Community Response to

HIV/AIDS Efforts

Community Outreach

• 70s and 80s increasing emphasis on immunization programs for children and pregnant women

Full-time public health nurse went to 20-25 locations

• 90s malaria research

Antiretroviral Therapy (ART)

Clinic opened March 2005

ARVs (Antiretrovirals)

• The drugs that actually treat the AIDS virus

• Must be taken once or twice daily for the rest of the patient’s life

• If taken 95% correctly, after 3-6 months the virus cannot be found in the patient’s blood

With ARV Treatment

• CD4 count returns towards normal

• People can live a normal life again

• Instead of a funeral every week we now attend a funeral every month or two and most are not HIV related.

• Instead of 7-8 staff deaths per year there have been only five staff deaths in eight years

Test and Treat

• Article in the Lancet (British Medical Journal) December 2008

“Universal Voluntary HIV Testing with Immediate Antiretroviral Therapy as a Strategy for Elimination of HIV Transmission: a Mathematical Model”

Test and Treat

• If 100% of the people in a community can be tested for HIV once a year

• and EVERYONE who tests positive is put on ARVs immediately, rather than waiting until their CD4 lymphocyte cell counts drops

• in 10 years we can lower the number of new cases by 95% and essentially eliminate the disease in 30 – 40 years

Test and Treat

• Doctors from Erasmus University in Holland and University of MD and Johns Hopkins encouraged us to implement this as a pilot project at Macha – since it had actually never been done

• The reason they thought we should do it at Macha is the success with the malaria program, which is based on similar principles of treating people in the community who have the disease but are not yet sick.

Test and Treat – Community

Involvement

• Discussion with

Chief Macha

Test and Treat – Community

Involvement

Workshop with Headmen

To have every person present at this workshop be tested and reveal their status to the group.

Community HIV Testing

• 3500 people in 5 months

• During those same months those tested at the hospital increased from 500/month to 1000/month

Prevention of Mother to Child

Transmission of HIV• Transmission of HIV from mother to child

can be prevented by ARVs

• Almost all women get tested

• 40% of HIV+ women did not come for ARVs

• Importance of male Involvement

• Men only came after we did what the community told us to do

• Now 85% of pregnant women are accompanied by their partner

Macha: Outcome of PMTCT

efforts

Portion of HIV+ Mothers on PMTCT at time of delivery:

by Type

Macha: Outcome of PMTCT

efforts