Prevention of parent to child transmission programme


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Prevention of parent to child transmission programme

  1. 1. Mother to child transmissionof HIV and Breast feeding<br />A. Narendra<br /> 1<br />
  2. 2. HIV can Spread through :<br />2<br />Transfusion of infected blood/ blood produts<br />3<br />Sharing of contaminated needles/syringes <br />4<br />Infected mother to child<br />1<br />Unprotected sex with an infected person <br />
  3. 3. Mother To Child Transmission Of HIV<br />Problem statement<br />About 2% of HIV cases reported in India have acquired the infection through mother to child transmission<br />In India prevalence rate of HIV is more than 1% among ANW in states of Maharashtra Karnataka TamilNadu, Andhra Pradesh, Manipur, Nagaland.<br /> ( High Prevalence states)<br />
  4. 4. High Prevalence States<br />Maharashtra <br />Karnataka <br />Tamil Nadu, <br />Andhra Pradesh, <br />Manipur, <br />Nagaland.<br />
  5. 5. Mother to child transmission<br />Mothers with HIV can transmit virus to their infants during pregnancy, childbirth and breast feeding.<br />
  6. 6. Risk of transmission is more during child birth<br />
  7. 7. Maternal <br />Risk factors for Mother to child transmission during pregnancy and delivery<br />MTCT<br />Obstetrical <br />Child<br />Viral<br />
  8. 8. Stage of maternal HIV disease<br /><ul><li>Whether in early or advanced stage</li></ul>Maternal nutritional Status<br /><ul><li>Maternal malnutrition increases the risk</li></ul>Disruption of Placental barrier integrity<br />Maternal factors<br /><ul><li>Infection of placenta increases the risk</li></ul>STD during pregnancy<br /><ul><li>STD increases the risk of transmission</li></li></ul><li>Vaginal delivery over cesarean section<br />Preterm delivery <br />Breast feeding <br />Rupture of membranes<br /><ul><li>Elective cesarean section decreases the risk
  9. 9. A low birth weight baby is at higher risk
  10. 10. Mixed feeding increases the risk
  11. 11. Early rupture of membranes increases the risk </li></ul>Obstetrical factors<br />First born among twin pregnancy<br />
  12. 12.
  13. 13. During child birth<br />During pregnancy<br />When we can take measures to prevent child to mother transmission <br />During breast feeding<br />Before pregnancy<br />
  14. 14. IEC activities<br />Family planning<br />Counseling & testing<br />Primary preventive strategies<br />Prevention of getting HIV infection among mothers , before they become pregnant<br />Delivery of FP services more extensively<br />Education the adolescent girls about reproductive health , safe sex and consequences of sexual behaviour<br />Referring to ICTC<br />Indentify HIV infected women in antenatal period<br />
  15. 15. Secondary preventive strategies<br />Multivitamin supplementation<br />Avoid invasive procedures<br />Anti retroviral therapy<br />Measures to reduce or prevent the risk of transmission during pregnancy and child birth<br />to reduce the risk of LBW.<br />amniocentesis, aminoscopy, fetal scalp electrodes etc.<br />Measures of PMTCT during pregnancy:<br />
  16. 16. Avoid invasive procedures<br />The procedures that either increase the chance of the mother bleeding or may cause breaks in the skin of the fetus through which there may be direct contact with the mother’s blood or vaginal secretions will increase the risk of transmission of HIV from mother to child.<br />These procedures can increase risk of transmission.<br />Amniocentesis <br />Aminoscopy<br />Fetal scalp electrodes <br />Fetal sampling<br />
  17. 17. Zidovudine<br />Anti-retroviral therapy <br />various regimens are recommended.<br />300mg twice a day for the full course of pregnancy from the second trimester may be initiated.<br />Another regimen: ZDV 300mg bd from 34th week of pregnancy till delivery]. <br />
  18. 18. Measures of PMTCT during <br />child birth:<br />Antiretroviral therapy<br />Prevention of premature rupture of the membranes<br />Mode of delivery<br />Care of the new born<br />
  19. 19. Zidovudine<br />Antiretroviral therapy during child birth<br />ZDV 300mg ,three hourly during delivery;<br />If the mother is brought during labor and if there is no H/o ART during pregnancy , she is given 200mg Nevirapine [NPV]as a single dose at the onset of labor.<br />This reduces the risk of transmission from 35% to 12%.<br />Under PPTCT programmeNevirapine is given<br />
  20. 20. Prevention of premature rupture of the membranes<br />Recent studies showed that the risk of mother-to-child transmission increased 2% each hour after membranes ruptured.<br />Mode of delivery<br />Cesarean section before labor and/or rupture of membranes reduces risk of mother-to-child transmission by 50–80% compared with other modes of delivery<br />No evidence of benefit with cesarean section after onset of labor or membranes have been ruptured<br />Cesarean section, however, increases morbidity and possible mortality to mother<br />
  21. 21. Mode of delivery<br />If at all vaginal delivery/home delivery has to be conducted due to constraints of resources like hospital or experts or equipments or money, it should be conducted carefully by the health personnel, preferably by avoiding episiotomy.<br />If at all the episiotomy is given, it needs to be sutured as early as possible to reduce the risk of occupational exposure.<br />
  22. 22. Universal precautions are very important<br />Recommended Infection Prevention Practices<br /><ul><li>Needles:
  23. 23. Take care! Minimal use
  24. 24. Suturing: Use appropriate needle and holder
  25. 25. Care with recapping and disposal
  26. 26. Wear gloves, wash hands with soap immediately after contact with blood and body fluids
  27. 27. Cover incisions with watertight dressings for first 24 hours
  28. 28. Use:
  29. 29. Plastic aprons for delivery
  30. 30. Goggles and gloves for delivery and surgery
  31. 31. Long gloves for placenta removal
  32. 32. Dispose of blood, placenta and waste safely</li></ul>PROTECT YOURSELF!<br />
  33. 33. Gloves Before touching blood , body fluids, mucus membranes, non intact skin or performing venepuncture<br />Dispose of needles with syringes and sharp instruments in puncture resistant container<br />Hand washing<br />Wash hands immediately with soap after gloves are removed<br />Do not recap needles or otherwise manipulate by hand before disposal<br />Mouth piece of resuscitator bags should be available to minimize need for emergency mouth to mouth resuscitation<br />Masks & protective eye ware shields from splashes of blood or body fluids, <br />Waste and soiled material should be disposed properly<br />Gown/apron<br />For produres likely to generate splashes of blood or body fluids, <br />
  34. 34. Care of the new born<br />Suction from the throat first flowed by that from nose to prevent swallowing of the secretions.<br />Wipe the baby’s body thoroughly with warm, clean towel to remove the any blood stained secretions.<br />Administer single dose of NPV [nevirapine] 2mg/kg syrup orally to the child within 72 hours after birth<br /><ul><li>Follow up of the body to check for HIV infection after 18 months of age.[HIV test is not useful before 18 months of age].</li></li></ul><li>Breastfeeding<br />Formulafeeding<br />Breast feeding Issues<br /><ul><li>associated with a 14% risk of HIV transmission to newborns, yet provides nutrition for the newborn
  35. 35. Inexpensive method of feeding and contraception.
  36. 36. also poses risks to the newborn, such as diarrhea from contamination of formula with unclean water or malnutrition from formula being too dilute.</li></li></ul><li>Cracked nipples/breast abscess or mastitis<br />Factors associated with breastfeeding and mother-to-child transmission:<br />Newborn oral thrush<br />Duration of breastfeeding<br />Exclusively breastfeeding versus breastfeeding and formula feeding.<br />
  37. 37. Breastfeeding Recommendations<br /><ul><li>Ensure adequate nutrition of mother during postnatal period
  38. 38. If the woman is:
  39. 39. HIV-negative or does not know her HIV status, promote exclusive breastfeeding for 6 months
  40. 40. HIV-positive and chooses to use replacements feedings, counsel on the safe and appropriate use of formula
  41. 41. HIV-positive and chooses to breastfeed, promote exclusive breastfeeding for 6 months
  42. 42. Inform mother to avoid breastfeeding if she has crackled nipples , mastitis or breast abscess</li></li></ul><li>South Africa Breastfeeding Trial: Objective and Design<br />Objective: <br /> To assess whether pattern of breastfeeding is a critical determinant of early mother-to-child transmission of HIV<br />549 HIV-infected women studied<br />Compared newborns at 3 months that had been:<br />Exclusively breastfed<br />Breastfed and formula-fed<br />Never breastfed<br />
  43. 43. 27<br />Results <br />Risk of transmission in:<br />156 newborns who were never breastfed: 18.8% (95% CI 12.6–24.9)<br />288 newborns who were breastfed and formula fed: 24.1% (95% CI 19.0–29.2)<br />103 newborns who were exclusively breastfed: 14.6 (95% CI 7.7–21.4)<br />Conclusion: <br />Newborns who were exclusively breastfed for at least 3 months did not have any excess risk of HIV infection compared to newborns who were not breastfed<br />
  44. 44. Measures to prevent child to mother transmission <br />Before pregnancy<br />During pregnancy<br />During child birth<br />During breast feeding<br /><ul><li>IEC
  45. 45. Family planning
  46. 46. Counseling & testing
  47. 47. Multivitamin supplementation
  48. 48. Avoid invasive procedures
  49. 49. Anti retroviral therapy
  50. 50. Antiretroviral therapy
  51. 51. Prevention of premature rupture of the membranes
  52. 52. Mode of delivery
  53. 53. Care of the new born
  54. 54. Counseling
  55. 55. Maternal nutrition
  56. 56. Exclusive breast feeding
  57. 57. Breast milk vs. formula</li></li></ul><li>AIM<br /><ul><li>To prevent the perinatal transmission of HIV from an HIV infected pregnant mother to her newborn baby.</li></ul>PPTCT programme <br />The Prevention of Parent to Child Transmission of HIV/AIDS (PPTCT) programme started in 2002 following a feasibility study in 11 major hospitals in the five high HIV prevalence states.<br />
  58. 58. The programme entails counselling and testing of pregnant women in the ICTCs. <br />Interventions <br />Pregnant women who are found to be HIV positive are given a single dose of Nevirapine at the time of labour<br />Newborn babies also get a single dose of Nevirapine immediately after birth<br />
  59. 59. Coverage <br /><ul><li>In the year 2006, 2.1 million pregnant women accessed this service. Of these, more than 16,500 pregnant women were HIV positive.</li></ul>Future <br /><ul><li>In order to provide universal access to these services further scale up is planned up to the level of Community Health Centre and the Primary Health Centre, as well as private sector by forging public-private partnerships. </li></ul>Target <br /><ul><li>Through these measures NACO hopes to achieve the UNGASS target of reducing the proportion of infants infected with HIV/AIDS by 50 percent by 2010. </li></li></ul><li>