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Improvements of sexual and reproductive healthcare needs of women with HIV

in primary care settingW Wan Ismail, Family Medicine Specialist, Mahmoodiah Health Clinic, Johor Bahru, Malaysia.

A Abdullah, Medical Officer, Sultan Ismail Hospital, Johor Bahru, Malaysia.

INTRODUCTION

More than 20 years since the first HIV case in 1986, Malaysia is today classified by the World Health Organisation as having a concentrated HIV epidemic. Malaysia’s epidemic was fuelled initially by the sharing of injecting drug equipment. However, it is increasingly experiencing a third of new infections being transmitted sexually. As of December 2010, 91,362 HIV cases have been reported through the national HIV surveillance system. 18.3% women and girls and 40.3% through heterosexual transmission (UNIAID 2010). Mahmoodiah Health Clinic is situated in the District of Johor Bahru, the southern part of peninsular Malaysia which borders Singapore. The total daily attendance was approximately 1000 patients a day. A total number of 98 HIV patients receiving care and treatment from this clinic in which 16 were women.Women with HIV may face difficulties to achieve optimal care due to their lack of access to and control over resources, family and child care responsibilities, restricted mobility and limited decision making power. Care of women with HIV in community clinic have greatly improved access to services related to HIV infection and as a platform to address sexual and reproductive health issues.

METHODS

Statistical methodsThe data were analysed using SPSS PC statistical package version 17. Descriptive statistics were used to evaluate demographic data and guidelines adherence. Paired t-tests were used to compare the means of HIV status at initial and current visit to the health centre. Bivariate logistic regression model were used to identify factors that improve sexual and reproductive health in women with HIV attending the primary healthcare clinic. A p value of <0.05 will be taken to indicate statistical significance.

RESULTS

Patient’s characteristics:16 case notes of women with HIV attending Mahmoodiah Health Centre between 1st January 2011 and 31st December 2011 were reviewed and analysed (Table 1). The mean age of patients was 33.5 years (age range between 21-52 years) with the mean time since HIV diagnosis and follow-up was 30.5 months (range between 3-68 months). All the patients were infected through heterosexual transmission.

Table 1: Characteristics of patient

CONCLUSIONS

REFERENCES

From the analysis, it was found that most women with HIV attending the health clinic received HAART treatment according to the consensus guideline in place at the time of auditing. Initiatives to improve care of HIV women in the community is greatly needed to ensure that the patient get comprehensive and holistic care. Health care providers need to address issues such as prevention of transmission of HIV, especially condom use, contraceptive use to prevent pregnancy, sexual health issue especially in women who abstain after the diagnosis and also to explore mental health issue in these women.HIV treatment in primary health care clinic can improve access to sexual and reproductive healthcare provided that healthcare providers were given appropriate training and support.

OPTIONALLOGO HERE

OPTIONALLOGO HERE

1.UNIAID 2010. AIDS Epidemic Update. http://www.unicef.org/malaysia/UNICEF-Global_Malaysia_AIDS_Statistics_Overview_2010.pdf (Accessed 20th April 2012)2. Recommended standards for NHS HIV services 2003. Published by Medical Foundation for AIDS & Sexual Health. BMA House. London.3. H Curtis, CA Sabin, MA Johnson 2003. Findings from the first national clinical audit of treatment for people with HIV. HIV Medicine; 4:11-17.4. S Lambert, A Keegan, J Petrak 2005. Sex and relationships for HIV positive women since HAART: a quantitative study. Sexually Transmitted Infection Journal; 81:333-337

OBJECTIVES

The case notes of women with HIV infections attending the HIV clinic at Mahmoodiah Health Clinic in the year 2011 were reviewed and audited. Assessment criteria include adherence to consensus guideline, screening of Sexually Transmitted Infections, sexual behaviour, intervention to reduce the risks of transmission, and choice of contraceptive methods.

n %Number of patients

16 100

Race

Malay 6 37.5 Chinese 1 6.2

Indians 6 37.5

Others 3 18.7Marital Status

Single 3 18.8 Married 7 43.8

Divorced

5 31.2

Unknown 1 6.2

How HIV was diagnosed?voluntary screening 3 18.8

work permit screening

4 25.0

premarital screening

1 6.2

ANC screening 3 18.8

TB screening 2 12.5

contact tracing 3 18.8

Sexual behaviour and contraceptive use

All the patients were infected through heterosexual transmission. After the diagnosis of HIV 87.5% were still sexually active while 37.5% abstained from having sex (Table 3). The main reasons of abstinence were avoidance (62.4%) and relationship problems after the diagnosis (37.6%). Only 4 patients (25%) were using condom. The main reasons of not using condom were having partners who is also HIV positive, partner refusal and plan to become pregnant.62.6% of patient practice contraceptive method which include abstinence (37.5%), condom (18.8) and tubal ligation (6.3%).

Univariate logistic regression analysis done on factors that improve immunological status of women with HIV, were those on HAART (95% Confidence interval [0.919-5.92], p=0.056) and sexually active women (95% Confidence interval [0.169-1.089], p=0.056).

Clinical management: All the patients were screened for syphilis, gonorrhoea, hepatitis B, hepatitis c, toxoplasmosis and pulmonary tuberculosis. 12.5% were diagnosed to have STIs and were treated accordingly.Only 31% of the patient undergone cervical cytology /pap smear testing in the health centre. 25% of the patients had opportunistic infection such as herpes zoster, candidiasis tuberculosis and folliculitis. Immunological Status:Table 2 showed that there was a significant correlation between mean CD4 count at initial and current visit (p<0.05). It showed improvement of mean CD4 count for women with HIV attending the health clinic. Table 2: Immunological status of the patients

Mean CD4 count CD4 Range

Initial 373.6 48-1009

Current 418 139-713

At the start of HAART

105.3 48-173

Table 3: Sexual behaviour and contraceptive use of the patients.

n %SEXUALLY

ACTIVE Yes 8 50 No 8 50

USE OF CONDOM Yes 4 25.0 No 12 75.0

CONTRACEPTIVE USE

Yes 10 62.5 No 6 37.5

TYPE OF CONTRACEPTIVE Abstain 6 37.5 Condom 3 18.8 Tubal ligation 1 6.3

Nil 6 37.5

The objectives of this paper are:

1. To determine adherence to Clinical Practice Guideline in clinical management of women with HIV in a primary healthcare clinic.2. To assess improvement of HIV status in women with HIV attending a primary healthcare clinic.3. To determine factors that improved sexual and reproductive health in women with HIV attending a primary healthcare clinic.