Prevention and Control of

HIV at District Level

Rural Posting 4th rotation

Group 8

Nur Shazwani Binti Shabani

Nur Syahida Binti Musa

Nur Syarafina Binti Abdul Malek

Nur Syazana Binti Marashin@Hashim

Puteri Nur Fatin Binti Rosli

Introduction

Globally….

• 34 millions people currently living with HIV

• Estimated 2.7 millions more people become infected with HIV

• Each year, 2 millions dies of AIDS

Definition...

• HIV is communicable disease of acquired immune deficiency syndrome by the virus called HIV or Human Immunodeficiency Virus. The virus causes severe damage to the immune system

• A retrovirus, the Human Immunodeficiency Virus (HIV) was identified in 1983 as the pathogen responsible for the Acquired Immunodeficiency Syndrome (AIDS).

• AIDS is the final stage of the infection .

Transmission• Sexual Intercourse

• Body fluids

• Mother to child

Stages of HIV

STAGE 1: Primary HIV infectionProduction of HIV antibodies and cytotoxic lymphocytes. This lasts for a few weeks and patient may present with a short flu-like illness.

STAGE 2: Clinically asymptomatic stageHIV is very active in the lymph nodes. This stage lasts for an average of ten years with no major symptoms except for swollen glands.

STAGE 3: Symptomatic HIV infectionImmune system is damaged and symptoms develop due to the emergence of opportunistic infection.

STAGE 4: Progression from HIV to AIDSAt present, AIDS is confirmed if a person with HIV develops one or more of a specific number of severe opportunistic infections or cancers or they have a very low count of T helper cells in their blood.

Importance of Prevention and

Control of HIV

• socioeconomic and human impact of AIDS on the individual, family, community and society.

• To create and maintain a conducive and enabling environment for government and civil society to play meaningful and active roles in decreasing stigma and discrimination.

• To further increase general awareness and knowledge of HIV, and reduce risk behaviour for at risk and vulnerable populations.

• To further reduce by 50% the number of new HIV infections by scaling up, improving upon and

• initiating new and current targeted and evidence based comprehensive prevention interventions

Strategies

National Strategic Plan on HIV AIDS 2011-2015 objectives

!)further reduce 50% num new infections

2)Increase Quality of care,treatment and support for PLWH

3)To alleviate socioeconomic impact of AIDS

on indv,family,society

Primary HIV preventionobjective : to increase awarenes &knowledge of HIV status,control HIV progress &

prevent HIV spread to all populationVoluntary Confidential Counselling &Testing (VCT programme)

Premarriage, Prenatal,Postnatal HIV Screening • provided by all health clinics in Sabak Bernam. • can be obtained within 10 minutes,free of charge ,result is remained confidential. • provided with pre and post counselling.(eg Family planning)

Healthy Programme Without AIDS for Youth (PROSTAR)• Through PROSTAR, trained teenagers will give information and teach other

teenagers about HIV and the high risk behaviours that can transmit HIV (Motivation for behavior change, Problem solving skills,Build confidence)

Pamphlet and Education• Produced & provided in every health clinic in Sabak Bernam• highlighted on the mode of transmission of HIV and how to prevent it• promote the HIV prevention programmes held in Malaysia and the ARV therapy• talks regarding HIV,its prevention & control had been organized in plantations and

factories with the objective of educating foreign workers in Sabak Bernam.

Safety Precautions and Substitution of Needle and Syringe• wear Personal Protective Equipment• to avoid recapping the needle, to throw used needle and tools into

proper bins • new needles like butterfly needle had been distributed to all the

health clinics to substitute needle and syringe• For health care worker who had been exposed to HIV, a Post

Exposure Prophylaxis consisting of ARV medication is given.

Celebration AIDS DAYS• School Programme (eg Poems Competition)• Getting to zero:Zero new HIV infection• Zero Discrimination:Zero AIDS related Disease

Secondary HIV preventionImproving quality of prevention programmes among vulnerable & most at risk population (MARP) (eg: SWs, MSM, transsexuals/ transgender, displaced persons, refugees, migrant labourers,indigenous peoples)

A)Prevention through sharing needle &syringes

i) Needle Syringe Exchange Programme (NSEP)• Harm Reduction Programme. • provided only in Sungai Air Tawar Health Clinic.

1)community leaders are approached & taught about NSE2) introduce the programme to IDU they can identify3)IDU confident,can come to the clinic->Agreement (identity protected)4)amount of needle &syringe is provided according his/her need. Used needle &syringe should be

brought to the clinic to be exchanged with new ones.

• objective :to prevent HIV transmission among IDU.

ii)Methadone Maintenance Theraphy(MMT)

• reduces the frequency of injecting and of needle sharing.

B)Prevention through unprotected sex

•Provide Sexual Reproductive Health (SRH) education•Counselling to married/unmarried couples (STI,promoting usage of condoms) esp MARP•Motivation Programme from AADK to IDU/OKP•Ops Bersih To Hotel (eg New Year) with JAIS

C)Prevention of Mother to Child Transmission (PMTCT)•Early diagnosis and treatment of pregnant mothersPregnant mothers are screened for HIV in their first visit to the Mothers and Child Health.For HIV positive mothers proper steps are taken to reduce transmission to the child such as:

•Antiretroviral therapy for the mother•Giving birth through caesarean section(planned delivery)•Giving formula milk to the baby(avoid bf)•Prophylaxis treatment for the baby after being born

D)Contact Tracing• pt confirmed infected by HIV, his/her wife/husband/partner and children will be traced for HIV infection •according to pt high risk activity(eg:IVDU friends)

D)Management of HIV Infected Cadaver

• Muslim’s cadaver- firstly washed with Clorox- Aft bathed with water,firstly wrapped with cloth followed by a plastic and later with cloth again.

• Non-Muslim’s cadaver, it is washed firstly with Clorox followed by water. Then it is put into a coffin while in the morgue.Any pus is cleaned and later the cloth and bed sheet is also washed with Clorox.

• Family members are taught on how to manage the cadaver. They must have proper understanding on how HIV can and cannot be transmitted.

• Personal Protective Equipment( apron, glove, boot, face mask) must be worn. They also should not have any wound or breach of their skin.

Health care worker will monitor/ help the process. Minimal contact with cadaver is advised& limited amount of family members are allowed.

• The Clorox will wash away the HIV while the plastic is used to prevent body fluid from leaking into the ground.

Tertiary HIV PreventionAim: HIV-Infected Person

Preventing disease progression and suffering after a diagnosis is established; treatment and rehabilitation

•Improve the quality and coverage of testing and treatment (HAART)

•Increase the access and availability of care, support and program for PLHIV

•Continuous need to improve research, surveillance and data analysis of monitoring and evaluation of HIV programme.

Highly Active Anti-Retroviral Therapy

HAART must be taken at the right time, right doses for whole life-to extend the life span of HIV patient

-to prevent opportunities infection

-to improve quality of life

How HAART work??

• Increase CD4

• Suppress HIV virus

When to start HAART??

• Symptoms of AIDS

• CD4 <350 sel/mm3

• Patient willingness

• Pregnant woman with HIV

Activities

Programs Issues Date Participants Activities Venue

Prevention and Control of HIVamong immigrants

Increasing in HIV/AIDS cases among immigrants

10/7/2012 Immigrants Education Sabak Bernam

To Increase Awareness among Teenagers

Increasing in HIVcases among teenagers

• 24/7/12

• 5/7/12

• 19/10/12

• 70 students

• 200 students

• 150 students

Seminar (education)

• Giat Mara• Kolej

Komuniti• Politeknik

Sultan IdrisSabakBernam

Program Issues Date Participants Activities Venue

Increase Awareness of HIV among Female

Increasing cases

7/11/12 Female of all sectors

Promote Safe SexAmong High Risk Group

BaitulEhsan,SabakBernam

Prevention of HIV/AIDS

Educate Community in SabakBernam

-promote HIV screening-promote safe sex

SabakBernam

Monitoring and Surveillance

System

3 types of screening at clinic

Data given to district health office

District health officer find the patient and take the history regarding hiv infection + contact tracing

Patient is advised for ARV programme by district health clinic

HIV screening

1. Register

2. See the healthcare professional on duty and ask for HIV screening.

3. The healthcare professional on duty will provide counselling before the test.

4. The finger prick test will be done, and the results will be known in 15 minutes (using rapid test kits).

5. If the result is “non-reactive”, you will be given further explanation. If you have any of the risk factors of HIV infection, you will be advised to repeat the test after six months.

6. If the result is “reactive”, counselling will be given to obtain your agreement to conduct a confirmation test.

The HIV confirmation test is as follows:

1. Around 5ml of blood will be withdrawn.

2. The healthcare professional on duty will give an appointment date within two weeks to give the results of the confirmation test and further counselling.

3. If the result of the confirmation test is negative, you will be given an appointment in six months’ time for a repeat test.

4. If your result is positive, you will be referred to the appropriate health services for further care.

Mandatory notification under CDC Act 1988

-Akta Pencegahan Dan Pengawalan Penyakit Berjangkit1988(Akta 342)

• The mandatory notification is important for surveillance and disease control and prevention activities.

• Every medical practitioners will have to notify any CDC cases to the nearest District Health Office

• If fail to notify, they can be compounded

• The earlier notifying system was by phone and form, or by fax, post or hand.

Communicable Disease Control Information System (CDCIS)

• Concept: Online notification

• Advantages

– Data up-to-date (daily input)

– Enable data sharing

– Faster analysis

– Accessible at all level

– Prompt preventive and control activities

– Forecasting of outbreak

• enotifikasi.moh.gov.my

District Performance

0

2

4

6

8

10

12

14

16

2008 2009 2010 2011 2012

5

8

11

13

15

1

3

9

8

3

NU

MB

ER O

F C

ASE

S

YEAR

HIV & AIDS, SABAK BERNAM (2008 - 2012)

HIV AIDS

• AIDS cases have decreased due to widespread use of highly active antiretroviral therapy (HAART) which prolongs the time from diagnosis with HIV infection to progression to AIDS.

• HOW? It suppressed amount of HIV virus in the blood + to get CD4 count as close to normal as possible.

• Estimated deaths among persons with AIDS have most likely decreased as a result of HAART.

Summary

• The theme for World AIDS Day in 2012 is Getting To Zero:Zero new HIV infections and Zero Discrimination:Zero AIDS Related Deaths.

• However, the target were not achieve in the Sabak Bernam district. Why?

Stigma and discrimination in the community towards HIV patient.

patient shy + loss hope Patient not consumed the medication provided.

• To prevent HIV from increasing, we really need cooperation from many other parties.

• We need to educate people, make people aware that HIV is not transmitted by casual contact and touching items that were touch by a person infected with the virus.

• A more thousand days remain before the world has to achieve its global 2015 targets…