Session: 4 Role of Maternal and Child Health Services in the prevention of HIV infection in infants and young children Dr.Pushpalatha, Assistant Professor,

Session: 4Session: 4 Role of Maternal and Child Role of Maternal and Child

Health Services in the Health Services in the prevention of HIV infection prevention of HIV infection

in infants and young in infants and young childrenchildren

Dr.Pushpalatha, Dr.Pushpalatha, Assistant Professor, Assistant Professor, Dept of Pediatrics,Dept of Pediatrics,

Vani Vilas Hospital,Vani Vilas Hospital,BangaloreBangalore

PPTCT programs need to be integrated as an essential part of MCH care.

All mothers and infants will benefit from the integration of PPTCT into existing care services.

Maternal and child health servicesMaternal and child health services

MCH programmes facilitate PPTCT by MCH programmes facilitate PPTCT by providing:providing: Essential antenatal careEssential antenatal care Family planning servicesFamily planning services ARV prophylaxisARV prophylaxis Safer delivery practicesSafer delivery practices Counseling and support for the woman’s chosen Counseling and support for the woman’s chosen

infant feeding methodinfant feeding method

Many elements of PPTCT programmes Many elements of PPTCT programmes parallel and complement initiatives of MCH parallel and complement initiatives of MCH services.services.

Some of the essential components of MCH Some of the essential components of MCH are:are: Essential obstetric careEssential obstetric care Safe abortion servicesSafe abortion services Strengthening of FRUs and emergency obstetric Strengthening of FRUs and emergency obstetric

carecare Promotion of institutional deliveries and 24 hr Promotion of institutional deliveries and 24 hr

delivery services at PHCs and CHCsdelivery services at PHCs and CHCs Baby friendly hospitalsBaby friendly hospitals

At present, these services are provided under At present, these services are provided under the the RCH program,RCH program, which also includes which also includes services for the services for the prevention and control of prevention and control of RTIs/STIsRTIs/STIs, which have an important role in , which have an important role in prevention of HIVprevention of HIV

Comprehensive MCH servicesComprehensive MCH services

Recognize that the best approach to preventing HIV Recognize that the best approach to preventing HIV infection in infants and children begins with infection in infants and children begins with prevention of primary infection in parents-to-be.prevention of primary infection in parents-to-be.

Provide information to Provide information to prevent unintended prevent unintended pregnanciespregnancies in both HIV infected women and high- in both HIV infected women and high- risk women with unknown statusrisk women with unknown status

Provide education in Provide education in early recognition and treatment early recognition and treatment of STIsof STIs

Provide education in Provide education in risk reduction for MTCTrisk reduction for MTCT

Link and refer clients to Link and refer clients to community services community services that include the following elements:that include the following elements: Treatment for chronic primary care conditions Treatment for chronic primary care conditions

including asthma, hypertension and DMincluding asthma, hypertension and DM HIV testing and counselingHIV testing and counseling Nutritional careNutritional care ARV treatmentARV treatment Economic assistanceEconomic assistance Psychosocial and/or spiritual supportPsychosocial and/or spiritual support

Educate clients about how to recognize Educate clients about how to recognize symptoms of symptoms of opportunistic infections opportunistic infections and and measures they can take to prevent such measures they can take to prevent such infectionsinfections

Educate clients about how to Educate clients about how to recognize early recognize early symptoms of HIV infectionsymptoms of HIV infection in the infant or in the infant or childchild

Integration of PPTCT within Integration of PPTCT within postnatal MCH servicespostnatal MCH services

Effective integration of PPTCT within Effective integration of PPTCT within postnatal MCH services is likely to increase postnatal MCH services is likely to increase community acceptance of PPTCT programmes community acceptance of PPTCT programmes and strengthen maternal care, infant care and and strengthen maternal care, infant care and family care.family care.

Maternal Care-protecting mother’s health by providing medical and psychosocial support.

Infant Care-growth and development nutritional support,immunization and early HIV testing.

Family Care-provides social support,testing and counselling for family members;referrals to community services.

The PPTCT programThe PPTCT program

The The 4 prongs4 prongs of comprehensive care in PPTCT of comprehensive care in PPTCT are:are: Primary prevention of HIV infectionPrimary prevention of HIV infection Prevention of unintended pregnancies in HIV Prevention of unintended pregnancies in HIV

infected womeninfected women Prevention of HIV transmission from HIV infected Prevention of HIV transmission from HIV infected

women to their infantswomen to their infants Provision of treatment, care and support to HIV Provision of treatment, care and support to HIV

infected women, their infants and their familiesinfected women, their infants and their families

Without intervention, the Without intervention, the risk of MTCT is 25-40%risk of MTCT is 25-40% Combination interventions can Combination interventions can reduce the MTCT rate reduce the MTCT rate

by upto 40%by upto 40% in breast feeding populations in breast feeding populations Because ARV prophylaxis alone does not provide Because ARV prophylaxis alone does not provide

long term benefit to the mother’s infection, long term benefit to the mother’s infection, on going on going care and supportcare and support are needed are needed

MCH services can act as an entry point to the range MCH services can act as an entry point to the range of services that can provide care and support to HIV of services that can provide care and support to HIV positive women and affected family memberspositive women and affected family members

Linkages to community services provide enhanced Linkages to community services provide enhanced care and support.care and support.