PRESENTATION 3.

PREVENTION OF MOTHER-TO-
CHILD TRANSMISSION (PMTCT)
during ANC

Federal Democratic Republic of Ethiopia

Ministry of Health

BEmONC – LRP
ETHIOPIA Best Practices in Maternal and Newborn Care
 Session Objectives

 To discuss best practices for antenatal care of the HIV-positive

mother to reduce mother-to-child transmission
 To describe the evidence supporting these practices

BEmONC – LRP: Ethiopia PMTCT

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Best Practices in Maternal and Newborn Care
 QUESTION ???

 When does most transmission of HIV from

mother to child occur?

BEmONC – LRP: Ethiopia PMTCT

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Best Practices in Maternal and Newborn Care
 Timing of Mother to Child Transmission
of HIV

During pregnancy
(5-10%)

During labor and delivery (10-20%)

During breastfeeding
(5-10%)

BEmONC – LRP: Ethiopia PMTCT

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Best Practices in Maternal and Newborn Care
 QUESTION ???

 What are some of the effects of HIV infection

in the mother on the pregnancy and health of
the newborn?

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Best Practices in Maternal and Newborn Care
 Antenatal factors influencing MTCT

Viral Maternal
 Viral load (the higher  Maternal immunological status
the viral load, the  Maternal nutritional status
greater the risk of  Maternal clinical status
HIV transmission) (including co-infection with an
 Viral genotype and STI)
phenotype
 Behavioral factors
 Viral resistance
 Antiretroviral treatment

BEmONC – LRP: Ethiopia PMTCT

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Best Practices in Maternal and Newborn Care
 QUESTION ???

 What points are important when

counseling a pregnant women with HIV
during ANC?

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Best Practices in Maternal and Newborn Care
 Ante natal care

 ANC allows interaction between the health facility

and sexually active women to:
 provide information on HIV
 promote safer sex practices,
 provide opportunity for the pregnant woman to know
her HIV status
 Identify and treat STIs
 Advice on use of ITN
 Provides opportunities to discuss the interventions
for reducing the risk of MTCT
BEmONC – LRP: Ethiopia PMTCT
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Best Practices in Maternal and Newborn Care
 Counseling HIV positive pregnant
women???
 Effect of pregnancy on HIV infection
 Effect of HIV on pregnancy outcome

 Risk of transmission to fetus and infant

 Treatment options in pregnancy

 Interventions to prevent mother to infant

transmission
 Infant feeding options

 Disclosure of results to partner

 Need for follow up of mother and child

 Future BEmONC fertility and

– LRP: contraceptive
Ethiopia options
PMTCT
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Best Practices in Maternal and Newborn Care
 Question

 What measures can you take during antenatal care

(ANC) of an HIV-positive woman to reduce the risk
of transmission of HIV?

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Best Practices in Maternal and Newborn Care
 Antenatal interventions to reduce MTCT
 HIV testing and counseling services
 Behavior change communication:
 Sexual
 Injection drug use
 Alcohol use and smoking

 Prevention of new infections in pregnancy

 Identification and treatment of STIs (genital ulcers and abnormal vaginal
discharge)
 Use ITN for malaria prevention
 Prevention and treatment of anemia (balanced diet and nutritional
supplementation)
 Avoiding invasive testing procedures in pregnancy
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Best Practices in Maternal and Newborn Care
 Antenatal interventions to reduce MTCT
contd
 Antiretroviral Treatment
 Initiate HAART to all HIV positive pregnant women identified according to
the national guideline (option B+):
(ART’s should be provided to the mother for her health as well as for the health
of the baby.) First line preferred regimens TDF, 3 TC, EFV (single tab
combinations one tab daily)
Alternative :
TDF+ 3 TC+ NVP (1F)
AZT+3 TC+NVP (1C)
AZT+3TC+ EFV (1D)
Physical examination to detect any signs of HIV-related illness
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Best Practices in Maternal and Newborn Care
 Antenatal interventions to reduce MTCT
cont’d
 Use ITN for malaria prevention
 Mebendazole at first visit in areas of high worm
prevalence
 Isoniazid (INH) prophylaxis for tuberculosis (TB) if
indicated
 Pneumocystis carinii pneumonia (PCP) prophylaxis,
in women with clinical signs of AIDS or CD4 counts
of below 200 mm3
 Psychological support
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Best Practices in Maternal and Newborn Care
 Summary

 Women with HIV infection require focused antenatal care provided in

accordance with national protocols.
 HIV can be transmitted from an infected mother to her child during
pregnancy, labour and delivery, or through breastfeeding.
 Appropriate counselling, avoiding invasive procedures during
pregnancy are recommended to decrease MTCT
 Antiretroviral therapy regimens reduce the risk of MTCT and improve
maternal survival in both breastfeeding and non-breastfeeding women.

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Best Practices in Maternal and Newborn Care
 References

 DeCock K et al. 2000. Prevention of mother-to-child transmission in

resource-poor countries: Translating research into policy and practice. J
Am Med Assoc 283(9): 1175–1182.
 Anderson J (ed). 2001. A Guide to the Clinical Care of Women with
HIV, 2nd ed. U.S. Department of Health and Human Services, Health
Resources and Services Administration: Rockville, Maryland.
 Guidelines For Prevention of Mother-to-Child Transmission of HIV In
Ethiopia: (Federal HIV/AIDS Prevention and Control Office Federal
Ministry of Health), 2011.

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Best Practices in Maternal and Newborn Care