PREVENTION OF

MATERNAL TO CHILD
TRANSMISSION OF
HIV

Objectives

Describe relationship of HIV on pregnancy

Factors affecting vertical transmission

Strategies to prevent maternal to child

transmission

Introduction

UNAIDS about 25 million adults& children

living with HIV/AIDS in Sub Saharan
Africa.
4million new cases yearly
300,000 to 600,000 AIDS related deaths in
1999 in children (0 -14yrs)

HIV AND PREGNANCY

Effect of pregnancy on HIV progression

Effect of HIV on pregnancy outcome

Effects of pregnancy on HIV

infection

No effect on HIV progression.

Slight decline in absolute numbers of CD4

count ( % of CD4 cells remains stable

No overall significant in deaths rate

Effect of HIV on pregnancy

course and outcome

Maternal to Child Transmission

Accounts to 15 % of all transmission in Uganda

Accounts for > 90% of infection in children
In Africa rate of MTCT is 20 -40%
Overall risk at point estimate for transmission

During pregnancy: 5 -10%

In labour: 15 -20%
Breast feeding : 10-15%

Factors affecting
transmission

Viral factors:(Load,strain
variation)*
Maternal: CD4 count
STD infections*
Substance abuse
Sexual behavior*
Placental disruption

Preterm deliveries
Duration of membrane
rupture.*
Invasive procedure in
Labour( Instrumental
vaginal
deliveries,episiotomies*
Mode of delivery
Fetal/neonatal factors
Breast feeding *

Prevention of Maternal to
Child Transmission

Comprehensive MCH services

( antenatal,intrapartum,postnatal)
VCCT
Short course antiretroviral treatment
Modified and optimal obstetrical practice
Support for safe infant feeding
Family planning services & counseling

Comprehensive ANC
minimum package for
PMTCT
Provision of quality ANC

Health education
Micro nutrient supplementation
Prevention and treatment of infections
Anti- retroviral drugs

Provision of Quality ANC-1

Early Attendance
Refocused ANC with at least 4 to 5 visits
Detailed history taking
Examination to rule out signs of HIV related illness
Baseline Investigation: Hemoglobin,RPR for
syphilis,Urine analysis
Voluntary confidential counseling and testing.

Provision of Quality ANC-2

1st Visit:Detailed history, examination, investigation, folic

supplements,deworming and VCCT
2rd Visit:Monitor progress of pregnancy, Counsel on pmtct
and breast feeding option, 1st dose of IPT,tetanus
toxoid,iron/folic supplementation.
3rd Visit:Monitor progress of pregnancy,blood pressure
,Hb and urine analysis,2rd dose IPT,tetanus toxoid,
iron/folic supplementation.Counseling support
4th Visit: As above. Enrolment on the PMTCT
program,Give antiretroviral drugs

Health education

Nutrition,personal hygiene,environmental sanitation

Normal Tetanus toxoid schedule
STI treatment
Benefits of VCCT
Condom usage and family planning
Male involvement
Breast feeding /other feeding options