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Collecting Data on HIV Infection and Acting on it

Dr Chisale Mhango FRCOG

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Objective

The objective of this presentation is tounderstand national policy on the diagnosing and managing women living with HIV and AIDS with the aim of improving maternal and neonatal health in Malawi.

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Outline of Presentation

1. Policy on HIV screening in Malawi2. Checking HIV status of pregnant women3. Offering counselling4. Contact tracing5. PMTCT and ART coverage in pregnant women6. How to manage pregnant women who are HIV

positive

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Policy on HIV Testing

1. HTC vs VCTa. Option to opt out

2. Pre-Testing Counsellinga. Need to be testedb. Implication of each test result

3. Post-Testing Counsellinga. Negative resultb. Positive result

4. Follow-upa. Who needs CD4 count?b. Who needs ART?

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Checking HIV Status of Pregnant Women

1. Routine offer of HIV testing – with option to opt out

a. Why test is necessary?b. When is the test done?c. Who does the testing?d. Where is testing done?e. When is result provided?

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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.)

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Contact Tracing

1. Sexual partners (Not necessarily spouses)

2. Siblings

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Malawi implements the B+ Option for Antiretroviral prophylaxis for HIV-infected pregnant women

WHO option A WHO option B Malawi MOH option B+

Mother Antepartum zidovudine from 14 weeks’ gestation,single-dose nevirapine at onset of labour, andzidovudine plus lamivudine during labour and delivery and for 7 days’ postpartum

Triple ART regimen from 14 weeks’ gestation until 1 week after all exposure to breast milk has ended

Triple ART regimen started from 14 weeks’ gestation and taken for life

Breastfeeding baby Daily nevirapine from birth to 1 week after all exposure to breast milk has ended

Daily nevirapine syrup from birth to 6 weeks

Daily nevirapine from birth to 6 weeks

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PMTCT and ART Coverage in Pregnant Women

1. Coverage for ANC – 97% (98% urban, 96% rural)

2. Coverage for ART3. Challenges:

1. Test kits2. Missed opportunities3. Inadequate infrastructure for PMTCT

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Part 2

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The implications of being HIV positive for preventing puerperal sepsis

Sepsis is 2nd commonest 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

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The implications of being HIV positive for preventing puerperal sepsis cont.

1. No policy on prevention of puerperal sepsis in HIV+ women

i. HIV infection said to be major factor in puerperal sepsis

ii. No supporting research data2. Need for research

i. Prevalence of HIV infection among patients with puerperal sepsis

ii. Micro-organisms in puerperal sepsis

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How to Manage Pregnant Womenwho are HIV positive

Maternal Concerns1. Screening for opportunistic

infectionsa. STIb. TBc. Respiratory infections

2. Prevention of super-infection3. Prevention of opportunistic

infections4. Prevention of puerperal sepsis5. Reducing vertical transmission

(Prong 2)

Foetal Concerns1. Reduction of maternal viral

load2. Safer mode of delivery3. Prevention of neonatal

infection4. Safer infant feeding5. Confirmation of HIV status

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