unit 2 mtct and prevention strategies
TRANSCRIPT
Factors that increase transmission and strategies to reduce
transmission
Session Objective and content
• Objective: At the end of the session the participant should be able discuss MTCT, and transmission factors that may increase transmission and measures that reduce transmission
• Content• Timing of transmission• Factors influencing transmission (risk factors)• Interventions to reduce transmission – 4 elements of
perinatal HIV prevention
Mother-to-Child HIV Transmission
• MTCT is responsible for over 90% of childhood HIV infections.
• MTCT can take place:– During pregnancy – During labour and delivery– Postnatal due to breastfeeding
• Overall, the transmission rate is 40% without interventions.
Timing of transmissionNo BF 6 months
BF 18-24 months BF
Intrauterine 5-10% 5-10% 5-10%
Intra partum 10-20% 10-20% 10-20%
PostpartumEarly (1st 2 monthsLate (After 2 months)
5-10%1-5%
5-10%5-10%
Total 15-30% 25-35% 30-40%
Maternal Factors
• High maternal viral load• CD4 count• Stage of HIV disease• Smoking and substance abuse• STIs and other co infections• Maternal malnutrition (low vitamin A levels)
Labour and Delivery Factors
• Genital viral load• Duration of rupture of membranes • Invasive delivery procedures (episiotomy, artificial
rupture of membranes)• External cephalic version (ECV)• Chorioamnionitis• Premature delivery• Low birth weight• Mode of delivery
Breastfeeding Factors
• High breast milk viral load• Duration of breastfeeding• Mixed infant feeding• Breast abscesses, nipple fissures, mastitis• Poor maternal nutritional status• Oral disease in the baby (thrush or sores)
Four- Elements for Perinatal HIV Prevention
Prevention of HIV in women, especially young women
Prevention of unintended pregnancies in HIV-infected women
Prevention of transmission from an HIV-infected woman to her infant
Support for mother and family
Phase 1 Phase 2 Phase 3 Phase 4