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National Centre for AIDS
and STD Control
Module 2
Session 2
Comprehensive Approach to
Prevention of HIV Infection in
Infants and Young Children
National Centre for AIDS
and STD Control
Session 2 Objectives
 Describe the four elements of a comprehensive
approach to prevention of HIV infection in
infants and young children (4 prongs of PMTCT)
 Provide examples of each of the four elements
National Centre for AIDS
and STD Control
Comprehensive Approach to Preventing
HIV Infection in Infants and Young
Children
 To significantly reduce MTCT and achieve targets,
PMTCT must be viewed as a comprehensive public
health approach
 Focus is on:
 Women with HIV and their partners, children and
families
 Parents-to-be whose HIV status is unknown or
who have tested HIV-negative
National Centre for AIDS
and STD Control
Four Elements of a
Comprehensive Approach
Element Target Population
 Primary prevention Women and men who
are sexually active
 Prevention of unintended
pregnancies among women
infected with HIV
HIV-infected women
 Prevention of HIV
transmission from women
with HIV to their infants
HIV-infected women
 Provision of treatment, care
and support to women with
HIV, their infants and families
HIV-infected women,
their children and
families
National Centre for AIDS
and STD Control
Prong 1:
Primary Prevention of HIV (Continued)
 ABC: an HIV primary prevention strategy
 A = Abstain
 B = Be faithful to one partner also called mutual
faithfulness
 C = Use condoms correctly and consistently (every time)
National Centre for AIDS
and STD Control
Primary Prevention: Issues for Women
 Especially for young women, successful
implementation of the ABCs may require support
 Factors contributing to womens vulnerability to HIV
include poverty, culturally defined roles, lack of
information, abuse, violence, coercion by men and
the inability to negotiate safer sex
 HCWs can help women address these challenges
through education, support and community linkages
National Centre for AIDS
and STD Control
Condom Access
 Male &female condoms, when used correctly and consistently, can
help prevent:
 HIV transmission, STIs, Unintended pregnancy
 PMTCT programmes should make male and female condoms
available
 Condom Access: HCWs Role
 Provide clients with information
on how to use condoms
 Support client who is
negotiating with partner
for safer sex
 Promote joint responsibility for preventing the transmission of
HIV
National Centre for AIDS
and STD Control
STIs: Prevention & Early
Treatment
STIs affect HIV and vice versa
Having other STIs increases the risk of HIV
infection
HIV infection tends to make an STI more
severe
National Centre for AIDS
and STD Control
Prevention for People who Inject drugs
 Important mode of HIV transmission in Nepal
 Women who inject and female partners of men who
inject are at risk of getting Infection
 Harm reduction:
 Needle Syringe Exchange Programs
 Drug Treatment Programs
 Oral Substitution Therapy (Methadone or Buprenorphine)
National Centre for AIDS
and STD Control
Prong 2:
Preventing Unintended Pregnancies
 Family planning saves lives and enhances the health status
of women and their families
 This is one of most cost-effective elements of PMTCT
 Family planning provides benefits by helping women avoid
unintended pregnancy.
 Family planning counselling helps women and/or couples to
 Dual protection against unintended pregnancy& STIs
 Get emergency contraceptive services
 Get referrals to providers of care, treatment and support
National Centre for AIDS
and STD Control
Effective Family Planning
 Must demonstrate respect for clients rights
 Prevents unintended pregnancies, Spaces births
 Helps women who are HIV-infected protect their own
health while taking care of their families
 Pregnant women practise safer sex:
 Pregnant women are at a higher risk of acquiring HIV
than non-pregnant women, and
 Pregnant women who are newly infected are more likely
to pass HIV to their infants
National Centre for AIDS
and STD Control
Family Planning Counselling
Pregnant women are at a higher risk of acquiring HIV than
non-pregnant women, and
Pregnant women who are newly infected are more likely to
pass HIV to their infants
Every woman, regardless of her HIV status, has the right to
make a free and informed decision about
 Whether and when she becomes pregnant
 Whether to use contraception, Which method to use
 Where possible, encourage women to include their
partners in family planning counselling sessions
National Centre for AIDS
and STD Control
Support the client to select a contraceptive
method
 Most methods of contraception are
safe for use by women with HIV
 Condoms are important as dual protection
Family Planning Counselling
(Continued)
Condoms
Hormonal contraceptives
IUDs
Sterilization
National Centre for AIDS
and STD Control
Contraceptive Methods
(continued):
Hormonal contraceptives, are highly effective but:
 Counsel women about possible interactions
between hormonal contraceptives and ARV
drugs. The use of a back-up method like a
condom is recommended.
 Injectable like Depo-Provera may be more
reliable than ORCPs in women on ART.
 Women taking rifampicin for TB should use a
back-up method of contraception like condoms.
National Centre for AIDS
and STD Control
Contraceptive Methods
(Continued)
(continued):
 IUDs can be used by asymptomatic or mildly
symptomatic women; they are not
recommended for women with advanced HIV
who are not on ARV therapy
 Sterilization is effective for women with HIV
National Centre for AIDS
and STD Control
Family Planning Counselling
(Continued)
Discuss HIV and fertility
 HIV may reduce fertility by as much as 40%
but ART increases fertility
 Ensure that couples are aware of possibility of
fertility returning
 Emphasize family planning
National Centre for AIDS
and STD Control
Prong 3: PMTCT Interventions
Intervention These interventions work
by
HIV testing and counselling
during ANC, labour and delivery
and postpartum (individual,
couple, group)
 Providing information about
HIV, PMTCT, safer sex
 Identifying women infected
with HIV
Provision of antiretroviral (ARV)
drugs to mother and infant
Reducing maternal viral load
Safer delivery practices Reducing infant exposure to
maternal blood
Infant feeding information,
counselling and support
Reducing infant exposure to the
virus in breast milk
Referrals to comprehensive
treatment, care and social
support for mothers and families
with HIV infection
Ensuring the woman and her
family have access to life-saving
care, treatment and support
services
National Centre for AIDS
and STD Control
Partner Involvement in PMTCT
 PMTCT interventions should be based on
the principle that both mothers and
fathers have an effect on HIV
transmission to the infant
Involving both men and women in all 4 elements is vital
to the success of PMTCT
National Centre for AIDS
and STD Control
Element 4: Treatment, Care and Support
Medical Treatment Care and Social support
 Provide treatment care and support to HIV infected parents,
infants and their family members
 Ensure regular physical check up of woman, infant and their
family member- lab investigation, FP services, SRH care, STI ,
oral hygiene and skin care etc.,
 Ensure nutritional care  carbohydrate, protein, and vitamin
enriched food
 Ensure PLHIV linkages-encourage to participate PLHIV group,
social care protection, palliative care, CHBC and religious group
for physical, social, economic and psychosocial support
 Provide follow up care, information for HIV exposed babies
National Centre for AIDS
and STD Control
Linkages for HIV-Exposed Infants and
Children
 Infants & children born to HIV-infected mothers require regular
follow-up care, mainly during first two years of life
 Immunizations, HIV testing (PCR, Antibody Test)
 Prophylaxis for Pneumocystis pneumonia, other common
infections
 Monitoring: feeding, nutrition, growth & development
 Linkage essential for HIV-exposed children as they are at higher risk
for illness and malnutrition:
 May be infected with HIV and become illeven with adequate
healthcare and nutrition
 If receiving replacement feeding, may be at risk of infections and
malnutrition
 If mother is ill, she may have difficulty caring for her children
National Centre for AIDS
and STD Control
Key Points
 A comprehensive approach is needed to prevent HIV in
children. The four elements of PMTCT are:
 Primary prevention of HIV infection
 Prevention of unintended pregnancies among HIV infected
women
 Prevention of HIV transmission from women to their infants
 Provision of treatment, care and support to women infected
with HIV, their infants and families
 MCH services, especially ANC care, are an entry point to
services required to meet the needs of HIV-infected women
and their families

More Related Content

4. National PMTCT Training Module 2 Session 2.ppt

  • 1. National Centre for AIDS and STD Control Module 2 Session 2 Comprehensive Approach to Prevention of HIV Infection in Infants and Young Children
  • 2. National Centre for AIDS and STD Control Session 2 Objectives Describe the four elements of a comprehensive approach to prevention of HIV infection in infants and young children (4 prongs of PMTCT) Provide examples of each of the four elements
  • 3. National Centre for AIDS and STD Control Comprehensive Approach to Preventing HIV Infection in Infants and Young Children To significantly reduce MTCT and achieve targets, PMTCT must be viewed as a comprehensive public health approach Focus is on: Women with HIV and their partners, children and families Parents-to-be whose HIV status is unknown or who have tested HIV-negative
  • 4. National Centre for AIDS and STD Control Four Elements of a Comprehensive Approach Element Target Population Primary prevention Women and men who are sexually active Prevention of unintended pregnancies among women infected with HIV HIV-infected women Prevention of HIV transmission from women with HIV to their infants HIV-infected women Provision of treatment, care and support to women with HIV, their infants and families HIV-infected women, their children and families
  • 5. National Centre for AIDS and STD Control Prong 1: Primary Prevention of HIV (Continued) ABC: an HIV primary prevention strategy A = Abstain B = Be faithful to one partner also called mutual faithfulness C = Use condoms correctly and consistently (every time)
  • 6. National Centre for AIDS and STD Control Primary Prevention: Issues for Women Especially for young women, successful implementation of the ABCs may require support Factors contributing to womens vulnerability to HIV include poverty, culturally defined roles, lack of information, abuse, violence, coercion by men and the inability to negotiate safer sex HCWs can help women address these challenges through education, support and community linkages
  • 7. National Centre for AIDS and STD Control Condom Access Male &female condoms, when used correctly and consistently, can help prevent: HIV transmission, STIs, Unintended pregnancy PMTCT programmes should make male and female condoms available Condom Access: HCWs Role Provide clients with information on how to use condoms Support client who is negotiating with partner for safer sex Promote joint responsibility for preventing the transmission of HIV
  • 8. National Centre for AIDS and STD Control STIs: Prevention & Early Treatment STIs affect HIV and vice versa Having other STIs increases the risk of HIV infection HIV infection tends to make an STI more severe
  • 9. National Centre for AIDS and STD Control Prevention for People who Inject drugs Important mode of HIV transmission in Nepal Women who inject and female partners of men who inject are at risk of getting Infection Harm reduction: Needle Syringe Exchange Programs Drug Treatment Programs Oral Substitution Therapy (Methadone or Buprenorphine)
  • 10. National Centre for AIDS and STD Control Prong 2: Preventing Unintended Pregnancies Family planning saves lives and enhances the health status of women and their families This is one of most cost-effective elements of PMTCT Family planning provides benefits by helping women avoid unintended pregnancy. Family planning counselling helps women and/or couples to Dual protection against unintended pregnancy& STIs Get emergency contraceptive services Get referrals to providers of care, treatment and support
  • 11. National Centre for AIDS and STD Control Effective Family Planning Must demonstrate respect for clients rights Prevents unintended pregnancies, Spaces births Helps women who are HIV-infected protect their own health while taking care of their families Pregnant women practise safer sex: Pregnant women are at a higher risk of acquiring HIV than non-pregnant women, and Pregnant women who are newly infected are more likely to pass HIV to their infants
  • 12. National Centre for AIDS and STD Control Family Planning Counselling Pregnant women are at a higher risk of acquiring HIV than non-pregnant women, and Pregnant women who are newly infected are more likely to pass HIV to their infants Every woman, regardless of her HIV status, has the right to make a free and informed decision about Whether and when she becomes pregnant Whether to use contraception, Which method to use Where possible, encourage women to include their partners in family planning counselling sessions
  • 13. National Centre for AIDS and STD Control Support the client to select a contraceptive method Most methods of contraception are safe for use by women with HIV Condoms are important as dual protection Family Planning Counselling (Continued) Condoms Hormonal contraceptives IUDs Sterilization
  • 14. National Centre for AIDS and STD Control Contraceptive Methods (continued): Hormonal contraceptives, are highly effective but: Counsel women about possible interactions between hormonal contraceptives and ARV drugs. The use of a back-up method like a condom is recommended. Injectable like Depo-Provera may be more reliable than ORCPs in women on ART. Women taking rifampicin for TB should use a back-up method of contraception like condoms.
  • 15. National Centre for AIDS and STD Control Contraceptive Methods (Continued) (continued): IUDs can be used by asymptomatic or mildly symptomatic women; they are not recommended for women with advanced HIV who are not on ARV therapy Sterilization is effective for women with HIV
  • 16. National Centre for AIDS and STD Control Family Planning Counselling (Continued) Discuss HIV and fertility HIV may reduce fertility by as much as 40% but ART increases fertility Ensure that couples are aware of possibility of fertility returning Emphasize family planning
  • 17. National Centre for AIDS and STD Control Prong 3: PMTCT Interventions Intervention These interventions work by HIV testing and counselling during ANC, labour and delivery and postpartum (individual, couple, group) Providing information about HIV, PMTCT, safer sex Identifying women infected with HIV Provision of antiretroviral (ARV) drugs to mother and infant Reducing maternal viral load Safer delivery practices Reducing infant exposure to maternal blood Infant feeding information, counselling and support Reducing infant exposure to the virus in breast milk Referrals to comprehensive treatment, care and social support for mothers and families with HIV infection Ensuring the woman and her family have access to life-saving care, treatment and support services
  • 18. National Centre for AIDS and STD Control Partner Involvement in PMTCT PMTCT interventions should be based on the principle that both mothers and fathers have an effect on HIV transmission to the infant Involving both men and women in all 4 elements is vital to the success of PMTCT
  • 19. National Centre for AIDS and STD Control Element 4: Treatment, Care and Support Medical Treatment Care and Social support Provide treatment care and support to HIV infected parents, infants and their family members Ensure regular physical check up of woman, infant and their family member- lab investigation, FP services, SRH care, STI , oral hygiene and skin care etc., Ensure nutritional care carbohydrate, protein, and vitamin enriched food Ensure PLHIV linkages-encourage to participate PLHIV group, social care protection, palliative care, CHBC and religious group for physical, social, economic and psychosocial support Provide follow up care, information for HIV exposed babies
  • 20. National Centre for AIDS and STD Control Linkages for HIV-Exposed Infants and Children Infants & children born to HIV-infected mothers require regular follow-up care, mainly during first two years of life Immunizations, HIV testing (PCR, Antibody Test) Prophylaxis for Pneumocystis pneumonia, other common infections Monitoring: feeding, nutrition, growth & development Linkage essential for HIV-exposed children as they are at higher risk for illness and malnutrition: May be infected with HIV and become illeven with adequate healthcare and nutrition If receiving replacement feeding, may be at risk of infections and malnutrition If mother is ill, she may have difficulty caring for her children
  • 21. National Centre for AIDS and STD Control Key Points A comprehensive approach is needed to prevent HIV in children. The four elements of PMTCT are: Primary prevention of HIV infection Prevention of unintended pregnancies among HIV infected women Prevention of HIV transmission from women to their infants Provision of treatment, care and support to women infected with HIV, their infants and families MCH services, especially ANC care, are an entry point to services required to meet the needs of HIV-infected women and their families