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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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learning objectives
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

background
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

impact of hiv aids on malaria
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

impact of malaria on hiv aids
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

malaria control and prevention strategies in ethiopia
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

uganda study
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

insecticide treated nets itns
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

malaria treatment 1
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

malaria treatment 2
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

unanswered questions
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

key points
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

module 7 wrap up
Module 7 Wrap-Up

Module 7: Malaria and HIV/AIDS