7/21/2019 CH04 HIV

1/19

Infectio

nInternational

PREVENTION OF MATERNAL

TO CHILD TRANSMISSION OF

HIV

7/21/2019 CH04 HIV

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Infectio

nInternational

Objectives

Describe relationship of HIV on

pregnancy

Factors affecting vertical transmission

Strategies to prevent maternal to child

transmission

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Infectio

nInternational

Introduction

U!IDS about "# million adults$

children living %ith HIV&!IDS in Sub

Saharan !frica' (million ne% cases yearly

)**+*** to ,**+*** !IDS related

deaths in -... in children /* 0-(yrs1

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Infectio

nInternational

HIV AND PREGNANCY

2ffect of pregnancy on HIV progression

2ffect of HIV on pregnancy outcome

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5/19

Infectio

nInternational

Effects of pregnancy on HIV

nfecton

o effect on HIV progression'

Slight decline in absolute numbers of 3D(

count / 4 of 3D( cells remains stable

o overall significant in deaths rate

7/21/2019 CH04 HIV

6/19

Infectio

nInternational

Effect of HIV on pregnancy

co!rse an" o!tco#e

7/21/2019 CH04 HIV

7/19

Infectio

nInternational Materna$ to C%$"

Trans#sson !ccounts to -# 4 of all transmission in Uganda

!ccounts for 5 .*4 of infection in children

In !frica rate of 6737 is "* 0(*4 Overall ris8 at point estimate for transmission

During pregnancy9 # 0-*4

In labour9 -# 0"*4

:reast feeding 9 -*0-#4

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Infectio

nInternational

Factors affecting transmission

Viral factors9

/;oad+strain variation1rovision of @uality !30"&st Vst'Detailed history+ e=amination+ investigation+

folic supplements+de%orming and V337

(r" Vst'6onitor progress of pregnancy+ 3ounsel on

pmtct and breast feeding option+ -st dose of

I>7+tetanus to=oid+iron&folic supplementation'

)r" Vst'6onitor progress of pregnancy+blood pressure

+Hb and urine analysis+"rd dose I>7+tetanus to=oid+

iron&folic supplementation'3ounseling support

*t% Vst'!s above' 2nrolment on the >6737

program+Bive antiretroviral drugs

7/21/2019 CH04 HIV

13/19

Infectio

nInternational

Health education

utrition+personal hygiene+environmental sanitation

ormal 7etanus to=oid schedule

S7I treatment :enefits of V337

3ondom usage and family planning

6ale involvement

:reast feeding &other feeding options

7/21/2019 CH04 HIV

14/19

Infectio

nInternational !30(

&+Mcro,n!trent s!pp$e#ents

(+Pre-enton . treat#ent of nfectons

Intermittent presumptive treatment9 ) dosesof S>

identification$ treatment of S7I

)'Ant retro-ra$ treat#ent !C7

everapine

7/21/2019 CH04 HIV

15/19

Infectio

nInternational 3are during ;abour and

Delivery&+ Bood Obstetric practice

"' !nte retroviral drugs

)' 6odified Obstetric practice Delay !A6

23V

Aoutine episiotomies

Instrumental deliveries

7raumatic suction of child

Universal precautions'

(' 6ode of delivery

7/21/2019 CH04 HIV

16/19

Infectio

nInternational

Short course anti0retroviral

treatment

Options9

!C7 after ), %ee8s antepartum+intrapartum

amd post partum %ith neonatal treatment for

days' /4Aeduction #*41 at E%ee8s

evirapine In labour and neonatal treatmentfor (E to " hours' /4 reduction (41 at E

%ee8s

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Infectio

nInternational

Oral !nti retroviral treatment

Antepart!# Intrapart!# Post part!#For mother

neonata$

-'A/T)**mgs

p'o :'D after )#%ee8sgestation

A/T)**mgs p'o

)hourly tilldelivery

A/T)**mgs p'o

:'D for days(mgs&8g p'o :'Dfor days

"' one NVP"** mgs p'pat onset of labour

none "mgs&8g p'o (E0" hours

7/21/2019 CH04 HIV

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Infectio

nInternational

>ost natal care

Dual use of 3ontraception/ :arrier$

contraception1'

Ongoing 3are

3ounseling and support

3are of the eonate+/2=clusive breast

feeding for )&-" months or !rtificial

infant feeding1

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Infectio

nInternational

3onclusion

6aternal to child transmission can be

reduced by #*4

2ffective counseling +support+treatment

of opportunistic infections and anti

retroviral treatment can improve ?ualityof life'