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PMTCT Prevention of Mother-to-Child Transmission of HIV

PMTCT Prevention of Mother-to-Child Transmission of HIV. Module 4: Maternal, Infant and Young Child Nutrition in PMTCT. Learning Objectives. Explain the relationship between breastfeeding and HIV transmission

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PMTCT Prevention of Mother-to-Child Transmission of HIV

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  1. PMTCTPrevention of Mother-to-Child Transmission of HIV Module 4: Maternal, Infant and Young Child Nutrition in PMTCT Zambia PMTCT Training Module 4: Maternal, Infant and Young Child Nutrition 1

  2. Learning Objectives • Explain the relationship between breastfeeding and HIV transmission • Describe national recomendations for feeding the HIV exposed infant and young children • Outline the counselling process about the feeding the HIV exposed infant and young child • Describe other key components that promote infant feeding in the context of HIV Zambia PMTCT Training Module 4: Maternal, Infant and Young Child Nutrition 2

  3. Introduction • Maternal, infant and young child nutrition is an important component of PMTCT • Infant feeding guidance in the context of HIV has evolved rapidly over the last decade due to emerging evidence • Zambia has a breastfeeding population and also high has HIV prevalence. • Balancing breastfeeding's lifesaving benefits and the risk of HIV transmission should the focus • Current guidelines emphasize improving HIV free survival as well as focusing on the mother’s health Zambia PMTCT Training Module 4: Maternal, Infant and Young Child Nutrition 3

  4. Magnitude of risk of HIV transmission through breastfeeding • Without intervention, 5% to 20% of infants breastfed by mothers who are HIV-positive may acquire HIV-infection through breast-feeding. • With intervention transmission rates are reduced to less than 2% Zambia PMTCT Training Module 4: Maternal, Infant and Young Child Nutrition 4

  5. Magnitude of risk of HIV transmission through breastfeeding Zambia PMTCT Training Module 4: Maternal, Infant and Young Child Nutrition 5

  6. Risk of HIV transmission by mode of feeding Risk of HIV transmission with full package of MTCT prevention Interventions (HAART, replacement feeding, caesarean section)< 2% Risk of HIV transmission through breastfeeding: • Exclusive breastfeeding (6 weeks – 6 months) ~ 4% • Breastfeeding as usual (varying duration) 5-20% Source: WHO, 2006 Zambia PMTCT Training Module 4: Maternal, Infant and Young Child Nutrition 6

  7. NATIONAL GUIDELINES FOR INFANT AND YOUNG CHILD FEEDING Outline of the guidelines • IYCF in the general population • IYCF when a mother is HIV positive in the first 24 months iii) Antiretroviral regimen during the infant and young child feeding period iv) IYCF for HIV negative Mothers or whose status is unknown Zambia PMTCT Training Module 4: Maternal, Infant and Young Child Nutrition 7

  8. i) Infant and young child feeding in the general Population • Breastfeeding should be protected, promoted and supported. • Mothers should exclusively breastfeed their infants for the first 6 months of life and thereafter, continue breastfeeding up to 24 months or beyond with timely, adequate and safe complementary feeding Zambia PMTCT Training Module 4: Maternal, Infant and Young Child Nutrition 8

  9. ii) IYCF when a mother is HIV positive in the first 24 months Breastfeeding is the only infant feeding recommendation • Mothers known to be HIV-infected (and whose infants are HIV-uninfected or of unknown HIV status) should: • exclusively breastfeed their infants for the first six months of life, • introduce appropriate complementary foods • continue breastfeeding for the first twelve months of life. • Breastfeeding should then only stop once a nutritionally adequate and safe diet without breast milk can be provided. Zambia PMTCT Training Module 4: Maternal, Infant and Young Child Nutrition 9

  10. ii) IYCF when a mother is HIV positive in the first 24 months cont.d • If infants and young children are known to be HIV-infected, • exclusively breastfeed for the first six months of life • and continue breastfeeding as recommended for the general population, that is up to two years or beyond. • Stopping breastfeeding should be gradual ( within one month). • Abrupt weaning is not recommended Zambia PMTCT Training Module 4: Maternal, Infant and Young Child Nutrition 10

  11. iii)ARVs during the infant and young child feeding period • All HIV exposed breastfeeding infants whose mothers were on ARV prophylaxis must be started on NVP prophylaxis from birth and continued throughout the breastfeeding duration. • All HIV exposed breastfeeding infants whose mothers did not receive any prophylaxis antenatally, must be started on NVP prophylaxis from birth and continued throughout the breastfeeding duration. • NVP should be stopped one week after complete cessation of breastfeeding. • All HIV exposed breastfeeding infants whose mothers are on ART, must be started on NVP prophylaxis from birth until 6 weeks of age.

  12. iv)Mothers who are known to be HIV negative or whose status is unknown • Mothers who are known to be HIV negative or whose status is unknown should be counselled: • to exclusively breastfeed their infants for the first six months of life • and then introduce complementary foods while continuing breastfeeding for 24 months or beyond. • They should also be offered HIV testing. • HIV negative Mothers should be counselled on prevention of HIV infection and about other services available eg family planning

  13. Advantages and Disadvantages Breastfeeding (Group Work) • Advantages • The mother • The baby • Disadvantages • Making breastfeeding safer

  14. Counselling an HIV Infected Mother About Infant Feeding cont.d • Opportunities for counselling and follow up • antenatal clinic visits • immediately after childbirth (6 hours) • early postnatal visit (6 days) • late postnatal visit (6 weeks) • at early infant diagnosis • monthly children’s clinic visits until the baby is 24months. • Health workers should identify and establish community support to refer mothers for follow up Zambia PMTCT Training Module 4: Maternal, Infant and Young Child Nutrition 14

  15. Counselling for infant feeding in relation to HIV During antenatal • In the group education breastfeeding should be promoted • This should include information on the importance of: • breastfeeding both to the mother and the baby • exclusive breastfeeding • early initiation of breastfeeding (within one hour of delivery ) • good positioning and attachment • demand feeding • risks of mixed feeding • Timely and appropriate complementary feeding Zambia PMTCT Training Module 4: Maternal, Infant and Young Child Nutrition 15

  16. Counselling for infant feeding in relation to HIV • Mothers should be encouraged to test and retest every 3 months for HIV to promote safe breastfeeding practices. • Individual Infant feeding counseling should be offered after obtaining the HIV test results. • It may be appropriate to reschedule for a visit specifically for infant feeding counseling. Zambia PMTCT Training Module 4: Maternal, Infant and Young Child Nutrition 16

  17. Counselling for infant feeding in relation to HIV cont.d Mother should be provided with Information and skills for successful breastfeeding: • Exclusive breastfeeding for the first 6months • Initiation of breastfeeding with 1hour of delivery • Positioning and attachment • Demand feeding • Risks of mixed feeding • Continuation of breastfeeding after 6 months • Timely and appropriate complementary feeding • Gradual weaning from the breast ***** Refer reference manual and discuss**** Zambia PMTCT Training Module 4: Maternal, Infant and Young Child Nutrition 17

  18. Counselling for infant feeding in relation to HIV During delivery • Immediately after delivery, the health worker should help the mother to initiate breastfeeding within the first hour of birth. • Health workers should identify and establish community support groups to refer mothers to for follow up. Zambia PMTCT Training Module 4: Maternal, Infant and Young Child Nutrition 18

  19. Counselling for infant feeding in relation to HIV Postnatal Period Infant Feeding for a mother who is HIV Positive and whose infant is known to be already HIV Positive • Exclusively breastfeeding for the first 6 months of life and continued breastfeeding up to 2 years of age and beyond with appropriate complementary feeding is strongly encouraged. Zambia PMTCT Training Module 4: Maternal, Infant and Young Child Nutrition 19

  20. Postnatal : Infant Feeding for a mother who is HIV Positive and whose breastfeeding infant is known to be negative • Infant may be at risk of contracting HIV through breastfeeding. The risk is low (less than 2%) as long as the baby continues extended infant NVP prophylaxis. • The importance of breastfeeding exclusively for the first 6 months and continuation of breastfeeding up to at least 12months • Mixed feeding at less than 6 months of age increases the infant’s chance of becoming infected with HIV. • Artificial feeding exposes the infant to the risks of infectious diseases and malnutrition Zambia PMTCT Training Module 4: Maternal, Infant and Young Child Nutrition 20

  21. Counselling for infant feeding in relation to HIV cont.d • Complementary feeding - This means giving other foods in addition to breastfeeding. This should start after the first 6 completed months • Information on complementary feeding should include: • Importance of complementary for all infants • Timely introduction – at 6 completed months • Adequacy (Frequency, Variety and locally available food, Quantity, appropriateness) • Hygiene • Continuation of breastfeeding . • ARV prophylaxis to their infants until one week after stopping breastfeeding Zambia PMTCT Training Module 4: Maternal, Infant and Young Child Nutrition 21

  22. Important information and skills for successful breastfeeding • Initiation of breastfeeding with 1hour of delivery • Positioning and attachment • Expressing breastmilk • Gradual weaning from the breast Zambia PMTCT Training Module 4: Maternal, Infant and Young Child Nutrition 22

  23. Addressing misconceptions about breastfeeding(group work) About • The mother • The baby Zambia PMTCT Training Module 4: Maternal, Infant and Young Child Nutrition 23

  24. Other key components for Optimal IYCF a) Growth Monitoring regular weighing of a child and charting or plotting of the weight on an under-5 growth card. it is important for all children, especially if HIV exposed and on replacement feeding . b) Feeding the sick child need to eat small frequent meals to enhance recovery. Breastfed babies should continue breastfeeding during the period of sickness. After the illness, they should be offered at least one extra meal a day and encourage them to eat more. Zambia PMTCT Training Module 4: Maternal, Infant and Young Child Nutrition 24

  25. Other key components for Optimal IYCF c) Baby Friendly Hospital Initiative d) Compliance to the marketing of breast milk substitutes legislation Zambia PMTCT Training Module 4: Maternal, Infant and Young Child Nutrition 25

  26. IYCF in special situations • Refer to annex ……… in the reference manual Zambia PMTCT Training Module 4: Maternal, Infant and Young Child Nutrition 26

  27. Summary • Good nutrition is vital for health and reproductive performance of women and survival of the children • Counseling and support for infant feeding can improve feeding practices and prevent malnutrition and reduce the risk of death in children. • Breastfeeding is the only infant feeding option for HIV Positive mothers • After 6 months of exclusive breastfeeding, timely, adequate and safe complementary feeding should be introduced while breastfeeding is continued • Mothers should be counselled on adherence to the ARV regimen • All HIV-exposed infants should be followed up and information recorded appropriately. Zambia PMTCT Training Module 4: Maternal, Infant and Young Child Nutrition 27

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