HIV & AIDS Prevention

DR ATABO AMODU (FWACP) CONSULTANT FAMILY PHYSICIAN DEPARTMENT OF FAMILY MEDICINE FEDERAL MEDICAL CENTRE MAKURDI

OUTLINE
y Introduction (HIV/AIDS) y Mode of transmission y prevention y Conclusion

HIV
y HIV is the simplest, most primitive life form on

earth.
y HIV is unable to replicate (reproduce) on its own

and must first infect a living cell in order to replicate.

y HIV is a retrovirus. A retrovirus is an RNA

virus which uses DNA as an intermediary for its replication.

y HIV is a virus that is in the body of infected persons and is

present in high amounts (without treatment) in the blood, semen, or genital tract.

HIV

y Fundamental pathology is the inability of the host

immune system to eradicate HIV infection, which results in a progressive destruction of the immune system.
HIV HIV HIV HIV HIV

y When this happens, people get sick and may get AIDS.

Global Picture:
Fourth leading cause of mortality in the world Estimated 42 million persons living with HIV/AIDS About one-third are between 15-24 years Most people are unaware they are infected Young women are more vulnerable

Nigeria
y 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 with HIV. y Approximately 220,000 people died from AIDS in Nigeria in 2009.

HIV ESTIMATES IN NIGERIA

2005 2006 2010

No of people infected

2.86 m

2.99m

3.4m

No of new HIV infections:  Adults

Children

296,320

305,080

346,150

(<15 yrs) 73,550 74,520 75,780

No requiring ART: Adults

Children

412,450

456,790

538,970

(<15yrs)

94,990

98,040

106,840

Annual HIV +ve births

73,550

74,520

75,780

Cumulative deaths

1.45 m

1.70m

2.82m

Mode of transmission
y Sexual intercourse

receptive anal intercourse receptive vaginal intercourse insertive vaginal intercourse insertive anal intercourse
y

Contaminated needles intravenous drug users needle stick injuries injection

y Mother

child

in utero at birth breast milk

y Organ/tissue donation

blood /blood product semen kidneys skin, bone marrow, corneas, heart valves, tendons etc.

Ways Someone Can Get HIV

PREVENTION
EDUCATION.
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.

TYPE OF EDUCATION
y Talks

Schools Churches/Mosques

Organizations

Workplaces

y Workshops

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

y Plays, songs and music. y Community meetings y Door to door y Pamphlets y Newspapers/radio

Preventing Sexual Transmission:

y ABC-Plus Strategy

A..Abstain/delay sexual debut BBe faithful/partner reduction CUse Condoms

Use of Condoms
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

Male condom

Female condom

y Plus

- Male Circumcision - Avoid illicit Drug use - Empower women(educationally/economically) - Increase male/youths involvement -Prevent MTCT -Identify and treat STIs

Prevention of HIV Transmission Among IDUs

y HIV transmission among injection drug users can be reduced

through communitybased peer outreaches that are linked to: 1. Information, education and communication (IEC) programs for high-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

Prevention of Blood Transfusion-Related Infections

y Prevent or treat causes of anemia and blood loss

y y y y

(e.g.,malnutrition, malaria, parasitic infestation, pregnancyrelated anemia) promptly Minimize unnecessary transfusions: Use blood substitutes (crystalloid/colloid) for volume replacement when possible Select blood donors carefully: Paid or professional donors are a higher risk Create a national blood transfusion service Screen blood supply (and body organs and tissue earmarked for transplantation)

UNIVERSAL PRECAUTIONS
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

Exposure to risk

Precautions for prevention of transmission of HIV wear gloves use a closed vacuum system if available discard needle and syringe into sharps box discard gloves and swabs into leakproof plastic bag for incineration label blood bottle and request form "inoculation risk" wear gloves and apron, protect your eyes (glasses or protective goggles) discard sharps into sharps box clear up as soon as possible using available disinfectant (e.g. glutaraldehyde, phenol, sodium hypochlorite) avoid mouth-to-mouth resuscitation (use bag and mask)

venepuncture

invasive procedure, surgery, delivery of a baby spilled blood or other body fluids resuscitation

laundry disposal

wear gloves and apron dispose into leakproof plastic bags wash laundry at high temperatures or with appropriate chemical disinfectant

Postexposure Prophylaxis (PEP)

Defined: A program through which exposed individuals (health care workers and otherwise) are offered antiretroviral medication(s) to reduce the risk of HIV transmission

Type of exposure
Percutaneous 0.4% per singleneedle stick Mucocutaneous 0.09% per exposure Intact skin theoretical but undocumented risk

PEP: Types of Fluid

y Infectious
y y y y y y y y

Blood Amniotic Pericardial Pleural Ascitic Synovial CSF Genital secretions

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

RISK FACTORS
y Quantity of blood

y Disease status of source patient

y Host defenses

y Post-exposure prophylaxis

Post Exposure Prophylaxis (PEP)

y

Intact skin, mouth or nose: immediately wash with soap and water and rinse thoroughly

to remove all potentially infectious particles.

Cut or punctured skin: allow to bleed fully.

Eye: flush immediately with water, then irrigate with normal saline for 30 minutes.

Consider post exposure prophylaxis if there risk of transmission:

Post Exposure Prophylaxis continued

yHIV testing immediately, 6 weeks, 6

months and 12 months yTreatment, if started, should continue for 4 weeks. yProphylaxis should commence as soon as possible (1-6 hrs of exposure)

PEP: Choosing a Regimen

y 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 or

Efaviren.

y PEP may have to be individualized according to ARV treatment

status of the source patient. Consult HIV specialist in such cases.

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

positive or if testing the perpetrator is not possible.

Comprehensive Package for PMTCT:

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

Future Directions
y Vaccines

Global ongoing research to develop vaccines against HIV. Initial vaccines likely to be only about 30- 40% effective. y Microbicides Products inserted into vagina to destroy HIV and other microorganisms 50 or more products now undergoing testing; about 25% in various stages of clinical trials in humans

CONCLUSION
y HIV/AIDS is a global disaster

y Public health problem

y Morbidity and mortality is high

y Adequate prevention practice can reduce this phenomenon to near

zero

Thanks for your attention

References
1. Ball, A.L. 1998. Overview: Policies and Interventions to stem HIV-1 epidemics associated with injecting drug use. In: Drug Injecting and HIV infection by G. Stimson, DC Des Jarlais & AL Ball. London, UCL Press 2. FHI. 2001. HIV/AIDS Prevention and Care in Resource-Constrained Settings: a handbook for the design and management of programs. Edited by Lamptey PR and Gayle HD. 3. Global HIV Prevention Working Group. 2002. Global mobilization for HIV prevention:a blueprint for action. 4. Grosskurth H et al. 1995. Impact of improved treatment of sexually transmitted diseases on HIV infection in rural Tanzania: A randomized control trial. The Lancet, 346:530-536. 5. HRSA/JHPIEGO. 2001. A guide to the clinical care of women with HIV. Edited by Jean Anderson. 6. Jean Anderson. 2002. Clinical Care of Women Living with HIV/AIDS: Multimedia Tutorials on CD-ROM. JHPIEGO, Baltimore, Maryland.

7. Smith, S., T. Green, P. McDermott, S. Schmidt, P. Waibale, and Lillian 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 Policy Implications for HIV Prevention and Reproductive Health. Draft Conference Report, September 18-19, 2002. 10.WHO. 2002. Safety of Injections. Fact Sheet No. 231. 11. Wilkinson D et al. Population based interventions for reducing STIs including HIV infection (Cochrane Review). In: Cochrane Library, Issue 1, 2002. Oxford: Update software.