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Unit 3 counseling for pmtct
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Unit 3 counseling for pmtct

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  • 1. Counselling and testing in PMTCT context
  • 2. Session Objective and content
    • Objective: At the end of the session the participant should be able Discuss counselling and testing in the PMTCT context
    • Content
        • General information on PMTCT in ANC
        • Counselling (individual counselling, spouse involvement, confidentiality)
        • Testing (opt in opt out approaches, timing of testing -- pre pregnancy, antenatal, intrapartum, postpartum)
  • 3. Benefits of testing
    • PMTCT
    • Prevention of opportunistic infections
    • Reduction of HIV transmission risk
    • Access to care
    • Future Planning
  • 4. Confidentiality in TC in PMTCT
    • All patient information is kept private.
    • Information is shared only with providers directly involved in care—and only on a “need to know” basis.
    • All medical records and registers are kept in secure place.
  • 5. General information
    • All pregnant women should receive information on
      • Safer sexual practices
      • Prevention and treatment of STIs
      • PMTCT
        • HIV and AIDS
        • Transmission and prevention
        • HIV testing and test result interpretation
        • Availability of counseling and follow-up services
  • 6. Pre test counselling in PMTCT
    • Clarify the purpose, advantages, and disadvantages of testing
    • Ensures understanding of the TC process
    • Respects the client's testing decision
  • 7. Post test counseling in PMTCT
    • Always give results in person.
    • Post-test counseling for all.
      • Provide the test result.
      • Help the woman understand the test result.
      • Encourage risk-reducing behaviour.
      • Encourage disclosure and partner testing.
    • Post test counseling for HIV-positive result
      • Clarify understanding.
      • Acknowledge feelings.
      • Review benefits of knowing HIV status.
      • Address immediate concerns.
      • Schedule follow - up visit.
      • Provide name and telephone number of clinic and contact person.
  • 8. Approaches to HIV Testing in PMTCT
    • Opt-In
    • Explicit request to be tested
    • Written or verbal informed consent
    • Opt-Out
    • Testing routinely offered
    • Clients not explicitly asked to be tested
    • Client may refuse
  • 9. Opt-Out strategy
    • Opt-Out approach
    • Normalises HIV testing by integrating it into ANC care
    • Increases the number of women who receive testing and PMTCT interventions
    • May increase the uptake of PMTCT services including testing
  • 10. Algorithm for Use of 3 Rapid HIV Tests (Serial Testing) First HIV Rapid Test Pre-Test Education and/or Counselling Positive Test* Result Negative Test Result/Counsel for Negative Result Second HIV Rapid Test Positive Test Result/Counsel for Positive Result Negative Test Result Third HIV Rapid Test Positive Test Result/Counsel for Positive Result Negative Test Result/Counsel for Negative Result * In the context of labour in a MTCT-prevention setting, it is advised to give a single dose of nevirapine on the basis of a single positive rapid test. This should then be confirmed after delivery.
  • 11. Diagnosing HIV in Infants Exposed to HIV
    • Antiretroviral prophylaxis reduces but does not eliminate MTCT transmission of HIV infection.
    • Since maternal antibodies cross the placenta, antibody testing is not recommended prior to 18 months of age.
    • Infants who are breastfeeding require additional testing once breastfeeding has completely discontinued.
  • 12. Antibody Testing of the Infant Exposed to HIV
    • Non-breastfeeding
    • At or after 18 months of age:
    • Negative HIV antibody test indicates that the child is not infected.
    • Positive HIV antibody test indicates that the child is infected.
    • Breastfeeding
    • At or after 18 months of age:
    • Negative HIV antibody test should be repeated 6 weeks after complete cessation of breastfeeding.
    • Positive HIV antibody test indicates that the child is infected.
  • 13. HIV DNA PCR in Infants
    • Detects presence of virus (antigen) in the blood
    • Can be done as early as 48 hours after birth
    • Early diagnosis means early treatment and care.
  • 14. DNA PCR in Exposed Infants
    • For children who are not breastfeeding:
      • Consider testing the neonate before 48 hours (optional) and if positive, the child is considered HIV-infected during pregnancy.
      • If negative, child could still be infected during delivery and will need to be re-tested at 1–2 months and possibly 3–6 months.  
    • For children who are breastfeeding:
      • Consider testing the neonate before 48 hours and if positive, the child is considered HIV-infected during pregnancy.
      • If negative, child could still be infected during delivery and will need to be re-tested at 2–6 months.
      • If positive at 2 – 6 months of age, a second viral assay should be repeated as soon as possible on a second blood specimen. A second positive viral assay confirms that the infant has HIV infection.
  • 15. Working with Couples
    • Provides TC to male partners
    • Emphasises male responsibility to protect the health of partner and family
    • Reduces “blaming” the woman
    • Identifies discordant couples
  • 16. Timing of testing
    • Pre pregnancy- ideal
    • Antenatally – as Early as possible
    • Intrapartum
    • Post partum
    • Post pregnancy

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