Prevention of Mother to child transmission of HIV infection

Prevention of Mother to child transmission of HIV infection-Mother to child transmission of HIV from an infected mother to her baby. Globally, almost half of all adults living with HIV are women. In sub-sahara Africa including Nigeria, women represent about 61% of adults living with HIV. Most children less than 15 years living with HIV acquire the infection through mother to child transmission. (MTCT). Transmission of mother to child of HIV can occur during pregnancy, labour, and delivery or during breastfeeding.

This is known as vertical transmission or prenatal transmission. In the absence of interventions, the risks of such transmission is 15-30% in non-breastfeeding infected mothers. The risk of MTCT can be reduced to less than 2% by interventions that include antiretroviral (ARV) prophylaxis given to women in pregnancy and labour with obstetrical interventions like elective cesarean delivery. Without intervention, 25-40% of infants born to HIV positive women will be infected.

However, other important measures include the use of  ARV prophylaxis for infants for 6 weeks after delivery and complete avoidance of breastfeeding if acceptable, feasible, safe and sustainable. (AFASS)

What are the Risk Factors of Mother to child transmission of HIV

The rate of mother to child transmission of Hiv is affected by many factors; these factors are grouped into:

• Viral
• Maternal
• Obstetrical
• Fetal
• Breastfeeding factors.

These factors could be present during pregnancy, labour, delivery, and breastfeeding.

The most important risk factor for MTCT id the amount of the virus in the mother’s blood known as the viral load. The risk of transmission to the baby is high when the maternal viral load is high, which is the case with recent HIV infection or advanced HIV and AIDS.

Mixed feeding is also an important risk factor. Artificial feeding increases the risk of intestinal illness and a weakened intestine associated with contaminated breast milk which increases the chances of HIV crossing the intestinal barrier.

Effects of HIV on Pregnancy

• HIV has the following effects on pregnancy;
• Increased risk of spontaneous abortions and stillbirth
• Preterm deliveries
• Low birth weight infants
• Bacterial pneumonia, UTI and other illnesses
• Postnatal infections

Effects of Pregnancy on HIV infection

• Pregnancy suppresses the immune function on both HIV infected and non-infected women
• Studies have shown that pregnancy does not seem to have an effect on the progression of HIV infection

How can it be prevented?

The world is focusing is now focusing on the prevention of HIV infection among the most vulnerable individuals: newborn infants and young children The WHO and UN partners have advocated four strategic elements of PMTCT which include;

1. Primary prevention of HIV

This can be achieved through;

• Safer and responsible sexual behavior and practices
• Provision of early diagnosis and treatment of STIs
• Making HIV testing and counseling widely available
• Provision suitable counseling for women who are HIV negative

2. Prevention of unwanted pregnancies among HIV positive women

It is every woman’s fundamental right to decide for herself, whether or not to have children. To achieve this, HIV positive women and their partners need comprehensive information and education from HIV and STIs and from unwanted pregnancies. Also, integrating HIV prevention into family planning counseling services.

3. Prevention of HIV Transmission from HIV infected mothers to their unborn babies and infant.

They could be best achieved through;

• HIV testing and counseling
• Antiretroviral prophylaxis and treatment
• Safer delivery practices
• Infant feeding counseling for safer infant feeding practices.

Linkages to treatment, care and support for HIV Positive women, their infants, partners, and families

HIV positive women should have linkages on the following;

• Linkages between maternal child health, adult and HIV services.
• Linkages with other health programs for special needs e.g family
• Planning, treatment of STIs, PLHA, support groups
• Linkages to community-based HIV/AIDS service organizations for other support like NGOs, FBO, CBO.

 The Role of maternal and child health services in PMTCT

Mother and child health care encompasses a broad range of educational and clinical services that help mothers, children, and their families live healthy lives. Although all the four elements of a comprehensive PMTCT program are important, antenatal care is the most common entry point for women in those programs.

MCH programmes facilitate PMTCT by providing;

• Essential antenatal care.
• ARV prophylaxis and treatment
• Safer delivery practices
• Counseling and support for women chosen infant feeding
• Intrapartum postnatal care
• Family planning services
• Cervical screening services

Conclusion

HIV/AIDS is an ill wind that blows no one any good. All hands must be on deck to check the menace of this deadly disease through a comprehensive approach to prevent HIV infection to infants and young children;

• Primary prevention
• Prevention of unwanted pregnancy
  Prevention of HIV transmission from women infected with HIV to their infants
• Provision of treatment, care, and support to women infected with HIV, their families, and infants.

However provision of MCH services is the only entry point to the prevention of mother to child transmission of HIV infection and linkages to community services to enhance treatment, care, and support.

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