PMTCT Training2
Transcript of PMTCT Training2
Preventing Maternal to Child
Transmission of HIV
(PMTCT)
-- Dec 2010
HIV Services at Mae Tao Clinic
Objectives for this Training
Explain basic HIV/AIDS information.
Present information about HIV transmission and
prevention.
Describe benefits and risks of HIV screening for
pregnant women
Describe the stages of the PMTCT program
PMTCT Counseling Knowledge Quiz
List the Ways in Which HIV Infection Is Transmitted
Unprotected sex with an infected person.
From an infected mother to her infant before birth,
during birth, or during breastfeeding.
Blood transfusion in areas where blood is not
screened.
Blood-to-blood transmission.
Injection drug use.
Accidental exposure to needles or sharps.
What Body Fluids Contain High Concentrations of HIV?
Blood
Semen
Vaginal secretions
Breast milk
What Specific Part of the Human Body Does HIV Attack and What Is the
Result?
HIV infects the immune system,
specifically the CD4 cells.
Over time, the weakened immune system
has a progressively more difficult time
fighting infections.
If 100 Women Who Were HIV Infected Gave Birth to 100 Babies and They All
Breastfed Their Babies and None of Them Received Any Treatment, How
Many Babies on Average Would Become Infected With HIV at 1 Year of
Age?
Mother to Child Transmission
100 infants born to HIV-infected women who breastfeed,
Without any interventions
60 to 75 infants
will not be HIV
infected
25 to 40 infants will be HIV infected
5-10 infants
infected
during
pregnancy
About 15
infants
infected
during
labour and
delivery
5-15
infants
infected
during
breastfeed
ing
Name at Least 4 Interventions That Are Universal Precautions.
Wash hands after any direct contact with patients.
Do not recap needles.
Dispose of needles and sharps safely in puncture-
proof containers.
Wear gloves
Promptly and carefully clean up spills of blood and
other body fluids.
2 Reasons Why an HIV Positive Woman May Choose to Breastfeed
To avoid stigma
To maintain denial of her HIV status
To comfort the infant in an easy way
To save money if she cannot afford milk
powder and cannot get it another way.
To accommodate family pressure
What Is Specifically Measured in an HIV Screening Test?
Antibodies
What Does “Window Period” Mean?
This is the period between initial infection
and the time when the HIV test can detect
the antibodies.
People infected with HIV usually develop
antibodies 4 to 6 weeks after infection but it
may take as long as 3 months.
What 2 Factors Increase the Risk of Transmitting Infection to the Baby
During Pregnancy
New HIV infection during pregnancy
Malaria or any other infection that goes to
the placenta
STI
Maternal malnutrition
Advanced or late-stage AIDS
Name 1 Symptom Associated With HIV Infection in the Infant or Child.
Low weight and failure to gain weight
Pneumonia
Lymphadenopathy
Diarrhea
TB
HIV and AIDS Overview
HIV and AIDS
Human Immunodeficiency Virus
H = Human
I = Immunodeficiency
V = Virus
HIV and AIDS
Acquired ImmunoDeficiency Syndrome
A = not inherited
I = immune system
D = deficiency – inability to protect against illness
S = syndrome, a group of symptoms or illnesses
that occur as a result of HIV infection
CD4 The average person has between 800 & 1500
CD4 cells per cubic millimetre of blood
The immune system helps fight diseases
Disease CD4 Disease
KILLS DISEASE
IMMUNE
SYSTEM
ATTACKS DISEASE
T Cells (CD4 Cells) =
Part of body’s immune system
Transmission of HIV
HIV is transmitted by
Direct contact with infected blood
Sexual contact: oral, anal or vaginal
Direct contact with semen or vaginal and cervical secretions
Mothers infected with HIV to infants during pregnancy, delivery and breastfeeding
Coughing, sneezing
Insect bites
Touching, hugging
Water, food
Kissing
Public baths/pools
Transmission of HIV
HIV cannot be transmitted by:
Toilets
Handshakes
Work or school contact
Telephones
Cups, glasses,
plates, or other utensils
Women are 3 times more easily infected than males!
The vagina is more susceptible to lesions allowing the virus to pass into the body, and semen can remain in the body for up to three days.
Worldwide 75% of HIV is transmitted sexually.
¾ of infections are through heterosexual sex and ¼ are homosexual sex.
Are Some People More Susceptible to HIV?
Are Some People More Susceptible to HIV?
People with STIs are up to 10 times more at risk as many of the STI will result in cuts and open sores giving the HIV more chance to enter the body.
HIV Animation
Natural History of HIV Infection
Severity of illness is determined by amount of virus in the body (increasing viral load) and the degree of immune suppression (decreasing CD4 count).
Higher the viral load, the sooner immune suppression occurs.
When does HIV become AIDS?
1500 to 800 CD4 - Average healthy person
Below 500 CD4 - HIV+ person at risk from
Opportunistic Infections
200 CD4 Person is considered to have AIDS
CD4
COUNT
! In many developing countries they are unable to conduct the
difficult CD4 count tests. In these countries AIDS is
diagnosed by looking at the symptoms that the person has.
26
PREVENTION OF MOTHER-TO-CHILD TRANSMISSION OF HIV Module 1
Draft
_______________Head__________________
Toxoplasmosis (Toxo)
Cryptococcal meningitis
_______________Eyes__________________
Cytomegalovirus (CMV)
___________Mouth and Throat__________
Candidiasis (Yeast)
________________Lungs________________
Pneumocystis carinii pneumonia (PCP)
Tuberculosis (TB)
Histoplasmosis
_________________Gut_________________
Cytomegalovirus (CMV)
Cryptosporidiosis
Mycobacterium avium complex (MAC)
________________Skin_________________
Herpes simplex
Shingles
_______________Genitals______________
Genital herpes
Human papillomavirus (HPV)
Vaginal candidiasis (Yeast)
HIV-Related Opportunistic Infections
PMTCT Program
PMTCT Strategies
Prevention of primary HIV infection
Prevention of unintended pregnancies among
women infected with HIV
Prevention of mother to child transmission
Providing treatment, care and support to
women who are HIV infected, their infants,
and their families
HIV Prevalence at Mae Tao Clinic
Insert
Percent of ANC clients testing
positive
0.00
0.50
1.00
1.50
2.00
2.50
1999 2000 2001 2002 2003 2004 2005 2006 2007
Pregnant Women
4,545 seen in ANC in 2007
3,421 (75.3%) tested for HIV in 2007
1,124 (24.7%) not tested
53 (1.55%) tested positive
for HIV
3368 (98.45%)
tested negative
+1 patients diagnosed elsewhere
54 patients enrolled in PMTCT in 2007
13 (24.07%) lost to follow-up
11 (20.37%)
pending
delivery at
< 28 weeks
as of 1/18/2008
27 (50%) received AZT
antepartum
Assume 1.55%
HIV rate
17.42 (1.55%)
hypothetical HIV
positive
1106.58
(98.45%) not
hypothetically
HIV positive
1089.43
(98.45%)
Hypothetical
HIV Negative
17.15 (1.55%)
Hypothetical
HIV Positive
(seroconversion
during pregnancy)
5.38 (30.9%)
Hypothetical
HIV infected
infants
12.04 (69.1%)
Hypothetical
Non HIV
infected infants
4.02 (30.9%)
Hypothetical
HIV Positive
infants
8.98 (69.1%)
Hypothetical
HIV Negative
infected infants
52.20 (1.55%)
Hypothetical
HIV Positive
(seroconversion
during pregnancy)
3315.80
(98.45%)
Hypothetical
HIV
Negative
5.30 (30.9%)
Hypothetical
HIV Positive
Infants
12.09 (69.1%)
Hypothetical
HIV Negative
Infants
2 (3.70%)
received
NVP at
delivery, no
AZT
antepartum
1 ( 1.85%)
patient given
wrong result and
thus not enrolled
in program until
after delivery
4 (14.8%)
pending
delivery as of
1/18/2008
23 (85.2%)
delivered as
of 1/18/2008
Outcomes for ANC Screening in 2007
Antenatal Care for PMTCT
Extensive post-test counseling
Includes partner, STI, GBV, TB screening, VDRL,
Hepatitis B, discrimination, work)
Home-based care and/or other Support Networks
World Vision, METRO
Mae Sot hospital
Ultrasound, repeat HIV testing with ELISA)
Start daily dose of AZT at 28 weeks gestation
Labour and Delivery
Delivery at Mae Sot Hospital
Before rupture of membranes
Normal (vaginal) or Cesarean
Post partum tubal ligation available
Intrapartum Medicine
Nevirapine, Lamivudine, AZT
Post-Partum
Continue medication and personal care
Family Planning
Baby to start 1-3 drug therapy
Baby HIV test at 12 months of age is
important
Infant Feeding choice
Types of Infant Feeding
1. Breastfeed exclusively
Except for medicine and vitamins
2. Replacement feeding – milk formula
3. Mixed feeding
Both breast milk and formula
Mixed feeding should be avoided - it increases the risk of HIV infection, diarrhea and other infections
Formula Feeding Is OK When It Is:
Acceptable
– no stigma
Feasible
– mother can correctly prepare it
Affordable
– can pay for cost (incl. travel)
Sustainable
Will not switch back to breast milk
Safe
Clean water, cups, bottles
Breast Feeding
Give breast milk for first few months only
then switch to other foods
About 6 months
No Breast milk if mother has
new HIV infection
AIDS or Opportunistic Infections
Explain what a positive HIV test means to a
client.
Explain what a negative HIV test means.
Case 1
20 year old G1 P0 at 3 months gestation.
No previous ANC.
She comes by herself.
Complains of diarrhea for 2 weeks and weight loss, weakness.
Exam shows bruises on her face, chest and legs.
Case 1
She tells you her husband beats her and told her to get an abortion when he found out she was pregnant.
Her HIV test is reactive.
How do you counsel her?
What services should she receive?
Case 2
22 year old G1 P0 admitted to RH IPD for septic induced abortion at 2½ months gestation.
She is not married.
She has worked in a brothel for 3 months and plans to continue there.
Her HIV test is reactive.
How do you counsel her?
What services should she receive?
Case 3
34 yr old G4 P1+2 at 6 months gestation comes for
her first ANC visit.
Her husband is working in Bangkok. He is not the
father of this baby. He does not know she is
pregnant and sends her money every month.
Her HIV test is reactive.
How do you counsel her?
PMTCT Goals for 2008: Goal 1
90 percent or more of all ANC clients will be screened for HIV (and Hepatitis B and VDRL).
Women will be tested at the first ANC visit
Repeat testing will be done in the third trimester for women at high risk for infection
New STI
Partner positive
Other risk factors
PMTCT Goals for 2008: Goal 2
All HIV infected ANC clients will have a peer counselor to meet with throughout pregnancy and afterwards either through Home-based Care or at RH OPD.
Each session will include education about HIV transmission, ARV’s, infant feeding, and risk reduction practices.
PMTCT Goals for 2008: Goals 3 & 4
All HIV infected clients will be referred to
Mae Sot Hospital for CD4 count and if
eligible full ARV therapy through the
migrant ARV program.
All data forms on ANC HIV infected clients
will be complete, accurate, and prompt.