mtct tu4 en

Information about mtct tu4 en

Published on January 11, 2008

Author: Quintino

Source: authorstream.com

Content

Slide1:  Children living with HIV/AIDS New HIV infections in children in 1999 Child deaths due to HIV/AIDS in 1999 Cumulative number of child deaths due to HIV/AIDS June-2000 global estimates Children (<15 years) 1.3 million 620 000 500 000 3.8 million Slide2:  Estimated impact of AIDS on under-5 child mortality rates – Selected African countries, 2010 Source: US Bureau of the Census 250 200 150 100 50 0 per 1000 live births with AIDS Botswana Kenya Malawi Tanzania Zambia Zimbabwe without AIDS Slide3:  Prevention of Mother to Child Transmission (PMTCT) . during late pregnancy . during labor . through breast-feeding Prevention of unwanted pregnancies (Family Planning) Three integrated strategies to reduce paediatric AIDS Primary HIV prevention in parents to be Slide4:  Primary HIV prevention in the context of pregnancy Information, Education and Communication programmes Screening and treatment of Sexually Transmitted Infections Condom promotion HIV counselling NB: The risk of MTCT increases when the mother is infected during pregnancy or breastfeeding Benefits of information, counselling and voluntary HIV testing for the community:  Benefits of information, counselling and voluntary HIV testing for the community Widespread availability and use of counselling and voluntary HIV testing can : Reduce fear, ignorance and stigma surrounding HIV Stimulate a community response in support to those needing care Contribute to an environment supportive of safer sexual behaviour Reduce spillover of artificial feeding to HIV(-) mothers Slide6:  Family Planning Strengthening To prevent unwanted pregnancies HIV should never be used as a reason to pressurise women into having or not having children To delay subsequent pregnancies For the health of mothers, WHO recommends a minimum of 2 years between pregnancies. To replace the contraceptive effect of breastfeeding Avoidance of breastfeeding for PMTCT should not lead to rapid, unplanned subsequent pregnancy Slide7:  Prevention of MTCT through antiretrovirals Mechanisms of action: Ante and intra-partum regimen: Reduce viral load in mother ’s blood and genital fluids during pregnancy, labor and delivery Post-partum regimen: Act as post-exposure prophylaxis (viral particles eventually transmitted during birth are eliminated) Slide8:  Non-antiretroviral based intervention to prevent MTCT at birth Ceasarian section : 50% risk reduction if performed before onset of labour Avoidance of unnecessary invasive procedures (episiotomy, rupture of membranes…) : reduce infant contact with mother ’s infected blood and genital fluids Vaginal lavage with chlorhexidine : may be protective in case of prolonged rupture of membrane (>4 hours before delivery) Vitamin A supplementation : not effective to reduce MTCT Slide9:  Prevention of MTCT after birth Avoidance of breastfeeding = Replacement feeding: First 4-6 months: - Commercial infant formula - home made infant formula (diluted animal milk + sugar + vitamins) From 6 months to 2 years: - Enriched family foods Exclusive breastfeeding + early weaning (as soon as replacement feeding is feasible and safe) Slide10:  The variable risk of MTCT of HIV (with and without preventive interventions) Slide11:  ARV regimen of proven efficacy Antenatal Intrapartum Postnatal ZDV long ZDV short ZDV+3TC (1) ZDV+3TC (2) NVP Infant Infant+Mother Infant+Mother 14wk 36wk Onset of labour Delivery Birth 1wk PP 6wk PP Infant Slide12:  Balancing the risks of breastfeeding and formula feeding 6 wks 14 wks 6 months 12 months 24 months Child age Source: Nduati et al. JAMA 2000 Slide13:  A cascade of interventions P Pregnant  Pre-test counselling Test accepted Results given ARV initiated ARV completed Safer infant feeding ANC Infections averted Slide14:  Botswana pilot programme example First 8 months P HIV+ Pregnant  Pre-test counselling Test accepted Results given ARV initiated ARV completed Safer infant feeding ANC Infections averted (estimated) N=2900 N=2900 N=1650 N=754 N=435 232 174 N=638 70 Slide15:  Botswana: Challenges and Responses Challenges : Offer pre-test counselling to all women Increase acceptability of HIV test Responses : Train all mid-wives and doctors in HIV counselling Develop communication programmes Involve partners and/or other significant relatives

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