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Module 2

Module 2. Overview of HIV Prevention in Mothers, Infants and Young Children. Module Objectives. Provide an overview of mother-to-child transmission of HIV (MTCT) Identify factors that increase the risk of MTCT

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Module 2

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  1. Module 2 Overview of HIV Prevention in Mothers, Infants and Young Children

  2. Module Objectives • Provide an overview of mother-to-child transmission of HIV (MTCT) • Identify factors that increase the risk of MTCT • Describe the four elements of a comprehensive approach to prevention of HIV infection in infants and young children PMTCT Generic Training Package Module 2, Slide 2

  3. Module Objectives (Continued) • Provide examples of each of the four elements • Describe the role of maternal and child health (MCH) services in the prevention of HIV infection in infants and young children PMTCT Generic Training Package Module 2, Slide 3

  4. Session 1 Introduction to Mother-to-Child Transmission of HIV PMTCT Generic Training Package Module 2, Slide 4

  5. Session 1 Objectives • Provide an overview of mother-to-child transmission of HIV (MTCT) • Identify factors that increase the risk of MTCT PMTCT Generic Training Package Module 2, Slide 5

  6. MTCT • Mother-to-child transmission of HIV (MTCT) is the transmission of HIV from an infected mother to her baby during pregnancy, labour and delivery and breastfeeding • Also known as “vertical transmission” or “perinatal transmission” • Most children with HIV acquired the virus through MTCT PMTCT Generic Training Package Module 2, Slide 6

  7. PMTCT • PMTCT: common term for programmes, services and interventions whose goal is to reduce the risk of MTCT PMTCT Generic Training Package Module 2, Slide 7

  8. PMTCT (Continued) • PMTCT services include: • HIV testing and counselling during ANC, labour and delivery and postpartum • Provision of ARV drugs to mother and infant • Safer delivery practices • Infant feeding information, counselling and support • Referrals to comprehensive treatment, care and social support for mothers and families with HIV infection PMTCT Generic Training Package Module 2, Slide 8

  9. Universal Access • The idea that everyone has a right to the prevention, care, support and treatment related to HIV and AIDS PMTCT Generic Training Package Module 2, Slide 9

  10. Access to PMTCT UNICEF PMTCT Report Card 2005 Findings: In 2005, only 11% of women in 58 countries surveyed received PMTCT counselling and less than 10% were tested for HIV In 2006, less than 10% of pregnant women who tested HIV-positive worldwide received ARV drugs for PMTCT PMTCT Generic Training Package Module 2, Slide 10

  11. Weak healthcare systems, inadequate ANC Limited access to pre-test counselling Lack of effective coordination to oversee implementation Inadequate community engagement Stigma and discrimination Lack of awareness that HIV can be passed from mother-to-child Inadequate access to ARV therapy or prophylaxis Barriers to Universal Access to PMTCT PMTCT Generic Training Package Module 2, Slide 11

  12. Scale-up of PMTCT • Scale-up of PMTCT services is essential • To avoid new infections among children • As part of the strategy to realize the vision of an HIV-free and AIDS-free generation PMTCT Generic Training Package Module 2, Slide 12

  13. Exercise 2.1 Local HIV Terminology: Discussion PMTCT Generic Training Package Module 2, Slide 13

  14. MTCT: Overview • The term “MTCT” attaches no blame or stigma to a woman who gives birth to a child who is HIV-infected • Does not suggest deliberate transmission by mother, who is often unaware of her own infection status and unfamiliar with how HIV is passed from mother-to-child PMTCT Generic Training Package Module 2, Slide 14

  15. MTCT: Overview (Continued) • The term should not hide this fact: eitherthe woman or her sexual partner may introduce HIV into a family—and both of them share responsibility for preventing transmission to the infant PMTCT Generic Training Package Module 2, Slide 15

  16. MTCT Overview (Continued) • MTCT can occur during • Pregnancy • Labour and delivery • Breastfeeding Without intervention, the overall MTCT rate is 20-45% PMTCT Generic Training Package Module 2, Slide 16

  17. MTCT Overview (Continued) • Risk of transmission during breastfeeding depends on: • Use of safer breastfeeding practices (e.g., avoidance of mixed feeding) • Duration of breastfeeding PMTCT Generic Training Package Module 2, Slide 17

  18. MTCT Overview (Continued) • With breastfeeding to six months overall transmission rate is 20-35% • With breastfeeding to 18-24 months overall transmission rate increases to 30-45% PMTCT Generic Training Package Module 2, Slide 18

  19. HIV-Exposed Infant Outcomes 100 infants born to HIV-infected women who breastfeed, without any interventions 55–80 infants will not be HIV-infected 10-15 infants infected during labour and delivery 5-10 infants infected during pregnancy 5-20 infants infected during breast-feeding 20-45 infants will be HIV-infected PMTCT Generic Training Package Module 2, Slide 19

  20. Reducing MTCT • In industrialized countries the rate of MTCT has been reduced to 2% MTCT can be reduced by 40-70% through core PMTCT interventions PMTCT Generic Training Package Module 2, Slide 20

  21. Transmission Risk Factors What are the risk factors for MTCT? PMTCT Generic Training Package Module 2, Slide 21

  22. Transmission Risk Factors • Risk of transmission to infant is highest when mother’s viral load is high, e.g. in: • Recent HIV infection • Advanced AIDS The most important risk factor for MTCT is the amount of HIV in the mother's blood. This is known as the viral load PMTCT Generic Training Package Module 2, Slide 22

  23. Transmission Risk Factors (Continued) During Pregnancy: • High maternal viral load (new infection or advanced AIDS) • Viral, bacterial, or parasitic placental infections, such as malaria • Sexually transmitted infections (STIs) PMTCT Generic Training Package Module 2, Slide 23

  24. Transmission Risk Factors (Continued) During Labour and Delivery: • High maternal viral load (new infection or advanced AIDS) • Rupture of membranes for more than 4 hours • Invasive delivery procedures that increase contact with mother's infected blood or body fluid • Chorioamnionitis • Preterm delivery • Low birthweight PMTCT Generic Training Package Module 2, Slide 24

  25. Transmission Risk Factors (Continued) During Breastfeeding: • High maternal viral load (new infection or advanced AIDS) • Duration of breastfeeding • Mixed feeding (giving water, other liquids, or solid foods in addition to breastfeeding) • Breast abscesses, nipple fissures, mastitis • Oral disease in the baby (e.g. thrush or sores) PMTCT Generic Training Package Module 2, Slide 25

  26. HIV and Pregnancy Effect of pregnancy on HIV infection: • Pregnancy suppresses immune function in both HIV-infected and non-infected women • Studies have shown that pregnancy does not seem to have an effect on progression of HIV disease PMTCT Generic Training Package Module 2, Slide 26

  27. Effect of HIV on Pregnancy • More complications, including increased risk of: • Spontaneous abortions and still birth • Stillbirth • Pre-term deliveries • Low birth weight infants • Bacterial pneumonia, UTI and other illnesses • Postnatal infections • It is critical that pregnant women with HIV get the best possible ANC and postpartum care PMTCT Generic Training Package Module 2, Slide 27

  28. Session 2 Comprehensive Approach to Prevention of HIV Infection in Infants and Young Children PMTCT Generic Training Package Module 2, Slide 28

  29. Session 2 Objectives • Describe the four elements of a comprehensive approach to prevention of HIV infection in infants and young children • Provide examples of each of the four elements PMTCT Generic Training Package Module 2, Slide 29

  30. Comprehensive Approach to Preventing HIV Infection in Infants and Young Children • To significantly reduce MTCT and achieve targets, PMTCT must be viewed as a comprehensive public health approach • Focus is on: • Women with HIV and their partners, children and families • Parents-to-be whose HIV status is unknown or who have tested HIV-negative PMTCT Generic Training Package Module 2, Slide 30

  31. Four Elements of a Comprehensive Approach PMTCT Generic Training Package Module 2, Slide 31

  32. Elements 1 and 2 • Elements 1 and 2 are the most effective ways to prevent MTCT • Element 1: Prevention of HIV infection in all women and men. • Also called “primary prevention” • Element 2: Prevention of unintended pregnancy among women infected with HIV PMTCT Generic Training Package Module 2, Slide 32

  33. Elements 1 and 2 (Continued) Elements 1 and 2 are beneficial to women and can decrease the percentage of infants who become infected with HIV by 35% to 45% in many countries See Appendix 2-A PMTCT Generic Training Package Module 2, Slide 33

  34. Element 1:Primary Prevention of HIV • Primary prevention: most effective way of controlling the spread of HIV • Must continue to be a major part of every comprehensive country response to HIV PMTCT Generic Training Package Module 2, Slide 34

  35. Element 1:Primary Prevention of HIV (Continued) • “ABC”: an HIV primary prevention strategy • A =Abstain • B =Be faithful to one partner • also called “mutual faithfulness” or “mutual monogamy” • C = Use condoms correctly and consistently (every time) PMTCT Generic Training Package Module 2, Slide 35

  36. Primary Prevention: Issues for Women • Especially for young women, successful implementation of the “ABCs” may require support • Factors contributing to women’s vulnerability to HIV include poverty, culturally defined roles, lack of information, abuse, violence, coercion by men and the inability to negotiate safer sex • HCWs can help women address these challenges through education, support and community linkages PMTCT Generic Training Package Module 2, Slide 36

  37. Mutual Faithfulness • Mutual faithfulness is effective when: • Both partners are HIV-negative and have no other risk of HIV infection • Both partners are HIV-positive • If one is HIV-positive and the other HIV-negative then mutual faithfulness must be combined with condom use to be effective PMTCT Generic Training Package Module 2, Slide 37

  38. Condom Access • Male and female condoms, when used correctly and consistently, can help prevent: • HIV transmission • STIs • Unintended pregnancy • PMTCT programmes should make male and female condoms available PMTCT Generic Training Package Module 2, Slide 38

  39. Condom Access: HCW’s Role • HCWs should: • Provide clients with information on how to use condoms • Support client who is negotiating with partner for safer sex • Promote joint responsibility for preventing the transmission of HIV PMTCT Generic Training Package Module 2, Slide 39

  40. STIs: Prevention & Early Treatment • STIs affect HIV and vice versa • Having other STIs increases the risk of HIV infection • HIV infection tends to make an STI more severe and less responsive to conventional treatment PMTCT Generic Training Package Module 2, Slide 40

  41. STIs: Prevention & Early Treatment (Continued) • Early diagnosis and treatment of STIs: Can reduce incidence of HIV in general population by about 40% STI treatment services present an opportunity to provide information on HIV infection & MTCT and to refer for testing and counselling PMTCT Generic Training Package Module 2, Slide 41

  42. HIV Testing and Counselling • HIV screening or diagnostic HIV testing and counselling should be: • Routinely offered to clients attending in-patient and community-based services, e.g.: Hospital, ANC, family planning, STI and post-delivery settings • Widely available and, where necessary, re-oriented to meet young people’s needs PMTCT Generic Training Package Module 2, Slide 42

  43. Counselling for HIV-Negatives • Can be a powerful tool to: • Encourage adoption of safer sex practices • Encourage partner HIV testing • Discuss family planning • Provides patients the opportunity to learn how to protect themselves and their infants from HIV infection PMTCT Generic Training Package Module 2, Slide 43

  44. Male Circumcision • WHO and UNAIDS recommend male circumcision be available in countries highly affected by HIV • Recent studies show that male circumcision reduces risk of heterosexually acquired HIV infection in men by ~60% • Should be performed by trained providers only in sanitary settings with adequate equipment and counselling PMTCT Generic Training Package Module 2, Slide 44

  45. Male Circumcision (Continued) • Counselling of men and partners necessary to prevent: • developing false sense of safety • engaging in high-risk behaviours (could undermine partial protection provided by male circumcision) • Male circumcision does not provide complete protection against HIV: circumcised men must continue to use other forms of protection from HIV, such as condoms PMTCT Generic Training Package Module 2, Slide 45

  46. Blood-to-Blood Transfusion • Screen all blood and blood products for HIV according to national guidelines • Follow Standard Precautions (including Universal Precautions) in the clinic setting PMTCT Generic Training Package Module 2, Slide 46

  47. Exercise 2.2 HIV and STI handshake: group game PMTCT Generic Training Package Module 2, Slide 47

  48. Element 2: Preventing Unintended Pregnancies • Family planning saves lives and enhances the health status of women and their families • The cost of infection and child deaths averted through family planning is substantially less than the cost of child death averted through the 3rd and 4th elements • Family planning provides intrinsic benefits by helping women avoid unintended pregnancy and, in effect, saving lives and enhancing the health status of women and their families PMTCT Generic Training Package Module 2, Slide 48

  49. Element 2: Preventing Unintended Pregnancies (Continued) • Unintended pregnancies are avoidable • Family planning counselling helps women and/or couples to: • Prevent unintended pregnancies • Discuss condoms and condom use: dual protection against unintended pregnancy and STIs • Get emergency contraceptive services • Get referrals to providers of care, treatment and support PMTCT Generic Training Package Module 2, Slide 49

  50. Effective Family Planning • Prevents unintended pregnancies • Spaces births • Helps women who are HIV-infected protect their own health while taking care of their families PMTCT Generic Training Package Module 2, Slide 50

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