TESTING AND COUNSELING SCALEUP AT THE COUNTRY LEVEL: MALI

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TESTING AND COUNSELING SCALE-UP AT THE COUNTRY
LEVEL MALI

• Dr Aliou SYLLA
• Fight Against AIDS Unit Coordinator/Health
  Ministry
  
• President of ARCAD/SIDA/CESAC
• Co-founder of the International Plus Coalition
  against AIDS

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Presentation Plan

• Introduction
• HIV Epidemiologic Situation in Mali
• Testing and counseling scale-up
• Findings
• Difficulties
• Conclusion

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Introduction

• From its first manifestations in the 70s and
  80s, AIDS has been perceived as a disease that
  challenges science, and it has been linked to
  inmoral sexual behavior
• PLHIV were and are still subject to stigma,
  discrimination and misunderstanding...
  
• Low level of voluntary testing among population

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HIV Epidemiologic Situation in Mali
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Mali is a large country in West Africa with a
population of about 12 million peopleHIV
Prevalence Rate 1.3 DHS 2006Variable HIV
prevalence among vulnerable groups (2.2-35.3
ISBS 2006)Generalized epidemic
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HIV Prevalence Rate Comparison in Mali between
EDSM 2001 and 2006
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HIV prevalence among groups at risk (ISBS 2000,
2003 2006)
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Testing and Counseling Scale-up
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Scale-up of VCT in Mali from 2001 to 2008

• Before 2001
• Testing was made at CESAC, which was the only
  structure to assume responsibility for ART
  
• In 2001
• Study trip by the National AIDS Programme in
  three countries with previous experience in the
  HIV/AIDS testing
  
• Production and validation of a Reference Manual
  (Competencies in HIV/AIDS Counseling and Service
  Providers Protocol)
  
• Validation of three tests by the reference lab in
  Mali, the INRSP (Détermine, Oraquick
  Hémastrip), on 700 blood samples from CESAC

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Scale-up of VCT in Mali from 2001 to 2008

• Production of a first algoritm based on rapid
  validated testing
  
• Letter from the Health Ministry authorizing the
  use of rapid validated tests by the INRSP
  
• Issue of the Mali Initiative of Access to
  Antiretrovirals (IMAARV) to minimize the ethical
  aspects related to HIV-positive testing
  
• Issue of the first Standards and Procedures paper
  related to voluntary testing by the Health
  Ministry
  
• Implementation of the first independent pilot VCT
  labeled  Centre Eveil  from PSI

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Scale-up of VCT in Mali from 2001 to 2008

• From 2002 - 2004
• Validation of the Standards and Procedures Paper
  for discussion among stakeholders
  
• Implementation of 23 VCT together with the NGOs
  International Plan
  
• Start-up of voluntary testing at a mobile
  strategy
  
• In 2005
• Issue of a Decree relative to the implementation
  of VCT (involving communities and public
  services)

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Scale-up of VCT in Mali from 2001 to 2008

• In 2006
• Revision of the Standards and Procedures Paper
  relative to HIV voluntary testing
  
• Implementation of an integral VCT program at 34
  Community Health Centers (CSCOM) in collaboration
  with NGOs
  
• In 2007
• Production of a Voluntary Testing Guide at a
  mobile strategy
  
• In 2008
• Integration of testing services into 100 CSCOM
  directly under community administration to ensure
  continuity
  
• Revision of the HIV/AIDS Counseling Reference
  Manual
  
• Production and validation of a Testing Quality
  Control paper

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Findings from Testing and Counseling Scale-up
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Findings from VCT from 2005 to 2007
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Problems related to Testing and Counseling
Scale-up

• Lack of enough qualified human resources to carry
  out such activities
  
• Lack of integration of VCT into the health
  structures
  
• Lack of financial resources to support the VCT
  program
  
• Solution to issues related to human rights within
  the HIV context (privacy, confidentiality)
  
• Hard preservation of rapid tests in tropical
  countries, need of a cooling system (for
  temperatures between 2C and 8C or 2C and
  30C)
• Short preservation delay window for rapid tests
  (9 months for most samples)
  

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Conclusion 

• To know your HIV status to benefit from an early
  HIV care and treatment
  
• Encourage Up Out in the test counseling
• Reduce the number of new infections
• Encourage the VCT for vulnerable groups (MSM, Sex
  Workers)
  
• Reduce stigma and HIV unawareness to ensure
  universal access
  
• A public health imperative

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