Download WASH and HIV: current research and opportunities

WASH & HIV: links with maternal
& child health
Joe Brown
London School of Hygiene & Tropical Medicine
Department of Disease Control
Faculty of Infectious & Tropical Diseases
[email protected]
24 July 2012
The big picture
• HIV+ mothers and children are highly
vulnerable to WASH-related co-infections
• Providing critical WASH interventions,
together with ART for mother and baby, can
lower the risk of child death and may lower
the risk of mother-to-child transmission
(MTCT)
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 gondii and 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
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
• 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
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
• Increased retention in
PMTCT programming 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, vs
12% (disinfectant use
among mothers with
young children) or 20% (all
households in Malawi)
Rosen S, Fox MP, Gill CJ (2007) Patient Retention in Antiretroviral Therapy Programs in SubSaharan 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
• 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)
• Russo et al. 2012, Malawi: benefits of hygiene and
safe water programs can extend beyond
antenatal beneficiaries to include friends and
relatives
What we can do now
Add WASH to HIV PMTCT programming because:
• 1. We know HIV-affected children 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
Thank you
Creative and Novel Ideas in HIV Research (NIH)
P&G
London School of Hygiene and Tropical Medicin
Environmental Health Group
University of Zambia School of Medicine
Charlie Van Der Horst & the UNC CFAR