3. 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
5. 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
6. 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
7. 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”
8. 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
9. 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.
10. Test and Treat – Community
Involvement
• Discussion with
Chief Macha
12. Workshop with Headmen
To have every
person
present at this
workshop be
tested and
reveal their
status to the
group.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22. Community HIV Testing
• 3500 people in 5 months
• During those same months those
tested at the hospital increased
from 500/month to 1000/month
23. 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
24.
25. Macha: Outcome of PMTCT
efforts
Portion of HIV+ Mothers on PMTCT at time of delivery:
by Type
