Dessie City Health Department

Dessie City Health Department How to reduce a direct transmission of HIV (PMTCT)

07/03/2017

HIV Prevention
Preventing Mother-to-Child Transmission of HIV
(Last updated 11/14/2016; last reviewed 11/14/2016)

Key Points
Mother-to-child transmission of HIV is the spread of HIV from an HIV-infected woman to her child during pregnancy, childbirth (also called labor and delivery), or breastfeeding (through breast milk). Mother-to-child transmission is the most common way that children become infected with HIV.
Because of the use of HIV medicines and other strategies, fewer than 200 babies are born with HIV in the United States each year.
Pregnant women with HIV receive HIV medicines during pregnancy and childbirth to prevent mother-to-child transmission of HIV. In some situations, a woman with HIV may have a scheduled cesarean delivery (sometimes called a C-section) to prevent mother-to-child transmission of HIV during delivery.
Babies born to women with HIV receive HIV medicine for 4 to 6 weeks after birth. The HIV medicine reduces the risk of infection from any HIV that may have entered a baby’s body during childbirth.
Because HIV can be transmitted in breast milk, women with HIV living in the United States should not breastfeed their babies. In the United States, baby formula is a safe and healthy alternative to breast milk.
What is mother-to-child transmission of HIV?
Mother-to-child transmission of HIV is the spread of HIV from an HIV-infected woman to her child during pregnancy, childbirth (also called labor and delivery), or breastfeeding (through breast milk). Mother-to-child transmission of HIV is also called perinatal transmission of HIV.

Mother-to-child transmission is the most common way that children become infected with HIV.

Can mother-to-child transmission of HIV be prevented?
Yes. Because of the use of HIV medicines and other strategies, fewer than 200 babies are born with HIV in the United States each year. The risk of mother-to-child transmission of HIV is low when:

HIV is detected as early as possible during pregnancy (or before a woman gets pregnant).
Women with HIV receive HIV medicine during pregnancy and childbirth and, in certain situations, have a scheduled cesarean delivery (sometimes called a C-section).
Babies born to women with HIV receive HIV medicines for 4 to 6 weeks after birth and are not breastfed.
Is HIV testing recommended for pregnant women?
The Centers for Disease Control and Prevention (CDC) recommends that all women who are pregnant or planning to become pregnant get tested for HIV as early as possible.

Pregnant women with HIV receive HIV medicines to reduce the risk of mother-to-child transmission of HIV and to protect their own health. HIV medicines are recommended for everyone infected with HIV. HIV medicines help people with HIV live longer, healthier lives and reduce the risk of transmission of HIV.

How do HIV medicines prevent mother-to-child transmission of HIV?
HIV medicines work by preventing HIV from multiplying, which reduces the amount of HIV in the body. Having less HIV in the body reduces a woman's risk of passing HIV to her child during pregnancy and childbirth. Having less HIV in the body also protects the woman's health.

Some of the HIV medicine passes from the pregnant woman to her unborn baby across the placenta (also called the afterbirth). This transfer of HIV medicine protects the baby from HIV infection, especially during a vaginal delivery when the baby passes through the birth canal and is exposed to any HIV in the mother’s blood or other fluids. In some situations, a woman with HIV may have a cesarean delivery (sometimes called a C-section) to reduce the risk of mother-to-child transmission of HIV during delivery.

Babies born to women with HIV receive HIV medicine for 4 to 6 weeks after birth. The HIV medicine reduces the risk of infection from any HIV that may have entered a baby’s body during childbirth.

Are HIV medicines safe to use during pregnancy?
Most HIV medicines are safe to use during pregnancy. In general, HIV medicines don’t

07/03/2017

PREVENTION OF MOTHER-TO-CHILD TRANSMISSION (PMTCT) OF HIV
PMTCT.jpg

HIV can be transmitted from an HIV-positive woman to her child during pregnancy, childbirth and breastfeeding. Mother-to-child transmission (MTCT) accounts for over 90% of new HIV infections among children.1

Prevention of mother-to-child transmission (PMTCT) programmes provide antiretroviral treatment to HIV-positive pregnant women to stop their infants from acquiring the virus.

Without treatment, the likelihood of HIV passing from mother-to-child is 15% to 45%. However, antiretroviral treatment and other effective PMTCT interventions can reduce this risk to below 5%.2Since 1995, an estimated 1.6 million new HIV infections among children have been averted due to the provision of antiretroviral medicines.

A comprehensive approach to PMTCT

Effective PMTCT programmes require women and their infants to have access to - and to take up - a cascade of interventions including antenatal services and HIV testing during pregnancy; use of antiretroviral treatment (ART) by pregnant women living with HIV; safe childbirth practices and appropriate infant feeding; uptake of infant HIV testing and other post-natal healthcare services.3

Since 1995, an estimated 1.6 million new HIV infections among children have been averted due to the provision of antiretroviral medicines.
The World Health Organization (WHO) promotes a comprehensive approach to PMTCT programmes which includes:

preventing new HIV infections among women of childbearing age
preventing unintended pregnancies among women living with HIV
preventing HIV transmission from a woman living with HIV to her baby
providing appropriate treatment, care and support to mothers living with HIV and their children and families.4
World Health Organization PMTCT guidelines

In September 2015, the WHO released new guidelines recommending lifelong antiretroviral treatment for all pregnant and breastfeeding women living with HIV.5

Guidelines for pregnant and breastfeeding women living with HIV

The 2015 guidelines recommend Option B+ where lifelong antiretroviral treatment is provided to all pregnant and breastfeeding women living with HIV regardless of CD4 count or WHO clinical stage. Treatment should be maintained after delivery and completion of breastfeeding for life.

Previously, the 2013 guidelines included another choice called Option B, where treatment was only continued after the completion of breastfeeding if the mother was eligible for antiretroviral treatment for her own health. The 2015 guidelines no longer recommend this option.

Guidelines for HIV-exposed infants

All infants born to HIV-positive mothers should receive a course of antiretroviral treatment as soon as possible after birth. The treatment should be linked to the mother's course of antiretroviral drugs and the infant feeding method.

Breastfeeding - the infant should receive once-daily nevirapine from birth for six weeks.
Replacement feeding - the infant should receive once-daily nevirapine (or twice-daily zidovudine) from birth for four to six weeks.
At four to six weeks old, all infants who are born to HIV-positive mothers should be given an early infant diagnosis. Another HIV test should be done at 18 months and/or when breastfeeding ends to provide the final infant diagnosis.6

Global PMTCT targets

In 2011, a Global Plan was launched to reduce the number of new HIV infections via mother-to-child transmission by 90% by 2015.7

The WHO identified 22 priority countries, with the top 10 (Angola, Botswana, Burundi, Cameroon, Chad, Côte d’Ivoire, Democratic Republic of the Congo, Ethiopia, Ghana and India) accounting for 75% of the global PMTCT service need.

It was estimated that the effective scaling up of interventions in these countries would prevent over 250,000 new infections annually.8

In 2016, UNAIDS with PEPFAR among others launched Start Free, Stay Free, AIDS Free – a framework calling for a worldwide sprint towards “super fast-track targe

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