hiv & aids prevention

8/6/2019 HIV & AIDS Prevention

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DR ATABO AMODU (FWACP)CONSULTANT FAMILY PHYSICIAN

DEPARTMENT OF FAMILY MEDICINEFEDERAL MEDICAL CENTRE MAKURDI

HIV & AIDS Prevention


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OUTL INE

y Introduction (HIV/AIDS)

y Mode of transmission

y prevention

y Conclusion


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HIVy HIV is the simplest, most primitive life form on

earth.

y

HIV is unable to replicate (reproduce) on its ownand must first infect a living cell in order toreplicate.

y

HIV is a retrovirus . A retrovirus is an RNAvirus which uses DNA as an intermediary for itsreplication.


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y HIV is a virus that is in the body of infected persons and ispresent in high amounts (without treatment) in the blood,semen, or genital tract.

HIV


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y Fundamental pathology is the inability of the hostimmune system to eradicate HIV infection, whichresults in a progressive destruction of the immunesystem.

HIV

HIV

HIV

HIV

HIV


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Gl oba l Picture:

F ourth lead ing cause of mort ality in the wor ld

Esti ma te d 42 m illion persons living w ith HIV/AIDS

About one-thir d a re bet ween 15-24 years

Most peop le are un awa re they are infe cte d

Young women are more vu lner abl e


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Nigeriay the HIV prevalence rate among adults ages 15-49 is 3.9

percent.y Nigeria has the third-largest number of people living with

HIV.y 2009, there were 3.3 million people living withHIV.y Approximately 220,000 people died fromAIDSin Nigeria in

2009.


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HIV ESTIMATES IN NI G ERIA

20052005 20062006 20102010

No of people infectedNo of people infected 2.86 m2.86 m 2.99m2.99m 3.4m3.4m

No of new HIV infections:No of new HIV infections:A dults A dults

Children (


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Mode of transmission

y Sexu al inter course

receptive anal intercoursereceptive vaginal intercourseinsertive vaginal intercourseinsertive anal intercourse

y C ont amin ate d nee dl es

intr avenous drug users

nee dl e sti ck injuries

inje ction


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y Mother child

in utero

at birth

breast milk


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y O rg an / tissue don ation

bloo d /bl oo d pro duct

semen

k idneys

sk in, bone ma rro w, corne as, he art valves, ten dons et c.


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Ways Someone Can Get HIVWays Someone Can Get HIV


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PREVENTIO N

EDUC ATIO N.y Education is the cornerstones of HIV prevention strategy.

y Many infections are passed on by those who do not know that

they are infected.


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TY PE OF EDUC ATIO N

y Talk s

Schoo ls

C hur ches / Mosques

O

rg aniz ations

Wor kp lac es


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y Wor kshops

Workshops give people chance to people to discuss issues in more detail

y

P lays, songs and m usi c.

y C omm unity meetings

y Door to door

y P amph lets

y Newspapers / rad io


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Preventing Sexua l Transmission:y ABC -P lus Str ategy

A..Ab stain /d elay sexu al d ebut

BB e f aithfu l/ partner re duction

C U se C on doms


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U se of C ondoms

y The only effective FP method to prevent HIV/STI transmission

and acquisition is the condom

y Male and female condom should be available over the counter

y

Clients should be instructed in proper use

y Consistent use must be emphasized


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Ma le condom


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Fema le condom


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y P lus- MaleCircumcision- Avoid illicitDrug use

- Empower women (educationally/economically)- Increase male/youths involvement-Prevent MTCT-Identify and treat STIs


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Prevention of HIV TransmissionAmong ID U sy HIV transmission among injection drug users can be reduced

through communitybased peer outreach es th at are linked to:

1. Information, education and communication (IEC) programs forhigh-risk groups.

2. Risk reduction counseling for injection and sexual behavior change

3. Increased access to sterile injecting equipment

4. Increased access to drug dependence treatment


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Prevention of B loodTransfusion-Re lated Infectionsy Prevent or treat causes of anemia and blood loss

(e.g., malnutrition, malaria, parasitic infestation, pregnanc yrelated anemia) promptly

y

Minimize unnecessary transfusions: Use blood substitutes(crystalloid/colloid) for volume replacement when possibley Select blood donors carefully: Paid or professional donors

are a higher risky

Create a national blood transfusion servicey Screen bloo d supp ly (and b ody org ans and tissue

earmarked for transplantation)


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U NIVERSAL PRE C AUT IO NS

y Personal protective equipment

y Hand washing

y Needle and sharps handling and disposal

y Disinfection of instruments

y Appropriate disposal of tissues and other contaminated items


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Exposure to risk Precautions for preventionof transmission of HIV

venepuncture wear glovesuse a closed vacuum system if availablediscard needle and syringe into sharps boxdiscard gloves and swabs into leakproof plastic bag for incinerationlabel blood bottle and request form"inoculation risk"

invasive procedure,surgery, deliveryof a baby

wear gloves and apron, protect your eyes (glasses or protective goggles)discard sharps into sharps box

spilled blood or other body fluids

clear up as soon as possible using available disinfectant (e.g.glutaraldehyde, phenol,sodium hypochlorite)

resuscitation avoid mouth-to-mouth resuscitation(use bag and mask)

laundry disposal wear gloves and aprondispose into leakproof plastic bagswash laundry at high temperatures or with

appropriate chemical disinfectant


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Postexposure Prophy laxis (PEP)

Defined:A program through which exposed

individuals (health care workers andotherwise) are offered antiretroviralmedication(s) to reduce the risk of HIVtransmission


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Type of exposure

Percutaneous 0.4% per singleneedle stick

Mucocutaneous 0.09% per exposure

Intact skin theoretical but undocumented risk


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PEP: Types of F luidy Infectious

y Bloody Amnioticy Pericardialy Pleuraly Asciticy Synovialy CSFy Genital secretions

y Non-Infectiousy Urine, feces (unless visibly contaminated by blood)y Saliva, tears


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RISK FACTO RS

y Q uantity of blood

y Disease status of source patient

y Host defenses

y Post-exposure prophylaxis


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Post Exposure Prophy laxis(PEP)

y Int ac t skin, mouth or nose: immediately wash w ith soap and wa ter and rinse thorough ly

to re move all potenti ally infe ctious parti cles .

y Cut or punctured skin: allow to bleed fully.

y Eye: flush immediately with water, then irrig ate w ith nor mal saline for 30 minutes .

y C onsi der post exposure prophy laxis if there ris k of tr ansmission:


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Post Exposure Prophy laxis continuedy HIV testing immediately, 6 weeks, 6

months and 12 monthsy

Treatment, if started, shouldcontinue for 4 weeks.y Prophylaxis should commence as

soon as possible (1-6 hrs of exposure)


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PEP: C hoosing a Regimeny Low rates of seroconversion make it difficult to study.

y PEP dosage for low risk exposure :- ZDV 250 -300mg bd+Lamivudine 150mg bd.

y PEP dosage for high risk:- ZDV + Lamivudine + Indinavir orEfaviren.

y PEP may have to be individualized according to ARV treatmentstatus of the source patient. Consult HIV specialist in such cases.


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Rape victim.y Rape victim should receive PEP if the perpetrator tests HIV

positive or if testing the perpetrator is not possible.


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C omprehensive Package forPM TCT :4 Elements

y Primary prevention for all women

y FP for the prevention of unintended pregnancy in HIV infected women

y Prevention of MTCT in pregnant HIV infected women

y Care and support for HIV infected women, their infants and family


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Future Directionsy Vacc ines

Global ongoing research to develop vaccines against HIV.Initial vaccines likely to be only about 30- 40% effective.

y

Micro b icidesProducts inserted into vagina to destroy HIV and othermicroorganisms50 or more products now undergoing testing; about 25%

in various stages of clinical trials in humans


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CO NCLU SIO N

y HIV/AIDS is a global d isaster

y Publ ic he alth pro blem

y Mor b id ity and m ort ality is high

y Adequ ate prevention pr ac tice can re duce this pheno menon to ne ar

zero


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T hanks for your attention


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References1. Ball , A.L. 1998. O vervie w: P olicies and I nterventions to ste m HIV-1

epi demics associate d w ith inje cting drug use . In: Drug Inje cting and HIVinfe ction by G. Stimson, DC Des Jar lais & AL Ball. Lon don, UC L P ress

2. F HI. 2001. HIV/AIDS P revention and C are in Resour ce- C onstr aine dSettings: a handb oo k for the design and ma nagement of progr ams. Edite dby Lamptey P R and Gayle HD.

3. Global HIVP

revention Wor king Group . 2002. Global m obilization for HIVprevention: a bl ueprint for action .4. Gross kurth H et al. 1995. Im pact of improve d tre atment of sexu ally

tr ansmitte d d iseases on HIV infe ction in rur al Tanz ani a: A randomize dcontro l tri al. T he Lancet, 346:530-536.

5. HRSA/JH P IEGO . 2001. A gui de to the clini cal ca re of women with HIV.Edite d b y Jean Anderson .

6. Jean Anderson . 2002. C lini cal C are of Wo men Living with HIV/AIDS : Mu ltimedia Tutori als on C D-RO M. JH P IEGO , Baltimore, Mary land.


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7. Smith, S., T. Green, P. McDermott, S. Schmidt, P. Waibale, andLillian Mworeko. HIV/AIDS Assessment Team Field Visit.Entebbe, Uganda. Synergy/TvT Associates, Inc. and USAID.November-December 2001.

8. UNAIDS. 2002. Report on the global HIV/AIDS epidemic.9. USAID Office of HIV/AIDS. Male Circumcision: Current

epidemiological and field evidence-Program and PolicyImplications for HIV Prevention and Reproductive Health. DraftConference Report, September 18-19, 2002.

10.WHO. 2002. Safety of Injections. Fact Sheet No. 231.

11. Wilkinson D et al. Population based interventions for reducingSTIs including HIV infection (Cochrane Review). In: CochraneLibrary, Issue 1, 2002. Oxford: Update software.

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