SHASHEMENE TOWN HEALTH OFFICE HEALTH FACILITY ON JOB

REFRESHIMENT ORIENTATION
FOCUS AREA
1. Different Reform (EHCRIG,Civil Cervantes adm )
2. Program Update (HIV/AIDS,NCD and NTD and MCH)
 Part I:
HIV/AIDS Program New Initiatives Update

Shashemene Town Health Office

By Muhammed G (BSC in Nurs,C/Pharmacist and
MPH)
 I. Background (Epidemiology of HIV)
II. HIV Case Finding and type of RTK (PrEP, HTS, ICT,
HIVST, Recency)
III. Linkage & cohort dynamics (Cohort growth)
IV. Prevention,Palliative care :TB Diagnosis and TPT,
Cervical Cancer,Mental health
Presentation V. VL Monitoring and 2nd line ART Initaition
Outlines VI. Elimination of Mother to Child Transmission
(eMTCT)
VII.HMIS Indicators
1. Background: Epidemiology of HIV-Global(2022)
Estimated number of Annual HIV new Annual AIDS related
PLHIV infection death
 Background: Epidemiology of HIV-Global(2022)
In 2021 globally,
 84.2 million people have become infected with HIV since the start of the epidemic
 Receiving antiretroviral therapy=28.7 million
 having claimed 40.1 million lives so far.
The WHO African Region is the most affected region, with 25.6 million (60%) people
living with HIV.
85% = know their HIV status (4.0 million need to be made aware)
75%= (a gap of 5.9 million) of people living with HIV were receiving treatment or 88%
of diagnosed
68% of PLWHIV or 92% of those people on treatment were virally suppressed(a gap of
6.7 million to reach the 3rd 95 target).
 Overview of Pediatric HIV
Global data of 2022, Out of 38.4 million PLHIV, Children <15years account 1.68 million
 Only half (52%) of CLWHIV
are on ART (far behind adults
4%(1.68 million) of all PLHV
(76% are on ART)
 Sub-Saharan Africa,
particularly Southern Africa,
remains the region most
heavily affected by the
10% (160,000 )of new HIV infections epidemic
 88% of children and
adolescents living with HIV
are from SSA

15%(98,000) of all AIDS-related deaths

UNAIDS Global update (2022)

 Background…Overview of Pediatric HIV
Global UNAIDS Global update (2022) National
 In 2022 estimate nationally 36,812 CLHIV

 14,725 (40%)- knew status,

59% knew their status  13,057 (88%) -on ART (DHIS-2)

52% Received ART

40 % 88 % 92%

 Across the three 95 for children 40/88/92 ( adult 87/90/97)

 There is significant Inequality
40% Suppressed Virally  Far behind in the progress towards meeting the first 95 in 2025
Background …National HIV situation in 2022(Ethiopia)
Estimated number of PLHIV Annual HIV new Annual AIDS related
infection death
610,000 8,300 11,000
(510,000-750,000) (4,000-18,000) (6900-20,000)

570,000 6,000 9,800

350,000 4,100 5,100

220,000 1,900 4,700

37,000 (6.1%) 2,000 (30%) 1,500(13.6%)

Source: 2022 spectrum Estimates and Projections in Ethiopia

Oromia Progress Towards 3-95 as of March 2023 EFY
Estimated PLHIV = 158,152
97,258 (72% from 3rd 95
127,592 (85% of 1st 95 Target 123,638 (87% of 2nd 95 target ,75% from Tx-
& 81% of estimated) people Target,97% of Diagnosed &78% Curr,61.5% of estimated
estimated to know their status estimated) PLHIV, & 96.4% from VL
tested)

Unmet=22,652 Unmet=19,094 Unmet=38,338

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 According to 2022 EPHI spectrum estimate:

 National HIV
 Prevalence:0.91, Incidence: 0.01
 Vertical Transmission=12.04% (2022), 9.35%(2023)

 Oromia HIV
 Prevalence: 0.64, Incidence: 0.01
 Vertical Transmission=15.82% (2022), 10.18%(2023)
 Goal and Objectives of National Road Map
The goal is to attain epidemic control by 2025
 Both new infection and AIDS death <1/10,000 population
 Reduce the number of new infections to < 7400
Objectives by 2025
 Reach 95% of KPP with combination prevention – Behavioral, biomedical and structural interventions
 90% of KPP use condoms at last high-risk sex
 90% of Eligible people access PrEP
 VMMC coverage reaches 90% in high-incidence regions (Gambella)
 Reach 90% of PWID with needle syringe and 40% with OST
 Reduce stigma and discrimination among PLHIV below 10%
 Ensure there are policies and legal frameworks that support HIV programs targeting KPPs
 HIV/AIDS Treatment Global Target By 2030

95 percent of
95 percent of
95 percent of people people on
people who know
living with HIV know treatment have
their HIV status are
their HIV status suppressed viral
accessing treatment
loads

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2. HIV Case Finding and type of RTK
•HIV Screening Tool
•HTS
•Pr-EP
•ICT
•HIVST
•Recency
 Combination HIV Prevention
Is an approach that seeks to achieve maximum impact for preventing new HIV infections by:
Behavioral interventions: reduce behaviors that increase risk of HIV transmission. Eg:
condom promotion,SBCC..
Biomedical interventions: directly influence the biological system through w/h the virus
infects a new hosts.eg: condom use, PrEP, PEP, VMMC, STI screening & Mgt, HTS &
ART
Structural intervention: social, legal, political & environmental enablers

Ways to prevent HIV infection:

 ABCD
 Implementation of Test and Start
 Prevention of Mother to Child transmission (PMTCT)
 Positive Health Dignity and Prevention (PHDP)
 Voluntary medical Male circumcision (VMMC)
 Infection Prevention (IP)
 Post Exposure Prophylaxis (PEP)
 Pre-Exposure Prevention (PrEP)
HIV Screening Tools utilization
• HIV Risk Screening Tool for Children < 15 years of age
• HIV Risk Assessment Tool for Adult &adolescent/youth clients (15-24)
years at outpatient/Inpatient
 Pre-Exposure Prophylaxis
is the use of ARV drugs by people who are not infected with HIV to block the acquisition of HIV. It is an evidence-
based HIV risk-reduction intervention that is offered to all people at substantial risk of acquiring HIV.

Eligibility criteria for Pr-EP

HIV Negative FSWs: HIV Negative Partners in Sero-Discordant Couples:
 HIV negative using a rapid antibody test as per  HIV negative using a rapid antibody test as per the
the National HIV testing algorithm on the day National HIV testing algorithm on the day of PrEP
of PrEP initiation. initiation.
 No suspicion of acute HIV infection.  No suspicion of acute HIV infection.
 Self- identifying FSWs.  Substantial risk of HIV infection (any ONE of the
 No contraindications to PrEP medicines following in the past six months):
(TDF/3TC) o Has a known HIV positive sexual partner(s)
who is not on ART or
o On ART less than six months, or not yet
achieved undetectable viral load < 50 ml/copies
or
 No contraindications to PrEP medicines
(TDF/3TC)
 When to stop taking Pr-EP?
From Clinician Side
 HIV sero-conversion while on PrEP
 Sustained creatinine clearance (eCRCL) < 60ml/min.
 Clients who have side effects from the medicine that interfere with quality of life.
 Finding of Hepatitis B infection (clients with HBsAg Positive test result) while taking PrEP
 Clients with poor adherence for two consecutive months (Missing five and above pills per month) to the
prescribed dosing regimen despite efforts to improve daily adherence.
 A Partner with HIV achieves at least one undetectable viral loads result while on ART.
From Client Side
 Acquisition of HIV infection (Positive HIV result)
 No longer at substantial risk (e.g., no longer engaged in sex work)
 Poor adherence for two consecutive months (Missing five and above pills per month) to the
 prescribed dosing regimen despite providing enhanced adherence counseling to improve daily
adherence
 HIV Testing Services
HTS approaches recommended to reach the 2030 global target to end HIV/AIDS
epidemic control:

I. Client Initiated: Voluntary Counseling and Testing (VCT)

II. Provider Initiated Testing and Counseling(PITC)

III. Index Case Testing (ICT)

IV. Social Network based HIV testing Strategy (SNS)

V. HIV self-testing (HIVST)

The eligible Target clients for routine HTC by using PITC approach are:

1. All pregnant at first ANC visit, laboring, and postpartum women with unknown HIV status
2. Partners of HIV positive pregnant/ postpartum women
3. Sexual partners of index cases and all under 19 children of PLHIV; biological siblings and biological
parents.
4. Female sex workers with unknown HIV status.
5. All TB patients and presumptive TB cases with unknown HIV status
6. All patients with Sexually transmitted infections (STIs) and their partners
7. Children orphaned by AIDS.
8. Patients with clinical signs or symptoms of HIV/AIDS visiting health facilities
NB:
The above-mentioned target population are directly eligible for HTS. Other patient/client should be
screened by national HIV risk screening tools). It‘s mandatory that all health care providers MUST
use HIV risk screening tool at every POC/SDPs.
 Spectrum of HIV Diagnosis and Type of RTK
.

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 Types of HIV Testing Kits selected

1. One step anti-HIV (1&2),

2. First response HIV 1-2 card test (Ver.2.0) and
3. Uni Gold HIV 1.2.0.

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 ONE STEP Anti-HIV (1&2) Test

1. Collect test items and other 2. Remove device from package & 3. Collect specimen using a new
necessary supplies label with panel ID disposable pipette provided with
the kit

6. Wait for 15 minutes but no

4. Hold vertically and add 1 5. Hold vertically and add 1 drop of
longer than 20 minutes
drop of specimen to the sample buffer to sample port
port
Interpretations: For both Testers and Readers

Record result including invalid; check

the job aid and repeat invalid and
document in following row
Result Interpretation

Note: The Invalid test results should be retested with new test
device.
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Ministry of Health-Ethiopia
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 First Response

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 Cont’d…

• This conjugated antigen-antibody complex moves through the nitrocellulose

membrane and bind to the corresponding immobilized HIV-1 and HIV-2
antigen (Test Lines).
• Formation of purple colored indicating reactive results.

• Purple colored control line will appear irrespective of the reactive or non-reactive
specimen.

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Test Procedure

 Ensure that the test device & other components are at room temperature (15°C
to 30°C) before starting the procedure.

 Open the device pouch.

• Do not use the test device if the desiccant color has changed from orange to green.

 Label the test device with the patient identification number. Place the test device
on a flat, clean and dry surface.

 Using the specimen transfer device draw up the serum/plasma up to 10 μl

marking line and for the capillary or venous whole blood up to 20 μl marking
line on the specimen transfer device.
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 Cont’d…

 Gently squeeze the bulb of specimen transfer device to add 20 μl of whole

blood or 10 μl of serum/ plasma to the specimen well.

 Hold the assay buffer bottle vertically and add one drop of assay buffer to
the specimen well.

 Observe for development of purple colored lines in the results window.

 Interpret test results at 15 minutes after adding assay buffer to the specimen
well.

 Do not interpret the test result after 25 minutes.

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 Cont’d…

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Test Interpretation

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 Uni Gold

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Principle

• Uni-Gold™ HIV is a rapid immunoassay based on the immunochromatographic

sandwich principle.

• Recombinant proteins representing the immunodominant regions of the envelope

proteins of HIV-1 and HIV-2, glycoprotein gp41, gp120 (HIV-1) and glycoprotein
gp36 (HIV-2) respectively, are immobilized at the test region of the nitrocellulose strip.

• These proteins are also linked to colloidal gold and impregnated below the test region
of the device.

• A narrow band of the nitrocellulose membrane is also sensitized as a control region.

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 Cont’d…

 Two drops of serum, plasma or whole blood is applied to the sample port, followed
by two drops of Wash Solution and allowed to react.

 Antibodies of any immunoglobulin class, specific to the recombinant HIV-1 or HIV-2

proteins will react with the colloidal gold linked antigens.

 The antibody protein colloidal gold complex moves chromatographically along the
membrane to the test and control regions of the test device.

 Excess conjugate forms a second pink/red band in the control region of the device.

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Test procedure

 Collect the blood from the fingerstick using disposable pipette.

 Hold the pipette vertically above the sample port, squeeze the bulb and discharge
two (2) drops of whole blood onto the sample pad.
 Allow the sample to fully absorb.
 Ensure there are no air bubbles in the sample port.
 Hold the Wash Solution dropper bottle vertically over the sample port; add two
(2) drops to the sample port.
 Read test results after 10 minutes but no later than 12 minutes incubation time.

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 Test Interpretation

• Two pink/red lines of any intensity adjacent to letter “T” (test) and adjacent to “C”
(control). This indicates a Reactive result

• A pink/red line of any intensity adjacent to the letter “C” (control), but no pink/red
line adjacent to "T” (test). This indicates a Non-Reactive result.

• No pink/red line appears in the device window adjacent to the letter “C” (control)
irrespective of whether or not a pink/red line appears in the device window adjacent
to “T” (test). This is an Invalid result. An invalid result must be repeated.

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 Cont’d…

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Interpretation

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 Cont’d…

Perform A1
 Proper interpretation of each test results

A1+
A1­-
Report as HIV
according to the validated testing algorithm
Negative
is important to accurately diagnose and
Perform A2

A1+, A2- know the final status of the clients.

Report HIV
A1+, A2+ A1+, A2- Inconclusive.
Plan testing after 14
days  Based on the national approved testing
Repeat A1 only
A1-, A2-
Report HIV
algorithm, the final status of the clients
Negative
could be reported as:
Perform A3  Positive
 Negative and
A1+ A2+ A3-
A1+ A2+ A3+
Report HIV Positive Report HIV Inconclusive  Inconclusive
Plan testing after 14
days
Note: when results are inconclusive after the 14 days, report the
results as Negative.
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 HIV Testing Algorithms
National HIV Testing Strategy (three test algorithm instead of the tie-breaker test)
The three test Perform A1
kits namely;
 One step Anti- A1­-
HIV (1&2)
A1+
Report as HIV Negative
Tests
 First Response
Perform A2
HIV 1-2.0 A1+, A2-
CARD test A1+, A2- Report HIV Inconclusive.
A1+, A2+
 Uni-Gold Plan testing after 14 days
Repeat A1 only
A1-, A2-
Report HIV Negative

Perform A3

A1+ A2+ A3+ A1+ A2+ A3-

Report HIV Positive Report HIV Inconclusive
Plan testing after 14 days
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RTK Summary:a total of 110µl is required for the thre tests
Test
Category Source of Sample Sample Voleum Buffer Time

Whool blood
1drop/30µl 1drop 15-20minutes
One Step Serum/Plasma
2drop (line 2) =
Whool blood 20µl
1drop 15-25minutes
1st 1drop (line 1)=10µl
Response Serum/Plasma

Unigold Whool blood

60µl 2drops 10-12minutes
Serum/Plasma
What Is Partner and family based Index Testing?
Index ≠ Household

er
Sex rtn
pa
par x
tne Se
r( s)

Biologic mother Biologic children

(if index < 19 yr)
HIV-positive (if index=Female)
index client 40
 Index Case Testing Service
Definition: Voluntary process where the service provider asks index clients to list all of the
sexual partners within the past year including the biological children, offering and conducting
HIV testing.
Goal: to break HIV transmission cycle, linking them to care and treatment and to prevention
services.
There are 4 options for notifying and testing Index client partner for HIV
 Traditional Partner Testing Approaches:
Client Referral - Index client tells partner(s) and encourage him/ her to go for HTS &
treatment,
Innovative Assisted HIV Partner Testing Approaches:
Contract Referral - 14 days are given for the index to tell his/her partner then provider
contacts,
Dual Referral - Index client and service provider will notify his/her partner together,
Provider Referral (Optional) - provider calls or sends text message to solicited partner
 Index Testing Services Should Be Offered to
All HIV-Positive Partners and children
When a partner tests HIV-positive, he/she becomes a new index patient,
and the process starts over from the beginning.

Index Client Names Index Client

Three Partners

Partner 1 Partner 2 Partner 3

Two of the Partners Test HIV-Positive HIV-Positive HIV-Negative

HIV-Positive

Linked to HIV Treatment and Offered Linked to HIV

Both Partners Become Index Testing Services Prevention Services
New Index Clients (PrEP, VMMC,
Condoms, Dreams)
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 Minimum Standard for ICT

Providers trained on HTS including index testing procedures, IPV screening, adverse event
monitoring, 5Cs, and ethics.
Adherence to 5C‘s (consent, confidentiality, counseling, correct test results, and connection
to prevention/treatment)
IPV risk assessment and provision of first line response, including safety check and referrals
to clinical and non-clinical services (if not provided on site)
Secure environment to store patient information.
Site level adverse event monitoring reporting system
• ICT Registers
 Key Population and Social Network Strategy
• SNS is strategy that uses social network connections to locate individuals engaging sexual
partner/s and it can also be applied for FSWs, drug injecting partners and social contacts of
key population members with HIV and of those who are HIV- negative and at ongoing risk.
• The assumption of SNS is that people in the same social network share similar risk behaviors
that predispose them for HIV
There are four major phases to a social networks program.
Recruiter Enlistment
Engagement (Orientation, Interview, and Coaching)
Recruitment of Network Associates
HTS
 Key Population Service
What makes them key populations?
Disproportionately affected by HIV
Engage in behaviors that:
• Put them at high risk for HIV (Substance use, Unprotected, condom less vaginal and
anal sex, Multiple sex partners)
• Are socially unacceptable
• Often criminalized
• Experience stigma and discrimination for engaging in these behaviors
A comprehensive package of services has been defined to respond to HIV among key
populations
 HIV Self Testing
• Is a process in which a person collects his or her own specimen (oral fluid or blood) and then performs an HIV
test and interprets the result, often in a private setting, either alone or with someone he or she trusts. It should be
offered as an additional approach to HTS and should always be voluntary, not coercive
• Directly assisted: trained/ oriented providers, or peers giving individuals an in person demonstration before or
during HIVST on how to perform the test and interpret the test result. The assistant will provide pretest
information, demonstration, and interpretation of the result.
• Unassisted: refers to when individuals self-test for HIV and only use an HIVST kit with manufacturer-provided
instructions for use.
• For individuals with non-reactive self-test results, the assistant should advise the self- tester to retest in 3-6
months if the client has an ongoing risk to HIV infection.

Secondary distribution of HIV self-testing (HIVST) kits, through index cases to their sexual partner/s and by
index clients attending general health care to their sexual contacts, can increase the number of HIV case detection
on key and priority population. Hence, providers working in all service delivery points should consider secondary
HIVST-kit distribution as an alternative approach to enhance case finding among key and priority populations
 Recency Testing
 Recent HIV infection is HIV infection acquired in the past 12 months.
 Recency testing distinguishes between recent (HIV infection acquired in the past 12 months)
and long-term HIV infection.
 Recent HIV infections are presented as high viral load, immature and weak immune
response, continued high risk behavior, High probability of ongoing transmission (40%-60%
of transmissions).
 Recency testing provides opportunity for interruption of transmission by contact tracing and
it increase yield of HIV testing.
Probable recent infection: confirmed newly diagnosed HIV positive individual who tested
positive for recent infection.
Confirmed recent infection: confirmed newly diagnosed HIV positive individual who tested
positive for recent infection and has high viral load.
 Purpose of Recency Testing
Site Level Response
Document all probable recent infections and risk factor information about the newly identified
HIV positive cases to provide enhanced response and timely monitoring.
Site level response includes:
All newly diagnosed HIV positive individuals should be linked and start ART within the
same day.
ICT services should be provided for sexual partners and eligible biological children
Above-Site level response
o Primarily based on the identification and analysis of clusters based on the CBS data.
o The type and level of public health response is guided by the magnitude and the spread of
transmission. Some clusters may require routine public health actions such as ICT Services
and linkage to care and treatment services, while other clusters may require enhanced
response activities (e.g. targeted demand creation and testing as well as strengthening
partnership of relevant stakeholders)
3. Linkage and ART initiation flow chart
 The Effect of leak PipeCOA Cohort Dynamics
Factors That Increase TX_CURR
Contributors for cohort Growth
1. Case detection
ICT/PNS

2. Treatment initiation
RBT
VCT

Tx- 3. Retention
4. VL testing coverage & suppression
new

rt
ta

Data Quality is the Metrics !!!

Res
TI
Detectio
Case

p
t
Los

Dro

TO
d
n

Dea

TO
HIVST
SNS
KP

f
Sel
Factors That Decrease TX_CURR 51
 Key elements of chronic HIV care are
1. Retesting for verification 9 Screening for and managing mental health
problems and substance use
2. Complete clinical assessment (history
taking, complete physical examination and 10. Adherence and psychosocial counseling
relevant lab tests) and support
3. WHO clinical staging 11. Nutritional assessment and counseling
4. Prevention, screening and management of 12. Screening for other STIs
opportunistic infections and co-morbidities 13. Prevention screening and treatment of
5. Rapid ART initiation cervical cancer.
6. Patient monitoring and follow up 14. Management of pain and symptoms.
7. Support for disclosure and assisted 15. Pregnancy status, family planning and
partner notification contraception.
8. Risk reduction counseling and 16. Document all relevant client
combination HIV prevention approaches information.
 Attention
Approach to CD4 Testing
• Viral load testing remains the primary method used to monitor the effect of therapy. CD4 testing is used to
identify individuals with advanced HIV disease.

1. For new clients/initiating ART :

• CD4 cell count testing at baseline for all people living with HIV remains important.

2. For those who are treatment experienced:

• PLHIV ≥ 5 years of age and ALHIV who had previously initiated ART and are re-engaging with care after 28
days or greater of ART interruption
• Clinically unstable young CLHIV (< 5 years of age) on ART

• Individuals who have documented viremia (most recent VL >1,000) should have a CD4 performed to diagnose
presence of advanced HIV disease and determine eligibility for the advanced disease package
IV .Prevention and Palliative care:
ART Choric care,TPT(3HP),CxCa, HIV and Mental Health illnesses
1. End TB…..
Interventions to reduce TB associated morbidity and mortality among PLHIV

• TB infection Control and Prevention

• Community/household level
• Facility level
• TPT & ART:
- TPT: Prevents TB by up to 62% (independent of ART status)
- ART & TPT together prevent TB incidence by up to 89%
• Timely diagnosis of TB through Intensified TB Case finding
• Routine TB screening
• Evaluation of PLHIV using rapid and sensitive tests (depending on stage of disease)
 Lateral Flow Lipoarabinomannan (LF-LAM)
Lipoarabinomannan (LAM): is virulence factor for TB, released from metabolically active or those that are
being degraded bacteria. It has structural epitopes that are unique to MTB. LAM is found in blood and
sputum as well as in urine.
•It is a glycolipid that is a component of the cell wall of the bacillus Mycobacterium tuberculosis,
 LAM levels in urine are known to be elevated in people with HIV–TB co-infection, and increase as CD4
counts decrease. Does not require collection of a sputum sample and it can be easily measured in low-cost
immunoassay-based rapid-test formats

Eligibility Criteria for LF-LAM:

with signs and symptoms of TB (pulmonary and/or extra-pulmonary) or
 Seriously ill or
AHD
Irrespective of signs and symptoms of TB who have a CD4 cell count of less than
• Outpatient setting: CD4≤100 cells/mm3
• Inpatient Settings: CD4< 200 cells/mm3
When do TB/HIV diagnosed clients start ART????
 Rationale for TB preventive therapy
 cost-effective intervention that reduces TB incidence and mortality among high-risk groups (60-90%)
 To interrupt disease transmission with eventual goal of ending TB.

• PLHIV and HIV negative HH contacts <15 years are the priority targets to take TPT for TB prevention.
TB preventive treatment recommended for
1.Adults and children living with HIV who are unlikely to have active TB
on appropriate clinical evaluation
•Children 12 months or older who are living with HIV and are
unlikely to have active TB on appropriate clinical evaluation and
• Infants aged <12 months living with HIV who are in contact with
a case of PTB and unlikely to have active TB on appropriate clinical
evaluation should receive TPT
2. HIV-negative adult and child contacts
3. Other HIV negative at-risk groups (pts on dialysis, organ transplant and
patients with silicosis )
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 TB preventive Treatment options
1. Daily INH for 6 months (6H)
2. Daily INH for 9 months (9H)
3. Rifapentine + isoniazid weekly for 3 months (3HP)*
4. Rifapentine + isoniazide daily for 1 month (1HP)**
5. Rifampicin plus isoniazid daily for 3 months for children and adolescents
<15y (3HR)*
6. Rifampicin daily for 4 months (4R)**
 Selection of TPT regimen for PLHIV
Selection of TPT regimen
Age group and ART regimen
Preferred regimen Alternative regimen

1. Adults, adolescents, children and infants of Daily isoniazid preventive

all ages taking a PI-based ART regimen treatment (IPT) for 6 months

2. Children and adolescents aged <15 years Daily isoniazid preventive

taking a DTG-based ART regimen treatment (IPT) for 6 months

- Daily rifampicin Plus

isoniazid for 3 months
3. Children and adolescents aged 2-14 years Weekly isoniazid Plus (3RH)
taking a EFV-based ART regimen rifapentine for 3 months (3HP) - Daily isoniazid preventive
treatment (IPT) for 6
months

4. Adolescents and adults living with HIV (≥ - Daily isoniazid preventive

Weekly isoniazid Plus
15 years of age) taking non-PI based ART treatment (IPT) for 6
rifapentine for 3 months (3HP)
regimen months
 ARV Drug Regimen vs TPT(3HP)
1st Line Reg Adult 1 st Line Reg imen Pediatric 2st line regimen
1d = AZT-3TC-EFV 4d = AZT+3TC+EFV
2e= AZT+3TC+LPV/r 5e=ABC + 3TC + LPV/r
1e = TDF-3TC-EFV 4e= TDF+3TC+EFV
2f=AZT+3TC+ATV/r 5f=AZT + 3TC + LPV/r
1g= ABC + 3TC + EFV 4f=AZT + 3TC + LPV/r
2g= TDF-3TC-LPV/r 5g= TDF + 3TC + EFV
1j=TDF + 3TC + DTG 4g=ABC + 3TC + LPV/r

1k= AZT +3TC +DTG 2h =TDF-3TC-ATV/r 5h=ABC + 3TC + EFV

4i= TDF + 3TC + DTG

4j= ABC +3TC + DTG 2i = ABC + 3TC + LPV/r 5i=TDF + 3TC+ LPV/r

4k= AZT + 3TC + DTG 2j = TDF + 3TC + DTG 5m = ABC + 3TC + DTG
4L= ABC + 3TC + EFV 2k = AZT + 3TC + DTG 5n= AZT + 3TC + DTG
4h=other first line
5o= TDF + 3TC + DTG
1i = Other specify 4L= ABC + 3TC + EFV
2l=other secondline 5j=other second line
ARV Drug Regimen vs TPT
3rd Line Adult 3rd line Pediatric

3a=DRV/r+DTG+AZT/3TC 6c=DRV/r+DTG+AZT+3TC

3b=DRV/r+DTG+TDF/3TC 6d=DRV/r+DTG+TDF+3TC

3c=DRV/r+ABC+3TC+DTG 6f= DRV/r + DTG + ABC + 3TC

3e= DRV/r+TDF+3TC+EFV 6g= DRV/r +ABC+3TC+ EFV

3f= DRV/r+AZT+3TC +EFV 6h= DRV/r +AZT+3TC+EFV

3d=Other thirdline 6e=Other thirdline regimen

HIV Negative Personnel
Selection of TPT regimen
Age group and ART Preferred regimen Alternative regimen
regimen

Infant and children <2yrs of age Daily rifampicin Plus isoniazid Daily isoniazid preventive
for 3 months (3RH) treatment (IPT) for 6 months

Eligible adolescents aged >2-14 Weekly isoniazid Plus rifapentine Daily isoniazid preventive
years for 3 months (3HP) treatment (IPT) for 6 months
-3RH will be used as alternative
Algorithm for adults and adolescents ≥15 years living with HIV

Adult or adolescent ≥15 years

Symptoms: living with HIV
Current cough (any CD4 or ART status)
Any fever
Unintentional weight Loss
Any night sweats 1
Screen for Active TB
No symptom disease
Presence of Any
suggestive of TB one symptom
2
Assess for contra- Investigate for TB
indications to 3HP and other diseases

No Contraindications
contraindication to 3HP Other TB diagnosed
diagnosis

Assess Eligibility for other Treat as

Initiate 3HP TPT regimens TB Treatment
appropriate

Follow up and
If eligible: If not eligible: consider TPT
H= isoniazid Defer preventive once illness
R=Rifampicin Initiate alternative treatment until
HP= isoniazid/Rifapentine
regimen resolved
contra-indication
(6H) resolved
Children aged < 15 yrs living with HIV, with and without household TB exposure

Children <15 yrs living with HIV

(Any CD4 count or ART status
*Poor weight gain, fever, current
Refer for Screen for Active TB disease & cough, household contact with PTB
hospitalization TB exposure status
b
case
Can also consider: Loss of appetite,
Yes Neck swelling*, lethargy/fatigue/
No Symptom suggestive of reduced playfulness, wheeze a
Symptom* TB present and no TB
Any concern for a
suggestive of TB exposure
severe illness
present or
a known household TB diagnosis
No TB exposure excluded

Age Age
Refer for further diagnostic work- 0-12 months > 12 months
up (Xpert; CXR) f
Close contact of START TPT c,d,eI
Yes
PTB index case?

Xpert MTB/RIF Xpert MTB/RIF not No CXR findings

detected detected or not done suggestive of TB No Children on DTG, Children on
and resolution of LPV/r, or NVP EFV
symptoms
Persistent physical
Start TB signs / symptoms No Preventive 6H/B6
treatment g 3HP/B6
or CXR positive? Therapy
 What is 3HP?

• One of short-course TPT regimen recommended by WHO for treatment of latent TB infection

• Combination of two drugs: isoniazid (H) and rifapentine (P)

• Full course of treatment: 12 doses administered once weekly for three months duration
Specific counselling points for 3HP:
What do you need to know about administering 3HP ?

Full course of treatment: 12 weekly doses

The appropriate dose must be taken

• at once
• on the same day
• every week for 12 weeks
 Weekly dosage of INH & Rifapentine (3HP) for adults and
adolescents above 14 years of age

Weight bands for patients aged >14 years

Medicine Formulation Comments

30–35 kg 36–45 kg 46–55 kg 56–70 kg >70 kg

Isoniazid 300 mg 3 3 3 3 3

Rifapentine 150 mg 6 6 6 6 6

Isoniazid + Rifapentine FDC being

300 mg / 300 mg 3 3 3 3 3
FDC developed
Weekly dosage of INH & Rifapentine for children and adolescents (3HP) between 2-
14 years of age
Dosing of rifapentine and isoniazid (3HP) for treatment of latent TB infection

Weight bands for patients aged 2-14 years

Medicine Formulation Comments
10–15 kg 16–23 kg 24–30 kg 31–34 kg >34 kg

adult 300 mg tab. can

Isoniazid 100 mg 3 5 6 7 7
reduce pill burden

Rifapentine 150 mg 2 3 4 5 5

Isoniazid +
150 mg /150 mg 2 3 4 5 5 FDC being developed
Rifapentine FDC
 Notes to the algorithm
1. Follow appropriate national guidelines for 3. Contraindications to 3HP/6H use:
investigation of TB disease 1. Active Hepatitis (acute or chronic)
2. WHO recommends symptom screen 2. Regular & heavy alcohol use
1. Cough, fever, weight loss, night sweats to rule out TB 3. Severe peripheral neuropathy
2. No chest X-ray 4. Pregnant and breastfeeding mothers* (for rifapentine only)
3. No proof of infection (TST/IGRA) 5. Unwilling/unable to use non-hormonal forms (barrier
methods) of contraception (rifapentine only)

These are therefore not necessary for TPT initiation 6. On Protease Inhibitor or NVP – based ART (rifapentine
including 3HP only)

4. Patients on TPT may additionally receive vitamin

B6/Pyridoxine to prevent neuropathy
3HP Is indicated for

Indication C/I
• >2 years • pregnant/BF
• >15 years on Non-PI Based • <2yrs
• 2-14years not on DTG but EFV • <15yrs on DGT-based
• Not HIV-Exposed on NVP • Any age receiving PI-Based
 Management Ctd…
Actions to be taken if patients missed doses of 3HP:
• Encourage a weekly routine of taking medications i.e. Sunday. If a patient misses Sunday, they can take
3HP within 3 days and go back to their normal Sunday routine
• If they miss a dose for more than 3 days there are two options:
1) They can skip this dose and go back to their original chosen day i.e. Sunday and continue until all
12 doses have been taken
OR
2. Start the new schedule on the day they remembered to take the dose i.e. Schedule was a Sunday and
only remembered Thursday, they now start a once weekly Thursday routine and forget about
Sundays
• The 12 week course should be completed within 16 weeks which provides some leeway for missed doses
(11 doses can be counted as complete although not ideal)
• For TPT completion is 6/9:Complete full course of therapy with nine months and interruption <3months is
resumed the same and adde mised dose at end but>3months is re-initiated new course of Tx
 3HP- drug safety and adverse events
• Overall, 3HP is a safe, tolerable and effective treatment for latent TB
infection.
 Minor adverse events are likely to occur in small proportion of individuals/patients.

Rarely serious adverse events may occur, and hence both the health care provider and
patient should be vigilant and manage such events rapidly.
Drug reactions are usually mild and self-limiting, but occasionally they can be severe.

• Most adverse events associated with 3HP are due to drug reactions (rash, hepatitis, flu-like
syndrome) or drug-drug interactions (lowering of drugs used to treat other conditions)
3HP – what sorts of adverse events

Adverse drug reactions Other unexpected medical events

• Flu-like syndrome • Drug-drug interactions
• Hepatotoxicity • Pregnancy
• Hypersensitivity reactions • Active TB
• Unrelated illnesses eg malaria
2. Summary of Components of Packages of Care for AHD Clients in Ethiopia
STOP Approach for Managing Pediatric AHD
3. HIV and Mental Health Illnesses
why mental health care important for people with HIV/AIDS?
 HIV infects the brain
 The stresses of living with HIV/AIDS can also cause mental health problems( poor nutrition, sleep, and chronic
pain)
 Face ongoing stigma, the burdens of ongoing medical treatment, and worry about their own health and that of
friends and family members.
 Some of the medicines used to treat HIV and the infections that come with it have mental health side effects.
 Having a mental health problem is one of the risk factors for becoming infected with HIV.

Priority mental health disorders (WHO) Target Group for Screening:

 Psychosis  Newly initiated on ART
 Mania  Patients with high viral load
 Depression  Patients re-engaged into care after treatment interruption
 Suicide  Patients with problem of ART adherence
 Abuse of alcohol and other substances  Patients who refused to start ART
 Childhood mental disorders  Patients who are on ART preparation for >2 weeks
 Dementia  Patients with advanced HIV disease
 Epilepsy  Patients with other health problems
5. Natural history of cervical carcinogenesis
 WHO Cervical Cancer Elimination

To eliminate cervical cancer as a public health problem within a century, 90-70-90

targets must be reached by 2030 .
Prevention…cont’d
Primary prevention : prevention of infection of HPV
• HPV vaccination for 9-14yrs( >90 %) …(Cervix, Gardasil & Gardasil 9))
• health information and warnings about tobacco use
• Sexuality education tailored to age & culture
• Condom promotion/provision for those engaged in sexual activity
• NB :- Condom use doesn’t reduce HPV infection as effectively as reducing the risk of other STIs.
Secondary prevention : prevent invasive cervical cancer by detecting and treating precancerous lesions of the
cervix before they progress to cancer.
Screening methods (Screening is not undertaken to diagnose a disease, but to identify individuals with a
high probability of having or of developing a disease.)
• Cytology-based screening : Conventional (Pap) and liquid based cytology (LBC)
• Visual inspection with Acetic Acid (VIA) /VILI
• HPV testing for high risk HPV types
Tertiary Prevention includes management of invasive cervical cancer
(i.e. surgery, radiation therapy, chemotherapy and palliative care)
CRITERIA FOR AGE AND FREQUENCY OF CERVICAL CANCER
SCREENING
 Priority should be given to women who are between 30–49 years old for screening. HIV
positive screen upon diagnosis and 15- 49 for WLHIV (regardless of age based on sexual
exposure) and currently from 49 to 65 are included
 The screening interval (frequency) should be every 3 years for women with negative VIA
result (GP) and every 2 years for WLHIV.
 HPV negative 5 years for GP and 3 years for WLHIV
 For HPV positive followed by VIA negatives follow up will be after one year for WLWIH
and 2years for GP.
 For VIA positive women who were treated with cryo/TA or LEEP follow up visit should be
scheduled a one year period for GP and 6 month for WLHIV
 Priority should be given to maximizing coverage a woman’s life time
 All women who screen for cervical cancer should be offered HIV testing and counseling
based on RAT
V. Viral Load Monitoring and 2nd Line ART Initiation
 When to take a first viral load test?
 For those who are already on chronic care:
Do VL test during their scheduled visit and then every 12 months thereafter routinely;
 For those who are newly initiated:
Routine viral load monitoring can be carried out at 6 months on ART, at 12 months and then every 12
months thereafter if the patient is stable
 Targeted VL testing offered for suspected clinical or immunologic failure
 Monitoring viral suppression with viral load testing for newly HIV positive pregnant mothers :
at 3months of ART initiation,
at 34-36 weeks of GA or delivery at the latest,
followed by three months after delivery and
then every 6months.
For those who are already on ART with previous VL test conducted more than three months back repeat VL
test at 1st ANC contact /PMTCT visit, at 34-36 weeks of gestational age (or at the latest at delivery) and 3
months after delivery and every six months thereafter until MTCT risk ends
Whenever possible, use same-day point-of-care testing for viral load testing of pregnant and breastfeeding
women to expedite the return of results and clinical decision-making.
 Viral load is the best measure of treatment response. Why?

TIME

Poor Virological Clinical Failure:

Immunological Failure
Adherence Failure- VL specific illnesses
(Predictor of TF) – CD4

Earliest indicator – tells us if the virus is replicating

 Viral Load Result Categories
Viral suppression:
A viral load that is undetectable, equal to or less than 50 copies/ml.
Low-level viraemia
-one or more viral load results that are detectable (more than 50 copies/ml) but equal to
or less than 1000 copies/ml.
Virological failure:
-Viral load above 1000 copies/ml based on two consecutive viral load measurements in 3
months, apart with enhanced adherence support following the first viral load test

What is suspected treatment failure and treatment failure management? EAS?

Treatment Monitoring Algorithm
Identifying Treatment failure
• Viral load testing should be done after initiation of ART at 6 months, 12 months and every 12 months
then after in order to detect treatment failure proactively.
• Viral load testing should be used aside from the routine testing whenever there is clinical or immunologic
suspicion of treatment failure.
• Virological failure Viral load above 1000 copies/ml based on two consecutive viral load measurements in
3 months, apart with enhanced adherence support following the first viral load test. Treatment failure
threshold should remain at 1000 copies/ml.
• Viral suppression or undetectability, however, are defined as viral load equal to or less than 50 copies/ml.
• PLHIVs should be supported with adherence counselling to achieve viral suppression
• However, treatment failure should be considered for those with a repeat viral load result >1000 copies/ml
after three months of EAS following the first viral load.
• Those with low-level viraemia at the first viral load test (50–1000 copies/ml) need to be provided with
enhanced adherence support (EAS)and repeat viral load test after 3 months to promote viral suppression.
• If viral load is still 50-1000 copies/ml, maintain ARV drug regimen and continue viral load test every six
months.
• In addition, continue the routine follow up support and link to community-based adherence support
services.
DEFINITION OF CLINICAL, IMMUNOLOGICAL, AND VIROLOGICAL
TREATMENT FAILURE
What ART regimen to switch to (second-line ART)

• Using a boosted PI + 2 NRTI combinations is recommended as the preferred strategy for

secondline ART for adults, adolescents and for children when NNRTI-containing regimens
were used in first-line ART.
• Two NRTI + DTG can be used as second line regimen if it is not used in the first line.
• In children using a PI-based regimen for first-line ART, switching to NNRTI or maintaining the
PI regimen is recommended according with age.
• Two NRTI + DTG can be used as second line regimen if it is not used in the first line.
Guidance for Changing ARV Regimens for treatment failure
• Ensure diagnosis of treatment failure to avoid premature switching.
• Assess level of adherence and address barriers
• Address Drug interactions issues
• Do not add one drug to a failing regimen!
• Consider resistance & cross resistance
• Get advice from experienced clinicians
• Use at least two new drugs in the new regimen, preferably one new drug class
 Second line ART for children (including adolescents)
• For children starting first-line ART with an NNRTI or DTG based regimen, PI-based regimens remain the

recommended choice for second-line therapy.

• LPV/r is the preferred 168 boosted PI option, but ATV/r may be considered if more appropriate formulations

become available for appropriate age.

• After failure of a first-line LPV/r-based regimen, children can be switched to DTG based regimen as per table below.

• After failure of a first-line regimen of ABC or TDF + 3TC, the preferred NRTI backbone option for second-line ART is

AZT + 3TC and failure of a first-line regimen is containing AZT + 3TC, the preferred NRTI backbone option for

second-line ART is ABC or TDF + 3TC.

2nd Line ART Initiation
Population 1 st line regimens 2 nd line regimens

Adults and adolescents 10 Preferred TDF + 3TC + DTG AZT+3TC+ATV/r LPV/r or

years and above
Alternative TDF+3TC+EFV AZT+3TC+DTG or ATV/r or LPV/r
AZT+3TC+ EFV TDF+3TC+DTG or ATV/r or LPV/r

AZT+3TC+DTG TDF+3TC+ ATV/r or LPV/r

Special Circumstances ABC+3TC+EFV AZT+3TC+ DTG or ATV/r or LPV/r

ABC+3TC+DTG AZT+3TC+ATV/r or LPV/r

TDF+3TC+ATVr LPV/r AZT+3TC+DTG

AZT+3TC+ATVr LPV/r TDF+3TC+DTG

Children 4weeks to 10 Preferred ABC+3TC+DTG AZT+3TC+LPV/r

years and >3kg
Alternative ABC+3TC+LPV/r AZT+3TC +DTG

AZT+3TC+DTG ABC+3TC+LPV/r

Special Circumstances ABC+3TC+EFV AZT+3TC+DTG

AZT+3TC+EFV ABC+3TC+DTG or LPV/r

AZT+3TC+LPV/r ABC+3TC+DTG or EFV

 Eligible patients for second line ART service at health center
The following criteria should be used to sort out treatment failure patients who will be switched to
second line ART or will have follow up at the health centers:

1. Patients who fulfill the criteria of treatment failure and with no signs of clinical failure

2. Patients who are initiated on second line ART at hospital and became stable with no signs of OI
or drug toxicity and transferred out to health centers having second line ART.
VI. Elimination of Mother to Child
Transmission (eMTCT)
What is new on ANC schedule?
WHO FANC MODEL 2016 WHO NEW MODEL

First trimester First trimester

• Contact 1: up to 12 weeks
• Visit1: 8-12 weeks
Second trimester
Second trimester
• Contact 2: 20 weeks
• Visit 2: 24-28 weeks
• Contact 3: 26 weeks
Third trimester Third trimester
• Visit 3: 32 weeks • Contact 4: 30 weeks
• Visit 4: 36-38 weeks • Contact 5: 34 weeks
• Contact 6: 36 weeks
• Contact 7: 38 weeks
• Contact 8: 40 weeks

If woman not delivered until 40Wks, appoint her at 41 weeks

 The Four-Pronged Approach to eMTCT
Prong 1: Primary Prevention of HIV, Syphilis and Hepatitis B infection
Prong 2: Prevention of unintended pregnancies in HIV positive women
Prong 3: Prevention of HIV, Syphilis and Hepatitis B transmission from
women to their infants
 Prevention of MTCT of HIV
 Prevention of MTCT of syphilis
 Prevention of EMTCT of HBV
• Prong 4: Treatment, care and support for HIV, Syphilis and Hep B virus positive mothers,
their exposed, infants, partners and family
 Basic principles in the use of ARV drugs for PMTCT
Treatment of Hep B virus
Additional elements of clinical care
 Triple Elimination Strategy
• Triple elimination refers to elimination of MTCT of HIV, syphilis and Hepatitis at
national, regional, district and community levels.
• The goal for EMTCT initiatives is to reduce MTCT to a very low level, so that it is no
longer a public health problem (<50 per 100,000 live births).
• Alternatively, elimination of MTCT of HIV is defined as:
transmission rate of <2% for NBF and <5% for BF infants.
eliminate new pediatrics HIV infection due to MTCT and congenital syphilis by 2020
and keep their mothers alive.
Summary of ePNP recommendation
Maternal and Infant scenario
Scenario Mother diagnosed Maternal ARV Infant ARV Duration of infant
Prophylaxisa Prophylaxis ARV prophylaxis
During pregnancy ART: TDF+3TC+DTG NVP for 12 weeks
NVP+ AZT AZT for 6 weeks
During labor, within one month before ART: TDF+3TC+DTG NVP for 12 weeks
delivery or NVP + AZT AZT for 6 weeks
postpartum within 72 hours
regardless of feeding plan
HIV exposed Infant identified any time after ART: TDF+3TC+DTG NVP for 12 weeks
birth NVP+AZT AZT for 6 weeks
(through infant or maternal PLUS
HIV antibody testing) and -Take DBS specimen for DNA PCR for EID if infant
is breastfeeding older than 4weeks.
HIV exposed Infant identified 72 hours after ART: TDF+3TC+DTG -Do DNA PCR testing;
birth No prophylaxis -no infant ARV prophylaxis;
(through infant or maternal needed -Initiate ART if the infant is infected
HIV antibody testing) and is
NOT Breastfeeding
Mother receiving ART but interrupts ART Alternative ART NVP + AZT -Until 6 weeks after maternal
regimen while breastfeeding (such regimen or ART is restarted or until 1 week after
as toxicity, stock-outs or refusal to continue) Counsel continuing ART breastfeeding has ended,
without interruption -Do DNA PCR testing
 Enhance infant prophylaxis
Infant age NVP daily dosing Dose in ml AZT daily dose Daily dose in ml
Birth to 6 weeks
Birth weight 2mg/kg 0.2ml/kg 2mg/kg 0.2ml/kg
<2000g daily once once daily twice daily twice daily
Birth weight: 2000- 10 mg 1ml 10mg 1ml
2499 g once daily once daily twice daily twice daily
Birth weight >2500 15mg 1.5ml 15mg 1.5ml
g once daily once daily twice daily twice daily
Age 6 weeks to 12 weeks
Age 6 weeks to 12 20 mg 2ml once daily or
weeks once daily half a 50mg tablet
once daily
 Components of Services in HEI Care
 Essential New born care
 Proper review through history and physical exam
 Daily NVP
 Testing for HIV infection (DNA/PCR or RHT)….6weeks,if negative at 9months
 Support for proper infant feeding
 Growth monitoring
 Developmental assessment
 Co-trimoxazole prophylaxis
 Infant feeding
 Immunization
 Tb risk assessment
 Documenting and reporting
 Basics of HBV and MTCT
Hepatitis B Virus (HBV) is a DNA virus, which causes acute and chronic hepatitis that could range from
asymptomatic carrier states to fulminant liver failure
HBV is prevalent in Ethiopia and based on few studies it has a prevalence of 8-12%.
Chronic HBV infection
Defined as, persistence of hepatitis B surface antigen (HBsAg) for six months or more after acute infection with
HBV.
HBV is transmitted by:-
• Blood and/or body fluids(saliva, menstrual, vaginal and seminal fluids) from infected individuals,
• Use of contaminated traditional and medical equipment's.
• Mother to child
HBV is extremely infectious (about 100 times as infectious as HIV and 10 times more infectious than Hepatitis
C).

All pregnant women should be tested for hepatitis B surface antigen (HBsAg) at least once
and as early as possible particularly in settings with a ≥2% HBsAg seroprevalence in the
general population.
 103

VII. Reporting and HMIS Indicators

 104

Final revised HMIS indicators

DHA

2017_HMIS 2021_HMIS
Total Indicator:131 Total indicators:177

Continued: Dropped:
103 Modified: 3 New:71
25
 105

Revised Indicators (2021) 13 % of total Indicators are only

HIV
Number of indicators by category (2017 versus 2021)
SN Indicator Category 2017 2021 SN Indicator Category 2017 2021

1 Reproductive and Maternal 14 15

11 Neglected Tropical Diseases (NTD) 2 8
health
12 Non-communicable diseases (NCD) & 3 10
2 PMTCT 7 6 mental Health
3 EPI 13 12 13 HEP and Primary Health care 3 4
4 Child health 8 10 14 Leadership and governance 4 4
5 Nutrition 8 8 15 Health Financing 3 4
16 Pharmaceutical supply and services 4 7
6 Hygiene & environmental 2 10
Health
17 Evidence based decision making 3 6
7 Medical service 12 21
18 Health Infrastructure 4 2
8 HIV/AIDS/Hepatitis 10 15
viruses 19 Human Resource Development & mgt 4 3

9 Tuberculosis/TB/ & 22 22
20 Regulatory system 1 2
Leprosy
Total 131 177
10 Malaria 5 8
Reportable data elements from PMTCT register..21
S.N Reportable data element

1 No. of HIV positive pregnant women who received ART during ANC for the first time

2 No. of HIV positive Pregnant women who received ART during L&D for the first time

3 No. of HIV positive Pregnant women who received ART during PNC for the first time

4 No. of HIV-positive women who get pregnant while on ART and linked to ANC

5 No. of HIV exposed infants who received Virological HIV test 0- 2 months of birth

6 No. of HIV exposed infants who received an Virological HIV test 2-12 months of birth

106
PMTCT register cont….
S.No, Reportable data element
7 No. of infants born to HIV positive women started on co-trimoxazole prophylaxis within two
months of birth

8 No. of HIV exposed infants who received ARV prophylaxis

9 No. of HIV exposed infants receiving HIV confirmatory (antibody test) by 18 months

10 No. of partners of pregnant, laboring and lactating women tested and know their results

11 Number of adults who are currently on ART

12 Number of PLHIV on ART documented as Lost/lost to follow up during the reporting period.

13 Number of adults and children with HIV infection newly started on ART

14 Number of adults and children who are still on treatment at 12 months after initiating ART

107
 PMTCT register cont….
S.N Reportable data element

15 Number of persons on ART in the original cohort including those transferred in, minus those
transferred out (net current cohort).
16 Total number of adult and pediatric ART patients with an undetectable viral load
<1000copies/ml in the reporting period
17 Number of adult and pediatric ART patients with a viral load test in the reporting period.

18 Number of PLHIV who were assessed/screened for malnutrition

19 Number of PLHIV that were nutritionally assessed and found to be clinically undernourished

20 Number of clients who were on ART and screened for TB during the reporting period

21 Number of PLHIV women who are using modern family planning

108
 PMTCT Reports of Y Facility of June Report
MTCT PMTCT

MTCT_TST Pregnant and lactating women who were tested for HIV and know their results 201

MTCT_TST.1. Number of Pregnant women tested and know their HIV result during pregnancy 193

MTCT_TST.2. Number of pregnant women tested and know their HIV result during labor & delivery 2

MTCT_TST.3. Number of women tested and know their HIV result during the postpartum period 0

MTCT_Test.4. Number of women with known HIV positive status attending ANC, delivery and postpartum for new pregnancy 6
MTCT_NW pos. Number of new HIV positive women during ANC, L&D and Postpartum 2
Percentage of HIV-positive pregnant women who received ART to reduce the risk of mother-to child-
MTCT_ART transmission (MTCT) during pregnancy, L&D and PNC
Number of HIV positive women who received ART to reduce the risk of mother to child transmission during ANC
MTCT_ART.1. for the first time 0
Number of HIV positive Pregnant women who received ART to reduce the risk of mother to child transmission
MTCT_ART.2. during L&D for the first time 0
Number of HIV positive lactating women who received ART to reduce the risk of mother to child transmission
MTCT_ART.3. during PNC for the first time 1

MTCT_ART.4. Number of HIV-positive women who get pregnant while on ART and linked to ANC 4
 HEI-DBS/Ab test
MTCT_HEI_EID.1 Total Number of infants within 12 month received virological test result 1
MTCT_HEI_EID.1.1 Number of HIV exposed infants who received an HIV test 0- 2 months of birth

MTCT_HEI_EID.1.1. 1 Positive

MTCT_HEI_EID.1.1. 2 Negative

MTCT_HEI_EID.1.2 Number of HIV exposed infants who received an HIV test 2-12 months of birth 1

MTCT_HEI_EID.1.2. 1 Positive

MTCT_HEI_EID.1.2. 2 Negative 1
Percentage of HIV exposed infants receiving HIV confirmatory (antibody test) test
Antibody test by 18 months
Number of HIV exposed infants receiving HIV confirmatory (antibody test) by 18
MTCT_HEI_ABTST.1 months 2

MTCT_HEI_ABTST.1. 1 Positive

MTCT_HEI_ABTST.1. 2 Negative
 111
HIV and Hepatitis Indicators
Sr # List of Indicators Remarks
1 Percentage of people living with HIV who know their status Existing
2 Number of people living with HIV currently receiving ART Existing

3 Number of adults and children with HIV infection newly started on ART Existing

4 ART retention rate Existing

5 Number of ART Clients that interrupted Treatment New

6 Viral load Suppression Modified

7 Number of individuals receiving Pre-Exposure Prophylaxis New
8 Number of persons provided with Post-Exposure prophylaxis Existing

9 Proportion of clinically undernourished People Living with HIV (PLHIV) who Existing
received therapeutic or supplementary food
What is expected
• The services should be provided as per SOP,Guidline,Algorism
• All necessary inquires like algorism, SOP and other reference should be
available in all SDP,
Example: ANC Re-test,RTK Algorism,VLT monitoring,
• ART Service should be integrated
• Providing staff has to be well updated (training)
• All service delivery units use HIVRST
 Together we can break the
chain of HIV transmission !!!

CT
I
Thank You!!