Prevention of Mother to Child Transmission of AIDS/HIV Anti Retro-viral Therapy, Voluntary HIV Counselling and testing in Nepal

1. PREVENTION OF MOTHER-
TO-CHILD TRANSMISSION
OF HIV / AIDS
PREPARED & PRESENTED BY :- BPH 3RD BATCH BOYS, UCMS

2. STATUS OF HIV/AIDS IN THE WORLD
• HIV continues to be a major global public health issues, having
claimed more than 35 million lives so far.
• In 2016, one million people died from HIV- related causes globally.
• There were approximately 36.7 million people living with HIV at the
end of 2016 with 1.8 million people becoming newly infected in
2016 globally.
- Who 15 feb 2018

3. STATUS OF HIV/AIDS IN NEPAL
• As data provided by National centre for AIDS and STD Control
division,
Reported HIV cases in July 2017 -
Male- 18,989
Female-11,535
Transgender- 122
Total HIV cases- 30,646

4. INTRODUCTION
Mother-to-child transmission (MTCT) of HIV, also called perinatal or
vertical transmission, occurs when HIV is spread from an HIV+ women
to her baby during pregnancy, labor & delivery or breastfeeding.
Prevention of Mother-to-child transmission (PMTCT), also known as
prevention of vertical transmission
Refers to interventions to prevent transmission of HIV from an HIV+
mother to her infant during pregnancy, labor, delivery, or
breastfeeding.

5. • Overall incidence without intervention is 15 to 45 %distributed over
- Antenatal period
- The labor & delivery period
- Breastfeeding
• Around 15-30 % of babies born to HIV+ women will become infected with
HIV during pregnancy & delivery.
• A further 5-20 % will become infected through breastfeeding.
• This rate can be reduced to levels below 5 % with effective interventions.

6. COMPONENTS OF PMTCT
The WHO recommends a four-prolonged approach to a comprehensive
PMTCT strategy :-
1. Providing primary prevention of HIV infection among women
childbearing age
2. Preventing unintended pregnancies among women living with HIV
3. Preventing HIV transmission from women living with HIV to their infants
4. Providing appropriate treatment, care & support to mothers living with
HIV & their children & families.

7. A full PMTCT package for mothers, infants and partner
will include
1. HIV counseling and testing
2. Antiretroviral prophylaxis for HIV infection mother and infant
3. Infant feeding counseling and support
4. Safe obstetrical care
5. Family planning counseling and referral service
6. Referral care and support of HIV infected mother and infant

8. HIV counseling & testing in the context of PMTCT
services
Counseling and testing will be provided at well setting where pregnant women and
woman of child bearing age receive services; antenatal, labour, delivery, postnatal, FP
other pre-test and post –test counseling will be provided.
1. Pretest information and counseling + HIV education in ANC setting including
education methods on preventing MTCT + Couple counseling
2. HIV testing
3. Post test information and counseling
4. Disclosure of HIV status
5. Counseling and testing for women of unknown HIV status at the time of labour and
delivery.

9. Anti-Retro Viral
therapy

10. Recommended PMTCT protocol
HIV infected pregnant woman should be offered the standard recommended
regimen.
• ZDV from 28 weeks gestation, once the women is in labour, ZDV+ 3TC + Sd
NVP
• A one week tail of ZDV+3TC is given in the postnatal period to prevent NVP
resistance( due to long half life of NVP).
• The baby receive Sd NVP plus a one week course of infant ZDV.
* ZDV= zidovudine( azidothymidine)
* Sd NVP= single dose nevirapine
* 3TC= lamivudine.

11. Delivery at home/at a PHCH/HP; minimum standard
single dose nevirapine for mother and baby

12. Hospital & other health facilities with an established PMTCT
program recommended standard PMTCT protocol for mother &
baby

13. Voluntary HIV/AIDS
Counselling & Testing
Centre

14. VCT CENTRE
• A VCT centre refers to any setting where a qualified and trained counsellor
provides confidential HIV pre- and post-test counselling according to standard
counselling protocols and where a qualified and trained laboratory person
provides HIV testing according to standard laboratory protocols
• The process helps people prepare for and understand their HIV test results & also
helps people reflect on issues of sexual behaviour, drug use, and behaviour
change to prevent HIV, STIs or unintended pregnancy.
• People who test HIV negative can learn ways to avoid becoming infected, and
people who test HIV positive can learn how to live longer, healthier lives and
prevent transmission to others.

15. Goals of voluntary HIV/AIDS counselling and testing
1. To ensure that HIV-infected persons and persons at increased risk of HIV
infection:
• Have access to HIV testing
• Receive high-quality HIV prevention counselling
• Ensure provision of information regarding transmission, prevention, and the
meaning of HIV test results.
• Ensure access to appropriate treatment and care including ART.
2. To ensure that HIV-negative persons have access to the knowledge and skills to
prevent HIV infection and remain HIV negative.

16. The VCT
process

17. Where can VCT services be provided
• Outreach programs and health services for vulnerable groups: IDUs,
migrants/refugees, men who have sex with men (MSM), street children, sex workers
• Hospital services (public or private)
• Part of the continuum of care/home care
• Linked to blood banks
• NGO
• Integrated into general medical services as part of specialist care: STI, antenatal clinics
(PMTCT), family planning clinics, tuberculosis
• Correctional facilities
• Drug prevention and treatment programs

18. THANK YOU