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WHO and HHS/CDC Prevention of Mother-to-Child Transmission of HIV (PMTCT) Generic Training Package Components - Presentation Module 3


 

MODULE 3: Specific Interventions to Prevent MTCT.


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MODULE 3: Specific Interventions to Prevent MTCT


Module 3: Objectives. Name specific interventions for prevention of mother-to-child transmission (PMTCT). List locally available and recommended antiretroviral (ARV) regimens. Discuss antenatal management of women infected with HIV and women whose HIV status is unknown.
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Module 3: Objectives


Module 3: Objectives. Explain the management of labour and delivery in women infected with HIV and women whose HIV status is unknown. Explain postpartum care of women infected with HIV and women whose HIV status is unknown. Explain immediate care of infants born to mothers infected with HIV and to mothers whose HIV status in unknown.
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Module 3: Objectives


Specific Interventions to Prevent MTCT OF HIV. Session 1: Antiretroviral Treatment and Prophylaxis for the Prevention of MTCT.
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Session 1: Antiretroviral Treatment and Prophylaxis for the Prevention of MTCT


Antiretroviral (ARV) Treatment and Prophylaxis. ARV Treatment: Long-term use of antiretroviral drugs to treat maternal HIV/AIDS and prevent PMTCT. ARV Prophylaxis: Short-term use of antiretroviral drugs to reduce HIV transmission from mother to infant
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(Antiretroviral (ARV) Treatment and Prophylaxis


Antiretroviral Treatment. Reduces viral replication and viral load. Treats maternal infection. Protects the HIV-exposed infant. Improves overall health of mother. Requires ongoing care and monitoring.
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Antiretroviral Treatment


Co-Infection with Tuberculosis. Women infected with HIV can receive both antiretroviral and TB treatment at the same time with Additional drug selection & Clinical management.
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Co-Infection with Tuberculosis


ARV Prophylaxis for PMTCT. WHO (2004). Longer, combination prophylaxis regimens. Short-course prophylaxis regimens: Combination regimen not available. Combination regimen is not feasible.
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ARV Prophylaxis for PMTCT


ARV Prophylaxis for PMTCT. Information not inserted as intended: country protocol.
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ARV Prophylaxis for PMTCT


Alternative Regimens for ARV Prophylaxis. Refer to country protocol.
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Alternative Regimens for ARV Prophylaxis


Specific Interventions to Prevent MTCT OF HIV. Session 2: Antenatal Management of Women Infected with HIV and Women with Unknown HIV Status.
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Session 2: Antenatal Management of Women Infected with HIV and Women with Unknown HIV Status.


Antenatal Management. Reduces risk of MTCT. Provides linkage to treatment, care and support services. Helps women infected with HIV stay healthier longer. Helps HIV-negative women stay uninfected.
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Antenatal Management


Routine Antenatal Care. Test and counsel for HIV. Diagnose and treat STIs. Promote safer sex practises. Provide information on HIV. Provide infant-feeding counselling and support.
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Routine Antenatal Care


Prevent, Screen and Treat TB and Malaria. Co-infection with tuberculosis (TB): Follow country guidelines for prevention and treatment. Any woman with cough of two weeks or more needs to be screened and treated when indicated. Malaria. Follow country guidelines for prevention and treatment.
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Prevent, Screen and Treat TB and Malaria


Preventing and Treating Infections. Monitor and provide early treatment for: Urinary tract infections, Recurrent vaginal candidiasis, STIs. Provide prophylaxis for OIs according to country protocol.
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Preventing and Treating Infections


Psychosocial and Community Support. Pregnancy – a stressful time – link to: PLWHA support organizations, Community services for support with housing, nutritional needs, spiritual needs, ARV treatment when indicated and available.
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Psychosocial and Community Support


Specific Interventions to Prevent MTCT OF HIV. Session 3: Management of Labour and Delivery of Women Infected with HIV and Women with Unknown HIV Status
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Session 3: Management of Labour and Delivery of Women Infected with HIV and Women with Unknown HIV Status


Goals of Labour and Delivery. Reduce MTCT risk by providing ARV prophylaxis or treatment. Minimise exposure of foetus to maternal blood and body fluids. Support safer delivery practices.
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Goals of Labour and Delivery


Reducing MTCT Risk During Labour and Delivery. Minimise cervical exams. Use partogram to monitor labour. Avoid: Routine rupture of membranes, Prolonged labour, Unnecessary trauma during childbirth.
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Reducing MTCT Risk During Labour and Delivery


Reducing MTCT Risk During Labour and Delivery. Minimise risk of postnatal haemorrhage. ?? Use safe transfusion practises (blood screened for HIV and syphilis, malaria, hepatitis B & C when possible).
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Reducing MTCT Risk During Labour and Delivery


Elective Caesarean Section versus Vaginal Delivery. Elective cesarean section: Consider elective cesarean delivery when safe and feasible, Done at the onset of labour or membrane rupture. Vaginal delivery: When ARV prophylaxis or treatment has effectively reduced the viral load.
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Elective Caesarean Section versus Vaginal Delivery


Reducing MTCT Risk in Women with Unknown HIV Status. Offer rapid HIV testing with right to refuse. Discuss benefits to knowing HIV status. If HIV-positive, ARVs can be given for PMTCT and refer for treatment and care.
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Reducing MTCT Risk in Women with Unknown HIV Status


Reducing MTCT Risk in Women with Unknown HIV Status. Describe the testing process. Provide post-test counselling. If HIV-positive, provide ARV prophylaxis based on country regimen.
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Reducing MTCT Risk in Women with Unknown HIV Status


Specific Interventions to Prevent MTCT OF HIV. Session 4: Immediate Postpartum Care of Women Infected with HIV and Women with Unknown HIV Status.
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Session 4: Immediate Postpartum Care of Women Infected with HIV and Women with Unknown HIV Status


Immediate Postpartum Care. Patient Education: Symptoms of infection. Information on where to return for care. Perineal care. Breast care. Disposal of bloodstained pads.
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Immediate Postpartum Care


Immediate Postpartum Care of Women with HIV Infection. Continuing Care: Provide gynaecologic care, including pap smears. Monitor for OIs, provide prophylaxis. Prevent or treat TB and malaria. Refer for ARV treatment, care and support.
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Immediate Postpartum Care of Women with HIV Infection


Immediate Postpartum Care of Women with HIV Infection. Newborn Feeding: Mother chooses and begins feeding option. Support the choice of feeding option. Provide training on feeding option. Observe feeding technique.
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Immediate Postpartum Care of Women with HIV Infection


Immediate Postpartum Care of Women with HIV Infection. Signs & Symptoms (S&S) of Postnatal Infection: Instruct on S&S of infection. Provide information on where and when to seek health care. Instruct on perineal and breast care. Instruct on safe disposal of lochia & bloodstained materials.
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Immediate Postpartum Care of Women with HIV Infection


Postpartum Care of Women. Family Planning: Prevent unintended pregnancies. Support child spacing. Promote continued safer sex practices.
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Postpartum Care of Women


Women of Unknown HIV Status: Benefits of HIV Testing After Delivery. Initiate ARV prophylaxis for infant if indicated. Encourage safer feeding selection option should she test positive. Encourage exclusive breastfeeding if she tests negative or refuses to be tested.
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Women of Unknown HIV Status: Benefits of HIV Testing After Delivery


Specific Interventions to Prevent MTCT OF HIV. Session 5: Immediate Newborn Care of Infants and Infants who are HIV-Exposed with Unknown HIV Status.
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Session 5: Immediate Newborn Care of Infants and Infants who are HIV-Exposed with Unknown HIV Status


Immediate Newborn Care of HIV-Exposed Infants. DO: Cut cord under cover of light gauze. Determine mother’s feeding choice. Administer Vitamin K. Use silver nitrate eye ointment (within 1 hour of birth). Administer BCG as per country protocol.
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Immediate Newborn Care of HIV-Exposed Infants


Immediate Neonatal Care of Infant. DO NOT: Suction unless meconium-stained liquid is present. Use mouth-operated suction. Use mechanical suction at greater than 100 mm Hg pressure.
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Immediate Neonatal Care of Infant


ARV Prophylaxis for the Infant who is HIV-Exposed. Information not inserted as intended on country protocol.
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ARV Prophylaxis for the Infant who is HIV-Exposed


Infants Born to Mothers of Unknown HIV Status. Information not inserted as intended on country protocol.
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Infants Born to Mothers of Unknown HIV Status


Treatment, Care and Support of HIV-Exposed Infants. Information not inserted as intended on country protocol.
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Treatment, Care and Support of HIV-Exposed Infants


Treatment, Care and Support of HIV-Exposed Infants. Routine assessment for signs/symptoms of HIV (persistent diarrhoea, failure to thrive). According to country guidelines: HIV testing. PCP prophylaxis (starting at 6 weeks). Prevention and treatment of TB or malaria.
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Treatment, Care and Support of HIV-Exposed Infants


Module 3: Key Points. Integrating PMTCT services into the essential package of ANC services promotes improved care for all pregnant women and provides the best opportunity for a successful PMTCT programme. Specific interventions to reduce MTCT include ARV treatment and prophylaxis, safer delivery procedures, and counselling and support for safe infant feeding.
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Module 3: Key Points


Module 3: Key Points. Using antiretroviral treatment and prophylaxis reduces the risk of MTCT. Longer-course combination regimens are effective, but shortcourse prophylaxis regimens may be more feasible in some resource-constrained settings. PCP prophylaxis and prevention and treatment of TB and malaria are part of comprehensive care for mothers infected with HIV and their infants.
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Module 3: Key Points


Module 3: Key Points. Safer delivery procedures includes avoiding unnecessary invasive obstetrical procedures and offering the option of elective cesarean section when safe and feasible. Infant-feeding options to minimise the risk of MTCT require support and guidance throughout ANC, labour and delivery, and postpartum.
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Module 3: Key Points


 

 

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