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MODULE TWO

MODULE TWO. PMTCT information. Learning Objectives. After this module, participants should be able to: Define PMTCT Describe the four prongs/elements of PMTCT Explain the key PMTCT interventions and describe the follow up schedule and services due to the HIV positive mother

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MODULE TWO

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  1. MODULE TWO PMTCT information

  2. Learning Objectives After this module, participants should be able to: Define PMTCT Describe the four prongs/elements of PMTCT Explain the key PMTCT interventions and describe the follow up schedule and services due to the HIV positive mother Describe the use of group education for PMTCT

  3. Learning Objectives cont.. Provide detailed information on PMTCT in the Antenatal, delivery and postnatal period Explain infection prevention and universal precautions during labor and delivery. Explain linkages to other treatment, care and support services for the mother, baby and family Describe the follow up schedule for the HIV exposed baby and details of services due Explain the identification of the child with suspected symptomatic HIV infection

  4. DEFINITION OF PMTCT P-prevention of M-mother T-to C-child T-transmission of HIV

  5. PMTCT in Zambia About 16% of all women in the reproductive age have HIV The prevalence in pregnant women is about 16.4% The risk of transmission from an HIV infected mother to her child in Zambia is around 40 %

  6. Preventing Mother to Child Transmission (PMTCT) PMTCT is part of a comprehensive approach that consists of 4 elements: Element 1:Primary prevention of HIV infection in women Element 2: Prevention of unintended pregnancies among women infected with HIV Element 3: Prevention of HIV transmission from HIV infected mothers to their infants Element 4: Provision of treatment, care and support to women infected with HIV, their infants and their families

  7. Modes of MTCT During pregnancy During labour and delivery During breastfeeding

  8. Transmission risk can be reduced by at least 50% through feasible, affordable interventions: HIV Rapid testing and counselling Antiretroviral treatment Safer delivery practices Safer infant-feeding practices The most important Interventions for PMTCT (core)

  9. Motivational Talk KEY PMTCT MESSAGES birth preparedness and complication readiness danger signs HIV And pregnancy malaria in pregnancy nutrition in pregnancy Detection and treatment of STIs

  10. Antenatal visits When a pregnant woman has no complications, they have to make four visits to the ANC and it is during this visits that the appropriate care is provided including health education. All pregnant women are encouraged to attend the first antenatal visit by 14 weeks or soon after.

  11. First visit – 14weeks or soon after Health Education History taking Taking of vital signs Lab investigations including HIV test, RPR, HB, urinalysis, CD4 count to determine ART or ARV prophylaxis eligibility. Physical exam

  12. First visit – 14weeks or soon after • Counselling on ARVs • Cotrimoxazole prophylaxis to prevent OIs • IPT • Counseling on IYCF. • Check and support disclosure. • Encourage couple counselling. • ITNs • Deworming • TT • Iron and folic acid supplementation

  13. 2nd , 3rd and 4th Visits Has the woman prepared a birth plan Has she received the preventive medications including ARVs Is she experiencing any side effects from the drugs Check adherence to ARVs and remind to take SD-NVP 200mg at onset of labour.

  14. 2nd , 3rd and 4th Visits • Reminder about rest, danger signs and taking of medications • Have the routine and repeat tests like HB been done ? • Discussions on infantfeeding options (breast feeding and replacement feeding) • Check and support disclosure.

  15. Birth Preparedness / Complication Readiness Expected date of delivery Danger signs in pregnancy Danger signs for her newborn baby

  16. Making a birth plan When will the baby be born Place of labour and delivery, emphasize the importance of delivering in a health facility Attendant for delivery Items needed for a clean and safe birth and for the newborn

  17. Making a birth plan • Transportation in case of hospital transfer • Money for transport and delivery. • Postpartum family planning goals

  18. Danger signs during pregnancy • bleeding from private parts • severe headache • swelling of the feet and hands • body hotness or feeling cold • severe stomach pains • baby not moving or moving less • discharge or sores on the private parts • very tired, tires easily or is very pale

  19. Danger signs during childbirth labour lasting more than twelve hours heavy bleeding from the private part when the cord, hand comes before the baby severe headache placenta not delivered within 30 minutes after the baby is

  20. After delivery She may have : severe headache body hotness or feeling cold severe increasing stomach pain or pain in the private parts, heavy bleeding breast sores, cracked nipples, redness or swelling of breasts bad smelling discharge from private parts

  21. Danger signs for the baby The baby may have: breathing difficulties, or not breathing chills, fever, fits, rash yellowness of the skin or eyes poor suckling or feeding difficulties, or vomiting not active diarrhea or constipation, red swollen eyes redness, pus, or blood from the umbilical stump

  22. HIV and Pregnancy What is HIV/AIDS? HIV (Human Immuno-deficiency Virus) is the germ that causes AIDS. AIDS (Acquired Immune Deficiency Syndrome) is the disease that is caused by the HIV virus.

  23. How is HIV transmitted from the mother to the child? HIV is transmitted from the mother to the child: During pregnancy in the womb During labour and delivery when the blood or fluids from the infected mother mixes with the baby's blood During breast feeding through breast milk from an infected mother

  24. For all women, advise them to: always use a condom every time they have sex to protect themselves from infection, re-infection and from infecting others Encourage HIV retesting after 3 months for women who test HIV negative get early treatment for any STIs prepare a detailed birth plan (refer to card on birth plan)

  25. For all women, advise them to: encourage women to join mother support groups encourage women to eat a mixed diet for them to get all the necessary nutrients talk to them and their partners about family planning for the future

  26. For HIV positive women, advise them to: always use a condom every time they have sex to protect themselves from re-infection and from infecting others take antiretroviral drugs (when prescribed) to reduce chances of transmission during pregnancy, delivery and breastfeeding review the woman's choice of feeding options and support her to practice it correctly and consistently

  27. For HIV positive women, advise them to: If a woman decides to breast feed her baby, advise her to exclusively breast feed for 6 months without giving any other fluid. Consider transitioning to replacement feeding at 6 months If she decides to give replacement feeds, advise her to give replacement feeds exclusively for 6 months and then introduce complimentary feeding. Never breastfeed and give formula milk at the same time.

  28. For HIV negative and unknown status women Counsel them on exclusive breast feeding for six months Advise them to use a condom consistently and correctly every time to avoid getting infected during pregnancy Encourage the pregnant woman to know her status and advise them to repeat the test after three months if they have had sex without using a condom recently.

  29. Follow-up Schedule for the HIV Positive Mother Receive all three (3) doses of Fansidar starting from 16 weeks and repeated every after 4 weeks. As much as possible, all HIV positive mothers must have a CD4 count done as soon as they are known to be HIV positive, and this must be repeated after 6 months. All HIV positive mothers must be given AZT/NVP at the first contact preferably from 14 weeks

  30. Follow-up Schedule for the HIV Positive Mother • All HIV positive mothers must be started on Septrin for prevention of opportunistic infections regardless of CD4. • Mothers must visit the clinic monthly to collect the AZT and Septrin tablets for prevention of OIs • At the onset of labor the woman will need to take the tablet of NVP as well as Zidovudine (AZT) combined with Lamivudine(3TC)throughout labor.

  31. Follow-up Schedule for the HIV Positive Mother/baby After delivery the woman continues with Zidovudine (AZT) combined with Lamivudine (3TC) for one week. Extended NVP therapy to all exposed infants i.Breastfeeding infants:NVP at birth and daily until one week after all exposure to breast milk.

  32. Follow-up Schedule for the HIV Positive Mother/baby • ii Non breastfeeding infant and those whose mothers are on HAART: NVP at birth and for 6 weeks. • ii. To all exposed infants: start co-trimoxazole from 6 weeks until HIV status confirmed negative.

  33. Malaria in pregnancy What is malaria? Malaria is a common disease which spreads from person to person through a mosquito bite. Malaria affects people of all ages, but is more dangerous to pregnant women and children under five years.

  34. Why is malaria in pregnancy dangerous? Malaria parasites hide in the placenta of the pregnant mother even though the mother maybe without symptoms. Immunity of a pregnant woman is lower than other adults.

  35. Why is malaria in pregnancy dangerous? Pregnant women who look and feel well may have malaria without knowing that they have it. Malaria parasites in the placenta may lead to death of the baby before it is born or born small for-date. HIV positive pregnant women are more likely to pass HIV to their unborn child if they have malaria while they are pregnant.

  36. How can malaria in pregnancy be prevented Insecticide Treated nets Clear house area of stagnant water Cover arms and legs in evening Take prophylaxis/treatment (IPT) Three doses of Fansidar are given and this has been found to be safe for both mother and baby.

  37. Schedule for Intermittent Preventive Therapy (IPT) Sulphadoxine pyramethamine (Fansidar) 3 tablets taken at once as directly observed therapy 3 times during the second and third trimester of pregnancy 1st 2nd 3rd • 16 weeks of gestation • At least one month after the 1st dose • At least one month after the 2nd dose

  38. Symptomatic Malaria Any pregnant woman who has symptoms of malaria should go to the health facility promptly to be tested and treated even if she was recently given Fansidar. The symptoms of malaria are very dangerous in pregnant women, and can lead to the death of the baby and/or the mother.

  39. Nutrition during pregnancy Eat at least one extra serving of staple food per day during pregnancy and the equivalent of an extra meal per day during lactation. Gain at least one kilogram per month during the second and third trimesters. Rest more during pregnancy and lactation.

  40. Nutrition during pregnancy What foods does a pregnant woman need to eat? A pregnant woman needs to mix the kind of foods she eats so as to get a good variety. Where possible a pregnant woman needs to get at least one food from each category in order for her to get the right mix, and bearing in mind adequate intake.

  41. Nutrition during pregnancy What foods does a pregnant woman need to eat? Energy giving Body building foods Protective Fats and Oils She needs to avoid too much strong tea or coffee and alcohol.

  42. Micronutrients Iron-needed for blood and prevents as well as treats anaemia Folate-Helps in blood formation and prevents as well as treats anaemia Iodine- found in fortified salt For normal physical and mental development of the body Vit. A- found in fortified sugar.

  43. Activity and exercise during pregnancy Pregnant women should: Avoid physical work such as digging or weeding for long periods, lifting and carrying heavy loads, and walking for many hours. Rest as she feels she needs both during the day and at night. As the baby gets bigger inside, the woman needs even more rest.

  44. Activity and exercise during pregnancy Exercise. Walking for short distances, mild exercises and remaining active through pregnancy can help keep the muscles strong, improve digestion and help pregnant women sleep better. However, a pregnant woman should avoid those sports and activities that could cause her to fall or injure herself and the baby.

  45. Activity and exercise during pregnancy Take care when traveling. If a pregnant woman must travel she should be comfortable, stop, stretch her legs and empty her bladder frequently. Wear comfortable clothing. Pregnant women should wear loose clothing and shoes that are comfortable. Sexual activity. A couple can continue to have intercourse during the woman's pregnancy as long as there is no bleeding and the woman feels comfortable

  46. Child birth The birthing process can be painful and cause the woman anxiety and fear. Labour can be tolerated best when the woman is knowledgeable, confident and when she has support and encouragement from someone close to her.

  47. What is labour? Labour is a process by which anytime after the 28th week of pregnancy the uterus prepares to deliver the baby and the placenta. Labour between 28-36 weeks is considered premature but after 37 weeks and beyond is full term labour.

  48. What are the signs of labour? Signs may not occur in any particular order, and some women may only see one. The following three signs indicate that labour is starting: Regular and progressive contractions of the uterus A discharge mixed with blood and mucus, known as show may come out A gush of water from the vagina – indicating that the bag that carries the baby has broken.

  49. How to deal with labour Explain to the woman what the process is – Encourage the woman to ask questions and answer her questions. Advise the woman to stay calm and relaxed Advise the family to designate a support person -. Explain to the woman the various positions – A woman should be advised to drink or eat if she feels like it; this will help keep her energy up and prevent her from becoming dehydrated.

  50. Principles of a clean and safe delivery Clean environment Clean hands Clean delivery surface Clean perineum Clean cord cutting. Clean wrapper for the baby and mother

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