Scale up of Prevention of Mother to Child HIV Transmission Programme in Delhi by Dr.A.K. Gupta, Additional Project Director cum Technical Lead, Delhi State AIDS Control Society, Dept of Health & Family Welfare, Govt of Delhi
We are still using SD NVP prophylaxis even though there is enough evidence that multi-drug regimens are much better. NACO, MoHFW, Govt of India is implementing new PMTCT strategy in Delhi in 2013-14 which will eliminate Pediatric HIV infections in the coming years.The presentation highlights key features of the New PMTCT Strategy of the country.
The document discusses prevention of parent-to-child transmission (PPTCT) of HIV. It outlines NACO's four-pronged strategy for PPTCT, which includes primary prevention of HIV among women, preventing unintended pregnancies in HIV+ women, preventing transmission from mother to child, and treatment/care for women and children living with HIV. It then discusses factors influencing transmission risk and interventions to reduce risk during pregnancy, delivery, and infancy including antiretroviral prophylaxis and therapy.
Based on the current NACO guidelines for prevention of parent to child transmission of HIV in India. Also describes the medication, testing and followup of children born to HIV positive mothers.
The PPTCT program in India provides services through ICTCs to test pregnant women for HIV and prevent mother-to-child transmission. If tested positive, women receive counseling, ART treatment, monitoring, and are encouraged to have institutional deliveries. Infants receive post-exposure prophylaxis. The goal is to eliminate vertical transmission through antenatal, intrapartum, postnatal care and promoting safe infant feeding practices.
Option B+ proposes providing lifelong antiretroviral therapy (ART) to all HIV-infected pregnant women beginning in antenatal clinics, continuing after delivery for life. This further simplifies services and harmonizes with ART programs. It also protects against transmission in future pregnancies and to partners. While benefits need evaluation, it is an appropriate time for countries to assess experience and options to make optimal choices. WHO advises all countries to examine goals and experiences to better integrate PMTCT and ART, with evidence from Option B+ implementation helping to inform future guidelines.
The document summarizes updates to PMTCT (prevention of mother-to-child transmission) guidelines from the WHO and DHHS. Key changes include initiating ART for pregnant women at a CD4 count of <350 cells/mm3, starting ART earlier in pregnancy to reduce viral load, and recommending combination ART or HAART as the preferred regimen over AZT alone. The rationale for these changes is the earlier initiation of HAART in non-pregnant adults, the timing of mother-to-child transmission both with and without breastfeeding, and the importance of effective regimens to reduce transmission and prevent resistance. Safety data now supports the use of 3-drug regimens during pregnancy.
The document discusses prevention of parent-to-child transmission (PPTCT) of HIV. It outlines NACO's four-pronged strategy for PPTCT, which includes primary prevention of HIV among women, preventing unintended pregnancies in HIV+ women, preventing transmission from mother to child, and treatment/care for women and children living with HIV. It then discusses factors influencing transmission risk and interventions to reduce risk during pregnancy, delivery, and infancy including antiretroviral prophylaxis and therapy.
Based on the current NACO guidelines for prevention of parent to child transmission of HIV in India. Also describes the medication, testing and followup of children born to HIV positive mothers.
The PPTCT program in India provides services through ICTCs to test pregnant women for HIV and prevent mother-to-child transmission. If tested positive, women receive counseling, ART treatment, monitoring, and are encouraged to have institutional deliveries. Infants receive post-exposure prophylaxis. The goal is to eliminate vertical transmission through antenatal, intrapartum, postnatal care and promoting safe infant feeding practices.
Option B+ proposes providing lifelong antiretroviral therapy (ART) to all HIV-infected pregnant women beginning in antenatal clinics, continuing after delivery for life. This further simplifies services and harmonizes with ART programs. It also protects against transmission in future pregnancies and to partners. While benefits need evaluation, it is an appropriate time for countries to assess experience and options to make optimal choices. WHO advises all countries to examine goals and experiences to better integrate PMTCT and ART, with evidence from Option B+ implementation helping to inform future guidelines.
The document summarizes updates to PMTCT (prevention of mother-to-child transmission) guidelines from the WHO and DHHS. Key changes include initiating ART for pregnant women at a CD4 count of <350 cells/mm3, starting ART earlier in pregnancy to reduce viral load, and recommending combination ART or HAART as the preferred regimen over AZT alone. The rationale for these changes is the earlier initiation of HAART in non-pregnant adults, the timing of mother-to-child transmission both with and without breastfeeding, and the importance of effective regimens to reduce transmission and prevent resistance. Safety data now supports the use of 3-drug regimens during pregnancy.
1) Prevention of Mother to Child Transmission (PMTCT) programs provide antiretroviral drugs, counseling, and support to pregnant women living with HIV to reduce the risk of transmitting the virus to their babies during pregnancy, childbirth, and breastfeeding.
2) Key interventions include antiretroviral prophylaxis for pregnant and breastfeeding women and their infants, safer delivery and infant feeding practices, and treatment, care and support for women and families.
3) In Tanzania, the national PMTCT program incorporates antiretroviral prophylaxis including various combination drug regimens during antenatal, intrapartum, postpartum, and infant periods, depending on when
This document provides guidelines for antiretroviral therapy (ART) for HIV-infected adults and adolescents in India, including post-exposure prophylaxis.
The guidelines were developed by the National AIDS Control Organization of India (NACO) to assist physicians prescribing ART and to provide practical recommendations for treatment of HIV/AIDS in the context of India's national ART program and the role of the private sector.
The objectives of the guidelines are to provide long-term ART to eligible patients, monitor treatment outcomes, ensure high levels of individual drug adherence, increase life spans for those on ART, and enable patients to return to employment. ART is offered to all clinically eligible persons with HIV infection.
This document summarizes India's HIV epidemic and prevention strategies. It notes that India has the third largest HIV epidemic globally, with approximately 2.5 million people living with HIV. The National AIDS Control Organization aims to reduce new HIV infections by 50% through the current NACP-IV program. It then discusses strategies for preventing mother-to-child transmission, including antiretroviral treatment protocols for HIV-positive pregnant women and breastfeeding guidelines. Finally, it outlines the role and functions of Integrated Counselling and Testing Centres in detecting HIV early and linking those infected to care.
Elimination of mother to child transmission of hivstompoutmalaria
The document discusses eliminating mother-to-child transmission of HIV by 2015. It provides facts on the magnitude of MTCT, defines elimination as reducing the transmission rate to below 5%, and outlines the tools and costs required. These include ARV regimens, family planning services, and focused efforts in the 25 highest burden countries. Peace Corps volunteers could help implement prevention activities and promote services to measure progress towards elimination goals.
Dr k prabha devi new pptct guidelines-1(1)Ratan Yadav
The document outlines new guidelines for initiating ART for HIV-infected pregnant women in India. It recommends providing lifelong ART to all pregnant and breastfeeding women living with HIV, regardless of CD4 count or clinical stage, to prevent mother-to-child transmission. This includes initiating a regimen of TDF+3TC+EFV and continuing it throughout pregnancy, delivery, and breastfeeding. It also details protocols for providing antiretroviral prophylaxis to newborns to reduce HIV transmission and the durations of prophylaxis depending on the mother's ART history.
Approximately 8,500 women living with HIV give birth annually in the US. Since the beginning of the AIDS epidemic, almost 5,000 children under age 13 who got HIV through perinatal transmission have died. New HIV infections in children have dramatically declined from 400,000 in 2009 to around 220,000 in 2014 due to efforts like the UNICEF Global Plan. Prevention of perinatal transmission is crucial since there is no HIV vaccine; it requires pregnant women to take antiretroviral therapy consistently during and after pregnancy and avoid breastfeeding. Challenges to prevention include not all pregnant women knowing their HIV status and inconsistent access to treatment.
This document summarizes guidelines for preventing mother-to-child transmission (PMTCT) of HIV. It discusses how HIV can be transmitted from mother to child during pregnancy, delivery, and breastfeeding. The overall transmission rate without intervention is 15-45%, which can be reduced below 5% with effective interventions. These include voluntary counseling and testing for pregnant women, access to antiretroviral treatment for HIV-positive mothers and their infants, safe delivery practices, and guidance on infant feeding options. The document provides details on testing and treatment recommendations during the antenatal, intrapartum, and postpartum periods to reduce HIV transmission from mother to child.
This document provides guidelines for managing HIV in pregnancy. It discusses screening all pregnant women for HIV and other infections. For HIV-positive mothers, it recommends prompt referral to a multidisciplinary team and starting combination antiretroviral therapy (cART) by 14 weeks of pregnancy to prevent mother-to-child transmission. The guidelines cover antenatal care, immunization, labor and delivery recommendations depending on viral load, and neonatal and postpartum management of HIV-positive mothers and exposed infants. The overall aim is to optimize care and reduce risk of HIV transmission through comprehensive antenatal and delivery protocols.
Mother to child transmission of HIV can occur during pregnancy, childbirth, and breastfeeding. The risk is higher if the mother's HIV infection is in an advanced stage, if she is malnourished, has other STDs, or her membranes rupture early. Antiretroviral therapy and cesarean delivery before labor can reduce transmission risk. Exclusive breastfeeding for 6 months poses a lower risk than mixed feeding. India's PMTCT program provides counseling, testing, antiretroviral prophylaxis to pregnant women and newborns to prevent transmission and aims to reduce transmission by 50% by 2010.
Lisa Bohmer worked as the HIV/AIDS Director for UNICEF in Ethiopia and presented on challenges and opportunities for preventing mother-to-child transmission of HIV/AIDS in Africa. Key points included: HIV transmission can occur during pregnancy, labor, delivery or breastfeeding; Ethiopia faces high infection rates particularly among young people and women; and challenges include stigma, improving safer birthing practices, counseling on infant feeding options, and ensuring a steady supply of drugs and testing kits. Opportunities lie in increased funding, integrating PMTCT into other health programs, and engaging communities to promote testing and reduce stigma.
1) The document discusses pharmacological principles for treating HIV in pregnant women to reduce mother-to-child transmission.
2) Updated perinatal guidelines from 2007 recommend initiating HAART after 14 weeks of gestation and continuing treatment throughout pregnancy, labor, and delivery.
3) Clinical scenarios provide examples of applying the guidelines, such as recommending HAART, scheduled C-sections if viral load is high, and 6 weeks of infant ZDV treatment starting within hours of birth.
Dr. Laura Guay, the Foundation’s Vice President of Research, also conducted a journalist training today sponsored by the National Press Foundation, teaching reporters about some of the most misunderstood issues concerning HIV and children
2018 Prevention of Mother to Child Transmission of HIV InfectionHelen Madamba
The document discusses prevention of mother-to-child transmission (PMTCT) of HIV in the Philippines. It outlines the objectives of discussing PMTCT program prongs, HIV epidemiology in the Philippines, transmission and management principles, and screening/testing during pregnancy. It provides statistics on increasing HIV prevalence in the Philippines, especially among men who have sex with men, IV drug users, and teenagers/single mothers. Modes of HIV transmission include unprotected sex and needle sharing. The document emphasizes screening, counseling, and ARV treatment during pregnancy and delivery to reduce mother-to-child transmission risk, as well as strategies to prevent unintended pregnancy and support women living with HIV.
This document discusses HIV infection in pregnancy and strategies to reduce mother-to-child transmission of HIV. It covers antepartum, intrapartum, and postpartum care for HIV-infected women including antiretroviral regimens, monitoring, testing protocols, and delivery methods. The goal is to reduce the risk of perinatal HIV transmission to less than 2% through highly effective antiretroviral therapy, elective cesarean section when appropriate, and avoiding breastfeeding.
The document discusses the effects of pregnancy on HIV-positive women and the risks of mother-to-child transmission during delivery. It states that a woman's absolute CD4 count decreases during pregnancy regardless of HIV status, but her percentage of CD4 cells and viral load do not change due to pregnancy. It also notes that invasive obstetric procedures can increase the risk of mother-to-child transmission by exposing the fetus to more infected maternal blood and secretions. Finally, it reports that a cesarean section before labor and membrane rupture can reduce transmission risk by 50-80% compared to other delivery modes for women not on antiretroviral therapy or only on ZDV, but there is no evidence of benefit for
HIV and Pregnancy : Dr Ruby Bansal (1st Session of DGF HIV Committee on 10th ...Lifecare Centre
This document discusses HIV and pregnancy in India. Some key points:
- Over 21 million people live with HIV in India, including 880,000 women. 60% of pregnant women with HIV access antiretroviral therapy (ART).
- ART and other interventions can reduce the risk of parent-to-child HIV transmission to under 2%. Without treatment, transmission rates range from 15-45%.
- Timely diagnosis and treatment of HIV-positive pregnant women is important to prevent transmission to infants. Options include different ART regimens starting during pregnancy, delivery, or breastfeeding depending on when the woman is diagnosed.
- Close coordination between HIV physicians, gynecologists, and other care providers is
Prevention of Mother to Child Transmission of HIV 2018Helen Madamba
Babies of pregnant women living with HIV can be born free of HIV infection. HIV counselling and testing is the gateway to diagnosis, treatment, care and support. Healthcare services need to provide enabling environments to support and empower women living with HIV and their children, to increase HIV knowledge and reduce stigma and discrimination.
POGS Clinical Practice Recommendations on PMTCT of HIVHelen Madamba
With guidelines from WHO and DOH, the Philippine Obstetrical and Gynecological Society (POGS) releases it clinical practice recommendation on prevention of mother to child transmission of HIV. With the concentrated Philippine HIV/AIDS epidemic in the cities and among key affected populations, it is important to target pregnant Filipino women for screening, diagnosis and treatment.
This is a lecture given to medical students of Cebu Institute of Medicine under the reproductive module. It contains a discussion of principles of HIV infection screening, diagnosis, staging and management, especially during pregnancy.
This document provides information on HIV/AIDS including:
- HIV is a retrovirus that causes AIDS by infecting CD4 cells. It can be managed but not cured.
- AIDS is the late stage of HIV infection when the immune system is severely damaged.
- The natural history of the virus is described from its discovery in 1981 through treatments developed.
- The virus's structure and life cycle involve invading cells and integrating its DNA for dormancy.
- Transmission occurs through bodily fluids like blood, semen, breastmilk. Testing and treatment can control spread.
Highly Active Antiretroviral Therapy (HAART) involves using a combination of at least three antiretroviral drugs to suppress the HIV virus and stop the progression of HIV disease. HAART decreases the viral load, improves immune function, and prevents opportunistic infections. The goals of HAART are to prolong life, improve quality of life, achieve maximal viral suppression, restore immune function, reduce HIV transmission, and rationally sequence drugs to limit toxicity while maintaining treatment options. Current guidelines recommend starting ART for all individuals regardless of CD4 count. Second line regimens are recommended when clinical or immunological failure occurs on first line therapy. Managing adverse events and comorbidities like hepatitis co-infection is also
1) Prevention of Mother to Child Transmission (PMTCT) programs provide antiretroviral drugs, counseling, and support to pregnant women living with HIV to reduce the risk of transmitting the virus to their babies during pregnancy, childbirth, and breastfeeding.
2) Key interventions include antiretroviral prophylaxis for pregnant and breastfeeding women and their infants, safer delivery and infant feeding practices, and treatment, care and support for women and families.
3) In Tanzania, the national PMTCT program incorporates antiretroviral prophylaxis including various combination drug regimens during antenatal, intrapartum, postpartum, and infant periods, depending on when
This document provides guidelines for antiretroviral therapy (ART) for HIV-infected adults and adolescents in India, including post-exposure prophylaxis.
The guidelines were developed by the National AIDS Control Organization of India (NACO) to assist physicians prescribing ART and to provide practical recommendations for treatment of HIV/AIDS in the context of India's national ART program and the role of the private sector.
The objectives of the guidelines are to provide long-term ART to eligible patients, monitor treatment outcomes, ensure high levels of individual drug adherence, increase life spans for those on ART, and enable patients to return to employment. ART is offered to all clinically eligible persons with HIV infection.
This document summarizes India's HIV epidemic and prevention strategies. It notes that India has the third largest HIV epidemic globally, with approximately 2.5 million people living with HIV. The National AIDS Control Organization aims to reduce new HIV infections by 50% through the current NACP-IV program. It then discusses strategies for preventing mother-to-child transmission, including antiretroviral treatment protocols for HIV-positive pregnant women and breastfeeding guidelines. Finally, it outlines the role and functions of Integrated Counselling and Testing Centres in detecting HIV early and linking those infected to care.
Elimination of mother to child transmission of hivstompoutmalaria
The document discusses eliminating mother-to-child transmission of HIV by 2015. It provides facts on the magnitude of MTCT, defines elimination as reducing the transmission rate to below 5%, and outlines the tools and costs required. These include ARV regimens, family planning services, and focused efforts in the 25 highest burden countries. Peace Corps volunteers could help implement prevention activities and promote services to measure progress towards elimination goals.
Dr k prabha devi new pptct guidelines-1(1)Ratan Yadav
The document outlines new guidelines for initiating ART for HIV-infected pregnant women in India. It recommends providing lifelong ART to all pregnant and breastfeeding women living with HIV, regardless of CD4 count or clinical stage, to prevent mother-to-child transmission. This includes initiating a regimen of TDF+3TC+EFV and continuing it throughout pregnancy, delivery, and breastfeeding. It also details protocols for providing antiretroviral prophylaxis to newborns to reduce HIV transmission and the durations of prophylaxis depending on the mother's ART history.
Approximately 8,500 women living with HIV give birth annually in the US. Since the beginning of the AIDS epidemic, almost 5,000 children under age 13 who got HIV through perinatal transmission have died. New HIV infections in children have dramatically declined from 400,000 in 2009 to around 220,000 in 2014 due to efforts like the UNICEF Global Plan. Prevention of perinatal transmission is crucial since there is no HIV vaccine; it requires pregnant women to take antiretroviral therapy consistently during and after pregnancy and avoid breastfeeding. Challenges to prevention include not all pregnant women knowing their HIV status and inconsistent access to treatment.
This document summarizes guidelines for preventing mother-to-child transmission (PMTCT) of HIV. It discusses how HIV can be transmitted from mother to child during pregnancy, delivery, and breastfeeding. The overall transmission rate without intervention is 15-45%, which can be reduced below 5% with effective interventions. These include voluntary counseling and testing for pregnant women, access to antiretroviral treatment for HIV-positive mothers and their infants, safe delivery practices, and guidance on infant feeding options. The document provides details on testing and treatment recommendations during the antenatal, intrapartum, and postpartum periods to reduce HIV transmission from mother to child.
This document provides guidelines for managing HIV in pregnancy. It discusses screening all pregnant women for HIV and other infections. For HIV-positive mothers, it recommends prompt referral to a multidisciplinary team and starting combination antiretroviral therapy (cART) by 14 weeks of pregnancy to prevent mother-to-child transmission. The guidelines cover antenatal care, immunization, labor and delivery recommendations depending on viral load, and neonatal and postpartum management of HIV-positive mothers and exposed infants. The overall aim is to optimize care and reduce risk of HIV transmission through comprehensive antenatal and delivery protocols.
Mother to child transmission of HIV can occur during pregnancy, childbirth, and breastfeeding. The risk is higher if the mother's HIV infection is in an advanced stage, if she is malnourished, has other STDs, or her membranes rupture early. Antiretroviral therapy and cesarean delivery before labor can reduce transmission risk. Exclusive breastfeeding for 6 months poses a lower risk than mixed feeding. India's PMTCT program provides counseling, testing, antiretroviral prophylaxis to pregnant women and newborns to prevent transmission and aims to reduce transmission by 50% by 2010.
Lisa Bohmer worked as the HIV/AIDS Director for UNICEF in Ethiopia and presented on challenges and opportunities for preventing mother-to-child transmission of HIV/AIDS in Africa. Key points included: HIV transmission can occur during pregnancy, labor, delivery or breastfeeding; Ethiopia faces high infection rates particularly among young people and women; and challenges include stigma, improving safer birthing practices, counseling on infant feeding options, and ensuring a steady supply of drugs and testing kits. Opportunities lie in increased funding, integrating PMTCT into other health programs, and engaging communities to promote testing and reduce stigma.
1) The document discusses pharmacological principles for treating HIV in pregnant women to reduce mother-to-child transmission.
2) Updated perinatal guidelines from 2007 recommend initiating HAART after 14 weeks of gestation and continuing treatment throughout pregnancy, labor, and delivery.
3) Clinical scenarios provide examples of applying the guidelines, such as recommending HAART, scheduled C-sections if viral load is high, and 6 weeks of infant ZDV treatment starting within hours of birth.
Dr. Laura Guay, the Foundation’s Vice President of Research, also conducted a journalist training today sponsored by the National Press Foundation, teaching reporters about some of the most misunderstood issues concerning HIV and children
2018 Prevention of Mother to Child Transmission of HIV InfectionHelen Madamba
The document discusses prevention of mother-to-child transmission (PMTCT) of HIV in the Philippines. It outlines the objectives of discussing PMTCT program prongs, HIV epidemiology in the Philippines, transmission and management principles, and screening/testing during pregnancy. It provides statistics on increasing HIV prevalence in the Philippines, especially among men who have sex with men, IV drug users, and teenagers/single mothers. Modes of HIV transmission include unprotected sex and needle sharing. The document emphasizes screening, counseling, and ARV treatment during pregnancy and delivery to reduce mother-to-child transmission risk, as well as strategies to prevent unintended pregnancy and support women living with HIV.
This document discusses HIV infection in pregnancy and strategies to reduce mother-to-child transmission of HIV. It covers antepartum, intrapartum, and postpartum care for HIV-infected women including antiretroviral regimens, monitoring, testing protocols, and delivery methods. The goal is to reduce the risk of perinatal HIV transmission to less than 2% through highly effective antiretroviral therapy, elective cesarean section when appropriate, and avoiding breastfeeding.
The document discusses the effects of pregnancy on HIV-positive women and the risks of mother-to-child transmission during delivery. It states that a woman's absolute CD4 count decreases during pregnancy regardless of HIV status, but her percentage of CD4 cells and viral load do not change due to pregnancy. It also notes that invasive obstetric procedures can increase the risk of mother-to-child transmission by exposing the fetus to more infected maternal blood and secretions. Finally, it reports that a cesarean section before labor and membrane rupture can reduce transmission risk by 50-80% compared to other delivery modes for women not on antiretroviral therapy or only on ZDV, but there is no evidence of benefit for
HIV and Pregnancy : Dr Ruby Bansal (1st Session of DGF HIV Committee on 10th ...Lifecare Centre
This document discusses HIV and pregnancy in India. Some key points:
- Over 21 million people live with HIV in India, including 880,000 women. 60% of pregnant women with HIV access antiretroviral therapy (ART).
- ART and other interventions can reduce the risk of parent-to-child HIV transmission to under 2%. Without treatment, transmission rates range from 15-45%.
- Timely diagnosis and treatment of HIV-positive pregnant women is important to prevent transmission to infants. Options include different ART regimens starting during pregnancy, delivery, or breastfeeding depending on when the woman is diagnosed.
- Close coordination between HIV physicians, gynecologists, and other care providers is
Prevention of Mother to Child Transmission of HIV 2018Helen Madamba
Babies of pregnant women living with HIV can be born free of HIV infection. HIV counselling and testing is the gateway to diagnosis, treatment, care and support. Healthcare services need to provide enabling environments to support and empower women living with HIV and their children, to increase HIV knowledge and reduce stigma and discrimination.
POGS Clinical Practice Recommendations on PMTCT of HIVHelen Madamba
With guidelines from WHO and DOH, the Philippine Obstetrical and Gynecological Society (POGS) releases it clinical practice recommendation on prevention of mother to child transmission of HIV. With the concentrated Philippine HIV/AIDS epidemic in the cities and among key affected populations, it is important to target pregnant Filipino women for screening, diagnosis and treatment.
This is a lecture given to medical students of Cebu Institute of Medicine under the reproductive module. It contains a discussion of principles of HIV infection screening, diagnosis, staging and management, especially during pregnancy.
This document provides information on HIV/AIDS including:
- HIV is a retrovirus that causes AIDS by infecting CD4 cells. It can be managed but not cured.
- AIDS is the late stage of HIV infection when the immune system is severely damaged.
- The natural history of the virus is described from its discovery in 1981 through treatments developed.
- The virus's structure and life cycle involve invading cells and integrating its DNA for dormancy.
- Transmission occurs through bodily fluids like blood, semen, breastmilk. Testing and treatment can control spread.
Highly Active Antiretroviral Therapy (HAART) involves using a combination of at least three antiretroviral drugs to suppress the HIV virus and stop the progression of HIV disease. HAART decreases the viral load, improves immune function, and prevents opportunistic infections. The goals of HAART are to prolong life, improve quality of life, achieve maximal viral suppression, restore immune function, reduce HIV transmission, and rationally sequence drugs to limit toxicity while maintaining treatment options. Current guidelines recommend starting ART for all individuals regardless of CD4 count. Second line regimens are recommended when clinical or immunological failure occurs on first line therapy. Managing adverse events and comorbidities like hepatitis co-infection is also
India has seen a 57% reduction in its HIV count between 2001-2011, while Bangladesh and Sri Lanka saw increases of 25%. As of 2011, an estimated 2.1 million people in India were living with HIV. India's epidemic is heterogeneous and concentrated in certain states and sub-populations. Successful prevention efforts have led international figures to praise India's HIV/AIDS prevention model. However, more work remains as even a small increase in prevalence could mean over half a million new infections. The continuum of HIV care involves testing and counseling, treatment of opportunistic infections, anti-retroviral therapy initiation and monitoring, management of co-infections, and adherence support. WHO guidelines recommend treatment for all HIV-positive individuals
The document outlines the history and activities of India's National AIDS Control Program (NACP) which was established in 1987 by the Ministry of Health and Family Welfare to prevent the spread of HIV/AIDS. It discusses the objectives and phases of NACP from 1987 to the present, highlighting key activities like surveillance, prevention among high-risk groups, care and treatment, blood safety, and community outreach. The goal of NACP is to provide accessible HIV/AIDS services across India through strategies tailored for different state-level epidemics.
The latest recommendations by WHO on HIV treatment--New GuidelinesSyriacus Buguzi
This document provides consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection. It includes recommendations for a public health approach across the continuum of HIV care, from diagnosis to treatment to monitoring. The guidelines were developed by the World Health Organization and draw on the most recent evidence from multiple sources. They are intended to guide national HIV programs in providing optimal HIV treatment, care, and prevention.
The document outlines national guidelines for antiretroviral therapy (ART) in India. It notes that India has the third highest number of people living with HIV globally. The goals of ART are to improve quality of life, reduce HIV-related illness and mortality, and suppress viral load. People are recommended to start ART if their CD4 count is below 350 or if they have WHO Stage 3 or 4 disease. First-line ART regimens typically include two nucleoside reverse transcriptase inhibitors and one non-nucleoside reverse transcriptase inhibitor. Patients are monitored regularly after starting ART to assess clinical status, adherence, and CD4 count. Treatment is changed if adverse effects occur, if treatment fails to suppress viral load
Early initiation of HAART why, when and how.anil kumar g
This document discusses guidelines for initiating antiretroviral therapy (ART) for HIV, including for pregnant women, children, and prevention. It recommends starting ART for all people living with HIV at a CD4 count of ≤500 cells/mm3. For pregnant and breastfeeding women, the preferred first-line regimen is tenofovir + lamivudine (or emtricitabine) + efavirenz. Early initiation of ART reduces disease progression and transmission risk, and lifelong ART is recommended for all pregnant and breastfeeding women. Simplified regimens help improve treatment access and outcomes for children.
The document summarizes India's National AIDS Control Programme (NACP) which aims to contain the spread of HIV in India through a four-pronged strategy of prevention, care and support, treatment, and strengthening infrastructure. The HIV epidemic in India is concentrated among high-risk groups like female sex workers, men who have sex with men, and injecting drug users. The NACP implements targeted interventions for these groups, promotes condom use, treats sexually transmitted infections, and provides counseling, testing, and treatment services. While the response has stabilized the epidemic in some states, emerging hotspots in northern states require increased focus and attention to fully achieve reversal goals.
This document provides guidelines for antiretroviral therapy (ART) for HIV-infected adults and adolescents in India, including post-exposure prophylaxis.
The guidelines were developed by the National AIDS Control Organization of India (NACO) to assist physicians prescribing ART and to provide practical recommendations for treatment of HIV/AIDS in the context of India's national ART program and the role of the private sector.
The objectives of the guidelines are to provide long-term ART to eligible patients, monitor treatment outcomes, ensure high levels of individual drug adherence, increase life spans for those on ART, and enable patients to return to employment. ART is offered to all clinically eligible persons with HIV infection.
current hiv situation in india and national aids control programme an overviewikramdr01
The document provides information about an orientation programme for doctors on the National AIDS Control Programme (NACO) in India. It will take place on December 26-27, 2013 at the Government Thiruvarur Medical College and Hospital in Thiruvarur, India. The programme will provide an overview of the current HIV situation in India, NACO's objectives and approaches, national guidelines for detecting HIV, and NACO's comprehensive HIV care and antiretroviral therapy (ART) services.
AIDS and its vengeance saw a back seat after we achieved the zero level of growth for it. But worries regarding the people living with AIDS are still on and we need to take care of these segments in an integrated manner
HIV AIDS is one of the most dreadful of all diseases. Newer drugs and drug combination are coming quite frequently. Attempts to design an HIV vaccine is also underway.
This seminar is my attempt this interesting topic with all the latest data I could collect on the internet.
The document summarizes India's National AIDS Control Programme Phase IV (NACP-IV). Key points include:
NACP-IV aims to accelerate reversal of the HIV epidemic by reducing new infections by 50% and providing comprehensive treatment and support. Its strategies include intensifying prevention, expanding access to care and treatment, capacity building, and strengthening strategic information management. The package of services includes targeted interventions, treatment, counseling and testing, condom promotion, and management of opportunistic infections. NACP-IV also aims to scale up prevention of parent-to-child transmission and target key vulnerable groups.
Antiretroviral therapy what a general practitioner must knowParvez Pathan
This document summarizes current guidelines for antiretroviral therapy. It begins by stating that eradication of HIV is not currently possible due to reservoirs of latent infection. It then reviews recommendations for starting ART based on CD4 count from various organizations. A list of approved antiretrovirals is provided grouping them by class. The benefits of earlier treatment include reduced transmission risk, lower non-AIDS related mortality, and increased CD4 recovery. Studies supporting these benefits are summarized. Optimal first-line regimens now include tenofovir/emtricitabine due to lower toxicity compared to older drugs. Special considerations for ART in pregnancy and tuberculosis are discussed.
After the successful NSP 2017-2025,Goi is lauching NSP 2017-2025 for elimination of TB on 24th march( World TB day ) 2017. Module is on MOHFW site but i have try to keep it brief,hope its ll be useful specially for academic and administrative purposes.
The document summarizes India's National AIDS Control Programme (NACP) which aims to prevent the spread of HIV/AIDS in India. It describes the epidemiology of HIV/AIDS in India, noting stable national prevalence but rising trends in some states. It outlines the early response through NACP I and II, including establishing surveillance, promoting condoms, treating STDs, and targeted interventions. NACP III expanded these efforts and added programs for preventing parent-to-child transmission and increasing access to testing, treatment, and care. Future plans include continuing and strengthening current strategies through NACP IV.
The document provides information on HIV/AIDS, including:
1. HIV was first identified in 1981 and there have been two major strains identified, HIV-1 and HIV-2.
2. HIV is transmitted through bodily fluids and can be transmitted sexually or through contact with infected blood.
3. There are three phases of HIV infection eventually resulting in AIDS if not treated. Antiretroviral treatment can suppress the virus and prevent AIDS.
This document provides information about HIV/AIDS, including:
- It defines endemic, epidemic, and pandemic, with AIDS classified as a pandemic.
- As of 2003, it was estimated that 40 million people worldwide were living with HIV/AIDS, with 25-28.2 million in Sub-Saharan Africa.
- HIV attacks and destroys CD4 cells, weakening the immune system and leaving the body vulnerable to opportunistic infections over time without treatment.
- HIV is transmitted through direct contact with infected bodily fluids like blood, semen, vaginal fluids. It cannot be transmitted by casual contact.
- Prevention strategies include blood screening, education on safer sex practices, STI treatment, and preventing mother
Similar to Scale up of Prevention of Mother to Child HIV Transmission Programme in Delhi by Dr.A.K. Gupta, Additional Project Director cum Technical Lead, Delhi State AIDS Control Society, Dept of Health & Family Welfare, Govt of Delhi
This document provides guidelines and statistics related to HIV and ART in India. It discusses:
- Global and national HIV prevalence statistics, with over 2 million people living with HIV in India.
- The national response to HIV/AIDS in India, including establishment of organizations and funding for prevention and treatment programs over time.
- Diagnosis of HIV infection, pre-ART care, CD4 count monitoring, and guidelines for primary opportunistic infection prophylaxis.
- Guidelines for initiation of ART based on CD4 count and clinical staging, including first-line ART regimens, management of HIV-TB co-infection, and changes to WHO recommendations over time.
- Potential immune reconstitution inflammatory syndrome (IR
Vertical transmission prevention for HIVKosie Namba
Vertical transmission of HIV can occur from mother-to-child. Steps to prevent vertical transmission include minimizing infant exposure to the virus through maternal viral load suppression, infant post-exposure prophylaxis, early infant diagnosis, and cotrimoxazole preventive therapy. Tightening the definition of high-risk exposure for infants to include any maternal viral load above 50 copies/mL and providing all exposed infants with dual prophylaxis could prevent many HIV infections while simplifying management. Similarly, aligning infant follow up, maternal ART and family planning with the EPI schedule supports integrated care.
Washington Global Health Alliance Discovery Series
Catherine Wilfert, MD [
December 1, 2008
'Global Prevention of Mother to Child Transmission of HIV-1'
Preventing MTCT in Africa: Using New Paradigms - A Dr Besser Presentationmothers2mothers
The document discusses challenges with preventing mother-to-child transmission of HIV in Africa, including high HIV prevalence rates, low access to treatment and care, and difficulties with infant feeding options. It presents data showing that integrated programs that provide testing, counseling and antiretroviral treatment can significantly reduce transmission rates from 25% to as low as 1%, but coverage remains a challenge due to weaknesses in health systems.
This document provides information on HIV/AIDS in India, mother-to-child transmission of HIV (MTCT), and the management of HIV-infected pregnant women. Some key points:
- An estimated 2.39 million people are living with HIV in India, with 0.9 million women infected.
- Without intervention, the rate of MTCT is 20-45%, but can be reduced to 10-1% with proper intervention.
- Triple antiretroviral therapy is recommended for all HIV-infected pregnant women in India, regardless of CD4 count, to be continued lifelong.
- Elective c-section is recommended at 38 weeks for women with high viral loads (>1000 copies/mL
This document discusses non-invasive prenatal testing (NIPT) in Denmark. It shows that first trimester screening uptake has increased to over 90% and invasive testing has decreased significantly since 2005. NIPT is now being used as a second-line test for those at high risk (>1:300) from first trimester screening. While several NIPT assays are available, implementation has differed regionally without a national policy. The professional societies support maintaining first trimester screening and using NIPT for those at high or intermediate risk, but the National Board of Health has not established a national NIPT plan.
The document summarizes the key changes in WHO's 2010 guidelines for preventing mother-to-child transmission of HIV (PMTCT), including recommending lifelong antiretroviral treatment (ART) for all HIV-positive pregnant women and more effective prophylaxis options. It outlines two approaches - Option A focusing on antenatal/intrapartum drugs while Option B continues treatment during breastfeeding. Proper implementation of the new guidelines could reduce transmission rates to below 5% and bring the world closer to virtual elimination of pediatric HIV.
The journey towards making elimination of mother to child transmission a real...HopkinsCFAR
The document discusses the journey towards eliminating mother-to-child transmission of HIV (eMTCT) and the contributions of clinical research. It outlines the burden of mother-to-child HIV transmission and the progress made through PMTCT interventions and clinical trials. Landmark trials in Uganda evaluated effective ARV regimens and extended infant prophylaxis, informing WHO guidelines. Ongoing research addresses challenges like adherence and retention through interventions like peer support groups. Further research on new drugs, testing approaches, and integration of services is still needed to achieve eMTCT goals.
This document provides an overview of viral load testing in Zambia. It defines viral load and viral load suppression. It discusses Zambia's achievement of 90-90-90 targets and the scale up of PCR labs across the country's 10 provinces. It reviews viral load testing platforms, sample types, and expected results and schedules for both adults and children, including a minimum 80% viral suppression rate expected in children by 6 months on first-line ART.
Early initiation of haart why, when and how 21 juneanil kumar g
This document discusses guidelines for early initiation of HIV treatment. It recommends starting antiretroviral therapy (ART) for all people living with HIV, including pregnant and breastfeeding women, regardless of CD4 count or clinical stage. The benefits of early treatment include reduced progression to AIDS, lower rates of illness and death, and decreased HIV transmission. First-line ART regimens preferably include tenofovir, lamivudine and efavirenz. Viral load testing is the best way to monitor treatment response and detect treatment failure.
The document summarizes the process undertaken by Malawi to revise its national PMTCT guidelines in line with recent WHO recommendations. It discusses key changes such as recommending lifelong ART for all HIV-positive pregnant women (Option B+), noting this simple approach could help scale up coverage and reduce maternal mortality. While challenges like cost and adherence exist, the document argues Option B+ outweighs disadvantages and is the most realistic strategy for Malawi given limited CD4 testing availability. It stresses the need for international guidelines and national policies to follow a public health approach that can be implemented at scale.
This document discusses perinatal transmission of HIV (PPTCT), including statistics on HIV prevalence in India, factors that affect mother-to-child transmission, strategies for prevention and treatment, and India's national PPTCT program. Some key points:
- PPTCT accounts for over 90% of HIV infections in children.
- Prevention strategies include antiretroviral treatment for mothers and infants, with transmission risk reduced to under 2% with appropriate intervention.
- India's national PPTCT program aims to offer HIV testing to all pregnant women and prevent perinatal transmission, working toward eliminating new HIV infections in children by 2015.
Physician and public health researcher Mitchell Besser visited the School of Public Affairs on Oct. 4, delivering a presentation on the prevention of mother-to-child transmission of HIV in Africa. Besser is the founder of Mothers2mothers, an organization that trains mothers with HIV to work in health centers to educate and support pregnant women who are HIV-positive.
Besser talked about "task shifting" some of the responsibilities of health care education from nurses and doctors (that are always in short supply and high demand) to the mothers, and utilizing new technologies such as mobile phones to expand the scope of care.
As an obstetrician and gynecologist, Dr. Besser professional career has been dedicated to the public health needs of women. In 1999, Dr. Besser joined the University of Cape Town's Department of Obstetrics and Gynecology, assisting with the development of services to meet the needs of pregnant women living with HIV and to prevent the transmission of HIV from mothers to their children (PMTCT). Dr. Besser recognized the need for an education and psychosocial support program that would contribute to PMTCT services achieving the best medical and social outcomes. Hoping to fill this void, he founded mothers2mothers in which mothers with HIV are employed to work in health centers, educating and supporting pregnant women and new mothers with HIV; reducing the workload of doctors and nurses and increasing the effectiveness of interventions that reduce the number of babies born with HIV and keep mothers healthy and alive to raise their children. Since its inception in 2001, the program has grown to provide services in more than 680 health care facilities in nine countries in Africa, with more than 3 million contacts with woman each year, reaching 20% of the HIV-positive pregnant women in the world. Dr. Besser has received Global Health Council’s Best Practice Award, Skoll Award for Social Entrepreneurship, Presidential Citizens Award of the United States Government and is an Ashoka and Schwab Fellow. He has presented at TED, appeared on BBC’s Forum and has given a Friday Evening Discourse at the Royal Institution of Great Britain.
Drug interactions and overlapping toxicities between ART and other medications require expertise to determine the optimal treatment regimen. Involving an HIV specialist helps ensure the regimen is both effective against HIV and safe for the pregnant woman and developing fetus.
Programs to improve infant and young child nutrition in the context of HIVRENEWAL-IFPRI
Presented at RENEWAL’s Satellite Session "Nutrition Security, Social Protection and HIV: Operationalizing Evidence for Programs in Africa" at the XVIII International AIDS Conference. By Rene Ekpini
This document summarizes the National AIDS Control Programme (NACP) in India. It discusses the four phases of NACP from 1992 to 2024, which aim to prevent new HIV infections and provide treatment. Key aspects of NACP include targeted interventions for high-risk groups, integrated counseling and testing centers, prevention of parent-to-child transmission, post-exposure prophylaxis, coordination with tuberculosis programs, and World Health Organization treatment guidelines. The document also outlines the structure of the National AIDS Control Organization.
This document discusses the case of a 25-year-old HIV-positive pregnant woman. It provides background on her diagnosis and treatment history, as well as the management of her current pregnancy. Key points include planning a cesarean delivery at 38 weeks given her undetectable viral load on antiretroviral therapy. The newborn will receive post-exposure prophylaxis with nevirapine and exclusive formula feeding is recommended to prevent HIV transmission through breastfeeding. Testing of the newborn will occur within 48 hours and at intervals through 18 months to monitor HIV status.
1. The document discusses prevention of parent-to-child transmission (PPTCT) of HIV, including that transmission can occur during pregnancy, labor, delivery and breastfeeding. It also discusses the importance of PPTCT for preventing pediatric HIV infections.
2. PPTCT services in India aim to detect positive pregnant women and provide them comprehensive services including antiretroviral treatment (ART). The objectives are to detect over 80% of positive women, provide services to over 90%, and ensure over 95% ART compliance for positive women.
3. Care for HIV exposed infants includes care at birth, infant feeding support, antiretroviral prophylaxis, vaccines, cotrimoxazole
This document discusses human immunodeficiency virus (HIV) infection in obstetrics and gynecology. It covers topics such as HIV transmission, testing methods for HIV and antibodies, antiretroviral treatment regimens, opportunistic infection prophylaxis based on CD4 count, screening for fetal abnormalities, safety of invasive prenatal testing for HIV-positive women on treatment, ultrasound guidelines, and complications of HIV infection and antiretroviral therapy on pregnancy outcomes.
Similar to Scale up of Prevention of Mother to Child HIV Transmission Programme in Delhi by Dr.A.K. Gupta, Additional Project Director cum Technical Lead, Delhi State AIDS Control Society, Dept of Health & Family Welfare, Govt of Delhi (20)
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Scale up of Prevention of Mother to Child HIV Transmission Programme in Delhi by Dr.A.K. Gupta, Additional Project Director cum Technical Lead, Delhi State AIDS Control Society, Dept of Health & Family Welfare, Govt of Delhi
1. Revised Guidelines for PMTCT and Infant Feeding in
the Context of HIV
Presented
BY
DR. A. K. GUPTA MD(PEDIATRICS)
Additional Project Director
Delhi State AIDS Control Society
Govt of Delhi
2. “We have effective drugs.
There is no reason why any mother
should die of AIDS.
There is no cause for any child to be
born with HIV
If we work hard enough we can
virtually eliminate mother-to-child
transmission.”
3. Risk of Mother-to-Child
HIV Transmission
Background transmission risk: 15-45%
15-30% Risk during pregnancy and delivery
10-20% Additional risk postpartum via breastfeeding
35% Average risk without any intervention
Transmission risk with interventions:
19.8% Sd NVP to MB Pair ( Study by DSACS)
<5% 2010 interventions, BF
<2% 2010 interventions, no BF
5. TREND OF ICTC ANC POSITIVITY RATE IN NACP III
250000 0.25
0.23 0.23 0.23
200000 0.20 0.20
0.17 0.17
150000 0.15
100000 0.10
50000 0.05
0 0.00
2007-08 2008-09 2009-10 2010-11 2011-12 UPTO DEC 2012
PRE TEST 82673 152894 176062 166704 208728 159727
TEST 72469 146469 170941 161043 204241 154494
POST TEST 60077 137381 162971 151294 190870 146839
POSITIVE 167 334 386 329 356 258
MB PAIR 81 162 228 222 224 234
% POSIVIVE 0.23 0.23 0.23 0.20 0.17 0.17
6. PMTCT & Early Infant Diagnosis programme
(April 11 -Dec’ 12)
Total Number of ANC Screened for HIV 154494
Total Number of ANC Detected Positive for HIV 258 (0.17%)
Total Number of HIV Positive ANC Delivered 232 (90%)
Total no. of ANC registered at ARTC 229 (89%)
Total Number of CD4 done in registered ANC 217 (95%)
Total Number of ANC eligible for ART (CD4 <=350) 100 (46%)
Total Number of ANC initiated on ART 82 (82%)
DBS Test done in HIV exposed infants 237
DBS HIV-1 DNA Positive 30 (12.7%)
DBS HIV-1 DNA Negative 186 (78.5%)
DBS Report Awaited 21
No. of DBS positive infants tested by WB HIV-1 DNA PCR 28 (93%)
WB DNA PCR Positive 19 (68%)
WB DNA PCR Negative ie false positive DBS tests 9
Number of HIV Infected Infant started on ART 17 ( 90%)
7.
8. The 2010 revised PMTCT recommendations
are based on two key approaches
:
1. Lifelong ART for HIV-infected women in
need of treatment for their own health, which
is also safe and effective in reducing MTCT-
CD4 ≤ 350 ( 40% PW)
2. ARV prophylaxis to prevent MTCT during
pregnancy, delivery and breastfeeding for HIV-
infected women not in need of treatment-
CD4 > 350 (60% PW)
9. WHY ART to Pregnant Women with CD4 <350?
9
• MTCT risk: > 75%
• Account for >80% of postpartum transmission
(BF)
• Account for 85% of maternal deaths within 2
years of delivery
• Strong benefit from initiating ART for maternal
health and PMTCT during pregnancy, labour
and delivery and breastfeeding
10. 1. When is ART indicated In pregnant women with confirmed HIV infection
Indicated for all women with CD4 cell counts of ≤350 cells/mm ,
irrespective of the WHO clinical staging, and for all women in WHO clinical
stage 3 or 4, irrespective of the CD4 cell count.
2. When to start ART in pregnancy
HIV-infected pregnant women in need of ART for their own health should
start ART as soon as feasible regardless of gestational age
3. What ART regimen to initiate
In pregnant women in need of ART for their own health the preferred first-
line ART regimen is AZT + 3TC + NVP /or EFV . Alternative recommended
regimens are TDF + 3TC + EFV/ or NVP. Avoid the use of EFV in the first
trimester and use NVP instead.
4. What ARV prophylaxis to give infants of HIV-infected women receiving
ART
All HIV exposed infants (regardless of whether breastfeeding or receiving
only replacement feeding) should be given daily NVP from birth or as soon
as feasible thereafter until 6 weeks of age.
11. 1. Pregnant Women Eligible for ART (CD4<350)
Should be initiated on lifelong ART as soon as possible
ART Regimens
1st Line
Preferred AZT 300 mg BD+3TC 150 mg BD +NVP 200 BD (or
EFV 600 mg OD)
Alternative TDF 300 mg OD +3TC 150 mg BD+NVP 200 mg
BD(or EFV 600 mg OD)
If anemic (Hb<8 Gm/L), replace the AZT-containing regimen with TDF (10%
cases) .
If 1st trimester, do not use EFV-containing regimen: Use NVP
Baby receives daily NVP for 6 weeks after birth
12. 2. ARV Prophylaxis to PW (CD4 > 350)
Option-B WHO PMTCT Guideline of adapted by NACO
ARV Prophylaxis Ante-partum Intra-partum Post-partum
and dosing
TDF 300mg once Start at 14 Continue • Continue triple ARV
daily + weeks or as triple ARV prophylaxis until 1
3TC 300 mg once soon as prophylaxis week after all infant
daily + possible exposure to breast
EFV 600mg once thereafter milk has ended
daily
13. Infant ARV Prophylaxis with NVP
• 15 mg once daily (if birth weight
>2500 g) or
• 10mg once daily (if birth weight
≤2500 g) from birth until 4 to 6
weeks of age
14. ARV prophylaxis for women presenting directly in labour
• Start Triple ARV Prophylaxis (same as option
B) to all HIV positive PW presenting directly in
labour
• Continue prophylaxis postpartum throughout
breast feeding until 1 week after BF is
stopped
• Do CD4 count at the earliest to assess
eligibility for lifelong treatment
• Infant is given NVP once daily for 6 weeks.
15. Increased NVP Hepatotoxicity in
women with higher CD4 counts
1. CD4 > 350- NVP is not recommended in such
women
2. CD4 250-350: There may or may not be an
increased risk of hepatotoxicity, benefits of
using NVP outweigh the risks of not initiating
ART, Close clinical /Lab monitoring during
the first 12 weeks of therapy in women with a
CD4 cell count of 250 to 350 cells/mm
16. Potential Teratogenicity of EFV-
EFV rarely can cause neural tube defects.
Potential risk (probably <1%) of neural tube defect with
use of EFV in first month of pregnancy (before 6 weeks of
gestation)
Neural tube closure occurs by approximately 28 days of
gestation and very few pregnancies are recognized by this
time, the potential risk with the use of EFV is primarily in
women who become pregnant while already receiving the
drug.
EFV should not be initiated in the first trimester of
pregnancy but may be initiated in the second and third
trimesters.
17. Toxicity of TDF
• Risk of Nephro-toxicity with use of TDF
• Limited data available on potential for
maternal and infant bone toxicity
18. PI Inhibitors in cases of Sd NVP
Exposure
LPV/r-based regimen is recommended
for women who require ART for their
own health who have received SdNVP
within 12 months of initiating ART.
This regimen is available only at COE,
MAMC.
19. Women receiving ART
and planning to become pregnant
• Fully suppressive ART before conception and
that it be maintained during pregnancy, labour,
delivery and breastfeeding.
• Preferred ART regimens in such situations
should have minimal teratogenic potentials for
infants (does not include EFV in first 28 days of
gestation)
• For women receiving an EFV-based regimen and
who plan to become pregnant, substitution of
NVP in the place of EFV for at least the peri-
conception period
20. Women receiving ART who become
pregnant
• If a Woman receiving EFV is recognized as
pregnant before 28 days of gestation, EFV
should be stopped and substituted with NVP
or a PI.
• If a woman is diagnosed as pregnant after 28
days of gestation, EFV should be continued.
• There is no indication for abortion in women
exposed to EFV in the first trimester of
pregnancy
21. Clinical and laboratory monitoring of pregnant women receiving
ARV
prophylaxis and their infants
• CD4 cell counts X every 6 months
• Clinical and laboratory monitoring of adverse
reactions related to the antiretroviral drugs
should be based on the potential adverse
reactions of the drugs use
22. Women with HIV-2 infection
• Testing for both HIV-1 and HIV-2 before initiating a PMTCT ARV intervention.
• HIV-2 may also progress to AIDS, although progression is generally much
slower
• HIV-2 has the same modes of transmission as HIV-1 but has been shown to
be much less transmissible from mother to child (transmission risk 0−4%).
• NNRTI drugs, such as NVP and EFV are not effective against HIV-2
• First-line ART regimen for women who are infected with HIV-2 alone-and
eligible for treatment (based on the same eligibility criteria as for HIV-1)- AZT
+ 3TC + ABC)
• ARV Prophylaxis- Pregnant women living with HIV-2 alone who are not
eligible for treatment for their own health should receive an ARV prophylaxis
intervention consisting of AZT from 14 weeks of pregnancy (or as soon
thereafter as possible) and continuing during labour and delivery. This
maternal intervention should be coupled with twice-daily AZT given to infants
from birth until 4 to 6 weeks of age. In
23. Women with active tuberculosis
• HIV-infected pregnant women with active TB should start
ART, irrespective of the CD4 cell count.
• The TB treatment should be started first, and followed by
ART as soon as clinically possible ( between rifampicin and
some of the antiretroviral drugs (i.e. the boosted protease
inhibitors)
• As for all adults, EFV is the preferred NNRTI for HIV/TB co-
infected pregnant women (starting after the first trimester).
• For those HIV/TB coinfected women not able to tolerate EFV,
an NVP-based regimen or a triple NRTI regimen (e.g. AZT +
3TC + ABC or AZT + 3TC + TDF) can be used.
24. Adverse Effects
• Nevirapine- Nevirapine is associated with
systemic symptoms (e.g. nausea, vomiting,
malaise, fatigue, anorexia, jaundice, liver
tenderness and hepatomegaly) ,increases in
hepatic transaminase enzymes and skin rash,
mainly in the first 18 weeks after starting
treatment.
NVP-related rash and hepatotoxicity can be life-
threatening, particularly among pregnant women
with CD4 counts of >250 cells/mm
25. • Efavirenz: EFV is primarily associated with toxicities
related to the central nervous system (CNS), rash and
possible Teratogenicity (if taken during the first
trimester of pregnancy). The rash is generally mild and
self-resolving and usually does not require
discontinuation of therapy.
The CNS symptoms are common. While they typically
resolve after 2 to 4 weeks, they can persist for months
and require discontinuation of the drug.
EFV should be avoided in
(i) Patients with a history of psychiatric illness,
(ii) When there is a potential for pregnancy (unless
effective contraception can be assured) and
(iii) During the first trimester of pregnancy
26. • LPV/r- The most frequent side-effects of LPV/r
consist of
- Weakness, headache and moderate digestive-
disorders (diarrhoea, nausea, abdominal pain,
vomiting),
- Fat mal-distribution and Dyslipidaemia
- Pancreatitis, Hepatotoxicity
• TDF- Nephrotoxicity, Fetal Bone defect and
LBW
27. The counseling messages given to mothers
during antenatal changes with the new
guidelines
In the new guidelines (2010):
HIV+ mothers are strongly encouraged to breastfeed their
exposed infants for 12 months while on ARV’s
Exclusive BF until 6 months, complementary from 6-12 months
Breastfeeding is no longer Just “necessary” but “critical”
because of the nutritional need and because ARV prophylaxis
now limits the risk of transmission
However, if the mother still prefers to replacement feed after
counseling, she can do so if AFASS criteria is met
28. Implementation Challenges
Successful implementation of the new guidelines depends on:
• Scale up HIV testing and counseling for pregnant women
• Availability of CD4 testing and ARVs at ANC/ICTC/PPTCT level
• Integration of PMTCT and MCH; PMTCT and ART
• Improved follow-up of pregnant women antenatally and of
mothers and HIV-exposed infants after birth
• Ability to provide prophylaxis to the mother or baby throughout
breastfeeding
• Health systems strengthening
• Enhanced M&E, including impact assessment
29. Existing facilities in Delhi
• ANC Testing Sites (PPTCTs/ICTCs)- 46
• CD4 Testing labs- 5 (NICD, AIIMS, SJH, MAMC,
RML)
• ART centres-9 (8 for PPTCT programme, except
ARTC LRS Institute)
• EID Test Lab for DNA-PCR testing-1 (AIIMS, New
Delhi)
• EID sample collection sites- 27 ICTCs
• Whole Blood Collection for DNA-PCR sites (ART
centers)- 7
Dr.A.K.Gupta,New Delhi
31. Setting up F-ICTCs at 50 ANC
sites through ANMs
DSACS trained 572 ANMs in Feb- March 12 on whole blood single prick test
for screening of Pregnant women, for tracking of HIV positive women and
HIV exposed infants.
In Nov’12, 74 ANMs were given refresher hands on training on WB HIV
screening test and provided test kits and reporting formats and IEC
material.
These FICTCs are placed in Govt. dispensaries where no ICTC center was
functioning nearby.
After screening, the suspected HIV positive ANC will be linked to nearest
ICTC for confirmatory testing.
It is expected that these centers will cover an additional number of 11000
ANC per year besides improving referral linkages of ICTCs with ARTCs.
In addition to above 50 FICTs, one at Naraina Maternity Home is also doing
HIV screening of ANC.
32. CD4 Testing –Revised Strategy
CD4 sample is now drawn at ICTC/PPTCTC for testing
directly at NCDC (except ICTC/PPTCTCs with CD4 Labs
who will send sample to their labs)
No prior ART registration is done to:
1. Save time &
2. Segregate HIV positive ANC with CD4 < 350 & > 350
to prioritize further action of ART or ARV prophylaxis.
ART will be started at nearest ART centre &
ARV prophylaxis will be given at PPTCTC/ICTC.
33. PMTCT software
PPTCT software has been installed at all
45 ICTC/ PPTCT centers catering to ANC
which will be useful to track mother and
her baby till EID enrollment & up to 18
months.
34.
35. Mainstreaming Pvt. Sector
Assessment of 100 leading Private hospital
on PMTCT Programme through survey is
being undertaken in March-April 2013 to
help in mainstreaming National PMTCT
Protocol in Pvt Sector of Delhi during 2013-
14 and setting up PPP ICTCs.
36. ANC Target 2013-14
• 2,75,000 ANC to be counseled &
tested
• 500 ANC HIV +ve expected
• ANC Expected ARV Prophylaxis
(Option B) - 60% with CD4 Count >
350= 300
• ANC expected eligible for ART-40%=
200
Dr.A.K.Gupta,New Delhi
37. Sites of Emergency Labour Room Testing-75
sites
• Hospitals – 37 (Delhi Govt- 21,
DGHS/GOI Hospitals-3, AIIMS, ESI-4, Rly-
2, Army-3, MCD -4)- ICTC services
available in all hospitals
• Maternity homes- 37 (33-MCD, 2-
NDMC, CGHS-2)- ICTC services available
in 11/37.
• RHTC, Nazafgarh- ICTC services
available.
Dr.A.K.Gupta,New Delhi
38. Nominations TOT for Master Trainers
• 4 days training programme by NACO in Delhi
in April-May 2013
• Regional TOT Master Trainers (PPTCT)
(a) Doctors (O&G )-30
(b) Paramedical staff (ANMs, Counselors, Staff nurses)-
30
• Slot for 10 O&G M.O./ specialists available
Dr.A.K.Gupta,New Delhi