2. "Mothers known to be HIV-infected… should
exclusively breastfeed their infants for the first 6
months of life, introducing appropriate
complementary foods thereafter, and continue
breastfeeding for the first 12 months of life.” World
Health Organization
3.
4. Martina a 30 year old pregnant lady comes for an ANC
visit at 21 weeks gestation and tests HIV positive.
What will you do for her?
5. Martina reveals that she does not want to disclose her
status to her joint family members.
She lives in a thatched house and has no electricity
Her source of fuel is wood or occasionally charcoal
They fetch water from the nearby well.
6. Martina is in good health and is in WHO stage 1.
Her CD4 count is 425 and hb 12.7g/dl
What medications will you put her on?
8. In many countries, both health services and
individual mothers have not been able to adequately
support and provide safe replacement feeding.
HIV-positive mothers have faced the dilemma of
either giving their babies all the benefits of
breastfeeding but exposing them to the risk of HIV
infection, or avoiding all breastfeeding and increasing
the risk of death from diarrhoea and malnutrition
9. At AIDS 2010, WHO released new guidelines on
PMTCT and infant feeding practices.
Kenya has adapted these guidelines
If widely implemented, these guidelines will provide
the basis for more effective PMTCT interventions in
resource-limited settings, and will virtually eliminate
the number of new paediatric HIV infections.
For the first time, the elimination of mother-to child
transmission of HIV (MTCT) is considered a realistic
public health goal.
10. 1. Earlier antiretroviral therapy (ART) for a larger group
of HIV-positive pregnant women to benefit both the
health of the mother and prevent HIV transmission to
her child during pregnancy and breastfeeding.
11. 2.Longer provision of antiretroviral (ARV) prophylaxis
for HIV-positive pregnant women with relatively
strong immune systems who do not need ART for
their own health. This would reduce the risk of HIV
transmission from mother to child.
12. 3.Provision of ARV prophylaxis to the mother or child
to reduce the risk of HIV transmission during the
breastfeeding period. For the first time, there is
enough evidence for WHO to recommend ARVs
while breastfeeding.
13. Lifelong ART for HIV-infected women in need of
treatment for their own health, which is also safe and
effective in reducing mother to child transmission of
HIV (MTCT).
Short-term ARV prophylaxis to prevent MTCT during
pregnancy, delivery and breastfeeding for HIV-
infected women not in need of treatment.
14. Mother takes ARVs from 28th week
of pregnancy until 1 week after
labour, or for an indefinite amount
of time if the mother is taking ARVs
for their own health.
Short ARV regimen during
breastfeeding period for either
mother and/or infant
Exclusive breastfeeding for 6
months
Rapidly wean from breastmilk
No mixed feeding
Not recommended to breastfeed
after 6 months
Mother takes ARVs from 14th week
of pregnancy until 1 week after
labour, or for an indefinite amount
of time if the mother is taking ARVs
for their own health.
Long ARV regimen during
breastfeeding period for either
mother and/or infant
Exclusive breastfeeding for 6
months
Gradually wean from breastmilk
Mixed (complementary) feed after 6
months
Recommended to breastfeed and
mix feed in conjunction with ARVs
2010 WHO Infant Feeding
Guidelines
15. A mother may decide to breastfeed exclusively, but
may start giving her infant additional fluids because
she does not believe she has enough breastmilk.
16. "The family will tell her
that breast milk is not
enough for the baby, she
must also mix it with
formula feeding, and she
can’t deny that because
she hasn’t told them why
she chose to exclusively
breastfeed her baby so
she will just mix feed.”
South African health
worker
17. It is the only 100 percent effective way to prevent mother-
to-child transmission of HIV after birth, but the risk of
infant mortality from other illnesses such as diarrhoea
must be taken into account.
The World Health Organization recommends that
replacement feeding for women in low and middle-income
countries should only be implemented if the following
circumstances are achieved or appropriate, which can be
summarised as AFASS:
19. Breastfeeding is the norm in most cultures, and is
generally encouraged by health workers. By choosing
not to breastfeed, a mother risks revealing that she is
HIV positive, and becoming a target for stigma and
discrimination.
She must be able to cope with this problem and resist
pressure from friends and relatives to breastfeed.
20. A mother must have adequate time, knowledge, skills and other
resources to prepare the replacement food and feed her baby up
to twelve times in 24 hours.
Boiling water over a charcoal stove, for instance, can take up to
fifteen minutes per feed. Unless refrigerated, prepared formula
becomes unsafe after just two hours.
It is better to feed with a cup rather than a bottle because cups
are easier to clean, and because cup feeding promotes greater
interaction between the mother and her baby
23. Feeding an infant for the first six months of life
requires around 20 kg of formula and regular access
to water.
24. Replacement food should be nutritionally sound and
free from germs. The water should be boiled, and
utensils should be cleaned (preferably boiled) before
each use.
This means the mother must have access to a reliable
supply of safe water and fuel.
25. PREPARING feeds
GIVING feeds
NEED for sterile equipment AND hygiene
TAUGHT correct dilution
ADVISED on dangers of keeping prepared formula for
long periods at room temperature.
28. The 2010 guidelines have great potential to improve
the mother’s own health and to reduce mother-to-
child HIV transmission risk to 5% or lower in a
breastfeeding population, from a background
transmission risk of 35% (in the absence of any
interventions and with continued breastfeeding).
