International HIV Counselling and Testing Workshop

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• International HIV Counselling and Testing
  Workshop
  
• Lusaka, Zambia, January 21-24, 2008

HIV Testing and Counselling in PMTCT Settings
in Swaziland
Dr. Caspian Chouraya, MD Medical Officer, EGPAF S
waziland
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Swaziland Data

• 2007 DHS
• Estimated of adults (1549) HIV infected ..
  26
  
• Estimated of women (1549) HIV infected 31
• Estimated of men (1549) HIV infected .....
  20
  
• women receiving ANC . 97
• births delivered by skilled health workers
  .74
  
• 2006 ANC Sentinel surveillance
• Percent HIV positive pregnant women...39.2

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HTC in PMTCT Settings

• Entry points for HTC
• ANC
• Labour and Delivery
• PNC clinics
• Family Planning clinic

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HTC in PMTCT Settings

• Goal To test all women in these settings
• for early identification of HIV positive
• women and refer for
• PMTCT interventions
• HIV care and treatment
• Infant feeding counseling and support

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Pregnant Woman
Opt-out HIV testing
Woman is HIV Negative
Woman is HIV Positive
CD4 Count (automatically done with blood from HIV
test)
Clinical Staging (WHO)
1-2 Week Follow-Up Visit for CD4 Results
Woman receives prevention counseling, and standa
rd antenatal and postnatal care

CD4 less than 350 or Stage III or IV
CD4 above 350
PMTCT services HIV care and monitoring, ARV
prophylaxis, counseling, infant feeding support
HAART for PMTCT and maternal care and treatment,
counseling, infant feeding support
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HTC Approach

• Routine offer of HTC to all women
• Testing offered during every encounter
• Provider initiated opt-out approach
• Women receive HIV information
• Women are informed that a standard set of tests,
  including HIV, will be performed
  
• Women are informed that they may refuse HIV
  testing
  
• Women are tested unless they explicitly refuse

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HTC Approach

• Components of HTC for women
• Pre-test HIV education session
• HIV testing
• Post-test counseling
• Ongoing counseling and referrals

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Pre-test session

• To ensure that this information is received
• Basic facts on HIV
• Safer sex practices and HIV
• HIV testing and counseling
• Interpretation of test results
• Partner HIV testing and couseling

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HIV Testing

• On-site testing according to the national HIV
  testing algorithm
  
• Serial testing, using rapid tests with same day
  results
  
• Determine
• Unigold

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Post-test Session

• In case of HIV-negative result
• Offer re-test three months after last exposure
  (unprotected sex or breast feeding)
  
• Discuss prevention of future infection
• Review MTCT risks with new infection

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Post-test Session

• In case of HIV-positive result
• Ensure that the client fully understands the
  result
  
• Review benefits of knowing HIV status
• Address immediate concerns
• Discuss the follow-up schedule

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Ongoing counseling Referrals

• Ongoing counseling of patients
• Linkages to care and treatment services
• Psycho social support of patients
• Referrals to available community services

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Data Collection

• Patient cards
• ANC (mothers) Card
• Child Health Card
• Registers
• ANC Register
• Maternity Register
• PNC Register
• Child Health Immunization Plus

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Achievements
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Achievements

• Increased uptake of HTC services amongst pregnant
  women in Swaziland (100 at some of the sites)
  
• This has resulted in
• Reduced number of women delivering without
  knowing their HIV status
  
• Increased uptake of PMTCT regimens
• Increased number of women and children enrolled
  for care treatment

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Challenges

• Low disclosure rates
• Low partner testing
• Limited testing of HIV-exposed infants /
  pediatric testing
  
• Long turn-around time of DNA PCR test results

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Acknowledgments

• Mary Pat Kieffer EGPAF SWAZILAND
• Mohammed Ali Mahdi EGPAF SWAZILAND
• Fortunate Zwane EGPAF SWAZILAND
• Peter Vranken CDC SWAZILAND
• Schilsky Allison CDC

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(No Transcript)