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HIV Prevention in Mothers and Infants

HIV Prevention in Mothers and Infants. DR KANUPRIYA CHATURVEDI. Objectives of the lesson. Upon completion of this lesson , the participant will be able to: describe the comprehensive approach to prevention of HIV infection in infants and young children

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HIV Prevention in Mothers and Infants

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  1. HIV Preventionin Mothers and Infants DR KANUPRIYA CHATURVEDI

  2. Objectives of the lesson • Upon completion of this lesson , the participant will be able to: • describe the comprehensive approach to prevention of HIV infection in infants and young children • discuss mother-to-child transmission (MTCT) of HIV infection • describe the four-pronged comprehensive approach to the prevention of parent-to-child transmission (PPTCT) of HIV • describe the role of maternal and child health (MCH) services in the PPTCT of HIV

  3. 100 # uninfected 90 80 70 # infected during 63 BF for 2 yrs 60 uninfected 50 # infected during 40 delivery 15 30 #infants infected 20 15 during 10 7 pregnancy 0 MTCT in 100 HIV+ Mothers The majority of children do not get infected even when we do nothing

  4. Children Infected 2 3 5 5 30 infected 15 Children at Risk 98 80 75 70 uninfected 95 100 Early antenatal Late postpartum Late antenatal Early postpartum 36 wks 6 months Labor & Delivery Mother-Infant HIV Transmission in Hypothetical Cohort of 100 Children of HIV+ Mothers

  5. Comprehensive Approach to Reducing HIV Infection in Infants and Young Children • Comprehensive PPTCT services include 4 prongs: • Prong 1 Primary prevention of HIV infection • Prong 2 Prevention of unintended pregnancies among HIV-infected women • Prong 3 Prevention of HIV transmission from HIV-infected women to their infants • Prong 4 Provision of care and support to HIV-infected women, their infants, and their families

  6. Rationale for PPTCT in India 27 million pregnancies per year 1,62,000 infected pregnancies Cohort of 48,600 infected newborns per year 0.6% prevalence 30% transmission Most of these children die within 2-5 years

  7. The Terminology of HIV/AIDS • MTCT – mother-to-child transmission • PMTCT – prevention of MTCT • PTCT – parent-to-child transmission • PPTCT – prevention of PTCT • PLWHA – people living with HIV/AIDS

  8. Estimated MTCT Rates • Without intervention • During pregnancy 5 - 10% • During labour and delivery 15- 20 % • During breastfeeding 5 - 15% • Total 25 - 45%

  9. PPTCT: Interventions to Decrease Risk of HIV Transmission to Infant • During pregnancy • Decrease viral load (ARV prophylaxis and treatment) • Monitor and treat infections • Support optimal nutrition

  10. PPTCT: Interventions to Decrease Risk • During labour and delivery Avoid • Premature rupture of membranes • Invasive delivery techniques • Unresolved infections such as STIs • Provide • Elective caesarean section when safe and feasible

  11. PPTCT: Interventions to Decrease Risk • Promote safer infant feeding • Replacement feeding • Exclusive breastfeeding for limited time • Avoidance of mixed feeding • Reporting breast problems • Support for optimal nutrition

  12. The Four-Pronged Approach to Comprehensive Prevention of HIV in Infants and Young Children • A comprehensive approach prevents HIV infection in infants and young children. • The four prongs of PPTCT comprehensive care are • Primary prevention of HIV infection • Prevention of unintended pregnancies in HIV-infected women • Prevention of HIV transmission from HIV-infected women to their infants and • Provision of treatment, care and support of HIV-infected women, their infants and their families

  13. Prong 1:Prevention of Primary HIV Infection • For parents-to-be . . . the ABCs • A = Abstinence • B = Be faithful to one HIV-uninfected partner • C = Condoms — use consistently and correctly • Adapt approach to local culture and target groups at risk

  14. Prong 2: Prevention of Unintended Pregnancies in HIV-Infected Women • Access to counselling and referral for family planning • Safe, consistent, effective contraception

  15. Prong 3: Preventing HIV Transmission from HIV-Infected Women to Infants • PPTCT core interventions • HIV counselling and testing • ARV prophylaxis • Safer delivery practices • Safer infant feeding practices

  16. Prong 4: Provision of Care and Support to HIV-Infected Women and Their Families • Prevention and treatment of opportunistic infections • ARV treatment • Palliative and non-HIV care • Nutritional support • Reproductive healthcare • Psychosocial and community support

  17. Comprehensive MCH Services • Essential obstetric care (ANC) • Family planning services • Counselling and testing for HIV • Emergency obstetric services • Nutritional Care • ARV prophylaxis • Early recognition and treatment of HIV • MCH postnatal care and support

  18. SUMMARY • Without interventions the risk of MTCT is 25-40% • Combination interventions can reduce MTCT rate by up to 40% in breastfeeding populations • Because ARV prophylaxis alone does not treat the mother’s infection, ongoing care and support is needed • MCH services can act as an entry point to the range of services that can provide care and support to the HIV-positive women and affected family members • Linkages to community services can provide enhanced care and support

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