1 / 26

Prevention of Mother to Child Transmission of HIV

Prevention of Mother to Child Transmission of HIV. Session Objectives. By the end of this session participants would be able to: Describe the m agnitude of the problem and its impact; Describe the routes, rates and risks of

iola
Télécharger la présentation

Prevention of Mother to Child Transmission of HIV

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Prevention of Mother to Child Transmission of HIV

  2. Session Objectives By the end of this session participants would be able to: Describe the magnitude of the problem and its impact; Describe the routes, rates and risks of HIV transmission from mother to child.

  3. Magnitude of the Problem • MTCT most significant source of HIV infection in children below age 15. • More than 5 million children infected since beginning of epidemic. • Almost 4 million children have died. • 90% of MTCT occurs in Africa. • Transmission higher in developing countries than in industrialized countries due to lack of treatment.

  4. Estimated impact of AIDS on under-5 child mortality rates, select African countries, 2010 250 Deaths per 1000 live births 200 Without AIDS With AIDS 150 100 50 0 Botswana Kenya Malawi Tanzania Zambia Zimbabwe Source: US Census Bureau

  5. Routes, Rates,and Risk Factors of Vertical Transmission

  6. HIV Transmission to Infants • Less than 60 % of babies born to HIV-positive mothers become infected • Peri-natal • In utero (during pregnancy) • Intrapartum (during delivery) • Post-natal • Breastfeeding (risk of increases over time. The longer the baby is breastfed the greater the risk of infection)

  7. Routes of MTCT of HIV Father Intercourse Mother Pregnancy Labor & Delivery Breastfeeding Infant

  8. Risk Factors during Breastfeeding • Prematurity • Duration of breastfeeding • Infant immune responses • Mixed feeding • Maternal viral load • Mastitis

  9. Balancing the Risks of BF and Formula Feeding 12 months 24 months 6 months 14 wks 6 wks Child age Source: Nduati et al. JAMA 2000

  10. Weighing the Risks and Benefitsof Breastfeeding with HIV • Replacement feeding prevents transmission of HIV through breastfeeding • But: • Essential to have sterile water • Risk of death due to artificial feeding? • Cost of replacement feeding? • Stigma if not breastfeeding? • Early return of fertility?

  11. Maternal Factors Stage of maternal HIV disease (viral load) Maternal nutritional status Disruption of placental barrier integrity STD during pregnancy Factors related to the child Genetic characteristics suspected as potential risk Obstetrical Factors Vaginal delivery (versus C-section) First-born of twins Pre-term delivery Hemorrhage during labor Bloody amniotic fluid Invasive procedures Viral Factors MTCT rates higher for HIV-1 than for HIV-2 Risk Factors for MTCT during Pregnancy and Delivery

  12. Benefits of Breastfeeding • Benefits for Infants • Adequate nutrition • Provides protective against infections through maternal antibodies • Increase intellectual potential (?) • Promotes bonding between mother and infant • Benefits for Mothers • Facilitates uterine contraction • Protects against excessive blood loss • Delays the return of normal menstruation • Contributes to child spacing • Promotes bonding between mother and infant • Conforms to social norms

  13. Rates of Vertical Transmission Without ART • Pregnancy/delivery/breastfeeding…………35% (no intervention) • Pregnancy/delivery/replacement feeding….20% (BF contributes 15%)

  14. Risk of Transmission Source: De Cock KM et al. 2000.

  15. The Variable Risk of MTCT

  16. Probability of MTCT of HIV(No intervention) Mother Pregnancy/delivery HIV+ Infants (20) HIV- Infants (80) Post partum & BF HIV+ (12) HIV- (68) Estimated outcome based on 100 single births to HIV infected mothers

  17. Probability of MTCT of HIV(Nevirapine) Mother Pregnancy/delivery HIV+ Infants (10) HIV- Infants (90) Post partum & BF HIV+ (14) HIV- (76) Estimated outcome based on 100 single births to HIV infected mothers

  18. Strategies for the Prevention of MTCT

  19. A Comprehensive Approach to Prevent HIV Infection in Infants and Young Children WHO, 2000

  20. Four Integrated Strategies to Reduce Pediatric AIDS (WHO/UNICEF 4 Pillars of MTCT) 3. Prevention of transmission from mother to child 1. Primary prevention of HIV in young adults 4. MTCT-Plus: care and support for HIV+ women, their infants, and families 2. Prevention of unwanted pregnancies among HIV+ women (family planning)

  21. Strategy 1: Primary Prevention of HIV Infection • Safe sexual behavior and condom use • Reproductive health services • Management of STIs • VCT • HIV prevention interventions aimed at pregnant and lactating women, and women of child bearing ages

  22. Strategy 2: Prevention of Unintended Pregnancies in HIV+ Women • Strengthening family planning services • To prevent unintended pregnancies • To delay subsequent pregnancies • To replace the contraceptive effect of breastfeeding • Access to safe abortion services where allowed by law • VCT so that they know their HIV status

  23. Strategy 3: Prevention of Transmission in HIV+ Women • Pregnancy and delivery • Antiretroviral therapy (ART) • Vaginal disinfection (little evidence of success and can increase inflammation) • Improved obstetrical practices (avoid unnecessary invasive procedures, safer delivery) • Treatment of STIs • Breastfeeding • Good nutrition and good BF technique instruction • Short course ART for baby

  24. Strategy 4: MTCT-Plus • Secondary HIV prevention • Clinical care (including ART) • Community care • Stigma reduction • OVC services • Impact mitigation

  25. Approach to HIV VCT in ANC Settings • "Opt in" approach: • HIV VCT is offered to pregnant women as a separate intervention from routine ANC and women are requested to provide explicit consent to receive the intervention (VCT) • "Opt out" approach: • HIV is offered to pregnant women as part and parcel of routine ANC and women are given the option to refuse the intervention based on their personal/individual situation

More Related