Maternal and Newborn Health Training Package Session 11
Maternal and Newborn Health Training Package Session 11: HIV and Maternal & Newborn Health Office of Global Health and HIV (OGHH) Office of Overseas Programming & Training Support (OPATS)
Four Prongs of a Comprehensive PMTCT Approach § Primary prevention targeting girls and young women § Prevention of unintended pregnancies among HIV-positive women § HIV testing and access to ARVs for HIV-positive mothers/prevention of transmission of HIV from an HIV-positive woman to infant during pregnancy, labor, childbirth, and breastfeeding § Follow on care and support to mothers and
PMTCT cascade Taken from Global e learning
HIV and Reproductive & Maternal Health § Women/girls most affected by HIV/AIDS § HIV and childbearing complications: leading cause of death of women of reproductive age § HIV-positive pregnant women: 8 x more likely to die § Postpartum women with HIV: higher risks of developing puerperal sepsis § MM: increased over past 20 years in eight sub. Saharan countries with high HIV prevalence
HIV and Newborn Health § Vast majority of newly infected children are newborns § Maternal status affects newborn survival – Increased risk of stillbirth and death – More likely to be very LBW and preterm § High risk of passing infection to newborn when women becomes infected during pregnancy or while breastfeeding § Interactions of HIV, infections, and indirect effects (greater poverty) = poor newborn outcomes § Confusing information about feeding choices: spillover negative effect on non-HIV mothers and infants
HIV Interactions and MNH: Double Trouble § § § HIV + Malaria HIV + Tuberculosis (TB) HIV + Sexually Transmitted Infections (STI) HIV + AIDS-Related Pneumonia HIV + Nutritional Deficiencies HIV + Neonatal Infections
PMTCT Treatment Regimens § Option B+: HIV-positive pregnant women are initiated on lifelong ART § Change from previous regimens § Newborns of HIV-positive women: daily ARV prophylaxis (NVP or AZT) from birth through age 4 -6 weeks of age, regardless of infant feeding method § Early Infant Diagnosis of HIV Infection: 4 -6 weeks of age or earliest opportunity
Pregnant Women and Access to Treatment Regimens § Pregnant women in developing countries: – Only 38% received HIV counseling and testing – 57% received effective ARV drugs – while increased from 48% in 2010 – access to ARV drugs was LOWER compared to general population adults (despite fact that coverage of HIV testing in pregnant women generally higher than other adult population)
Why Options B/B+ Important § Option B+ in Malawi: change of regimen and larger strategy to integrate ART and PMTCT § Greater equity and reach § Opportunity to roll out “treatment as prevention, ” which can have significant impact in reducing new HIV infections due to sexual transmission among sero-discordant partners
Responses to HIV § While progress to expand access to HIV testing and ART, pregnant women have lower access § And…. other pillars have made comparatively poor progress, including: – Preventing new HIV infections among women – Preventing unintended pregnancies among women with HIV – Providing CST services to women with HIV and their families
Barriers to Uptake and Retention in HIV Services and PMTCT § Supply – Poor quality of care, disrespect, and abuse of HIV-positive pregnant women during ANC and delivery; inadequate skills and availability of staff – Poor treatment due to fragmented services; stock-outs of drugs and supplies – Delays in service provision; weak referral systems, poor linkages § Demand – HIV-related stigma and discrimination; psychological factors – Lack of knowledge of ART benefits; not having symptoms of HIV – Women’s limited autonomy and access to social support; financial constraints, geographic distance
- Slides: 11