HIV IN PREGNANCY

Geneva Foundation for Medical Education and Research GFMER Sudan 2012Forum No: ( 2 )

NAME OF PRESENTERName Position Institution

Dr. Amal Khalil Coordinator of Reproductive & Child Health Research Unit (RCRU).

UMST

Name Position Institution

Dr . Hani Mohammed Ibrahim

Medical Director Research Assistant at (RCRU).

Um Bakhita Maternity .HUMST

Dr . MAJDI SABAHELZAIN

Pharmacist/ MSc. Public and Tropical Health

UMST

Name of contributors

CONTENT OF THE PRESENTATION

MTCT PMTCT in Sudan PMTCT Centers Prevention of MTCT

MTCT

largest source of HIV infection in children below the age of 15 years (95%).

< 80% of MTCT occurs late in the third trimester, during labour and delivery.

vaginal delivery, duration of membranes rupture, chorioamnionitis, preterm delivery and breast feeding.

INCREASED RISK OF MTCT IN

well advanced maternal HIV disease. low antenatal CD4 T- lymphocyte

counts . high mean plasma viral.

TIMING AND RISK OF TRANSMISSIONTransmission Rate

5 – 10% During pregnancy

10 – 20% During labour & delivery

5 – 20% During breast feeding

15 – 30% Overall without breastfeeding

25 – 35% Overall with breast feeding till 6 months

30 – 45% Overall with breast feeding till 18 to 24 months

PMTCT IN SUDAN

A pilot project was implemented in four states to examine the applicability of such an intervention before starting a nationwide implementation.

result of this project was 6593 pregnant women counseled, 927 tested and 7 was found to be positive and the prevalence was 0.76%.

PMTCT CENTERS

2007: 7 centers in high prevalence areas of South Darfur, Khartoum, Kassala, North Kordofan and Red Sea.

7,848 pregnant women attending had access to PMTCT services by receiving routine counseling and testing.

HIV PREVALENCE AMONG WOMEN ATTENDING PMTCT SERVICES IN SUDAN FROM AUGUST 2007 TO JULY 2008

Prevalence %

Total positive

Total tested Site

2.28 12 525 Omdurman

0.086 1 1159 Saudi Hospital

0.34 4 1185 Turkey Hospital

1.8 4 219 Port Sudan

0.8 8 994 Kassala

0.8 4 497 Elobeid

0.27 2 727 Nyala

0.66 35 5306 Total

BENEFITS OF HIV TESTING FOR PREGNANT WOMEN?

A mother who knows early in her pregnancy that she is HIV infected has more time to make important decisions. She and her health care provider will have more time to decide on effective ways to protect her health and prevent mother-to child transmission of HIV She can also take steps to prevent passing HIV to her partner.

IN SUDAN…

Awareness about mother-to-child transmission of HIV is 26.4%.

Knowledge of ways of mother-to-child transmission of HIV (all three means of vertical transmission) is 54%.

SHHS 2006

Knowledge of ways of mother-to-child transmission of HIV (%)

Awareness about mother-to-child transmission of HIV(%)

State

35.7 82.1 Khartoum

40.8 75.7 River Nile

12.5 21.0 W. Darfur

19.8 37.6 S. Kordofan

PREVENTION OF MTCT

using antiretroviral therapy (ART)- two complementary goals: to prevent the transmission of HIV to the unborn child and to safeguard the health of the mother.

delivery by elective caesarean section. vaginal under certain precautions avoidance of breast feeding (risk highest in

first 3 months). Formula feeding is associated with reduction

of MTCT to around 14%.

INFANT FEEDING RECOMMENDATIONS FOR HIV-POSITIVE WOMEN

•When replacement feeding is acceptable, feasible, affordable, sustainable and safe, avoidance of all breastfeeding by HIV-infected mothers is recommended.

•Otherwise, exclusive breastfeeding is recommended during the first months of life.