus to pass into the infant’s bloodstream

  • Safe water and hygiene play a major role in the limited circumstances when replacement feeding/early weaning are indicated


Retention in care

Retention in care

  • Increased retention in care as a result of VitaMeal and hygiene packages (soap, P&G packets/cloth+ storage container) offered

  • Also reported “99.4% usage” of water treatment at 3 month follow up, versus 12% (disinfectant use among mothers with young children) or 20% (all households in Malawi)


Why wash matters to people living with hiv

Rosen S, Fox MP, Gill CJ (2007) Patient Retention in Antiretroviral Therapy Programs in Sub-Saharan Africa: A Systematic Review. PLoS Med 4(10): e298. doi:10.1371/journal.pmed.0040298

http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0040298


Cost effectiveness

Cost effectiveness

  • Low cost of including WASH in treatment and care programs

    • Pennies on the dollar!

    • Sustained access to safe water would be <5% of the cost of first-line ARVs (drugs only)

  • Significant net savings with integrated programming (Khan et al 2012)

  • Benefits of hygiene and safe water programs can extend beyond antenatal beneficiaries to include friends and relatives (Russo et al. 2012)


What we can do now

What we can do now

Add WASH to HIV PMTCT programming because:

  • 1. We know HIV-affected children and adults are highly vulnerable to diarrheal illnesses

  • 2. We know that WASH interventions can reduce diarrhea by 50% or more

  • 3. We know that diarrhea in mothers and children can contribute to lower uptake of life-saving drugs that prevent MTCT

  • 4. We know it can increase retention in treatment and care, at low cost


Why wash matters to people living with hiv

Thank you

Creative and Novel Ideas in HIV Research (NIH)

P&G

London School of Hygiene and Tropical Medicine,

Environmental Health Group

University of Zambia School of Medicine

Charlie Van Der Horst & the UNC CFAR


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