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PMTCT in Antenatal

The document outlines the role of Maternal and Child Health (MCH) services in preventing mother-to-child transmission (PMTCT) of HIV, emphasizing the importance of antenatal care and HIV testing. It details recommended antiretroviral regimens for pregnant women, including the new option B+ regimen, and highlights the need for comprehensive care throughout pregnancy, labor, and postnatal periods. Key approaches for managing HIV-positive women during labor and the significance of counseling and support are also discussed.

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Isheanesu Mugwisi
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4 views29 pages

PMTCT in Antenatal

The document outlines the role of Maternal and Child Health (MCH) services in preventing mother-to-child transmission (PMTCT) of HIV, emphasizing the importance of antenatal care and HIV testing. It details recommended antiretroviral regimens for pregnant women, including the new option B+ regimen, and highlights the need for comprehensive care throughout pregnancy, labor, and postnatal periods. Key approaches for managing HIV-positive women during labor and the significance of counseling and support are also discussed.

Uploaded by

Isheanesu Mugwisi
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
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MRS FUTI

2022
 By the end of this session students should
be able to;
 Describe the role of MCH services in PMTCT
 Describe the comprehensive antenatal care

package for all pregnant women


 Describe the nationally recommended

antiretroviral regimen for PMTCT


antenatally
 To describe the treatment regime in the

first stage of labor in PMTCT.


 Antenatal care is the most common entry
point for women into PMTCT programmes.
 MCH programmes facilitate PMTCT by

providing:
 Essential antenatal care
 Family planning services
 ARV treatment and prophylaxis
 Safe delivery practices
Care of the newborn
 Postnatal care for the mother
 Counseling and support for the woman’s

chosen infant-feeding method


 Continuity of care and follow up of mother-

child pair
• The entry point into PMTCT programme for
every pregnant woman and her partner is to
know their HIV status
• Our guidelines call for an opt-out approach
to HIV testing
• Group health education is the main method
of giving information.
• Individual counselling is reserved for post
test and those seeking further clarification
• Basics of HIV
• HIV testing process
• HIV test results
• Family centred approach
• HIV testing of the infant
• The PMTCT and ART programme
• IYCF
• Importance of facility delivery
• Family Planning
• Couples counselling and disclosure
• Obtain detailed client history
• Physical exam: Include assessment for TB,
& WHO clinical staging of HIV disease
• Provide all elements of Focused Antenatal
Care (FANC), including
– HIV testing and counseling
– Syphilis testing and treatment
• Counseling should include:
– Treatment preparation, with a
– Focus on patient comprehension
– Rationale and importance of life long ART
– Adherence
 Cotrimoxazole is recommended for all HIV +
women after first trimester either one
double dose strength tablet or two single
strength tablet once daily.
 Women receiving cotrimoxazole should not

be given IPT.
 Encourage the woman to deliver in the

hospital
 Nevirapine
◦ Intrapartum
 1 dose of 200 mg orally at onset of labour
◦ Postnatal
 1 dose of 2mg/kg within 72 hours of birth to the
infant
◦ Efficacy
 Decreased transmission 41% in breastfed infants at
18 months of age
 Short course of Zidovudine (ZDV, AZT)
◦ Antenatal
 300mg orally twice/day from 36 weeks of pregnancy
(Note: in Zambian the current guideline is to start at
14 weeks)
◦ Intrapartum
 300mg orally 3-hourly from onset of labour to
delivery
◦ Efficacy
 Decreased transmission 50% non-breastfed infants
and 26% in breastfed infants
 Long course of Zidovudine (ZDV, AZT)
◦ Antenatal
 300 mg twice a day from 14 weeks up to onset of
labour
◦ Intrapartum
 2 mg/kg for first hour then 1 mg/kg/hour until delivery
◦ Postnatal
 2 mg/kg ZDV syrup 6-hourly for 6 weeks to the infant
◦ Efficacy
 Decreased transmission 68% on non-breastfed infants.
 Beginning therapy earlier in pregnancy is more likely to
prevent MTCT that occurs during the antenatal period.
 AZT 300 mg tablets twice a day from 14
weeks then 300 mg every 3 hours in labour
until delivery
 NVP 200 mg at onset of labor and single

dose 2mg/kg syrup for baby within 72 hours


Laboratory tests
Tests required before initiating optoin B+
 Hb
 Urine protein
 Urine bilirubin
 Syphylis rapid test
 TB screening
 Cd4 count every after six months
 ALT and creatinine clearance
 Viral load
 All HIV Positive women should be initiated
on Life-long ART immediately regardless of
CD4 count (given no contraindications
arising from laboratory results & Client
readiness)

 The HIV positive partner is also


automatically eligible for initiating ART
irrespective of CD4 or WHO staging.
Recommended first line in pregnancy

1st NRTI 2nd NRTI NNRTI

Emtricitabine (FTC)
Tenofovir (TDF) + OR
Lamivudine (3TC)
+ Efavirenz (EFV)
 Alternative first line regimen in pregnancy

1st NRTI 2nd NRTI NNRTI

Abacavir (ABC) + Lamivudine (3TC) + Efavirenz (EFV)


 Recommended first line agents in
pregnancy in patients exposed to sdNVP
 1st NRTI 2nd NRTI PI

Emtricitabine (FTC) Lopinavir/r (LPV-r)


Tenofovir (TDF) + OR
Lamivudine (3TC)
+ OR
Atazanavir/r (ATV-r)
 Improved maternal health
 Reduced/lowered transmission to infants.
 Lower transmission to HIV negative male

sexual partners.
 Antenatal care is the entry point to PMTCT.
 It involves pre-test and post-test counseling
 Two treatment options are in current use;

option B and option B+.


 The recommended regimen now is option

B+.
.
 NEW REGIME OPTION B+

 ATRIPLA (life long 3 drug combination)


 tenofovir 300mg
 efavirenz 600mg
 emtristabine 200mg
 There are 3 key approaches that have been
established for PMTCT when a woman is in
the first stage of labour:
 FIRST APPROACH
 If the pregnant woman took the NVP labour

dose from home, counselling is done on


starting ART for life.
 When she accepts,

- Atripla is given (TDF + FTC + EFT) for life.


 If she refuses,
-give her (TDF + FTC) or lamivudine for 7
days and afterwards should stop.
 If she did not take NVP labour dose at

home, counsel her on life long ART.


 If she accepts give atripla.
 If she refuses, give her atripla for 1 day and

then continue with truvada for the next 7


days.
SECOND APPROACH
if she was on AZT during her pregnancy,
 Ask her if she took NVP labour dose at home

and if she did not, counselling is done.


Atriplar is given when she accepts life long
treatment.
 THIRD APPROACH
 If she is already on full ART,
 She will continue on that medication for life.
There is need for midwife to carry out certain
measures that will allow the unborn from
further exposure during the first stage of
labour, this includes;
Midwives should avoid the artificial rapture of

membranes.
 Unnecessary vaginal examination should be
avoided at all cost.
 The use of African syntocinine by women

who are in labour should be discouraged.


 Argumentation is encouraged when labour

is prolonged.
 The physiological transition from pregnancy
to motherhood heralds an enormous
change in each woman physically and
psychologically hence the midwife who is
the caregiver must exercise great
sensitivity at this time in order to meet the
needs of the individual woman and her
family especially PMTCT mothers who needs
extra care.

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