PMTCT: Counseling of Pregnant Women. Amungwa Athanasius Nche, Public Health Specialist HIV/AIDS Training Officer/Counselor, UNMISS Amungwa Esther Nju, Social Worker Social Action Chief/counselor /Social Worker, Regional/Day Hospitals.
Lesson objectives : At the end of this session, you will be able to:• Briefly explain the place of counseling of pregnant mothers in services related to prevention mother to child transmission of HIV( PMTCT) including the role of health facilities in PMTCT.• Identify the issues and challenges of counseling pregnant women;• Explain how the counseling of pregnant women could scale up PMTCT services;• Identify the gaps that may exist in a PMTCT programme which may affect the counseling of pregnant women;• Identify key actions points related to scaling up PMTCT services.
Why Counseling Pregnant is important?Counseling can benefit pregnant (would-be)women who are either HIV-positiveor unaware of their HIV status. It facilitates their making informed choices aboutwhether to become pregnant if HIV-infected; whether to take a test beforepregnancy; and, if pregnant, whether to terminate the pregnancy, where abortionis legally available.For those already pregnant, counseling can also discuss the use of zidovudine(ZDV, also known as AZT), where available, to reduce the risk of transmittingHIV to the unborn child, and breastfeeding and other infant feeding options.Where possible, and when the woman agrees, it is advantageous to involve hermale partner in the counseling sessions. Ideally, women should have counselingavailable to them before they become pregnant.Source:UNAIDS Technical update:Counsellingand HIV/AIDS
Importance of Counseling Pregnant women in HIV/AIDSPrimary prevention of new infections;Prevention of unintended pregnancies among womenliving with HIV for HIV+ women not desiring children•3.Reduction of HIV transmission from the pregnant HIVpositive Women from 35%-<2% through education and theuse of Nevirapine.•3.Prevention of HIV transmission from mothers living withHIV to their infants; and•4.Care, treatment, and support for mothers living withHIV, their children, and families.
Role of Health Facilities in PMTCTCapacity building - whichincludes training of peer Research: which focuses oneducators and counselors linking institution-based PMTCT services with primary prevention among youngQuality assurance: Monitoring women and with communityinputs provided through based services for care andtraining, counseling and Anti- supportRetroviral (Nevirapine). Safer infant feeding toMonitoring and reduce HIV transmission toevaluation(supporting data the baby after deliverycollection, compilation, analysisand analysis dissemination ofresults
Scaling Up Counseling of Pregnant Women Ante-Natal Care Group Education and Pre-test counseling HIV Testing(after informed consent) Post-Test Counseling Institutional delivery : Safe Birthing Practices Administration of Nevirapine to the woman during labor Administration of Nevirapine within existing norms and standards. Counseling of mother for safer infant feeding options. Care and support.
Enrollment Procedure OfferedANC Group HIV test EducationOne-To-One Client may opt-in(accept) or opt-out(refuse) Post-Test HIV If client accepts Counseling Test Pre-TestHIV + HIV - Counseling One-To-OneEnrollment: Primary PreventionAZT/NVP Proper care, support and follow up
Existing Gaps in PMTCT ProgrammesInadequate expansion of PMTCT services beyond the large deliveryunits for all women to access to the services.Low proportion of HIV infected women receive the Nevirapineprophylaxis. .Over focus on identifying infected women as against the HIV..Lack of research to help identify and prioritise high prevalencedistricts for concentrated actionPrivate sectors not involved in monitoring and evaluation.
Strategies to scale up PMTCT:1. Scale up services to all districts;1. Greater involvement of the private sector.2. Assure of services in the existing centers to retain all women coming to these centers.1. Care, Support and Treatment services for women and children to be a priority so that in the counseling of pregnant women is assured.2. PPTCT Programme will be one of the Entry Points for ART3. Strengthening the other entry points for counseling pregnant women(VCCT centers, TB DOTS centers, STI clinic, Blood banks and networks of people living with HIV and AIDS.
Issues and challenges• Scaling up the access to PMTCT services• Focusing on quality Counseling services• Streaming client Flow• Emergency counseling and testing• Strengthening referral links and services• Creating awareness among all women including young ones.
Broad Strategies• Improve on population-based PMTCT;• Defining a minimum package of services to be provided at the different levels of care including standard operating procedures for strengthening linkages between PMTCT and ART services;• Strengthening follow up services for HIV positive mothers and their children within a continuum of prevention and care, and support;• Intensifying HIV/STI/RH preventive interventions for HIV negative pregnant women in the context of PMTCT
Key action pointsDecreasing the loss to follow up in the existing PMTCT centers.Strengthening emergency counseling and testing service at all PMTCTsites.Improving on(scaling up) PMTCT services to cover all public health caresites.Building up and strengthening public private partnershipsIncreasing access to quality counseling services to women in thereproductive age group and enhancing institutional deliveries.Building capacity of all health care providers (up to grassroots level) inHIV /AIDS counseling and management of HIV /AIDS cases.Linking PMTCT programme to existing primary prevention and care andsupport programs for HIV /AIDS in regions and strengthening links withPeople Living with HIV /AIDS networks (PLHA) of all PMTCT servicesites.
ConclusionThe center of PMTCT is counseling of thepregnant who is the main actor in theprogramme as far adherence and uptake areconcerned. This is why much emphasisshould be placed on the counseling of thepregnant woman.