PMTCTPMTCT

Presented by:Presented by:Ms T. Nondanyana (PMTCT COORDINATOR)Ms T. Nondanyana (PMTCT COORDINATOR)

Room: 129Room: 129Tel:053 8300 637Tel:053 8300 637

tnondanyana@ncpg.gov.zatnondanyana@ncpg.gov.za

BackgroundBackground

What is PMTCT?What is PMTCT?

- - Prevention of Mother To Child Transmission of HIVPrevention of Mother To Child Transmission of HIV

The PMTCT programme was conceptualized in The PMTCT programme was conceptualized in 2000,piloted in 2001 and was implemented in 2002 2000,piloted in 2001 and was implemented in 2002 nationally with single dose Nevirapine, updated in nationally with single dose Nevirapine, updated in 2008 to a dual therapy protocol (AZT and NVP)2008 to a dual therapy protocol (AZT and NVP)

2010 added Truvada (FTC+TDF) post delivery2010 added Truvada (FTC+TDF) post delivery NVP stat dose for babies then up to six weeks or for NVP stat dose for babies then up to six weeks or for

the duration of breastfeeding the duration of breastfeeding Its aim to reduce (MTCT) to less than 5% Its aim to reduce (MTCT) to less than 5% (NSP 2007-2011)(NSP 2007-2011)

MTCT can occur in three stages Ante-partum (During pregnancy) Intra-partum (Labour and delivery) Post-partum ( After delivery)

FACTORS THAT INCREASE FACTORS THAT INCREASE THE RISK OF MTCT DURING THE RISK OF MTCT DURING

PREGNANCYPREGNANCY Any disruption in the maternal-foetal blood Any disruption in the maternal-foetal blood

barrier, e.g. abruptio placenta.barrier, e.g. abruptio placenta. Sexually transmitted diseasesSexually transmitted diseases Increased viral loadIncreased viral load Low CD4 countLow CD4 count Cigarette smokingCigarette smoking

FACTORS DURING LABOUR FACTORS DURING LABOUR AND DELIVERYAND DELIVERY

ChorioamnonitisChorioamnonitis Mixing of blood during the birth processMixing of blood during the birth process PrematurityPrematurity Multiple pregnancyMultiple pregnancy Prolonged rapture of membranesProlonged rapture of membranes EpisiotomyEpisiotomy Assisted deliveries such as vacuum extraction Assisted deliveries such as vacuum extraction

and forceps deliveryand forceps delivery

FACTORS POST-NATALLY FACTORS POST-NATALLY (DURING BREASTFEEDING)(DURING BREASTFEEDING)

Maternal factorsMaternal factors-Primary infections-Primary infections-CD4 count-CD4 count-High viral load-High viral load Breast pathologiesBreast pathologies-Mastitis-Mastitis-Abscess-Abscess-Nipple fissure or crack-Nipple fissure or crack

FACTORS POST-NATALLY FACTORS POST-NATALLY (DURING (DURING

BREASTFEEDING)BREASTFEEDING)22

Infant factorsInfant factors

-Breastfeeding patterns (mixed feeding)-Breastfeeding patterns (mixed feeding)

-Breastfeeding duration-Breastfeeding duration

-Condition of the baby’s mouth such as ulcers and oral thrush-Condition of the baby’s mouth such as ulcers and oral thrush

CHALLENGES

DisclosureMixed feedingRe- infection

STRATEGIES TO PREVENT STRATEGIES TO PREVENT MTCTMTCT

Encouraging couples/partners to go for HIV Counseling and Encouraging couples/partners to go for HIV Counseling and testing if they are planning for pregnacy. testing if they are planning for pregnacy.

Awareness campaignsAwareness campaigns Male involvementMale involvement If tested HIV negative they should remain so (ABC) and retested If tested HIV negative they should remain so (ABC) and retested

at 32 weeks or before deliveryat 32 weeks or before delivery- If tested HIV positive they will be assessed and referred If tested HIV positive they will be assessed and referred

accordingly.accordingly.- Pregnant woman will receive AZT at 14 weeks or ARVs , AZT Pregnant woman will receive AZT at 14 weeks or ARVs , AZT

and NVP during labour and Truvada post delivery the baby will and NVP during labour and Truvada post delivery the baby will also receive syrup of NVP until six weeks or as long as is also receive syrup of NVP until six weeks or as long as is breastfed.breastfed.

Stick on the chosen method of feedingStick on the chosen method of feeding

STRATEGIES TO PREVENT STRATEGIES TO PREVENT MTCTMTCT22

Use condoms to avoid re-infectionUse condoms to avoid re-infection Baby to be taken to the clinic at six Baby to be taken to the clinic at six

weeks(1month and 2 weeks) for immunizations, weeks(1month and 2 weeks) for immunizations, test for HIV(PCR) and receive cotrimoxazole.test for HIV(PCR) and receive cotrimoxazole.

To be tested again at eighteen months (1year 6 To be tested again at eighteen months (1year 6 months)months)

Progress

Progress…

Progress…

QUESTIONS?QUESTIONS?

THANK YOUTHANK YOU