Prevention of Mother to Child Transmission
Antiretroviral Drugs to Prevent MTCT
UNICEF/Pirozzi
Presentation Objectives
By the end of the presentation you should be able to:
•explain strategies for the prevention of MTCT;
•describe the different types of antiretroviral drugs for PMTCT.
Types of ARVs
There are various types of ARV for the prevention of mother to child transmission including:– Nevirapine– Zidovudine
Short course prophylactic regimens of– zidovudine alone– zidovudine plus lamivudine– nevirapine alone intrapartum
Choice of ARV Regimen
• Regimen should be determined by– Feasibility– Efficacy– Acceptability– Cost
• Nevirapine (single dose)– Demonstrated efficacy in clinical trials
(HIVNET 012 and SAINT)– Low cost and ease of use – Resistance?
Lessons Learned and Future Challenges
Lessons Learned and Recommendations
• Introducing ARV and/or replacement feeding options to reduce MTCT is a complex process
• Costs and benefits need to be carefully assessed• Strategy should be tailored to suit local
conditions– HIV prevalence rates – Risks of replacement feeding– The state of the existing health system and
MCH services – Maturity of the epidemic– Attitudes toward HIV in the community
Integrated PMTCT Services
• PMTCT services are (or should be) integrated into Maternal and Child Health clinics.
• Implications:– Staff workload increases– ‘new’ skills are needed – Enhanced ANC for all women
Issues to Consider when Planning MTCT Interventions
• Effective primary prevention programs and family planning services
• Adequate and functioning antenatal care programs
• Access to confidential VCT services• Follow-up care for mother and infant• Regulation and supply of ARV and
breastmilk substitutes
Future Challenges for PMTCT
• Ensuring that basic services are ready to integrate the new interventions
• Rising need for VCT services• Reorganization of pre-, peri-, and post-
natal care and family planning• Making decisions about infant feeding• Remaining questions about ART, infant
feeding, and MTCT• Care for orphans• Stigma and discrimination