# Presentation: 000983

## Specific Interventions to Prevent MTCT

- M O D U L E   3

- Module 2

## Module 3: Objectives

- Name specific interventions for prevention of mother-to-child transmission (PMTCT).
- List locally available and recommended antiretroviral (ARV) regimens.
- Discuss antenatal management of women infected with HIV and women whose HIV status is unknown.

- Module 2

## Module 3: Objectives

- Explain the management of labour and delivery in women infected with HIV and women whose HIV status is unknown.
- Explain postpartum care of women infected with HIV and women whose HIV status is unknown.
- Explain immediate care of infants born to mothers infected with HIV and to mothers whose HIV status in unknown.

- Module 2

## Specific Interventions to Prevent MTCT OF HIV

**Session 1**
**A****ntiretroviral Treatment and ****Prophylaxis for the Prevention of MTCT **

- Module 2

## Antiretroviral (ARV)Treatment and Prophylaxis

*ARV Treatment *
- Long-term use of antiretroviral drugs to treat maternal
- HIV/AIDS and prevent PMTCT
*ARV Prophylaxis*
- Short-term use of antiretroviral drugs to reduce HIV
- transmission from mother to infant
**	**

- Module 2

## Antiretroviral Treatment

- Reduces viral replication and viral load.
- Treats maternal infection
- Protects the HIV-exposed infant
- Improves overall health of mother
- Requires ongoing care and monitoring

- Module 2

## Co-Infection with Tuberculosis

- Women infected with HIV can receive both antiretroviral  and TB treatment at the same time with
- Additional drug selection
- Clinical management

- Module 2

## ARV Prophylaxis for PMTCT

**WHO (2004)**
- Longer, combination prophylaxis regimens
- Short-course prophylaxis regimens
- Combination regimen  not  available
- Combination regimen is not feasible

- Module 2

## ARV Prophylaxis for PMTCT

- Insert country protocol.

- Module 2

## Alternative Regimens for ARV Prophylaxis

- Refer to country protocol.

- Module 2

## Specific Interventions to Prevent MTCT OF HIV

**Session 2**
**Antenatal Management of **
**Women In****fected with HIV an****d **
**Women with Unknown HIV Status**

- Module 2

## Antenatal Management

- Reduces risk of MTCT
- Provides linkage to treatment, care and support services
- Helps women infected with HIV stay healthier longer
- Helps HIV-negative women stay uninfected

- Module 2

## Routine Antenatal Care

- Test and counsel for HIV
- Diagnose and treat STIs
- Promote safer sex practises
- Provide information on HIV
- Provide infant-feeding counselling and support

- Module 2

## Prevent, Screen and Treat TB and Malaria

- Co-infection with tuberculosis (TB)
- Follow country guidelines for prevention and treatment.
- Any woman with cough of two weeks or more needs to be screened and treated when indicated.
- Malaria
- Follow country guidelines for prevention and treatment.

- Module 2

## Preventing and Treating Infections

- Monitor and provide early treatment for
**  **Urinary tract infections
-   Recurrent vaginal candidiasis
-   STIs
- Provide prophylaxis for OIs according to country protocol.

- Module 2

## Psychosocial and Community Support

**Pregnancy **– a stressful time – link to:
- PLWHA support organizations
- Community services for support with housing, nutritional needs, spiritual needs
- ARV treatment when indicated and available

- Module 2

## Specific Interventions to Prevent MTCT OF HIV

**Session 3**
**Management of Labour and Delivery ****of**** Women Infected with HIV**** ****and Women with Unknown HIV Status**

- Module 2

## Goals of Labour and Delivery

- Reduce MTCT risk by providing ARV prophylaxis or treatment.
- Minimise exposure of foetus to maternal blood and body fluids.
- Support safer delivery practices.

- Module 2

## Reducing MTCT Risk During Labour and Delivery

- Minimise cervical exams.
- Use partogram to monitor labour.
***Avoid ***
- Routine rupture of membranes
- Prolonged labour
- Unnecessary trauma during childbirth

- Module 2

## Reducing MTCT Risk During Labour and Delivery

- Minimise risk of postnatal haemorrhage.
- Use safe transfusion practises (blood screened for HIV and syphilis, malaria,    hepatitis B & C when possible).

- Module 2

## Elective Caesarean Section versus Vaginal Delivery

- Elective cesarean section
- Consider elective cesarean delivery when safe and feasible
- Done at the onset of labour or membrane rupture
- Vaginal delivery
- When ARV prophylaxis or treatment has effectively reduced the viral load

- Module 2

## Reducing MTCT Risk in Women with Unknown HIV Status

- Offer rapid HIV testing with right to refuse
- Discuss benefits to knowing HIV status
- If HIV-positive, ARVs can be given for PMTCT and refer for treatment and care

- Module 2

## Reducing MTCT Risk in Women with Unknown HIV Status

- Describe the testing process
- Provide post-test counselling
- If HIV-positive, provide ARV prophylaxis based on country regimen

- Module 2

## Specific Interventions to Prevent MTCT OF HIV

**Session 4**
**Immediate Postpartum Care of Women Infected with HIV and Women with Unknown HIV Status**

- Module 2

## Immediate Postpartum Care 

***P******atient ******Education***
- Symptoms of infection
- Information on where to return for care
- Perineal care
- Breast care
- Disposal of bloodstained pads

- Module 2

## Immediate Postpartum Care of  Women with HIV Infection

***Continuing Care***
- Provide gynaecologic care, including pap smears.
- Monitor for OIs, provide prophylaxis.
- Prevent or treat TB and malaria.
- Refer for ARV treatment, care and support.

- Module 2

## Immediate Postpartum Care of  Women with HIV Infection

***Newborn Feeding***
- Mother chooses and begins feeding option.
- Support the choice of feeding option.
- Provide training on feeding option.
- Observe feeding technique.

- Module 2

## Immediate Postpartum Care of  Women with HIV Infection

***Signs & Symptoms (S&S) of Postnatal Infection***
- Instruct on S&S of infection.
- Provide information on where and when to seek health care.
- Instruct on perineal and breast care.
- Instruct on safe disposal of lochia & bloodstained materials.

- Module 2

## Postpartum Care of Women

***Family Planning***
***   ***Prevent unintended pregnancies.
-    Support child spacing.
-    Promote continued safer sex practices.

- Module 2

## Women of Unknown HIV Status: Benefits of HIV Testing After Delivery

- Initiate ARV prophylaxis for infant if indicated.
- Encourage safer feeding selection option should she test positive.
- Encourage exclusive breastfeeding if she tests negative or refuses to be tested.

- Module 2

## Specific Interventions to Prevent MTCT OF HIV

**Session 5**
**Immediate Newborn Care of Infants and Infants who are HIV-Exposed with Unknown HIV Status**

- Module 2

## Immediate Newborn Care of HIV-Exposed Infants

***DO*****	**
- Cut cord under cover of light gauze.
- Determine mother’s feeding choice.
- Administer Vitamin K.
- Use silver nitrate eye ointment (within 1 hour of birth).
- Administer BCG as per country protocol.

- Module 2

## Immediate Neonatal Care of Infant

**DO***** NOT***
- Suction unless meconium-stained liquid is present.
- Use mouth-operated suction.
- Use mechanical suction at ***greater*** than 100 mm Hg pressure.

- Module 2

## ARV Prophylaxis for the Infant who is HIV-Exposed

- Insert country protocol.

- Module 2

## Infants Born to Mothers of Unknown HIV Status 

- Insert country protocol.

- Module 2

## Treatment, Care and Support of HIV-Exposed Infants

- Insert country protocol.

- Module 2

## Treatment, Care and Support of HIV-Exposed Infants

- Routine assessment for signs/symptoms of HIV (persistent diarrhoea, failure to thrive)
- According to country guidelines
- HIV testing
- PCP prophylaxis (starting at 6 weeks)
- Prevention and treatment of TB or malaria

- Module 2

## Module 3: Key Points

- Integrating PMTCT services into the essential package of ANC services promotes improved care for all pregnant women and provides the best opportunity for a successful PMTCT programme.
- Specific interventions to reduce MTCT include ARV treatment and prophylaxis, safer delivery procedures, and counselling and support for safe infant feeding.

- Module 2

## Module 3: Key Points 

- Using antiretroviral treatment and prophylaxis reduces the risk of MTCT. Longer-course combination regimens are effective, but short-course prophylaxis regimens may be more feasible in some resource-constrained settings.
- PCP prophylaxis and prevention and treatment of TB and malaria are part of comprehensive care for mothers infected with HIV and their infants.

- Module 2

## Module 3: Key Points

- Safer delivery procedures includes avoiding unnecessary invasive obstetrical procedures and offering the option of elective cesarean section when safe and feasible.
- Infant-feeding options to minimise the risk of MTCT require support and guidance throughout ANC, labour and delivery, and postpartum.

- Module 2