1. PMTCT Presented by: Ms T. Nondanyana (PMTCT COORDINATOR) Room: 129 Tel:053 8300 637 tnondanyana@ncpg.gov.za

2. Background What is PMTCT? - Prevention of Mother To Child Transmission of HIV - Prevention of Mother To Child Transmission of HIV  The PMTCT programme was conceptualized in 2000,piloted in 2001 and was implemented in 2002 nationally with single dose Nevirapine, updated in 2008 to a dual therapy protocol (AZT and NVP)  2010 added Truvada (FTC+TDF) post delivery  NVP stat dose for babies then up to six weeks or for the duration of breastfeeding  Its aim to reduce (MTCT) to less than 5% (NSP 2007-2011) (NSP 2007-2011)

3. MTCT can occur in three stages   Ante-partum (During pregnancy)   Intra-partum (Labour and delivery)   Post-partum ( After delivery)

4. FACTORS THAT INCREASE THE RISK OF MTCT DURING PREGNANCY  Any disruption in the maternal-foetal blood barrier, e.g. abruptio placenta.  Sexually transmitted diseases  Increased viral load  Low CD4 count  Cigarette smoking

5. FACTORS DURING LABOUR AND DELIVERY  Chorioamnonitis  Mixing of blood during the birth process  Prematurity  Multiple pregnancy  Prolonged rapture of membranes  Episiotomy  Assisted deliveries such as vacuum extraction and forceps delivery

6. FACTORS POST-NATALLY (DURING BREASTFEEDING)  Maternal factors -Primary infections -CD4 count -High viral load  Breast pathologies -Mastitis-Abscess -Nipple fissure or crack

7. FACTORS POST-NATALLY (DURING BREASTFEEDING) 2  Infant factors -Breastfeeding patterns (mixed feeding) -Breastfeeding duration -Condition of the baby’s mouth such as ulcers and oral thrush

8. CHALLENGES   Disclosure   Mixed feeding   Re- infection

9. STRATEGIES TO PREVENT MTCT  Encouraging couples/partners to go for HIV Counseling and testing if they are planning for pregnacy.  Awareness campaigns  Male involvement  If tested HIV negative they should remain so (ABC) and retested at 32 weeks or before delivery - If tested HIV positive they will be assessed and referred accordingly. - Pregnant woman will receive AZT at 14 weeks or ARVs, AZT and NVP during labour and Truvada post delivery the baby will also receive syrup of NVP until six weeks or as long as is breastfed.  Stick on the chosen method of feeding

10. STRATEGIES TO PREVENT MTCT 2  Use condoms to avoid re-infection  Baby to be taken to the clinic at six weeks(1month and 2 weeks) for immunizations, test for HIV(PCR) and receive cotrimoxazole.  To be tested again at eighteen months (1year 6 months)

11. Progress

12. Progress…

14. QUESTIONS?

15. THANK YOU THANK YOU