Patient adherence to HIV treatment and prevention in the Centre de Santé Communautaire de Sikoro, Bamako, Mali
TOUNKARA Karamoko, KONE Youssouf, KOTY Zoumana, ABOUBACAR Ben, WERWIE Timothy, DE GROOT Anne S.
GAIA Vaccine Foundation (Mali and Providence), Brown Medical School and the University of Rhode Island
Introduction : The Global Alliance to Immunize against AIDS Vaccine Foundation (GAIA) provides financial and technical support to a small infirmary, the Centre de Santé Communautaire (CSCOM) located in Sikoro, Bamako, Mali. The CSCOM is part of a national network that were created to bring health care to residents of Mali. The national HIV prevalence rate is 1.3% but is believed to be higher in Sikoro, where unemployment and illiteracy rates are much higher than elsewhere in the country. GAIA has been supporting access to HIV counseling and testing, to HIV medicine (MTCTP) and to artificial milk for pregnant women attending the Sikoro prenatal care center (Chez Rosalie) since 2005. We evaluated acceptance and adherence among women attending Chez Rosalie during the period January 2007-October 2008.
Results : Chez Rosalie counselors received 2,540 women during the study period. An average of 115 pregnant women were seen each month. All were offered a free HIV test, following pre-test counseling, and 99.8% agreed. During this period, 48 women (1.89%) tested HIV sero-positive and 29 (60.41%) delivered at the CSCOM. Of the 48, only four women did not accept anti-retroviral (ARV) prophylaxis prior to delivery. Following delivery, most (86.5%) of the new HIV-seropositive mothers elected to use artificial milk and 13.5% chose breastfeeding. During this period six children who had reached 18 month of age were also tested for HIV. Of those who were fed artificial milk during the first six months of their life, all (4/4) were negative and 2/2 (100%) of the children who were naturally breastfed were HIV-seropositive.
Conclusion : Enrollment and adherence to the PMTCT program and testing at the CSCOM are increasing, due in part to the CSCOM’s central location, the availability of tests and reagents, and the establishment of trust between patients and clinical staff. Some women still refuse ARV prophylaxis and artificial milk, increasing the risk of HIV transmission. GAIA is working on new methods to destigmatize HIV and PMTCT in Sikoro, and to scale-up peer-education programs that are already in place in Sikoro so as to improve willingness to participate and continue in PMTCT.