Collecting Data on HIV Infection and Acting on it

1. Collecting Data on HIV Infection and Acting on it Dr Chisale Mhango FRCOG NPC Training in MNH

2. Objective The objective of this presentation is to understand national policy on the diagnosing and managing women living with HIV and AIDS with the aim of improving maternal and neonatal health in Malawi. NPC Training in MNH

3. Outline of Presentation • Policy on HIV screening in Malawi • Checking HIV status of pregnant women • Offering counselling • Contact tracing • PMTCT and ART coverage in pregnant women • How to manage pregnant women who are HIV positive NPC Training in MNH

4. Policy on HIV Testing • HTC vs VCT • Option to opt out • Pre-Testing Counselling • Need to be tested • Implication of each test result • Post-Testing Counselling • Negative result • Positive result • Follow-up • Who needs CD4 count? • Who needs ART? NPC Training in MNH

5. Checking HIV Status of Pregnant Women • Routine offer of HIV testing – with option to opt out • Why test is necessary? • When is the test done? • Who does the testing? • Where is testing done? • When is result provided? NPC Training in MNH

6. Offering Counselling • Who provides the counselling? • The Rapid Test is provided by the ANC service provider in the ANC clinic: Patients are not to be sent to the Laboratory • Confidentiality • Privacy (nobody else apart from the single service provider and the patient need to know the result) • Communication to spouse (PMTCT involves the woman, the unborn child, the woman’s spouse and the siblings in the family.) NPC Training in MNH

7. Contact Tracing • Sexual partners (Not necessarily spouses) • Siblings NPC Training in MNH

8. Malawi implements the B+ Option for Antiretroviral prophylaxis for HIV-infected pregnant women NPC Training in MNH

9. PMTCT and ART Coverage in Pregnant Women • Coverage for ANC – 97% (98% urban, 96% rural) • Coverage for ART • Challenges: • Test kits • Missed opportunities • Inadequate infrastructure for PMTCT NPC Training in MNH

10. Part 2 NPC Training in MNH

11. The implications of being HIV positive for preventing puerperal sepsis Sepsis is 2ndcommonest cause of MMR • Prophylaxis antibiotics? • Early PNC • ART NB PMTCT has concentrated on saving the baby and not the mother. It is no use protecting a baby who will only soon be orphaned and die because we did not save the mother. SAVE THE MOTHER AS WELL NPC Training in MNH

12. The implications of being HIV positive for preventing puerperal sepsis cont. • No policy on prevention of puerperal sepsis in HIV+ women • HIV infection said to be major factor in puerperal sepsis • No supporting research data • Need for research • Prevalence of HIV infection among patients with puerperal sepsis • Micro-organisms in puerperal sepsis NPC Training in MNH

13. How to Manage Pregnant Womenwho are HIV positive Maternal Concerns Foetal Concerns Reduction of maternal viral load Safer mode of delivery Prevention of neonatal infection Safer infant feeding Confirmation of HIV status • Screening for opportunistic infections • STI • TB • Respiratory infections • Prevention of super-infection • Prevention of opportunistic infections • Prevention of puerperal sepsis • Reducing vertical transmission (Prong 2) NPC Training in MNH