HIV IN PREGNANCY Geneva Foundation for Medical Education and Research GFMER Sudan 2012 Forum No: ( 2 )
NAME OF PRESENTERName Position InstitutionDr. Amal Khalil Coordinator of UMST Reproductive & Child Health Research Unit (RCRU). Name of contributors Name Position Institution Dr . Hani Mohammed Medical Director Um Bakhita Maternity .H Ibrahim Research Assistant at UMST (RCRU). Dr . MAJDI Pharmacist/ MSc. Public UMST SABAHELZAIN and Tropical Health
CONTENT OF THEPRESENTATION MTCT PMTCT in Sudan PMTCT Centers Prevention of MTCT
MTCT largest source of HIV infection in children below the age of 15 years (95%). < 80% of MTCT occurs late in the third trimester, during labour and delivery. vaginal delivery, duration of membranes rupture, chorioamnionitis, preterm delivery and breast feeding.
INCREASED RISK OF MTCT IN well advanced maternal HIV disease. low antenatal CD4 T- lymphocyte counts . high mean plasma viral.
TIMING AND RISK OFTRANSMISSION Transmission RateDuring pregnancy 5 – 10%During labour & delivery 10 – 20%During breast feeding 5 – 20%Overall without breastfeeding 15 – 30%Overall with breast feeding till 6 months 25 – 35%Overall with breast feeding till 18 to 24 30 – 45%months
PMTCT IN SUDAN A pilot project was implemented in four states to examine the applicability of such an intervention before starting a nationwide implementation. result of this project was 6593 pregnant women counseled, 927 tested and 7 was found to be positive and the prevalence was 0.76%.
PMTCT CENTERS 2007: 7 centers in high prevalence areas of South Darfur, Khartoum, Kassala, North Kordofan and Red Sea. 7,848 pregnant women attending had access to PMTCT services by receiving routine counseling and testing.
HIV PREVALENCE AMONG WOMENATTENDING PMTCT SERVICES IN SUDANFROM AUGUST 2007 TO JULY 2008Site Total tested Total positive Prevalence %Omdurman 525 12 2.28Saudi Hospital 1159 1 0.086Turkey Hospital 1185 4 0.34Port Sudan 219 4 1.8Kassala 994 8 0.8Elobeid 497 4 0.8Nyala 727 2 0.27Total 5306 35 0.66
BENEFITS OF HIV TESTING FORPREGNANT WOMEN? A mother who knows early in her pregnancy that she is HIV infected has more time to make important decisions. She and her health care provider will have more time to decide on effective ways to protect her health and prevent mother-to child transmission of HIV She can also take steps to prevent passing HIV to her partner.
IN SUDAN… Awareness about mother-to-child transmission of HIV is 26.4%. Knowledge of ways of mother-to-child transmission of HIV (all three means of vertical transmission) is 54%.
SHHS 2006State Awareness about Knowledge of ways of mother-to-child mother-to-child transmission of HIV transmission of HIV (%) (%)Khartoum 82.1 35.7River Nile 75.7 40.8W. Darfur 21.0 12.5S. Kordofan 37.6 19.8
PREVENTION OF MTCT using antiretroviral therapy (ART)- two complementary goals: to prevent the transmission of HIV to the unborn child and to safeguard the health of the mother. delivery by elective caesarean section. vaginal under certain precautions avoidance of breast feeding (risk highest in first 3 months). Formula feeding is associated with reduction of MTCT to around 14%.
INFANT FEEDING RECOMMENDATIONS FOR HIV-POSITIVE WOMEN•When replacement feeding is acceptable,feasible, affordable, sustainable and safe,avoidance of all breastfeeding by HIV-infectedmothers is recommended.•Otherwise, exclusive breastfeeding isrecommended during the first months of life.