PMTCT: Counseling of Pregnant Women.

Amungwa Athanasius Nche, Public Health SpecialistHIV/AIDS Training Officer/Counselor, UNMISS

Amungwa Esther Nju, Social WorkerSocial Action Chief/counselor /Social Worker,

Regional/Day Hospitals.

Lesson objectives : At the end of this session, you will be able to:

• Briefly explain the place of counseling of pregnant mothers in services related to prevention mother to child transmission of HIV( PMTCT) including the role of health facilities in PMTCT.

• Identify the issues and challenges of counseling pregnant women;

• Explain how the counseling of pregnant women could scale up PMTCT services;

• Identify the gaps that may exist in a PMTCT programme which may affect the counseling of pregnant women;

• Identify key actions points related to scaling up PMTCT services.

Why Counseling Pregnant is important?

Counseling can benefit pregnant (would-be)women who are either HIV-positive or unaware of their HIV status. It facilitates their making informed choices about whether to become pregnant if HIV-infected; whether to take a test before pregnancy; and, if pregnant, whether to terminate the pregnancy, where abortion is legally available.

For those already pregnant, counseling can also discuss the use of zidovudine (ZDV, also known as AZT), where available, to reduce the risk of transmitting HIV to the unborn child, and breastfeeding and other infant feeding options. Where possible, and when the woman agrees, it is advantageous to involve her male partner in the counseling sessions. Ideally, women should have counseling available to them before they become pregnant.

Source:UNAIDS Technical update:Counselling

and HIV/AIDS

Importance of Counseling Pregnant women in HIV/AIDS

Primary prevention of new infections;

Prevention of unintended pregnancies among women living with HIV for HIV+ women not desiring children •3.Reduction of HIV transmission from the pregnant HIV positive Women from 35%-<2% through education and the use of Nevirapine.•3.Prevention of HIV transmission from mothers living with HIV to their infants; and•4.Care, treatment, and support for mothers living with HIV, their children, and families.

Role of Health Facilities in PMTCT

Capacity building - which includes training of peer educators and counselors

Quality assurance: Monitoring inputs provided through training, counseling and Anti-Retroviral (Nevirapine).

Monitoring and evaluation(supporting data collection, compilation, analysis and analysis dissemination of results

Research: which focuses on linking institution-based PMTCT services with primary prevention among young women and with community based services for care and support

Safer infant feeding to reduce HIV transmission to the baby after delivery

Scaling Up Counseling of Pregnant Women

Ante-Natal Care

Group Education and Pre-test counseling

HIV Testing(after informed consent)

Post-Test Counseling

Institutional delivery : Safe Birthing Practices

Administration of Nevirapine to the woman during labor

Administration of Nevirapine within existing norms

and standards.

Counseling of mother for safer infant feeding options.

Care and support.

Enrollment Procedure

ANC GroupEducation

OfferedHIV test

Post-TestCounseling HIV

Test Pre-TestCounseling

Enrollment:AZT/NVP

HIV + HIV -

Primary PreventionOne-To-One

One-To-One Client may opt-in(accept) or opt-out(refuse)

If client accepts

Proper care, support and follow up

Inadequate expansion of PMTCT services beyond the large delivery units for all women to access to the services.Low proportion of HIV infected women receive the Nevirapine prophylaxis. . Over focus on identifying infected women as against the HIV.. Lack of research to help identify and prioritise high prevalence districts for concentrated actionPrivate sectors not involved in monitoring and evaluation.

Existing Gaps in PMTCT Programmes

Strategies to scale up PMTCT:

1. Scale up services to all districts;

1. Greater involvement of the private sector.

2. Assure of services in the existing centers to retain all women coming to these centers.

1. Care, Support and Treatment services for women and children to be a priority so that in the counseling of pregnant women is assured.

2. PPTCT Programme will be one of the Entry Points for ART3. Strengthening the other entry points for counseling pregnant

women(VCCT centers, TB DOTS centers, STI clinic, Blood banks and networks of people living with HIV and AIDS.

Issues and challenges

• Scaling up the access to PMTCT services

• Focusing on quality Counseling services

• Streaming client Flow

• Emergency counseling and testing

• Strengthening referral links and services

• Creating awareness among all women including young ones.

Broad Strategies• Improve on population-based PMTCT; • Defining a minimum package of services to be provided at the

different levels of care including standard operating procedures for strengthening linkages between PMTCT and ART services;

• Strengthening follow up services for HIV positive mothers and their children within a continuum of prevention and care, and support;

• Intensifying HIV/STI/RH preventive interventions for HIV negative pregnant women in the context of PMTCT

Key action pointsDecreasing the loss to follow up in the existing PMTCT centers.

Strengthening emergency counseling and testing service at all PMTCT sites.

Improving on(scaling up) PMTCT services to cover all public health care sites.

Building up and strengthening public private partnerships

Increasing access to quality counseling services to women in the reproductive age group and enhancing institutional deliveries.

Building capacity of all health care providers (up to grassroots level) in HIV /AIDS counseling and management of HIV /AIDS cases.

Linking PMTCT programme to existing primary prevention and care and support programs for HIV /AIDS in regions and strengthening links with People Living with HIV /AIDS networks (PLHA) of all PMTCT service sites.

Conclusion

The center of PMTCT is counseling of the pregnant who is the main actor in the programme as far adherence and uptake are concerned. This is why much emphasis should be placed on the counseling of the pregnant woman.