Protecting Our Protecting Our Introduction Family Family - PDF document

Protecting Our Protecting Our Introduction Family Family • Globally HIV/AIDS has left its mark on every continent, with its highest prevalence being in sub ‐ Saharan Africa • 10% of the worlds population An Assessment of • In 2008, 67% of infected HIV/AIDS individuals resided in this area • In Ghana, mother ‐ to ‐ child ‐ transmission ( MTCT ) is the second Screening of HIV/AIDS in highest mode of transmission of HIV/AIDS • 90% of all HIV/AIDS cases in children under the age of 15years in the country Pregnant Women in • Without intervention, up to 40% of HIV positive mothers will transmit the virus to their babies. Apam and Axim Ghana • Comparatively developed countries MTCT rates are less than 2% • Thought to be achieved by: • testing of all pregnant woman, ART, safe delivery practices, and counseling and support for infant breast feeding By Alia Sommerville, D.O., MSc. National Strategic Interventions of NSF Framework • The major interventions in this plan include: • There have been 3 projects each with a goal 1. Review, update and wide dissemination of policies, guidelines and time frame of 5 years to increase HIV/AIDS other Standards 2. Strengthening programme management, resource mobilization testing, available resources and treatment. and coordination at national, regional and district levels 3. Strengthen the human resource capacity for provision of the • National Strategic Framework(NSF) I a program integrated package of PMTCT services in affect from 2001 ‐ 2005 4. Improvement in service delivery of integrated package of PMTCT services at all level, including community involvement • NFS II from 2006 ‐ 2010 5. Infrastructure and equipment capacity for provision of integrated package of PMTCT services • Prevention of Mother to Child Transmission 6. Improvement in the procurement and supply chain management system for HIV related services including PTMCT (PMTCT) Scale Up Program 2011 ‐ 2015 7. Strengthening the management information system, including • most current operational research Priority of Testing as per 2013 WHO Guidelines The Region • All forms of HIV testing and counseling should be • Pregnant Women (First Priority) voluntary and adhere to the five C’s • consent • Blood Safety • confidentiality • counseling • Other/ Outpatient • correct test results • connections to care, treatment and prevention services • Recommendations • Provider ‐ initiated testing and counseling recommended • Re ‐ testing is recommended in the third trimester, or during labor or shortly after delivery

Maternal HIV Testing Goal • I dentification of infected pregnant women is critical to • Reduce morbidity and mortality of mothers and control of perinatal transmission children due to vertical transmission of HIV/AIDS • The use of routine or "opt ‐ out" HIV rapid testing • Increase the number of women tested for HIV/AIDS strategy has proven highly effective during pregnancy • informs all pregnant women that they will be tested for HIV unless they specifically decline • Improve screening methods of early detection • result in >95% same day HIV testing • Ensure safe delivery • “opt ‐ in” approach • Early treatment of mother and child and before • individual pregnant women were counseled about HIV beginning to breast feed testing and then had to consent in writing if they wished to be tested • Increasing Pre and Post Test Counseling • Only two ‐ thirds of pregnant women receiving testing in • Help women stay negative decrease overall most antenatal settings transmission of virus Methods Apam Survey • 60 patients in Apam • 2 Part Study • Questions for pregnant Patients in Apam: • Patients Name, Age, Gestational Age, Parity • A retrospective review of the number of • Have you been tested for HIV this pregnancy? pregnant women tested for HIV/AIDS from • If no, do you plan on getting tested? 2009 ‐ 2013 in Axim in comparison to the District • If no, would you get tested if recommended by a doctor or nurse? • Would stay to receive the result of your HIV test? as well as Apam in comparison to GOMAO West • Are you aware that there is counseling at the hospital for those who test positive? District • If tested positive would you be willing to come to monthly counseling/treatment sessions at the hospital? • Survey performed in the antenatal clinic (ANC) • Are you aware that there is medication for patients that test positive? at St Luke’s Hospital in Apam and Axim Hospital • Do you plan to deliver at the hospital? • How far do you have to travel to come to the hospital? in Axim • Do you know HIV can have an affect your health and the health of your baby? Apam Demographics Axim Survey Demographics Range Mean Mode • 116 patients in Axim Age: 19‐44 28 24 Gestational Age: 4‐9mo 6.7mo 8mo • Same questions asked in Apam Gravid: 1‐6 3 2 Parity 0‐5 2 1 • Additional Questions : Distance from Hospital: 15min‐1hr 27.58min • What month were you tested? Mode of Transportation Walk, Taxi, Bus Taxi • Were you given a result? • Are you aware that HIV/AIDS can affect your health as well the health of your baby? If yes what affect does it have?

Gestational Age Axim Demographics Breakdown Demographics Range Mean Mode Age: 14‐41 26 25 Gestational Age: St LUKE’S HOSPITAL AXIM HOPSITAL 1 st Trimester Gestational Age: 2‐9mo 6.3mo 8mo 3.3% 12% 2 nd Trimester Gravid: 1‐10 2.9 2 35% 29% Parity: 0‐9 1.9 1 3 rd Trimester 58% 56% Distance from Hospital: <15 min to 3hours 26 min Mode of Transportation Walk, Bus, Taxi Taxi Pregnancy Testing HIV Results Apam vs District St. Lukes Hospital • Data Analyzed from 2009 ‐ 2013 for ANC Registrants, and PMTCT • 60 ANC Registrants Surveyed at Apam • 116 ANC Registrants Surveyed at Axim Gomoa West District St Luke’s Hospital GOMA West District 3500 6000 3000 5000 2500 4000 ANC 2000 ANC Tested 3000 Tested Untested Untested 1500 Positive Positive 2000 1000 1000 500 0 0 2009 2010 2011 2012 2013 2009 2010 2011 2012 2013

Apam Survey Results What Apam Does Well • 28/60 (46%) pts were not tested for HIV • When test kits are available, every pregnant woman receives testing • Of the 28 pts not tested, 26 pts (92%) of pts said they would if recommended by a Doctor • Those pregnant women being tested for Or Nurse HIV/AIDS receive pre and post counseling • Patients tested were aware of results, and could • 58/60 (96%) pts stated if tested would be recall testing months willing to stay to know their result • Privacy of testing and release of results • 100% of women reported willing to go for counseling/treatment if tested positive Apam Deviations from Additional Concerns National Guidelines • Nationally the instruction for hospitals/clinics is • Acquiring Test Kits Every month priority for testing of pregnant women • System of retroactive testing for mothers who • Priority used: Blood Safety, Clinical Suspicion, are not tested to due to regional or national and then Pregnant Woman shortage • ANC HIV test kits are exhausted patients are not referred to the main laboratory for testing • Standardized Pre and Post Counseling unless clinical suspicion of HIV/AIDS information disseminated by HIV counselor • In absence of test kits all pregnant women are not being referred for testing Pregnancy Testing Axim Hospital HIV/AIDS Axim 1600 Axim Hospital 1400 Year 2009 2010 2011 2012 2013 1200 ANC 1170 1119 1226 1465 1251 1000 Tested 1358 979 1454 1235 1219 800 ANC Untested ‐ 118 140 ‐ 228 230 (15.7%) 32 (2.5%) Tested 600 (12.5%) Untested Positive 400 Positive 12 17 25 29 10 200 0 2009 2010 2011 2012 2013 ‐ 200 ‐ 400

Pregnancy Testing Nzema District HIV/AIDS for District 3000 Nzema East Municipal 2500 Year 2009 2010 2011 2012 2013 ANC 2412 2483 1750 1980 1309 2000 Tested 616 1112 1907 1713 1270 ANC 1500 Untested 1796 1371 (55.2%) ‐ 157 267 (13.5%) 39 (2.9%) Tested (74.5%) Untested 1000 Positive Positive 14 86 27 32 19 500 0 2009 2010 2011 2012 2013 ‐ 500 Axim Hospital What Axim Does Well • 65 of the 116 ANC Registrants (56%) of women stated they • Every pregnant women is being tested had received HIV/AIDS Testing this pregnancy • Testing twice during pregnancy • 42 if the 116 ANC Registrants (36.2%) of women stated they had not received HIV/AIDS Testing this pregnancy • System in place to obtain ensure necessary • Of the 42 patients that had been tested 4 were actively being tested and unaware of what test they were receiving (9%) stock for test kits • 24 of the 65 ANC Patients that answered “Yes” to Receiving • Privacy in Patient Testing and Results (recent Testing Were not told the result (20.8%) improvement) • Mode for Patient knowledge testing 3 months • Average month tested about 4 months AXIM Deviation of Additional Concerns National Guidelines • All patients are not receiving pre and post • Pre ‐ counseling is given by one Nurse. counseling • Counseling Session is once a day first thing in • Patients unaware being tested the morning • Patients unaware of results • No system ensuring the patient understands and acknowledges pre and post counseling