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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

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

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

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

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)

and STD Control
Primary Prevention: Issues for Women
• Especially for young women, successful
implementation of the “ABCs” may require support
• Factors contributing to women’s 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

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: HCW’s 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

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

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)

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

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

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

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
(Continued)
Condoms
Hormonal contraceptives
IUDs
Sterilization

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.

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

and STD Control
(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

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

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

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

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 ill—even 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

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

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4. National PMTCT Training Module 2 Session 2.ppt

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