Module 1 Background_ Sep 2021.pptx presid

Module 1: Understanding HIV
Epidemic & HTS Model in
South Sudan

Module 1 Contents - HIV Status Slides
1. HIV Epidemic in South Sudan: progress and cascade
2. Review of New HTS Guidelines
3. Overview of HIV/AIDS & Immune system
4. HIV Modes of Transmission & Methods of Risk Reduction

People living with HIV by WHO region (2016)

Background Information
• The firs critical step of the HIV treatment cascade is
access to HIV Testing Services.
• South Sudan HIV epidemic prevalence estimated at
2.7%, meaning >204,062 (~18,000 children) people
are estimated to be living with HIV (South Sudan
2017 SPECTRUM Report).
1st
-90
• At 13% national performance towards the
1st
90, HIV testing remains the biggest
challenge to meeting the 90-90-90 targets,
with over 170,000 PLHIV being unaware of
their status.
• MOH plan is Strategic expansion of High-yield
HIV testing strategies in our health facilities is
critical if we are to match-up to the national HTS
gap at hand

Background: SS’s 90-90-90 Treatment
cascade, 2017
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
>204,062
27,072
(14.7%) 23,000 (14%)
156,583 142,290
NUMBER
(85.3%?
)
(86%?)
90 90 90
UNAIDS, 2016
PLHIV who Know HIV status On ART VL suppression
Estimated PLHIV
183,655 165,290 148,760
?
We have a
long way to
reach the
first 90!!!

HTS Progress over the years (1st
90 Where we are?)
Over the years,
testing has
been
consistently
below the NSP
targets ….. ?
NSP, 2017

•The long way is
much longer for
some sub
populations
(children, men,
adolescents)

HTS volume – Gender
36%
Over the years,
Male Testing has
been consistently
low

HTS volume- Age
Adolescent &
children Testing
has been
consistently even
lower

HTS Status in South Sudan
• By 2016 in South Sudan, its estimated that less than 20% of PLHIV knew
their status.
• To reach the UN 90:90:90 goals, it is critical that HIV testing services be
strategically expanded to diagnose as many people with HIV as early as
possible.
It is critical that HIV testing services be strategically expanded in our
health facilities to be able to diagnose as many people with HIV as
early as possible.

Yield
Concept of yield: proportion of
HIV positive people identified per
100 people tested.
• We have to monitor yield to inform
our intervention
• Evidences show higher yield
among STI, TB, Key populations,
families of clients in care
• Evidences also show varying yield
by different modalities
(PITC>VCT>campaigns)

Yield by Testing Modality- FY17 Q4 Results
13
HomeM
od
Index
[added]
Inpat Malnutrit
ion
[added]
MobileM
od
OtherPI
TC
[added]
Pediatric PMTCT
ANC
TBClinic VCT VCTMod
[added]
VMMC
0
10,000
20,000
30,000
40,000
50,000
60,000
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
45 504 758 48 769 941 76 935 418 3531 259 1
12%
35%
6% 6%
4%
6%
2% 2%
11%
7%
21%
5%
Positive Value Negative Value
PEPFAR/CDC, 2017
Highest yield comes from
PITC: Index (35%), TB
(11%), IPD (6%),
Malnutrition (6%);
VCT: 7%

HTS Opportunities to strengthen
Take home message
• All patients, clients, and their families who come in through the facility
gate….when they go out….should know their HIV status.
• Through scale up / expansion of :
• PITC for all those who walk into and out of the hospitals
• Family Index testing
• Adolescent friendly testing strategy
• Male involvement in testing
• Key population HTS

1. HIV Epidemic in South Sudan: progress and cascade
2. Review of New HTS Guidelines
3. Overview of HIV/AIDS & Immune system
4. HIV Modes of Transmission & Methods of Risk Reduction

2017 National HTS guidelines
HIV Testing Services; emphasizes the need to provide full range of prevention , care and
treatment services together with HIV testing.
These include
• Pre-test information & Post-test counselling
• Linkage to appropriate HIV prevention, care, and treatment services and other clinical
and support services
• Re-testing before ART initiation
• Quality HIV testing - Accurate test results and diagnosis
• Coordination with lab services to support quality assurance
• Scale-up of High yield/impact/Cost-effective/quality interventions:
• PITC
• Family Index testing @ all ART
• Male testing
• Children & Adolescent friendly testing services
1. Re-testing before ART initiation
2. HTS Quality
3. High yield strategies

HTS Guidelines continued
Recommendation 2017 HTS guidelines
Frequency of
testing
To be guided by risk assessment done at every
clinical encounter
3 monthly for high risk groups
For the HIV-negative person in sero-discordant couples,
offer re-testing at least every 6–12 months and more
often if the HIV-positive partner is not on ART or viral
load is not suppressed
At least annually for all sexually active adults and
adolescents as determined by risk profile

HTS Guidelines cont’d
2017 HTS guidelines
HIV Testing
algorithm
Introduction of confirmatory retesting for all patients
who test positive on 2 serial HIV rapid tests before
initiation on ART
Retest to be done by different tester on a different
sample but can be on the same day, in the same location
(Same client, same algorithm, different sample, different tester,
possibly same location and same day)
Pre-Art patients to require retesting before initiation on
ART

Retesting in HIV testing
•Retesting to verify HIV-positive
diagnoses before initiating ART
• MOH recommends that all individuals be retested
to verify their HIV status prior to enrolling in care
and/or starting ART.
• To ensure that individuals are not needlessly
placed on life-long ART (with potential side-
effects, waste of resources, psychological impact
of misdiagnosis),
Retesting
New specimen
A different provider
Same testing
algorithm

HIV Testing Services Pathway
• Following this pathways ensures HCWs to provide quality HIV Testing
Services and link patients to care:

HIV
• A retrovirus that causes AIDS in humans.
• A person with HIV has HIV infection.
• HIV infection leads to a weakened immune
system, making a person with HIV vulnerable to a
group of illnesses called opportunistic infections.
People without HIV are not as easily affected by
these infections.
H Human
I Immunodeficiency
V Virus

What is AIDS
 AIDS: results when HIV infection
damages the immune system to the
point when the body can no longer fight
illness
 AIDS is a syndrome – characterized by a
group of illnesses called opportunistic
infections
 Drugs called antiretroviral (ARs) can treat
HIV and AIDS but there is no cure
A Acquired (not inherited or
genetic)
I Immuno (the body’s defence
against the disease)
D Deficiency (not working to the
proper degree)
S Syndrome
(group of signs and
symptoms of the
disease)

Figure 1: Life cycle of the HIV
HIV attacks many CD4 cells. The infected CD4 cells produce many new copies of the
virus and then die. The new copies of HIV will then attack other CD4 cells which will in
turn produce new copies of HIV and then die. This goes on and on and more and more
CD4 cells are destroyed. The vicious cycle continues.

UNDERSTANDING THE IMMUNE
SYSTEM
• The body has an immune system that defends the body and
keeps it well.
• HIV attacks and kills the "soldiers" in the immune system
(called CD4 cells).
• Without these CD4 cells the body is unable to defend itself
from germs.
• It takes the HIV many years (between 3 and 20) to damage all
the CD4 cells so it takes a long while before they are too few to
defend the body.
• A person can remain well for many years after infection.

Natural History of HIV
Figure 4: The natural history of HIV/AIDS

Figure 5: Natural History of HIV
without Intervention
.

KEY POINTS TO REMEMBER
•HIV is the virus that causes AIDS.
•Not everyone who is infected with HIV has AIDS.
• Everyone with AIDS is infected with HIV because AIDS is the result of the
progression of HIV infection.
• It is important to remember and reinforce to your patients that anyone
infected with HIV can still transmit the virus to another person even if they feel
and appear healthy.

HIV Modes of Transmission
Write down the ways you have heard that HIV is
transmitted

HIV Transmission
HIV transmission or spread occurs in three major ways:
• Sexual contact with an infected partner without protection (92%)
• From mother-to-child and from infected mother to an unborn child (7%)
• Blood contact and other body fluids (1%)
Note: According to the latest Modes of Transmission study in South
Sudan, (MoT, 2013), sex workers, their clients, and peri-natal transmission
(Mother-to-Child Transmission), account for seven out of every ten new
HIV infections.

HIV Transmission cont’d
• Young people, ages 13-24, account for approximately 35% of new HIV
infections.
• Persons aged 25-54 and older accounted for 50%
• Persons aged 55 and older accounted for 15%

Occupational Exposure in health facilities
• HIV transmission is blood borne.
• This means that in a health facility, HIV can be transmitted to a healthcare worker through
accidental needle sticks with needles contaminated with blood from an HIV infected
patient.
• The needle stick accidents often happen while drawing blood from an infected patient or
disposing of contaminated “sharps.”
• Sharps include items such as needles, blades, scalpels.
GOOD NEWS
• The risk of HIV transmission from a needle stick injury is very low at 1 in 300.
• The risk of HIV transmission is even lower after exposure to the eye, nose or mouth to HIV
infected blood at approximately 1 in 1,000.

How HIV is NOT transmitted
HIV is NOT transmitted by:
• Casual person-to-person contact
• Shaking hands
• Hugging
• Touching
• Casually kissing (“closed mouth kiss”)
It is important to note that HIV is NOT transmitted by casual
person-to-person contact such as shaking hands, hugging,
touching or casually kissing (“closed mouth kiss”).

How HIV is NOT transmitted (2)
HIV is NOT transmitted through:
• Toilets
• Swimming pools
• Sharing eating or drinking utensils
• Insect bite (such as mosquitoes)
• Witchcraft
There is NO evidence that HIV can be transmitted through
sharing toilets, swimming pools, sharing eating or drinking
utensils, or insects bite (such as mosquitoes).

Prevention of HIV infection and
transmission
• Abstaining from sex
• Delaying sexual debut
• Use of safer sex methods such as condom use
• Faithfulness to one tested faithful partner
• Avoiding sharing unsterilized cutting utensils
• Prevention of mother to child transmission (PMTCT)
• Screening blood and blood products
• Following standard precautions of infection prevention and
control
• Providing access to HIV testing and counselling

Factors Influencing Transmission of HIV
 Delay in seek ART
 Viral Load
 Type of Sex
 Presence of STIs
 ARV

Other factors that affect the likelihood of HIV transmission. For example:
A: Condition of the person who is HIV infected—Where is he/she in the
‐
disease progression (newly infected or in later stages?). What is his/her viral
load? Is he/she on ART? Does he/she have other STIs? Each of the set things
affects the likelihood that he/she may pass the virus on to his/her partner.
B: Their sexual exposure—how frequently do they have sex? How much
semen/vaginal fluid are they exposed to? Do they use condoms sometimes
or always?
C: Condition of the person who is not HIV infected—how is his/her
‐
health? Is his/her immune system strong? Does he/she have any STIs? Is
he/she well nourished?
‐

SAFETY PRECAUTIONS
Even though transmission of HIV in the healthcare setting is
rare, precaution has to be taken to minimize the risk.
These precautions include:
• Wear latex gloves when performing venepuncture or giving an injection.
• Do not re-cap needles.
• Dispose of “sharps” in puncture-resistant disposal containers. Do not
dispose of contaminated sharps in a kidney dish or other unsecure container.
• Keep containers near point of use, preferably elevated on a table rather than
on the floor.
• Clean spills of blood or fluids with diluted bleach solution (ratio 1:10).

Key points
• HIV is a virus that destroys the body’s defense system
rendering it weak to fight off other diseases.
• HIV transmission, or spread, occurs in three major ways:
• Sexual contact (92%)
• From mother-to-child (7%)
• Blood contact (1%)
• AIDS is a collection of illnesses that take advantage of
the weakened immune system as a result of HIV
infection.

Discussions
Q& A activity
• What can we do more to improve HTS services in our facility/
community

Module 1 Background_ Sep 2021.pptx presid

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