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HIV Prevention in a Military Setting

Prevention. STI Syndromic Management. V. Mass Awareness Campaigns. Education & Training included in all steps. HIV Screening. V. V. HIV Diagnostics. Infrastructure Development. HIV Care & Treatment Management Training. HIV Prevention in a Military Setting.

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HIV Prevention in a Military Setting

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  1. Prevention STI Syndromic Management V Mass Awareness Campaigns Education & Training included in all steps HIV Screening V V HIV Diagnostics Infrastructure Development HIV Care & Treatment Management Training HIV Prevention in a Military Setting Department of Defense HIV/AIDS Prevention Program (DHAPP) Naval Health Research Center

  2. Develop plans with the military to achieve its HIV prevention goals Mass awareness campaigns Education and training (instructor training, peer education, workplace) Behavioral change communication (BCC) HIV screening [prevalence, voluntary counseling & testing (VCT)] HIV/AIDS surveillance Sexually transmitted infection (STI) syndromic management Occupational exposure prevention Policies and procedures for HIV-positive military Long-term treatment and HIV management Components of HIV Prevention in a Military Setting

  3. Develop Plans With Military to Achieve Their HIV Prevention Goals • Make contact with appropriate personnel within the military • Create liaison with US in-country Embassy • Work with the individual country to identify its needs and potential solutions • Work with other programs such as Centers for Disease Control and Prevention, Global AIDS Program, Joint United Nations Programme on HIV/AIDS, and US Agency for International Development

  4. HIV/AIDS Policies Policies should encompass the following components: • Medical readiness • Social norms of community • Training • Prevention • Confidentiality • Human rights • Testing • Surveillance • Care

  5. Prevention V STI Syndromic Management Mass Awareness Campaigns HIV Screening Education & Training included in all steps V HIV Diagnostics Infrastructure Development V HIV Care & Treatment Management Training HIV/AIDS Prevention Develop a Strategic Plan

  6. Prevention V STI Syndromic Management Mass Awareness Campaigns HIV Screening Education & Training included in all steps V HIV Diagnostics Infrastructure Development V HIV Care & Treatment Management Training HIV/AIDS Prevention Develop a Strategic Plan • Safe blood supply • Occupational exposure intervention

  7. Prevention V STI Syndromic Management Mass Awareness Campaigns HIV Screening Education & Training included in all steps V HIV Diagnostics Infrastructure Development V HIV Care & Treatment Management Training HIV/AIDS Prevention Develop a Strategic Plan • Safe blood supply • Occupational exposure intervention • Surveillance • Voluntary counseling & testing

  8. Prevention V STI Syndromic Management Mass Awareness Campaigns HIV Screening Education & Training included in all steps V HIV Diagnostics Infrastructure Development V HIV Care & Treatment Management Training HIV/AIDS Prevention Develop a Strategic Plan • Safe blood supply • Occupational exposure intervention • Surveillance • Voluntary counseling & testing • CD4 counts • Viral load • Role of rapid tests

  9. Prevention V STI Syndromic Management Mass Awareness Campaigns HIV Screening Education & Training included in all steps V HIV Diagnostics Infrastructure Development V HIV Care & Treatment Management Training HIV/AIDS Prevention Develop a Strategic Plan • Safe blood supply • Occupational exposure intervention • Surveillance • Voluntary counseling & testing • CD4 counts • Viral load • Role of rapid tests • Manage HIV • Treat endemic infectious disease • Treat OI, TB, malaria

  10. Prevention V STI Syndromic Management Mass Awareness Campaigns HIV Screening Education & Training included in all steps V HIV Diagnostics Infrastructure Development V HIV Care & Treatment Management Training HIV/AIDS Prevention Develop a Strategic Plan • Safe blood supply • Occupational exposure intervention • Surveillance • Voluntary counseling & testing • CD4 counts • Viral load • Role of rapid tests • Communication & coordination • Treatment clinics • Laboratories • Blood banks • Training facilities • Pharmacies • Manage HIV • Treat endemic infectious disease • Treat OI, TB, malaria

  11. Prevention V STI Syndromic Management Mass Awareness Campaigns HIV Screening Education & Training included in all steps V HIV Diagnostics Infrastructure Development V HIV Care & Treatment Management Training HIV/AIDS Prevention Develop a Strategic Plan • Safe blood supply • Occupational exposure intervention • Surveillance • Voluntary counseling & testing • Ambush Theater • Radio & TV programs • Billboards • Promotional materials • CD4 counts • Viral load • Role of rapid tests • Communication & coordination • Treatment clinics • Laboratories • Blood banks • Training facilities • pharmacies • Manage HIV • Treat endemic infectious disease • Treat OI, TB, malaria

  12. Prevention V STI Syndromic Management Mass Awareness Campaigns HIV Screening Education & Training included in all steps V HIV Diagnostics Infrastructure Development V HIV Care & Treatment Management Training HIV/AIDS Prevention Develop a Strategic Plan • Prophylactic medicine for sexual contacts • Follow-up to ensure effective drug regimen • Sexual health training for patients • Safe blood supply • Occupational exposure intervention • Surveillance • Voluntary counseling & testing • Ambush Theater • Radio & TV programs • Billboards • Promotional materials • CD4 counts • Viral load • Role of rapid tests • Communication & coordination • Treatment clinics • Laboratories • Blood banks • Training facilities • pharmacies • Manage HIV • Treat endemic infectious disease • OI, TB, Malaria

  13. Education • Identify local social norms & customs • Provide: • Learning aids (flip charts/diagrams/fact sheets) • Visual aids (photographs/posters) • Encourage & facilitate: • Story-telling (sharing experiences) • Group discussions • Continuing education

  14. Master trainers Peer educators Drama troupes Counselors Nurses Physicians Laboratory personnel Pharmacy personnel Chaplains Social workers Senior military staff Uniformed personnel Provide Training for:

  15. PREVENTION

  16. Occupational Exposure Intervention & Prevention Hospital staff and patients are at high risk for HIV infection, therefore: • Assess: • Infection control practices • Facilities for tuberculosis (TB) isolation and ventilation • Provide mandatory training of health care personnel • Consider logistics: • Design efficient patient care areas (e.g., where to place sharps disposal containers) • Identify solutions for sharps and hazardous waste disposal (such as syringes, scalpels) • What kind of disposal container is most appropriate to contain waste/sharp • Where to place sharps (clean & dirty) so personnel are least likely to incur occupational exposures • Maintain ample stock of protective supplies (gloves, biohazard waste, sharps disposal) • Decrease multiple uses of sharps • Increase hand washing • Develop & schedule regular equipment maintenance & waste disposal routines

  17. HIV Screening(prevalence, surveillance: active duty & recruits) • Requires personnel who are properly trained and educated • Consider logistics: test kits, locations, building, clinics that will ensure confidentially • Develop policy to standardize and ensure quality of: • Laboratory testing • Counseling guidelines • Personnel training • Offer & encourage counseling upon screening • Testing options for HIV positives: • HIV rapid testing • ELISA testing • CD4 counts • Behavioral risk surveys to understand risk behavior • Provide follow-up for positives

  18. Surveillance Develop surveillance tools: • Conduct seroprevalence survey • Use data to: • Estimate HIV infection prevalence in each military • Map prevalence trends over time • Estimate resource burden • Create annual reports • Set up a sentinel population

  19. Voluntary Counseling & Testing (VCT) • Ensure privacy of information/confidentially • Be sensitive & aware of the potential discrimination & stigmatization the patient may encounter • Ensure patient receives test results • Provide & encourage counseling

  20. Behavior Change Communication (BCC) Multi-level tool to promote and sustain risk-reducing behavior change in individuals and communities via tailored health messages in a variety of communication channels BCC can help: • Increase safe sex practices • Reduce stigma • Increase demand for VCT, mother-to-child transmission • Increase clinic visits for STIs, opportunistic infections (OIs), TB

  21. Safe Blood Supply • Provide personnel training • Develop screening algorithm for blood supply usage • Develop infrastructure capabilities

  22. Provide media such as “Ambush Theater” that are more likely to be accepted in the community Develop mass media programming to include military-specific characters and themes Consider culture-specific language, behaviors, and perceptions when designing campaigns Identify myths and misconceptions Communication tools that can be utilized for mass awareness include: Radio Films/video Posters Newspapers Bulletin boards Training events Mass Awareness Campaigns

  23. INFRASTRUCTURE DEVELOPMENT

  24. Communication & Coordination • Establish phone and e-mail communication • Improve Internet technology support • Establish office so that information can be updated and communicated to all members of the organization • Specify job descriptions and tasks for which each staff member/organization is responsible • Limit number of levels of management

  25. Department of Defense-Executed HIV/AIDS Rudimentary Civilian Construction/Refurbishment Projects • Design & construct: • HIV/AIDS education & training facilities • Clinics, especially VCT centers • HIV/AIDS diagnostic laboratories • Blood banks & blood collection centers • Supply warehouses solely supporting HIV/AIDS programs (e.g., climate-controlled, secure storage for antiretroviral pharmaceuticals) • Small AIDS treatment and care hospitals • Other (considered on a case-by-case basis)

  26. Laboratory Equipment & Procedures • Laboratory tests & equipment may include: • Rapid test kits • ELISA machine • CD4 counter • Microscope • Magnetic bead CD4 cell separation materials • Develop testing algorithm to ensure accuracy of positive HIV test results

  27. HIV CARE andMANAGEMENT

  28. HIV Diagnostics & Staging Capability • Provide laboratory infrastructure and equipment • Provide personnel training • Conduct HIV disease monitoring (CD4 lymphocyte count, viral load, consider alternative options in resource-poor settings) • Consider role of rapid tests (evaluation of rapid tests as available)

  29. STI Syndromic Management Coinfection of STI increases likelihood of HIV transmission & acquisition: • Syndromic management reduces HIV infection rates & provides an opportunity for HIV prevention education Provide preventive medicine: • Establish programs to contact and test past sexual contacts of known STI patients • Know current pharmacological data, sensitivities, most-effective drug regimens • Set up clinics where patients may be followed up for progress • Provide intensive sexual health training for STI patients

  30. HIV Care and Treatment Management Training • Provide: • Management of HIV • Treatment of endemic infectious diseases in HIV seropositives • Treatment for OIs, TB, and malaria

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