Ranatunga J1, Rajapaksha DI2, Perera ABP2

1Consultant Venereologist, 2 Registrar in Venereology, National STD/AIDS Control Programme

How feasible is it to include HIV screening to the existing Syphilis screening among pregnant women?

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Introduction • Prevention of mother to child transmission (PMTCT)

of HIV infection is a well identified strategy in maintaining the current low prevalence in Sri Lanka.

• National Strategic Plan target is 50% antenatal clinic (ANC) attendees to receive HIV screening by 2017[1]

• Consultative meeting held on 21. 05.2013 decided to scale up the EMTCT of HIV in SL – Colombo, Gampaha, Galle, Hambantota, Kandy – 2013 – Kurunegala, Kalutara, Puttlam – 2014 – All districts by 2016

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Introduction continued…

• In 2011, only 3% of pregnant women were tested for HIV [1] where as 97% were tested for syphilis at the national level[2].

• It has been shown that only 1/2 of registered mothers received this syphilis screening through the MOH ante-natal clinics. [2]

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General Objective

• To understand how feasible it is to include HIV testing to the existing Syphilis screening service done in the antenatal clinics conducted at MOH areas of the district of Gampaha

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Specific Objectives

• To assess the level of syphilis screening coverage among antenatal mothers during the year 2012.

• To ascertain the difficulties faced by the public health staff in carrying out of antenatal syphilis screening

• To describe the knowledge, and attitudes of public health staff on HIV testing among antenatal mothers

• To comprehend the influence of introduction of HIV test to the existing system

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Methodology

• Cross sectional study was carried out among 36 medical officers and 20 public health nursing sisters (PHNS) in the 15 Medical Officer of Health (MOH) areas of the district of Gampaha.

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Data Collection/ Analysis

• Data Collection

–Self administered questionnaire containing both qualitative and quantitative questions.

–Data was extracted from the consolidated H509 form from year 2009 - 2012.

–Structured interview with RDHS/ MO-MCH, Gampaha District

• Analysis was done by SPSS version 19.

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Study Setting – District of Gampaha

• Number of MOH areas – 15 • Mid Year Population (2012) – 2,294,641[3]

• Total No: of AN mothers registered during 2012 - 40473

• Total Number of deliveries during 2012- 33074

• Female literacy rate – 95.1% (2001)

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Study Sample

• All MOH/AMOHs & PHNS in the District of Gampaha – 86

• Responded

– MOH/AMOH – 36

– PHNS -20

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Composition according to the number of years of service in this

category (n=56)

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Results

• VDRL Coverage among AN mother through the Clinics conducted by MOH area in the Gampaha district

– 2009 – 3.35%

– 2010 – 7%

– 2011 – 18.5%

– 2012 – 33%

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Difficulties identified in conducting syphilis screening of AN mothers

(n=56)

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From where do they get the test done? (N=56)

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Time taken, for the report to reach the clinic once blood is taken (n=45)

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Knowledge on Modes of HIV Transmission from mother to child

(n=56)

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Knowledge on Modes of HIV Transmission from mother to child

• 4 (11% ) medical officers and 6

(30%)PHNS were un aware of the MTCT of HIV during the AN period

• 3 (8% ) medical officers and 3 (15%) of PHNS were unaware of the MTCT of HIV via breast feeding

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Best time for HIV testing among ante natal mothers (n=56)

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Is there an issue of confidentiality during conveying the report to

mothers (n=56)

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Who should know the HIV status of a positive mother (n=56)

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Advantages of HIV Testing among antenatal mothers (n=56)

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Effects of Introducing HIV screening for AN mother on existing clinic set

up (n=56)

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Barriers for pre - test counselling for HIV in ANC setting (n=56)

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Summary of constraints for testing

Lack of ◦ Regular supplies of equipment ◦ Transport facilities ◦ Skilled personnel to draw blood

Issues regarding confidentiality Barriers for pre – test counselling ◦ Lack of skills ◦ Lack of staff ◦ Lack of space ◦ Lack of IEC material ◦ Language barriers

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Information obtained from discussion with RDHS & MO-MCH/ Gampaha

• Use of normal syringes and only to double the number of tubes

• Sending the samples through a labourer and an allowance could be paid to him.

• Send a nurse/ nursing sister from the nearest hospital once a month to respective clinics to draw blood.

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Information obtained from discussion with RDHS &MO-MCH/ Gampaha

• Arrange a series of workshops to give them necessary knowledge and skills of introducing the HIV test to the mothers ( opt- out testing) as group counseling.

• The question of uptake of the test by mothers was a concern to both officers.

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Conclusions Almost one third of the syphilis screening of the

pregnant women were carried out by the antenatal clinics conducted in the MOH areas

The major deficiencies identified were

lack of regular supplies of equipment transport facilities skilled personnel to draw blood.

A significant proportion identified HIV testing as a necessity considering the advantages to the babies, mothers and their partners and to the health care staff as well

No body had identified the benefits for health care workers as the only advantage of HIV screening

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How feasible is to test HIV with syphilis screening?

As the VDRL coverage from the government sector is 33%, this will be the coverage for the HIV screening in the beginning

Difficulties of improving the VDRL coverage

at the field level Additional burden on the field staff due to

introduction of the HIV screening Pre-test counselling, records & returns,

confidentiality issues

Taking up of the test by the mothers

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Further improvements for the study

• Carrying out the study in the other districts

• Including the other categories of field staff

• Studying the problems faced by at the receiving end of the samples

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Acknowledgements

• Dr. A.L.A.L. Padmasiri, Regional Director of Health Services, Gampaha

• Dr. Thilak Udayasiri, MO/MCH, Gampaha

• All the public health staff in the Gampaha District who participated in the study

• Dr. A. Karawita, Consultant Venerologist, NSACP

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References

• National STD AIDS Control Programme. National Strategic

Plan: 2013 – 2017. Sri Lanka. NSACP: 2013

• Family Health Bureau [homepage online]. statistics. [cited on 10, August 2013, updaten on 13-09-2013 08:49] Available from:http://www.familyhealth.gov.lk/web/index.php?option=com_content&view=article&id=134&Itemid=74&lang=en

• Department of census and statistics[homepage online]. Population and housing statistics. Available from: http://www.statistics.gov.lk/PopHouSat/CPH2011/index.php?fileName=Activities/TentativelistofPublications

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THANK YOU

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