Session: 3

The four pronged approach to comprehensive prevention of HIV in infants and young children

Dr.Pushpalatha, Assistant Professor, Dept of Pediatrics, Vani Vilas Hospital, Bangalore.

Although PPTCT Programs often focus on ARV prophylaxis, a

comprehensive approach

to the prevention of HIV infection in infants and young children consists of

4 elements

The four-pronged approach

Prevention of primary HIV infection

  HIV will not be passed on to children in parents-to-be are not infected.

Decreasing the number of HIV infected mothers is the most effective way of reducing MTCT

Prevention of primary HIV infection- strategies

 Safe and responsible sexual behavior and practices –

the ABC approach

• A=abstinence • B=be faithful to one partner • C=condom use, correctly and consistently Increasing new HIV infection-from husbands to wives.

Needs behavioural changes and education to safer sex practices.

Factors contributing to women’s vulnerability to HIV are Poverty,lack of information,abuse,violence.

BCC –aim to change the risky behaviour

 PROVIDE EARLY DIAGNOSIS AND TREATMENT OF STI’s  PROVIDE ACCESS TO CONDOMS  PROVIDE SUITABLE COUNSELLING FOR HIV NEGATIVE WOMEN  MAKE HIV TESTING AND COUNSELLING WIDELY AVAILABLE

The four-pronged approach

Prevention of unintended pregnancies among HIV infected women

   Women who know that they are HIV infected can avoid unintended pregnancies Family planning counseling for such women and their partners is critical.

Providing safe and effective contraception and high quality reproductive health counseling contributes to informed decision making about pregnancy choices.

The four-pronged approach

Prevention of HIV transmission from HIV infected women to their infants

  PPTCT refers to specific program to identify HIV infected pregnant women and to provide them with effective interventions to reduce MTCT The most important risk factor for MTCT is the VIRAL LOAD . High viral load is seen with recent HIV infection or with advanced HIV/AIDS

   ANC for the HIV infected woman includes basic prenatal care that emphasizes identifying and treating HIV related diseases ARV prophylaxis for the mother and infant decreases the risk of MTCT during labor.

However, ARV prophylaxis does not decrease the long term risk of transmission during breastfeeding.



PPTCT core interventions

HIV testing and counseling 

How these interventions work

Identifies HIV infected women  ARV prophylaxis  Reduced maternal viral load during pregnancy  Safer delivery practices  Reduced infant exposure to the virus during labor  Safer infant feeding practices  Reduced infant exposure to the virus through safer feeding options

Ways to reduce MTCT

      HIV testing and counseling Early MTP- when safe and acceptable to the woman ARV prophylaxis Elective Cesarean section when safe and feasible. Safer obstetrical procedures.

Infant feeding counseling for safer infant feeding practices.

ARV prophylaxis

  ARV prophylaxis , given to a HIV positive pregnant woman does not confer long term benefit to the woman herself With advanced HIV –combined ARV prophlaxis and treatment

ARV prophylaxis

  In industrialized countries – • triple drug ARV, • No breastfeeding, • Elective LSCS- rate of MTCT is 2% ARV prophylaxis can reduce MTCT by 40-70%.

Current regimens prevent infection only during early breast feeding period.

Partner involvement in PPTCT

   Both partners need to be aware of the importance of the safe sex through out pregnancy and breastfeeding.

Both partners should be counseled and tested for HIV Both partners should be made aware of and provided with PPTCT interventions.

The four-pronged approach

Provision of treatment, care and support to HIV infected women, their children and their families

   Medical care and social support are important in helping these women We need to address concerns about their own health and the that of their children and families If a woman is assured of this, she is more likely to accept counseling and testing and if infected, interventions to reduce MTCT

HIV related treatment, care and support services for women

      Prevention and treatment of opportunistic infections ARV treatment Palliative and non-ARV care Nutritional support Reproductive health care including family planning and counseling Psychosocial and community support

    

Care and support of the HIV exposed infant and child

These children have a higher risk of illness and malnutrition.

They may be infected with HIV and may become ill even when adequate health care and nutrition are provided Those who do not receive breast feeding lack its protective benefits against gastroenteritis, respiratory infections and other complications If mother is ill, she may be unable to give adequate care The family may be economically vulnerable due to AIDS related illness and deaths among adults

    

Nutritional support for HIV exposed infant or child

Supporting the mother’s chosen infant feeding option Providing education on hydration and early reporting of diarrhea Monitoring for growth and development Monitoring for signs of infection that can alter feeding patterns Regular follow-up during first 2 years of life, including immunizations and HIV testing