International

Infectio
n

PREVENTION OF MATERNAL
TO CHILD TRANSMISSION OF
HIV

International

Infectio
n

Objectives

Describe relationship of HIV on

pregnancy
Factors affecting vertical transmission
Strategies to prevent maternal to child
transmission

International

Infectio
n

Introduction

UNAIDS about 25 million adults&

children living with HIV/AIDS in Sub
Saharan Africa.
4million new cases yearly
300,000 to 600,000 AIDS related
deaths in 1999 in children (0 -14yrs)

International

Infectio
n

HIV AND PREGNANCY

Effect of pregnancy on HIV progression

Effect of HIV on pregnancy outcome

International

Infectio
n

Effects of pregnancy on HIV

infection
No effect on HIV progression.
Slight decline in absolute numbers of CD4
count ( % of CD4 cells remains stable
No overall significant in deaths rate

International

Infectio
n

Effect of HIV on pregnancy

course and outcome

International

Infectio
n

Maternal to Child
Transmission

Accounts to 15 % of all transmission in Uganda

Accounts for > 90% of infection in children
In Africa rate of MTCT is 20 -40%
Overall risk at point estimate for transmission

During pregnancy: 5 -10%

In labour: 15 -20%
Breast feeding : 10-15%

International

Infectio
n

Factors affecting transmission

Viral factors:
(Load,strain variation)*
Maternal: CD4 count
STD infections*
Substance abuse
Sexual behavior*
Placental disruption

Preterm deliveries
Duration of membrane
rupture.*
Invasive procedure in
Labour( Instrumental
vaginal
deliveries,episiotomies*
Mode of delivery
Fetal/neonatal factors
Breast feeding *

International

Infectio
n

Prevention of Maternal to
Child Transmission

Comprehensive MCH services

( antenatal,intrapartum,postnatal)
VCCT
Short course antiretroviral treatment
Modified and optimal obstetrical practice
Support for safe infant feeding
Family planning services & counseling

International

Infectio
n

Comprehensive ANC
minimum package for PMTCT

Provision of quality ANC

Health education
Micro nutrient supplementation
Prevention and treatment of infections
Anti- retroviral drugs

International

Infectio
n

Provision of Quality ANC-1

Early Attendance
Refocused ANC with at least 4 to 5 visits
Detailed history taking
Examination to rule out signs of HIV related illness
Baseline Investigation: Hemoglobin,RPR for
syphilis,Urine analysis
Voluntary confidential counseling and testing.

International

Infectio
n

Provision of Quality ANC-2

1st Visit:Detailed history, examination, investigation,
folic supplements,deworming and VCCT
2rd Visit:Monitor progress of pregnancy, Counsel on
pmtct and breast feeding option, 1st dose of
IPT,tetanus toxoid,iron/folic supplementation.
3rd Visit:Monitor progress of pregnancy,blood pressure
,Hb and urine analysis,2rd dose IPT,tetanus toxoid,
iron/folic supplementation.Counseling support
4th Visit: As above. Enrolment on the PMTCT
program,Give antiretroviral drugs

International

Infectio
n

Health education

Nutrition,personal hygiene,environmental sanitation

Normal Tetanus toxoid schedule
STI treatment
Benefits of VCCT
Condom usage and family planning
Male involvement
Breast feeding /other feeding options

International

Infectio
n

ANC-4

1.Micro-nutrient supplements
2.Prevention & treatment of infections
Intermittent presumptive treatment: 3 doses
of SP
identification& treatment of STI
3.Anti retroviral treatment
AZT
Neverapine

International

Infectio
n

Care during Labour and

Delivery

1. Good Obstetric practice

2. Ante retroviral drugs
3. Modified Obstetric practice

Delay ARM
ECV
Routine episiotomies
Instrumental deliveries
Traumatic suction of child
Universal precautions.

4. Mode of delivery

International

Infectio
n

Short course anti-retroviral

treatment

Options:
AZT after 36 weeks antepartum,intrapartum
amd post partum with neonatal treatment for
7 days. (%Reduction 50%) at 8weeks
Nevirapine In labour and neonatal treatment
for 48 to 72 hours. (% reduction 47%) at 8
weeks

International

Infectio
n

Oral Anti retroviral treatment

Antepartum

Intrapartum

Post partum
For mother

neonatal

1.AZT 300mgs
p.o B.D after 35
weeksgestation

AZT 300mgs p.o

3hourly till
delivery

AZT 300mgs p.o

B.D for 7 days

4mgs/kg p.o B.D

for 7 days

2.

NVP 200 mgs p.p

at onset of labour

None

none

2mgs/kg p.o 4872 hours

International

Infectio
n

Post natal care

Dual use of Contraception( Barrier&

contraception).
Ongoing Care
Counseling and support
Care of the Neonate,(Exclusive breast
feeding for 3/12 months or Artificial
infant feeding)

International

Infectio
n

Conclusion

Maternal to child transmission can be

reduced by 50%
Effective counseling ,support,treatment
of opportunistic infections and anti
retroviral treatment can improve quality
of life.