Factors that increase transmission and strategies to reduce

transmission

Session Objective and content

• Objective: At the end of the session the participant should be able discuss MTCT, and transmission factors that may increase transmission and measures that reduce transmission

• Content• Timing of transmission• Factors influencing transmission (risk factors)• Interventions to reduce transmission – 4 elements of

perinatal HIV prevention

Mother-to-Child HIV Transmission

• MTCT is responsible for over 90% of childhood HIV infections.

• MTCT can take place:– During pregnancy – During labour and delivery– Postnatal due to breastfeeding

• Overall, the transmission rate is 40% without interventions.

Timing of transmissionNo BF 6 months

BF 18-24 months BF

Intrauterine 5-10% 5-10% 5-10%

Intra partum 10-20% 10-20% 10-20%

PostpartumEarly (1st 2 monthsLate (After 2 months)

5-10%1-5%

5-10%5-10%

Total 15-30% 25-35% 30-40%

Maternal Factors

• High maternal viral load• CD4 count• Stage of HIV disease• Smoking and substance abuse• STIs and other co infections• Maternal malnutrition (low vitamin A levels)

Labour and Delivery Factors

• Genital viral load• Duration of rupture of membranes • Invasive delivery procedures (episiotomy, artificial

rupture of membranes)• External cephalic version (ECV)• Chorioamnionitis• Premature delivery• Low birth weight• Mode of delivery

Breastfeeding Factors

• High breast milk viral load• Duration of breastfeeding• Mixed infant feeding• Breast abscesses, nipple fissures, mastitis• Poor maternal nutritional status• Oral disease in the baby (thrush or sores)

Four- Elements for Perinatal HIV Prevention

Prevention of HIV in women, especially young women

Prevention of unintended pregnancies in HIV-infected women

Prevention of transmission from an HIV-infected woman to her infant

Support for mother and family

Phase 1 Phase 2 Phase 3 Phase 4