Epidemiology of HIV / AIDS

1.       Objectives & Need of Programmes

q  To prevent HIV/AIDS transmission and to control its spread

q  To minimize the morbidity and suffering associated with the infection

q  To mobilize the government and NGOs’ resources in the fight against HIV/AIDS

q  To promote and enhance international collaboration and cooperation.

2.       Programme strategies

·         Screening for HIV

1. Inmates of rehabilitation centre (1989)
2. Prisoners (at risk)
3. Antenatal mothers (1997)
4. TB cases
5. STI cases
6. Donated blood (1986) /blood products
7. Foreign workers - FOMEMA
8. Blood dependent patients
9. Contact of HIV infected person
10. All occupational sectors
11. Sex workers
12. premarital

·         Notification of HIV/AIDS/AIDS Death

·         Partner Notification

·         Contact Tracing

·         Provision pf Medical Care and Counselling services

·         Treatment For HIV/AIDS

·         Standard Precaution (Universal Precaution)

·         Health Education (PLKN trainees, women, youth, children, sex workers, IDU & partner, school counselors)

·         Voluntary HIV Testing

·         HARM REDUCTION

·         Death Management Programme (Program Pengendalian Jenazah) – for muslim & non-muslim

·         HIV education to religious leader

3.       Implementation of act from district to peripheral level

a.       PPHIV ( Pengendalian Pesakit HIV)

HAART treatment given only in clinics with FMS (Fly Medicine Specialist).  @ Pusat Rawatan 1 (PR1)

Team in PR1 consist of

·         FMS (Pakar Perubatan Keluarga)

·         MO (Pegawai Perubatan dan Kesihatan)

·         MA (Pembantu Perubatan)

·         Nurses (Jururawat Kesihatan / Jururawat Masyarakat)

·         Pharmacist (Pegawai atau Pembantu Farmasi)

·         Caunsellor

Services offered

·         Risk analysis

·         Counseling

o   Pre-test

o   Post-test

o   Pre-treatment , Issues to be covered:

§  Basic knowledge of HIV infection

§  Initial difficulty in determining HIV status of the baby and the necessity of repeating blood testing (PMTCT)

§  CD4/ Viral load

§  Modes of transmission

§  Potential risk of HIV transmission to the neonate

§  Natural history of HIV infection in children.

§  Abstinence from breastfeeding

§  Safe sex / Harm reduction

§   Counseling and HIV testing for the spouse

§  Spouse/ Partner notification

§  Counseling family members

§  Addressing patient’s concerns

§  Need for compliance if starting on ARVT

§  Benefits of HAART for patient

§  Importance of HAART and clinical follow-up .

§  Possible HAART side-effect to patient.

o   Supportive

o   Crisis Intervention

o   Bereavement

·         Lab investigation

o   CD4, Viral load & Serum lactase done in Hosp A.Star

·         Clinical assessment

·         Treatment & follow up

·         Partner notification & contacts screening

·         Reference to hospital and other agencies

·         Home visit

b.      PLWHAS (People Living With HIV/AIDS)

·         Society  for wife of HIV/ AIDS patient

·         In Kuala Kedah

·         Under UNICEF

·         Not active

c.       HARM REDUCTION (Components) – community based project, done by trained NGOs through drop in centers.

·         Health education ( methods of reducing HIV/AIDS, Hep and STD infections)

·         Counselling

·         Screening for HIV, STD, TB

·         Treatment

·         NSEP

                                                                           i.      1 for 1 exchange

                                                                         ii.      Collect and destroy used needles

                                                                        iii.      Reduce HIV incidence among IDUs

·         Drugs Exchange Programme (methadone)

                                                                           i.      Started in OCT 2005 in 4 zones

                                                                         ii.      Under MO supervision

                                                                        iii.      1.7 million spent on methadone (2.3million given)

·         Condom

NSEP : Activities in Drop In Centers (DIC)

IEC – Information, Education, Communication         VCT – Voluntary counseling & testing

Records maintenance

Results will be repeated and in cases involving pregnant mothers, confirmation done as the blood sample is sent to IMR (Institute for Medical Research) and western blot is done. Only results obtained from government lab are valid.

Notification is done when

·         HIV case detected

·         AIDS case detected

·         Death encountered among HIV/ AIDS patient.

~ Difference between hospital and primary care ~

by Mohanajothi Samasuvam