Pptct in pregnancy

only the must-know

1. PPTCT in HIV program

2. What is it? NACO under the Ministry of Health, Government of India, launched the Prevention of Parent to Child Transmission (PPTCT) of HIV program in 2002 In 2012, the multidrug regimen as recommended by WHO has also been accepted by the PPTCT program

3. The services are provided through the ICTCs- Integrated Counseling and Testing Centres Standalone ICTCs: located in the medical colleges, district hospitals, taluk hospitals, and community health centres Facility integrated ICTCs: located in the primary health centre. The staff in PHC are trained in counselling and testing for HIV with kits provided. If a women tests positive, she is referred to ICTCs.

4. The aim of PPTCT programme is to offer HIV testing to every pregnant women (universal coverage) in the country, and eliminate the transmission of HIV from mother to child

5. Goals of the PPTCT program Antenatal care Intrapartum care Postnatal care

6. Antenatal care Pretest and posttest counselling >counseled regarding hygiene, nutrition, safe sex and avoiding substance abuse, safe delivery, birth planning and infant feeding Plasma viral load, CD4 counts, renal function tests, and liver function tests done and repeated every 3 months Offering termination of pregnancy to HIV-positive women

7. Screening for genital infections done early and repeated at 28 weeks. Syphilis and hep B screened on booking Detailed anomaly scan is a priority Hep B and pneumococcal vaccination is recommended and safe Influenza vaccination also safe and can be administered >mumps, measles, rubella, varicella zoster vaccines contraindicated

8. Prophylaxis for Pneumocystis carinii pneumonia is indicated when the CD4 count is <200/mm3- cotrimoxazole + folic acid 5mg/day (CPT) Providing ART Psychosocial support Routine antenatal care

9. WHOrecommended ART regimen Pregnant and breastfeeding women with HIV Regardless of CD4 counts or clinical stage (OR) CD4 count<500 (OR) clinical stage 3 or 4 Lifelong therapy with TDF+3TC (or FTC) + EFV CD4 count >500 TDF+ 3TC (or FTC) + EFV Stop ART after 1 week of complete cessation of breastfeeding

10. Tenofovir (TDF) – 300 mg Lamivudine (3TC)- 300 mg Emtricitabine (FTC) – 200 mg Efavirenz (EFV) – 600 mg At birth, or when exposure is diagnosed postpartum Infants (breastfeeding) – 6 weeks daily NVP Infants (replacement feeding)- NVP for 4-6 weeks or AZT twice daily

11. Intrapartum care Promotion of institutional deliveries of all HIV infected women Caesarean section is the preferred mode of delivery in HIV infected women Elective C-section is associated with reduced rates of MTCT among women >who have not received ARTs >who have received AZT alone >who have not achieved viral suppression (>1000 copies/ mL )

12. In resource-limited regions >vaginal delivery accepted > amniotomy avoided unless delivery is imminent Universal or standard precautions are followed

13. Universal or standard precautions Care in handling of – >blood (dried also), >all other body substances, secretions (including sweat), regardless of whether they contain visible blood > nonintact skin >mucous membranes

14. Universal or standard precautions Personal hygiene practices >hand washing PPE >double gloving >gowns >protective eyewear Aseptic technique Safe disposal systems for >sharps >contaminated matter Adequate sterilization of reusable equipment Environmental controls

15. Postpartum care Couselling regarding breastfeeding >avoidance of breastfeeding is a definite way to prevent transmission >recommendation: exclusive breastfeeding (exclusive replacement feeding) for 6 months inititated within an hour of delivery ART for mother and infant continued Family planning services EID- early infant diagnosis by HIV DNA PCR

16. References Sheila balakrishnan , 2 nd edition Lakshmi seshadri , 1 st edition K.Park , 23 rd edition