ICTC Team Training 1 Prevention of Parent to Child Transmission (PPTCT)

ICTC Team Training1

Prevention of Parent to Child Transmission (PPTCT)

Starter Quiz

Exclusive breastfeeding is defined by WHO as giving an infant only breastmilk. The ONLY other things also allowed are ChocolatesDrops or syrups containing vitamins, mineral supplements, or medicinesMasoor Dal waterBottle feeds made by companies like Amul and Cerelac

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Starter Quiz

When the mother chooses replacement feeds (instead of breastfeeding), all these are good reasons to choose cup feeding over bottle feeding EXCEPT forCups are safer because they are easier to clean with soap and water than bottles.Cups are less likely than bottles to be carried around for a long time, giving bacteria a chance to increase.Cups come in different designs and colours which can be used to stimulate mental growth in the child.Cup feeding requires the person feeding the child to hold the child and this increases physical and social contact.

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Starter Quiz

All the following are reasons why a woman infected with HIV/AIDS may choose to breastfeed her newborn child instead of giving a breastmilk substitute. The ONLY EXCEPTION isTo reduce her expenses because replacement feeding is expensive.To avoid accidentally disclosing her HIV status to others.To avoid stigma.To delay accepting her HIV statusTo bond with her child physically and socially.To improve her child’s future job prospects.

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Starter Quiz

Name the two tests that can detect HIV infection in an infant:An HIV antibody test (ELISA or a rapid test) conducted at 3 months after birthAn HIV antibody test (ELISA or a rapid test) conducted at 18 months after birthAn HIV antigen test like the PCR test 6 weeks after birthA urine test

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Starter Quiz

Maternal factors that may increase the risk of HIV transmission during pregnancy includeNew HIV infection during pregnancyStarting a new job during pregnancyAdvanced HIV disease or AIDS in the motherHigh maternal viral loadViral, bacterial, and parasitic infection of the placenta (especially malaria)Maternal malnutrition (indirect cause)STIs ICTC Team Training6

If 100 HIV-positive women give birth to 100 infants, then

5 – 10 of the infants will be infected during pregnancy

10 - 20 will be infected during labour and delivery

20 – 30 will be infected during breastfeeding

The total number of children infected is 25 to 40.

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PPTCT as a Case of Provider-Initiated Testing

ICTC provides opportunity to interact with pregnant patients.

ICTC team to actively generate referrals from private and public maternity services

Educate women about how knowing their HIV status can help

Encourage men to bring their female partners for testing and services


Advantages of PPTCT

Mother Decreased chance of

HIV transmission to her child

Post partum care Infant feeding support

Child Decreased chance of being

infected with HIV Proper nutritional guidance –

breastfeeding vs replacement feeding

Prevention & treatment of OI– Proper immunization – Cotrimoxazole prophylaxis

ART when required


Routine Antenatal Care


Client history Physical exam and vital signs Abdominal exam Lab diagnostics Tetanus toxoid immunizations Nutritional assessment and counselling STI screening Anti-malarials Counselling on infant feeding Counselling on pregnancy danger signs Partners and family Effective contraception plan

Antenatal care of HIV-infected women

HIV Testing Preventing Opportunistic Infection Assessment and Management of HIV-related

illnesses Recurrent or Chronic Infection Treatment of STIs Psychosocial and Community Support


Partner involvement in PPTCT

Counselling should include, where possible, the male partner of the pregnant woman in order to acknowledge his role in protecting the child.


ARV Treatment and Prophylaxis

ARV prophylaxis: drugs to prevent primary infection in the infant

ARV treatment: drugs to limit the effect of HIV in the woman.

Prophylaxis does not provide long-term protection for the infant.


NACO recommended regimen for prophylaxis

200 mg oral tablet of Nevirapine given to the mother at the beginning of labour.

Newborn babies should receive 2 mg/ kg NVP in suspension within 72 hours of birth.


Management of Labour & Delivery of Women Infected with HIV

ARV Prophylaxis Universal Precautions Minimising Cervical Examinations Avoiding Prolonged Labour Avoiding Prolonged Membrane Rupture and Routine

Artificial Rupture of Membranes Avoiding Unnecessary Trauma during Childbirth Minimising the Risk of Postpartum Haemorrhage Safe Transfusions


Infant Feeding: Breast Feeding

Exclusive breast feeding of the newborn should be advised to all HIV positive mothers for first six months of life unless replacement feeding is Acceptable, feasible, Affordable, Sustainable, and Safe (AFASS)

If the woman opts to exclusively breast feed the bay, it should be stopped at 6 month (early cessation) followed by adequate add timely weaning.


Infant Feeding : Breast Feeding

Breast Milk could transmit HIV infection if mother is infected

Can lower this transmission rate through measures such as ART for mothers, treating breast infections in mother, oral infections in child

Counsel mother to breastfeed exclusively for 6 months and then rapidly wean child within 2 weeks.


Infant Feeding: Replacement Feeding


Early Infant Diagnosis

HIV infection follows a more aggressive course among infants and children.

Early HIV diagnosis and treatment for children slows the progress of HIV.

It is mandatory to establish a definite diagnosis at 18 months by HIV antibody.

Number of tests 6 weeks – 6 months 6 months – 18 months

First test DNA-PCR DBS Rapid test

Second test DNA-PCR WB DNA-PCR DBS

DNA-PCR WB

Exposed Baby Care

All children born to HIV-positive woman until established not positive

Regular growth monitoring and clinical assessment can lead to early detection of HIV infection


Cotrimoxazole Prophylaxis


Weight (kg) Child dispersible tablet

(20mg TMP/100mg SMX)

Once daily

< 5 1 tablet

5 – 10 2 tablets

10 – 15 3 tablets

15 – 22 4 tablets

WHO Immunisation Recommendations

Age of infant Vaccine

Birth BCG, OPV-O

6 weeks DPT-1, OPV-1



9 months Measles

Key: BCG= Bacille Calmette Guerin; OPV= Oral Polio Vaccine; DPT= Diphtheria, Pertussis, Tetanus


Exercise

1. What are the testing needs of the female client?

2. What should counselling cover on the first visit?

3. What should counselling cover on the second visit?

4. Are there organizations or services where you could refer the client?


Information to be extracted for the monthly report

Total number of women who register at the ANC Antenatal women who receive pre-test counselling/ information Antenatal women who receive post-test counselling The sero-status of the ANC client Details of ANC including parity, Expected Date of Delivery, plan

of delivery Counselling and testing of women directly coming in labour Spouse or partners counselled, tested and their HIV status Positive women who delivered and received NVP Unregistered ANC women accessing HIV service Referrals to and from TB and details regarding the same Referrals to other care and support services Stock of NVP, kits and condoms

ICTC Team Training 1 Prevention of Parent to Child Transmission (PPTCT)

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