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

3. 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. 2 NPC Training in MNH

4. Outline of Presentation 1.Policy on HIV screening in Malawi 2.Checking HIV status of pregnant women 3. Offering counselling 4.Contact tracing 5.PMTCT and ART coverage in pregnant women 6.How to manage pregnant women who are HIV positive 3 NPC Training in MNH

5. Policy on HIV Testing 1.HTC vs VCT a.Option to opt out 2.Pre-Testing Counselling a.Need to be tested b.Implication of each test result 3.Post-Testing Counselling a.Negative result b.Positive result 4.Follow-up a.Who needs CD4 count? b.Who needs ART? 4 NPC Training in MNH

6. 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? 5 NPC Training in MNH

7. 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.) 6 NPC Training in MNH

8. Contact Tracing 1.Sexual partners (Not necessarily spouses) 2.Siblings 7 NPC Training in MNH

9. Malawi implements the B+ Option for Antiretroviral prophylaxis for HIV-infected pregnant women WHO option AWHO option BMalawi MOH option B+ MotherAntepartum zidovudine from 14 weeks’ gestation, single-dose nevirapine at onset of labour, and zidovudine 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 babyDaily 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 8 NPC Training in MNH

10. PMTCT and ART Coverage in Pregnant Women 1.Coverage for ANC – 97% (98% urban, 96% rural) 2.Coverage for ART 3.Challenges: 1.Test kits 2.Missed opportunities 3.Inadequate infrastructure for PMTCT 9 NPC Training in MNH

11. Part 2 10 NPC Training in MNH

12. The implications of being HIV positive for preventing puerperal sepsis Sepsis is 2 nd 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 11 NPC Training in MNH

13. 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 data 2.Need for research i.Prevalence of HIV infection among patients with puerperal sepsis ii.Micro-organisms in puerperal sepsis 12 NPC Training in MNH

14. How to Manage Pregnant Women who are HIV positive Maternal Concerns 1.Screening for opportunistic infections a.STI b.TB c.Respiratory infections 2.Prevention of super-infection 3.Prevention of opportunistic infections 4.Prevention of puerperal sepsis 5.Reducing vertical transmission (Prong 2) Foetal Concerns 1.Reduction of maternal viral load 2.Safer mode of delivery 3.Prevention of neonatal infection 4.Safer infant feeding 5.Confirmation of HIV status 13 NPC Training in MNH

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