Prevention Of Parent To Child Transmission - PPTCT

• Without interventions the risk of MTCT is 25-40%
• Combination interventions can reduce MTCT rate by up to 40% in breastfeeding populations
• Because ARV prophylaxis alone does not treat the mother’s infection, ongoing care and support is needed
• MCH services can act as an entry point to the range of services that can provide care and support to the HIV-positive women and affected family members
• Linkages to community services can provide enhanced care and support

• An important component of the Indian government’s AIDS control programme
• Parent-to-child transmission (PPTCT) of HIV, or perinatal transmission, accounts for 2.72 percent of the total HIV infection load in the country.(India)
• Parent-To Child Transmission (PPTCT) of HIV can occur during pregnancy, at the time of delivery or through breastfeeding.
• If an HIV positive woman becomes pregnant, there is a 25-30% chance that the baby will also be infected.

Elements of the PPTCT programme:

• Primary prevention of HIV infection in young people & women of child bearing age through promotion and provision of free, subsidized or commercially marketed condoms, provide diagnosis for treatment of sexually transmitted diseases, and behaviour change communication efforts to reduce behaviour that place individuals at risk, and information about risks of PTCT during pregnancy, delivery, breastfeeding & encouragement to see VCT counselor or health provider for information on how to prevent HIV/AIDS among infants & young children.

• Prevention of unintended pregnancies in HIV positive women through reproductive health services, which include family planning.

• Prevention of transmission from an HIV positive women to her infant through anti-retroviral (ARV) prophylaxis and safer delivery practices

• Care and support services to HIV-infected women who are enrolled with the programme and to their children and families, including counselling on infant feeding.

Prong 1 Primary prevention of HIV infection
• 
  
• Prong 2 Prevention of unintended pregnancies among HIV-infected women
• Prong 3 Prevention of HIV transmission from HIV-infected women to their infants
• Prong 4 Provision of care and support to HIV-infected women, their infants, and their families

Rationale for PPTCT in India

27 million pregnancies per year

1,62,000 infected pregnancies

Cohort of 48,600 infected newborns per year

0.6% prevalence

30% transmission

Most of these children die within 2-5 years

The Terminology of HIV/AIDS

• MTCT – mother-to-child transmission
• PMTCT – prevention of MTCT
• PTCT – parent-to-child transmission
• PPTCT – prevention of PTCT
• PLWHA – people living with HIV/AIDS

Estimated MTCT Rates

• Without intervention
• During pregnancy 5 - 10%
• During labour and delivery 15- 20 %
• During breastfeeding 5 - 15%
• Total 25 - 45%

PPTCT: Interventions to Decrease Risk of HIV Transmission to Infant

• During pregnancy
• Decrease viral load (ARV prophylaxis and treatment)
• Monitor and treat infections
• Support optimal nutrition
  

PPTCT: Interventions to Decrease Risk

• During labour and delivery Avoid

• Premature rupture of membranes
• Invasive delivery techniques
• Unresolved infections such as STIs

• Provide
• Elective caesarean section when safe and feasible

PPTCT: Interventions to Decrease Risk

• Promote safer infant feeding
• Replacement feeding
• Exclusive breastfeeding for limited time
• Avoidance of mixed feeding
• Reporting breast problems
• Support for optimal nutrition

• For parents-to-be . . . the ABCs
• A = Abstinence
• B = Be faithful to one HIV-uninfected partner
• C = Condoms — use consistently and correctly

Category: PSM Notes