Location via proxy:   [ UP ]  
[Report a bug]   [Manage cookies]                
Scribd Logo
Upload

Welcome to Scribd!

  • 65 views

    Prevention of Parent To Child Transmission of HIV : Dr. Shobha

    Uploaded by

    jijani
    The document discusses prevention of parent-to-child transmission of HIV. It notes that the overall HIV prevalence among antenatal clinic attendees in India is 0.35%. Counseling and testing is offered to all pregnant women, with an opt-out approach. For HIV-positive pregnant women, lifelong antiretroviral therapy is initiated regardless of CD4 count or clinical stage. The preferred first-line ART regimen is Tenofovir, Lamivudine and Efavirenz. Breastfeeding is promoted as the preferred feeding option with antiretroviral prophylaxis for the infant. Early infant diagnosis and co-trimoxazole prophylaxis are also emphasized.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd

    Prevention of Parent To Child Transmission of HIV : Dr. Shobha

    Uploaded by

    jijani
    65 views52 pages
    The document discusses prevention of parent-to-child transmission of HIV. It notes that the overall HIV prevalence among antenatal clinic attendees in India is 0.35%. Counseling and testing is offered to all pregnant women, with an opt-out approach. For HIV-positive pregnant women, lifelong antiretroviral therapy is initiated regardless of CD4 count or clinical stage. The preferred first-line ART regimen is Tenofovir, Lamivudine and Efavirenz. Breastfeeding is promoted as the preferred feeding option with antiretroviral prophylaxis for the infant. Early infant diagnosis and co-trimoxazole prophylaxis are also emphasized.

    Original Description:

    pptct

    Original Title

    hiv (1)

    Copyright

    © © All Rights Reserved

    Available Formats

    PPTX, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    The document discusses prevention of parent-to-child transmission of HIV. It notes that the overall HIV prevalence among antenatal clinic attendees in India is 0.35%. Counseling and testing is offered to all pregnant women, with an opt-out approach. For HIV-positive pregnant women, lifelong antiretroviral therapy is initiated regardless of CD4 count or clinical stage. The preferred first-line ART regimen is Tenofovir, Lamivudine and Efavirenz. Breastfeeding is promoted as the preferred feeding option with antiretroviral prophylaxis for the infant. Early infant diagnosis and co-trimoxazole prophylaxis are also emphasized.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    65 views52 pages

    Prevention of Parent To Child Transmission of HIV : Dr. Shobha

    Uploaded by

    jijani
    The document discusses prevention of parent-to-child transmission of HIV. It notes that the overall HIV prevalence among antenatal clinic attendees in India is 0.35%. Counseling and testing is offered to all pregnant women, with an opt-out approach. For HIV-positive pregnant women, lifelong antiretroviral therapy is initiated regardless of CD4 count or clinical stage. The preferred first-line ART regimen is Tenofovir, Lamivudine and Efavirenz. Breastfeeding is promoted as the preferred feeding option with antiretroviral prophylaxis for the infant. Early infant diagnosis and co-trimoxazole prophylaxis are also emphasized.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 52

    Prevention

    of parent to
    child
    transmission
    of HIV…
    DR. SHOBHA
    ONLY WHEN WE KNOW THE
    IMPACT AND MAGNITUDE OF A
    PROBLEM, WE WILL BE
    INTERESTED IN ITS SOLUTION…
    Numbers First…
     Overall HIV prevalence among ANC clinic attendees,
    considered as a proxy for prevalence among the
    general population, is 0.35%.

     Of every 100 HIV positive persons, 39 are women and 7


    are children less than 15 years.
    PRONG PRONG PRONG PRONG
    1 2 3 4
    Prevention
    Primary of
    prevention unintended
    PPTCT
    of HIV pregnancies
    in HIV +ve
    women Support for
    the mother
    Triple drug and family
    Sex
    regimen,
    education, Dual
    care of the
    awareness protection;
    HIV
    about MTP
    exposed
    condoms
    infant
    Prevention of
    mother to child
    transmission

    Prevention of
    parent to child
    transmission
    Essential package of PPTCT services
    Counselling
     Routine offer of HIV counselling (Group/Individual
    counselling) and testing to all pregnant women
    attending ante-natal care, with ‘opt out’ option.

     Ensure involvement of spouse & other family members


    and move from an “ANC centric” to a “Family centric”
    approach.
    OPT OUT COUNSELLING
     Provider initiated counselling and testing.
     The patient is given basic information on HIV,
    informed about the benefits of testing and also about
    the potential risks such as discrimination.
     Also informed about their right to refuse testing.
     If a patient does not opt out then she is tested for HIV.
     Followed by post test counselling.
     Follow up counselling is provided for those who are
    in the window period.
    OPT IN…
     These are clients who present themselves at the ICTC
    of their own free will.
     Thus this is client initiated counselling and testing.
    Pre test counseling
     Nurse/counsellors to provide information on the ante
    natal screening comprehensive package including HIV
    testing through both individual counselling and group
    counselling information sessions.

     Those who opt out of HIV testing should be offered


    repeat counselling to explore the reasons for opting
    out, address any misunderstandings and encourage
    her to reconsider her decision.
     Offer HIV testing at each subsequent clinic visit.
    Counseling session in progress…
    Post test counseling
     Educate those with negative test to remain uninfected.
     For those with confirmed HIV positive tests, further
    counselling, support and referrals to care and
    treatment services.
    Antenatal care for HIV +ve women
     The initiation of ART should not be delayed for want
    of CD4 test results.
     Initiate lifelong ART in all pregnant women with
    confirmed HIV infection regardless of WHO clinical
    stage or CD4 cell count.
     TDF + 3TC + EFV is recommended as first-line ART in
    pregnant and breastfeeding women, (including
    pregnant women in the first trimester of pregnancy
    and women of childbearing age).
     ART shall be initiated only at ART centre
    AN care (contd..)
     Co-trimoxazole should be started if CD4 count is ≤ 250
    cells/mm3 and continued through pregnancy, delivery
    and breastfeeding as per national guidelines (Dose:
    Double strength tablet – 1 tab daily).
     Ensure that pregnant women take their folate
    supplements regularly.
    WHY LIFELONG ART?
     Avoiding stopping and starting drugs with repeat
    pregnancies.
     Provide early protection against mother to child
    transmission in future pregnancies.
     Avoiding drug resistance.
    Routine antenatal care
    Initial assessment
     At least 4 ANC check ups during pregnancy:
    Registration and I check up within 12 weeks
    II between 14-26 weeks
    III between 28-32 weeks
    IV between 36-40 weeks
     Hb, blood grouping and typing, urine routine at first
    visit.
     Test for syphilis, Hepatitis B and HIV.
     Annual screening with pap smear for ca cervix.
    SUBSEQUENT VISITS
     Urine routine to be done at all visits.
     Hb to be rechecked at third visit at 28-32 weeks.
     Iron and folate supplementation as usual.
    HIV and TB
     Screen for TB at each visit.
     Clinical screening: h/o cough, expectoration,
    unexplained fever, weight loss, loss of appetite,
    lymphadenopathy, pleuritic chest pain.
     A failure to gain adequate weight should arouse the
    suspicion for further evaluation.
    Vaccination in HIV mothers
     Two doses of tetanus toxoid to be given as usual.

     H1N1 vaccination
    PREGNANCY HAS
    NO EFFECT OVER
    HIV DISEASE
    PROGRESSION
    EFFECTS OF HIV ON PREGNANCY
     A large meta-analysis that included articles from
    several countries between 1998 and 2006 showed that
    overall, highly active antiretroviral therapy (HAART)
    did not increase the risk of prematurity.
     However, the use of regimens with protease
    inhibitors seemed to increase prematurity
    slightly.
     A possible association exists between HAART and
    preeclampsia.
    EFFECTS OF HIV ON PREGNANCY
     The development of glucose intolerance may be
    more common in pregnant women with HIV.
     Originally thought to be associated with protease
    inhibitors, gestational diabetes appears to be
    somewhat increased regardless of the medication
    regimen.
     As such, during pregnancy, women should be screened
    and monitored for glucose intolerance.
    ART
     Provide ART to all HIV infected pregnant women
    regardless of WHO staging and CD4 count results.
    Preferred regimen is TDF+3TC+ EFV.

     Promote institutional delivery for all HIV infected


    pregnant women.

     Provision of care for associated conditions (STI/RTI,


    TB & other Opportunistic Infections (OIs).
    2010 vs 2013 guidelines
     As per 2010 guidelines ART initiated in pregnancy if
    CD4<350 cells/cubic mm 0r the WHO disease stage is
    3 or 4.
     However according to recent guidelines, regardless of
    CD4 count or WHO stage, ART is to be initiated.
    THE ART THAT WE USE… TLE
    TENOFOVIR

    LAMIVUDINE

    EFAVIRENZ
    ART…
     The recommended first line regimen for HIV infected
    pregnant women is:
     Tenofovir TDF 300 mg
     Lamivudine 3TC 300 mg
     Efavirenz EFV 600 mg
     Available as a once daily fixed dose combination in a
    single tablet, preferably taken at bed time.
     Used if there is no prior exposure to NNRTIs
    (NVP/EFV) at any gestational age.
    DRUG ADVERSE EFFECTS

    Tenofovir Nephrotoxicity and hypophosphatemia

    Lamivudine Rarely pancreatitis

    Efavirenz CNS toxicity: vivid dreams, nightmares,


    insomnia, headache, impaired
    concentration, depression, hallucination,
    exacerbation of psychiatric illnesses
    (resolves in 2-6 weeks)

    Protease inhibitors GI disturbances, glucose intolerance,


    lipodystrophy, dyslipidemia
    ALTERNATE REGIMENS
     Zidovudine, Lamivudine and Efavirenz
     Zidovudine, Lamivudine and Nevirapine
     Tenofovir, Lamivudine and Nevirapine
    For women with prior exposure
     For those with prior exposure to SdNVP or EFV, the
    TLE regimen may not be fully effective due to
    persistence of archived mutations to NNRTIs.
     These women require a Protease Inhibitor such as
    Lopinavir or Ritonavir.
     The dose will be TDF+3TC (1 tablet daily) +
    LPV(200mg)/r(50mg) 2 tablets BD.
    Women presenting directly in
    labour
     Women who are screened and found HIV Infected
    during labour or just after delivery should be given a
    Top Priority for Clinical Management and CD4
    assessment in the ART centre.
     Immediately started on drugs.
    Universal precautions
    OBSTETRIC MANAGEMENT
     Caesarean section should be performed for obstetric
    indications only.

     Keep membranes intact for as long as possible.

     Avoid instrumental delivery and routine episiotomy.


    DO’S AND DONT’S IN A NUTSHELL
     Do one PV examination to assess the woman.
     Give ART to the mother as prescribed.
     Clean vagina with 0.25% chlorhexidine.
     Adequate perineal support to prevent episiotomy.
     Follow universal work precautions always.
    DON’T
     Isolate the woman.
     Shave pubic area.
     Give enema.
     Perform frequent PV examinations.
     Rupture membranes unless indicated.
     Use instrumental deliveries unless absolutely
    necessary.
    POSTPARTUM CARE
     Condom should be used by all HIV positive males
    irrespective of using other methods of
    contraception…DUAL PROTECTION.

     PPIUCD is a safe contraceptive for women with HIV


    when used alongside condom. A single device can be
    used for up to ten years.

     Screening for post partum depression.


    DISCORDANT COUPLE
     If the wife is HIV positive and husband HIV negative,
    she has to take ART obviously.
     If husband is positive and wife negative, she should be
    tested again after the window period.
     Dual protection after child birth.
     Role of IUI with washed sperms.
    BOTTLE vs BREAST feeds
    Breast feeding
     Provide counselling and support for initiation of
    exclusive breastfeeds within an hour of delivery as the
    preferred Option and continue for 6 months.

     After 6 months, complementary feeding should be


    given along with breastfeeds.

     Provide antiretroviral prophylaxis to infants from birth


    up to a minimum period of 6 weeks.
    HIV Exposed Infant (HEI)
     Continued breastfeeds in addition to complementary
    feeds after 6 months up to 1 year for EID negative
    babies and up to 2 years for EID positive babies who
    receive Paediatric ART.
     Early infant diagnosis (EID) at 6 weeks of age; repeat
    testing at 6 months, 12 months & 6 weeks after
    cessation of breastfeeds.
     Confirmation of HIV status of all babies at 18 months
    using all 3 Antibody (Rapid) Tests.
     Co-trimoxazole prophylaxis from 6 weeks of age.
     No vaccine available hence preventing transmission is
    important.
     MDG to bring new infections in children to zero by
    2015.
    TAKE HOME MESSAGES
     Early detection of HIV
     Adequate AN care along with triple drug ART
     Patient counselling and widespread awareness
     Breast feeding the newborn
     Early detection of HIV in the newborn and appropriate
    treatment
     Absolutely no discrimination!!
    THANK YOU

    You might also like