PMTCT by Dr. Sewangi J. RACC Mbeya

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PMTCTby Dr. Sewangi J. (RACC Mbeya)
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Approach

• Definition
• Brain storming
• Transmission
• Clinical presentation
• Prevention
• MTCT plus
• General discussion

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PMTCT

• Is the short form of Prevention of Mother To
  Child Transmission of HIV
• This is the most significant source of HIV
  infection in children below 15 years.
• Since the beginning of the pandemic, an estimated
  5.1 million children worldwide have been
  infected, almost all through MTCT.
• In 2001,gt800,000 children became infected,90 of
  whom were in Africa southern of Sahara

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Brain storming

• Is it true that some children are born free from
  HIV infection despite that their mothers do have
  the virus? Explain!
• Is MTCT preventable? Why/How?
• Can a positive HIV test become negative later?
  Why/When?

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Risk of Transmission

• HIV can be transmitted from an infected mother to
  her child in 25 to 30 of HIV infected mothers
  during
• Pregnancy
• up to 75
• labour and delivery
• Breastfeeding(20-25)

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Clinical presentation

• Intra-Uterine Fetal Death
• Abortion
• Normal baby with HIV infection
• Presenting with
• Antibodies
• Major and minor signs

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Major signs

• A loss of 10 or more of body weight within a
  short period
• Failure to gain weight
• Chronic diarrhoea persisting for more than one
  month
• Persistent fever lasting for more than one month

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Minor signs

• Persistent cough for more than one month
• Multiple skin infection bacterial, viral, fungal.
• Oropharyngial candidiasis
• Swelling of lymph nodes
• Parotitis
• Recurrent herpes zoster
• Multiple organ involvement liver, heart, spleen
  etc

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The Prevention

• This intervention aims at improving the survival
  of children born to HIV positive mothers
• The approach is through multisectoral response
• Primary prevention of HIV among parents to be
• Prevention of unwanted pregnancies between HIV
  infected women
• Prevention of HIV transmission from HIV infected
  women to their newborns through provision of
  antiretroviral drugs to HIV infected pregnant
  women and their newborns
• Safe delivery practices
• Counseling
• Support for safer infant feeding practices

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Key components of PMTCT

• Offering Voluntary Counseling and Testing
• Testing algorithm
• Modified obstetric care
• Administration of Anti-retroviral
• Infant feeding counseling
• Monitoring and evaluation
• MTCT (Mother To Child Transmission) plus

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VCT

• Is the main activity and it helps the client to
  make an informed decision

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Laboratory testing algorithm

• Use of one (if negative) or two (if positive)
  rapid tests

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Anti-RetroViral administration

• HIV positive clients are given Nevirapine tablet
  200mg during labour and her newborn is given
  syrup Nevirapine 2mg/kg body weight within 48-72
  hrs after birth

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Modified obstetric care

• This protects the baby during the time of maximum
  risk of transmission
• Involves avoiding all the invasive procedures
  during delivery e.g. episiotomy
• Surgical delivery

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Infant feeding counseling

• Client is given knowledge to be able to make the
  right decision on how to feed her baby
• Explain the risk of MTCT and not breastfeeding
• Discuss her home circumstances which allows the
  counselor to understand which option may be the
  most suitable for the mother
• Explain available feeding choices that are
  available to the mother within reach
• Help the mother make the decision
• Help mother to identify and agree to receive
  support so that she can carry out her decision
• Addressing the issue of prevention of
  re-infection
• Plan for future appointments with the mother

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Monitoring and evaluation

• Continuous monitoring of mother child pair to 18
  months to assess the safety and effectiveness of
  the intervention
• Prophylactic treatment to infants against
  Opportunistic Infections using Cotrimoxazole from
  6 weeks until diagnosis is confirmed

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MTCT plus

• Is a new intervention designed to link prevention
  with care and treatment for HIV infected women
  and their families
• Antiretroviral drugs are given in combination to
  all HIV positive family members who are found to
  be eligible under medical grounds.

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Thank you