Presentation on theme: "Module 7: Malaria and HIV/AIDS Palliative Care for People Living with HIV/AIDS."— Presentation transcript:
Module 7: Malaria and HIV/AIDS Palliative Care for People Living with HIV/AIDS
Module 7: Malaria and HIV/AIDS2 Learning Objectives Describe the interactions between malaria and HIV. Discuss strategies for preventing malaria as part of the palliative care package. Implement strategies to treat malaria among people with HIV/AIDS.
Module 7: Malaria and HIV/AIDS3 Background Malaria and HIV/AIDS are both endemic in Ethiopia: 50 million people are at risk for malaria. 9 million reported cases annually. Leading cause of morbidity and mortality. 0.9–3.5% HIV prevalence, 420,000, 1.3 million with HIV/AIDS The most vulnerable groups for malaria and HIV/AIDS are similar: pregnant women, young children, the poor. Coordinated service delivery can help prevention and treatment of both diseases. Source: UNICEF; FMOH, 2004; FMOH, 2006; UNAIDS, 2007
Module 7: Malaria and HIV/AIDS4 Impact of HIV/AIDS on Malaria People with HIV/AIDS are more likely to have symptomatic malaria, severe malaria, and anemia. Prevalence and density of placental and peripheral parasitemia are higher in HIV- infected pregnant women. Pregnant women coinfected with HIV and malaria are at higher risk for anemia, preterm birth, and low birth weight infants. Antimalarial treatment failure may be more common in people with low CD4 counts. Sources: Francesconi, et al, 2001; French, et al, 2001; Patnak, et al, 2005; ter Kuile, et al, 2004; Ayisi, et al, 2003
Module 7: Malaria and HIV/AIDS5 Impact of Malaria on HIV/AIDS Long-term data are lacking Acute malarial episodes cause a temporary increase in viral replication Placental malaria may increase viral load Sources: Kublin, et al, 2005; Whitworth, et al, 2005
7 Malaria Control and Prevention Strategies in Ethiopia Rapid diagnosis and prompt treatment. Selective vector control: ITN (Insecticide treated nets). IRS (indoor residual spray). Others: −Environmental modification. −Larviciding. Early detection and containment of malaria epidemic. Other strategies that work are intermittent presumptive treatment of pregnant women, pCTX, HAART. Focus on children <5 years and pregnant women in endemic areas.
Module 7: Malaria and HIV/AIDS8 Uganda Study Combination of: pCTX ART Treated nets Associated with a 95% reduction in the incidence of symptomatic malaria among people with HIV/AIDS. Source: Mermin, et al, 2006
Module 7: Malaria and HIV/AIDS9 Insecticide-Treated Nets (ITNs) In Africa, ITNs have been shown to reduce all cause mortality by 20%. ITNs will have a public health impact if >80% of the population at risk uses them. Pregnant women and children under five living in malarial areas are the top priority for ITN. Application of insecticide (dipping) greatly enhances the protective efficacy of bed nets. Long lasting nets are distributed in Ethiopia, which is advantageous because they don’t need pretreatment.
Module 7: Malaria and HIV/AIDS10 Malaria Treatment (1) Use laboratory tests to diagnose malaria when possible. The Ethiopian guidelines recommend: Health post level: clinical or clinical + RDT Health center and hospital level: Microscopy Use laboratory tests in HIV-positive people whenever possible HIV/malaria coinfected patients may show different clinical symptoms. Look for and treat anemia.
Module 7: Malaria and HIV/AIDS11 Malaria Treatment (2) Rapid treatment with artemisinin-based combination therapy (ACT). Contraindicated in children <5 kg and pregnant women.
Module 7: Malaria and HIV/AIDS12 Unanswered Questions What is the impact of malaria on MTCT? What are some interactions between antimalarial drugs and ARVs? What is the relationship between pCTX and malaria? Note: Preventive therapy for pregnant women on pCTX not advised by WHO. What is the role of pCTX in preventing peripheral and placental malaria?
Module 7: Malaria and HIV/AIDS13 Key Points Integration of malaria and HIV prevention and treatment activities is crucial. People with HIV/AIDS are more likely to have symptomatic and severe malaria, and anemia. Pregnant women and children with HIV/AIDS are most at risk for malaria. Education on preventive measures and provision of ITNs is part of the HIV care package. The use of ITNs, pCTX, and ART can greatly reduce malaria incidence in people with HIV. Watch for interactions of ACT and ARVs.
Module 7: Malaria and HIV/AIDS14 Module 7 Wrap-Up