Basic Demography Health Indicators1999 (census)2004 Population50,84061,215 Age 0-1421,837(42%) Age 15-2914,198 (27%) Age 65+1113 (2%) Crude Birth Rate41.21/1000 pop 49.2 in 1988 26.45/1000 Crude Death Rate4.47/1000 pop.4.31/1000 Life ExpectancyLife expectancy at birth: Female (67) Male (64) Female (69.4) Male (65.7)
HIV Report 2001 QuarterlyMale TestedFemale TestedTotal Tested First Quart90459549 Second107569676 Third Quart3268021128 Fourth82535617 Total605 (20%)23652970
HIV/AIDS Screening from 01/01/2002 to 12/31/2002 AGE GroupMaleFemaleTotal < 15 age114159279 15-19 age290559849 20-24 age178660839 25-29 age91462554 30-34 age87328415 35-39 age58249307 40-44 age37189227 45-49 age23136159 50+ age43153197 Total921(24%)2895(76%)3,826
Reason For Test (Screen) for 2002 STD106 (2.70%) PRENATAL1,212 (30.9%) PREEMPLOYMENT1,577 (40.2%) STUDENTS891(22.75%) OTHER (VOLUNTARY)129 (4%) TOTAL3,915
Number of HIV Tests 2001- 2004 Years2001200220032004 HIV Tests Performed 297038262387
Comparison between Majuro and Ebeye HIV Program NAMEMAJUROEBEYE POPULATION(+)35,000(+)11,000 HIV (POSITIVE)CUMULATIVE (10)Only one case residing in Ebeye SUBPOPULATIONPREGNANT/STUDENT/ALIEN/ STD/F.HANDLERS/VOLUNTARY/ Taxi Driver Same but not include taxi drivers CME/OUTREACH PROGRAMS Ongoing Activities DIAGNOSTIC TESTRAPID TESTS (SERODIA TEST) CONFIRMATION (OFF ISLAND) SAME BARRIERS+++++
NUMBER OF HIV (RMI) In 1984: (4) HIV positive and (2) AIDS. In 1993: (1) 19 y/o female with (+) HIV test. In 1994: (1) 21 y/o male with (+) HIV test. (Contact of 1993 case). 2 AIDS cases: Died with PC and KS lesion. In 1996: (1) 34 y/o male with (+) HIV test. In 2000: (1) 24 Age female with (+) HIV test. In 2001: (1) 31 Age female with (+) HIV test. Cumulative: (+) HIV (10) & AIDS (2).
MAJURO HIV PROGRAM In early 2004, encountered 2 HIV positive tests (one pregnant and one foodhandler). Two series of blood sample from both clients were taken in two different occasion and all HIV serodia tests were still positive. Samples were sent off island to Aloha Lab for confirmation. Result for the pregnant was negative for ELISA and the male client was indetermined. In two, four and six months period, male client was retest and serodia test turn negative. Pregnant client delivered a healthy baby girl and retest two weeks later and result was negative.
MAJURO HIV PROGRAM There was no positive test until early 2005, 17 y/o pregnant girl with two partners was reported to the program due to positive HIV test. Second blood sample was drawn for retest. Second sample was positive. Two partners were located and advise for HIV test. Both were negative. Multiple counseling sessions were conducted with the client with guidance and consultation with Dr. Amy Kindrick. (Thanks you, Dr. Kindrick)
MAJURO HIV PROGRAM Around that time, two positive HIV tests were detected. (couple). There were referred to my office for counseling and retest. They were seen at separate time. The male were complaining of diarrhea and weight lost but female partner was only experiencing weight lost 5-7 bounds. Both clients denies having other outside affair other than their previous partner many years ago.
MAJURO HIV PROGRAM Blood samples for three clients(pregnant girl and the couple) were sent off island (aloha lab) for confirmation. Confirmation was received on email on (date) with result positive for ELISA test and western blot. Post test counseling were conducted to all three client. Pregnant client was immediately called for post counseling and immediate family members were involved in the counseling session.
MAJURO HIV PROGRAM Plan for elective C-section was introduce and successfully agree with the pt and family members. On (date) patient underwent c-section without complication. Baby was tested for HIV and result was negative. Baby was on bottle feeding and remain to be on bottle until now. Follow up for mother and baby was conducted on two, four and six weeks postpartum. Mother was retest at four weeks postpartum and result was negative.
MAJURO HIV PROGRAM Meeting was conducted with the chief of laboratory and two other senior lab technicians. Recommendations to retest all positive HIV in one month period and any positive tests will be send off island for re-confirmation. Couple are still anxious on when to start the ARV. AVR procurement is still going with the new pharmacist on island working on it. Pregnant client doing fine and baby was taken to outer island by grandparent.
MAJURO HIV PROGRAM Around that time, the fourth positive HIV test was referred to my clinic. This is ?age taxi driver who is marriage and have multiple sexual partners. Two samples was positive for HIV test and both were sent to aloha lab for confirmation. In less than two weeks time, result come back negative for ELISA test. Until now, result hasn’t disclose to the patient.
Questions for discussion? Why are we encountering too many false positive confirmation? How common is to get a false positive result? How reliable or the effectiveness of the serodia test? (specificity and sensitivity?) Is Aloha lab a reference lab?or does CDC play role in helping the islands to do confirmation tests? Where are we in term of ARV procurement plan? What is the role of AETC in this situation? When do we disclose the result to patient?health workers?family member?public?
ACCOMPHLISMENTS: Conduct a Lecture on STD/HIV to Churches Youth Groups. Congregational church on July 15, 2004 BNJ (Assumply of God Church) July 16,2004. Rita Assumply of God Church) July 17,2004 Total participants roughly around 300-350. Attend a VTC on HIV case presentation on July 28, 2005 via Peacesat Program.
ACCOMPHLISMENTS: Present a lecture on STD and HIV to YTYIH program (NGO) participants on July 22, 2005. ( 30 participants). SPC HIV surveillance specialist make a site visit on 10/2/2004 and recommends a new HIV database system to installed and BBS and SGS survey. Attended a PMTCT workshop in Fiji from October 21-22, 2004.
ACCOMPHLISMENTS: World AIDS day activities on December 4, 2004. December 4, 2004, approximately 600 to 700 participants participate in the three site for the walkaton activities. January 20,2005, conduct a lecture on HIV during the teacher and principal workshop. (30+ teachers and principals attend the lecture) Presentation on the RMI HIV situational analysis by a visiting Medical Student from University of Auckland, New Zealand. VTC on HIV case presentation (AETC) on February15, 2005.
ACCOMPHLISMENTS. March 3, 2005, gave a HIV lecture to the CMI Nursing Students. (Around 20 students). Present the HIV positive case (17 y/o pregnant girl) to the medical staffs. March 7-11 2005, HIV workshop by the Chuuck HIV team conducted. (97 participants from the MOH including medical staffs attended).
GHALLENGES/BARRIERS LACK OF MANPOWERS. CLINICAL MANAGER IS WEARING TOO MANY HATS (OVERWHELMING RESPONSIBILITY) OUT DATED PROTOCOL AND GUIDELINE. NO ARV PROCUREMENT PLAN. ENCOUNTERING TOO MANY FALSE POSITIVE TEST. NO ARV AGENTS FOR THE PMTCT.
ACCOMPHLISMENTS: LACK OF TRAINING. PRE AND POST COUNSELING. UNIVERSAL PRECAUTION. HIV 101/102 NO GUIDELINE FOR REFERRING CLIENT. STIGMA. CULTURAL BELIEF (SENSITIVE ISSUE TO AWARE THE PUBLIC). SMALL POPULATION CONFIDENTIALITY. DISCLOSURE TO PT/HEALT WORKERS/FAMILY AND PUBLIC.
Recommendations To install a new database system for better recording and surveillance. To do a need assessment for the HIV program by conducting a BBS and SGS survey. To upgrade and revise the existing HIV guideline and protocol. To increase the capacity building by performing more training to the staffs as well as to the medical staffs. To implement an accessible and feasible ARV procurement system.
Recommendations To expand the community outreach activities to the outer islands and remote villages. To link or network with Ebeye HIV program for sharing and collaborating work related activities like training and workshop. Increase the manpower and conduct counseling workshop. Implement HIV test on all TB clients. To conduct a week Youth Community Workshop in Majuro (Capital City).