Title: Prevention of Mother to Child Transmission of HIV
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.
3Magnitude 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.
4Estimated 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
5Routes Ratesand Risk Factors of Vertical
Transmission
6HIV 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)
7Routes of MTCT of HIV
Father
Intercourse
Mother
Pregnancy
Labor Delivery
Breastfeeding
Infant
8Risk Factors during Breastfeeding
- Prematurity
- Duration of breastfeeding
- Infant immune responses
- Mixed feeding
- Maternal viral load
- Mastitis
9Balancing 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
10Weighing 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
11Risk Factors for MTCT during Pregnancy and
Delivery
- 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
12Benefits 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
13Rates of Vertical Transmission Without ART
- Pregnancy/delivery/breastfeeding35
- (no intervention)
-
- Pregnancy/delivery/replacement feeding.20
- (BF contributes 15)
14Risk of Transmission
Source De Cock KM et al. 2000.
15The Variable Risk of MTCT
16Probability 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
17Probability 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
18Strategies for the Prevention of MTCT
19A Comprehensive Approach to Prevent HIV Infection
in Infants and Young Children
WHO 2000
20Four 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(No Transcript)
22Strategy 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
23Strategy 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
24Strategy 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
25Strategy 4 MTCT-Plus
- Secondary HIV prevention
- Clinical care (including ART)
- Community care
- Stigma reduction
- OVC services
- Impact mitigation
26Approach 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