Collecting Data on HIV Infection and
Acting on it
Dr Chisale Mhango FRCOG
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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.
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Outline of Presentation
1.
2.
3.
4.
5.
6.
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
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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?
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Checking HIV Status of Pregnant Women
1. Routine offer of HIV testing – with option to
opt out
a.
b.
c.
d.
e.
Why test is necessary?
When is the test done?
Who does the testing?
Where is testing done?
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+
Antiretroviral prophylaxis for
pregnant women
Option for
HIV-infected
WHO option A
WHO option B
Malawi MOH option
B+
Mother
Antepartum
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 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 ART
3. Challenges:
1. Test kits
2. Missed opportunities
3. 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 data
2. 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 Women
who are HIV positive
Maternal Concerns
1. Screening for opportunistic
infections
a.
b.
c.
STI
TB
Respiratory infections
2. Prevention of super-infection
3. Prevention of opportunistic
infections
4. Prevention of puerperal
sepsis
5. Reducing vertical
transmission (Prong 2)
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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
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