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Module 7: Malaria and HIV/AIDS

Palliative Care for People Living with HIV/AIDS. Module 7: Malaria and HIV/AIDS. Learning Objectives. Describe the interactions between malaria and HIV. Discuss strategies for preventing malaria as part of the palliative care package.

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Module 7: Malaria and HIV/AIDS

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  1. Palliative Care for People Living with HIV/AIDS Module 7:Malaria and HIV/AIDS

  2. 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/AIDS

  3. 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. Module 7: Malaria and HIV/AIDS Source: UNICEF; FMOH, 2004; FMOH, 2006; UNAIDS, 2007

  4. 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/AIDS

  5. 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 Module 7: Malaria and HIV/AIDS Sources: Kublin, et al, 2005; Whitworth, et al, 2005

  6. Module 7: Malaria and HIV/AIDS

  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/AIDS

  8. Uganda Study • Combination of: • pCTX • ART • Treated nets • Associated with a 95% reduction in the incidence of symptomatic malaria among people with HIV/AIDS. Module 7: Malaria and HIV/AIDS Source: Mermin, et al, 2006

  9. 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/AIDS

  10. 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/AIDS

  11. Malaria Treatment (2) • Rapid treatment with artemisinin-based combination therapy (ACT). • Contraindicated in children <5 kg and pregnant women. Module 7: Malaria and HIV/AIDS

  12. 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/AIDS

  13. 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/AIDS

  14. Module 7 Wrap-Up Module 7: Malaria and HIV/AIDS

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