This is a lecture for medical students of the Cebu Institute of Medicine as an orientation on the prevalence of HIV infection in the Philippines, the basic knowledge on HIV and the program on prevention of mother to child transmission of HIV.

1. HIV IN PREGNANCY
Helen V. Madamba, MD MPH-TM DHPEd FPOGS FPIDSOG
13 August 2020

2. HIV PREVALENCE
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3. The decrease of cases
in March 2020 might
be attributed to
reduction in HIV
counselling and
testing due to the
COVID-19 pandemic.
https://www.doh.gov.ph/sites/default/files/statistics/EB_HARP_Jan-Mar_AIDSreg2020.pdf
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4. Majority of patients belong
to the 15 to 34 years old age
group – the reproductive
years.
https://www.doh.gov.ph/sites/default/files/statistics/EB_HARP_Jan-Mar_AIDSreg2020.pdf
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5. https://www.doh.gov.ph/sites/default/files/statistics/EB_HARP_Jan-Mar_AIDSreg2020.pdf
Decrease in number patients
initiated on ART
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6. https://www.doh.gov.ph/sites/default/files/statistics/EB_HARP_Jan-Mar_AIDSreg2020.pdf
Increase in total newly diagnosed
Increase in advanced HIV infections
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7. https://www.doh.gov.ph/sites/default/files/statistics/EB_HARP_Jan-Mar_AIDSreg2020.pdf
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8. https://www.doh.gov.ph/sites/default/files/statistics/EB_HARP_Jan-Mar_AIDSreg2020.pdf
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9. https://www.doh.gov.ph/sites/default/files/statistics/EB_HARP_Jan-Mar_AIDSreg2020.pdf
MSM
PWID
M-F SEX
The most prevalent mode
of transmission should
dictate the method of HIV
prevention.
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10. https://www.doh.gov.ph/sites/default/files/statistics/EB_HARP_Jan-Mar_AIDSreg2020.pdf
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11. https://www.doh.gov.ph/sites/default/files/statistics/EB_HARP_Jan-Mar_AIDSreg2020.pdf
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12. https://www.doh.gov.ph/sites/default/files/statistics/EB_HARP_Jan-Mar_AIDSreg2020.pdf
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13. BASIC HIV KNOWLEDGE
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14. What is HIV?
•H – human
•I – immunodeficiency
•V - Virus
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15. What are the stages of HIV infection?
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16. What are the modes of transmission
of HIV infection?
1. Unprotected penetrative sexual intercourse
with an infected individual
2. Transfusion or exchange of infected blood
3. From an infected mother to her unborn
child
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17. What are the four body fluids that
transmit HIV infection?
1. Seminal fluid
2. Vaginal fluid
3. Blood
4. breastmilk
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18. What are the methods of prevention of
HIV infection?
A – abstinence
B – be mutually faithful
C – check your status
D – don’t inject drugs
E – educate yourself and others
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19. PREVENTION OF MOTHER TO
CHILD TRANSMISSION OF HIV
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20. PREVENTION OF MOTHER TO CHILD
TRANSMISSION OF HIV INFECTION
•Prong 1 - Primary prevention of HIV among
women of child-bearing age.
•Prong 2. Preventing unintended pregnancies
among women living with HIV.
•Prong 3. Preventing HIV transmission among
women living with HIV to her infant.
•Prong 4. Providing treatment, care and support
to women living with HIV, their children and
their families.
https://www.hsph.harvard.edu/population/aids/philippines.aids.09.pdf
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21. PRONG 1: Primary prevention of HIV
among women of child-bearing age.
•Adolescent reproductive health
programs
•Sex education in schools
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22. HIV AND STI
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23. STI LINK WITH HIV
•Same modes of transmission
•Same preventive measures
•STI services is the entry point for HIV services
•Persons with STI have higher risk of acquiring
and transmitting HIV
•Persons with STI should be treated and offered
HIV testing
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24. PRONG 2: Preventing unintended pregnancies
among women living with HIV
DUAL PROTECTION
• Protection from unintended pregnancies
• Protection from HIV transmission
POGS Clinical Practice Recommendations on PMTCT
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25. PRONG 2: Preventing unintended pregnancies
among women living with HIV
•Choosing sexual activities that do not
allow semen, fluid from the vagina, or
blood to enter the mouth, vagina or anus
of the partner
•Correct and consistent use of condoms
during every sexual act
•Reducing the number of partners
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26. PRONG 3: Preventing HIV transmission among
women living with HIV to her infant
•Antenatal care, HIV screening, ARV
initiation
•Peripartum interventions: management
of delivery
•Postpartum infant feeding and
puerperium
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27. HIV Screening
Preliminary Counselling Dialogue
•Providers of obstetric care should
inform the patient that an HIV
screening test will be performed as
part of the recommended routine
antenatal package of tests of
infections (HBsAg, RPR/VDRL,
rubella IgG, papsmear, urine culture)
POGS Clinical Practice Recommendations on PMTCT
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28. HIV Screening
Preliminary Counselling Dialogue
Key Message:
The fact that you are pregnant is an
evidence of unprotected penetrative
sexual contact which is a mode of
transmission for HIV.
POGS Clinical Practice Recommendations on PMTCT
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29. Anti-retroviral (ARV) Drugs
Eligibility for ARV Prophylaxis
•start triple ARVs as soon as diagnosed
and continued for life
4 weeks ART initiation
before delivery
POGS Clinical Practice Recommendations on PMTCT
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30. Management of Delivery
POGS Clinical Guidelines on HIV 2015
An elective cesarean delivery is
scheduled at 38 weeks AOG
Emergency CS is done for those in
labor and with ruptured membranes <4
hours unless delivery is imminent
POGS Clinical Practice Recommendations on PMTCT
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31. Management of Delivery
POGS Clinical Guidelines on HIV 2015
Vaginal delivery maybe done when the
risk of maternal to child transmission is
low:
- those who had ARV treatment
- HIV viral load <1000 copies/ml
- if with ruptured membranes, the time
elapsed should be <4 hours to delivery
POGS Clinical Practice Recommendations on PMTCT
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32. Management of Delivery
Essential Intrapartum Newborn Care (EINC)
Thoroughly dry newborn infant
×vigorous suctioning
Skin to skin bonding should be encouraged
×Delayed clamping of umbilical cord is NOT
recommended.
Latching on is done ONLY IF breastfeeding has
been chosen.
POGS Clinical Practice Recommendations on PMTCT
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33. Infant Feeding
•continuing ARV medications
•replacement feeding: acceptable, feasible,
affordable, sustainable and safe (AFASS)
•risks, follow up and other options for
replacement feeding
•relieve breast engorgement
POGS Clinical Practice Recommendations on PMTCT
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35. PRONG 4: Providing treatment, care and support to
women living with HIV, their children and their families
•Immunization
•Healthy Lifestyle
•STI & Cancer Screening
•Opportunistic Infections
•Support Groups
•Livelihood Skills Training
•Advocacy to reduce Stigma and Discrimination
•HIV Awareness Campaigns
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36. Framework of WHO
recommendations and
good practice
statements to advance
the sexual and
reproductive health and
rights of women living
with HIV
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37. https://www.facebook.com/apulsipher/
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38. https://www.facebook.com/apulsipher/
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39. #HealthXPH tweetchat
•Healthcare Conversations on Twitter
•Saturdays 9:00 p.m. to 10:00 p.m.
•@helenvmadamba
•https://www.facebook.com/Helen-V-Madamba
•http://www.slideshare.net/HelenMadamba
•http://helenvmadamba.blogspot.com/
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40. HIV IN PREGNANCY
Helen V. Madamba, MD MPH-TM DHPEd FPOGS FPIDSOG
13 August 2020
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