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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