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
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 HIVSTAGE 1: Primary HIV infectionProduction of HIV antibodies and cytotoxic lymphocytes. This lasts for a fewweeks 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 tenyears with no major symptoms except for swollen glands.STAGE 3: Symptomatic HIV infectionImmune system is damaged and symptoms develop due to the emergence ofopportunistic infection.STAGE 4: Progression from HIV to AIDSAt present, AIDS is confirmed if a person with HIV develops one or more of aspecific number of severe opportunistic infections or cancers or they have avery low count of T helper cells in their blood.
• 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
StrategiesNational Strategic Plan on HIV AIDS 2011-2015 objectives !)further reduce 50% num new infections2)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 prevention Improving 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 &syringesi) 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 ofcondoms) esp MARP•Motivation Programme from AADK to IDU/OKP•Ops Bersih To Hotel (eg New Year) with JAISC)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 Mothersand Child Health.For HIV positive mothers proper steps are taken toreduce 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 bornD)Contact Tracing• pt confirmed infected by HIV, his/her wife/husband/partner andchildren 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 Prevention Aim: HIV-Infected PersonPreventing 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 andprogram for PLHIV•Continuous need to improve research, surveillance and dataanalysis of monitoring and evaluation of HIV programme.
Highly Active Anti-Retroviral TherapyHAART 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 lifeHow HAART work??• Increase CD4• Suppress HIV virusWhen to start HAART??• Symptoms of AIDS• CD4 <350 sel/mm3• Patient willingness• Pregnant woman with HIV
ActivitiesPrograms Issues Date Participants Activities VenuePrevention Increasing 10/7/2012 Immigrants Education Sabak Bernamand Control in HIV/AIDSof HIV casesamong amongimmigrants immigrantsTo Increase Increasing • 24/7/12 • 70 Seminar • Giat MaraAwareness in HIV students (education) • Kolejamong cases • 5/7/12 • 200 KomunitiTeenagers among students • Politeknik teenagers • 19/10/12 • 150 Sultan Idris students Sabak Bernam
Program Issues Date Participants Activities VenueIncrease Increasing 7/11/12 Female of all Promote BaitulAwareness cases sectors Safe Sex Ehsan,Sabakof HIV Among High Bernamamong Risk GroupFemalePrevention Educate Community -promote Sabakof HIV/AIDS in Sabak HIV Bernam Bernam screening -promote safe sex
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 tracingPatient is advised for ARV programme by district health clinic
HIV screening1. Register2. 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 Berjangkit 1988(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
HIV & AIDS, SABAK BERNAM (2008 - 2012) 15 16 14 13 12 11NUMBER OF CASES 9 10 8 8 8 6 5 3 3 4 2 1 0 2008 2009 2010 2011 2012 YEAR 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…